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Paperwork Reduction Act Notice
<br />i uiriri lclwrf:n~1 ulifJcu f~: :u~S wiic~iwn tit uilUl JCalinn :~ C~~L ~.Ii241 is ~. ar• frr.,i; ~ ran,~~ nr tii :,..afti a5 an
<br />avrrege per response for some minor facilities, to 110 hours as an average per resnonse for cnmr m~!jnr facilities, ~
<br />with a weighted avemge for major and tnioor facilities of IS hours per response, including time for reviewing '
<br />instructions, searching existiue data sources, gathering and maintaining the data ner~led, .and campleting and ~
<br />reviewing [he collection of informatioo. Send comments regarding the burden estimate nr 1!y achy. a.;rrc! of
<br />this cnllerrinn of information, including s,iggestions for rcduc!vg this 6urdec, [o Chief, lnformation poGcv
<br />Branch, PA4-223, U.S. Environmental protexhon Agency, 401 M Street, SW Washington, DC 204tiG; and to the
<br />~, Olf¢e of inlurmauon and Regulatory Affairs, Office of A1anagemeot and Budge[, Washingtan, DC 20503. '
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<br />General Instructions
<br />I. If form has Fern partially completed by preprinting, disregard instructicns directed at en[r~ of tl;at ;,-,for~„atia~
<br />already prepria[ed.
<br />2. Enter 'Pernrittee ,4'ame,:tfailing Address (and facility ttamellocation, if differenQ," "Perrreir wrunhor." ~~d
<br />"UrsrhnrRe ~'urnher" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dales be;,inning and ;:nding ".V,na(avrg Pennd" covered by form wherC indicated.
<br />4. Emer cach 'Pormnrr. r" ac spnaGed in monitoring requirenitnts of penult.
<br />5, Enlcr ".~'ompir 1lraei,runenl" d.iW for cach pa:aum(ei under "Quarrhrd' and "QuulrN" in units specified in permit.
<br />"Average" is norma117 arithmetic avcragc (geonicuic avcragc for bacleritd parameters) of all sample measurements
<br />(or cach parameter obtdiucd during "ll~,rul~rin,Y Pe,ruJ", '7/uuurum" and "Alinu+nun" a:c ~~armally extreme hig~,
<br />and low mc.2surcments obtained during ".tlnnrrurmJr Penud" (Note to municipals ~..~C~ secondary treatmcni
<br />rcyuiro!aii. i_oiu ";-Je•..ir_i.i~, .;f y.in:y.L•: ~:.,. i:,n~c~euts uada " iveruge," and .; .::.. imam 7-ti i~ avcragc
<br />of sample measurements obtained during monilonng period under ".tlazimm~i. ")
<br />6. Enter "Penmt Regvirrrnenr" for cach paramct~~r ^ndcr "Q!mnrih,," and "Qunlrrv" s s; cri'!vd in pern:it
<br />7. Under "~'u 1:~' cn!c m_mber of samp!e :... mcnts during .^.:or.itn.^:ne prna~' tl'a; exceed mavmum (and.'or
<br />minimum of '-din ai ci,i~c .v nppropi late) pcnniif r:;;,nn•incnl fir rich parnn,t~r If ..one, enter "0..
<br />::. Enter "~r.'r"'-"" a -I ri]rl it:f~ bGih di .r .lirun:n riidi,i" 'aCiir.ii it:you:~i ui 53iii'wi' aiid auai w5 aria
<br />r,.. ,,iL f :u.~ t N"g
<br />during monitoring period) and as "Penny( Rcqurrrureer" spccdicd in prrniii. Ice . Enter "('ont," for continuotu
<br />mvn,tornd „l;~„ f;~. ~r: d::^ p: ........ "I i0" fe; .,.._ •' ~ pz. ':ac.... -"' _ _.~ a ~. pc,;;;;;,,, , ,,;: .
<br />y. Suter ".`ample I rpr ootit as ' Aomplr .veo.vnr~emeuY~ (nclnal sample n;nr nsrri annng mannonng penod) and as
<br />"Penn( Rrqurremenl," (c. g., Enter 'Grab" for individual sample, "'1/It"' for 23-boor composite, "N.a" far
<br />wuUnuuus tnanitoring, etc.)
<br />I0. Where violations of permit requtremenls are reposed, attach a brit( explanation to describe cause and correclivr
<br />actions taken, and reference each violation by dale.
<br />1 L U "no discharge" occurs during monitoring period, enter 'SVo Dischmrge" across form in place of data entry.
<br />12. Enter "NamerTi([e ojPrincipal Executive D~cer" with "Signature ujPrrncipal Executive (J~cer ojAuthorized
<br />Agent," "Telephone Number," and "Dare" at bottom of fornt.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />I4. More detailed instructions for use of this Discharge Afonttnring Repot( (DtifR) form may be obtained from Offce(s)
<br />specked in permit.
<br />Legal Notice
<br />'I'bis 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 oot 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 3320-1 (Rev. 08-95)
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