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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a range of 10 hours as en
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a wei~gh[ed average for major and minor facilities of 18 hours per response, including time for reviewing ,
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send G~tnments regarding the burden estimate or any other aspect of ~,
<br />this collection of information, including suggestions for reducing this burdeo, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Offce of Management and Budget, Washington, DC 20503. i
<br />General Instructions
<br />1. If form, has been partially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already ,Preprinted.
<br />2. Enter ~Permi((ee Name%llailing Address (and facility name/location, if different)," "Permit Number," and
<br />"Discharge Number" t~~hcre indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and ending "Afoniroring Period"covered by form where indicated.
<br />4. Enter each "Parameter' as specified in monitoring requirements of permit.
<br />5. Enter "Sample dleasurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"A~~erage" is normally arithmetic average (geometric average for bacterial para;nders) of all sample meanuements
<br />(or each parameter obtained during '9ifoni(arirg PrriaJ"; ".1laxirnuur" and ",Minimum" are norntally extreme high
<br />and lory mcasurcmcnts obtained during ",tlo;utorrng Period" (Note to mwucip.tls pith secendaq~ treatment
<br />regwrement Enlcr 3u-day average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during moniUring period under ",tfnximum.
<br />6. Enter "Permit Requirement" for each parameter under "Ouontiry" and "Quality" as specified m permit.
<br />7. Under "Nu Ex" enter number of sample mcaatrnrents during monitoring period that exceed maximtrrn (anr/or
<br />minimum or 7-day average as appropriate) perniil regwremen[ for each parameter. if none, enter "0".
<br />8. Enter "Frequency ojAnalvsis" both as ".Cmnple dleasvrment" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Permit Reruirenrent" specified in permit. (e.g., Enter "Cant," for continuous
<br />monitoring, "1,7" for one day per week, "1,30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "$arnple Type" both az "Sample ,1'leasurrnrent" (actual sample type used during monitoring period) znd as
<br />"Permit Requirement," (c.g., L'nter "Grab" tx individual sample, "24NC' for 23-hour composite, "N/F" for
<br />continugrrs monitoring, etc.)
<br />10. Where violations oC permit requirements are reported, attach a brief expianauon to describe pose and corrective
<br />actions taken, and reference pch violation by date.
<br />11. U "no d~scharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/1't(!e ojPrincipal Executive Officer" with "Signature ajPrincipnl Executive Officer ojAuthari~ed
<br />Agent," "Telephone Number," and "Dare" a[ bottom of form.
<br />13. Mail signed Report to O6ce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge hfonitoring Report (D,'rfRJ form may be obtained from OBice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is utred 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 enaNies 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 on.: year, or by both.
<br />EPA Form 3340-1 (Rev. OS-95)
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