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Paperwork Reduction Act Notice <br />Public reporting burden for tlvs collection of information is estimated [o vary from a range of IO hours as an <br />average per response for some minor facilities, to I ]0 hours rs en average per response for some major facilities, <br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing <br />instructions, searching ezistmg'data sources, gathering and maintaining the data needed, and complotiug and <br />reviewing the collection of irforma[ion. Send comments regarding [be burden estimate or any other aspect of <br />this collection of informato~ , including suggestions for reducing t!»s burden, to Chief, Information Policy <br />Branch, PM-223, U.°. ~nvircnmental °rotection Agency, 40I M Street, SW Washington, DC 20460; and to the <br />Office of information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions <br />3. if form bas been partially completed by preprinting, disregard instructions directed at entry of that information <br />already preprinted. <br />2,_Fnjflr "Permittee Name%t-/ailing Address (and Cacility name/location, if different)," "Permit Number," and <br />Discharge Number" where indicated. (A ~epa'rate form is required for each discharge.) <br />3. Enter dates beginning and ending 'i1 foniloring Period" covered by form where indicated. <br />4. Enter each "Parameter" as soecified in monitoring requirements of permit. <br />5. Enter "Sample ~Lfeasuremcrt" data for each parameter under "Quantity" and "Quahl•" in units specified in permit. <br />"Average" is normally arittrnetic average (geometric average for bacteria] parameters) o+ all sample measurements <br />for each parameter obtained] during "Monitoring Period"; "Maximum" and "Afinimum" are normally extreme high <br />and low measurements obtained during "Monitoring Perod." (Note to municipals wish secondary treamtent <br />requirement: Ente- 30~ay average of sample measurements under "Average," and enter maxirnunt 7-day a~•erage <br />of sample measurernen's ob arned during monitoring period under "Maximum.') <br />6. Enter "Permit Reguiremcnf far each parameter under "Quantity" and "Quality" as specified in permit. <br />7. Under "No Er" enter nume_; of sample measurments during monitoring period that exceed maxin+um (and/or <br />minimum or 7-day average tc appropriate) permit requirement for eacr. parameter. if none, enter "0". <br />8. Enter "Frequency ojAnallsis" both as ".Sample ,tfeosurmenP' (actual frequent}' of sampling and analysis used <br />during monitoring period) and as "Pernnl Requirement" specited in permit. (e.g , Enter "Cbnl," for wntinuous <br />monitoring, "1:7" for one dry per week, "//30" for one day per month, "//90" for one day per quarter, e[cJ <br />9. Enter "5anrple Tvpe" uoth as "Sample Measurement" (actual sample type used during monitoring period) and as <br />"Permit Requirement," (e.g., Enter "Orah" for individual sample, "?4HC" for 24-hour rnrnposite, "N/A" for <br />continuous monitoring, etc.) <br />10. Where violations of permit requirements are repor!ed, attach a brief explanation to describe cause and corrective <br />ac4ons taken, and rrf_rencc each ~iolauon by date. <br />11. If "no discharge" occurs durng monitoring period, enter ",4'o Discharge" across form in place of data entry. <br />12. Enter "Name/f'itle ojPrinc,pa! Executive Officer" with "Signature ojPrincipa! Executive O)Tcer ojAuthorized <br />Agent," 'Telephone ,Number," and "Dale" al bottom of form. <br />13. Mail signed Report to Office(s) by date(s) specified in pern»t. Retain copy Cor your records. <br />14. More detailed instructions fcr use of this Dischnrge.4lonitoring Report (D~ifR) Corm may be obtained from Office(s) <br />specified in permit. <br />Legal Notice <br />This report is squired by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or Failure 'o report [n.thfully can <br />result in civil penalties not to exceed E 10,000 per day of violation; or in criminal penalties nut to excest S25,OOG per day <br />of violation, ut by imprisonment for not move than one year, or by both. <br />;. <br />EI"I[ Form 3320-1 (Rev. OR-95) <br />