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~ Paperwork Reduction Act Notice
<br />I~ PuF.!ic reporting burden f^r [hi=_ cr•!le~tion of irformatir•n is estirc.ted rc vnr,.• frn:^, a rcrt~e of 10 h;.ur; a., ;,:,
<br />average per response for some minor iaciinies, to i rG hours as an average per response for some ma3or facihnes,
<br />with a weighted averages for major and manor facilities of l6 hour per resrio~se, w~iudiog iunr lur reviewing
<br />' instructions, searching existurg data sources, gathering and maintaining Uie data needed, and comple[mg and
<br />reviewing the collection of information. Send comments regarding the burdeo estimate or any other aspect of
<br />'i this collection of infotmation, includin.Q sut;Restions for reducing this burden, to Chief, lnformalioo Policy
<br />Branch, PNf-223, U.S. EnvirunmenWl Y, ulecuun Agency, 401 Nf Street, SW Wash,nghm, UC 20.360; and to the
<br />~ Office of Informa[iun and Regulatury Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprintioK, disregard instructions directed at entrv of that information
<br />already preprinted.
<br />2. Enter 'Permittee S'nrne.alml!ng Ar/dre.cs (and facility nameJlocation, if different)," "Perna! Number," and
<br />"Ueschnrge Juno',er" where mdieatcd. (A separate form is regmrett (or each drschargeJ
<br />3 Enter dates begmmng and ending "1;an,rnnn,K Prr,.u!" covered by form where indicated
<br />4. Enter Bach "Parnrnen•r'~ a, speeihrd ut mwuwung rcgwrcnlents of permit.
<br />5. Enter ".1'omple .1leacurr•rnen(" dam 1'or each parameter under "~lunnrity" and "Clunlirv" 'n units specdicd m permit.
<br />"Arrrape" is notnrallti arithmetic average (geometric average for bacterial parameters) of all sample rncasurements
<br />for each parameter ooCiined during '.lJnnnr~rrng PrnruP' "ihe.[u,n,ne" and ".1!aeinuun" arc nunually c~treme high
<br />and tor. measurements obtained during ".1fon!(or,ng 1'cr!,ed." (Note ro municipals with scccn:ar) treatment
<br />'C^ytl: r"menu Fn!rr ~n-dam . a.,ern ~C Cf ~a m.~l_ m^~Sl'mr.,,, nit nn,!li_r ".[t~nrage. ?nd Cntrr m,y~..~t~m != ;^y averagr_
<br />of sample measurements obtarncd during monuoring period under ",11nrimum.
<br />G. Enter "Penner Requirement' for tact[ parameter under '4)um,on"and "~ruo0(v" as sp~rli,rc: in ;:a nu t.
<br />1. Under "A'o Fs" enter numher oC sample niuasurntcn[s during moniroring period that exceed maximum (artd/or
<br />minimum or',-day average as appropratc) pcr:nit rcgcircmcnt (or ^..^.ch paramctcr. If none, enter "0".
<br />_. .-.[.. ,, [ ..,., .. bt~tl[ "n - .,,. ~,.. ,.. hlal f' ',f Samnh n2 ..a ~I,: StS .., ..,
<br />.,.. ~ ., r,~. ...
<br />during monitoring period) and as "Pc•rm;l Regm.,-me,!r" specified in permit. (e.g., Enter "Cool," for continuots
<br />n,r,nnnnne "i -'" for me day per week, "I ?fi" for ma• d~n ~ mm~iii, ' /-P!1" ~~,: one day per quarter. c. c.)
<br />n n , / .i ... ~......,...t
<br />'i. GIItU 'JUBIpn l:/.~ bUti~ ~ i'„I%,)n t~ .. ..n,. ~ .. ~,. - ,,.. ::p:., i)r. .'~ d'~. ::o .wunw ng ter,^a~ °°'! -
<br />"Pernw Requiremenr." (e g., Enter "[;rah" for individual sample, "?JI/l"' for 2a-hour camposrtc. "\rl" far
<br />continuous mcnrtcrir~, etc.)
<br />10. Where violations of pernlit requiranems arc repored, attach a brief explanation to describe cause and cortective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, toter ",1'o Drschorgr" across form in place of data entry.
<br />12. Enter "NameiTille ojPrincipal F_recu(!ve Officer" with "S'lgna(ure ojPrincipnl Executive O~cer ojAu(horized
<br />Agen(," "Telephone ,'l'umber," and "Dare" al bottom o(form
<br />13. Mail signed Report to Office(s) by date(s) specified in perntil. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge tifonitoring Report (D.t9RJ form [nay be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />73is report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report nr 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 3320-1 (Rev. 08-95)
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