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<br />Paperwork Reduction Act Notice
<br />Ppblib. reporting burden for this collection of infotmatiun is estimated to vary from a range of l0 hours Ls m
<br />Avenge per response for some minor facilities, to I10 hours az an average per response for some major facilities,
<br />wit~~a v~iBhted average for major and minor facilities of I8 hours per response, including time for reviewing
<br />bisttuct[ms,'searching existing data sources, gathering and maintaining We data needed, end completing .end
<br />ttev4e~ving the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />tl[is~ collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Bturah, PM-223, U.S. Envirrnmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Offoe of Information and Regulatory Affairs, Office of 1,lanagement and Budget, Washington, DC 20503.
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<br />General Instructions
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<br />fy. if (arm has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />°iI. j!lready preprinted.
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<br />~;f; "5nter: "Permitree Name/Mailing Address (and facility rrame/logtion, if diflerenq," "Perms! Number," and
<br />~, ~ ."~'ischarge Number' where indicated. (A separate farm is required for each discharge)
<br />„~FxEnter dates beginning and ending ".4loniruring Perod"covered by (onn where indicated
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<br />4:Enter each "Parameter" as specified in monitoring requirements of permit.
<br />~~ Enter "Sample rLfeasurrmenr" aata for each parameter under "Quuntiry" and "Quality" in units specked in permit.
<br />"Avern~ •" is normally arithmetic avenage (geometric average fcr bacterial parameters) of all sample measurements
<br />for each parameter obtainer dur.ne ":~/unitoring PerioB'; "Aloximum" and "Minimum" are normally extreme high
<br />- and low measurcmcros obtained d:ai:rg ')tlnnitori,rg Period." (Note to municipals with secondary vestment
<br />' requirement: linter 30~ay average cf samplz measurements under "Average," and enter maximum 7-0ay average
<br />,- of sample measurements obtained during monitoring period under "Maximum.
<br />~6. Enter "Permit .4equiremenr" for each parameter under "Quantity" and "Quality" az specified in permit.
<br />{7i Under "No Fx" enter number of satrtple measurments during monitoring period that exceed maximum (and/or
<br />i , minimum or 7da}' average as appropriate) permit requirement for each parameter. If none, enter "tY'.
<br />'8. Enter "Frequency oj.4nalysi.~" both as ':Snnplc dfcasurrnenr" (actual frequency oC sampling and analysis used
<br />e during monitoring period) and az "Permrr Requiremertr" specified in permit. (e.g., Enter "Cam,' for continuous
<br />p.. monitoring, "I/7" for one da}~ per c,eek, "1:30" for oneBay per month, "1/90" for one day per quaver, etc.)
<br />a~ $nter "Sample Type" both az ".S.amplc !.lensurement" (actual sample type used during monitoring period) and az
<br />Y , rPermit Requvemem," (; g., Enter "Grab" for indr$idiral sample, ?dHC" for 24-hour composite, "NiA" (or
<br />continuous monitoring. etc.)
<br />~10:'Wherc violations o! permit requirements are reported; attach a brief explanation to describe cause and corrective
<br />? actions taken, and reference each violation by date. ,
<br />11. If "no discharge" occurs during monitoring period, enter ",Vo Discharge" across form in place of data entry.
<br />l2. Enter "i.mne,rl'ttle ojPrincipal ~•ecurive OJjrcer" with "Signature ojPrincipa/ Executive O)~cer ojAathorized
<br />~;-~ Agenf," "Telephone Number," anA °Dote" a[ bottom oCform.
<br />X13. Mail signed Report to Ollrce(s) b} da:e(s1 specified is permit. Retain copy for your records
<br />~. Mute detailed instruciio:ts fur use of this D:s. %,arge.tfonitorirrg Report (DMR) form may be obtained Gam Office(s)
<br />specified in permit.
<br />- Legal Notice
<br />fs report is required by law (33 ?1.;'.C, r.'.IS; 40 C.f P.. 125.27). Failure to report or failure to report truthfully can
<br />~1t jn civil ~na!tis not to exceed S IO,U;fl per d::y of vtulation: or in criminal pemalties not to ezceeci 525,000 per day
<br />j~iotalion, cr by imprisonment for nut more tt•.an one yea:, or by both.
<br />Form 3320.1 (Rev. 08-951
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