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Paperwork Reduction Act Notice
<br />Public reporting burden for this col]ection of information is estimated to vary from a range of 10 bows 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 bows 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 bwden, to
<br />~IChief, 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, Of&ce 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. Enter "Fermittee Name/Mailing Address (and facility name/loca[ion, if different)," "Permit Number," and "Disc/rarga
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Alonitoring Period" coveted by form where indicated.
<br />4. Enter each 'Param~rer" as specified i^ monitoring requvements of permit.
<br />5. Enter "Sample M~astn•emznt"data for each parameter under "Quantity" and Qualiq~" as specified in permit. "Av~rrge" is
<br />normally ari$rmetic average (geometric average far bacteria] parameters) of all sample measurements for each parameter
<br />obtained during ",Lf.nihring Period'; ';11~.cinnun" and Mininnun" are norznally exiremc high and Icw measurements
<br />obtained during "htonils~ing Pzrind", (1`?ote to municipals with secondary treatment requirement: Enter 30-day average
<br />of sample measurements wader "Ava-ag~,"and enter naximum 7-day average of surple measurements obtained during
<br />monitoring period under "Maximum. ")
<br />3. Entrr "Parvnit R../uirunrsrrt"for each parameter and: r "Qu.nuit}~"and "Quality" as specified in peroi`..
<br />7. Under "A%, Ex" enter number of sample measurement during monitoring perod Ghat r.xc'_'.d maximum (andtor minimum
<br />cr 7-day averagz as appropriate) Hermit requirement fnr each parameter. If none, eater "0".
<br />8. Enter "Froqu~,t~y ~f Analpsis" both as "S_~„r,~L• L./.•~su: aaart" (actual fraqucrcy of sampling and analysis used d rring
<br />mooitoring period) and as "Pz;;ait 2auirarn~nr" specified in pcrnit. (e.g: Enter "~•~n/,"for continuous monitoring, "I /7"
<br />for one day per v; cek, "//30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Lnter "Samph: T}F~"bot;i as "S.mp!_ ,Ll~~s~n s;:r_;tr" (acbial simple type ascd during monitoring pcried) and as "Psrntir
<br />Rr:quiremrrt," (e.g. ]:rifer "Gr,th" for individual sample, '741~~" for 24-bow composite, "N/A" for continuous
<br />monitoring, etc.)
<br />I0. Where violations of permit requirements aze reported, attach a brie`cxplanation to describe cause and corrective actions
<br />to be taken, and reference each violation by date.
<br />11. if "no discharge" occurs during monitoring period, enter "No Discharge" across form in place ofdata entry.
<br />12. Enter "Name/Title of Po•incipal F..rsartiv~ G~~~r" with "Signanu•e of Frin;ipal Exeautiu: Officer of Authorizzd
<br />.9gent, ""T~lephone Numt~r, "and 'Datz" 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 Dischargz Monitoring Rep.rt (DA9i) form may be obtained from Office(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 thaw one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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