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Paperwork Reduction Act Notice
<br />Public reporting burden for tkus collection of information is estimated m vary from a range of f0 hours as ao
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilipes of I8 hours per response, including time for ceY~iwiog
<br />instructions, searching existing data sources, Wiring and mahataining the data Deeded, and tom and
<br />reviewing the collection of information. Ser!d comilrents regardug the burden estimate or any ottti~tispect of
<br />this wllection 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 />Office of Information and Regilatory Affairs, Office of iJanagement and Budget, Washington, 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 "Permittee Nane/Maifing Address (and facility name/Iocation, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A so{bamte form is required far each discharge.)
<br />3. Enter dates beginning and ending "ttifonitpring Period" covered by form where indicated.
<br />4. Enter each "Pnrametei' as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measurement" 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 meastrements
<br />for each parameter obtained during "hloniraring Period"; "Afaximum" and "AfinintJrn" are normally extreme high
<br />and low measurements obained during ",monitoring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-day average of sample measurements under °Average," and enter maximum 7-0ay average
<br />of sample measurements obtained during monitoring period under "Maximum.')
<br />6. Enter "Permit Requirement` for each parameter un@er "Quantity" and "Quality" as specked in permit.
<br />7. Under "No Fs" enter num~es of sample measutments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average ,~s appropriate) permit requirement for each parameter. If none, toter "0".
<br />8. Eoler "Frequency oJAnalysis" both as ':Cnmple Aeasurment" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Fermi! Requirement" specified in pcnnit (e.g., Enter "Coot," for continuous
<br />monitoring, "1; 7" for one d2y per week, "/.-30" for one da}' per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Smnple Tvpe" both as ".Sample ,Lasurement" (actual sample type used during monitoring period) and as
<br />"Permit Requrrement," (e.g., Enter "Grab" for individual sample, "14NC" Cor 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where vioiations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />] l . If "no discharge" occurs during monitoring period, enter "Aro Discharge" across form in place of data entry.
<br />12. Enter "Nane/fitle ojPrincipal Executive O)Tcer" with "Signature ojPrincipal Executive Officer ojrluthorized
<br />Agent,' 'Telephone Number," and "Date" at bottom of form.
<br />I3. Mail signed Report to Office(s) by date(s) speci<ed in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DrLIRJ form may be obtained from Office(s)
<br />specified in permit.
<br />I.,egal Notice
<br />73is 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 ant to exceed 810,000 per day of violation; or in criminal penalties not to exceed $?5,000 per day
<br />of violation, o: by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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