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Paperwork Reduction Act Notice
<br />Public relrorting burden for this collection of information is estimated to vary from a range of IO hours as m
<br />average p:r response for some minor facilities, to 110 hours as m 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 collectioe of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of inforzation, including suggestions for reducing this burden, to Chief, Information Policy
<br />Bmnch, F'M-223, U.S. Environmental Protection Agency, 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 forte has heee pertrally mmplzted by prep:ieting, disregard instructions directed at entry of that. information
<br />alread;f Preprinted. '
<br />2. Enter 'Permute: Na;rre/hlailing ,4ddress (and facility namellocation, if different)," "Permit Number," and
<br />"Discharge ,Vumher" where indicated. (A s;.parate form is required for each discharge.)
<br />3. Enter dazes beginning and ending "Aloniroring P~rr~,d" covered by (orm where indicated.
<br />4. Enter each "Pnrnmere" as specified in monitoring requirements of permit.
<br />5. E^.'er "Sample Afea::.reme:u" aua fur each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Avrrnge" is norntall~ arithmetic avemge (geometric average far bacterial parameters) of all sample measurements
<br />for ea.h parameter obtained during "Afomr~ring Prnod"; ".tlaximum" and "Afintmum" ate normally extreme high
<br />and low measurements obtained during '+`om6.:r.-rg Period" (Note to mutticipats with secondary treatment
<br />rcyuiremcut: Enter 3C-dav avcrag. of samnge measurements under "Average," and enter maximum 7-0ay average
<br />cf sample measurements obtained during mon~loring period under "Afnximurn.'9
<br />6. Enter "Permit Regairemenr" far each paranrc;er under "Qaartity" and "Quality" as specified in permit.
<br />7. Under ",'Jo Fx" enter number of sample me:surnrents dunng monitoring pcried that exceed maximum (and/or
<br />minimum or 7-day average as ap^ropriatc) oernut requirement Cor each parameter ]f none, enter "0".
<br />8. Enter "Frequency nj 1nalvsis" bc:h as ".Sn.vrle A4ca.surrnvnt" (actual frequency of sampling and analysis used
<br />during; monitoring period) and as "Fermi! .Rrgniremenr" specifed in permit (e.g., Enter "Cons," for continuous
<br />monitoring, "1/7" for one day E•er week, '/~30" for one day per month, "/'90" for one day per quatter, etc.)
<br />9. Enter "Sample Type" both as 'Sn:npie Afea.,r.rerren~'' (actual sample ry•pe used during monitoring period) and as
<br />"Permit .Requirement." (e.g., Emc• "Gr~6" for individual sample, "2dHC' for 24-hour composite, "N/A" for
<br />conlir:uous monitoring, etc.)
<br />]0. [Nhen: violations of rxrmit requirements arc reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />1?. If"ro discharge" occurs dunng monitorng pcnod, enter "h'o Discharge" across form in place of data entry.
<br />t2. Ente: "Name/I'ille ojPrincipc/ E:-~currt•v U~7cer" ~.vi[h ".Signature ojPrincipnl Executive Officer ojAuthori.-ed
<br />Agent," "Telephone Number," and "Dar:" at bottom of form.
<br />13. Mail :;~gned Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More defiled instructions fur use of this Dir• h•rrge .4lnnitoring Report (DAfR) form may be obtained from Office(s)
<br />specified in permit.
<br />Lego: Notice
<br />This report s required by law (33 U.S.C. 13'b; 40 C.F.R. 125.27). Fa~le-z to report or failure to report truthfully can
<br />resuh in civi.I penalties not tc oxcee,; 610,000 p~~ d^y o(s;olation; or in crinunal penalties not to exceed x25,000 per day
<br />of violation, or by imprisonment for not more than r`re yeas, or by both.
<br />~ Forro .7320-1 (Rex. OS-QS?
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