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Paperwork Reduction Act Notice
<br />Public repenting burden for this collection of information is estirvated to very from a range of 10 hours as an
<br />average per response for some minor facilities, to l 10 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 raview.mg
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing tend
<br />reviewing tie collation 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 />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 204b0; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />Gener~-1 Instructions
<br />1. If form has been partially completed by preprinting, disregard instrvcliens directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permirree Name%Lfailing Addmss (ar,d facility name/lop[ion, if different)," "Permit A'umber," and
<br />"Discharge .Number" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending ':Lfariroring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as spccdied in monitoring requirements of permit.
<br />5. Enter ",Sample dfecuuremenP' data for each parameter under "Quanlily" acid "Qlcliry" in wits specified in peniut.
<br />"Average" is nomtally arithmetic acemge (geometric a~crage for bacicrial parameters) oFall sample measurements
<br />for each parameter obtained during ",tlnnimrml; P~rin~!"; ".lfarnnum" and ".l/i,vrrmn" are norna!ly extreme high
<br />and logy measurements ublain.d during ",tfonironng Perurd." (Nate to municipal; ~~ith secondary treatment
<br />requirement Enter }0-da., a~emge of sample neasurcments tinder ".ivernge," and enter m.tximan 7-day avcmge
<br />of samp'c measurements obtained dw ing monitoring period under "ifozim rm.
<br />6. Enter "Permit Requirement" for each parameter under "Ouonrity" and "Quality" a_s specified m pcrrtit.
<br />7. Under ",No Er" toter number of sample mca:;umrente during monitoring period that excacd maximum (and/or
<br />minimum or 7-day average as appropriate) perntil requirement for each parameter. if none, enter "0".
<br />8. Enter "Frequency ojanalvsis" both as ".Sample .tfeoavrmenr" (actual fizquen~r of sampling and analysis used
<br />during monitoring period) and as "Permit Rcquiremenr" specified in permit. (e g., Enter "Coot," for continuous
<br />monitoring, "li7" for one day per week, "I-j0" :or one day per monOt. "1190" for one day per quarter, etc.)
<br />9. Enter "Smmple Tvpe" both as "Sample ,l-/easuremen!" (actual sample type used during monitoring period) and as
<br />"PermiP Requirenrenr," (e.g., Enter "Grab" far individual sample. "Z411C" for 24-hour composite. ",Nis"' Cor
<br />continuous monitoring, etc.)
<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 dtte.
<br />11. If "no discharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry.
<br />12. Enter "NameiTirle ojPrincipal Executive Officer" with "Signature ojPrincipa! Ereculive O~cer ojAurhorized
<br />Agent," "Telephone Number," and "Dale" al bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specie led in permit. Retain rnpy for your records.
<br />14. More detailed instructions"for use of this Discharge Monitoring Report (D,t1R) form may be obtained Crom O6ce(s)
<br />specified in permit.
<br />Legal Notice
<br />TLis report isirequired by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, 4r by imprisonment for not more than one year, or by both.
<br />EPA Farm 3320-1 (Rev. 08-95)
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