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- - - - .?;f•rev~ra_ ~S:ca.;ction Act: l~•tice - - - ~ ~_„
<br />P~,:bFc reix:;tir.g bururn fr.r ih;s ~,~,ilection ~,' in5~ntrau.~n is estimated to 'vary from a range of ~J bour.~. ru an
<br />average par response for some Honor facilities, to 110 hours as an average pier re~:ponsr. for come major tacilitie:;,
<br />with a weighted sve:zge for major and minor facilities of 18 L..u;b per r.:.pon:., ir~~ludmg time. for r.:viewing
<br />in<t r~ct:ons, ;<arching ezrsmg data sources, gathering _ .-.l: o:ainin„ the ~l:~ta ne.rded, and completing and
<br />;evtewing the ~u6ecnun u: mfurcution. Sand corny..-. , at;ardr..g the burden estim.de or. any other, aspect of
<br />this cul,ution of information, Including suggestion< i:~r rz,7ueing this F~urdco, to Chief, Information Policy
<br />Branch, PM-223, U.S. Envtrotrmental Protection P.grn~}, 401 M Street, S'iV V't•shington, DC 20460; and to the
<br />Office cf lofomtation and Regulatory Affairs, Office of Management and E ~~dget, Wa_,hington, DC 20503.
<br />General Instruction.
<br />1. If form has been partial;y completed by preprinting, disregazd instrucpons directed at entry of that infonnatioo
<br />already preprinted. _ ..
<br />2. Enter "Pernlitree Name!~lfniling Address (and facility oame/localion, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'Afoniloring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as spec:.icd in monitoring requirements of permit.
<br />5. Enter "S'mnple Measurre.enl" ;zta for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />".{i'ernge" is nornally z.aluneuc :,voyage (geometric average for bactenal p;rcuneters) of all sample measurements
<br />for each pararncter ottaiccd daring "Afoniroring Penud'; ",tfaxirnurn" and "Minimum" are normally extreme high
<br />and low measurements obLuncd during "Sfonimring Period." (Note to municipals with secondary Vestment
<br />requiremenC Enter 3~:1-uay average of sample measurements under ".Iverage," and enter maximum 7-day average
<br />of sample measureme::u cbtatned during monitoring period under "Maximum.
<br />F. Enter ''Former F.equiren;ent" Cor each parameter under "Quan.rity" and "Quality" as specified in permit.
<br />~. Under "Nn F1-" toter r.u:nber of sample measunnents during monilo.ing period That excced maximum (and/or
<br />minimum or 7-day aver?ge as appropriate) permit requirement far each parameter. II'none, enter "0"r
<br />8. Enter "Frequency nj a~„7,ys.s' uoth as "Smnple Aferuvnnen!" (actual Crequcnry of sampling and analysis used
<br />during monitoring prrio,') and as "Pernrir Requirement" specified in permit. (e.g , Enter "Cool," for continuous
<br />monitoring, "1 '7" fur rte da}• peg reek, "1130" for one day per month, "i >90" for one day per quarter, etc.)
<br />9. Ertcr ':Smnple Type" b.dt as ".Sample .Lleasuremenl" (actual sample type used during monitoring period) and as
<br />"Fennel Feyviremer.!" ~~g., Fnter "Grab" for individual sample, "2JHC" for 24-hour composite, "N/A" for
<br />c;ontinuotu mcnuorine, ere )
<br />!0. Where violations of penoit requirements are reported. attach a brief explanation to describe cattle and rnrrective
<br />actions taken, and referc;tce each violation by date.
<br />1 ]. ff"no discharge" oca:rs : uring monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "hame7!n'e of Pnncipnl Gecutire Officer" With ":iignarure ojf'rincipal Executive Officer ojAuthorized
<br />.4genr," 'Telephone r'un.brr," eyed "Dote" a[ bottom oC form.
<br />13. Mail signed Report io QtTce(s) by date(s) specified in perntil. Retain copy for yottr records.
<br />14. t.;ore detailed inslructiotrs for use of this Discharge dlnniloring Report (DbfRJ form may be obtained from Office(s)
<br />specified in perenil.
<br />Legal Notice
<br />This repcrt is required by !.w (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />rcsalt in cis.l pena!tirs not :; . aceed 510,000 per day of violation; or in criminal penalties not to extend (?5,000 per day
<br />rf vinlahcn, ur by itnprisoru;e:u for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. Gt-95)
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