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)
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