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Paperwork Reduction Act Notice
<br />YII}11:C r~Dr,IlInQ flnrden fUr d11~ ~Ol~, n'Iinn nr mfnrmahnn a ectlm2r~.i In `; rt• r,~m ., ..,_. ~~ l~ hf5nr<wC all
<br />avers ee per response for come minor facilities M 110 hours as an average prr rrmnncg Fo•^~,•..tP ;*Y;~ur cacilitiea
<br />with a wclgh[ed average for rna)or and minor Facilities of IS hours pu response, including time for reviewing
<br />InStrLCh On6, SearChlnP CYICtIng data cnurcev, gathering sort m?mtalrLing the d,ra needed, and co~,ptcting and
<br />reviewing the r.Ullechnn of infnnnalion $rnd rnm mrnrs rroarding the hl~rllrn ecti~te or •y,y ~tber aspcit Gf
<br />this collc•_tion of Inform=tion, including subbeaions fcr r~ucing this burden, to G~~f, lafotumiiun policy
<br />Branch, PM-223, U.S. Cnvimnmoatal 1'roiectiun Agency, 401 M Stmt, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Afta¢s, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. !f form h3, been pa.^.:a!!y comp!et°.,,^. by pr:.printing, disregard instructions diru,tu; at entry .,f li+at udurmaiiun
<br />already preprinted.
<br />2. Enter 'Permitter r\'nme:,flailing Addrecc (and facilirv ttame/location, if different)," "Penni! .N_vrrb;•r," and
<br />"Discharge Number" o here indicated (A scoaralc fornl is required for each discharge.)
<br />3. Pinter dales bcginuulg and aiding ".llun,!urnrw /'tool/" covered by form where indicated.
<br />4. Cnler each "!'users<•1:~r" as specillad w nloniluring requirements o(perntit.
<br />5. Enter " 'ample ,llcasurenu•nf" data fur each parameter under "Qunnurg" and "Quality" in amts speclflcd in permit.
<br />"a garage" is nonnallc arithmetic averaQC (geometric average (or bnct~crial parameters) of all sample measurements
<br />for each parameter obtained During ",lJ,mruru{~ Penud", "1larmnun" and "dlinimurn" are normally extreme high
<br />and low measurements obtained dunng "Ilnnitrring Penud." (Note to municipals tiilh secondary Vestment
<br />ICgWrClllelll. Cllll'f lV-day aiefae;; vl o1111pIC masurcnlcnts undo ~~.i,eroge," and enter maximum 7~ay atcragc
<br />of sample measurements obtained during monitoring period under ",llnxnnu,n')
<br />6. Enter "Permit Requirroren!" for each pa~ar^.eter u..^.der "Qxanfif," and "Qua!iN" as spcci5cd In permit.
<br />~. '.: rder :'O .''_''' G~1er „uinbCr Of ;u n1N,c mc:uurmCrllS dunng itiJr,itOfiiig pi:niw 1)idi i.iocd nia~ii iiuill (d1lG/G:
<br />minimum or 7~a}' average as appropnate) pernlil rcgwrenicnl for each paranleler. If none. emer "U".
<br />o. Euia "Freyuencv uj:'vmitsrs" butil as "Smnple ,iieacurnu°nr" (actual frequency of sampling .Ind analysis used
<br />dunng monitoring period) and as "Penni! Reyuu-enrenr" specified in permit (e g , Enter "Cb,nr," for conu nurnls
<br />rronltorlitg, ": 7" tai crc J..: psi \l elk, "/ JO" iJr Giic u'.ij pci iiiuiii ii, "i ~:i° fJ, uiiC ddY yci yu Irt~,i, ,~C.j
<br />9. Enter ".b'amp/e 71pe" both ;~ ".1'onrplr .11en.cummrnf' (actual sample type used during mo.^.nonng penod) and •r_c
<br />"Permit Reyurrement," (e. g., Enter "Grab" for individual sample, "?-JH("' fo* 24-hour composue, "Iti" 4" for
<br />conUnuuus nwmtormg, etc.)
<br />10. Where violations of permit regwrements are reported, attach a brief explanation to descnbe cause and corrective
<br />actions taken, and reference each violation by dart.
<br />l 1. U "no discharge" occurs during monitoring penod, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/!'itle ojPrincipnl Executive Officer" with "Signature ojPrincipal Executive Officer ojAufhar!zed
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from 06ice(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 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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