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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 hotus 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. Environmental 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 "Perini[tee Name/Mai/ing Address (and facility name/location, if different)," "Permit Numher," and "Discharge
<br />Numhzi' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Paramater" as specified in monitoring requirements of permit.
<br />5. Enter "Sarnpl~ Maasuranrant"data for each parameter under "[iumuitj~"and [ualiq~" as specified in permit. 'il var~aa" s
<br />normally arithmetic avzrage (geometric avenge for bacterial parameters) of all sample measurements for each parmeter
<br />obtained during "M;nir;rirrg F~risd'; 'St4:rinurnr" and I`fi,rinrrm" are ^omtally cxh;:me high and low measurements
<br />obtained during "d/-.nil;; inb F'~rio~". (R'ote to municipals with secondary treatment requiremenk Enter 30-da}' avc-zge
<br />of sample mccsurem.:rts under "Aver ~~,-,"and toter maximum 7-day average of sample measurements obtained dwirg
<br />monitoring period under "A4azimum.")
<br />6. Enter ;°~n-ri( R.r,luirsraz:at"fo; each pazamcTCr und:, "entity"and "Qunfity"as specified in permit.
<br />7. Under "; lc rc" enter numb.;r of sample measuremc~~t during ~nor.itnring period Lhat exceed maximum (and/or minimum
<br />or 7-day avc^zgc as appropriate) Lcrmit rcquircmer,t for each parameter. [f none, enter "0".
<br />8. P;n;er "Fralvanr;, of Analpsis" bo8t cs "Ssu,-! ~ b1_~rrr_u; ~nr" (actual frequency n` sampling and analysis used during
<br />mm~itor+ng pzr.od) and as "P~;;:,i! Ra;uir_•;n_,rr" snecificd in permit. (e.g. Enter "~.,u,"for continuous monitoring, '7/7"
<br />for one day par week, "//30"for one day per month, "Ii90"for one day per quarter, etc.)
<br />9. Enter "Sample TyFa" bath as "S~nrp/e ~Ueasure;;r~;,!" (actual sample type used during monitoring period) and as 'Tenrri!
<br />Requir~nent," (c.g. Enter "Grvh" fer individual sample, "2411::" far 24-hour composite, "N/A" for cootineous
<br />monitoring, etc.)
<br />10. Where violations of permit requirements a,-e reported, attach a brief explanation to describe cause and corrective actions
<br />to be talccn, and reference cacti violation by date.
<br />] L [f"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12, Enter "Name/Title of Principal E.t~acutiv: Gear" with "Sibmature cf Prin,ipll Executive Officer of Authoriz.;d
<br />Agent, ""Telephone Numher,"and "Data" at bottom of form.
<br />13. Mail sigtred Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Diralrarge Movitorirrg Report (DA9R) farm may be obtained from Office(s)
<br />specified in permit.
<br />I..egal Notice
<br />Phis 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 to 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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