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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary frdm a range of 10 hours as m
<br />average per response for some minor facilities, to 110 hours as m everageper response for some major facilities,
<br />with a weighted average for,ingtjor and_ minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or aay other aspect of
<br />this ccllectioo of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, 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 directed et entry of that information
<br />alrerrdypreprinted.
<br />2. EntE:r ".Permirree ,Vame/hlailing Address (and facility name location, if di6'erent)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
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<br />3. Enter dates beginning and ending 'Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. En[cr "Sample Afea.curement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is nornally arithmetic average (geometric average for bacterial parameters) of all sample meastuements
<br />for each pammeler obtained during ",tfonitoring Period"; "Maximum" and "hlin)mum" are normally extreme high
<br />and low measurements obtained during ",tonitoring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-day average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "Maximum.')
<br />6. Enter "Permit RegmrcmenP' for each parameter under "Quantity" and "Quality" as spcc~ed in permit.
<br />7. Under ";/o Ex" enter number of sample measuements during monitoring period that exceed ma.~cimum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnaiysis" both as "Sample Jvleasunnent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Permi! Requirement" specified in permit. (e.g., Enter "Cons," for continuous
<br />monitoring, "I/7" for one day per week, "1.130" for one day per month, "I/90" for one day per quarter, etc.)
<br />9. Ente° ':Sample Type" both as "Sample Afeasuremenr" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g.. Enter "Grab" for individual sample, "?4HC" far 24-hour composite, "N/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 />actioiss taken, and reference each violation by dale.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "NmneiTitle ojPrincipa! Executive OJ~cer" with "Signature of Principal Executive Officer ojAuthorized
<br />.4genr," "Telephone Number," and "Dare" a[ bottom of form.
<br />13, Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for youf records.
<br />14. More detailed inswclions for use of this Discharge Monitoring Report (DMRj (orm may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />T1ris report ;:s 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 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 (Itev. 08-95)
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