|
Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated W vary from a range of (0 hours as as ~
<br />average per response for some minor facilities, to 110 hours as an average per response for soma ~pjor facilities,
<br />with a weighted average for major and minor facilities of 16 bolus per ~~. includigg tim~:f8yreviewing
<br />instructions, searching zxisting data sources, gathering and maietaining the dad needed, and cotrtPle;io~ and
<br />reviewing the collection of information. Send comments regarding Ute burdea estimate or any othyr aspbct. of ~
<br />thin collection of information, including suggestions for reducing this burden, to Chief, Information Policy `' ~.
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washin~tm, 20503. -
<br />- --~_
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard irrstrtM.Miooa!dirocted at entry of that information
<br />already preprinted. _ __... _ : 1
<br />2. Enter 'Permittee Name/Maiting Address (attd fadlity name/location, if diH'erent)," "Permit Number," and y
<br />"Discharge Number" where indicated. (A separate form is roquired for each discharge.) 1
<br />3'. Enter dates beginning and ending 'ilfonitoring Period" covered by Corm where indicated.
<br />. ; r
<br />4t.~nter each "Parametyf',~g yp{~j(1S~ i~Qt,~IgQngret~gr~t1 is of permit. - I
<br />5. Enter "SarnpfeAJeatrRie~rdlat41'~fr, ~ eter under "Quantity" and "Quality" in units specified in permH. •i ~';
<br />"Average" is notntatly atitlurtctie avlerege' c average for bacterial parameters) of all sample measurements 'r ~ ~~,
<br />for eac " eter obtained during "Monitori rind'; "tLfaximum" and "Minirnurn" are normally extreme high •
<br />and, menu obtained during "dfo ring Period." (Note to municipals with secondary treatment
<br />ream Enter 30-0ay average of sample measurements under "Average," and enter maximum 7 e
<br />of menu obtained_during monitoring period under "bfaximum.'J ?}'°
<br />6. Enter "pee~M _ urrement" fof ~ parameter under "Quamity" and "QuntiN" as specified in permit ~ r
<br />a-. f
<br />der "A!p` Ex" enter nu sample measurments during monitoring period that exceed maximum (and/or
<br />' um'or 7-0ay average ropriate) permit requirement for each parameter. If none, enter "0". 1 1
<br />{ ,, r "Frequency of Ana/y,~ls" both as ".Sample AleasurmenP' (actual frequency of sampling and analysis used q
<br />during monitoring period) and as "Fermi! Requirement" specified in permit (e.g., Enter "Cons," for continuous. ~":~' i
<br />monitoring, "/~ 7" for one day per week, "//30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Ttpe" both as "Sample Afeasuremenr" (actual sample type used during monitoring period) and as "-
<br />"Permit• Requirement," (e.g., Enter "Grab" for individual sample, ":4HC" for 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrincipa! Executive Officer" with "Signature ojPrincipa! Executive Officer oJAuthorized S
<br />Agent," "Telephone Number," and "Dare" at bottom of (otm.
<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 o(this Discharge Monitoring Report (DAfR) 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 SI0,000 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 />~..
<br />.X
<br />r.'
<br />EPA; Farm 332Q-1 (Rev. Og-95) -~
<br />' .. ..._ _ _ a'
<br />''~
<br />
|