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Paperwork Reduction Act Notice
<br />Pablic reporting burden for this collection of information is estimated to-vary from a rmge 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 '~ weighted average for major end 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 end
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />~,'PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; end to the
<br />QE}ice of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC20503.
<br />General Instructions
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<br />1-.;If form has been partially completed by.preprinting, disregard instructions directed et entry of that, information
<br />;already preprinted. -
<br />Z ^~nter "fermi/tee Narne/Mailing Address (and facility namelloealion, if different)," "Permit Number," and
<br />(` °'Discharge Number" where indicated. (A separate form is required for each discharge)
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<br />~~ ~o[er dates beginning and ending "tifonitoring Period" covered by (orm where indicated.
<br />~'a;~nter each "Parameter" as specified in monitoring requirements of permit.
<br />:~?~rtter "Sample tifeasurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"~ ~ "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />`. Sot each parameter obtained during "dfonitoring Period"; "Mazimurn" and "A4inimum" are nomtalty extreme high
<br />~ttd low measurements obtained during "MonitoringPeriod." (Note to municipals with secondary vestment
<br />`. i regnifeme+tt: Enter 30-day average of sample meastr(txnents under "Averagr," and enter maximum 7~ay average
<br />of sample:measurements obtained during monitoring period under "tifaximum.'J
<br />_~ Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specJed in permit.
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<br />7. Under "No Ex" enter number of sample measurmen[s during monitoring period that exceed maximum (and/or
<br />minimum or 7~ay average as appropriate) permit requiretltent Tor each parameter. If none, enter "0".
<br />L~S.~atter "Frequency ojAnalysis" both as "Sample Meosurn~enr" (actual frequency of sampling and analysis used
<br />p , ,during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cons," for continuous
<br />;; monitoring, "1/7" for one day per week, "I/30" for one-.day per month, "1/90" for one day per quarter, etc.)
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<br />.=Enter "Sample Type" both as "Sample Measurement" factual sample type used during monitoring period) and as
<br />fi '."Permit Requirement," (e.g., Enter "Grab" for individual. sample, 24HC' for 24-hour composite, "N/A" for
<br />.'continuous monitoring, ctc.)
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<br />Where violations of permit requirements are reporte~,attach a brief explanation to describe cause and corrective
<br />~, ~ ~ctians taken, and reference each violation by date.
<br />~. T{"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
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<br />t2. Enter "Name/title ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />E' 'Agent," "Telephone Number," and "Dare" at bottom of form.
<br />Mail signed Report to t?fiice(s) by date(s) specified in permit. Retain copy for your records.
<br />~: More detailed instructions for use of this Discharge Monitoring Report (DAIR) torn may be obtained from Office(s)
<br />~~: specified in permit.
<br />~..~ _ Legal Notice
<br />prep` ort 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 />t to civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />~ohation, or by imprisonment for not more than one year, or by both.
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<br />Etf}k Form 3320-1 (Rev. 08-95)
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