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Paperwork Reduction Act Notice <br />Pui,lu ielwr:iuK bwdeu fui ilun c~•ileeliim of iufunuui~~~. is uiiu_;~.u iu vary fr.u:, .+ ran¢r. , ; i0 haute as an <br />average per response for some minor facilities, to 110 hours ac an everaRe per response for come major facilities. <br />with a weighted average for major and [moor facihtms of tfi hours per response, including 4me for reviewing <br />instructions, searchioR existing daW sources, gathering and maintainine the data needed, and rnmnleting and <br />reviewing the collection n( information. Send comments re,cardinR [he burden estimate or auv other acnect of <br />this collection of mfnnnatinn, includinv suooe.ctinns for rrdurinv this; hurriNn, r~ f ~Pf~ Inform=tin.^. Policy <br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, CC 204b0; and to the <br />Office of Information and Regulatory Affxrrs, Oltice of Management and Budget, Washrgton, DC 20503. <br />General Instructions <br />I If form has hero partially rnmplered by preprinKne, disregard incrntctinns directed at ?ntry of that information <br />already preprinted. <br />2. Enter "Permittee Name,Aiaiimg Address (and facility name/location, if different)," "Permit Number," and <br />"Dischnrge Number" where indicated. (A separate form is required for each discharge) <br />3. Enlcr darts beginning and coding ".tlonnnrrnP Pcnnd" sneered b} torn[ where ;ndicated. <br />4. Enter each "Parmnere+-" as specilcd m monitonne requrements of permit. <br />5. Enter ".~'an,plc 1leannruic,;t" data for cast parameter under "{hrunrih'" and "t!'nlih" in units specified in pcmut. <br />".lrernge" is nonnall} arithmetic average (gcomcl tic aec rage for bacterial parameters) of all sample mcasuremenls <br />for cacti, parameter cbidrncd during ".1;unuuring /'.ri,,,."', ".llaxin;u;,," and ",lhnrnnun" are nornially c.Lc.l:a high <br />and low mrasurcmcnts obtained during ".tloni(or,rk I'ernut." (Tunic to municipals with seconda ;~ treatment <br />rcquirc„r_ni f.,l;u • , d.., :..c..,}: of.~..,;n;ac , ;.,, :.;s und_r'. - and enter ma~:~n,,,r 7';~ ,crags <br />o(samplc meastrrcnsnls obtained during monitoring period under ",L:a:irvvr,~. ", <br />fi. Enter "P,•nn,r Requrramem" for Inch pnrnmcrer under'Qumnirv" and "(Juah(v" as socctficd in pcmul. <br />?. LOtdc: "S'r. E_*" :ac. ..,..::bc. of ~•„up!c ...c~au. _ =._ mon,~riring penod th-i rrcrrd maximum (and/or <br />miniuuuu w --d:;y .,~cr.r~c .,s ..pprupn,, tei :~ .an; + .,,.. ~~for c.~.:` paramctr, r.r.:c :c, _c;cr "0". - - <br />n. Ln1Cr "(rnio.~rcj of .1;;N;~~.;rs G"[h ~~ ,.. ~ ~.,, ~...,,,, .,',_ ~~ ..,. y:ay.i: ,_.~ <br />during monitoring period) and asv"Perrnir Requirrurrnr' spcci;icd .n pcuwl (c. g., enter "('ant, "V for continuous <br />.,.onitor.ne, „ '" fa . r;c d~~} pc... ,: F:. "/ 'rr" Per . , , . ~~ ~'. '~ r '70" r,,. ~~ r:~. ~ ncr n...n°, cm 1 <br />v cnlcr'Jnmptr• Irpr onto as .xunpu• .itra,nrc•nrr," c~cni.i. s.~~,~,~~ ni~~ un~U ~~„i,,,~ wwriiU,iu,q ,.~_,~..u;.. ~„~ <br />"I'rrnur Regvrrenrrnr." (eg, Enter "Groh" for indit:dual sat^.nlc, "7111("' for ?~i-hour composilr. "1':1~"ufor <br />continucus monitoring, ctc.j <br />10. Where vtolalions of permit requirements arc reported, attach a brief esplanalion to describe cause and cerrecu~~c <br />actions taken, and reference each ~ iolalion by dale. <br />11. If "no discharge" occurs during monitoring period, emer ",4'u Discharge" across form in place of data entry. <br />12. Enter "Name/Ti(!e ojPrincipa( Executive Oj~cer" with ".Si,Qnature ojPrincipa! Executive Oi7cer ojAulhorized <br />Agent," "Telephone Number," and "Dare" al bottom of form. <br />13. Mail signed Report [o Office(s) by date(s) specified in permit. Retain copy for }'our records. <br />14. More detailed instructions for use of this Discharge Monitoring Report (DbfR) form may be obtained from OBice(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 $10,1)00 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) <br />