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Paperwork Reduction Act Notice
<br />Public reporting burden for [his collection of information is estimated to vary from a range of 10 hours as m~
<br />' average err rrspnmr. (nr .nmr minor fa,.,lq,~h, L; , r[, L.~•,._ >_ c^ sccr._ _ :..: r.. .; ~. -.-.. ...-.. ,,,~. i,.r :~,., _t.:;-_
<br />i with a weiehted average for miior end minor facilities of 18 hours per sespnrse, irdudinp ;ic~c fol rerii~wutr ~'
<br />tnstructions, searchioe existing dam sources, gathering and maintaining Le rf~L needed, and compl.:[ing avid
<br />reviewing the cnllertinn of infnr?natioe. Send comment. regarding the burden sti ma[a ur a,ly uiiler a.p.A:r of i
<br />this rnllrctinn of information, including suggestions for reducing this burdco, to ~il:cf, Lliulwaiiun Folic, '~
<br />I Branch, PM-223, U.S. Em•i ronm.:ntal Protection Aeencv. 401 hi S[, eet, SW Wasbinnrnn, [u_ 20ar.1_r ~nri t~ tpe '
<br />i Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. 1
<br />L- -- - -- - --- - - - -- ----~- -- ~ --
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed at entry of That information
<br />already preprinted
<br />2. Enter "Permnree Nnme•7llniling Address (and facility namelloca[ion, it dill'erent)," "Permit ,Vu»eber," and
<br />"Discharge Number" inhere indicated. (A separate form is required for each discharee )
<br />i. Euicr dais ireginnim~ ,Ind rnd!ng ".~tHmnunng Penod"covered by form :•.hcre indicated.
<br />4. Enter cacti "Pnramrtr," :;: specified In monitoring rrgwrements of p-rmit
<br />~. Enter "J'm;;plc 'Jru."urulrla" u. d., ful call p;u:uu.i.r ender "Llunnrirv' and "(h/ni,rv" in units speciGerJ in •• .r.:'
<br />".It ernKr" Is notntall~ arith;uctic at etage (gcmlmtnc average for bacterial parameters) of all sample measurallents
<br />for each parameter obtained during ".tlumtonng Prnorf', ".1laxirnurn" and "Allnununr" are normally extreme high
<br />and low mcasurnmenls obtained dwing ".1loniturulg Prrlud" (Note to municipals with seconda.-y l:~atmen[
<br />requircmcm: Enter 10-da}' average of sample mcasurcmcnts under "Avrrnge," and enter maximum 7t<y average
<br />Gf iBittiilt ,ilcJ."ui elil~JPl U~Llil:-,. dtlrlll~ I::OIIIIUI111E IJLI IOd nlld'_ -r '~/
<br />6. Enter "Peron! Krgrrr.•ment" for eac!t parameter under "~vanrtp" arc `'Qrmlih!" as specified in permit
<br />7. Under ".'~'o F_':" enter number of sampie mcnsunncnts during meniroring perod that exccctl maximum (and/or
<br />minimum or 7-da} a. ^_ragc as apprepr:u!c) pcn::il rcq;.ircn:cnt for vac!: p ~r:cter. If none, vale' "0". - _
<br />t?. Enter "Frequenct~ nj.!rel~:ris" ba!h a.. 'lSar,:plc i/cn.•:ar•n:r,1^ (actual fregven., ^f ;amgiiag and a,al}sis used
<br />during r;omtering period} uT~u' 15 "i'ci'u1~! l4'Ituu cm eui" SNeiulvJ w ycl uui. 1e g~ 1=r.iu "('uni " iur Genii riuJiii
<br />monitoring, "liT for ant day per week. "/.3G" Cor one day per month, "lty0" for one da} per quarter, etc )
<br />Y. Enlcr ".`iuntplr !}PL'.. Goth as ":;uny/rc .'Jru~urr/n,-:/' ta;.tv.:: ~e:uptc ppc L:..J dunag ulvuitoril!g rc!::ail end as
<br />"Permt kegmrement,' (ag., 'toter 'rrrnh' for Inulcltlunl sample, ''a,ti! ~~ lur '1~nour composlU• ~ t :f" for
<br />continuous monitoring, etc )
<br />10. Where violauons of permit requirements arc reported, attach a brief e.~planation to describe cause and corrective
<br />actions taken, and reference each violation by dart.
<br />11. If "no discharge" occurs during monitoring period, enter "A'o Dischnrge" across torn[ in place of daW coin'
<br />12. Enter "h'mne/Title ojPrincipal Executive Officer" with 'lS'ignature ujPrincipal Executive Officer ojAuthorized
<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. Mare detailed instructions for use of This Discharge /L/nnitoring Repor! (DAfR) torn[ may be obtained front 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
<br />result in civil penalties pot to exceed 510,000 per day of violalioo; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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