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Paperwork Reduction Act Notice <br />Public reporting burden for this collection of uformation is estimated to vary from a rangz of 10 hours as an <br />average per response for some minor facilities, Gr l t0 hours as an average per response for some major facilities, <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. Sznd comments regarding [he burden estimate or any other aspect of <br />this collectron of information, including suggestions for reducing this 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 of Management and Budget, Washington, DC 20503. <br />General Instructions <br />1. If form has beeo partially completed by preprinting, disregard instructions directed et entry of that information <br />already preprinted. <br />2. Enter 'Permitree Nmne/Afai/irtg Address Curd facility narrte/localion, if different)," "Permit Number," and <br />"Discharge Number" where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and ending ';4fonirorrng Period" covered by form where indicated. <br />4. Enter each "Parameter" as specified in monitoring requirements of permit. <br />5. Enter "Sample aleosuremenP' date for each parameter under "Quantity" and "Quolih%' in units specified in permit. <br />"Average" is nornialh arithmetic average (gcomctric average for bacterial parameters) of all sample measurements <br />for each parameter obtained during ".'.fonimri,+g Period"; ",1laxrmunr" and ",ttinimum" arc normally extreme high <br />and low measurements obtained during ".tfcnnoring Period" (Note to municipals with sccondaq• treatment <br />requirement. Enter 30-day average o,` sample measurcmer,ts under "Average," and enter maximum 7-da} average <br />of sample measurements obtained during monitoring period under "Afazimum.') <br />6. Enter "Fermi! RequiremenP' for each parameter carder "Quantity" and "Quality" as spceificd in pcmtit. <br />7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or <br />minimum or 7-da}' average as appropriate) permit rcquircmcnt for each parameter. if none, enter "0". <br />8. Enter "Frequency oJAnnlysis" both as "Semple Alenrurmen!" (actual frequc'tc~• of sampling and analysis used <br />during monitoring period) and as "Perrrrir Renuiremen!" specified in permit. (e.g., Enter "('ant," for continuous <br />monitoring, "//7" for one day per week, "1!30" for one da}• per month, "I/90" for one day per quarter, etc.) <br />9. Enter "Sample Tvpe" both as "Sample .t1c•asurrrnenl" (actual sample type used during monitoring period) ~:nd as <br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "2411C' for 24-hour composite, "1J/A" for <br />continuous monitoring, etc.) <br />10. Where violations of permit requirements are r_portcd, attach a brief explanation to describe cause and cortective <br />actions taken, and reference each violation b}• d;tte. <br />1 I. If "no discharge" occurs during monitoring period, enter ",Wo Discharge" across form in place of data entry. <br />12. Enter "NameiTi!!e ojPrincipal Executive Off.^er" with "Signature ojPrincipnl Executive Officer ojAuthorized <br />Agent," "Telephone Number," and "Date" al bottom of Corot. <br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. <br />14. More detailed instructions for use of this Dischnrge Afonitoring Report (D,i/IR) 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 oat 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) <br />.. <br />