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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 IO 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 18 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. Environmental 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, Washingtoq DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction duected at entry of that information aUeady
<br />preprinted.
<br />2. Eater "Permittee Name/Mailtng Address (and facility name location, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required For each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter " as specified in monitoring requirements of permit.
<br />5. Enter "Sanple Measurement"data for each parameter under "'~uontiry"and Qualih,~"as specified in permit. "Average" is
<br />normally arithmetic average (geometric average far bacterial parameters) of all sample measurements for each parameter
<br />obtained during "ivlonitoring Period'; "idarirn~rn" and Minimum" are normally extreme high and ]ow mcascrema;t,
<br />obtained during ".YL.»t~ring Pz; ~z!". (,tote io municipals with secondarj 'seatmz~t requirement: Enter 30-day a~~e~age
<br />of sample measurements under "rivsabe,"and enTa^ L,aximum 7-day avczgc of sr:nple mcasurem~^u obtained du ~ing
<br />monitoring period under "ivlirimutn.")
<br />5. _°nicr 'Tar,:rit Re.7:rir~mau"for each parameter urtler "~man!it;~"and "Qtraliry" as spr_cified in pc~m :.
<br />7. Under "1`,ro ~S.r" enter number of sample measurcrrc,'. cu*:ng :nonilor;ng period tl-a'. exceed marimwT (and/or miP~mu.n
<br />or 7-day a~~eragc zs appropriarc) permit rcquiremeot for eac;~ parametc:. If none, enter "0".
<br />8. En`cr "F'reguen;y •~`A;ralvsis" both as "Sant la .:iz~sur_,n~u" (ac ~nl f cqu:r.cy of sampling and analysis used Gw:n;;
<br />~nonitorng period) r.nd as "Prnnit Reyuirzmdnt" specifired in pc..niL (c.d.:inte: "C;n~,"for ecrlinuous monitoring, "//7"
<br />for one day per wee!c, "//30"for cne day par month, ".t/90" for one day per quaYie:, etc,;
<br />9. F,n:er "Sarnl-le TjFs"both •s "S~urFL ;vl~~su,e,;r•_,n"(actual sumnlc type us~i dur:.~g monitoring period) and as "Pa,~ni!
<br />k~yz~ir~nu7!," (e.g. enter "Gras" for iadividusl sample, "14U~" for 24-hour composite, "N/A" for con!inuous
<br />monitoring, etc.)
<br />] 0. 1x'hcre vioialiors of permit requirements are reported, attach a uric: explanz:ion To dcsc:ibe csesc and corrective actions
<br />to be ta!cen, and reference each violation by date.
<br />1 1. If "oo discharge" occurs during monitoring period, enter "No Discharge" across form in place of data yntry.
<br />12. Eater "Nome/Titla of Principal Executive Offica%" with "Si~~runrre of Frin~i; a! Executive Gfficer of Autl:orixd
<br />Agznt, ""Telephone Number, "and "Date" at bottom of forth.
<br />13. ivlai] signed Zeport to Cflice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Maritoring Report (DMIi} form may be obtained 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 imprisomnent for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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