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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 10 hours as an
<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 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 />'I 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 Streat, SW Washington, DC 20460; and to the
<br />~ Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<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 ,'Name„Llailing Address (and facility rtamelloca[ion, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'hlonirorinR Perrod" covered by form where indicated.
<br />4. Enter each "Pnranrerer" as specified in monitoring requirements oCpermit.
<br />S. Enter "Sample .llcosvrement" data for each parameter under "Quantity" and "Qunlihi' in units specified in pertttit.
<br />"Aresge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ",lfnnirnricg Periud'; " lfaximurn" and ",tlin;mum" arc normally extrem: t~gh
<br />and low measurements obtained during ".tloairoring Perrod." (Note to muniapals niih secondary treatment
<br />requirement: Enter JO-day avcmge of sample measurements under "Average," and enter maximum ~-dap average
<br />of sample measurements obtained during monitoring period under ",'vlazimmn.'J
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specifed in permit.
<br />7. Undzr ".\'a Ex" enter number of sample mcasurntents during monitoring period that exceed maximum (and/or
<br />minimum or 7~ap average as appropnatc) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency of Analysis" both as ".Sn,nple Alearurnren!" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Fermi! Requirenren!" specified in permit. (e.g., Enter "Cont," for continuous
<br />monitoring, "I ~7" for one day per wee}:, "1 r30" for one day per month, "I/90" for one day per quarter, etc.)
<br />9. Enter "Sample Tyne" both as "Sample lfeasvr•ement" (actual sample type used during monitoring period) and as
<br />"Permit Requrrenrenr," (e.g., Enter "Grub" far individual sample, "1JffC' for 24-hour composite, "rV/,1" Cor
<br />continuous monitoring, etc.)
<br />t0. Where violations of permit requirements arc rzported, attach a bricC explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. (f "no discharge" occurs during monitoring period, enter "Na Discharge" across Corm in place of data entry.
<br />12. Enter "Neme~Ti!!e oJPrincrpa! Executive O~cer" with "Signature ojPrincipnl Executive Officer ojAutharized
<br />Agent,"' "Telephone Number," and "Dare" al bottom of form.
<br />13. Mail signed Report to Offce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge A9aniroring Report (DMRJ 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 510,1X)0 per day of violation; or in criminal penalties not to exceed 525.000 per day
<br />of violation, otr by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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