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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as en
<br />average per response for some minor facilities, to l10 hours as m average per response for some major facilities,
<br />with a wyighted average for tnvjor 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 />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />Wia collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management end 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. Eater "Permittee Name/Mailing Address (and facility tuuneJloration, if dig'eren[)," "Permit .Number," and
<br />"Discharge Number" where indicated. (A separate tone is required for each discharge.)
<br />1 ,Enter dates beginning and ending 'it4oniroring Period" covered by form where indicated.
<br />4, )inter each "Parameter" as specified in monitoring requirements ofpermit.
<br />$. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specked in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during "Monitoring Period'; "Maximum" and'Minimum" are normally extreme high
<br />and bw measurements obtained during ":14onitor/ng Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-dav average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under ".A~faximum.')
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7.'Under ".No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />~minimuro or 7~ay average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />s8.tEnter "Frequency ojAnalysis" both as "Sample A-feasurnrent" (actual frequency of sampling and anal}'sis used
<br />' •during monitoring period) and as "Permit Requiremen!" specified in perrrut. (e.g., Enter "Copt," for continuous
<br />-monitoring, "IrI" for one day per week, "I/30" for one day per month, "1/90" for one day per quarter, etc.)
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<br />~'~~.-Enter "Sample Type" both as "Sample 6easurement" (actual sample type used during monitoring period) and as
<br />F ;"Permit Requirement," (e.g., Enter "Grab" for individual sample, "14HC" for 24-hour composite, ",'V/,9" for
<br />.continuous monitoring, etc.)
<br />~1i0.?Where violations of permit requirements are reported, attach a brief explanation to describe cause and cortective
<br />~; -actions taken, and reference each rlolation by date.
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<br />t. a t. R "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
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<br />3~. Enter "NameiTitJe ojPrincipal Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />~ Agent," "Telephone Number," and "Date" at bo0om of form.
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<br />f3. Mail signed Report to Offce(s) by date(s) specified in perntit. Retain copy for your records.
<br />19. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained Crom Office(s)
<br />specified in permit.
<br />' Legal Notice
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<br />~~~,,~~~~~~~~~,,,,,,,,, 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 />t in civil allies not to exceed SI0,000 r da of violation; or in criminal
<br />pea pe y penalties not to exceed 525,000 pet day
<br />vtolltion, or by imprisonment for not more than one year, or by both.
<br />C'
<br />)~Pi4~Form 3320-1 (Rev. 08-95)
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