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Paperwork Reduction Act Notiice
<br />Public reporting burden for this collection of informatioo is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 1 ]0 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of IS hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing [he collection of information. Send comments regazding the burden estimate or any other aspect of
<br />[his collection of iaforma[ioo, including suggestions for reducing this burden, to Chief, information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Weshiogtoa, DC 204b0; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and 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 .Nome~]vlailing Address (and facility nameJlocalion, if different)," "Permit Number," and
<br />"Discharge ,Number" where indicated. (A scpamte form is required for each discharge.)
<br />3. Enter dates begimting and ending ;4onitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoeng requirements of permit.
<br />S. Enter "Sample ,ifeo.ruremeru" data for each pa-ame[zr under "Quantity" and "Quah(v" in writs specified iu penni[.
<br />"Average" is normally arithmetic average (geometric avcmgc for bacterial parameters) of all sample measurements
<br />for each parameter obtained during " 1lnnitnrirg Period"; ':1laxinnun" and ".4linunwn" are norm lly extreme high
<br />and low mcasure.snts obtained during ".Ltontroring Penud." (Nate to municipals with secondary tre:,~,ment
<br />requirefnent Enter 30-day average of sarnplc measurements under "Average," and enter maximum 7~ay average
<br />of sample measurements obtatned during monitoring period under 'Stlaxin,um.
<br />6. Enter "Pernnt Requirement' for each parameter under "Quantity" and "Quality" as specified in penni[.
<br />7. Under !'.No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7~ay average as appropriate) permit requirement for each paramder !t none, enter "0".
<br />8. Enter "'Frequency oj,4nalysis" both as "Semple learunnent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Fermi; Renuiremenr" specified in permit. (e. g., Enter "Conn," Cor continuous
<br />monitoring, "li7" for one day per week, "l X30" for one day per month, "1i90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as "Sample ,lfeasurernent" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "24fIC" for 23-hour composite, "1J/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and inference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across Corm in place of data entry.
<br />12. Enter "NameiTi(le ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAvthorized
<br />Agent,""'Telephone Number," and "Dote" at bol[om oCCorm.
<br />13. Mail si~rted Report to Office(s) by date(s) specified in pemtit. Retain copy for your records.
<br />14. More detailed instructions for use of this Disch~rrge Monitoring Report (D.'t-1R) form may be obtained from OBice(s)
<br />specified in permit.
<br />Legal Notice
<br />This 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 />result N civil ~ettslties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, o by imprisonment for not more than one year, or by both.
<br />EPA Form 33~ 0-1 (Rev. 08-95)
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