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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of inforrnatioo is estimated to vary from a range of 10 hours as as
<br />average per response for sotme minor facilities, to 110 hours as m 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 existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any 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 Slreel, 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 />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permitree Namr-tfaii;ng .4ddress (and facility name/localion, if different)," "Permit Number," and
<br />"Discharge Numher" where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and ending ".tlomloring Permd" covered by form where indicated.
<br />4. Enter each "Poromerrr" as specified in monitonng requirements of permit.
<br />5. Enter ".rumple AleosurcrtenP' data for each pammcler under "Qunnrir}" and "Quolin" in units specified in permit.
<br />".4verobe" is nonually arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />Cor each parameter obtained during ",1lunirnring PerinrP'. ",tlaxinnnn" and ",1Lniururn" are normally ea9reme high
<br />and low measurements obtained during ".tlomrnring Perrod." (Note to municipals vtith secondary treatment
<br />requirement: Enter 10-d:,~ average of sample measurements under ",;veroge," and enter maximum 7-day average
<br />of sample meas~rrements obtained during monitoring period under ".lfanmum. "1
<br />6. Enter "Penni! Reyuirennvu" for each parameter under "Qunnlity" and "QuahO-" as specified in permit.
<br />7. Under "Aru Ex" enter n,rmbcr of sample measurntents during monitoring period that exceed maximum (and/or
<br />minimum or 7-day acemgc as appropriate) perntit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAra/vsis" both as "Smnple .4feasurmenr" (equal freyuency of sampling and analysis used
<br />during monitoring period) and as "Fermi! Requirement" specified in perntit. (e.g., Enter "Conn" for continuous
<br />monitoring, "L T' for onr. day per week, "/ i0" for one day per month, "I ~ 90" for one da} per quaner, etc.)
<br />9. Enter ".Smnple Ttpe" bath as "5'amp/e .tjeasuremenr" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "29HC" for 24-hour composite, "A':4" for
<br />continuous monitoring, t:tc. )
<br />!0. Where violations of permit requirements are repored, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />I I. If "no discharge" occurs during monitoring period, enter "A'o Discharge" across form in place of data entry.
<br />12. Enter "Name/Tirle ojPrincipal Executive Officer" with "Signature ojPrrncipnl Executive Officer oJAurhorized
<br />.4genl," "Telephone Number," and "Dare" a[ bottom of form.
<br />13. Mail signed Report to O1Tice(s) by date(s) specified in permit. Retain copy for yotu records.
<br />14. More detailed instructiotu for use of this Discharge tifoniroring Report (DA1R) form may be obtained from O@ice(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 truthfully can
<br />rtsult in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />o~F violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3)20-1 (Rev. OS-9!)
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