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Paperwork ][2eduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a range of 10 hours as .w
<br />average per response for some minor facilities, to l l0 hours as as 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. Semd comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, [o Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to [he
<br />Office of Information and Regulatory Affairs, Office of Management 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 .Vome,:Afarling Address (and facility namellocation, if different)," 'Permit Number," and
<br />"Discharge Number" where indicated. {A separate form is required far each discharge.)
<br />3. Enter dates beginning and ending 'Afonitoring Period" covered by farm where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit
<br />5. Enter "Sample Afeacuremenr" data for each parameter under "Qvnntity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ",Lfonitorirg Period"; ".1/azimum" and ",l finimum" are normally extreme high
<br />and low measurements obtained during "Afonitoring Penud" (VOLC to municipals with secondary trruncn[
<br />requiremenC Enlcr 30~ay average of sample -ncasurcmcnts under ".areragr," and enter maximum 7-day a~:erage
<br />of sample measurements obtained during monitoring period under ",lfaximum.")
<br />6. Enter "Pennil Requirement" for each paratncter under "Quantity" and "Quafity" as specified in permit.
<br />7. Under ".'Vn Fx" enter number of sample meazurr:rents during monitoring period that exceed maximum (and/or
<br />minimum or 7-day accrage az appropriate) permit regmrcment for each parameter. If none, enter "rJ".
<br />8. Enter "Frequency ojAnalysis' both as ".Sample ,1learurment" (actual Lcquenc}• o:` sampling and analysis used
<br />during monitoring period) and az "Permit Requirement" specified in permit. (e.g., Enter "Cant," for continuous
<br />monitoring, "!/T' for one day per week, "f.'.30" for one day per month, "1/90" for one day per quarier, etc.)
<br />9. Emer "Sample Tspe" both az ".Sample .lfeasvrrmenP' (actual sample type used during monitoring period) and az
<br />"Permit Requirement," (e.g., Enter "Groh" for individual sample. "2dHC" for 24-hour composite, "t•.~/f"' for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are n.porled, attach a brief explanation [o describe cause and comN.ive
<br />actions taken, and reference each violation by date.
<br />I1. ff "no discharge" occurs during monitoring pen~~d, enter "lv'o Discharge" across form in place of data entry.
<br />12. Enter ",'Vame/I'i(!e ojPrincipa! Executive O~~er" vvdth ".Signature ajPrincfpn! Executive Officer ojAufhori:ed
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pernvit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afonitoring 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. I3I8; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day ~~F 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 bosh.
<br />EPA Fotvt 3320-1 (Rev. 08-95)
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