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Paperwork Reduction Act Notice
<br />Public reporting burden for this collectiuo of information is estimated to very from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />v{if~ a weighted average for major and minor facilities of 18 hours, per response, including time for reviewing
<br />instrirctions, searching existing dsta sources, gathering and maintaining the data needed, and completing.aad
<br />revjewing the wllection of information, Send comments regarding the burden estimate or any other aspect of
<br />lhi9 wllection of information, including suggestions for reducing this burden, to Chief, lnforrnation Policy
<br />13rrmch, PM-223, J.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />'office of ]nformatioo and Regulatory Affairs, Office of Managemwt and Budget, Washington, DC 20503.
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<br />~~ ~~~ General Instructions
<br />p: i °: "
<br />#~ form Las been fartizlly complclNd b„ preprinting, disregard instve[ions directed at entry of that information
<br />r' ^ ~atf}eady preprinted.
<br />F: ;, .
<br />w:
<br />~~,~hter "Perrrirtee .~'arne%+foiGrg Addre.rc (and f._~;ility rume/location, ff different)," "Penmir Number," and
<br />,. ;.j Discharge Numbr^' Hhere indicared. (A separate form is regwr~ for each discharge.)
<br />'3' ~Rler dates b=gi nning and ending ".l~on~;orrr,,q F~: ~oJ" rnvered by form where indicated.
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<br />! H;~nter each 'Paracreter" as specified ~n monitoring requirements of permit.
<br />~'S. Enter "J'.,,,/ae 1 f.•a.r:v.•roenr" da~a fur u•:h pa" tmcter under "Quun(ity" and "Qurrlrty" in units specified in permit.
<br />"Averabr" s ncrn;ally arilhmcric a;, rae.. (grzunret: it accraee Cor bacterial parameters) or all sample measa*ements
<br />1' Cor oath DararnUer obtained dur~nK ''tlun;r a u•.g Pa,iod , "Afa~innun" and "bfinimum" are normally eaVeme high
<br />acrd low :ac_vrcments ohUined dunes ",llr•rinuing Period." (Hole to municipals with secondary tmatment
<br />~.: requiren!e:n Enter 30-da•, a•.c,at~ of ~sr.,~'c ,ncas',rreru^_ntf under ".9verngt," aad enter maximum 7-day average
<br />,_ of sample mea.urements obtainer dunn_ nw„iWmrg pcned urdcr ".Mrahnurn.
<br />6: Euter "Perris rcrquir^mrnt" :o: each p:uamct^, w+c'- ";J;.anuty" a':d "~uoli;v" as specified in permit.
<br />7:'Under ".Vo !~.." ~.nter number ~.+f sa,,;plc md~•,unrcros aariug monitoring period that exceed maximum (and/or
<br />.minimum or °-0ay average as ap!+*npriatc) peraut requiremrrrt for es.:h parameter. 1.r none, cuter "0".
<br />?8..°.ntec "Frvq~c.r;. ~~.1•;u:sis" h:~h s '~ar,ple ,L;:n~.r,.mrn!" (actual frequcnc}~ of sampling and analysis used'
<br />f , during ntcnit;rn6 ~-_ricai• and ~a "?c-nn; !:°mrir:°r~en„" stecified in permit. (e g., Enter "Cons," Cor continuous
<br />monitoring. `; ~7" roe arc das per •.veek. "!. ; 0" ]or ore d.;y per mor.rh, "i, 90" For ane day per quarter, etc.)
<br />d9. ~:rtler ".`::rrp!e Ttiy.;" both as "J~v+plr ; leoeuremen;` i,c;ual sanale Type used during monitoring period) and as
<br />k "PermR Reyurrer;en.'," (e.g., Emer ".:-en" for indivtdual sample, "2dHC" for 24-hour rnmposite, "A%A" for
<br />'continuous monitoring, etc.)
<br />;(1, :Where vitiations of permit req~~~rements :are reported, attach a.bricf explanation to describe cause and corrective
<br />~ actions ral:en, and reference each vio;utie:~ by date
<br />t<l. YL"na discharge" occurs during monitoring period, enter "Nn Discharge" across form in place o(data entry.
<br />l~i ~nler "Narrte%r'il:e njPrin,:ipal F~recuri+e (),(liter" wiUt "Signorri.e oJPrincipa! Executive Officer ojAulhorized
<br />' Agenr," "Telephone Number," and "Dare" ar bottom of form. -
<br />Mail signed Rcpcrt to Office(s) by d3tets) specifcd in pcrnrrt. Retain copy Car your records.
<br />More detailed inswctious for : sc of thi< Oischargz .Monitoring Rrpo."t (Db1RJ form may be obtained from O(]ice(s)
<br />specified in penrtit.
<br />- begat Notice
<br />m is requi:A~ by !aw (33 U.S. ~. l3'Y.; 4n ;'.F. R. 125.27). Fariure to report or failure to report truthfitlly can
<br />civil p:nalhes nut to exaxd ~ iQl:4!` f_r day of violation; or in criurinal penalties not to exceed 525,000 per day
<br />on, or ey impnsonmrnt for not more ti~:n :one ye:.r, cr by boll.
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<br />Ptinn 3320-1 (Rev. 08 9s)
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