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Paperwork Reduction Act Notice
<br />I'ubhc reposing burden for this collection of information is ecrimararl rn vary sr,,... , .;;n~~ ~r i%; h;,u~~ ~ ~~ ~~
<br />.. •...^,.pJ f.Jr r.:.,Y:;u~:: ~~• o.~a..- ,. i =n, :... l,ires, Lu ; 1(,' ~rJ4,s W K,1 nvauge pe,' response ror some me~or facilities,
<br />wl!n a wriphJ •ci +,ret-~" :rer m=_;ur ~d cursor facilities o! 18 hours per respons.,, wcl!,J wg aloe fur reviewing ,
<br />ii!stn!ctiups, sca>•ching existing data sources, gathering and maintaiping [he data peeded, and completing and '.
<br />reviewing the co~lectron of mfnrmation. Send comments regarding the burden estimate ur any other aspect of
<br />[his collectiop of ipforma[ion, including suggestions fbr reducing this burdep, to Chruf, Informauop Policy '
<br />Brcnch, Pxr-?23, U.S. Cnvuoamzvtal ,^ro[c..iiuu Ager.~y, 40i ivi Sirwl. S'r:' Washingtuu, U(' 70460; and totbe ~
<br />ii Office of Information and Regulatory Affairs, Office of Management and Budgzl, Washington, Df' 20503. ~~,
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed at eptrv of that ioformation
<br />already preprinted.
<br />2. Enter 'Permrtlee Name;\fmlrng Address Land facili[v t!arttellocation, tf different)," "Permit ,Vumher," and
<br />"Di.crhusr ,\';;;nb,~;" uhcrc indicated. (A separate Corw is required for each discharge.)
<br />3. F,nter dates beginning and ending `:lfommring Penud" covered by (orm where indicated
<br />. ~:ntcr cr``.rh "1'r:r::.n: r, r" as _:pcd,f~ed in munaonug requirements of pcnnit.
<br />J. LIIIU '~)LOI/~/L' Sltu.,...r/rave" dais fur each p:uamc!cr under ~~r)umrr+ry'' and °r(nnnn'' m amts specified in permit
<br />" h•.;-noe" !s normal!} an!hmctc average (gcometnc rnrrage for bacteria pu:ar.!::!crs) of all sample measurement,
<br />for cads parameter obtained during ".1 hrmtrrru/~ Pr nu,."', '.'.Ln~nmun" and ",l/nrunum" are normally extreme htgh
<br />and log: mcncnremenis cbtain_d during ".11nmlurin,q l'rrmJ" (:vote to r.:unfroals with secondary treatment
<br />requi rcmcm Fmcr 30-da: average of smm~lr. measu reni~ Ns n~d,-r " Joprnr~r,' ^~' 'ntPr n,.~.;ic,~~m 7-day a,'e:agc
<br />of sample mcasuremcuts obtaJncd dunng monnonng pcnod under •:Uarirnunr. ~'~
<br />u. Cntcr ", ..rn,i i„y.ur.u:enl° `w Cnuli N,udu~~iu ..udu~ "Qumuirl.. c,... ~~~iuullly~ 85 SpcCilieG ~._. petmrl.
<br />7. Under ".~'o Fs" enter number e( sample mcasurments ~trr!g nor~foring period that esccct~. maeimum (and/or
<br />nu nunum or 7-dav avcrane as anmm~riatrl nr•n„r! mnmrr•mrni r~r ~,~u parameter. If none. Pn!rr "t)°.
<br />R ~~!.,,, '•Hr ,' .,~, r.,,~r. ^~ ^•r '!.-. ......_.. r -~ fr cne of ~ -!'- used
<br />during monitoring prriod} and as "Pc•nnir /<rge~irevnrnf' specified in p_rmil (e.g.. Enter "C'ont,"J for~cuntinuotu
<br />monitoring. "1 ~7" for c; re rL:c p::r t: eck. "; 30" for nnc :I;;: r _.:aonlh. `1.~0" •'or one day ptr quarter, etc ;
<br />o Fop., „c,,..J.,r,. T.. Fn,6 ~~._,. -l„ . c... r .... -. '- ... _. _.m l - --=., .,..:. ce ..onitoring ,-x-.rig' --. -_
<br />"Perron RequrrerrJenr,' (e g., Enter "/irah" for md!v!dual sample, "~?~l/(' for 24-hour eompostte, "'^'~~ri' :nr
<br />continuous mnnitnrinv etc :
<br />10. Where s~olations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dale
<br />11. If "no discharge" occurs during monitoring period, enter ".4`o Disclmrgc•" across form in place of data entry.
<br />12. Enter ",'v'ame.Ti(le ojPrincrpal Execwive Officer" with ".S'igna(ure ojPrincipal Execu(ive Officer ojAulhorized
<br />Agent," "Telephone Numher," and "Da(e" at bottom of form.
<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 Discharge ,4fomroring Xeporr (DtifR) fornt ma} be obtained from O6'ice(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 $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 Fot'm 3320-1 (Rev. 08-95)
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