|
Paperwork Deduction Act Notice
<br />Public reporting burden for this 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,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching ezisting data sources, gathering and maintaining the data needed, and completing :md
<br />reviewing the collection of information. Send comments regarding [he burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this bu~deo, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20466; 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 'Permi((ee A~'ame%Llailing Address (and Caciliry name/location, if different)," "Perini( ,Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ':Lfomtnring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitor rig requirements of pcrrnit.
<br />5. Enter ".Sample Afeasuremen(" data for each pazameter under "Quantity" and "Qvalih'" in units specified in permit.
<br />"Average" is nornra,'Iy arithmetic average ;gmnetric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during 'Slfnnrtorirq Periorr'; "dfaxirnu.n" and ".Minimum" are normally extreme tdgh
<br />and low measuremrnls obtained dunng ".Ma nitoring Penad." (:Jots '.o municipals with secondary Vea tmcnt
<br />requirement Enter 3U-dap average of sample :neasurcmcnts under "Average," and enter maximum 7~1a}' average
<br />of sample measurements nbtaincd during monrtnring period under "Afazimum.
<br />6. Eoler "Fermi( RegvrremenP' for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ",No Ex" enter number of san~,ple measurments during monitoring period Iha[ exceed maximum (and/or
<br />minimum or 7-day average as appropriate) pert tit reyuiremcnt Cor each parameter. If none, enter "7".
<br />8. Enter "Frequency ajAnolvsis" bath as ".Smni.le .tfeosurrnen(" (actual frequents of sampling and analysis used
<br />during monitoring period) and as "Perini: Renuiremenr" specified in permit. (e.g., Enter "C'ont," Cor continuous
<br />monitoring, "1~7" Cor one day per wee4., "t 30" !'or one day per month, "Ir'JO" for one day per quaricr, etc.)
<br />9. Enter "5'ample Tvpe" both as "Sample Aleasurcurent" (actual sample type used during monitoring period) and as
<br />"Permit Reguirernenr," (e.g., Enter "Grab" for individual sample, "2aHC' for 24-hour rnmposite, "iV/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and rcCerence each violation b} date.
<br />11. If "no discharge" occurs during monitoring period, enter ",Va Discharge" across (arm in place of data entry.
<br />12. Enter "Nanre.Ti(le ojPrincipa! Executrve OJfcer" with "Signature ojPrincipa! Executive Officer ojAv(harized
<br />Agent," "Telephone A'umber," and "Da(e" a[ bottom oC form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pern»t. Retain copy for your records.
<br />14. More detailed instmctions for use of this Discharge A-loni(oring Report (DMR) (arm may be obtained from Office(s)
<br />specked in permit.
<br />LE~gal 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 SI0,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Fotat 3320-1 (Rev. OH-95)
<br />
|