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Paperwork Reduction Act Notice <br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an <br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities, <br />with a weighted average for major and minor facilitjes of 18 hrpgaper;response, including time for reviewing <br />[ions, searching existinf; data sources, gatherirt~arttttnq(~gllwtifg"the data needed, and completing and <br />.' g the collection of information. Send comments g, the burden estimate or any other aspect of <br />of reformation, including suggestions for "cing this burden, to Chief, Informatioo Policy <br />Branch, PM-223, U.S. Environmental Protection Ageccy, 40l M Street, SW Washington, DC 20460; and to the <br />Office of informatioo and Regulatory Affairs, Office o` Management and Budget, Washington, DC 20503. <br />General Instructions <br />1. if form has been partially wmpleted by preprinting, disregard instructions directed at entry of that information <br />already preprinted. <br />2.-$ntar ..'.Pem~ittee Name/Maifing Address (and facility nameflocation, ~ different)," "Permit Number," and <br />"Discharge Number" where indicated. (A separate form is required for each discharge.) ' <br />3. Enter dates beginning and ending 'Monitoring Period" covered by form where indicated. <br />4. Enter each "Parameter" as specified in monitoring requirements of permit. <br />S. Enter "Sample Measuremen.•" data for each parameter under "Quantity" and "Quality" in units specified in permit. <br />°Average" is normally aritlunetic averagge~ (geometric average for bacterial parameters) of all sample measurerttents <br />for each parameter obtained during "ACaeitoring Period"; "Maximum" and "Afinimum" are nomtally extreme high <br />and low measurements obtained "tifomroring Period:" (Note to municipals ~tiith secondary treatment <br />requirement Enter 30-day average o~Sainple measurements tinder "Average," and enter maximum 7-day average <br />o(sample measurements obtained during monitonnb pcriori under "Maximum.') <br />6. Enter "Permit Requirement" for each parameter under "Qc•anrity" and "Quality" as specified in permit. <br />7. Under "No Fx" enter numt~er of sample measurments during monitoring period that exceed maximum (and/or <br />minimum or 7-day average : s appropri8te) permit requirement for each parameler_ if none, enter "0". <br />B. Enter "Frequency oJAnnlyris" both "as "Sample ,Lfeasurment" (actual frequency of sampling and analysis used <br />during monitoring period) ;nd as "Permrt Requirement" slxcified in permit. (e.g ,Enter "font," for continuous <br />monitoring, "1/7" for one day per weep "f/30" for one day per month, "1/90" Cor one day per quarter, etc.) <br />9. Enter "Sample Type" both rs "Sample Afeasurentent" (actual sample type used during monitoring period) and as <br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "24ffC"' for 23-hour composite; "N/A" For <br />continuous monitoring, etc.) <br />10. Where violations of permit requirements are reported, attach a brief explanation to describ;, cause and corrective <br />aclans taken, and reference ach violation by date. - <br />11. If "no discharge" ocntrs during monitoring period, enter "No Discharge" across form in place of data entr}. <br />12. Enter "Name/I'itle ojPrincioai Execvtit~e O~cer" with "Signature ojPrincipa! Executie~e Officer ojAuthori~ed <br />Agent," "Telephone Nvnrber," and "Dare" at bottom of form. <br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. <br />14. More detailed instfuctiotu for use of this Discharge.lfoniloring Report (Db1R) form may be obtained from Office(s) <br />specified in permit. <br />Legal Notice <br />This report is required by law (33 U.S.C. 1318; 40 C.F.R.. 125.27). Failure to report or failure to report tnthfully can <br />rrsdt in civil penalties not to exceed $10,000 per day of violation; or in crintinal penalties not to exceed 825,000 per day <br />of violation, or by imprisomaent for wr more than one year, or by both. <br />EPA Form 3320-1 (Rev. 08-95) <br />