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Paperwork Reduction Act Notice <br />Public reporting burden for ibis collection of information is estimated to vary from a range of 10 hours as an <br />average per response for some minor facilities, to 110 hours as an average pa: 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 rnai~taining the data needed, and completing and <br />reviewing the collection of information. Send comments regx:disg the 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. Envirunmental Protcetion Agency, 401 M Street, SW Washington, DC 20460; and to the <br />Office of Information and Ref ;rlatory Affairs, Office of Management end Budget, Washington, DC 20503. <br />General Instructions <br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information <br />already preprinted. <br />2. Enter 'Permittee Name//Ifaifing Address (and facility name/location, if different)," "Permit Number," and <br />"Discharge Number' where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and ending 'itlonitoring Period" covered by form where indicated. <br />4. Enter each "Parameter" as specked in monitoring requirements of permit. <br />5. Enter "Sample dleasurement" data for each parameter under "Quantiry" and "Quality" in units specified in permit. <br />"Average" is normally aritltmelic average (geometric average for bacterial parameters) of alt sample measurements <br />for each parameter obtained during ",4onitoring Period'; "ttfaxintunr" and "ttifinintum" are normally extreme high <br />and low measurements ot~tained during ".4onitoring Perrod." (Nose to municipals with secondary treatment <br />requiremenL• Enter 30-0a} average of sample measurements under "Average," and enter maximum 7-day average <br />of sample measurements obtained during monitoring period under "Afaximvm. <br />6. Enter "Permit Requirement" For each parameter under "Quantiry" and "Quaiiry" as specked in permit. <br />7. Under "Nn Fx" enter number of sample measurntcnts during monitoring period that exceed maximum (and/or <br />ruaimum or 7-day average as appropriate) pernti[ requirement for each parameter. If none, enter "0". <br />8. Enter "F~equency of Ana/•~sis" both as "Smnpie hlensurnrent" (actual frequent~~ of sampling and analysis used <br />during monitoring period) and as "Pernrrr Reyurrenient" specified in permit. (e.g., ;.nter "Conn," for continuous <br />monitoring, "t/T' for one d:ty per week, "l/30" for one day per month, "1/90" for one day per quarter, etc.) <br />9. Enter "5'mnple Tvpr" bosh as "Sample Afeasvremen;" (actual sample type used during monitoring period) and as <br />"Fermi( Requirement," (e.,., Enter "Grab" for individual sample, "24HC" for 24-hour composite. "N/A" for <br />continuous monitoring, etc.) <br />10. Where violations o: pcnnit requirements are reported, attach a brief explanation to describe cause and corrective <br />actions taken, and reference each violation by dale. <br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. <br />12. Enter "Nanre/f'itle oJPrincipal Executive Officer" with "Signature oJYrincipal Executive O)rcer oJAuthorized <br />Agent," "Telephone Number," and "Date" at bottom of form. <br />13. Mail signed Report to OfLce(s) by date(s) specified in permit. Retain copy for your records. <br />14. More detailed instructions fur use of this Discharge Alanitoring Report (D.tiIR) iornt may be obtaned from Office(s) <br />specified in permit. <br />Legal Notice <br />Phis report is required by lsw (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can <br />result in civil penalties not to exceed SIO,OOD per day of violation; or in criminal penalties not to exceed 525,000 per day <br />of violation, or by imprisomnent for not morn than one year, or by both. <br />EPA Form 3320-1 (Rev. OS-95) <br />.3. <br />„_ <br />J _ <br />~:.:~_~ ~:-:r~ _ __ <br />