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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 />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environtnental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pzrmi[tee Nome/Moifing Address (and facility name location, if different)," " Permit Number," and "Discharge
<br />Number' where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Nfoni[oring Period"covered by form where indicated.
<br />4. Enter each "PQIaI)IalaT"as specified in monitoring requirements of permit.
<br />5. En[cr "Svnplz rLlaasuram~n!"data for each parameter under "~u~ntity" and Quolity" as specified in permit. "Avzr~ge"is
<br />normally a*ithmetic average (geumctric average for bacterial parameters) of all sample measurements for each pu~,~eter
<br />obtained du ing ",Lf:nitoring l~rriol"; ",l1-rxirnrrm" and Nfinimum" are normally e;aeme high and low measurem~_nts
<br />obtained during ';.fonih;,ine Frri;l". (Note !o municipals with secondary trealmcet .e;;uiremcnt: Enter 30-day a,~en~e
<br />of sa~~~ptc measuremcr,t~ under "Avarl~~:,"and enter mnzimum 7-day average of sanplc measuremcnu obained du:in;;
<br />monitoring period under "ivfaximmn.")
<br />6. En~cr'Tz.~;:il,'l.r.feir~m~nr"for eachparametaand.r"rer_r;tiq,"ar_d"Qno7ity"as specified inpcrmi'.
<br />7. Unacr ";:'•~ Tc" en'_; namL-cr oFszT~~l.: measurement during montorng ; ~riod P•at e:c~ed maximum (and/or mar mvm
<br />or 7-dzy avcra~c as appropriate) ~.ermit requiromcnt for each paraametcr. li none, enter "4".
<br />R. En'c; ";'~~ ~ rem_y ~,f Analpsir"both as "S-n,i !~ b1 •.reu a,nrn!" (octal frequency o"sampling end analysis used during
<br />moritori~g period) ar.9 as ","~nuit Rz:~rriremarr" specified in permit- (c.g. Enter "~rn~,";or continuous moaito,iog, "1/7"
<br />fir one day pz.- v; eels, "J/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. ~n:cr "S.z;; ~/ !_ TjF ~" both as "Smnp lz ;.iz~mr~maui"(zctual sample type used during rnonito-ing period) anr: as ""~,-,nir
<br />Raquirarrntl," (e.g. Enter "Graf" for individual sample, "24H~" for 24-hour composite, "N/~i" for con'iwous
<br />monitoring, etc.)
<br />] 0. VJhcre violations of pe,Trtit requir.;ments are reported, attach a brief explmtatiun W describe cause and corrcciive ae;ions
<br />to be ta'~en, and reference each violation by date.
<br />1 L If"no d;scharge" occurs d~_rimg mouitorin~ period, enter "No Discharge" across form in place of data unlry.
<br />]2. Enccr "1tGnrerTitl: '~j Frirtcil:al F.x-~r[ivz ~c.r" with "Sigrralurz of PrirnipJl Ezzcutiva Offixr of Authc;izzd
<br />Agent,""TzlzphonzNurrEer,"and "Data"at bottom of form.
<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 of this Disc/rarge Monitoring Rzpcrt (DA92J form may be obtained from Of ice(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 result in
<br />civil penalties not W exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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