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Paperwork Reduction Act Notice
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<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as am
<br />average per response for some minor facilities, to 110 hours az 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 existing data sources, gathering and maintaining the data needed, and completing and
<br />revieying the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />tbis.'collection of information, including suggestions for reducing this burden, to Chief, Infotmatiom Policy
<br />$'ranch, PM-223, U.S. Environmental Protection Agency, 40L M Street, SW Washington, DC 20460; and to the
<br />Otlice of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC'20503.
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<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
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<br />$'. Enter "Permirlee Nnrne ;hf¢ihng Address (arid. facility nameAocauon, if drfferenq," "fermi! Number," and
<br />` "4ischnrge A'umher" where indicated. (A separate form is required for each discharge.)
<br />3. Efrter dates beginning and ending 'Afonitoring Period"covered 5y Corm where indicated.
<br />4, _$n[er each "Par¢metvr" az specified in monitoring requirements of perma.
<br />~5. Enter ".)'ample A•feasvren,ent" data for cash paratucter under "Qu¢nrity' and "Qv¢liry" in units specified in permit.
<br />"Averag,°" is normally arithmetic average (ocomelric average fcr bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".11onr1uring Period'; "Afarirnum" and ",tfmimum" are normally extreme high
<br />and !ow measurements obtained during "alm•rroring Feriod." (Note to municipals with secondary treatment
<br />tgquiremerrt: enter 30~ay average eC sample mcatsurements under "Averq„e," and enter ma.:imrun 7-day average
<br />of sample mea;uret:rcnL obtained during monitoring period under ".4lnximnm
<br />~,6. Enter "Permil.Requo-a•nenP' for rack parameter under "Qupnlity" and "Quality" az specified in permit.
<br />;,7.,Unde,f ",Vu F_c" enter number of sample measttnnents during monitoring period that exceed maximum (and/or
<br />mirtithum or 7-day average as appropriate) permit r: quitesnent for each parameter. lI none, enter "0".
<br />~~g; Enter "Frequency u(.tnn.'uis" both as "S'omple :LlensirrvnenP' (actual frequency of sampling and analysis used
<br />iy.; $htring monitoring period; and ;is "Pun,i, Kequnerr;en(" Specified in permit. (e.g., Enter "font," for continuous
<br />yrtoniloring, "!~."' Cor one day per week, "1 X30" for one d,~y per month, "1 i90" for one day per quarter, etc.)
<br />~; F.rtler ",Sample Type" both as "Sa,npls bfeosw,~~nrnr" (edi:al sample ry3+^_ used during monitoring period) and az
<br />,; ,rFenait Requrrement." (r.g., enter "i;r¢h" far individual sample, '.'JHC"' for 24-hour composite, "A;~A" for
<br />."continuous monitoring, etc.)
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<br />)~); Where violations of ~tnnit requirements x :: rcpuned,. y(jach a brief exp'.anation to describe catrse and corrective
<br />. ,actions taken, and reference each violation by date
<br />Tf "no discharge" urcts during mmtiwrmg period. enter ",4'o Discharge" across form in place of data entry.
<br />Enter "A'arne,Ti!le ojPrincipul Eu"curir-e Ulcer" with ".Signature ojPrincipal Executive Officer ojAulhorized
<br />Agent," "Telephone Number," ano "Jule" at bottom of form.
<br />Marl signed Report to Office(s) by date(s) spccJ;xl in pemrit Retain rnpy for your records.
<br />More detailed instn.~t ions for use cr this D+scharge,Lforlitoring.Reporf (DMP) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />report is required by law (33 U.S.C. 1318; w0 C.F.R. 1'?5.27). Failure to report or failure to report truthfully can
<br />t in civil penalties not to ez.eed 510.000 per day of violation; or in criminal penalties not to exceed E25,000 per day
<br />~pttion, or by impnsorurent for not note than one year, er by both,
<br />3320-1 (Rev. 0:-95)
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