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Paperwork Reduction Act Notice
<br />Public reporting burden for this wllection of information is estimated m vary from a range of IO hours as an
<br />average per -eesonse for some minor facilities, to 1 l0 hours as an average per response for some major facilities,
<br />with a weighed a-~era~e for major and minor facilities of 18 hotus per response, including time for reviewing
<br />ins~ructiors, sra,•c;aing existing data sources, gathering and"• v' [Wing the dots Deeded, end completing and
<br />reviewing iue collection of information. Send commentc_~ g the burden estimate or aDy other aspect of
<br />this collection of information, including suggestions for reducing L'tis burden, to Chief, information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 i~ Street, SW WashiDgton, DC 20460; end to the
<br />Office of Ltformation and Resulaiory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form hes been partially completed by preprinting, disregard instructions dirxted at entry of that information
<br />already preprinted.
<br />2. Enter 'Penrtittee Name/Afailing Address (and facility rtame/loca[ion, if di6erent)," "Permit Nvrnber," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ;Lonitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measvremen!" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally aritltme[ic average (geometric average for bacterial parameters) of al] sample measurements
<br />for each parameter obtained during "Afoniroring Period"; ",tifaximwn" and "Afinimum" are normally exveme high
<br />and low measuretnenu obtained during ",4onitoring 'Period." (Note to municipals with secondary treaVnent
<br />requirement: Ente: 30-day average of sample measurements under "Average," attd enter ntaeimum 7-day average
<br />of sample measurements obtained during monitoring period trader "hfarimum.
<br />6. Enter "Permit Requirement' for each parameter under "Quantity" and "Quality" az specified in permit.
<br />7. Under "No Ex" enter number of sample meaztrrntenu during monitoring period [hat exceed maxitnunr (and/or
<br />minimum or 7-day average az appropriate) permit aquirement for each parameter. !f none, enter "0".
<br />8. Enter "Frequency oJAnolpsis" both az "Snmple Afeasurment" (actual frequency of sampling and analysis used
<br />during monitoring pcnad) and az "Pernut Requirement" specified in permit (e.g., Enter "Con!," for continuous
<br />monitoring, "1/7" for one day per week, "l/30" Cor one day per month, "/.90" for one day per quaver, etc.)
<br />9. Enter "Sarr;ple Type" both az "S'ample Afensurernen," (actual sample type used during monitoring period) and az
<br />"Permit Requirement," (e. g., Enter "Grab" for individual sample, "24HC" for 24-hour composite. "N/A" for
<br />continuous monitoring, etc..
<br />10. Where violations of permit requirements are reported, attach a brit( explanation to describe cause and corceclive
<br />actions taken, and reference each violation by date.
<br />11. !l "no discharge" occurs dtuing monitoring penod, enter "No Discharge" across form in place of data envy.
<br />12. Enter "NameiTitle ojPrincipal Executive Officer" tvith "Signature ojPrincipal Executive O~cer oJAuthorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Report to t~ce(s) by date(s) specked in permit. Retain rnpy for your records.
<br />14. More detailed instructions far rue of this Discharge Afnniloring Report (DA(R) form ma}• be obtained from OlTce(s)
<br />specified in permit.
<br />Legal Notice
<br />Tnis report is requitYd by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result ut civil peoaffies cat to axce,:d 510,1700 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />o(violatioc, or by imprisonrDent for not more titan one year, or by both.
<br />EPA Form 3320-1 (Rev. Ob-95)
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