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Paperwork Reduction Act Notir_e
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours es m
<br />avenge per response for some minor facilities, to l 10 hours as m averege per response for some major facilities.
<br />with a weighted average (or major and minor facilities of 18 hours per response, including time far review~g
<br />instructions, searching existing data sources, gathering and main[auring the data needed, and completing r~ncl
<br />reviewing the collection of information. Send comments regarding the burden esti.mata or any other aspect m'
<br />this collection of information, including suggestions for reducing th:s burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of information and Regulatory Affairs, Office o(Managemevt and Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already preprinted.
<br />2. Enter 'Permtttee ,Vmne%Llailing Address (and Cacility nameJlocaUOn, iC different)," "Permit Number," and
<br />"Discharge T'umber" where indicated. (A separate farm is required Cor each discharge)
<br />3. Enter dates beginning and ending 'Alo,ii(oring 1'rriod"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of pernul.
<br />5. Enter "Sample lfeacurement" data for each parameter under "Quantity" and "Quality" in units specdicd in pcrntil.
<br />"Arerage" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".4fnni(nrinr; Prriod'; ".lfannrvin" and ".~linimuni" arc normally extreme high
<br />and low measurcmrnts obtained during "Slonitoring I'erind" (Note to municipals with secondary vea mini
<br />requirement: Enter 30-day average of sample measurements under ".1 verge," ar,d enter mavmum 7-day m'cmgc
<br />of sample measurements obtained during monitoring period under ",llarimum.'J
<br />6. Enter "Permit Requirement" for exh parameter under "Quomity' and "Quality" as specified in permit.
<br />7. Under ".Vo Fx" enter number of sample measurments during monitoring period that exceed maximum (and/o:
<br />minimum or 7-0a}' average as appropriate) permit requirement for each parameter. iF none, enter "0".
<br />8. Enter "Frequency oJAnalysis" both as ".SmnFle .41eo.mrmenP' (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit (e g., Enlcr "C'onr," for continuous
<br />monitoring, "li7" for one day per week, "/.30" 1'or one day per month, "!/90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as "Sample bleosurr,nenP' (actual sample type used during monitoring period) and as
<br />"PermiP Requirement," (e.g., Enter "Grab" for individual sample, "2d1/C" for 24-hour composite, "N/A" for
<br />rnntinupus 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 date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle oJPrincipa! Executive Officer" with "Signnture oJPrincipal Executive Officer oJAutharized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to OBice(s) by date(s) specified in permit. Retain copy for your records.
<br />l4. More detailed instructions for use of this Discharge Afonitoring Report (D.IIR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is~,required by law (33 U.S.C. 1318; 40 C.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, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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