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Paperwork Reduction Act Notice
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<br />hl'c repo ing burden for this collection of information is estimated to vary from a range of l0 hours as an
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<br />eaage der nse for some minor facilities, to 110 hours as m average per response for some major facilities,
<br />wit~r_nteig ted average for major and minor facilities of IB hours per response, including time for reviewing
<br />instructions, ~ searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing th~Z collection of information. Send comments regarding the burden estimate or any other aspect of
<br />thi; 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 20460; and to the
<br />lNfice of Infbrmation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />~~ General Instructions
<br />Ii IF form has been partially completed by'preprin[ing; disregard instructions directed e[ entry of thatinformation
<br />`{ aGeady preprinted. -... -
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<br />2. Soler 'Permittee Name/Mailing Address (and facility name/loptibn, if diSerenQ," "Permit Nun+ber," and
<br />. '"Discharge Number" where indicated. (A separate funs is required for each discharge)
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<br />3~. dater dates beginning and ending "Afoniloring Pcriod" covered by (arm where indicated.
<br />4: Enter each "Parameter" as specified in monitoring requirements of permit.
<br />~il Enter "Sample Afen.curemcnr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />~F I "Averngr" +s normally arithmetic average (geometric a:eragc for bacterial parameters) of all sample measurements
<br />t ~ Wr each parameter obtained during ":i6autoring Perod'; ".lfaximum" and "a4inimun+' are normally extreme high
<br />~` ~ and low measurentcuts obtained during ".lfoniroring Pcriod." (Note to municipals with secondary treatment
<br />I, ' requirement Enter 30-day average ot'samp~c .necsurmcnts under "Average," and enter maximum 7day average
<br />I of sample measurements obtained daring monitoring period under "Afaximum. 1
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<br />i 6: Enter "Pervnit RequiremenP' for ach par~mcter under "Quantity" and "Quarity" as specified in permit.
<br />Under ".vo Ex" enter number of sample mcasurntents mating monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />Enter "Frequency njAna::sis" both as "Sample ilea~vrntent" (actual feyuency of sampling and analysis used
<br />during monitoring p_riod) and a: "Permit Requrrerue;:P' specified in permit. (e.g., Enter "Coat," for continuous
<br />monitoring, "1.7" for one day per week. "1.30" rot one, dn} per month, "//90" for one day per quarter, etc.)
<br />. Enter "Sample Type" both as ".•;ampie /~lensvrr:near" (actual sample type used during monitoring period) and as
<br />"Per.•hir Regw,-ement," (e g., Eater "Gr.:o" for individual sample, "24N.C" for 24-hour composite, "N/A" for
<br />.conUnucus moni[onng, etc.)
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<br />Where violatiors of pemct requircu;ents are tenoned. attach a brief explanation to describe cause and corrective
<br />actions trdccn, and reference each violation by dote
<br />i li'"no dtscharge" occurs during monitoring pe+iod, enter "No Dischage" across form in place of data entry.
<br />Enter ":Vame/1'itlc ojPrincipa! F:-ecurive OJJic,•r" with "Signcrure ojPrrncipal Executive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Dal.'" at boCam of form.
<br />Mail signed Report to Ofi''ce(s) b; dare(s) specified in permit. Retain copy (or your records.
<br />(€i More derailed tnstmctions for use of this Prschcrge a!,,ruloring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Leal Notice
<br />~, repen is required by law (3' U ~.~'. 1316: 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />r' tin ct~il penalties not to oxceed St0,oW per d:_t of violation: or in criminal penalties not to exceed 525,000 per day
<br />of tation, or by imprisonment fur qpi more thin one Near, or by both.
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<br />EP3r~Form 3320-1 (Rev. 08-95)
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