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Pa ,work. I~ecluction Act '>'+•c4•-
<br />Public reporting burden for this collection of information is esnmated n. .~ c .a~Cc ,~; ~ :~ i ~w ; as an '
<br />average per response for some minor facilities, to 116 hours as au average , :.. _~ :~,,.,. ar ~~~n:a ma ~:~r facilities, I
<br />~.vith a weighted average for major and minor facilities of 1S hour per ~~ i.c,... ut~;,dmg time f ~r re' iq++°ing ~'
<br />instructions, searching existing data sources, gathering ~er% n3intrininf: .. ~. ner~led, and :.rmplo~~ag attd I.
<br />reviewing the collection of information. Send comment. r_gardmg the ht rdec aimae cr arry other ,;.peer of '
<br />this collection of information, including suggestions for ruls~nl. this b._crden, to ~ nial~, [aforma[ion Policy j
<br />Branch, PM-223, U.S. Environmental Protection Agency. 4~0, t.. S'.reet, :i\1/ \V uiingt~m, DC 20460; and;to the
<br />Office of Information and Regulatory Affairs, Office of Management and 13tdiget, 'Nashmgton, DC 20503.-
<br />General Instruction,
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already Preprinted.
<br />2. Enter "Permiftee Name/Mailing Address (and facility ttatmellocation, if tlifl'ererd)," "Permr! Nurrrher," and
<br />'Discharge Number" where indicated. (A separate form is required for each dtscharg~:.)
<br />3. Enter dates beginning and ending 'Monitoring Period" covered by form where t ndiratcd.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit
<br />5, Enter "Sample Mensurement" data for each parameter under 'Quantity" and "Quality ' in unit specified in perntit.
<br />"Average" is normally arithmetic average (geometric average for baMeriall parameter;) of all sample measurements
<br />for each parameter obtained during "Monitoring Period"; "Maximum" and ",+l~vinru+n" are nornally edreme high
<br />and low measurements obtained during "Afoniroring Period." (Note to raunicipils with secondary treatment
<br />requirement: Enter 30-0ay average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period tinder "Maximum ')
<br />6. Enter "Permit RequiremenC for each parameter under "Quantity" and 'Qunbty" as specified in permit.
<br />7. Under "No Er" enter number of sample measurments during monitoring period trot excced maximum (and/or
<br />minimum or 7-0ay average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both as "Sample Measurmen!" (aMttal frequency n: sampling and catalysis used
<br />during monitoring period) and as "Perini! Requirement" specified in permit (e.g., Enter "Coot," fo: continuous
<br />monitoring, "1/7' Cor one day per week, "1/30" for one day per month, "/ip0" for one day per quarter, et ;.;
<br />9. Enter "Sample Type" both as "Sample cLleasuremen!" (actual sample tyfe used dunng monitoring perod) and ;ts
<br />'Permit Requirement," (e.g., Enter "Grab" for individual sample, "2~NC' for 2a-hour composioc ",4'/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause at d corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form n place of data et tr1•.
<br />12. Emer'Name./Pitle ojPrincipal Executive Officer" with "Signature ojPrinc+pal Ez~cutive Officer q'Aeahorisd
<br />Agent,' 'Telephone Number," and "Dale" at bottom of form.
<br />13. Mail signed Report to Vice(s) by date(s) specified in permit. Retain copy for yotu records.
<br />14. More detailed instructions for use of this Discharge Afoniloring Report 2s14RJ form may be obtained fiom Vice(s)
<br />specified in permit.
<br />Legal Notice
<br />Tbis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.2+x. Failure to ir~pnrt or failure to report tnthfully ca
<br />result in civil peoahies not to exceed 510,000 per day of violation; or in criminal penalties nut to exceed 525;GC:f p;,r ri~j
<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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