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j Paperwork Reduction Act Notice ~
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<br />i Public reonrtmv battler for Chic ro!!ec^^~ rf i^roT:at!cr.~ „ 4at:-,.,,;..~ • ... a,; .'., ~rn „ r.r,:~,:._ „* !~, 6our^ as an
<br />e: cag., y..: ,.ayv,.:~u .u. auuie r.unor facilities, to r lU nouro as en average per response for some mAlnr facilities,
<br />•x ~ih A , -~ ~'~-: ^••,;ra ~ .o; rn:. ur ~w,d ,muot fa~iliue.~ of IB huurs er res onse, includm time for reviewin ~ ~
<br />instructions, searching existing data soorces, ga!hering and tnaintainine [be data oeuled, and com;.!e!;ng and
<br />review!r~ the collection of informatioo. Send conmrenls regarding the burden es[i mate. or any other aspec! of
<br />i th!s collecGOn of mfotvialiun, including suRKes[ions fur reducing chic hurd~n, to Cbief, Inforaauc:n ^oGcv ~
<br />Bra:;ch, 1',`.f-223, U.S. cnvuonmental Frotecuun Agency, 401 M Street, SW Wacbmgton, DC 204!,0; and to the '
<br />~ Office of Information and Regulatory Affair, Offix of Management and Budget, Washington, DC 20503. ;
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<br />General Instructions
<br />I. if form has been partially completed by preprinting, disregard instructions directed a! ant:/ of that irlfJ,udtiuu
<br />already preprinted.
<br />2. Enter 'Permiltee Name/Mailing Address (and facility name location, if di&'erent)," "Permit :Numb.-.,' AnA
<br />"D. ci barge :ti'umber" tr here indicated. (A separate form is required for each discharge.)
<br />3. toter dates bcguunng and ending ",1lnruurrw~ ,°<•nod" covered by form tsherc indicated.
<br />Z. Eotcr cash "1'mvrn, Lr' ;,~ spaificd rn nruuuonng rcquucntcnts of pctnm
<br />5. Giiu ':'iampie ,iien..urenu•nr~ oata for cacl! paramdcr under "(hmrrirc' and "(hrulut~" iu units specified m permit.
<br />". h~r•rngr" a nc rntall) arithmetic a~cragc (gccmetric a~cragc for bacteria] parameters) of all sample measurements
<br />for cacf, parameter obtained during ",1 %nnrrorm>; Prr+ud' ~. ".11ar:nwru" and "Aluuntuut" arc uontctlly extreme high
<br />and low measurements obtained dunng ".t lonttunng Periud." (Note to municipals ~ti!h secondary Veatntent
<br />rcQUiremenl Fn1Cr 1R-da~~ m'en~r ..r c„~pt,_ ".r~r;;., ;non's :: ^'!s ". In~•, •,,r." a!.d co' , :....i :un 7~ay average
<br />of sample maisurcments obtained during mannoring pcnod under ".ilarimunr. ")
<br />u. Cr.tc, °Perrnii F.cyvire;ncru' for c:1Cit parameter under "Ounnt+lv'~ and "Ovolih" nc spcr-!fir_? .n pcrnu!
<br />7. L'ndcr ".\'n Es" enter mm~ber of sample mcasurmcnts durino monitoring p,,riod !ha'. c>.c_ d m:r;imum ;aud,b~
<br />mmtmum or 7-dm~ accragc a~ appreprian) pcmn` rcgair_mcnl for cacl: fara:nc;cr. if nun,;. crier "G"
<br />R. Enter "Fr::/::::n ~~~ tom,/. .. !-..;i t, _ ~.,u,r.~,. .. •,.::•••r,, •ll (a~;;::a ,•.':iis ,C~ caiiipi.ii~, Ni AliG11 ]I] U]lU
<br />during mannnring period)':.nd as "Perna! Kequurr^rnY' speciied in pcnuiL~ le.go,E.nlcr "('an(.` 'or conunnous
<br />mondonn•~. 1.7 for one dvr i r, crk, "/_Jn.. fur one r;,~ .~r .pnn;h ^r-~~ri^,:,. ~.•..:;.,:. .. ,. _,,,,., ..,.
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<br />.,... ... r._ ,,,,.,, .~ ..,.,,.p.. '„w.~,.;rru.ni t.,cm:u s,,a!pie i~pc u]cu uunng momionng penoai~M as
<br />"Yenmt Regtnremenr." (e g., Enter "(.rah' for iodic idual sample, ' _-!1l( for 2a-hour contpositc, ".\' a" I~or
<br />cnnlinunns monitoring, etc )
<br />lo. Where violations of permit requirements arc reported, clutch a brief esplanatiun to descnbe cause and corraltt~e
<br />actions taken, and reference each violation by date.
<br />1 I. U "no discharge" occurs during monitoring period, enter ",1'u Drerhorge" across form in place of data entry.
<br />l2. Enter "Name/I'itle ajPrincipaf Executive Officer" with "Signature ojPrtncipnl Executive Officer oj,9uthorized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />13. Mail signed Report to Oliice(s) by date(s) specified in permit. Retain copy for your records.
<br />t4. More detailed instrucuons for use of this Discharge Afonitoring Report (DA4R) form may be obtained from OBice(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 x25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3720-1 (Rev. OS-95)
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