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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as as
<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 revie•,ving
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regardine [he burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, 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 [nformatiom and Regulatory Affairs. Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />1. If form bas been partially completed by preprinting, disregard instructions directed at entry of [bat information
<br />already preprinted.
<br />2. Enter "Permillee Name%I'fai(ing Address ;and facility name/Iocatien, if diIli:rent)," "Perini! Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'illonirorinq Period" covered by torn where indicated.
<br />4. Enter each "Poron+eler" az spccified in monitoring requirements of permit.
<br />S. Enter "Sample Afeosurement" data for each parame(cr under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic avenge (geometric average for b~,ctcria] parameters) of all sarnple measurements
<br />for each parameter obtained during ".Uonitormg Perod": 'Lllasrnrun" 2nd "rllinimvm" are norrally extreme high
<br />and low measurements obLlined during ".llonitorin,K Period." (Note to municipals with s;,condary Veatment
<br />regwrement~ Enter 30-day average of sample mcass~ements under "Average," and enter maximum 7ilay average
<br />of sample measurements obtained during mon.toring ,reriod under "".fazimvm. ")
<br />6. Enter "Permit Requirement" ,tor each panmcter under "Quan[iry" and "Quality" as spccified in permit.
<br />7. Undzr "A'n fs" enter number of sannle mauvrments during monitoring period that e.eceed rnaxirnum (and/or
<br />minimum or 7-day average az appropriate) pcrnit rcgcirement for each p: rameter. If none, enter "0".
<br />8. Enter "Frequency ojAnulysis" both az ".1'an+ale +Llcasunnen[" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Perini! Requirement" spcc~ed in permit. (e.g., En[cr "Coat," ter conLnuous
<br />monitoring, "l/7" for one day per week, "1/30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Smnple Type" both as ':Sample alensu+•eu,ent" (actual sample type used during monitoring period) and az
<br />"Permit Requirement," (e.g., Enter "Grab" 1'or indi~idua] sample, "24HC" for 24-hour composite, "iJ/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements arc reported, attach a brief exp anation to describe cause and rnneclive
<br />actions taken, and reference each violation by date.
<br />l1. if "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter ",VameiTirle ojPrincipnl Executive O~cer" wish "Signature ojPrincipal Erecurive Officer oj.4utharized
<br />Agent," "Telephone Number," and "Date" al bottom of form.
<br />13. Mail signed Report to O[lice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions (or use of this Discharge Afoniroring Report (D~LfR) torn may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />'t'his report is required by law (33 U.S.C. 1318; 40 C.F.R. 175.27). Failure to report or failure to report truthfully can
<br />result in civil penahies not to exceed x10,000 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. OS-95)
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