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)
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