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' Paperwork Reduction Act Notice
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<br />PLblic repotting burden for this collection of iafor-rnatioo is estimated It1 vary from a range of IO hours as rm
<br />ayrirage per response for some mirror f>rcitities, to 110 hours au m average per response for some major faG tees,
<br />wit~`a weighted everage for trtajor ant~aj~nQr facilities of 1S hours per response, including time fo_r%dw_ing
<br />jmsttvctions, searching existing data sources, gat4ering and tttaintaining the data needed, and ~atrtDlgtimg and
<br />~W the collection of information. Send cominenls reg::rding the burdeq estimate or any;d{~br lrspeCt of
<br />eol(ection of information, including suggestions for redscing this burden, to Chief, Information Policy
<br />PM 223, U.S. Environmental protection Agency, 401 M Street, SW Washingqrrton, DC 20460; and to the
<br />l~ofi'inf6®ation and Regulatory Affair,, Office of Management end Budget, WasTtington, DC 20503.
<br />i': ~" ~~ =~ , ~ General Instructions
<br />~~~form has been partially complaed by preprinting; disregard instnutions directed at entry. of that information
<br />preprinted.
<br />~ E1ter 'Pernrittec Nmne.'i,for(r.rg Address (arid facility ttame/1ceaUOn, if drfferenQ," "Permit Number," and
<br />.~©ischarge Number" .here indiratcd. (A separate form is required for each discharge.)
<br />~§ttter~ates b'egimring and ending "dfonunrrng Perio~ "' covere~by form where indip[ed.
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<br />1:nter cash "Parameter" as spsttied in monitorir.3 rcgnrremcnU of pcnnit.
<br />3. EaNr ';Catnple Af.nrurrnrv„P' Bat, for rich pararc:lcr under "Quanri(v" and "Qualiry•" in units specified in permit.
<br />C t vernge" is nornalh ariGVnetic scrage (geor.•.~tric average for bacterial parameters) of all sample measurements
<br />for each parameter obrainrd during "A1rr.:+ . ~,•r :'~rtnrf'; ",Alnximm~;" and ".1lininturn" are normally extreme high
<br />and low mcasurcmers ob!srned dnrinp "?Ir.+-stun„g Period." Q7ote to nurnicipals with secondary trr:u(ment
<br />requirement. 1=r.tcr 30-eta: a•:crago of srn.ple :near.!rtmcnW rurdcr "average," and enter maximum 7~ay average
<br />a of sample measurements r'r'arned Burin, mo'u:min° perio,i und:r ";i;rximunr.
<br />Enter "!'rrmrt:~.^qurremenr" for each pararr,c~cr :girder "Ouanriry" and "Quality" as specified in permit.
<br />7, Urder ": Jo E:" en;e~ nnurber of simple mcasnr^rrnts during monitoring period that exceed maximum (and/or
<br />minimum or 7-d~. avera~c as appro, ria±q pen+irr^ruirement for each paratrtetzr. Tf none, enter "0".
<br />$i.~nter "h~rgw.cc.~ o~rA;r.'wrs" b:~~h u "J,uep/~ Ai~rsurwrenl" (actual frequenc~• of sampling and analysis used
<br />F' ttunng moni[r•rici; pct. ~dl std e,.. "^.rnrir Be,;vi: Pmenr" s?ecified in permit (e.g., Enter "Cant," for continuous
<br />tna+itoring. "i '%" fo! tau day p: r .~ ..... "/ ~"' :cr arc iay per month, "i '90" for one day per quarter, etc.)
<br />J, 3:nter "S-.tmplr T•~pe" both as "S-.rn,^.'e ,11err,urem~^~" tactual sample 4Pe used during monitoring period) and as
<br />?'Per+iu/ Regvrrrment." (e g., Enter `Gran" Gv ru±iwdual sample, "?4HC' iur 24-hour composite, "NiA" for
<br />continuous mounoring, etc )
<br />D, Where violations of permit requirement, fro .*_poried, attach a brief explanation to describe cause and corrective
<br />actions taiczn, and reference each -'iolation by da!e.
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<br />If "no discharge" occurs during monitorine period, cuter "rVo Discharge" across form in place of data entry.
<br />Enter "Name :"ide ojPrincipa! Executive OJicer" with "Signature ojPrincipa! Executive O~cer ojAuthorized
<br />Agen(," "Telephone Number," and "Da(e" at hottom cif form.
<br />Mail sign..d Report to Office(s) by Butz(.} specified n, permit. Retain copy for your records.
<br />More detailed instructions fur use of thi. !tiscti~rzr ~.(onitoring Report (DA1R) form may be obtained tram Office(s)
<br />specified w perrn:t
<br />Legal Notice
<br />rHpoK is required l-y law (33 U.rS~.C. 1315: 40 C.F.F. 125.27). Fadur..o mport or failure to report truthfully can
<br />t 1n civil penalties not to exceed ylt),t~ ~:r day of yr:~alron; or in criminal penalties not to exceed 525,000 per day
<br />or by imprisonment for not orate t'.:nr ono ~ -+•, or bV both.
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<br />t;Pi~ Form 3320-I (Rev. OS-9i)
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