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Pa • work Redu~~~ion Acs ~Vc?icN_ - - ~ -
<br />Public reporting burden for this collation of in forrnatiur. is estimued t: .. -.i.;e .a .(t :.~oui; as an ~
<br />average per response for some rumor facilities, l0 116 hours as mr average I .. . ~r.c ,; ~or,~ nu., ~, fm ilrtie>, I
<br />with a weighted average for major end minor facillies of 18 hc~~e: per rz u;,:. :nc.,dmg ti:r.•= `;~•r reviewing '
<br />instructions, searching existing data sources, galbeting a•: r.~r,nl:.ining t:.,. •1:t nee.,,:d, and complz~irg and
<br />reviewing the collection of inftmmetion. .Send comment, rcesruial; the bw~den estitoa,e or any other :}+xA;t of i
<br />this collection of information, including suggestions for rzdueing this bardzn, to Chief, Infurtnatio~ Policy
<br />Ftranch, PM-223, U.S. Environmental Protection Agency, 4G[ NI Street, SVJ VJ;u,ringtun, DC 20160; a~rl to the ~
<br />Office of Information and Regulatory Affairs, Office of Management and Itudget Washington, DC 20503. ,
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructrons directed at entry of that infornralion
<br />already preprinted.
<br />2. Enter "Permirtee Name/Mailing Address (and facility rtaimelloption, if di8'ercnQ," "Permit PVumber," artd
<br />"Discharge Number" where indicated. (A separate form is required for cech discharge.)
<br />3. Enter dates beginning and ending iLlonitoring Period" coverai by form where i~rdirairxi.
<br />4. Enter each "Paranreler" az specified in monitoring requirements of pernti:.
<br />S. Enter "Sample Measurement" data for each parameter under "Quantity" end "~ nality" in units s ed in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial pam,neters) of all sampl measurements
<br />for each parameter obtained during "Monitoring Period'; "Maximum" and "iiLriuuu+r" are nermall elreme high
<br />and low measurements obtained during "Monitoring Period." (Note to ro~nicip~Js with seen y treatment
<br />requiremenC Enter 30-day average of sample measurcmenls under "Average,' and enter maxim 7-day average
<br />of sample measurements obtained during monitoring period under "Maxirrrurn. ",
<br />6. Enter "Permit Requiremen!" for each parameter under "Quantity" and "Q.~aBry" az specified in permit.
<br />7. Under "No Ex" enter number of sample measurments during monitor, rig period that exceed maximum (and/or
<br />minimum or 7-day average az appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both az "Sample Measurmerrt" (actual t:reauenry at'sampling and analysis used
<br />during monitoring period) and az "Permit Requirenrenr" specified in pernrtt. (e.g . Enter "Conn," fo continuous
<br />monitoring, "1/7" for one day per week, "1/30" for one day per month, "/'90" for one nay per quarter, et.:.)
<br />9. Enter "Sumple Type" both az "Sample MeasuremenP' (actual sample tyre aged due ng monitoring pe iod) uid as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "[!NC"' for '_3-hour composite, ".V,:4" for
<br />rnnunuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause ar d correcu~;e
<br />actions taken, and reference each violation by date.
<br />t l . It "no discharge" occurs during monitoring period, enter ".No Discharge" :tcross form ~ n place of data Cr try•.
<br />12. Enter "Name/1'itle ojPrincipa! Executive OJ~cer" will[ "Sigrralure ojPrincipa! Executive Ojfcer o'Anlhe,izea
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />J 3. Mail signed Report to Office(s) by dale(s) specified in perntit. Retain copy for your ra;ords.
<br />14. More detailed instructions for rrse of this Discharge Monimring Report (D,L:R) form imay be obtained from ORices)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or tai{tire to report t:ulhfu!ly ca:.
<br />result io civil penalties not to exceed 510,000 per day of violation; or in criminal penalties oo: to exeeed 525,000 uzr c;.r;
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-t (Rev. OS-95)
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