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Paperwork Reduction Act Notice
<br />Public repor~:ag burden for Utie collection of information is estimated to vary from a range of t0 hours as m
<br />average pe:' c,:sponse for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with n weigS.ed average for roajor and minor facilities of (BLbttrs per response, including time for reviewing
<br />instructions, starching existing data sources, gatherittg and mainaiaing the darn needed, and completing and
<br />reviewing the collection of iaiornatioo. Send comments regarding the burden estimate or nay other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Streit, SW Washington, DC 20460; and to the
<br />Office of Information :utd Regulatory Affairs, Office of Management end Budge[, Washington, DC 20503.
<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2: Enter "Permittee Name//l%railing Address (and facility . nameJlocation, ii different)," "Pergtit Number," and
<br />"Discharge Number" where indicated. (A separate form is required Cor each discharge)
<br />3. Enter dates beginning and ending 'Afonitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" az specifted in monitoring requirements of permit.
<br />5. Enter "Smrrple Afeasuremer. P' data far each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each p,•trettteter obtained dw-ing ",monitoring Perod'; "Mazimum" and "blininiurn" are normally extreme high
<br />and low meazureu,cnts obtained during "Aonitoring Period." (Note im municipals with secondary treatment
<br />requirement. En[cr 33~:,v avemgc of sample measurements under "Average," and enter rutximum 7~ay average
<br />of sampie measuremt:rts obulined during monitoring period under "Afazimum. J
<br />6. Enter "Permit Requirernenr' for each parameter under "Quantity" and "Quality" az specked in permiE.
<br />7. Under "No Fx" en~er ru~aoer of sample measutments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average ss appropriate) permit requirement far each parameter. (f none, enter "0".
<br />8. Enter "Frequency ojAnallsi.r" both az ",Sample Ivleasurment" (actual ficquency of sampling and analysis used
<br />during monitoring period) rod as "Pernrrt Requirement" specified in permit. (e.g., Enter "Copt," for continuous
<br />monitoring, "li7" for one d; y aer week, "//30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvp,•" both u "San, ple ,tfeasurenrenl" (actuai sample type used during monitoring period) and az
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "24F(C" for 24-hour composite. "N/A" for
<br />continuous monitonng, etc.)
<br />10. VJirere violations o: pcatut requirements are reported, attach a oricf expianauon to describe catue and corrective
<br />actions taken, and reference each violation by date.
<br />1 I. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "NmrieiTifle of Principal Fxeeutive O~cer" with "S'igna(ure ojPrincipa! Executive Officer ojAuthonzed
<br />Agent," "Telephone Number," and "Date" al bottom of form.
<br />13. Matt signed Report to Office(s) by date(s) specified in permit. Retain copy for your remrds.
<br />14. More detailed instructions-for ttse of this Discharge A~onitoring Report (DAIR) loan may be obtained Crom Office(s)
<br />specified in permit.
<br />Legal Notice
<br />Tnis report is reuuir+~.,ti by lav (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure W report truthfully can
<br />:vult in civil penal5es nor io exceul S1D,DG0 per play of violation; or in criminal penahies not to exceed x25,000 per day
<br />of violation, or by impriscurant for not more that. one year, or by both.
<br />r. 'A Form 3320-i (Rtr. J4-95)
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