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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 l0 hours as an
<br />average per response for some minor facilities, [o 110 boors 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 />instructions, 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 />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, SN' Washington, DC 20460; and [o the
<br />Office of Information and Regulatory Affairs, Off,ce of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />l..lf form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Eofer +Permittee Nnme%'4lailing Address (aid facility namr•1localion, if differenQ," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required Cor each disclLnrge.)
<br />3. Enter dates beginning and ending ':1lomtnring Fervor/"covered by form wficre indicated.
<br />4. Enter each "Parameter" as specified in r.to.utor-ng regwrentenu of permit.
<br />5. Enter "S'ample.1leawremen!" data far each parameter under "Quamity" and "Quality" in units sptcified in perm:[.
<br />"Average" is normally ariUtmetic aterage (gcoruaric acemge for bacterial parmetcrs) of all sample meaa rements
<br />for each parameter obtained rlnring ";1lnmurru.g Perir,f~, "1,`exinm,n" ,trd 'S'~finivnun" arc normally extreme high
<br />and low mcasuremen~s obtained during ",11uniluring Per~ud." (h-otc ~o municipals with seccndary• treatment
<br />requirement: Enter 3~~-dav average of sample measurements under',dverogz," and enter maximum 7-day average
<br />of sample measurements obtained dunng moniUring period under "rLfoximum.'J
<br />6. Enter "Perna! Requirrmen!" for each parameter under "OuantiN" and "Quality" as specified m pcrtnil.
<br />7. Under "Nn Ex" ent•:r number of sample mca,umrents during monitoring period that exceed maximum (and/or
<br />minimum or 7~ay average as appropriate) pern±it requirement for each paramour. If none, enter "0".
<br />8. Enter "Frequency aJ.lnalysis" both as ".Sample d/ea.~urmenl" {actual frcquene; of sampling and analysis used
<br />during {monitoring period) and as "Fermi! Requirenamr" specified in permit- (c.g., Enter "Conn" for continuous
<br />monitoring, "1-T' for one day per week, "I.30" for one c'ay per month, "I X90" for one day per quarter, elcJ
<br />9. Enter "$arnple Tvpe" both as "Sample Alemuremen!" (actual sample p•pc used during monitoring period) and as
<br />"Perturb Requirement," (e.g., Enter "Grab" f>r individual sample, "2JHC" for 24-hour composite, "N/~" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are n.ported, attach a brief explanation to describe cause and corrxtive
<br />actions taken, and reference each violation by date.
<br />11. Tf "no discharge" occurs during monitoring peri~~d, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/1'itle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive OJ~cer ojAulhorized
<br />Agent," "Telephone Number," and "Dale" a[ bottom of form.
<br />13. Mail signed Report [o Office(s) by date(s) specified in pcrntit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This 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 />result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 330-1 (Rev. 08-95)
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