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Paperwork Reduction Act Notice
<br />Pltblic reporting burden for this collectioe 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 r weighted average for major and minor facilities of l8 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. 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 Street, SW Washington, DC 20460; and to the
<br />Cfffice of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503:
<br />General Instructions
<br />1. If form has be.°n partially completed by preprinting, disregard instructioni: directed at entry of thaz infomration
<br />Plready preprinted. .. ~.
<br />2: Enter 'Perrnirlee Name/Alailing Address (and facility nameJlocation, if different)," "Permit Number," and
<br />' "Discharge Number" where indicated. (A separate form is required for each discharge.)
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<br />t3. inter dates beginning and ending "Monitoring Period" covered by form where indicated.
<br />f~A}=~irtter each "Fcrnmerer" as specified in monitoring requirements of permit.
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<br />5, Enter "Sample ,NeasuremenP' data for each parameter under "Quamiry" 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 ".rvlonitoring Period'; ",14aximum" and "Minimum" are normally extreme high
<br />and bw measurements obtained during ".Lloniloring Period." (Note to municipals with seccndary treatment
<br />k requirement Enter 30-day average of sample measurgthents under "Average," and enter ma~cimum 7-day average
<br />f I of sample measurements obtained during monitoring perio$ under "bfaximwn.'J
<br />i::b Enter "Permit Requirement" for each parameter under "quantity" and "Quality" as specified in permit.
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<br />;'7.~Under ",No Fx" enter number oC sample measurments during 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 />8~n[er "Frequency ojAnalysis" both as "Sample Measui9nent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Coot," for continuous
<br />tponitoring, "!i7" for one day per week, "l/30" for one day per month, "1 i90" for one day per quarter, etc.)
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<br />"~9.:Emer "Sample Type" both as "Sample 6feasurement" (actual sample type used during monitoring period) and as
<br />'t' "PenNit Requiremen{" (e.g., Enter "Grab" for individual sample, 24HC' for 24-hour composite, ".N/A" Cor
<br />contitmous monitoring, etc.)
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<br />t0. Where violations of permit requirements are reported, attach a brief explanation to describe cause and correaioz
<br />.actions taken, and reference each violation by date.
<br />~-(. `If "no discharge" occurs during monitoring period, enter ",Vo Discharge" across form in place of data entry.
<br />~f2.'Enter "Name/I'i!le of Principal Executive OJTcer" with "Signature ojPrincipa! Executive Officer ojAutborized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />~3. Mail signed Repoli to Office(s) by date(s) specified in perntit. Retain copy Cor your records.
<br />34: More detailed instructions for use of this Discharge ,Lfonitoring Report (DMR) Corte may be obtained from OBice(s)
<br />.: specified in permit.
<br />`~ ' Legal Notice
<br />rR is required by law (33 U.S.C. 1318; 40 C.F.R. 1]5.27). Failure to report or failure to report truthfully can
<br />civil penalties not to exceed SI0,000 per day of violation;•or in criminal penalties not to exceed x25,000 per day
<br />pn, or by imprisonment for not more than one year, or by both.
<br />3320-1 (Rev. 08-95)
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