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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary Frnm " ~"ngP ,.a !n houa as an '
<br />-. _ cr re_puccc Cur ::: a:. minor reciiith..;, to 1 iU hcura s -.:. av ~, ag.. No. ,cspuuac :ur su rnu major facilities, I
<br />with e weighted average fur major and m,nnr facliites of i8 hour per resHOrc;;, :n.:ludmd iim...oi iev,ewwg
<br />instructions, searching existing data sources, gathering and maintaining the data needuJ, and completing and i
<br />reviewing ibe collection mf information. Send comments regarding the burden estimate ur any other asprxa of j
<br />ibis cullec;rion of information, including suggesuuns for reducing this burden, to ChieF, information Policy ~
<br />y~1n_h, PA4-Z23, U.S. Envi;nnmen~l Pro[cdioa agency, 401 tii $i,cci, S'iv 'Washington, CC -tG4ti0; wid to the ~~
<br />Office of Information and Regularory Affairs, Office of Management and Budget, R'ashington, DC 20503. ~
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<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee h'ameiMaifing Address (and facility ttameAocaUOn, if different)," "Permit Number," and
<br />"Dischnrge.~/umber" where indicated (A ;eparale fotnt is required for each discharge.)
<br />3. Euicr ti:rics bcgmumg and ending ".1 /lmu,nv,/; Perod' covered by fomt where indicated.
<br />4. Enter csc!:.'('armrir~:•r" ur spo_:ncd ~^ ^.or.~ioring ~cywr,msns of pcmut.
<br />`. ~,^:ICr ''OC~;;iN ` e.'.ae::,r,nr„!" ,;,:i.f fu, ca\ii pu:uu:cici under "VUnnur/' aind "i~ uohrv' in units specilictl m pefrrut.
<br />".~I rerag.^~ .., nonma!h anthmcuc .nvergc (gcometnc avcmgc for bacterial parantetcrs) of all sample measurements
<br />for each parameter obtained during ".tlonrinnrrC Period", ".llruvnu/u" and ",11/n/nwm" arc normally extreme high
<br />and low measurements obtained during ",l/nnrmru,g Penud" (tiole to municipals L+ilh secoudery treatment
<br />rcquircmcnl Enter 30-day avcra~'c of 5mnplc mcasurcmcnts under ".Ivrrn?e "and enter mavimnm 7~ay averav~
<br />o(samplc m(:awrements obtmncd dunng nionnoring pcnod under ",tluxuuun,. "l
<br />6. Enhr'.n: rl"ll ll_^[f!!lri ~;i:-ilrn fO-C'; it pL r1L1C.lC." i, ~.d... "~u'unf~(y •'.1,~~ "~uu.i.L" ~L1 ip~~ll,.u ,n peRlll[.
<br />7. Under ":\'n Fr" enter number of sarnplc mcasurmcnis during monitoring pcnod that exceed maximum (and/or
<br />minimum or 7-day avcraKc as aooroonalc) xmnt renu~remenr for earh nernmr'!rr IFnnun_ enter "0".
<br />% hnlPr '7•r/rmm~r', . .n/rely" nNh "\l, .,/,. A /.~„ .. r" l.,^r~_,~I rr,. „r ~ ~tpli: ^d ara'° ~......
<br />dunng monitoring ocriod) and as "Perrnri Requ,rroneni"specified in per!ni!~ (c.g, Enter "C`ont," (or continuous
<br />monitoring, „(,-", far one da•, per -•.,'.~t "' „ r ,per nin:ah "; ihT' C.:.::,;• d;.: per yua-?rr, clc )
<br />O Fmrr "Gn,nln 'I', hnih nc "\'.. nl,. ~1.,.,. •,. ., ,+~/..^/ ^,e •,-.a a.. - ^a) ^d
<br />"Pernui Regarremrn(," (cg, F,ntcr "iirnh" for indrvidual sample, "?aiit'~ !ur 2a-hour composnc. "~~A" for
<br />continuous monilorine etc )
<br />10 R'here violations of permit requirements arc reported, attach a brief explanation to describe cause utd corective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, emer ".h'n Di.crdnrge" across form in place o(data corn
<br />l2. Enter ",Namerl'it[e of Principa( Executive Officer" with "S'ignature of Principa( E.kecutive Officer ojAuthorized
<br />.4genf," "Telephone A`'untber," and "Dare" 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 hloniforing Report (DrL1R) form may be obtained from Of17ce(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 $ (0,000 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. 08-95)
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