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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to very from a sage of 10 hours as as
<br />~{~~tige per response for some minor facilities, to 1 l0 hours es as average per response for some major facilities,
<br />~ U ~ weighted average for major and minor facilities oC 18 hours per response, including time for reviewing
<br />Iructioos, searching existing data sources, gathering and maintaining the data needed, and completing end
<br />rtr~'etwigg thF collection of information. Seed comments regarding the burden estimate or any other aspect of
<br />1r6i~ collectign of information, including suggestions for reducing tlils burden, to Chief, Information Policy
<br />;.$~,hr6, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Offidii of Information and Regulatory Affairs, Office of Management and 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 />,. ~Iready preprinted.
<br />2: $hter "Pennirlee Name/Mailing Address (and facility ttame/location, if diH'erenQ," "Permit Number," and
<br />i a Discharge Number" where indicated. (A separate form is required (or each discharge.)
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<br />3. ~nterdates beginning and ending 'Monitoring Period" covered by form where indicated.
<br />4, '{Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />' :. ".4vernge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />-for each parameter obtained during "hloniroring Period"; "dlaximum" and "Mini,rrunr" are nomrally extreme high
<br />and low measurements obtained during "Aonitoring Period." (Note to municipals with secondary treatment
<br />requitement: Enter 30day average of sample measurements under "Average," and enter maximum 7-0ay average
<br />of sample measurements obtained during monitoring period under "Maximum.
<br />Entef "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />'7. -Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />~ntinimum or 7-0ay average as appropriate) permit requirement for each parameter. If none, enter "0".
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<br />tt8. Eater "Frequency ojAnalysis" both as '.Sample Aleasurment" (aGUal frequency of sampling and analysis used
<br />;during monitoring period) and as "Pernrir Requtre,nenP' specified in permit. (e.g., Enter "Cons," 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.)
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<br />,9.'Enter "Sample Type" both as "Sample Measuremem" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, 34HC' for 24-hour composite, "N.:4" for
<br />N :continuous monitoring, etc.)
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<br />~q, _ Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />:actions taken, and reference each violation by dale.
<br />U "r1o discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />Enter "Name//'ille ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />More detailed instructions for use of Otis Discharge Monitoring Report (DAIR) Corm may be obtained from OBice(s)
<br />specified in permit.
<br />Legal Notice
<br />s ieport 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 />~t ur civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />i~olatioa, or by imprisonment for not more than one year, or by both.
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<br />Form 3320-1 (Rev. 08-95)
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