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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to I ]0 hours as an average per response for some major facilities,
<br />with a weighted average for major end minor facilities of 18 hours per response, including rime for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing [he collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, lnformation Policy
<br />Brutch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />I! Office of Infotmatioo and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregard instructions directed at entry of that inforrualion
<br />already preprinted.
<br />2. Eater 'Permi(ree Name,Mailing Address (and facility rrame/lacation, if diH'crcnq," "Permit Nvmber," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ':4fontto."mg Period" covered b} form where indicated.
<br />4. Enter each "Paranie(er" as specified in monitoring requirements of permit.
<br />5. Enter "Sample .4feacuremenr" data for each parameter undo "Quantity" and "QualiR•" in units specified in permit.
<br />"Average" is nortnalh arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".1lomrnnrg Pcriorl"; ".L/axrmmm" and "blinimrun" are normally extreme high
<br />and low measurerncnts obtained during ",4fo,7itoring Period." (Hole 'o munici,o•'ils eilh secondary treatment
<br />requirement: Enter 3u~ay average of sample measurements under ",-0verage," and cuter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "Jfuximum.
<br />6. Enter "Permit Regnirenren(" for each pararaetcr under "Quattitti%' and "Quality" as spccrfied m permit.
<br />7. Under "A'o Ex" enter number of sample measuements during monitorirg period that exceed maximum (and/or
<br />minimum or 7-dav average as appropriate) pemri[ requircmen[ for each parameter. If none, enter "0".
<br />8. Enter "Frequencv oj.-tnalvsis" both as "S'amp(e Afeasurmenr" (actual frequenc}• of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cant," for continuous
<br />monitoring, "/%7" for one day per week, "/~30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as "5'ample :Vc•arur^neent" (actual sample type used during monitoring period) and as
<br />"Permit Regvirement," (e.g., Enter "Groh" Car inditidual sample, "74f/C" for 2J-hour composite, "T//A" for
<br />continuous monitoring. etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe caase and corrective
<br />actions taken, and reference each violation b}• date.
<br />11. tf"no discharge" occurs during monitoring period, enter "No Discharge" across form in place otdata entry.
<br />l2. Enter "Name/f'itle oJPrincipal Erecutir~e O~~ er" with "Signature ojPrincipnl Executive Officer ojAuthorized
<br />Agen(," "Telephone Number," and "Dare" at bottom of form.
<br />l3. Mail signed Report to OBice(s) b}• date(s) specified in permit. Retain copy for }•our records.
<br />14. More detailed instructions for use of this Discharge tifonitoring Report (D~i~R) 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 not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,00(1 per day
<br />of violation, or by imprisonment for not more than om~ year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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