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<br />Paperwork Reduction Act Notice 1
<br />', Pubhc reporting burden fur [his cnllerrinn of infnt7n9rinn ~r ectim:Na to ~•a.-~ frr.r. ,: r,,:;__ r,' ;~; 6nurs a~ an
<br />_. _:aac c : n;.~ or.:..: rcr s..u,., .-.,,..o, 1a~J~u~,, w 1 i0 hours as as average per responss for some major facilities, '
<br />w;ih a weiv~inrc n~~rr;.oe for major and nurar F.:cililiw o; l~ fiou,s },e, :capunse, including time for reviewing
<br />~ inst~vctions, searching existing data sources, gathering and maintaining [he data neeclu[l, and cumnleting and ~
<br />j reviewing the collection of information. Send comments regarding qre burden estimate or any other asnrAt of
<br />this coll.:ction of infurmaliom, including suggestions For reducing, this burden, to Chief, Infnrms!ior. policy ~
<br />~ Nrnr:ch, P?.7 223, U.S. Environmental ptuieclien Agency, 401 NI Street, SW Waslvnglon, DC' 20460; and to the ~
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Waslungtoo, DC 20503. I
<br />General Instructions
<br />I. If Form has been partially completed by preprinting, disregard instructions directed at entry of that mformatie~
<br />already preprinted.
<br />2. Enter "Permruee A'ame~illar6ng Address (and facility name/location, if diHerenq," "Perini! .1'uruber." and
<br />"Disrharg, ":umh,~r" ;;here indicated. (A separate (orm is requtred for each discharge.)
<br />3. Emcr dales beginning and end;n~ ''.tlunrmnn,q Period" covered by form where indicated.
<br />4. Futcr cacti "!'armnrlr-" ;_, ~p~cu;ed in ;na,~iiuung rapurenlcnts of permit.
<br />5 £ntc' ':',}.,,yd~ Sh•uwrnnrn," du;a Cur tacit parameter under "Uuonlm" and "(hra6rv" in um(s specified in permit.
<br />":1 verat e" is normall\ anihmcti~_ a\cr;,gc (gcomdnc a\emge for bactcnul parameters) of all sample measurements
<br />for each paramctcr obtained dwing ".11.;nirnrin,K P.°no'f'; ".1larnrurm" and "1Lrunum" arc normally extreme high
<br />and low meaatremenis obtained during ".1lunirunn,~ Perod" (Note to municipals with secondary treatment
<br />rcquircmcnt: Enter 3(1-da. n\•cra~c Of camnlr me;aalrrmcnh'!.^.dcr "lrerngc," nd c=r,er n;aximum 7~'ty a\uagc
<br />of sample measurements obtautcd~dunng monuonng pcnod under "t foxnnunt.)
<br />,,.-.._ .
<br />.,. £ntcr'....e„ Pty,,., ~,nrni" Cut taco paramctcr unocr ' ~iunnnty' and "(lualuv" as spcaficd rn pennn
<br />7. Under ".4'u F_s" entr number of sample measum\cnts dunng monitoring pcnod that e~r-r~~-;, ,,,a.intum (ardJa"
<br />minimum or 7-0ay averavr ne apnrol+rinlr) pr„t,.q .~.,~,+•.•..,,,~a; rte..."~ti pr; ;;n_ ~;. (f none. crc. "~ .
<br />. ,. ~ .. ........ .... ... t . ... ..e....b 1" ~.., ua,u
<br />during monnor.ng penod) and as "Prrmrl Rrquuron•nr" specified in purruit. (e.g., Enter "C'unr," Cor continuous
<br />monttonng, „/'7" fu: u:u d;i per \;cck, ' !'JO Cor out u;n ~~, ,,.olnn r anu, e.c ,
<br />Q Fnt?( °Qnm nln '/,....~" 1,..;6 ~ "\'~•.; ..:- • ~, .~,-,,,~,,.' \~~~;,w; o.. ,.ln~ ;~~~ uSl.u unl L,r IIIUIntOrlllg peflOUi i:Ilm .u
<br />"Perna( krgmrernenr," (c g., Enter "Grob" for tndividunl sample. "?JI!( "' tar 23-hour composite, "'~ :I" for
<br />conlimtom monnminp„ ctr )
<br />l0. Where \iolations of permit requirements arc reponcd, attach a brief esplanauon to describe cause and correcti\c
<br />actions taken, and reference each violation by dale.
<br />1 I. If "no discharge" occurs dunng monitoring period, enter "~'o Discharge" across form iu place of data entry.
<br />12. Enter "Name//-i(!e ojPrincipal Executive Officer" with "Signature ojPrincipa! F_xecurive Officer ojAurhorized
<br />Agent," "Telephone Nermher," and "Dale" a[ bottom oCform.
<br />13. Mail signed Report to Office(s) by daic(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (DA1R) form may be obtained from Offce(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. OS-95)
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