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- --Pa•rwcrk h_c:~i:L+CI~iJ.a Acct 1'•tit:e --- - ------
<br />' ._ ; nricg h.untcn fir this oollanon of u:r„rmauur. +s estimated t ~ •~c ; .tore a range of 10 boors !u an
<br />ore+ago ntr response for some minor facilities, l0 110 hours at. ea averag• per nspon>e for somn.Imjok facilities,
<br />with a v.~eightrd average :`or major end minor facilities of 1&hours per tespemse, ine:lutie~q time for, reviewing
<br />:n>tn+.t;..ns, aer:'r.:cc ex.::i~c data sources, gathering attd m:..;:.ining tha data rnerded, and complzting and
<br />rot;c~d ~:•~. the ..o;luu.~a , .., .,...:;ion. Sind e:Ommenls rrg..r.i+ng tha burden estimate or any other aspect of
<br />thi.; n. ie.:ion :,f +s: o:ct _..~.idirg suggedtieSns fa r.:~uciog th.s burden, to Chief, Information Policy
<br />Branch, P~.:-223, U.~. Er ' r r,.,cn•. LI !-ro!oction Agency, 401 M Stree+, ;W Washington, DC 20460; and to the
<br />Office of Information and hcgulate:y Affairs, Office of Management and Hudget, Washington, DC 20503.
<br />'General Instructions
<br />1. if form has beeo partially completed by preprinting, disregard ins[roctions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permillee ,VmneMailing Address (and facility nanrdlexaGon, if diH'u'enl)," "Permit Number," and
<br />"Discharge A'umber" tatcrc indicated. (A separate form is required for each discharge) '
<br />3. Enter dates beginning and ending 'Aonitoring Period" covered by font' where indicated.
<br />4. Enter each "Parmneter" as specked in monitoring requirements of permit.
<br />5. Enter ".Sample .\feasu~errenr" daa for each parameter under "Quamity" and "QuaJety" in units specified in permit.
<br />':;vrroi;e" is reem:diy .,r.tltme c average (geometric averaf;e for bacterial parameters) otall sample measrrrements
<br />for cash parameter obtained ~unng ",tfonitonng Pcrmd"; ",t./aximum" and ".'vlinimum" are normally extreme high
<br />and !ow meastiremer:u ~•btaincd during ".tlonimring Period." (Note to municipals with secondary treaunent
<br />requirement Ectcr 3:--:y accr.tge of sample measuremcm~; under "Average," and enter maximum 7-day average
<br />v(sample measurcmer.t. •. Jt:.ined during monitoring period under "Maximum.
<br />c. Enter "Permit Regire:, . ~.~" tot each parameter wuicr "Qumui(t'" and "i-'uaiiry° as specified in permit.
<br />7. tinder "~Yo £x" enter ..~,,.:iex:r of sample mcasunnents dwing monitoring period [hat exceed maximum (and/or
<br />minimum or 7-0ay aver::ee as appropriate) pcrntit requirement for each parameter. tf none, enter "0".
<br />E. Eutcr "Frey4eecr• oj.4nulysi~" Loth s "Sample .1leasurmenl" (actual frequency of sampling and analysis used
<br />Juring atomteritig perioa) and rs "Pcnmr Rer)uirenrenP' specified in pernut (e. g., Enter "Coot," for continuous
<br />mor.aoring, "i~7" for one day p..r .rut, "1130" for one day per month, "I/90" for ono day per quarter, elcJ
<br />4. Enter "Sample Ttpe" tx!h as ".Cr,~+pie i:earurement" (actual sample +ype used during monitoring period) and as
<br />'Pcrrnil Requirement." ,cg, ~.:!er "Grab" for individual s3rtrple, "2JHC" for 24-hour composite, "N,~A" for
<br />continuous montorine, etc )
<br />10. lYheie ,iu;aliens cf urc~~tit rcycirentents are reported, anach a brief explanation to describe cause and corrective
<br />actions L•:Icen, and reference each tiolation by date.
<br />11. !f "no discharge" exe;.,s t'urirg monitoring period, enter "PJo Discharge" across torn[ in place of data entry.
<br />12. Ener ".Vmne/I,de cj : r.ecipa( F1eculive Officer" with "Signature aj Principe! E'secvtive Odcer ojAuthorized
<br />.~ger.:," 'Te:ephone l.:u•.ber," a~tu "Date" at bottom of tome.
<br />13. ~fatl signed Report iC. r_ Tee(s) by date(s) specified in pemtil. Retain copy for your records.
<br />14. I\:otc detailed ::uuuc::c+t~ tar use of this Discharge.4Jonitoring Report (D,LfRJ form may be obtained from Ofi'ice(s)
<br />specified in permit.
<br />Legal Notice
<br />T`:is report +s -equired by ; .w +3? U.SC. 1318; 40 C.F.R. 125.27). Failure to report or failure to report ttuthfuily can
<br />nsuit ;:, aul Irena~lia act : %:.tc+:d $:G,tAO f,cr day of violation; or in criminal penalties mot to exceed 525,000 per day
<br />of violation, or by ire frisar ~ie~ t for not more than one year, or by both.
<br />EPA Fr;rm 3320-1 (lieu. 6;-7'--)
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