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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as m average per response for some major factlities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding [he burden estimate of any other aspect of
<br />i this collection of iafomtatiom, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 40] M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Off.ce of Management and Budge[, Washington, DC 20503.
<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Perm,ttee Nmne%4,failing Address (and facility name/loealion, if difl'erenQ," "Perini! Number,' and
<br />"Discharge h'urnber" where indicated. (A separate Cornt is required for each discharge.)
<br />3. Enter dates beginning and ending 'itfoniroring Pertod" covered by form where indicated.
<br />4. Enter each "Pormaeier" as specified in monitoring requirements of permit.
<br />5. Enter "Sornple .Veosurernenr" data far each pat:uncter under "QuannN" and "Quuliry" in units specified in permit
<br />"Areroge" is normally anthmelic average (grnmclric avemgc for bacCerial parameters) of all sample measurements
<br />for each pnramclcr obtained dttnng ".4fon:(nrirrg Period'; ":Llnximum" and'Stlu,imum" arc normally extreme higti
<br />and low measurctren!s obtained dunng ".Ifoarrnr,ng Period" (Nose ~o municipals t+ith secondary Veatmcr,~
<br />requirement: Enter ?0-day average of sample measurements under ",4verage," acid enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "afaximrnn.'q
<br />6. Enter "Permit Requireneenr" for each parameter under "QunntiN" and "Quality" as specdicd m permit.
<br />7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (anrl/nr
<br />minimum or 7-day average as appropriate) pcmtit requirement for each parameter. U none, enter "7".
<br />8. Enter "Frequency oJ.-1na(ysis" both as ".SamJae ,lfeasurmenP' (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Permit Rer, uircmenP' specified in permit. (e g., En[cr "Cant," for wntinuous
<br />monitoring, "l.'T for one day per week, "1,'30" for one day per month, "I/90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample .4fcasurrmenP' (actual sample type. used during monitoring period) end as
<br />"Permit Requirement," (e.g., Enter "Grab" [or individual sample, "2~JfIC" far 24-hour composite, "N/A" for
<br />conunupus monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dale.
<br />11. U "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />l2. Enter "Name/Title oJPrincipal Executive Officer" w~lh "Signature ojPrincipa! Fseculive Officer ojAurhorized
<br />Agent," "Telephone Number," and "Dare" a[ bot tons of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain rnpy for your records.
<br />14. More detailed instructions for use of this Disch~rrge iNoniroring Report (D,LIR) form may be obained from Offce(s)
<br />specified in permit.
<br />Legal Notice
<br />This report isrequired by law (33 U.S.C. 1318; 40 (;. F. R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, w by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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