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' Paperwork Reduction -Act Notice
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<br />Public reporting burden for this collection of information is estirmted to very from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted averege for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />rCvjeWing the collection of information. Send comments regarding the burden estirmte or any other aspect of
<br />tAi~, collectign of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Br~,gob, PM,223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Infbrmation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />`!~-If.form has been partially completed by preprinting, disregard instructions directed-at entry of that information
<br />"" Already preprinted. _ -.
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<br />2. Enter 'Permi((ee Name/INaiGng Address (and facility name/lacalion, if different)," "Permit Nun+ber," and
<br />F' ~ '"Discharge Number" where indicated. (A separate form is required for each discharge)
<br />3, Enter dates beginning and ending 'Monitoring Period" covered by form where indicated.
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<br />A:.£nter each "Parameter" as specified in monitoring requirements of permit.
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<br />'£uter "Smnple Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />~ •Average" is normally arithmetic average (geometric average (or bacterial parameters) of all sample measurements
<br />' ~ for each parameter obtained during ".4onitoring Period"; "Maxinrurr+" and "Minimum" are normally exlrente high
<br />', and low measurements obtained during "donitoring Period." (Note [o municipals with sernndary treatment
<br />• tequiremenC Enter 30-day average oC sample measurements under "Average," and enter maximum ?day average
<br />E, ; of sample measurements obtained during monitoring period under "Maximum.')
<br />bi, Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in pernut.
<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 />Bnter "Frequency ojAnalysis" both as "Sample tifeasurn+ent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Penr+ir Requir•err+ent" specified in permit. (e.g., Enter "Corr," for contlrmous
<br />monitoring, "/.'7" for one day per week, "(/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />"Sample Type" both as "Sample Measurement" (actual sample type used during monitoring period) and as
<br />i( Requirement," (e.g., Enter "Grab" for individual sample, "14HC' for 24-hour composite, "N'A" for
<br />uous 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 />U "no discharge" occurs during monitoring period, Doter "No Discharge" across form in place of data entry.
<br />Enter "Name/1'itle ojPrincipa! Executive O~cer" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dare" a[ bottom of form.
<br />Mail signed Report to O6ce(s) by date(s) specified in permit. Retain copy for your remrds.
<br />More detailed instructions for use of this Discharge Monitoring Report (Dti1RJ (orm may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />~rt is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully cen
<br />civil penalties not to exceed 610,000 per day of violation; or in criminal penalties not to exceed 325,000 per day
<br />or ¢y imprisonment for not more than one year, or by both.
<br />3320-1 (Rev. 08-95)
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