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Paperwork Reduction Act Notice
<br />1 ` tic reporting burden for this collection of information is estimated to vary from a range of l0 hours as m
<br />it (esponse for some minor facilities, to 110 hours as m average per response for some major facilities,
<br />p et~,(tted~average for major and minor facilities of 18 hours per response, including time for reviewing
<br />) t"i~trlr~ons, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing tlie.wllection of information. Send comments regarding the burden estimate or any other aspect of
<br />tli6 collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Btiinch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />C)Pfice of Information and Regulatory Affairs, Office of Management snd Budget, Weshtngton, DC 20503.
<br />' ~ General Instructions
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<br />form has been partially completed by preprinting, disregard instructions directed et entry of that information
<br />eady preprinted.
<br />r~ntt:r "Permittee Name/Mailing Address (and facility name/location, if difl'erent)," "Permit Number," and
<br />t ~'J7ischarge Number" where indicated. (A separate form is required for each discharge.)
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<br />G~ntt;r dates beginning and ending 'iLlonisoring Period" covered by form where indicated.
<br />~' 4.l;nter each "Parameter" as specified in monitoring requirements of permit.
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<br />5. Winter "Sample Measurement" Bata 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 />.tor each pazame[er obtained during "Monitoring Period"; "Maximum" and "tifinimum" are normally extreme high
<br />and low measurements obtained during "Monitoring Periol~je~ (Note [o municipals with secondary treatment
<br />requirement: Enter 30-day average of sample measuremen1sytr~t der "Average," and enter maximum 7day average
<br />- of sample measurements obtained during monitoring period u+i~Y "Maximum.')
<br />(. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "No Fx" enter number of sample measurments durrag.monitoring period that exceed maximum (and/or
<br />~: ;minimum or 7-day average as appropriate) permit require8t~ for each parameter. If none, enter "0".
<br />~',li.`Enter "Frerlueney ojAna(ysis' both as "Snmple Measu'iytent" (aMUal frequenry of sampling and analysis used
<br />during monitoring period) and as "Permit RequiremenP.'apecified in permit. (e.g., Enter "Cons," for rnntinuous
<br />,monitoring, "1/7" for one day per week "!/30" for one day per month, "I/90" for one day per quarter, etc.)
<br />'.'Enter "Sample Type" both as "Sample Measurement" (actual sample type used during monitoring period) and as
<br />~ '"Permis Reruirement," (e.g., Enter "Grab" for itt~tv~dual sample, 24HC' for 24-hour composite, "N/A" for
<br />jcon6nuous monitoring, etc.)
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<br />~4t. ^-Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />aetions taken, and reference each violation by date.
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<br />W. 'If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />~.~Enter "Name//'isle ojPrincipa! Execusive Officer" with "Signature ojPrincipn! Executive Officer ojAushorized
<br />,Agent," "Telephone Number," and "Date" at bottom of form.
<br />E3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />C.i. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s)
<br />specked in permit.
<br />Legal Notice
<br />T~s report 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 />rrsult to civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />o ;~foralioo, or by imprisonment for not more than one year, or by both.
<br />~ty~-;
<br />EpPpI+ Form 3320-1 (Rev. 08-95)
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