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Paperwork ]lZeduction Act Notice
<br />Public reposing burden for this collection of information is estimated >o 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 />reviewing the collection of inforrna[ion. Send comments regarding [he 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. Envtronmeotal Protei:tiom Agency, 401 M Street, SW Washmgtom, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Wasbingtoo, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permittee .Yame~'vfailing Address (and facility namt•Jlocation, if different)," "Permit Number," and
<br />"Discharge h'umbe•r" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ':tlonilorinAPeriod" rnvered by form where indica:ed.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sarnp(e dtemurernenr" data far each parameter under "Quantity" and "Qualit}'" in units specified in permit.
<br />"Average" is nornrallc arithmetic average (geometric average for bacteria parameters) of all sample measurements
<br />for each parameter obtained during ':4lonimrir,R Perind"; ".tlarimma" and ".tlmimwn" arc normally cxUemc high
<br />and lo.v measurements obtained during ".t fonitoring Penod." ('.Jotc to municipals with secondar}' Vestment
<br />requirement: Enter 3u~av average of s:u rple .ncasurcmcnts under "Average," and enter maximum 7-day average
<br />otsample measurements obtained during monitoring period under ",tlarin+um.
<br />6. Enter "Permit Requirement" far each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ".Vo Ex" eat.°r number of sample measurrments during moniroring period []rat exceed maximum (ancVor
<br />minimum or 7-day average as appropnate) pcrn~it requirement for each pa~ametcr. LC none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both as ",Sornple .lleoa~urment" (actual frequenq of samp:ing and analysis used
<br />during monitoring period) and as "Permit Requirerrren!" specified in permit. (e.g., Enter "Cunt," for continuous
<br />monitoring, "1:7" for one day per week, "1.30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Ttpe" both as "Sample .t lca.rurc•irient" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" Cur individual sample, "Z~JNC"' Cor 2.4-hour composite, ""';5" for
<br />continuous monitoring, etc.)
<br />10. Where violations oC permit requirements are reported, attach a brief explanation to describe cause and correc,ive
<br />actions taken, and reference each violation by date.
<br />1. If "no discharge" occurs during monitoring peri~~d, enter ".+4'o Discharge" across form in place of data entry.
<br />12. Enter "Name/I'itle ajPrincipal Executive Officer' with "Signature ajPrincipnl Executive Officer ajAuthorized
<br />Agent," "Telephone Number," and "Dale" al bottom oCCorm.
<br />13. Mail signed Report to lace(s) by date(s) specified in permit. Retain copy Cor your records.
<br />l4. More detailed instructions for use of this Discharge Afonitorrng Report (DMR) fora may be obtained Crom 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. 125.20. 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 525,1100 per day
<br />of violation, or by imprisonment for mot more than once year, or by both.
<br />EPA Form 3720-1 (Rev. 08-95)
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