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Paperwork Reduction Act Notice
<br />li plrb!ir MMrrTg 6nrrlNn for thje rr}!IrrriOH of infnRryahn0 l eStinL'.ted to •,ar~ from a rnEC :-.f i0 h~un ~~ mr
<br />avelube pGl rwpume iur suave minor faciiities, to i iG hour as an average per response for some mayor facilities,
<br />v.td} a ::•c}ghla: avcrdg:: fur m::jor and minor facilities of lg hours per ~espuuse, including trine for reviewing
<br />instructions, searching existing data sources, gathenng and maintaining [he data Healed, and completing anJ ~,~
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reduciHg [his burden, [o Chief, Lntormalinn Policy ~~
<br />6reuch, Fivi-223, U.S. Environmental ProtectioH Agency, 401 M Street, SW Wahmgtue, DC 20460; and to the
<br />j Office of Infot'mation and Regulatory Affairs, Office of Atanxgemenl and Budget, Washington, DC 20503. ~~,
<br />General Instructions
<br />1. 1( form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permit(ee Nnme~6far/mg .gddre.cc (and facility namellocation, if different)," "Permit ,Kumber," and
<br />"Dischor~;r :~,'umhrr"where indicated to separate form is rcgwred for each drschargeJ
<br />3. Enter dates beginning and ending ".1lnniroruv,¢ Pennd"covered by form where mdtcated.
<br />4. 1niU etch 'Turum.•!rr" as spcuLcd in uwuiiunug rcquucntcnls of pemrn.
<br />.,. Hn;cr '~A'mnple tlra,vrrnreru" data for each paramelcr w}der "~Juonaty" and "4)un1iR" m units specified in petnrit.
<br />".1:'rrn;;<" is nonnully arithmeut average (gcometnc avuage for bacterial parameters) of all amtple measurements
<br />for each parameter obtained during "L'nluo~nng Prri~rzr'; ".1lnximm~l' and ",tlirrirmm:" arc normall}' extreme high
<br />and low measurements obtained during "tlnnirormq P~nud." (Note to municipals with secondary treatmem
<br />renni remrnt~ Fntcr llrti~} avCragr of c~mple n,ry_rr... ~t~ none. ',r}~eragc,' ..nd rcL' ... .......... ~-da}~ a:cmgc
<br />of sample measurements obLaincd during monitoring period under ".1laximum.'7
<br />G. Entcr'Tcrrm! Reyuvrmrru" for each parawclrr uuu~~ ~~[runnrrlt~~ and '(lualin'' as specfied m perm[[.
<br />7. Under "S'u Ex" enter number of sample measurmcnts during monitoring ncr.c~ that e.xcecd maximum (and/or
<br />minimrm or ~-day; s^rrngc a` appropriate) perrnC regcircn::^.t fer each par:.n:~_;.-r ~f rc: c. ~n!c: „^"
<br />during monhoring pcnod) and as "Permit Rrquircmeri!" specified m pumit. (c. g., Enter "( ont," Cor continuous
<br />monhorne, "1 ~7" f•;r or.e da} per week, "1-ili" fu: nor d.:•- nrr ~nouli}, "!'!'Il" iiu rnrc d^} per quarter. rir }
<br />. .'-...'L':.r ,, ,;~;;y:~. ~`.r,- ~,n(.i ....~. .. .. ,.,.,,..a .,.d: y,~ ,F,.. ..... ,lU r,,,p i~l.~ ~~ul,,.g t.u, ..~ .:u~ ...
<br />"Yermu Requlremrnt,"J(eg. Enter "rrah" fur mdi}~idual armplc~ "711;(" for 2d-hour composilc.~"~~"4" for
<br />conL'nuet_ mcni!onn~, e!c )
<br />10. Where violations of petntit requirements are reported, attach a brief explanation to dcsenbe cause and cortcdice
<br />actions taken, and reference each atolation by date.
<br />I L If "no discharge" occurs during monitoring pcnod, enter ".Yo Discharge" across form in place of data entry.
<br />12. Enter "Name/I'ille ojPrincipal Executive Oj~cer" with "Srgnafure of Principn! Executive Oi7rcer ofAulhorized
<br />,4gent," "Telephone Number," and "Dore" at bottom of form.
<br />13. Mail signed Report to Of3ice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DtifRJ form ma}' be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />73is 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 510,000 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 Form 3320-1 (Rev. OS-95)
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