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<br />Pa • work I~edwctioa~ Act Nfce
<br />Yublic reporting burden for this colledioo of in formauou is estimated to .. ,- ,. ' oa:; ~, an
<br />average per response for some minor facilities, to 110 hours as an a~czragc I rr ::, .~nsr :u.,.,ume ma ~; facilities, ',
<br />wish a weighted average for major and minor facilities of t8 hour per ,e. pun. :n. ~dmg time ~ is ro. ~e..ing
<br />instructions, searchin6 existing data. sources, gathering amt nta~nhiinin~, L r '. t ner:!ed, and ccmpietiag and
<br />reviewing the collection of mfoimdion. Send cottuuen6 regard ins the s. -.i-r, aim, e ec aa~ outer aspect of '
<br />this collection of inforinatiuo, including suggestions for ralucioc this 6 r:e::, is i :uct, infi+rmation Policy ~
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 ht S:rzet, 3\~~ :Y s]irg ~^, DC 20460; w.! to the I~~
<br />Office of Information and Regulatory Affairs, Office of Management antl 13td~gzt, 'Vast: nElun, DC 20503 -
<br />General Instructions
<br />t. If form has been partially completed by preprinting, disregard instructions directe~~ st entry of that information
<br />already Preprinted.
<br />2. Enter "Permittee Nnme/Mailing Address (and facility namelloca[ion, if different)," "Permit Nu;nber," and
<br />"Discharge Number" where indicated. (A separate Conn is required for each discharge )
<br />3. Enter dates beginning and ending iNonitoring Period" covered by Comt where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Qualm'' in units specified in peimit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameter;) of all sample measurements
<br />for each parameter obtained during "Monitoring Period'; "Maximum" and "l.f~nirnwn" are normally e;•treme high
<br />and low measurements obtained during "Monitoring Period." (Note to rnurucip3ls with secondary treatment
<br />requiremenC Enter 30-0ay average of sample measurements under "Avenoge," and enter maximum 7-Jay average
<br />of sample measurements obtained during monitoring period tinder "Maximum. ",
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quabty" as specified in permit.
<br />7. Under "No Es" enter number of sample meastrrments during monitoring period t)tat exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. Lr none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both as "Sample Measurment" (ac[ml Irequenry ci sampling and a:ralysis used
<br />during monitoring period) and as "Permit ReguiremenP' specified in pemut. (e.g., Enter "Gout," fo: continuous
<br />monitoring, "1/7" for one day per week, "//30" for one day per month, "li90" 1'0. one may per quarter, er :.;
<br />9. Enter "Sample Type" both as "Sample h-feasurement" (actual sample typt: Itsec during monitoring pe~iod) and as
<br />"Permit Requirement," (e.g., Eo[er "Grab" for individual sample, "2J.HC' for 2~-hour composite, ";//A" fir
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause at d correMi~•e
<br />actions taken, and reference each violation by dale.
<br />11. If "no discharge" occurs doting monitoring period, enter "No Discharge" across fotm ; n place of data er +r,-.
<br />12. Enter "NameJ7'itle ojPrincipa! Executive Officer" with "Signature ojP~ir,Npn! Executive O~crr o-Authorized
<br />Agent," Telephone Number," and "Date' at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pemtit. Retain copy for your ter. ords.
<br />14. More detailed instructions Cor use of this Discharge Afonitorrng Repot( (Lrp,fRJ form may be obtained from. Offix(s)
<br />specified in permit.
<br />Legal Notice
<br />'Ibis 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 peralties not to exceed 525,000 nee day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-I (Rev. OS-9~
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