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Pa•rwork Reduction Act ~r•:c
<br />Public reporting burden for this collection of information is ax[imated to vary hom n range ,` ~ . _ ~_; :;.
<br />average per reslwnsr fur some minor facilities, to :10 hours as an average peer resranse 1br c _ . .. .. ,
<br />with a weighted average for major aw minor facilities of l8 hours per ~c p.~n,. ;n~..::u-~ ~ur ' .; re ,c~.:~,g
<br />instructions, searching rzisting dau, source, gathering smd maintaining ~ ~•: ~„ na.ku ,m~: a~.upldt og ~w
<br />rr.viewing the collection oC information. Send wmmenls regarding We ~utdre .5um.,Ic v. airy other aspect of
<br />this collection of information, including suggestions for reducing this F rJc i. ;a ~"uiei, iuf~rtralioo Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 40i M Street, 3 i tVi ymg;gym. JC 2(1460; ao.l to the
<br />Office of Information and Regulatory Affairs, Office of tv,anagennentand 3~aigd, Nash ngwu, DC 20503.
<br />General Instruction~~
<br />1. If form has been partially completed by preprinting, disregard instructions direxteJ a[ entry of that informelioo
<br />already preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility namellocatiort, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending Monitoring Period" covered by form vrhere indicated.
<br />4. Enter each "Parameter" az specified in monitoring requiremcots of permit.
<br />5. Enter "Sample Measurement" data for each parameter under "Quantity" ~cnd "4'ualin;" in traits specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacteri:d parameters) of aJl sample measurements
<br />for each parameter obtained during "Monitoring Period'; ",Maximum" a od 'S.;inimu:n" are normally erlrcme high
<br />and low measurements obtained during "Monimring Perim." (Note to municip~Js with seconda,-y treatment
<br />requirement: Enter 30-0ay average of sample measurements under "Ave rage," and enter maximum 7-Jay average
<br />of sample measurements obtained during monitoring period under "Maximum. ~
<br />6. Enter "Permi(RequiremenP for each parameter under "Quantity" and "Qenh'ty" az sp:cired in petmit.
<br />7. Under "No Fs" enter number of sample meastuments during monitona~g petiod clot exceed maximum (and/or
<br />minimum or 7-0ay average az appropriate) permit requirement for each p,ttameler. U' none, enter "0".
<br />8. Enter "Frequency ojAnofysis" both az "Sample A4eacurmen!" (actual ii~equenry o: sampling and a~talysis tts.~
<br />during monitoring period) and az "Pernri! RequirenrenP' specsed in pcrtrtit (e.g. Emer "Cart," fo rnntinuous
<br />monitoring, "1/7" for one day per week, "I/30" for one day per montl4 '/''i 0" ~cr one day per quarter, C.a.)
<br />9. Enter "Sample Type" both az "Sample Measuremen!" (actual sample tyiv: t_seu durng monitoring pe.~od) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "~•If/C" for ?4-hour composite, "id/A' :or
<br />continuous monitoring, etc.)
<br />]0. Where violations of permit requirements are reported, attach a brief ex rCanation to describe cause and correct ~e
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Uischarge" ncruss Form in place of data cctr/.
<br />12. Enter "Name//'ilfe ojPrincipaf Executive Officer" with "Signature ojPrincipa! Executive Officer ori.uthorized
<br />Agent," "Telephone Number," and "Da(e" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pernait. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (UitIR~ farm may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />Tbis report is required by law (33 U.S.C. 1318; 40 C.F.R. 175.2'1). Failure m report or failure to report trrtthfirlly can
<br />result in civil penalties not to exceed E10,000 per day of violation; or in crimio:;l penalties not to exceed 525,p0~ ;:er dty
<br />of violation, or by imprisonment for not more Wan one year, or by both.
<br />EPA Form 3320.1 (Itev. 0&95)
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