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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 eo
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with' a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instmctioms, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />thi6 collection of information, including suggestions for reducing this burden, to Chief, Information Folicy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management amd Budget, Washington, DC 20503.
<br />General Instructior~s
<br />l..~lf form bas been partially completed by prepriotimg, disregard instructions directed at entry of that information
<br />already preprinted.
<br />21.~Enter 'Permitree NameiMailing Address (and facility nartrr/location, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required far each discharge.)
<br />3.;Enter dates beginning and ending 'ilfonitoring Period" covered by form where indicated.
<br />f ~ 4.`Efiter each "Parameter" as specified in monitoring requirements of permit.
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<br />5.`Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />~? "Average" is normally arithmetic average (geometric average for bacterial pamme[ers) of all sample measurements
<br />..for bath parameter obtained during "Monitoring Period'; "Mayimum" and "A4inimum" are normally extreme high
<br />;• and low meazurements obtained dunng "tifonitoring Periotl." (Note to municipals with secondary treatment
<br />.requirement: Enter 30~ay average of sample measurementsu+uder "Average," and enter maximum 7-day average
<br />'~ of sample measurements obtained during monitoring periodartder "Maximum.')
<br />6.. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specified in permit.
<br />'. 7.~Under "No Ex" enter number of sample meazurments.:dudng monitoring period that exceed maximum (and/or
<br />zminimum or 7-day average az appropriate) permit requiretnbnt for each parameter. If none, enter "0".
<br />' S.~Enter "Frequency ojAnalysis" both az "Sample b1e~Rnreet" (actual frequency of sampling and analysis used
<br />during monitoring period) and az "Permit Requirement" specified in permit. (e.g., Enter "Coot," for continuous
<br />~" .monitoring, "//7" for one day per week, "1/30" for oye~ay per month, "J/90" for one day per quarter, etc.)
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<br />~4 y1;n1Gr "Sample Type" both az "Sample Measurerrrey~t;; (actual sample type used during monitoring period) and as
<br />,~' Permit Requirement," (e.g., Enter "Grab" for-in1{ividual sample, 24ffC" for 24-hour composite, "NSA" for
<br />continuous monitoring, etc.)
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<br />~0 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 />3EI. ff "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
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<br />12. "Enter "Name//'itle ojPrincipat Executive OJ~cer" with "Signature ojPrincipn! Executive Officer ojAuthorized
<br />h':., Agent," "Telephone Number," and "Date" at bottom of form.
<br />Mail signed Report to Office(s) by date(s) specified in permit. Retain rnpy for your records.
<br />More detailed ins[mctions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s)
<br />speed in permit.
<br />Legal Notice
<br />oR is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report wthfully can
<br />civil penalties mot 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 />Form 3320-1 (Rev. 08-95)
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