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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 10 hours as un <br />average per response for some minor facilities, to 110 hours as m average per response for some major facilities, <br />with a wgighted average for major and minor facilities of IB hours per response, including time for reviewing <br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing aztd <br />reviewing We collection of information. Send comments regarding the burden estimate or any other aspect of <br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy <br />Byuch, PM-223, U.S. Environnteotal Protection Agency, 401 M Street, SW Washington, DC 20460; end to Ure <br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />t cam: <br />l:iff.form has been partially <br />. Already preprinted. <br />General Instructions <br />completed by preprinting, disregard instructions directed at entry of thaF ~n[ormation <br />8:'l~ter 'Permitfee Name/Afnrfing Address (and facility namt•/loptton, tf diB'erent)," "Permit Number," and <br />;" "Discharge Number" where indicated. (A separate Corm is required for eac4 discharge.) <br />~. , Enter,lia[es beginning and ending "Afonitorrng Period" covered by form where indicated. <br />d: Enter each "Parameter" as specified in monitoring requirements of permit. <br />~. <br />Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified to Ixrmi[. <br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measur_ments <br />[or each parameter obtained during "Monitoring Period"; "hfaximum" and "Minimum" are normally extreme high <br />and klw measurements obtained during "bfoniloring Period." (Note to municipals with secondary treatment <br />requirement: Enter 30-day average oC sample measurements under "Average," and enter maxtmum 7-0ay average <br />of sample measurements obtained during monitoring period under "Maximum.') <br />Enter "Permit Requirernen!" for each pammeter under "Quantity" and "Quality" as specified in permit. <br />that exceed maximum (and/or <br />If none, enter "0". <br />ojAnalysis" both as ".Sample Measurnrent" (actual frequenry of sampling and analys,s used <br />period) and as "Fermi( Requirement" specified in permit. (e.g., Enter "Cons," for continuous <br />or one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.) <br />linter "Sample Type" both as "Sample Measurement" (actual sample type used during monitoring period) znd as <br />'!Farrar! Reguirernenl," (e.g., Enter "Grab" for individual sample, "14HC" for 24-hour composite, "h%A" for <br />continuous motutoring, etc.) <br />VVtterb violations oC permit requirements are reported, attach a brief explanation to describe cause and corrective <br />aMion's taken, and reference each violation by dale. <br />B'"no discharge" occurs during monitoring period, enter "No Discharge" across form in place o(data entry. <br />'Enter "Nnmelfitle ojPrincipal Executive OlTcer" with "Signature ojPrincipa! Fxeeutive O)Tcer oj.4utlrorized <br />Agent," "Telephone Number," and "Date" at bottom of form. <br />Mail signed Repot to OBice(s) by date(s) specified in permit. Retain copy for your records. <br />More detailed instructions for use of this Discharge Monitoring Report (OMRJ Corm 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 can <br />Ohder "No Fx" enter number of sample measurments during monitoring period <br />gtinimum'or 7-day average as appropriate) perntit requirement for each parameter. <br />civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day <br />or by imprisonment far not more than one year, or by both. <br />3320-1 (Rev. 08-95) <br />.1 <br />