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Paperwork Reduction Act Notice <br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an <br />average per response for some mina{~acilities, to 110 hours as an average per response for some major facilities, <br />~P!(h. a weighted average for major and minor facilitig,Sypf JS hoursper response, including time for reviewing <br />' Arctions, searching existing data sources, gathering and maintaining the data needed, and completing and <br />wing the collection of information. Saud commenLS„reg.~Le burden estimate or any other aspect of <br />,~ , ''ebllection of information, including suggestions for redttefng this burden, to Chief, Information Policy <br />PM-223, U.S. Environmental Protection Agency, 46~rI Street, SW Washington, DC 20460; and to the <br />Office of [nfortnatiom and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions <br />F& 7v.; <br />~.~if forts has bean partially completed by preprinting, disregard instructions directed at entry of that information <br />' already preprinted. <br />"PerrhiKee Nante/1Nai/ing Address (and facility name location, ff different)," "Permit Number," and <br />argie Number" where indicated. (A separate form is required for each discharge.) <br />beginning and ending 'Afonitoring Period" covered by form where indicated. <br />"Parameter" as specified in monitoring requirements of permit. <br />Eater,"Sample Measurement" data for each parameter under "Quantity" and "Qunlity" in units specified in permit. <br />° verage" is normally aritltntetic average (gebntetric average for bacterial parameters) oCall sample measurements <br />-~er each ptrameter obtained during "Afonitoring Period"; "Marimurn" and "Afinimunr" arc normally extreme high <br />iii low mmeastrements obtained during "Monitoring Period.` (Note to municipals with setrondary treatment <br />i~rjtiiiement: Enter 30~ay average of sample measurements under "Average." and enter maximtun 7-day average <br />of'saetple measurements obtained during monitoring period under "Marimum.'J <br />Elver."Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. <br />~ndetr :'No Ez" enter number of sample measuements during monitoring period that exceed maximum (and/or <br />trtinimum or 7~ay average as appropriate) permit requirement for each parameter. L` none, enter "0". <br />Enter; "Frequency ojAnalysis" both as "Sample .t'leasurment" (actual Crequenc3• of sampling and analysis used <br />alttring monitoring period) and as "Permit Requirenrent" specked in permit. (e.g., Enter "Coot," for continuous <br />'monitoring, "1 ~7" Cor one day per week, "J,%30" for one day per month, "1/90" for one day per quarter, etc. ) <br />Enter "Sample Type" both as "Sample Aeasurement" (actual sample type used during monitoring period) and as <br />"Pengi( Requirement," (e.g., Enter "Grab" for indi~~dual sample, 24HC" for 24-hour composite, "N/A" for <br />continuous monitoring, etc.) <br />t0. Where violations of perrnil requirements are reported, attach a brief explanation to describe cause and corrective <br />- actions taken, and reference each violation by date. <br />~: If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. <br />t <br />(?Z. Enter "Name/firle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAuthorized <br />figent,"'Telephone Number," and "Date" a[ bottom of form. <br />~y!3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy Cor your records. <br />t'- <br />)~4. More detailed instructions for use of this Discharge Afonitoring Report (DMR) form may be obtained from Otiice(s) <br />specJed in permit. <br />~'~ ` Legal Notice <br />~' <br />„ rrrrport is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to repot or failure to report truthfully can <br />r Wt~n civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day <br />iolation, or by imprisonment for not more than one year, or by both. <br />«,. <br />CsPi~ Form 3320-1 (Rev. OS-95) <br />r~.. <br />