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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)
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