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Pa~rwork Reduction Act Nice
<br />Pu~Gc reporting burden for this collection of information is estimated to vary from a range of 10 hours as m
<br />alr0rage per response for some minor facilities, to 110 hours az an average per response for some major facilities,
<br />vpi~'r weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />(f°tnstruceibns, searching existing data sources, gathering and maintaining the data Deeded, end completing and
<br />4 di~wing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />' c~ollectioo of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />'~h, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />~Efiee of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />'¢ ' ` - General Instructions
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<br />°l l,~f form has been partially completed by preprinting, disregard instructions directed et entry of that information
<br />~' . !'ialready preprinted.
<br />~`, Z Enter "Permitlee Name%1~ailing Address (and facility [tamdlocation, if different)," "Permit Number," and
<br />r , "'Discharge Number" where indicated. (A separate form is required for each discharge)
<br />3..Enter dates beginning and ending 'Monitoring Period"covered by form where indicated.
<br />'4. Enter each "Parameter" az specified in monitoring requirements of permit. '
<br />f 5. Enter "Sample Measurement' data for each parameter trader "Quantity" and "Quality" in units specified in permit.
<br />p^ ; "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample meastrements
<br />Sor each parameter obtained during "Monitoring Period"; "Maximum" and "tifinimum" are normally extreme high
<br />and !ow measurements obtained during ",4fonitoring Period." (Note [o municipals with secondary treatment
<br />i requirement: Enter 30-0ay average of sample measuremerµs under "Average," and enter maximum 7-day average
<br />~' of sample measurements obtained during monitoring period trader "hfarimum.
<br />~' Ci. Enter "Permit Requirement" for each parameter under "Qtrirntity" and "Quality" az specified in permit.
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<br />~:7.'Under "Na Fx" enter number of sample measurments~d`aring monitoring period that exceed maximum (and/or
<br />;minimum or 7-day average as appropriate) permit requirement for each parameter. U none, enter "0".
<br />f #$.-F,nter "Fregaency ojAnalysis" both az "Sample Measurment" (actual frequency of sampling and analysis aced.
<br />' during monitoring period) and as "Perneit Requirement" specified in permit. (e.g., Enter "Cool," for continuous
<br />~. ! :reonlloring, "//7" for one day per week, "//30" for one day per month, "1/90" for one day per quarter, etc.)
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<br />i9, Enter "Sample Type" both az "Sample Measurement" (actual sample type used dtrring monitoring period) and az
<br />"' '"Permi! Requirement," (e.g., -Enter "Grab" for indivfddal sample, "14HC" for 24-hour composite, "N/A" for
<br />~~' ~con[inttotrs monitoring, etc.) ~'
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<br />I . xWltoce violations of permit requirements are reported, attach a brief explanation to describe cattle and corrective
<br />!~~'=actions taken, and reference each violation by dale.
<br />'L~, If "M discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
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<br />{2. Enter "Name/title ojPrincipal Executive OJTcer" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />`_;, :Agent," "Telephone Number," and "Date" at bottom of form.
<br />Maif signed Report to Office(s) by dale(s) specified in permit. Retain copy for your records.
<br />1<4. More detailed instructions for use of this Discharge Monitoring Report (DMR) forth 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. 125.27). Failure to report or failure to report truthfully can
<br />~ltio civil penalties not to exceed 510,000 per dey of violation; or in criminal penalties not to exceed 525,000 per day
<br />~olation, or by imprisonment for not more than one year, or by both.
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<br />3320-1 (Rev. OS-95) ,-
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