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<br />Ideduc~'.t~~n. Act: ;'dot~ce
<br />Public reporting burden fnr this wllection of infotmatiou a estiooated to v,.i~ ~ ,... , ~g~ ,.~ ~.6 ,~~ . ;,. .,.
<br />average per response for some minor facilities, to 1:U hours as an average Ire, i _.. ..._ ...;,i,~ +;~ ~: ,: i ,~ ,
<br />~rth a weighted average for major and minor. facilities of 18 hates per rt,,"+:: tr.:. rr., .i.: ` , • :, z~.: ,~
<br />instnections, searching existing data sources, gathering and mei;L timg .h ~~~ `,ec.: J, xnd „uu+~izti-.g and ~ ,
<br />,eviewing the collection of information. Send cwrtmenls regaro.ug We bwJzo _..ictat: or ant- othor a~pec[ of
<br />[his collection of information, including suggestions for reducing this bunlzn o Chef, Infuttuation Pcliey
<br />Branch, PM X23, U.S. Envioonmental Protection Agency, ;G. M Street, SW Washington, DC 20960; snd tc the ~i
<br />Office of Infortnatioo and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.----
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<br />General Instructions
<br />I. If form has beer, partially completed by preprinting, disregard instretcticnos directed et entry of that information
<br />already preprinted. ..:
<br />2. Enter "Permittee Nnnte/Alniling Address (and facility rtamdlOCali0n. if d;H'erett[)," "Permit Nu,nber," and
<br />"Disr.hnrge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dales beginning and ending 'iNoniloring Period" coverer) by form where indicat:d.
<br />4. Enter each "Parameter" as specJed in monitoring requirements of permit.
<br />5. Enter "Sample MeasuremenP' data for each parameter under "Quantity" and "Qraliry" in units specified in permit.
<br />"Avernge" is normally arithmetic average (geometric average for bacterial para~netersl of all sample m:.asurentents
<br />for each parameter obtained during "Monitoring Period"; "Maximum" and "ALaimun"are normally e:veme high
<br />and low measurements obtained during "Monitoring Period." (Note to rat,nicip~ls with secondar/ treattment
<br />requirement: Enter 30~ay average of sample measurements under "Avernge," tmd enter maximum 7-,lay average
<br />of sample measurements obtained during monitopng period under "Maxi,;,e,rn.'~
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quoliry" as specified in permit.
<br />7. Under "No Ex" enter number of sample measuements during motritori~ag periori ti~at exceed maxinttm+ (and/or
<br />minimum or 7-0ay average as appropriate) permit requirement. foi each parameter. I1 none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both as "Sample tifeacurment" (actual firequcncy of sampling and a:ralysis used
<br />during monitoring period) and as "Permit RequirenrenP' spe:ified in permit. (e.g. Enter "Cont." Sb. continuous
<br />monitoring, "I/7" for one day per week, "I/30" for one day per month, "1,'Sr0" fo: ont, clay per quarter, et ..)
<br />9. Enter "Sample Type" both as "Sample Measurement" (actual sample type etseo during monitoring peiod} and a~
<br />"Permit Requirernenl," (e.g., Enter "Grab" for individual sample, "';'lfC"' for '_3-hour composite, "i•,iri'' :o.
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanauon le describe cause at d corrective
<br />actions taken, and reference each violation by date.
<br />11. if "no discharge" occurs during monitoring period, enter "Nn Discharge" across form in place oCdata et tr}.
<br />]2. Enter "Narne/I'ifle ojPrincipal Executive O~cer" with "Signature o(F-'rincipa! Executive O~cer nr.;utlrnrirec
<br />Agent," "Telephone Nurnber," and "Date" at bottom of farm.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for }our records.
<br />14. More detailed insWCtions for use of this Discharge Afonitoring Report (1:4LfR) four. ma} be obtained f,om''Jfllee(5.
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.2'). Failure to report or rai!ure to relwrt : vthfvlly ca:
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties uo; w exceed 52_~,OOG per ra}
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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