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<br />Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as ae
<br />average per response for some nrioor facilities, [0 110 hours as m average per response for some tmajor facilities,
<br />with a weighted average for major and minor facilities of 16 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 information. Send comments regarding the burden estimata or any other aspect of
<br />this collection of inferrnation, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environm~:ntal Protection Agency, 401 M Street, SW Washingtom, DC 20460; and to the
<br />Office of Informa[iom and Regulatory Affairs, Office of Management end Budge[, Washimglon, DC 20503.
<br />General Instructions
<br />1. If~form bas been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permirlee .Vanre~,Llad;ng .4d.fress (and facility name/location, d diH'erent)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates begiiming and ending ';tfoniroring Perod"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring regwrcmenls of permit.
<br />5. Enter "Sample A;earrrre.ntenr" data for each parameter under "Quantity" aid "QuoliN" in units specified in permit.
<br />",4vernge" is normally arnhmcJc aver.tge (geometric average for bacterial parameters) of all sample measurements
<br />(or each parameter obtained dtuing ",4fontloring Period", ",Lfanrnum" and "A-fmimum" are normally extreme high
<br />and low measurements obtained during ",1fonIIonng ^eriod." (Nate to municipals with secondary treatrnenl
<br />requirement: Enter 30-0ay avemez of sample rceasuremcnts wider "Avera.ge," and enter maximum 7{la} average
<br />of sample measurements obtained during monitoring penod under "Afaximwn.
<br />b. Enter "Pennlr Requvemen!" for each parameter under "Qaanlity" and "Qu~'iry" as specified in permit.
<br />7. Under "No Lis" enter number of sample measurnrents during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) perntit requirement for each par;.rrieter. U none, enter "0".
<br />8. Enter "Frequency rf Analysis" both ns ".Cnmple .41eanrrment" (actual frrquenry• of sampling and analysis used
<br />during monitoring period) and as "Pe•mir Require,nen!" specified in perndt. (e.g., F.nter "Conn," for continuous
<br />monitoring, "1~7" tar one day p:r week, "1130" for one day per month, "/~90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as "Sample Afeasuremen!" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., inter "Grab" for indirdual sample, "?4h'C'" for 24-hour cromposite, ".V,:4" for
<br />continuous monitoring, etc.)
<br />10. Where violations of pernul requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/fide ojPrincipal Executive Officer" with "Signature ojPrincipaf Executive Officer ojAufhorized
<br />Agent," "Telephone .Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge bfonlroring Report (DhLR) (orm may be obtained from OLfice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by Vow (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 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for nit more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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