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<br />Paperwork Reduction Act Notice
<br />public reportidg burden for this collection of information is estimated to vary from a range of IO hours es m
<br />average per trspottse for some minor facilities, to 110 hours as as average per response for some major facilities,
<br />Wit~B vyieighted average for major and_rnht~r facilities of 18 hours per response, including time for reviewing
<br />igstruertions, searching existing data sources, gathering and maintaining the data Deeded, and completing and
<br />Cv. the collection of informatioD. Send comps regarding the burden estitmate or any other aspect of
<br />tlti:, ~Ilectioe of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />PM~j:~4~ , U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />" bf IntpnAalioD and 1{egulatory Affairs, Office of Management end Budget, Washington, DC 20503.
<br />General Instructions
<br />y ,~
<br />has beep partially completed by preprinting, disregard instructions directed at entry of that information
<br />Preprinted.
<br />'Perrpittee Name%44ailing Address (and facility nameJlocation, if different)," "Permit Nrrnrber," and
<br />urge Number" where indicated. (A separate form is required for each discharge)
<br />Beginning and ending 'Monitoring Period" covered by form where indicated.
<br />"Parameter" az specified in monitoring requirements of permit.
<br />5 ~hter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units spccified in permit.
<br />"Average" is normally arithmetic average (geometric average (or bacterial parameters) of all sample measurements
<br />' -for each parameter obtained during ",tlonitoring Perrod"; ",Lfaximum" and "rLlinimum" are normally extreme high
<br />and low measurements obtained during "Monitoring Period." (Note to municipals w7th secondary treatment
<br />. requirement: Enter 30~ay average of sample nteasuremcnts under "Average," and enter maximum 7~day average
<br />of sample measurements obtained during monitoring period tinder "Alaximurn.'J
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<br />~6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specified in permit.
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<br />.7Under "No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7day average as appropriate) perntit req~iremen[ for each parameter. If none, enter "0".
<br />•$. Enter "Frequency ojAnalysis" both as "Sample MeasurmenP' (actual frequency of sampling and analysis used
<br />~: ,during monitoring period) and az "Permit Requirement" specified in pernut. (e.g., Enter "Con(," for continuous
<br />monitorng, "1/7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />~'9.3Emer "Sample Tvpe" both az "Sample MeasuremenP' (actual sample type used during monitoring period) and az
<br />~ - ; "Permit Requirement," (e.g., Enter "Grab" for individual sample, "24NC' (or 24-hour composite, "NiA" for
<br />}i'" • -eontjhuous monitoring, etc.)
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<br />rio. `Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />` ` actions taken, and reference each violation by date.
<br />1'1.:If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />k2. Enter "Namell'itle ojPrincipal Executive OjTcer" with "Signature ojPrincipal Executive OJTcer ojAuthorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />~~i. 'Mail signed Report to OBce(s) by date(s) specified in permit. Retain copy for your records.
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<br />ifd: More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained Gom Office(s)
<br />specified in permit.
<br />Legal Notice _
<br />'s 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 />civil penalties Dot to exceed S1U,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />o ytolation, or by imprisonment for not more than one year, or by both.
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<br />~~"t,rForm 3320-I (Rev. 08-95)
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