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)
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