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Paperwork Reduction Act Notice
<br />1'tIhIIC fepnfh n~ inrrn.. r.,r fhn ... ±rr v~r, ~.. rir~rn..., i:r .n rv'~n1Hlr;' In v;;rv fn,n! a fNnr.r „f 111 nnr~fc a.C 2n
<br />aVeragP. per iPCppnCe fnr FO me Tmnr faciGhes, LO I10 hours ns an avcraee per response for some major facilities.
<br />with a weighted average for major and minor facilities of 18 hour, per response, including time for reviewing I
<br />insln_rc[ions, v„a!ehjng ex~st!n~ data snu rces, natherin~ and coal main ink thr, data nerdrd, and cmm~leting and i
<br />reviewLng the rnlltrtinn of infnrrnaGrni. Send comments reeerrlinn the burrlrn estimate nr any olhrr aenect of I
<br />this collec[ien of information, including suggestions for reducing this burden, to Chief, [nfonnaion Policy
<br />Brunch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Inforutatioo and Regulatory Affairs, Office of Management and Budget, Washingtoo, llC 20503.
<br />General Instructions
<br />1. I f form has lxx;n partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted. -
<br />2 Enter "Permiiree Nmrrei7Lfniling Addre.vs (and facility ttamcJlocaUOn, if diH'erent)." "Prrnrii ,'Dumber," and
<br />"D;.cclrnree .Vu,nher" where indicated. (A separate form is requred for each discharge.)
<br />3 Enter dais bcginnuig and ending "MunitururK Perir,r(" covered by form where indicated.
<br />4. F.n(er cad: "Pnrmnen•r" as specified in numiloiing regwrements of pernut
<br />5. Lnter'.4mnple.tleu.`tuemm~r" dew far each parameter under "Qunnrily" a,:d "Quah(v" in units specified m permit.
<br />"Average" is normalls anthmetic average (gcomdric average for bacterial parameters) pf all sample measurements
<br />for each parameter obtained during ".tlummnn,>; Penud", ".1lusimuur" and ",tlinimunt" arc norn;:.lly caucmc high
<br />and low mcasurcmcnts obtained dunng "tfnnriuring 1'eriud." (Note to municipals with sccontia;y treatment
<br />reywrcmeui. cuiei ]:~~t<q a.cragc of sa;~:ph, maasurcra...,~ ~r,:a ". ir.'rugC," and eider ne:::in~.' '-day averag-
<br />of sample me:asuremcnts obtained during monitoring period ondcr ";.loxrnrum.
<br />6. Enter "Pernn! ftequ~r: menY' for each parameter under "~h`enriP~' and "Quahn%' as spcci0cd in permit.
<br />7. Uudei '?~~ E~" Cnt~r nwabcr cf sample mesunnents dunng monitoring ; _=c'_ that escecd maximum (and/or
<br />mmtmum or 7-dad a•:crage as appropnaie) p~_Inut rcyuilcmem for each p;u,,:~r~:~,. I(nunc, u~tcr "Q".
<br />.
<br />_ .. . ";lour tic ;iiru.l~rrucui" ' i'i:Lil .. .
<br />8, r.nter "Frequency u/ Nnaiy:cis ouiii us { t`~ L'tyu.: r.c} .. ;a;.:p;:::e W::. s:e-y s:- `~-•:~
<br />during monitoring ncripd) and a~ "Prnrur Krquireuteni" specified in pernut. (e. g., cnlci "Cwt(," for continuous
<br />uiunituriuv- ,..• r• ' ~" _,,, "I'p0" !'~~ : -, nl~arler. etc 1
<br />,,. "/ , G,: ~„~~ ,i.r. ~r .: c.. .ur pre :.. - ..th,
<br />9. Enter ".S'ump!c ~;~'" both as "suns; k• t1encr;remcn/" (acln:u sample r•pc nscu m~n:lr. n~~,~nru,iuK pcli~ur ,.r:,:.1,
<br />"Pcnnrr Rcgvrrrmertl," (e.g, Enter "rlrab" fa indnidual sample, "?~HC" for ZJ~hpur cowpasile, '". :." for
<br />continuous monitonng, etc.)
<br />10. Where violations of perntil requirements arc reposed, attach a brief explanation to describe cause a,rd corrective
<br />acuons taken, and rc(ercnce each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "h'o Drscharge" across form in place of data entry.
<br />12. Enter "Name//'iile oJPrincipal Execuiive O~cer" with "S'ignarure ojPrincipn! Executive O~cer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" al bottom of form.
<br />13. Mail signed Report [o Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge rt9oniroring Report (DM11R/ 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 failuro to report truthfully can
<br />result in civil penalties pot 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 (Rev. 08-95)
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