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Paperwork Deduction Act Notice
<br />Public reporting burden for this collection of inforrrwlion is estimated to vary from a range of ]0 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted 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 dares needed, and completing and
<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 reducing this burden, to Chief, Infor'matioo Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20466; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregazd instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee h'arneMailing Address (and facility nameJlocalion, if different)," ':permit Number," and
<br />"Discharge .Number" H here indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and ending "Afoniror-ing Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring rcqutrements of permit.
<br />5. Enter "Sample ,Vrasurement" data for each parameter under "Quantity" and "Quality" in uruts specified in permit.
<br />"Average" is normalh arithmr-tic average (gmntctric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during "Alonrlorieq Period"; "1laxmrmn" and "blinimurn" are normally extreme high
<br />and low measurements obtained during ';tlonuoring Period" (Note to municipals with secondary treatment
<br />regwrement. Enter 3U-day average of sample measurements under ",4verage," and enter maximum 7~ay average
<br />of sample measurements obtained during moniuring period under "Afaximmn.
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ",Yn Ex" enter number of sample measurmenls during monitoring period fleet exceed maximum (and/or
<br />minimum or 7-da} average as appropriate) porn pit requirement for each parameter. E none, enter "0".
<br />8. Er.ler "Frequencv oj.lnolysis" both as "Sample ,lfeosurmenP' (actual frequency of sampling and analysts used
<br />during monitoring period) and as "Fermi! Rer,~uirerrrent" specified in permit. (c. g., Enter "Copt," for continuous
<br />monitoring, "1 ~7" for one day per week, "1 X30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "S'ample Ttpe" both as "Sample aleasurrnenl" (actual sample type used during monitoring period) and as
<br />"Perini! Requirernenl," (e.g., Enter "Grob" for individual sample, "?dKC" for 24-hour composite, "N/,t" for
<br />rnnlinuous monitoring, etc.)
<br />(0. Where violations of permit requirements arc reported, attach a brief explanation to describe cause and correc!ive
<br />actions taken, and reference each violation by date.
<br />I1. if "no dischazge" occurs during monitoring period, enter "1\'o Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrincipal Executive O~cer" with "S'ignature ojPrincipal Ereculive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Date" a[ bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pernti[. Retain copy for }•our records.
<br />14. More detailed instructions for use of this Discharge tifoniloring Report (D,LIR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />"Ibis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report wthfully can
<br />result in civil penalties not to exceed x10,000 per day of violation; or in criminal penalties not to exceed 575,000 per day
<br />of violation, or by imprisonment for not more than orie year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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