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Paperwork Reduction Act Notice
<br />Public r=parting bu-'..tn f.-~r thi; collci,Gvu of u+fur n,aiiuo is estimated to vary imm ~ ~nc~ ~; 10 hour. as ar.
<br />average per response for some minor facilities, to 110 hours as en average per remnnse for some major facilities,
<br />with a weighed average for major and minor facilities of 10 hours per msponse, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data eeedrd, and cempletiog and
<br />reviewing the collection of infonnatiom. Send comments regarding [he burden rstimaM or any athcr asput of
<br />~ this collection of information, includinv suggrctions for reducing this burden, to Chief, Inforrualiua Pulicy
<br />~ Brmrch, PiVi-7.3, U,S. Eevironmental Protection Agwcy, 40l h1 Street, SW Washingloo, DC 20460; 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 directul at enLy of that infw waiion
<br />already preprinted.
<br />2. Enter "Permirtee .NameQlfai/ing Address (and facility name/localion, if different)," "Perm±! Number," 'rd
<br />"Discharge Numhei' where indicated. (A separate form is required (or each discharge)
<br />3. Enter dates beginning and ending 'ilfonitoring Period" covered by forth where indicated
<br />4. Enter each "Parame[ei' as specified in monitoring requirements of permit.
<br />5. Enter '.Sample ,lfearurrmenP' data for each parameter under "Quantity" and "Quality" in units specified in Hermit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ",tfonimring Period"; "Mariraun+" and "Minirnun+" are normally extreme high
<br />and low measurements obtained during "Afonitoring Period." (Note to municipals with secondary treatment
<br />requirement: Enter l0 day aceragc of sample measurements carder ",l verage," and enter maxinem -I-day average
<br />of sample measurements obtained during monitoring period under "Maximum. 1
<br />b. Enter "Penni[ Requ+rernent" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "Nn Fx" enter number of sample measurments dur.rg monitoring periad that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permii requirement far each parameter. If none, enter "0".
<br />S. Enter "Frequency oj;lnaly:;+s' bath ..^s '.ti'mnph- ;"Sensurnrenr" (actual Gcyuctuy of 5a,itpiing and analysis used
<br />during monitonng period) and as "Permit Requirement" specified in permit. (e.g., Enter "Coal," for conLnuous
<br />monitoring, "//T' for oae day per y-cek, "//30" for or.c dry per month, "i/40" ter on: rl.•y µr quarter, ate )
<br />9. Enter "Sample Tvpe" both as ",Sample b/rosvremenr'' (actual sample 4'Pc used dunng monitoring penod) and as
<br />"Perini! Requirement," (e.g., Enter "Grab" (or individual sample, "1a//("' for 24-hour composite, "N/A" for
<br />continuous monitoring, eic.)
<br />10. Where violations of permit regltiremen[s are reported, attach a brief explanation [o describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. if "tro discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Narnelfitle ojPrincipa! Executive Officer" with "Signature ojPrincipn( Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Report [o tlgce(s) by date(s) specified in perntit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring 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 $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 one year, or by both.
<br />EPA Form 3320.1 (Rev. 08-957
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