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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a range of 10 hours as as
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data nettled, and completing end
<br />~ reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />~ this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protutior. Agency, 40] M Streit, SW Washington, DC 20460; and to the
<br />Office of lnforthation and Regulatory Affair, Office of Management and Budget, Vashington, DC 20503.
<br />General Instructions
<br />1. I( form has been partially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already preprinted.
<br />2. Enter "Perrnittee ,VomeGtlailing Address (and facility nameAocation, if different)," "Permit .Nurnter," and
<br />"Discharge Number" where indicated. (A sept:ralc form is required for each discharge.)
<br />3. Enter dates beginning and ending ':4lnnitoring Perind"covered by forth where indicated.
<br />4. Enter each "Pararaetrr" as specified in momtong requirements of permit.
<br />S. Enter ".Sample ,4h•asuremen!" data for rich pa ametcr under "QuanuN" and "Quality" in units specified to permit.
<br />"Averagge" is normally arithn~ctic average (gcamctric average for bacterial pa;,:melcrs) of all sample measurements
<br />for pch yammerer obtained during ".iSuutori~rg Period"; •'.1larirnuu+" and "Alimnrum" arc normally extreme high
<br />and low measurements obtained during ",4lnnimrink 1'rnud." QJotc to municipals With secondary treun:em
<br />requirement Enlcr SO-day average m: svnple mcastucments under "lverage," and enter masimtun 7-dap areragc
<br />of sample measurements obtained during monitoring period tinder ";ifarimum.'y
<br />6. Enter'°Permit Reyuiremenr" for aach parameter under "Quantity" and "Quality" z- specified in pemtit.
<br />7. Under ~;'.No Ex" enter number of sample measurntents during moni[ori,tg period that exceed rttaximurn (anNor
<br />minimum or 7-dav average as appropriate) pcrtnit rcqulremcnt for each parameter. If none, enter "0".
<br />8. Enter "Frequency oJ,inolysis" both as ".Snrn,~le tileasurment" (actual frequenc~• of sampling and analysis used
<br />during 'monitoring period) and as "Pennir Reriuireurent" specified in permit (c.g., Enter "Cant," for continuous
<br />monitoring, "1 /7" for one day per week, "130" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample .fleasnrement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grob" Ibr individual sample, "1J/IC' for 24-hour composite, "N/A" (or
<br />continuous mottitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />31. U "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/1'itle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAu(harized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pemtit. Retain copy for your records.
<br />14. More detailed irrstrucuons for use of this Dischnrge rLfonitoring Report (DMR) form may be obtained From Office(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 in civil penalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than onr year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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