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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 t0 hours as m
<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 and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of infutmatiom. Send comm~:nts regarding the burden estimate or any other aspect of
<br />[his collection of information, including suggestions for redwing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Env.ronrrreotal Protection Agent}', 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 'Permitree Arame~,tlailing .4ddress (and facility ttanrellocalion, ff different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ".1lonitonng Period" covered b}' form where indicated.
<br />4. Enter each "Pnrnmeter" us specified in monitoring rcquircments of permit
<br />5. Enter "Sample Aleosurem~nt" data for each parameter under "Qunndty" and "QunLty" m uniu specified in permit.
<br />".4vernge" is normally aiilhmeric average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".Lfunuoring Perrod'; "Slanmum" and ",lhnimum" are normally extreme high
<br />and low measurements obtained during ",tonitoring Period." (Nate to municipals with secondary treatment
<br />requirement Enter 30-d;n a~~crabe of sample measurements under ":tr•eragr," and toter maximum 7-0ay average
<br />o(sample measurements obtained during monitoring period under "Afaximm~r "/
<br />6. Enter "Peron[ Reyuiremenr" for each parameter under "Quantity" and "Qualirt" as specified in permit.
<br />7. Under ":Vo Fs" enter [umber of sample meusurnrents during monitoring period that exceed maximum (and/or
<br />mininwm or 7~ay average as appropriate) permit requirement Cor each parantdcr. If none, enter "0".
<br />8. Enter "Freyuenc} ojAnn(cs~s" both as "Snnrple ,lleosuruten!" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Fermi! Reyuiremen!" specified in permit. (c.g., Enter "Cant." for continuous
<br />monitoring, "l.'7" for onr, day per week, "/ ~0" for one day per month, "1,90" for one day per quasar, etc.)
<br />9. Enter ".Sample Ttpe" bath as "Sample ,1lcasure»ren!" (actual sample 4Pe used during monitoring period) and as
<br />"Permit Reyuiremenr," (e.g., Enter "Grab" for individual sample, "24HC"' for 24-hour composite, ",h''.4" for
<br />continuous monitoring, etc.)
<br />10. Where violations of pcnnit rcquircments arc reposed, attach a brief explanation to describe cave attd corecuve
<br />actienstaken, and reference each violation by date.
<br />11. If"no discharge" occurs during monitoring period, enter ",4'o Discharge" across form in place of data entry.
<br />12. Enter "Narne/fitle ojPr•incipa! Execuliti•e Officer" with "Signature oJPrincipal Executive Officer ojAuthori.-ed
<br />Agent," "Telephone Number," and "Date" a[ bottom of form.
<br />13. Mail signed Report to OlTice(s) by date(s) specified in pemrit. Retain copy for your records.
<br />14. More detailed instructionu for use of this Discharge Monitoring Report (DA1RJ form may be obtained from Office(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 excced 510,11(X1 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 Farm 3320-1 (Rev. OS-9!~)
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