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Paperwork Reduction Act Notice
<br />~ Public reportin¢ burden for this collection of information is esti marrri ro ~~rv from ~ range ^f 1!? hour; a.
<br />o.c «~L Y..r rc~t.:,eac. for aom., aioo, :n~uuica, :u 1 i0 uUW.I Ll all MYGa~G per rnspuow fur some major facdr4es,
<br />with weigh!zd average for major sd rrunor !2_rl::ie~ of 1$ hours p,;r :zsp:ad.;, mc{uding [i we fur reriewimg I
<br />~~ imslruciions, srarehiog existing data sources, gathering and maintaining the data orzded, and completing and j
<br />revrewmg [he collectton of intbrtnahon. Send comments regarding the burden estimate or any other aspezt of
<br />i this collection of mtotinahom, inchuimg suggestions for reducing this hurden, to Chief, lnformatioo Policy
<br />Br~,ch, pfd-223, U.S. cuo~iruwlieuul Proirn.iion Ageu~y, 401 1Yi .iileni, 51J':~ashingtou, UC L046U; and In lh~
<br />' Office of Information and Regulatory Affairs, Office of Management and Budgcl, Washington, DC 20503.
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<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 Narne/Mni/ing Address (and facility name/location, if ditTerent)," "Permit Number," and
<br />"DSJra,ge ,'.uruber" Nhuc indicated. (A separate form is required for each di:,ci:arge.)
<br />s. Enter dates b.:gtmung and cndrng ".t1o;u6,ring Period" covered by form who;. indit.itzd.
<br />4. Enter cacl: ':°urwnrerr" as spcciGed r. ntcntlcnng requirements of permit.
<br />5. Eumr ":ample ,Ueasuremem" d:ua for each parameter under "Quantrty" and 't~ unhty" in units speaiuoa in permit.
<br />".1 ccrnge" is norntally arithmetic avenge (gcomctnc accrage for bac(erial parameters) of all satuple measurements
<br />for cash pa .vnctcr obtained during ".tJon,h,ring Plriud"~, ".l/nsinnun" and ",tJutnnunl' arc nonnall} extreme high
<br />and low measurements obtained during ".1lunirorui, 1'rriud" (Note to municipals with swon_^ary treatment
<br />rcquircmrnt~ Enter 111-day avemnc of camplc mcantrcmcnls tinder ".4vernge," and enter m»s~rnum 7~ay average
<br />of sample measurements obWincd during monitoring pcnod under ",tlnxunurn. ")
<br />6. Enter "Pcrmrr K, yuir~mrn!" for cacti pa~aulcls under "ti'~unril," end "duality" as spud ~..a i ~ ;..;nttil.
<br />7. Under ",Vo )~" enfcr number of sample measunnrnts during monitoring period that zxacd maximum (andlor
<br />minimum or 7-day :n•erage as apprnprialc) permit requirrmcnt for each parameter I(none, ewer "~--
<br />8. Enter "hmrurn.v r.(.tnah:cr.c bah .., .......,,, ...,_.........,.. ,..-tool .._ ...... .. .. ..........n~ ,.~ aravsts ..__..
<br />during monitoring period)~and as "Permit Hryuirrmrn!" specified in permit. (e g., Enter "font," for continuous
<br />monitoring, "I%7" fcr cnc day per week, "/ ?0" for ene d::'; p~-r mo:alt, "1 ;.^•" for one day per quarter, etc )
<br />9. Enter ".Sr.;np!r Ttpc" bosh as ".vnmplr w r,,,,,..._.;„_,.,~~• (aau.,l ~..,;.,~(._ t.,p,, ,,.~.t e„~ng v,,..,~r.,.;ng p°erod) znd as
<br />"Permu Requrremenl," (e.g., Enter "Groh" for mdivndual sample, "?aHC" for 24-hour compovte, "~Y'.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 reference each violation by date.
<br />11. if "no discharge" occurs during monitoring period, enter "A~o Discharge" across form in place of data entry.
<br />12. Enter "NanrelTitle ojPrirrcipal Executive OC~cer" with "Signature ojPrincipnl Executive O~cer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" at bottom of torn.
<br />13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Repot! (DMR) form may be obtained from Office(s)
<br />specited 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 510,000 per day of violation; or in criminal penalties not to exceCtl 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. 08-95)
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