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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 />aVPfa~P '.ar rnep(18~u f!`• ~.nui ?.?In:~i fli lll;,P, tU t 1J Pl ai f-, ae do 'A bCr-0PP n_ -. ~._: rC .'.--.. ., ra.t ~..r r_. ~1:::°',
<br />wait u wcigiued eve+age for mayor and minor facilities of 18 hours net response, including ti mr fn. reviewing
<br />ins;;-uchons, s~2~ching ezu,ing data sources, gathering and maintaining the data needed, and comple[mg and ~
<br />i
<br />I rwiewing [he collection of infortra[ion. Send comments regarding the burden estimate cr ary othc, u-,proi of ~
<br />' this collection of information, including suggestions for reducing this burden, to Chef, Infarn~tiuo Puiicy I
<br />Branch, PM-223, U.S. Environmental Prntrrtinn Agrncy, 401 R7 Street, S:V \Vashiugiuu. Di 704i+p; and to th;e :
<br />Office of ~rformutiun and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permi!!ee rti'amei7Nailing Address (and tactlity nameRocation, ff different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />Enter da!°~ bc~il:uulgr.nd c ding "! f;~nuurlaX Period" covered by form where indicated.
<br />4. Hn(cr c:,c6 "Pmam~r~r" as spcuGcd M Monitoring requirements of permit.
<br />5. ~ntc; "Ja;;;,~;e ','~ .,r,. ,-,-,~r" ,;;,~ io: ~_... + pirr,lucxr urdr "Q~arn;," .,rid "~;:r:auv" il: ,mils specu~ed :n permit.
<br />'~inra,gr' is nomraii) anurmet!c a\cagc'!gcomcnz average Cor bacterial pare: _:crsl efall sample measurements
<br />for each parameter ohtaiucd dur.ng ".tluulrururg I'rrmd', ".1/axirnu«1" and "A.Lnuuuni" are nonnalh~ ea1reme high
<br />and toe; mc.tsurcinca~, obtail~ed ~~nnng "1.'unrrt:ring I'Crrud" (hGt~ to mu:l:npals with scr:ondary treatment
<br />requirement Enter 3l1-day average of sample mwsureulcuts under ":Iveragr," and enter masimwa 7-day average
<br />of samnic mcasurcmcnw nhtaincd d!!r.r~ .^.;or.rtoring p.::i.;d c;~d.i ".thcl,..,:•„ ",
<br />6. Enter "Petrol( RegMrernrnt" for each oaramclcr ender "puanlirj' anal "Quehty'' as socctGcd in ncnnit
<br />7. flndrr "'\'n /•'*" enter number of sample r.;,:a;u ~,,,nts di,ri,.g ~uunitorin° period that ese~a maximum (and/or
<br />minimum or 7-d~\ avc+aKe as anproprialel prnnlt rCgwremen' rn~ r.~ch pa~ameler. IC none, e~tr "0".
<br />8. Enter "f:requency ul Annl\sls" both es ".1'n«rnlr t/rnmrrnn;,r= hrn~?i irrquency of camp:ir,~ .. ,...;•al}ss used
<br />dufi.^.g n'uc:~lorng ri,i;;) ,~~~d .~; ' ^.-r ,., . i(ritc~irrc:cn: sp::..:. 1° p: (c. g., P..nlcr "C '~i, 1, iui wuiiuuuus
<br />monitoring, "1/7" for~one day per week, "1.30" for one da} per mm~tb, "1•fl0'",for one day per quarter, etc )
<br />4. Er.tcr ".S.=ran!: TI'r?,'° ~rfJtll .1] "'~Ur11f 91 ~'.:Cn2.:.'1-::::: ::i '.~.i~~~).11 f•• ,ISlll t)JI111' 111UILIO(I^ •Cl~~n~ ..ad aS
<br />"Nor.«;r ,12.,...•,,•'x..; ••^r,•" r^-~rl rltcr "(./a%:" fUi ilidi\Id Udi dill 7il', tyNt`~ Illr [i-hnnr COUI OSItC. '. ".l" tOr
<br />i r.. ~~ 1~.6 , l P
<br />continuous monitoring, etc.)
<br />10. Where clolauons of pennll requirements are reported, aRach a brief esplanauor. to describe cause and correaice
<br />actions taken, and rcfcrcncc each violation by date
<br />I L IC "no discharge" occurs during monitoring period. enter ",ti`o Discharge" across form in pLce of data entry.
<br />12. Enter "Name,Tide njPrincipal Executive Officer" with "Signature ajPrmc+pn( Executive Officer oJAuthorized
<br />Agent," "Telephone A'umber," and "Dale" at bottom of Comt.
<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 Afonitaring Report (D~L1R) form 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 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3310.1 (Rev. OS-95)
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