|
Paperwork Reduction Act Notice
<br />-. r : .ng UT en t :5 C.. CCt:Or. O C-.:!L^ -h- „~ :,u 1 ,w ..u: c ui I;i nnU r. 85 ....
<br />average per rospoose for sumo honor tacuihes, to t lU hours as an average per response far some mainr facilities, '
<br />with ., w.,ishlrx; average fur major ar,d occur faciliiies of 18 boors per response, inciudmg time for reviewing I
<br />instructions, searching existing data sources, gathering and mainlaiciog the data needul, and completing trod i
<br />reviewing the collection of information. Sent comments regarding the burden estimate or any other amrct of
<br />i'his collection of information, including suggestions for reducing this burden, to ('hirf, loformatioa Policy ~
<br />13raech, Pbi-223, U.S. kovrronmrnlal Protrcnon Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budges, Washington, DC 20503. i
<br />General Instructions
<br />1. If forth has been partially completed by preprinting, disregard instructions dirtxteti at eelry of [hat infor:rW!ioc
<br />already preprinted.
<br />2. Enter 'Permirree NamehlnrLng .4:Idress (and facilit}• namrJlocation, S different)," "Permit A'umber." a,rd
<br />"Dischurge ,ti'unrher" when indicated. i ri separate fornr is required for each discharge)
<br />3. F,merdatcs beginning and ending ".ifonriurrn,q Prn/~r/"covered by form where indicated.
<br />4. Ewer c:rci+ "i'nrmurrt•r" as specifed in monuuring rcgmrcnients of permit
<br />S. enter ".~nmrlr 11rn.rvrrmrnt" data for cast: parameter nr.der "Qu,rnt!tc" and "(-hurliN" in units specified iu pemlit.
<br />"=h.rnke" is norniaily arithmetic acclage (bconietnc uvuage for bactenal parameters) of all sample measurements
<br />for each parameter eManicd during '21•u:uurin,4 Ycriorr , ".1:a.:ur,un!" ar.d "!;,nimmu" are norntally extreme high
<br />and Ioi. mcasurcmcnts obtained du!ing "lfnnuunnp i'eriu/i." (Note to municipals with secondary treatment
<br />rr•gpin~rrl^n!~ Fnro• Z/~-th, ... •:~[;;. .,r. ..;i i^ .~,... ~..: ..~ ~. 'ifd: ...d Cwu .. ~ } - g
<br />.:,Q: is\iiiiUm Ida .it crd C
<br />of sample measurements obLnined~dunng^mnnilonng period under "tlarimum 'q
<br />6. enter "!'enrol Kegmre!nen! for cacti parameter under "tJuonhty' ant "~uohry" as spcei fi ee. in czrnlit.
<br />7. Under ".~'u Ex" enter number of samnlc mcaammcnls dnrinv monhnring period that c~cr~-r' -+~a:-:mum (and/or
<br />minimum Or 7-dac m'cra~a as app rr;priale) permit rcgt:ircment for : ch parameter. If none, cote ",. .
<br />n ."rlr~ "F/,.,fl•~1,,: „' :.,,,, .,," j, ,: d~ '. ::..: ;. :~.i: a•: r: tic:::" ., .; ::..,,, ~ of s::[" 1:. .:. ar. :.'l sis used
<br />c dunn momtorin ~criud and as Pe;mil,Rr~ruireurenl" s nL - ~~ ~-y--~.-~ ..e....d .y
<br />g g P ) ~~ f Ix cc; in permit (e.g., Enter "t'nnt," for cominuuus
<br />nionnnring "! "7" 1nr one d..•: per rt~~^ek "/ ;D" for nnc r'-~; ~:cr rr•n-:.'., ':! 00:' Gtr One day nPr nilart r.r, ~.; ~.~
<br />:, ..
<br />7. ~Ii;:;i Diu//li/ir °'rln.' UJuI .u .~wnl.li ~itumiriiiil," tuJ Ual Saiii Nip :, u'~. Uxu uallll~', iiiuiuiOfilis Ixa iuLJ .:iiU .u
<br />:i
<br />"!4•r/nit Requirenn•n!," (e g , Enter "(itch" for indii ideal sample, "?-111("' for 24-hour composite, "\':1" for
<br />c^,ntirmcus maritonng, sic.)
<br />10. Where violations of perniil requirements arc reported, atmch a brief explanation to describe cause and correctirc
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during moniwring period, enter ".\'u Discharge" across furor in place of data entq.
<br />12. Enter "Name/Title ojPrincipa( Executive Officer" with "S'ignature ojPrincipa! Executive O~cer oJAuthorized
<br />Agent," 'Telephone Number," and "Date" al 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 instructions for use of this Discharge Afonitoring Report (DAfRJ Corm 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 truthfully can
<br />result in civil penalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed (25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
<br />
|