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Paperwork Reduction Act Notice
<br />p,i1.Gr• rn~: Jtfing In ~r.iv.. f... ri.i~ ~ollecrir•v of inf~rm~tinn t~ e~t!m3ted !a ~ ,~ from ~ _ c~ :C h;,urs as a:, ~
<br />overage per rspoase :br some minor rr"udities, to l i0 hours as av average per response tor^some ma3ur tacihties, i
<br />Kith a wcigh[.,c1 avorag:: for majcr anJ minor facilihs of IE hour per rsfro:~se, iuciudu,K aloe iur revmwmg i
<br />instructions, searctuog existing data sources, gathering and maintaining [he data nerded, and completing and ',
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspe('t of
<br />this collection of informa[iev, including suggestions for reducing this burden, to Chtef, information Policv
<br />Branch, PM-"[23, U.S. Environmental Prote.;tion Agency, 401 M Street, SW Waahinghm, UC 2U46U; and to [hr.
<br />Office of Information and R~gulalury Affairs, Office of Management and Budget, Washington, DC 20503,
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<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permit(ee NnrneiMni(ing Address (and facility name/location, if different)," "Perini( Nurnher," and
<br />"Drscharge ,Number" where indicated. (A separate fornt is required for each discharge.)
<br />3. Enter dales bceinnine and ending ".,b/nNrnrulP Pearuf" cm~cred by form where indicated.
<br />u. Enlcr UILtI "Prlrrl//11'11 +'~ .R sp„ Ifled III InUiIIIUi 111 rC(IW fe111Cn1g Of p1:r1011.
<br />7. Enter "tiuu~,c(e ,Vrm~urrrrrerrr` (Pita !or rich paranleier under "~ruunrir/' and "~hrnhn%' m amts specified m permit.
<br />".icerar;c•" s normall} arthnrtir. a(erage (geometric average for bacterial parameters) of all sample measurements
<br />for each paramcrer obr.ined during " 1lrnururu,K Pr•n+ul", '^:Jo(unmrr" and "~linurmnl" are normally extreme high
<br />and low mavsurcmcnts obuuncd dunng ".IlunlrunnK Pcnud." (Note to municipals with secondary treatment
<br />rrnn mrmrnl Fnrpr 111-~?• 9.,~C~~o ~ pF gam h m,~,Uq_rPmrntg ^1'd^r ", 11•r rn~r' anti ~nrrr mavj nt+atn 7_rj?v a.~P ra n~
<br />p ..._ ._~. ~ _. _. _o_
<br />o(sample measurements obtained dwing monitonng period under ",1>axlmum. "J
<br />b. Enicr 'Nerrml lteyulrrmrnl' for each pwanlctcl under ~ ~/umwrV ~ and '~lualup~~ as spcoliw tit pcrnul.
<br />7. Under "A'u fY' rater number of sample mcasurntcnls dwing monitoring perod that exceed maximum (and/or
<br />mir.imun: or ~-d.^. •: s,. ,_. _ .i...") ...~..;t . - ..~,.. ro.,.a~~; a.a.n~,,.. If con„ e..t~. ~~n.
<br />~~r
<br />during monitoring period) and as "Prrnur Rrguu~rnlrnr" spxificd .r, pcmlil~ (e g., Ccter "l'onr,"'~re~ conlinuous
<br />monllonn ~, "!-7" for one day on w'e('k, "i ?U" fu; u!le del} orr munii:. "r 9!i' fu: rnr de•~ tic: uualic:. e'. j
<br />1. ~.iu Cl :~u: L)hi is/.. , u .. ,.in ~t u.,..~. .. ,. ~,. .... 1.p:.. ,Y~ ~.b ,...,.... ab l)..~. __. __
<br />"l'rrmi( Requirement,"V(cg~ Enter "Groh" for indn~idual sample, "?JH("'for 24-flour composue,~"A''1"-(or
<br />cnminuous monitoring, etc )
<br />10. Where violations of permit requirements are reported, attach a brit[ explanation to describe cause and corecticc
<br />actions taken, and reference each violation by date.
<br />1 I. U "no discharge" occurs during monitoring period, enter ".4'o Di.rrhnrgr" across form in place of data emry
<br />12. Enter "Name/I'i((e ojPrrncipa( Executive Officer" with "Signature ojPrincrpa( Executive Officer oj.4u(horized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy Cor your records.
<br />l4. More detailed instructions for use of this Discharge hfonitoring Report (DtifR) form may be obtained Crom Offce(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
<br />result in civil penalties not to exceed f 10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Farm 3320-1 (Rev. 09-95)
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