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Paperwork Reduction Act Notice
<br />Public reporting burden for [his 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, i
<br />with a weighted average for major and minor facilities of IB hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and
<br />reviewing the collection of information. Send avmments 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 />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 Nan+eMailinR Address (and facility name/location, if different)," "Permit Number," and
<br />"Discharge Number" µhere indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginntng and ending "Aloniroring °eriod" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />S. Enter ".Smnple Alensurement" data (or each parameter under "Quantity" aad "Quclity" in units specified in permit.
<br />"Average" is normally arithmetic avemgc fgcomctnc arcrage for bacicrial parameters) of all sample measurements
<br />(or each parameter obtained during ".41nni(nr+n,g Perio.f'; ".Maximum" and '4tlini,num" are normaay extreme high
<br />and low measurements obtained during ",tlmritoring Per+od." (Note to municipals HilJt secondary treatment
<br />requircmenC Enter 3(t-day average of sample measZtremenls under "Average," and enter miximum 7-day average
<br />of sample measurements obtained during n,oni[nring period under ",tlarimam.
<br />6. Enter "Pern+i! Req:iiremenP' for each parameter under "Quan(iry" and "Qunlity" as specified +n permit.
<br />7. Under ".No Ex" enter number o' sample meatumtcnts during monitoring pcricd tlvat exceed maximum (and/or
<br />minimum or7day average as appropriate) perniit requirement for each parameter. If none, enter "0".
<br />B. Enter "Frequency oJAnalysis" both as ".tiamF/e Aleasurmen!" (actual frequency of sampling and artalysis used
<br />during monitoring period) and as "Pern+i! Requireu+ent" specified in permit. (e.g., Enter "Conn" for continuotu
<br />monitoring, "I/7" for one day per week, "130" 1'or one day per month, "//90" Cor one day per quarter, etc.)
<br />9. Enter ".Sample Type" both as ".Cample Afeasurernenr" tactual sample type used during monitoring period) and as
<br />"Permit Requuemcnr," (e.g., Enter "Grab" for individual sample, "24ffC' for 24-hour composite, "h%A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are r<:ported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference eac~t violation by ds te.
<br />11. U"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/I'i((e ojPrincipal Erecu(ive O~c:er" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at boll om of form.
<br />13. Mail signed Report to Ollice(s) b} date(s) speciC ed in permit. Retain copy For your records.
<br />14. More detailed instructions Cor use of this Discharge Monitoring Report (D.4fR) form may be obtained Crom O@ice(s)
<br />specified in permit.
<br />Leal 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 510,000 per day of violation; or is criminal penalties not to exceed (25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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