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Paperwork Reduction Act Notice
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<br />Public .repoding burden for this collection of information is estimated to vary from a range of l0 hours as an
<br />aYetage per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />wit~r. a u/eighted average for major and minor facilities of I8 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />rbviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />collxtioo of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />~rdnch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; end to the
<br />Of~tce of Information and Regulatory Affairs, Office of Management and Budget, Wa;hington, DC 20503,
<br />.' ~ General Instructions
<br />~;1!.If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />~ already preprinted.
<br />2. Enter 'Permitlee Name/Mailing .4ddress (and facilify nantdlot:ation, if dil]'erent)," "Permit Number," and
<br />"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.
<br />~.4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5.'Enter "Sample Measvremen!' data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />, for each parameter obtained during "Monitoring Period"; "Maximum" and "Minimum" are normally extreme high
<br />~t ' and low measurements obtained during "rLloniloring Period.~,~Note to municipals with secondary' treatment
<br />requitement: Enter 30-day average of sample measurements under "Average," and enter maximum 7day average
<br />of sample measurements obtained during monitoring period uni>er''Maximum.'J
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<br />b, Enter "Permit RequtrwnenP' for each parameter under "Qua kiry" and "Quality" as specified in permit.
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<br />i ~7, Under "No Er" enter number of sample measurments dpnng monitoring period that excced maximum (and/or
<br />minigtum or 7-day average as appropriate) permit requiregi~tt for each parameter. If none, enter "0".
<br />'~8.:Enter "Frequency ojAnalvsis" both as "Smnple Measurltren!" (actual frequenry of sampling and analysis used
<br />" during monitoring period) and as "Permit Requirerrrefrt" specified in permit. (e.g., Enter "Conn," far continuous
<br />monitoring, "//7" for one day per week, "1/30" for onq,day per month, "1/90" for one day per quarter, etc.)
<br />~. Enter "Sample Type" both as "Sample Measuretnen (actual sample type used during monitoring period) and az
<br />g ; .{ Permit Requirement," (e.g., Enter "Grob" for individual sample, 2~tHC" for 24-hour composite, "N/A" for
<br />+continuous monitoring, etc.)
<br />~Q'. Wham violations of permit requirements are repq{~ed, attach a brief explanation to describe cause and corrective
<br />,actions taken, and reference each violation by darn.,
<br />If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />..Enter "Name/!'itle ojPrincipa! Executive Officer" with "Signature oJPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />Mail signed Report to Olf"ice(s) by date(s) specified in permit. Retain copy for your records.
<br />More detailed instructions for use of this Discharge rLloniroring Repot! (DMRJ form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />'ppori 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 />in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />~tion; or by imprisonment for not more than one year, or by both.
<br />Form 3320-1 (7tev. 08-95)
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