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i ~ ~ Pa~ work Reduction Act N~ce -,
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<br />f ~ is repoding burden for this collection of information is estimated to vary from a range of 10 hours as m
<br />kj~ge per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />~?~ ~~i~h:a~vreighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />ibslnictions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />vidwing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />"'~ collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />PM-2`23, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />tCk of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />~G~ " , ' General Instructions
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<br />f w'g, f form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />x~ ready preprinted.
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<br />~ 7.~ter 'Permittee Name/hlailing Address (and facility name/location, if dill'erenQ," "Perini( Number," and
<br />` Discharge Number" where indicated. (A separate form is required for each discharge.)
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<br />` 3:>Eme~ dates beginning and ending 'iLloniroring Period" covered by form where indicated.
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<br />r ~ ~nter each "Parameter" az specified in monitoring requirements of permit.
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<br />~;5. Enter "Sample Measurement" data for each pammeter under "Quantity" and "Quality" in units specified in permit.
<br />r ~ "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />~ :for each pammeter obtained during "tifoniroring Period'; "Maximum" and "A-finimum" are normally extreme high
<br />~` :and low measurements obtained during "Monitoring Period." (Note to municipals with secondary Vea[mgnt
<br />requitement: Enter 30~1ay average of sample measurements under "Average," and enter maximum 7-0ay average
<br />i' dfsample measurements obtained during monitoring period under "Marimum. J
<br />{{i 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specified in permit.
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<br />f T. Under "Na Fx" enter number of sample measurments.during monitoring period that exceed maximum (and/or
<br />minitftum or 7-day average az appropriate) permit requirement for each parameter. U none, enter "0".
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<br />~B,.,Enter "Frequency ojAnalysis" both as "Sampte AfeasurmenP' (actual frequency of sampling and analysis used
<br />5 during monitoring period) and az "Permit Requirement" specified in pernul. (e.g., Enter "Coot," for wntinuous
<br />~ f: monitoring, "1/7" for one day per week, "1/30" for one day per month, "f/90" for one day per quarter, etc.)
<br />P. Enter "Sample Tvpe" both az "Sample ~Lfeasurernent" (actual sample type used during monitoring period) and az
<br />' "Pemtit Requirement," (e.g., Enter "Grab" for individual sample, 24NC'" for 24-hour composite, "N/A" for
<br />,,.. continuous monitoring, etc.)
<br />Whore violations oC permit requirements are reported,~aRach a brief explanation to describe cause and corrective
<br />~~ "actions taken, and reference each violation by date.
<br />~ ..~ "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />~;~Enler "Name/title ojPrincipal Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," "Telephone Nwnber," and "Date" at bottom of form.
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<br />E3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
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<br />More detailed instructions for use of this Discharge Monitoring Report (DMR) forth may be obtained from Office(s)
<br />' specked in permit.
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<br />i;~- Legal Notice
<br />'g~ rt 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 />t ~ivil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000. per day
<br />o b~ation, or by imprisonment for not more than one year, or by both.
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<br />EfFdrm 3320-1 (Rev. 08-95)
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