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F~r~vork Reductia~n Act A•:c .
<br />Public reporting burden for this cdlution of information is estimated t~; ~: ~ ..: r. ..:.;;r :~f :~., :.~.,u;.; s :.n
<br />average per response (or some minor facilities, w 110 hours as an averagt ..r ~. ~ ,.,:" or .o:n~ a~:., cr tc:i~itias,
<br />with a weighted average for major and minor facilities r: :S hour per -: i,: ^;. in~~.,dicg ore- i~,r re ie~.~irg
<br />instructions, searching ezistmg data sources, gathering :~n~. rna~intainin ~ i. . :.e mod, min aanplel ag and
<br />roviewing the collection of utformatioc. Send cotnmenu rcg;trding the o.tdrr .sum.re cr a„y other i<~ of
<br />this collection of information, including suggestions fee reducing this barua,t, to C'hie(, Information Polic}
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 ht Street, S"r' `Ni hingP:n, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Managecneot and 3mige[, WasFuagton, DC 20503.
<br />General Instructions
<br />If form has been partially completed by preprinting, disregard instructions direct,rJ et entry of that mformahon
<br />already preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility namdlocation, if differenQ," "Permit Number," and
<br />"Discharge Number" where intlipted. (A separate form is required for e<n:h discharge.) '
<br />3. Enter dates beginning and ending Monitoring Period" covered by form where i,~dica ~~~.
<br />4. Emer each "Parameter" as specified in monitoring requirements oCpermit.
<br />5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quolir%' in uniU specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial pars •neters) of all sample m:msttrements
<br />for each parameter obtained during "Monitoring Period"; ",Narimum" arod '7.i~nimunt" are normally .etitreme high
<br />and low measurements obtained during 'Monimring Perod." (Node to nu;nicipals with secondary treatment
<br />requirement: Enter 30-0ay average of sample measurements under "Average," and enter maximum 7-,day average
<br />of sample measurements obtained during monitoring period under "Maxinrurn.';
<br />6. Enter "Permit Requirement" for each parameter under "Qvannty" and "Q~,oliry" as specified in permit.
<br />7. Under "No Fx" enter number of sample measunnents during monitoring period tYat exceed rnarimtun (and/or
<br />minimum or 7-0ay average as appropriate) permit requirement for each parameter. It none, emer "0".
<br />8. Enter "Frequenry ojAnalysis" both as "Sample MeasurmenC' (actual frequency of sampling and analysis usad
<br />during monitoring period) and as "Perini! Requirement" specified in pcrnril (e.g . Enter "font," fo• continuous
<br />monitoring, "1/7" for one day per week, "1/30" for one day per month, "1 "90" for one :ay per quarter, ef:.;
<br />9. Enter "Sample Type" both as "Sample Measurement" (actual sample type urea during monitoring p@~iod) attd as
<br />"Permit Requirement,' (e.g., Enter "Grab" for individual sample, "?JHC' for _'•I-hour composite, ":1'/A" Fo;
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief exp6'anatian to describe cause at d corrective
<br />actions taken, and reference each violation by date.
<br />11. if "no discharge" oceurs during monitoring period, enter "No Uischarge" across Cotm in place of data et try'.
<br />12. Enter "Name~tle oJPrincipal F~eeutive Officer" with "Signature of Pr•incipnl Esrative O~rer o`hulhorizrd
<br />Agent," 'Telephone Number,' and 'Date" a[ bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pemtit. Retain copy fee yottr records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DRfi2; Galin may be ob4vred fr~c, Oltice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or fai;ure to :ep~rt lrvtbfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in crimia.] penalties nut to exceed S2_ti,000 per da}
<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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