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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 as
<br />~ average per response for some minor facilities, to 110 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 time for reviewing
<br />~ instructions, searching existing data sources, gathering and maintaining the data Deeded, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collectioD 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 been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permilfee Name/Mailing Address (and facility namellocalion, if ditTerenl)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and coding 'illoniroring Period" covered by form where indicated.
<br />4. Enter each "Parameter' as specified in monitoring requirements of permit.
<br />5. Enter "Sample tifearuremenr" data for each parameter under "Quantity" and "Quality" in units specsed in permit.
<br />"Average" is normall}' arithmetic avcragc (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ",binnitorirg Period"; ".tfasrmuur" and ",Llmimum" aze normally extreme high
<br />and low measurements obtained during ".lfonitonng Period." (Note to municipals uith secondary treatment
<br />requirement: Enter 30-day average o(sample measurcntenls wider "Average," and enter maximum 7-day average
<br />of sample meaarremcnls obtained during monitoring period under ",19azimum. ")
<br />6. Enter "Permit Requtrement" for each pararrtcler under "Quantity" and "Quality" as specified in permit.
<br />7. Under "h'n £_r" enter number of sample measurrncnts during monitoring period that exceed maximum (and/or
<br />minimum or 7-da}' avcragc as appropriate) permit rcquiremcnt Cor each parameter. ?f none, enter "0".
<br />6. Enter "Frequenry ojAnalysis" both as "Sample .4leasurment" (actual freque~tcy of sampling and analysis used
<br />during monitoring period) and as "Fermi; Renuirenrent" specified in permit. (e.g., Enter "Con(." for continuous
<br />monitoring, "liT' Cor one day per week, "1 X30" for one da}• per month, "I/90" for one day per quaRer, etc.)
<br />9. Emer "Sample Ttipe" bosh as ".Sample ,Ilrasurment" (actual sample b'Pc used during monitoring period) and as
<br />"Permit Requirement," (e.g., Ettter "Grab" for individual sample, "2J1/C"' for 24-hour composite, "IJ/A" Cor
<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 date.
<br />11. If "no discharge" occurs during monitoring period, enter ",Vo Discharge" across form in place of data entry.
<br />12. Enter "Name//'ifle ojPrincipal Executive Officer" vviW "S'igna(ure ojPrincipal Executive Officer ojAurhorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />] 3. 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 [his Discharge tifoniroring Report (D.t /RJ form may be obtained Gom 06ce(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 S 10,000 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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