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P~terwork R~eauction Act Notice ~
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<br />Public reporting burden for this collection of information is estimated to vary from a range of ~ 3 hours ~ an 'i
<br />average per response for some minor Facilities, to 110 flours as a9 average per response for some main( frcilitia.. ~
<br />with a weighted avr•.r~e `nr major and minor facilities of tits per respo~&~. ~.ncl•aAing •i:re for r~~: iew:n~ ',
<br />instructions, search;n_ ..us~uig data sources. ga~ering._ fining '.he .~% ~t11Jtl. ~n~J t~•n, te.in_ ~:r:d
<br />.. -- .~ ~ ~ t or .uiy r.h~. ~:;pect of
<br />' reviewing the ud~, i. -` trFurmatioo. Send CO _ he Surden c.:am^ e ~ '
<br />'~.. cn e:tion of :nf-:tmation, including suggestitStl~9°Por redu-r~, 'eis burden, to Chid. lnFirnuuun Pul:ra
<br />'3ranc't, ',.`-223, U.S. Enviroturte~ta Protection Agency, 40: n~ .i~reet, SN' Washington, JC 2J460~ and to :he ~~
<br />Office a` m'urmatinn and ReYtdat~rx;AYfairs, Office o: ,rfanac.:ment and Budget, Washington, DC 20503. i
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<br />'Ueneral Instctions
<br />I. If form has been partially completed by preprinting, disregard instructiun:::;ireeted at entry of that information
<br />~Y Preprinted. .
<br />2: Enter 'Pernriftee A'n,rr~.Afnrhng Address (and facniry nanteJloption, if diderent)," "Permit ~itmber," and
<br />"Discharge Nrrmhei' u itcrc indicated. (A 9Eparate form s required for each discharge.)
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<br />3. Enter dafes beginning and ending "MeMiMring Perrud" covbred by form where indicated. -
<br />4, Enter each "Poramere%' is specified in mptutoring requirements of permit.
<br />5. Enter "Sample AledcuremenP' da~a for eath parameter under "QuonnR" and "Oua/; p% in units spectficd in permit.
<br />".4 vernge" is normally a;ithmcuc average (geometric average for bactenai paramGCrsj of :ill sample measurements
<br />for each parameter obtained during "bfonimring Period"; "dfaximunr" and ",[fininunn" are norntally eetreme high
<br />and low measurements obtained during "Moniraing Periofi" (Note io mwuctpals with secondary lreatmem
<br />requirement: Suter l0-day average of sample measurements under ".4 vernge," and enter maximum 7-day average
<br />of sample measurent:~nts ubtatned during monitoring period under "Afnxi,nurn.')
<br />6. Enter "Perrrtir Requirement" for each parameter under "Quantity" and "Quality" as specif cd in permit
<br />7. Under "No Ex" entc~ nurcber of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7~av average as appropriate) permit requirement for each parameter. If none, ewer "0".
<br />8. Enter "Frequencv nfAnal~si.c" both as ".Sample AfeasurnrenP' (actual frequency of sampling and analysis used
<br />during monitoring period) and as"Fermi( Regairement" specified in permit. (e. g., Enter "Cunt," far continuous
<br />monitoring, "//7" for one tiny per week, "x/30" for one day per month, "1'90" for one day cer quaver. etc.)
<br />9: Enter "Sample Ttpe" oath as "Sample Afeasurernenr" (actual sample type used during monitoring period) and as
<br />"Fermi( Requiren+enr," (e. ;., Enter "Grob" for individual sample, 2~lHC' for 24-hour composite, ",1'%A" for
<br />cominuous monitoring, etc.l
<br />]0. Where violations of permit requirements are reported, attach a brief explanation to describe puce acrd corrective
<br />actions taken, and reference pch violation by date.
<br />11. If "no discharge" occurs dunng monitoring period, corer "No Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrtrrcipa! Executive Officer" with "Signatur¢ ojPrincipal Execuriye Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Oft-ice(s) by date(s) specified in peri»it. Retain copy for your records.
<br />14. More detailed instructionsix use of this Discharge .tifonimring Report (DA1R) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is reyuired by law (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 t~ sceod X10,000 per day of violation; of in criminal penalties not [u exceed E25,000 per Say
<br />of violation, or by imprisonrnenl fir not more than one year, or by both.
<br />EPA Form 3320-] (Rev "8-?S)
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