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Paperwork ~te~~uction Act Notice
<br />~ Public reporting burden for tnis collection of information is estimated [o vary from a range of i0 hours as an i '
<br />i average per response for ,ome minor facilities, to 110 hours as an gva[age per response for some major r"aa;tties,
<br />'. with a weieh!ed av ~r:~ •, `~~~~~ •+ta~or wd mioor facilities of t8 hours per response, including :ime for reviewing
<br />- ~ instructions, searching- c1r 4r% .',eta aources, gathering and mauWining the data needed, and cotnpieling and
<br />reviewing !ha soil. ""tin; ~f ir.`onnation Send ~:omments re~atdib~.tht~rurden estimate or :u!y other aspect or _ _,
<br />this coliecttoo of i.-•;~~ m:+~!or. includ~^_ •:u;eesuons ior,raducing"this burd,~_ '.o ~l':.i, tnfrnrra•wn Policy
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<br />Branch, ?ivf-223, U.S Envrrcnmzora; Yrolecuon Agency; 407 M,Street, Ste' •:`s.:,tinfroa, JC 2J460~ and to the
<br />Office of mfonnaG~~u ~!nd Zzgulatory Affairs. Office o: Management and B•id;;:!. ~!aaaington, ~C 20103.
<br />G~eral Instru ::ions
<br />1. if form has been partially oDmpfifed by preprinting, d!sre~ard instructions directed at entry' of that information
<br />already preprintzd. .; ~'~ .t_ ,
<br />2. Enter "Fermitn•r rVnme.Afailing Address°~mtd facility. name location, 'I different'," "Fannie Nuruber," and
<br />"Discharge n'umhe,^" where indicated. (A separate fotmss rcgtrired for each discharge.)
<br />3. Enter dales begi:.umg and ending '7llogitoring Period"Pcovered by farm atircrc indicated.
<br />4„ Enter each "Parurn.-rer' u specified in monitoring requirements of pernut.
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<br />5. Enter "Spmp& A1en.:ure;aeaP' data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />".average" ig normally a:uhmcuc average (geometric average for bacterial parametrrl of ,ill sample measurements
<br />for.each.parameter obtained during ",Llonitoring Pe"iod'; "Maximum" and "Alinimmn" arc normally extreme high
<br />and low meazurements obtained during "Afonito."ing Period." (Note to mwticupals wish secondary treatment
<br />iequiremenf Enter 30-day average of sample meazurements under "Average," and corer maxunum 7-0ay average
<br />of sample measurements obtained during monitoring period under "Afaxrmum. ")
<br />6. Enter "Perini! Requirzure~nr" for each parameter under "Quantity" and "Quality" az specified in permit.
<br />7. Under "No Fx" enter nun bar of sample measunnents during monitoring period that exceed maximum (andlor
<br />minimum or 7-da} average az appropriate) permit reyuirement for each parameter. [f none; enter "0".
<br />8. Enter "Frequency or.4nal/sis" both as "J'ampfe ,l-feasurmenr" (actual froquenry of sampling and analysis used
<br />during monitoring pcriod)~and az "Permit Requirement" specified in permit. (e.g., Enter "Conn" for continuous
<br />monitoring, "1 ~7" for one ~y per week, "1~3d' for one day per month. "/'90" for ono day cer quarter, elc.l
<br />9. Enter "J'ample 7iyr-" both az "Sample AfeasurerrtenP' (actual sample type used during monitoring period) and az
<br />"Permit Requirement," (e. g., Enter "Grab" for individual sample; "1JHC' for 24-hour composite, "~:!9" for
<br />continuous monitonng, etc.)
<br />10. Where violations of permit requirements are repoAed, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date. _'
<br />1-1. [f "no discharge" occurs du.ing monitoring period, eater "No Discharge" across form in place of data entry.
<br />12. Enter "Name/I'itle ojPrinripal Executive Officer" with "Signature ojPrincipnl Executive Officer oj.4uthorized
<br />.4gent," 'Telephone Numbt"," and "Date" a[ 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 Monitoring Report ~DA4R) Corm may bC obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by 'aw t3. U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure W report truthfully can
<br />result ip civil penalties uo::~_.-xcced E10,000 per day of violation; or in criminal penalties not to exceed 525,000 pzr day
<br />of violation, or by impnsurenent for not more than one year, or by both.
<br />EPA Form 3320-t (key •~»-.°;;
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