|
Paperwork Reduction Act Notice
<br />Public reporting burden for tvs collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />vOth a weighted average fo; ;aajor and minor facilities of 18 hours per response, including time for reviewing
<br />'lions, searching e;ustirg dale sources, gathering end maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this coL`ectio.-. of informatioc, including suggestions for reducing this burden, to Chief, Information Policy
<br />3rnnc_i, Pik-223, U.S. Environmental Protection Agency, A01 M Street, SW Washington, DC 2046G; and to the
<br />Ofr""ice of L-tfo,-mation 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. Enter 'Permittee Name/ilfailing Address (and facility nameJlocation, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending ':tonitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Smnple Mensuremeet" data foreach parameter under "Quarrtiti' and "Quality" i^ units specified in permit.
<br />"Average" is normdly aritltmeiic average (geometric average for bacterial parameters) cf aJl sample rreastmements
<br />for each parameter o~~ained during "Aonitoring Period'; "Maximum" and ",Llinimunr" are normally extreme high
<br />and Imv measurements oblaintti dtuing ",1onitoring Period." (Note to municipals nlth secondar}• treatment
<br />requirement Enter 30-day average of sample measurements under "Average," and enter maximum 7~ay average
<br />of sample measurements of iained during monitoring period under "Ma.rimurn.
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specified in perntit.
<br />7. Under "Nb E;:" enter number of sample measurments durng monitoring period that exceed maximum (and/or
<br />minimum or 7~ay average az appropriate) perntit requirement for each parameter. If none, enter "0".
<br />8. Enter "Hrequcney oJAnalvcis" both as ".Same/e Ideasurrnent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Fermi: Requirement" specified in permit. (e. g., Enter "Cant," for continuous
<br />monitorng, "I/7" fir one day per week, "1,30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Smnple Tvpe" both az "Sample Measurement" (actual sample t}•pe used during monitoring Qeriod) and az
<br />"Fermi( Requirement," (e.g., Enter "Grab" for individual sample, 24HC"' for 24-hour wmpostte, "N/,4" Cor
<br />continuous monitoring, etc.)
<br />10. Where violatiotu of permi: requirements are reported, attach a brief explanation ¢o descrbe cause and corrective
<br />actions taken, and reference each criolation by date.
<br />l 1. If "no disciuarge" ozcurs du 9ng monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Narnerf'itle ojPrincipnl Executive Officer" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />Agent," "Te;ephonc Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Ot3ice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. btore detaaed instructions 1'or use of this Discharge Afonitoring Report (DMRJ Corm may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is reynirexl by law (3 L.S.C. 1318; 40 C.F.R. 125.27). Failure to roport or failure to n:port L-uthfully can
<br />result in civi] per.n!ties ncl to exa~rl $1D,OD0 far day of violation; or in criminal penailies not to excettl 525,000 per day
<br />of violation, or by imprsonment for not more than one year, or by both.
<br />EPA Forw 3320-1 (Rev. JS-95)
<br />
|