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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 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of l8 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environrrtental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If farm has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pernrit[ee Name/M.riling Adtress (and facility name location, if different)," " Pznuit Nu7nPer," and "Gischarge
<br />Nuriiber" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Per•icd"covered by form where indicated.
<br />4. Enter each "Perzrneter" as specified in monitoring requirements of permit.
<br />5. Ente- "Smnpls M~asurana~it"data fnr eac`7 pa,~me'er under "~itrarvi:y"and ~Jv=liq~" as specified in pe~nit. "Avz, .ga" is
<br />normally arithmetic average (geometric a~: crage for L'scterial par;.mctea) cf all sample r:,easurmen*s for each paramc+rr
<br />obtained during ",bl;airoriag Pdrioy'; ",V,a.:bnu,ii" and hl%irir,.uui" a-:. normally r:a ~,.:; high and lom mcasu-cnents
<br />obtained during ",bf.nilariag Pa-i~,_/". (dote ;a mug eipsls with =.econdary treaGr.zr* re~u`remen_: Winter 30-clay eve ~~e
<br />of sample me~sureme-ts under "Av~r~~d,"and cater rrc::imum 7-dcy avccgc Of rc-isle m.asu-crcns ebti.ine- du Ong
<br />monitoring period under "Nlaxim:i;n.")
<br />5 ':^tcr ",°z;;nit Rrqui;znr~.a" ror each parameter under "~uartirt~"znd "~ualiry"a_, -, ,cified in pe ;.i;t.
<br />7. Und.r "P', .r:.r' enter number of scmplc measurement cur ing ;no-~~o;in~ ,e=od t'tat r•. ;c~~d aa~:~num rand/or rc ~~mv-~
<br />cr 7-dcy avc~a~e as rppropriate) permit re:quircment for each parameter. ]f none, cafe "0".
<br />3. P~~aer "Fr~t~~•a_y ~fA;ialysis" Loth s "S_~„.,-!a ,Ll.•~.~rr,~s„i~nt" (actual f c_j~ency o'st~pling and rnrl~sis used Pu ~~~
<br />noii'or~~perod)andas"Pe,;~7irR~;+vi,~;neat"secifiedinp;rmit.(e.g.~cter'_ '"areoct:,uousr_.onitori-~,"!/7"
<br />for one day p:r ~cce'.<, "1/30" for one day per month, "1/90" for one day pzr quarter, c'=.)
<br />9. r~er °~J1GF/. TVT'° bOtil .S "Sauipl: !1 ~'c1SP:'d,ddt(" (actual Sample type cs~~d dining rr:::n'ionno ecnud) and as "Pdnilir
<br />IZ~7uh ~;;r"rt," (e.g. Enter "GraF" for individual rc nplc, "2~11~" for 24-i-,o: ; co~npositc, 'S1VA" for contincous
<br />monitoring, etc.)
<br />10. ~.'.~~:rc violations cf permit requirements ar reported, attach a brief explaraicn to describ.; cause and corrective actions
<br />to be taken, and rcfetcnce each violation by date.
<br />",. ] f "no dischargz" occurs during monitoring pcried, enter "No Discharge" across farm is plsce of data entry.
<br />12. Enter "Aiame/Til/e of Principal E~zcutir~ Gffixr" with "Signatu,•z cf Frin.rip~1 Frscutiv~ Gffi •er of Auh'i..ri=a/
<br />Agznt, ""Teleph~n~ Ahrmbrr,"and "Cote" at bottom of form.
<br />13. ~ Qail 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 Monitoring Report (Cf~IR) form may be obtainer 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 result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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