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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 I8 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, OtI`ice 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 infomtation already
<br />Preprinted.
<br />2. Enter "Pzrmittee Name/Moi/ing Address (and facility nameAocation, if different)," " Pzrmit Number," and "Dischargz
<br />NumEzr" where indicated. (A sepazate 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 M~astlreme111" data for each parameter under "Qusntity"and Quality" as specified in permit. "Avzragz" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained during ",'v1~.nitsring P,:ri;d", ",1.1~rimum" and Mninrum" are normally extreme high and iwv measurements
<br />obtained during "i~/mitn,•ing P:rio.1". (Note to municipals wiEt secondary treatment requirement: F.ntcr 30-day al~,-arc
<br />of sample measurements under "Av.ngz,"and enter .-.zximum 7-day average of szm~'.e measurements obtained during
<br />monitoring period under "Mazimrrm.")
<br />5. Erfer 'PrrTrit Rzqui. ems:rt"for each pararmctet under "iirrJntity"and "Quality" as s*.ecified in permit.
<br />7. Under "Aro C.r" enter number of sample measurement during monitoring period that c;c°ed maximwm (and/or minima-n
<br />cr 7-day aver„e as appropriate) permit requirement for each parameter. If none, cnt_r "0".
<br />8. ?rater "F,rlusnoy rfA7alysir" both as "Sanrrle 1/t_ zsrnt:nan[" (acual frequcmcy of samp!ioo and analysis used ds-ing
<br />mcuitorin~ perod) and as "P~;vait R2.7uirenrznt"specified in permit. (c.g. P.mtcr "~%nt, " for continuous ~;onitorirg, "1/7"
<br />for enc day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc. )
<br />9. Enter "SanpL Tyi ~"both as "S:mpl~ Maa::u,-r:raorr" (actual sample type used during monitoring period) and as "P~ra~t
<br />R.:quirzrner[," (c.g. Enter "GraL'" for individual sample, "24!!~" for 24-hour composite, "N/A" for continuous
<br />monitoring, etc.)
<br />l0. `:,rterc violations of permit requirements are repcrtcd, attach a brief explanation to describe cause and com;c[ive ac8ons
<br />to be taken, and tzference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "1vTo Discharge" across form in place of data entry.
<br />I2. Enter "Namz/Title of Principal Esz.;utive Offi~sr" with "Signaturz of Prin viral Exzcutive Officer of Autlmrizzd
<br />Agent, ""Tzlephorrz Number," and 'Date" 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 Discharge Monitoring Report (DA92) forru may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. ]318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result in
<br />civil penalties not to exceed $] 0,000 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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