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Paperwork Reduction Act Notice
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<br />'P!uNlic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per (espoose for some minor fxilitiw, to i l0 hours as an average per response for some major fxilities,
<br />t+it~ a lvyighted average for major and minor fav~tie& of l8 hours per response, including time for revieworg
<br />,iistractibns,~searching existing data sources, gathering and maintaining the data needed, and completing and
<br />nw~ewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />15i wllectiQn of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />;Bth, PM~223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />(7f6ce of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />' General Instructions
<br />1'. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />j ,yl'ready preprinted.
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<br />ter 'Permittee h'nme/A4arling Address (and facility name location, if different)," "Permit Number," and
<br />jj~'s „isoharge Number" where indicated. (A separate form is required (or each discharge)
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<br />36?~it[gf;dates beginning and coding 'Afonitoring Period" covered by form where indicated.
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<br />4t dater each "Parameter" as specified in monitoring requirements of permit.
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<br />`S. ~bter "Sample Afeasuren+enr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />' "Average" is normally aritlunetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parametcr obtained during "ti/onimnng Period'; "Maximum" and "rtifininmm" are normally extreme high
<br />la''r and low measurements obtained during ",4fonitoring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-day average of sample measurements under ",4verage," and enter ma.+dmum 7~;y ;n~erage
<br />~' ' of sample measurements obtained during monitoring period under "Maximum.')
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<br />l} Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. if none, enter "0".
<br />Enter "Frequency of Analysis" both as "Sample Measurment" (actual frequenry of sampling and analysis used
<br />during monitoring period) and as "Permit Requtre»renr" specified in permit. (e.g., Enter "Cons," (or continuous
<br />monilon ng, "1.~7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />Emer "Sample Type" both as "Sample Measurement" (actual sample type used during monitoring period) and as
<br />'Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC' for 24-hour composite, "NSA" for
<br />•continuous monitoring, etc.)
<br />Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />Enter "Narne/!'itle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" a[ bottom of form.
<br />Mail signed Report to OtTce(s) by date(s) specified in pernrit. Retain rnpy for your records.
<br />More detailed tnstructions for use of this Discharge Afonitoring Reporf (DMR) form may be obtained from O6ce(s)
<br />specified in permit.
<br />Legal Notice
<br />art 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 />civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />ion,'or by imprisonment for not more than one year, or by both.
<br />3320-1 (Rev. 08-95)
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