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Reduction Act
<br />Pttbljc reporting burden for this collection of information is estimated to vary from a range of 10 hours as en
<br />t?avdrage per response for some minor facilities, to 1]0 hours as m average per response for some major facilities,
<br />`vtiWt a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />)racoons, searching existing data sources, gathering and maintaining the data needed, and completing and
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<br />vtmg tbq.collection of information. Send comments regarding the burden estimate or any other aspect of
<br />V~ ` Ilec[ion of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Br~ncth, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and [o the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />~iP.iIP.P~l~ TllCtl"llCtlnilC
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<br />1: f form has been partially completed by preprinting, disregard instructions directed at entry of that°irifornutioo
<br />,'already preprinted. .
<br />~ r.2. Tsnttr "Permittee Name/,1failing Address (and facility name/location, d di$'erent),' "Permit Number," and
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<br />"Discharge Number" where indipted. (A separate Corm is requited for cacti discharge)
<br />3 inter dates beginning and ending 'iYfonitoring Period" covered by form where indicated. .
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<br />-Enter each "Parruneter" as specified in monitoring requirements of permit.
<br />~ Frnte. "Sample Measurement" data for each parameter under "Qutmtity" and "Quality" in units specified in permit.
<br />!' 1 "Average' is normally arithmetic average (geometric average for bacterial parameters) of all sample meastuements
<br />I; l .for each parameter obtained during "rLfonttoring Period; "Maximum" and "A~inimum" are normally e>,lreme high
<br />and low measurements obtained during "~Lfonitorin~.Period." (Note to municipals with secondary treaunent
<br />~i. rtquitemenl: Enter 30~ay average of sample measurements under "Average," and enter maxiantm ~~ay average
<br />' of sample measurements obtained during monitoring Retied under "Maximum.')
<br />;16. Enter "Permit Requirement" for each parameter under"Quantity" and "Quality" as specified in permit.
<br />;7. Under "No Ex" enter nwnber of sample measurments during monitoring period that exceed maximum (and/or
<br />,miniotum or 7-0ay average as appropriate) permit requirement for each parameter. Lr none, enter "0". .
<br />~ai.~ntei' "Frequency oj.4nalysis" both as "Sample Mea"surment" (actual frequenry of sampling and analysis used
<br />'~ 'during monitoring period) and as "Permit Requiremrigt"'specified in permit. (e.g., Enter "Coot,' Tor continuous
<br />.': ;monitoring, "l/T' for one day per week, "f/30" for one,~ay per month, "1/90" for one day per quaAer,.elcJ =
<br />q9 ,Enter 'Sample Type" both as "Sample MeasuremenP'[actual sample type used during monitoring period) and as
<br />tf "Permit Requirernenl," (e.g., Enter "Grab" for ind~vtdual sample, 14HC" for 24-hour rnmposite, "N/A" for
<br />y continuous moruloring, etc.)
<br />jp. tWhore violations of permit requirements are reporte~`altach a brief explanation to describe t:ause and corrective
<br />} :actions taken, and reference each violation by date.
<br />~: of "ro discharge" occurs during monitoring period, enterANo Discharge" across form in place of data entry.
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<br />Enter "Name/title ojPrincipa! Executive Officer' with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />'wigenf," "Telephone Number," and "Dale" at bottotu of form.
<br />Vii. Mail signed Report to Office(s) by date{s) specked in permit. Retain copy for your records:
<br />10. More detailed instmctions (or use of this Discharge Monitoring Report (DMRJ form may be obtained from 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. 125.2. Failure to report or (allure to report Wthfully can
<br />'' ~t in civil penalties mot to excxd 510,000 per day of violation; or in criminal penalties not to exceed 625,000 per day
<br />o , jofation, or by imprisonment for mot more than one year, or by both.
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<br />Ef?~~Edrm 3320-1 (Rev. 08-95)
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