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- --- - Pa • work lYeduetian Act :~icce - --- -----~
<br />Public reporting border. (or this collation of informalior; rs esl,mated W nary t.om " rangt of ;0 touts as an ~
<br />average per response tr.r some minor facilities, to l10 hours as an average per rtswnse for ;otnemajnr facilities, I
<br />with a weightul average fur major and minor facilities of 18 haters per ta:jron:r, including time for res iewing ~
<br />~ mslnrctions, searching existing data sources, gathering atad m~inlainina the. dd, needed and ;:umplet~ng and ~I
<br />reviewing the collection of information. Send commcr,t: roganJing the ,r.r..,- .-.,~ .r , ..,ray uti~rer r,yxxt of
<br />This collection of information, including scggestioos for reducmg this t ~ :._.-: ;~~ ~;i~~t, Infannauoo Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, i',V 1Vi dingt•m, JC 20460; m, to the
<br />Office of Information and Regulatory Affairs, Office of M1San.,gemeat and Y3udget, Wash:ngtoo, DC 20503.
<br />General Instructions
<br />1. if form has been partially completed by preprintin=, disregard iastructiuos directeJ at entry of that information
<br />already preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name/Itxatio4 if differe[tt)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required Cor each discharge.)
<br />3. Enter dates beginning and ending iLlonitoring Period" covered by form where indiratt~.
<br />4. Enter each "Parameter" as speci<ed in monitoring requirements of permia.
<br />5. Enter "Sample Measurement" data for each parameter under "Quanliry" and "/%ualir~-" in [roils specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial paeameters) of all sample measrrements
<br />for each parameter obtained during "Monitoring Period"; "Mtuimum" anal "Apmmum" are normally e:•treme high
<br />and low measurements obtained during "Monitoring Period." (Note to municipals with secondar; treatment
<br />requirement: Enter 30-day average of sample measurements [older "Average," and r:nlcr maximum 7-,fay average
<br />of sample measurements obtained during monitoring period under "Marimum. j
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Qunliry" as sp:cified in permit
<br />7. Under "No Er" enter number of sample measurmenls during monitoring period that exceed maximum (and/or
<br />minimum or 7-0ay average as appropriate) perotit requirement for each parameter. U none, emer "0".
<br />R. Enter "Frequency ojAnalysis' both as "Sample A•leasurment (acYttal fi~equenry cf sampling and analysis used
<br />during monitoring period) and as "Permit Requirement specified in permit (e.g. Enter "Cons," fo: con[inuoas
<br />monitoring, "//7" for one day per week, "/i3o" for one day per mont}4 "/~Sr0" for one :Jay per quaver, e; :.)
<br />9. Enter "Sample Type" both as "Sample Measurement (acttuil sample type uses during monitoring pc iod) and as
<br />"Permft Requirement,' (e.g., Enter "Grab" for individual sample, "?dHC'" for 2=.-hour composite, ",ViA" for
<br />continuous 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. If "no discharge" occurs during monitoring period, enter'No Discharge" across form i n place of data ~r tr .
<br />12. Enter "Name/I}!le ojPrincipa! Executive Officer" with "Sigrvoture of"Principal Er,eurive Officer ~-Auiho,izrd
<br />Agent," 'Te/ephone Number,' and "Dale" a[ bottom of Corm
<br />13. Mail signed Report to Vice(s) by date(s) specified in permit. Retain copy for year records.
<br />14. More detailed instructions for use of this Discharge Monitoring Repot! (DtTt) farm may be obtained from. Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This repov is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure tc report or fiiiure to report truthfully can
<br />result in civil penalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed S25,IxJ nee dal
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-9~
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