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<br />Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a ranee of 10 hnurc ac an ~I
<br />... ~ _. .~ iaLlililca. I
<br />~... ego p...- r._.raaso fcr ~c.no ~icor fanhuc , io i .~ a....r :~ ..a ...c~ e,, per resp.,rs.. ,or SJuIL tiinpu
<br />with a werghteci averagr fm major and minor fnriLtirs of 18 %to~'^ p,_: rrspease, i~c!udmg t+me for rzwev'. u:g
<br />instructions, searching existing uala sowees, galheriug and maioiaining the data needed, and completing and
<br />' revtewmg the collection of information. Send comments regarding the burden estimate or any other aspect of '
<br />flits collaction of information, including suggestions for reducing Ihrs burcleo, to Chref, lnformatron Policy ~
<br />m auw, Ptil-22~, U. avr; Gamaatal rot:;chon Ageoc}', O1 h1 [rk i, J ~iinigiuu, v% 204vu, drw iu the ,
<br />~ Office of Information and Regulatory Affairs, Office of Management and Budgzt, Washington, DC 20503. ~
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<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard ins[rvctioas directed at entry of that informahott
<br />already preprinted.
<br />2. Enter 'Permittee Namei7ifailmg Address (and facility name/location, if ditTcrcnt)," "Perm+t :cumber," and
<br />"Dili ;,, /.xl~ .'.5lmber" ,:here indicated (A separate form is required for cacti di;; barge.)
<br />3. Enter dales begmmng and ending `,tlomranng Period" covered by form where indicmed.
<br />4. Euicr w:i~, "Purarnr;r. ` „_ s;xaficd i^ nim~aenng requirements cf;.c~iil
<br />~. Emct '~:imnp(c .l irmu,rml m" d.u.: ful caul pol.uuciu uildet "~~IIL/Il,li ..IJ "L/Y111111" 111 uud$ SpeCi/ICd iii N: Tu(.
<br />"A reragr" is ncrmallj nnthn:etlc average (grometnc av eragc for b^d.cr:al parameters) of all sample measurements
<br />for each parameter obtained daring ".tlautannG Perirrf'~, "tlnximnr,~" and ",Rlinirnum" arc ^ornvally extreme high
<br />and low mcasurcmenls obtained dunng "lfnnrlnru:g Penud." (tietc to municipals with ~ccordary Ireatmenl
<br />regmrcmcnl~ Enter 30-dav avcraQC of samolc measurements under "Average," and enter maxims-n 7-;ay average
<br />of sample measurements oblmncd during monitoring pcnod under ".tloarmum.
<br />O. Ellll'1 "PC///Ilr RI'ytli/I n.cnl' for CdCh f::.:dmclcr L'ndC' "(/L~iltlPy" gad "YJulirl'" ..S SpCCIfiCL '!1 p::rnnt.
<br />7. Under ",b'u hs" enter number of sample mcasurmcn[s dunng monitoring pcr.cd that c.vicecd tttaximum (.and/or
<br />minimum or'7-dav averar>e ac annronnalel oe rout reouirement for each pa rame!er if none, enter "0".
<br />o G.,,~ ~'>.~-,.,.,,..., ~,. nr e..,,+, .,,,-~• tinlti "~ ^r.,",nr„ ~ r..,, ,.,..n ••n! tannai i.-rn n.•n:: of ca ntoiine and aualvsis uxd
<br />_. ~..,.,r ....,___.. ...... _ ..
<br />during momloring period) and ns "Prruut Requireu+ent" specified In pcnmt. (u g., Enter "( ant," for continuous
<br />monitoring, "/'7" fc: one d:.j per ::ec4., "!'JO" for one day per mon!h, "I X90" fc- an^ d:>v per nuarier, etc )
<br />n c.,,.,, '~c•,...... r.. •r, .,,,,~~ r,,ati ~" ^r,...,r+,, n o,,.,-., r.,,,,,.„r r~.,,-Ill~l camnir iv nr ncrri rinnnv momlonne uorwdl and as
<br />.. I
<br />"Yernur Requtrernent." (e g., En[cr 'lirab" for individual sample, "JJIi(°' fcr 2i-ha,.: contposhc, ".1''A" (or
<br />rnnljnpnn5 mnnilnrinv cIC 1
<br />10. Where violations of perntit requirements arc reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />l I. if "no discharge" occurs during monitoring period, enter "A'o Dischar¢e" across form in place of daW entry
<br />12. Enter "Namerl'itle ojPrincipal Executive O~cer" with "Signature ajPrinctpnl Ekecutive OU~cer ojAuthorized
<br />.9gent," "Telephone h'umher," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) b}• date(s) specified in perntil. Retain copy for your records.
<br />l4. More detailed instructions for use of this Discharge Afonitoring Report (DM1RJ form ma}• be obtained from Offce(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 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 S25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-93)
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