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Pa• work I~educti~ort Act Ncct:,
<br />Public reporting burden for this. coilactioc of information is e:aimated to vaq '~rom ., range of .G huSan as are
<br />average per response for some minor facilities, to I IO hours as sm average :per r:: goose for some malor facilities,
<br />with a weighted average for major and minor fadiiti of 18 hQtlrti per rtapxs., including time ;ur 1e~iewing
<br />instructions, searching existing data sources, ~ulh. n1r end imaintaining :he raga nr~,lyd, and completing and
<br />reviewing the collection of information. Senn coes.e L regturding the burdeu stimrte or any other aspect of
<br />this collation of information, including suggestica G r reducing this burden, to Chief, Infurtnalior. Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 IN Street, StN Washington, DC 20460; aid to the
<br />Office of Information and Regulatory Affairs, Office of Management anu E a,ige., Washington, DC 20503.
<br />General Instriuctions
<br />I. If form has been partially completed by preprinting, disregard utstrucuoms r.irectui at entry of the: inforniation
<br />already preprinted.
<br />2. Enter "Permiltee Nnme/Mailing Address (and facility m:uneJlocaliort, if iifferent)," "Permit ANUmber," and
<br />"Discharge Number" where indipted. (A separate form is tequued for each rlischarg~n.)
<br />3. Enter dates beginning and ending "Monitoring Period"covered by form where mdica~:ed.
<br />4. Enter each "Parameter" az specified in morstotimg requirements of permit.
<br />5, Enter "Sample Measurement" data for each parameter under "Quantity` :md "')ualr; ~° in units specified in pemst.
<br />"Average" is normally arithmetic average (geometric average: for bac(eriul par.unelers) of all sample measurement:;
<br />for each parameter obtained during "Monitoring Period'; "Alasimum" and `A ininnrn" are normally ,:•Veme hagh
<br />and low measurements obtained during 'Monitoring Period." (Note to n:unicipaL With secondary treamten,
<br />requiremene Enter 30-day average of sample measurement. under "Avercgr," and .nter maximum ^-,lay average
<br />of sample measurements obtained during monitoring period under "Maxuuum.
<br />6. Enter "Permit Requiremen(" for each parameter under "Quantity" and "Quality" az specified in permit.
<br />7. Under "No Er" enter number of sample measurments during monitoring period that exceed maximum (andlor
<br />minimum or 7-0ay average az appropriate) permit requirement for each p~uarneter. It none, enter "0":
<br />8. Enter "Frequency ojAnalysis" both az "Sample bfeasurmen!" (actual :Freq,ucnry of sampling and .malysis used
<br />during monitoring period) and az "Permit Requirement" sptx;ified in permit. (e.g ,Enter "Coot," far wntinuous
<br />monitoring, "I/7" for one day per week, "1/30" for one day per month, "/'90" fur one day per quarter„ctn.}
<br />9. Enter "Sample Type" both az "Sump/e Measurement" (actual sample ty(a: used dw~ng monitoring ~;:iod) and a.
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, 'Jlfr" for ::d-hour compostlc, ~!'A" fo•
<br />continuous monitoring, etc.)
<br />]0. Where violations of permit requirements are reported, attach a brief explanation to describe cause and co;redive
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge' across form in place of data es'try.
<br />12. Enter "Name//'itle ojPrincipal Executive Officer" with "Signature ojf'rbrcipa! Eaeculive Officer +~`Adthorized
<br />Agent," "Telephone Number," and "Dale' at bottom of form.
<br />13. Mail signed Report to Vice(s) by date(s) specified in perms[. Retain cop7r fo ~ y our records.
<br />14. More detailed instructions for use of this Discharge Aonitoring Report (17Af1 J form may be obtaiucd f: om Of ices,
<br />specified in permit.
<br />Legal Notice
<br />Tbis report is required by law (33 U.S.C. 1318; 40 C.F.R. I25.?i). Failure :o report or fai?ore to reiwrt t vthfully car
<br />result in civil penalties not to exceed SI0,000 per day of violation; or in criminal penalties not io excud `P2r,00~ der real
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 ('Rev. 08-95)
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