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Paperwork Reduction Act Notice
<br />I
<br />Public reporting burden for this collection of information is estimated to vary from a range of 40 hours as an
<br />average per response for some minor facilities, to 110 hours as an avenge per response for some major fapt7ities,
<br />with a weighted average for major and minor facilities of IS hoius per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and:pnintaining the data needed, and completing and
<br />reviewing [he collection of information. Send comments regarding [he burden estimate or any other aspect of
<br />this collection of information, including suggestions for rzducing 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, Washington, DC 20503. .
<br />General Instructions
<br />1. If form bas been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee .\'ane:4fn,l,ng Address (and facility ttameflocalion, if different)," "Pernrit ,Vurnber," and
<br />"Dscharge Nwnher" whrrc md,catcd. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ".1onitoring Period"covered by form where indicated.
<br />4. Emer each "Pnrametrr" as specified in monitoring requirements of pcrmrt.
<br />5. Enter ".tinmple .hlensuren,ent" data for each parameter under "Qu~rnhty" and "nunhfy" in wins specified in permit.
<br />"Average" is normally arithmetic accrage (gcomdric average for bancri.d parameters) of all sample measurements
<br />for each parameter obtained durirg ".tlonitonng Period'; "alnsrmum" and " 11ir,inuun" arc normally extreme high
<br />and lo+v measurements obtamcd during ":5lonia~ring Period." (Note Co mwucipals with secondary treaunent
<br />requirement: Enter 30ta+ a+~~rage of sample measurements under ".-I+•erag:~," and enter maximum 7~ay average
<br />of sample measurements obtained during monitoring period under ".1lriximun;. ")
<br />6. Enter "Pernut Reyurrem~nr" for each parameter under "Qunntin" and "Quality" as specified in pcnnrt.
<br />7. Under ".Vo Ez" enter number of sample measurnrenls during monitoring period that exceed maximum (and/or
<br />minimum or 7-day avcra;c as appropriate) permit requirement for each parameter. If none, enter "ll".
<br />8. Enter "Frequency oj.-Inohss" both as "Sample ,1fea.,vrnten(" (actual frequency of sampling attd analysis used
<br />during monitoring pcriai) and a; "Perini! Requirement" specified in permit (e.g., Enter "Conn" for continuous
<br />monitoring, "/'7" for one day per week, "I'30" for one day per month, "1 90" for one day per quarter, etc.)
<br />9. Emer "Samp/e Type" both as "Sample ,tlensurement" (actual sample hpc used during monitoring period) and as
<br />"Permit Requirement," (c.g., Enter "Groh" for individual sample, 'r24HC" far 23-hour composite, ",VA" for
<br />continuous monitoring, etc.)
<br />]0. Where violations of pernut requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dale.
<br />1 ]. U"no discharge" occurs ~furing monitoring period, enter "No Discharge" across form in place of data envy.
<br />12. Enter "Name/I'itle ojPrincipal Executive O~cer" v+ith ".Signature ojPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bottom of Corm.
<br />13. Mail signed Report to Ott-ice(s) by date(s) specified in pemrit. Retain copy for your records.
<br />14. More detailed instructions for use o(this Discharge Afonitoring Report (DA1R) form may be obtained from O@ice(s)
<br />specified in permit.
<br />Legal Notice
<br />Tlris report is required by law i 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 S1U,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />E'PA Form 3320-1 (Rev. OS-95)
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