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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />i average per response for some minor facilities, to 110 hours as rm average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />~~, instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding [be burden estimate or any other aspect of
<br />this 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 \Vashingtom, DC 20460; end to the
<br />Office of Information and Regulatory Affairs, Office of h9anagement and Budget, Washington, DC 20503.
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<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 "Perrnittee .4'rune.,llmhng .4ddres.c (and facility name location, if different)," "Permit ,Number," and
<br />"Di.cchnrge Number" uhcre indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending '!tlnnitoring Period" covered by form where indicated.
<br />4. Enter each "Pnrnrnerer" ;s specified in monitoring requirements of permit.
<br />5. Emcr "h'nmple Afeocuremrrr" data for each parameter under "Qumrtity" and "UunGh'' in units specified in permit.
<br />":I vernge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter cbtat ud dtnug ".l!wti;uru+g Period", ",tlnximwn" and ".tlutirrturn" are normally extreme high
<br />and love measurements obtained dunng ".t/oruronng Prruu/." (Note to municipals eith secondary treatment
<br />requirement: Enter 30tlac average of sample measurements under ".I vera};e•," and enter maximum 7~ay average
<br />of sample measurements ~btainzd during momtonng period under ".t!nximurn ")
<br />6. Enter "Permit ReOuire,nrnP' for each parameter under "LJuantin•" and "QunLty" as specified in permit.
<br />7. Under ".Nn F-x" enter number of sample measurmcnts during monitoring period that exceed maximum (and/or
<br />minimum or 7-day averal;c as appropriate) perntit requirement for each parameter. [f none, enter "0".
<br />8. Enter "Frequenep oJAr.~/~~.,i.c" both as "Snrnple .il.°awrmrnt" (actual frequency of sampling and anal}'sis used
<br />doting monitoring period) anc as "R•nnf: Kegmrement" specified in permit. (e g., Enter "Cons," for continuous
<br />monitoring, "/. ?" for one da} per week. "I 'JO" for one d>n per month, "N90" for one day per quaver, etc.)
<br />9. Emer "Sample Ttpe" bosh as ',S'nmple .4!eosuremenr" (actual sample Ivpc used dunng monitoring period) and as
<br />"Permu Requirement," le.g., Enter "Groh" for individual sample, ".dN("' for 2d-hour composite, "h'!4" for
<br />continuous monitoring, cic.)
<br />10. Where ziolations of permit requirements are rcpored, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />l I. If "no discharge" occtus during monitoring period, enter ",4'o Discharge" across form in place of data entry.
<br />l2. Enter "A'ame.•TiNe oJPr+ncipal Executive Officer" with "Signnture ojPrincipnl Executive OJJicer oJAulhorized
<br />Agent," "Telephone Number," and "Dole" at bottom of form.
<br />13. Mail signed Report to Office(s) b} date(s) specif ed in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge ,lfnnitormg Report (DAAR) form may be obtained from O@ice(s)
<br />specified in permit.
<br />Legal Notice
<br />'Ibis 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 $10,(100 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not rrtore than ova year, or by both.
<br />EP'A Foam 3320-1 (Rev. 08-95)
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