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<br />~ F rworlc Ie ~4iuctio~ Act Notice '~,
<br />~ ..
<br />Public reporting burden for this motion ar :aformaiion is estimated to vary from a range of i0 hours as an
<br />average per response for so,nr minor facilities, So 110 hours as sit average per response for some major facilities.
<br />witb a weight:d aver+ge I~or .rw;nr 3rtd minor facilities of 18_ ho141tt~er response, iGcluding time for reviewing
<br />instructions, searcaing ext:.tog daa sources, g3~arin,~ an - g the lata ac.aul, and cimnlenng and
<br />~'~ reviewing the cotlectinn o+ irorrnauon. Send co ~ ~ ~ the hu-Scn ~_s':~,mate e: any oshrr aspect o` ',
<br />i this wllection of iaformat,nr. inciudtog suggestions acing this burden to ChteC information Poiicy
<br />Branch, PM-223, U.5 Eavircrunental Pmtaction Aget3cy, 40] M Sr:xt, SW Washington, DC 20460. and to the it
<br />Office of Infortnatioa end Regulatory Affaus, Office ,.f 1'.!znaget~~_nl and Budget, Washington, DC 20503.
<br />_ A
<br />~' ~eneralInst~uctions
<br />l: If form has been partially completed by preprinting; tficrega*d instructions directed al entry of that mfotmation
<br />already preprinted.
<br />2., Enter 'Permittee Nornectlm6nq Address (.and facility name/locauon, if different)," "permit .Number," and
<br />` "Discharge Nvmher" where mdtcated. (A separate fcrm is required for each discharge.) -
<br />3.. Enter dates beginning and t ndmg 'hlomtoring Period" cov.1'rsdi>y form where indicated
<br />4. Enter each "Parameter' as ;pacified !n monitoring requirements of permit.
<br />5. Enter "S'ample rtileasurenrer~'" data for each parameter under "Quanriry" and "Qual;rv° in units specified itt permit.
<br />"Average" is normally arittmcuc average (geofneuir average fqr bacterial parameters) of all sample measurements
<br />for each parameter obtained during "MoniroringPw•iod"; "Maximum" and ".1lininntnr" are nonoally extreme high
<br />and low measurements obtained during ",Llvnitoring Period." (dote to municipals with secondary trcaunent
<br />requiremenC Eillcr 30-da}' average of sample measurements under "Average," and enter ma:imtun 7-day average '
<br />of sample measurements obatncd during monitoring period under "dlarimurn.')
<br />6. Enter "PennrtRequrremenr" for each parameter under "Quantity" and "Qualrti'" az specified in permit.
<br />7. Under ",Lo Er" enter numoer of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average ss appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency vjAnnltsis" both az "Snmple ,1-Irnsurnrent" (actual frequenty of sampling and analysis rued
<br />during monitoring period) .md az "Permit Requiremen!" specified in permit. (e. g., Enter "Cont." Cot continuous
<br />monitoring, "N'7" for one d<y per week, "!/30" for one day per month, "1.'90" for one day per quarter, etc.)
<br />9. Enter "Snmple ftpe" both :u "Sample Afeasurement" (actual sample typo used during monitoring period) and az
<br />"Permit Requirement," (e.g.. Enter "Grab" for individual sample, "24HC" Cor 21-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dart:.
<br />11. U "no discharge" occurs during monitoring period, enter ";No Discharge" across form in place of data entry.
<br />12. Enter "NanreFfirle ojPrinc.pnl Executive O~cer" with ".Signature of Principal f'recutive OJJicer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bottom oC Corm. -
<br />13. Mail signed Report to Oliice(s) by dale(s) specified in permit. Retain rnpy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DtifR) Corm may be obtained from Office(s)
<br />specified in permit
<br />Legal Notice _ •
<br />This report is reyuired by law (33 U.S.C. 1315; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />resat: in =ivil penalties not to exceed 310,000 per day of violation; or in criatinal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment fcr not more than one year,'or by both. '
<br />EPA Form 3320-f (Rev. 08-95)
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