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Paperwork Reduction Act Notice
<br />Pubtic reporting burden for this collection of information is estimated to vary from a range of ]0 hours as ao
<br />average per response fur some intone tacdibe=., to ~ tU ho{:rs as an average per respoa=~ for c,;,::" rnaj:,r facilities.
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewine
<br />instructions, searching existing data sources, gathering and maintaining the data needul, and completing and
<br />rviewing the collection of information. Send comments regarding the harden estimate nr any other acnect of
<br />this collection of information, including suggestions for reducing this harden, to ChieF, Information Policy
<br />Branch, PLf-223, U.S. Environmental Protwtion Agency, 401 M Street, SW Washington, DC 20^.60; and to the
<br />Office of Information and Regulatory Affairs, Office of Management end Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permi((ee Nanre/Ilfoiling .4ddre.ss (and facility name location, if different)," "Permit Number," and
<br />"DicrhnrPe Numher" where indicated. (A separate form is required far each discharge.)
<br />;. Enter dates beginning and coding '&fomloring Period"covered by fiirm where indicated.
<br />4. Enter each "Pnrmne(er" as spcciLcd in monitoring requirements of permit
<br />S. tinter an:pta ~ (vncuremrn!' Baia un :<rc r iJJIJInCtel nllller "Clan;; (1t/' and "{lualr(~" m u111t5 speClfted In pernul.
<br />"Average" is normally arithmetic a)cragc (geometric average Cor bacterial parameters) of all sample measurements
<br />for each parameter obLlincd during "hloni(ormg Period'; "hlazirnurn" and "Minimwn" arc normally extreme high
<br />and low measurements obtained during "d;ari(uring Period." (Note to mur.inpals ~ailh secondary treatment
<br />requirement: Enter 30-day average of sample mcasurcmcnts under "Average," and enter maumum 7-0ay, average
<br />of sample measurements obtained dw iug monitoring pc;ied under "hfnrimurn.
<br />6. Enter "Permit RequirenrenP' for nch parameter under "Quantity" and "Quality" az specified in permit.
<br />7. Under "h'o h'z" enter number of sample meazurnrenls during rnoniio;ing period that cxcwd mraimum (and/or
<br />mirtimum or 7~ay avcmgc as appropriate) permit rcGuircment for earh parameter. If none, enter "0".
<br />6. Euiu "Frryurncv oJ.lralyais" both ; s "Smnple .4~:n.r_~rnren!" (2rn:at frrrmrncy of sampling and anarsis used
<br />during monitoring period) and a_s "Pe((ni( lfequux~rucnr` specified ir. pe::uii. (e.g., Fnt,_r "('.,,;;," ;,: continuous
<br />mordtoring, "1/7" for one day per week, "t/30" for one day per month, "190" for one day per quarter, etc.)
<br />9. Enter "S'ample Tvpe" both as "Sample ~h/rasuremr~il" (actual sample t~pc use ~?Ming mor.;toring period) ;:nd r
<br />"Permit Requirement," (e.g., Enter "Groh" for mm~iduai sample, "_;L~"' fu, 2~-Hour composite, ".',::;" fee
<br />continuous manilorirrg, etc.)
<br />10. Where violaUOns of permit rcquimments are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />I1. If "no discharge" occurs during monitoring period, eater "h'o Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrincipal Executive Officer" with "Signa(ure ojPrincipnl Executive Officer oJAu(horized
<br />Agen(," "Telephone Number," and "Date" at bottom of Form.
<br />]3. Mail signed Report to OtTice(s) by date(s) specified in perntil. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Moni(oring 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 510,000 per day of violation; or in criminal penalties not to exceed 3?5,000 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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