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Paperwork ~~diw;~tcoc: ,~,cti ~'t1•ce
<br />Public reporting burden for this collutioo.of information is estimated to ~ ~ ... ~. ., :.5 ,..,u:; as an
<br />average per response for some minor facilities, to 110 hours as .m average o~ ~ ~ .}~~,. • ., ..~,, ma 'r ta.aliGes,
<br />with a weighted average for major and minor_faCilities of IS hours per r,:>, .~;.,~ . a;:i...hnr. mmr Lv renewing
<br />instructions, searching existing dam sourees,'gathering and maim oiog tl. c_. _, oral-d, and :,ornpletiag and
<br />reviewing the collection of information. Send comments rt.;~. Jinn the bui:le.; c timate or say othar aspect of
<br />this collection of infornratioo, including suggestions for rd~cing this burden, to Ctuef, Information Policy
<br />Branch, PM-223, U.S. Environmeahl Protection Agency, -10. lvi Street, S~1' Washington, DC 20460; and to the
<br />Office o(Information and Regulatory Affairs, Office of Management and Budget, Washittglon, DC 20503.
<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregrlyd instructicros di ected a[ entry of that information
<br />already preprinted.
<br />2. Enter "Permitlee Name/Mai/ing Address (and facility ttame/loplion if different)," "Permit Number," and
<br />"Discharge Number" where intlipted. (A separate form is required for each discharge. )
<br />3. Enter dates beginning and ending 'Monitoring Period" coveretl by form where it •dip2d.
<br />4. Enter each "Parameter' az specifed in monitoring requirements of permit. -'
<br />5. Enter "Sample Afeasurement" data for each parameter under "Quantity' and "Qualih" in urtils specified in permit
<br />"Average" is normally arithmetic average (geometric average tar bacterial pare; peter; i of all sample m:~swements
<br />for each paramUer obtained during "Monitoring Period'; "Maximum" and "Ale rimur~" are normally e::treme high
<br />and low measurements obtained during "Monitoring Period." (Note mo mr.nicipals with secondgr+ treahneat
<br />requiremenC Enter 30day average of sample trteasurements under "Average "and enter maximum 7- ia} average
<br />of sample measurements obtained during monitoring period tinder "Mlaxirnum.')
<br />6. Enter "Permit Requirement" for each parameter under'Quantity" and "Quulit)•" as specified in permit.
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<br />7. Under "No Er" enter number of sample measnrmenls dialog monitoring period that excced maximum (and/or
<br />minimum or 7-0ay average az appropriate) permit requirement for each parameter. ]f none, enter "0".
<br />g. Enter "Frequency oJAnalysis" both as "Saatple Aleasurmen4" (acluat Gequency o," sampling and a:udysis used
<br />during monitoring period) and as "Pernri~Requiremenr" spaified in permit (e.g.. Enter "Coot," f6r continuous
<br />monitoring, "111" for one day per week, "1/~0" far one day par month, "1190" Coe one day per quarter, et :.,
<br />9. Enter "Sample Type" both az "Sample Menruremenr" (actual sample t}pc user duri,tg monitorng peiod) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "?-!HC" for ?d-how composil[, "h'!9"' for
<br />continuous monitoring, etc.)
<br />]0. Where violations of permit requirements are reported, attach a brief explanation to describe pose :u d c~rretxive
<br />actions taken, and reference each violation bydate.
<br />11. If "no discharge" naves during monitoring period, enter "No Discharge" across form ire place of daa ct try.
<br />12. Enter "Name/fille ojPrincipa! Executive Officer" pith "Signature ojPrinriFal Executive Oj7i-_er a'~;rnlmrir~d
<br />Agent," "Telephone Number," and "Date" a[ bottom of farm.
<br />13. Mail signed Report to 08ice(s) by dale(s) specified in permit. Retain copy for yow records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (L!dIR) form may be obtained f: ~m Office(s)
<br />specified in permit.
<br />Legal Notice
<br />7Lis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure t.. n;port or Failure to report t.uthru:Ar car.
<br />result in civil penalties not to excced (10,000 per day of violation; er in criminaN penalties not to exc:xd S2~,1X7:, nee [~•
<br />ofviolation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320.1 (Rev. OS-9~
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