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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 6toilities, to 110 hours as en average per response For some major facilities, <br />with a weighted average for major apd*iiFfacjiities of 18 hour per response, including time for reviewing <br />~• .~,, <br />instructions, searching existing data sources, gtt~erjng ana mainf{:uring the data needed, and completing and <br />reviewing the collection of information.. Send coihrnents :ege,ding the burden estimate or any other aspect of <br />this collection of information, igcJtr~tg suggestions for reducing this burden, to CI>ief, Information Policy <br />Branch, PM-223, U.S. Environip6rtMl Protection Agency, 401 M Street, SW Washington, DC 20460; and to the <br />Office of Inforrmtion and R + ` <br />egnlytory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions <br />l~ If form has been partially completed by preprinting, disregard instructions directed at entry of that information <br />«~rP,ady Preprinted. ~ . ~ ._ _>_.~,+ . .,..a ~. ~~. , <br />7: Enter "Pertnittee Name%tlai/ing Address (and facility nameAocation, if different)," 'Permit Number," and <br />"Discharge Number" where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and ending 'itlonitortng Period" covered by form where indicated. <br />4. Enter each "Parameter" az specified in monitoring'requirements ofpermit. <br />5. Enter "Sample Measurement" data for each parameter under "QucmtiN" 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 parameter obtained during ",tilnnitoring Perrorf'; ":V.faxintum" and "Minimum" are normally extreme high <br />and low meastuements obained during "Monitoring Period:" (Note to municipals with secondary treatment <br />requirement Enter 30-day avcrage of sample measurements trnder "Average," and enter maximum 7•day average <br />of sample measurements obtained during monitoring period under "Ma-simum.') <br />6. Enter "Permit RequiremenP for each parameter under "Quantity" ¢md "Quality" as specified in permit. <br />7. Under "No Fx" enter number of sample measuements during monitoring period that exceed maximtrm (and/or <br />minimum or 7-day average tts appropriate) permit requirement for each pararrteter. If none, enter "0". <br />8. Enter "Frequency oj.4nalvsis" both az "Sample beasurment" (actual frequency of sampling and atralysis used <br />during monitoring period) vnd az "Pernut Requirement" specified in permit (e.g., Enter "Coat," for continuous <br />monitoring, "1/7" for one day pcr week, `1/30" for one day per month, "1/90" for one d:ty per quarter, etc.) <br />9. Enter "Samp/e Tvpe" both t, "Sample dfeasuremect" (actual sample type used during monitoring period) and as <br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "14HC" for 24-hour composite, "N/A" for <br />continuous monitoring, etc.) <br />l0. Wirereviotations of permit requirements are reported, attach a brief explanation to describe Cause and correclive <br />actions taken, and reference ach violation by date. <br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. <br />12. Enter "Nanre//'itle ojPrincioal Executive Officer" with "Signature ojPrincipa! Executive OJrcer oj.quthorized <br />Agertt," "Telephone Number," and "Dore" a[ lwttonr of form. <br />13. Mail signed Report to Officeis) by date(s) specified in permit. Retain copy for your records. <br />14. More detailed instructions for use of [his Discharge Monitoring Report (DA1RJ form maybe obtained Gam OQice(s) <br />specified in permit. <br />Legal Notice <br />This report is required by law (33 D.S.C. 1318; 40 C.F.R. 125.27). Failure [o roport or failure to report truthfully can <br />result in civil penalties no[ to exceed S 10,000 per day of violation; or in criminal penalties not to exceed S25,G10 per day <br />of violation, or by imprisonment for no[ more than one year, or by both. <br />EPA Form 3320-1 (Rev. 08-95) <br />