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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 honrs 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, seazching 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 />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Entet "Permittee Name/Mailing A3~ress (and facility name/location, if different)," "Permit Number," and "Csscharge
<br />Number" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Mzasurement"data for each parameter under "Quanliry" and ~iuaiitp" as specified in permit. "Avis:rgr" is
<br />normally arithmetic average (geometric avenge for bacterial parameters) of all sample measurements for each pzreTeter
<br />obtained dying ',vf,nitoring Prri~d"; 'S~1uia&un" and ,btinimum" an: normally cxtn:me high and low measurements
<br />obwined d~:ring "V,cuilsrinb Psri;a". (Ttiute to muuiei2als witb secondary treanr.ent rcquiremrat: T-;nter 3C-day avcrdge
<br />of sample mcssure;mcnts under "Av~~,vbz,"and enter maximum 7-day avzmgc of s.nple measureroen's ob;z~ned du: in;;
<br />monitoring period under "iviazimum.")
<br />6. L•n:e,- "Pen.ri! Ra;t~~w,nzru"for each parameter under "Qu.mlity"and "~iualiry" as specified in pens':.
<br />7. Undc1 "A'% ,.x" c ~t:- ~u.nL'er e. simple ,: ~asurment d~.uing nanitoring rcccd Qt.at e.cc;;cd maxi~nutn (and,'ar ~nin' nwm
<br />or 7-day z~,crage as appropriate) permit rcquiremaa :or each parameter. IFnone, enWr "0".
<br />S. .~c:er "Fre7u.,r_y ~~`Anal}~sie"both as "S1r rE1~ ,Lf:.nursrn~, t" (aaual L-cqueucy o'samplin~~ and analysis _sed c~!rog
<br />racnitoring period) aid as "Prr,nit R>~uLrmari"specified in permit. (c.g. Entr "Cs;v!,"1'ur continuous monitor~~g, "1/;"
<br />for or.: da y per wce(c, "1/,IO" for one clay per month, "1/90"for one day per quarter, etc.)
<br />9. En:cr "Sams !z TyE r"both as "Sr:rEJ,: ,t.`_•:ur.•r>r±eur" (actual sample type used during monitorar2 period) and as "Parnil
<br />Raquir~arrat," (o.g. Enter "Grit" for individual sample, "24HC" for 24-hear composite, "iJ/A" Cor continuous
<br />monitoring, etc.)
<br />]0. 1r.'here violations of permit requirements are reported, attach a brief explanation to describe cause and connective actions
<br />to he taken, and refe_cnce each violation by date.
<br />1 I. If "no discharge" occus d.uing monitoring period, enter 'No Discharge" across form in place of dew entry.
<br />12. Enter '7Vamz/Title of Principal Fxacutive ~_zr" with "Sib azure of Prin:;iFal Erecrrtivz O~~er of Asrlhorized
<br />Agent, ""Te(aphonz Number, "and "Deli" at bottom of form.
<br />13. lY]ail signed Report ro Office(s) by date(s) specified in permit. Rewin copy for your records.
<br />14. tvlore detailed instructions for use of this Discharge Monitoring J2zport (DJNR) form may be obwined from OiTice(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 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 ooe yeaz, or both
<br />EPA Form 3320-1 (Rev. 03/99)
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