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Paperwork )rteduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as as
<br />average per response for some minor facilities, to 1 10 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, ga[,~ering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspec¢ of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protea:tion Agency, 401 M Street, SW Washington, DC 204b0; and to the
<br />Office of Information and Regulatory Affairs, Office of Management end 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 'Permitree Name/Mailing Address (and facility name/localion, if didcren[)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending 'St4onira•ing Period" covered by form µhere indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter ".Sample ,'ilca~vrcment" data far each parameter under "Quantity" and "Quality" in units specified in p'rrnit.
<br />"Average" is normally arithmetic at•emge ;gcontclric average far bacterial parameters) of all sample measurements
<br />for each parameter obtained during "hfonirorir.q Period"; "lloximum" and "Minimum" are normally c>,~treme high
<br />and low measurements obtained dunng ",tPom(oring Perod." (Note to municipals with secondary treatment
<br />regwrement Emer 30~av avemge of sample meastiremems undcr'Average," and toter maximum 7-day accragr.
<br />of sample measurements obtained during moniWring period under ",4farimum. J
<br />6. Enter "Permit Requirement" for each parancter under "Quantity" and "Quality" as spcc'u'ted m permit.
<br />7. Under ",Yo ~r° enter ntunbe~- oC sample mcamrments during monitotirg period that exceed maximum (and/or
<br />minimum or 7-day average as appropnalc) permit requirement Cor each parameter. If none, rnter "0".
<br />8. Enter "Frequency ojAnalysis" both as ".timnple .4leasurment" (actual frequency of sampling and anal)•sis lsed
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., L•nter "Coot," for rnntinuous
<br />monitoring, "/,7" far one day per week, "1.30" :nor one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample T}pe" both as "Sample aleasurement" factual sample type uses. during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" far individual sample, "24HC' Cor 23-hour composite, "?,%f" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements arc sported, attach a brief exp anaGon to describe cause and corrective
<br />actions taken, and referenre each violation by date.
<br />11. if"no discharge" occurs dating monitoring period, enter "No Discharge" across form in place otdata entry.
<br />12. Enter "Name/I'itle ojPrincipa! Executive 0~~.•er" with "Sngnature ojPrincipal Executive Officer ojAu(horized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pemtit. Retain copy far your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (D~L1R) form may be obtained from Oldice(s)
<br />specked in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 (:. F. R. ]25.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed E 10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />. EPA Form 3320-1 (Rev. OS-95)
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