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pnhiin rNmAing ti„rd~ fPa'perWOrk'Reduction'Act`Notice ^r n ~„~„ ~, ~„
<br />evmage prn I~.puuse iur su:nc irunur iaciii[ius, .0 1 iG hours as as ¢vcragr, per respo, se rue some motor tacdihes, I
<br />I with a wcight:;d aver'ge (ar mreior urd r;un„r Facdih.; of lE huura p.r respc;;a, u;iiudwg nine iur reviewing I
<br />'I Instructions, searching uxistmg data sources, gathering and maintaining thz data nzedcd, mid completing and
<br />i reviewing the wllection of information. Send comment, regarding the burden estinutz or any other aspect of ,
<br />this collection of mlormation, including suggestions for reducing this burden, to Chrcf, Information policy
<br />Branch, pivi-i13, i.i.S. Environtneotai Pro[.;cuom agency, 40i ivi Street, SW VJasiuugtun, UC 7114(JU; and to the
<br />~ Offce of lnformation and Regulatory Affairs, Office of Managzment and Budget, Washington, DC 20507, j
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed et entry of that infurm:Jlinn
<br />already nrenrinted.
<br />2. Enter "Permirrer Nnme~Afniling Addre.cc (and Facility namdlocation, if different)," "Pern/rt Number," and
<br />"D:.\cnu;;;c .'Curr:bl•r" ,lilcre indicated. (a separate form is required for each discharge.)
<br />3. Enter u;ucs iicguuu::r ;u:.i . ndiug ".lluruiuring Peruul" cncued b}' form whore indicated.
<br />•1. Emer C,r.,l; '~1'tlrtuNin r ` d., .p.C:llcd Ile uWUIt UIIIIg reglla Cl^l Lt$ Of permit. _
<br />1. r.nlcr ' sn,n; rl,• ~ iem~rr,~rn r,n' data for each pa ranlclc'r order "ih/nnrirr" and "~)unlity" in unlls specified in permit.
<br />".dl~e•roXc" ie nornlali} ar;(iwsli, ;:wr;ra,: (gcmnctric asrage for bacterial parameters) of all sample measurements
<br />(or each parrniita ubia~••:•.i di~rinl• ""r•n:(nrrr,>; Prnr•~f'. '^ ketinw„~" and ':1lmimum" arc normally extreme high
<br />atld lov. mcasurcmcuts obraincd du r,:;g ':'.tune: urulg /'rr;rul " (Note to municipals IJilh secondary treaunent
<br />ren:p ri mPnl,' FNr ~;1_rJ"o ?\~,, r~v:• of c npl~~ mn•ic„m~\cnlc ^rrinr ",t per./cn " nm.t rn,tnr tnaSlmmml 7-daV ;[\'C'.^^_
<br />o(samplc mcasurcmcnts obLVncd dunng monilanng period under':Alarirnum.
<br />G. Enter "Permu iiryutreu,en!" fu: cat.h p,,,a:ucle: under "fiuuu,,ry' rued "Qunlut" as spc~iiicd in petnut.
<br />7. Under ",V., P:r" enter number of sample mcasurmcros during monitoring period fro: r.;;cced maximum (and/or
<br />minimum or 7-d.:y accra~c as apps^pri^!^) pcrntit <,n,uircmcrt fee each parameter. if me -_, ~:-!:- "B"
<br />.,.. ,..., r .,. ..
<br />R Entr "F; r,::,. ~,;, ~, „' ;,;•.; ~. .. ;" t•;,t.'..,. ,,,~:;,,. ,'. l/. .. ...,.•,. .•. - ' &c ~nc~:c. ;, ,.. rt anatvsis :. ;.,..
<br />l 1.,, ,,,•., .., a
<br />during monitorng pcliod) and a; "r'.r;nu Rryui.rma;u" spccifcd in permit. (e. g., Erter "Can:," for continuous
<br />,n:c ti:.) uc: .n:nl, r ~ •1il" for u:Je ui t qu:Jrr r,
<br />uluo:iouug, "!•7" fat :mc d;;} [:': \\cck. '! ~~/" fu: • .:;, ., „' . - ~ y pe r;: .,
<br />n G n0~ /. 'I'. _ + L_n. nr_..._r . r. .a ..,r_ .. ,.J .J.rii ~ -d\ .
<br />ry,.~ ~.,ur as ., ;:.I,r:...~r....:c:...:;: ;:.r.,.:: s::n:;;r, t;tc ;s.,~ mg monitcrrlo p_,:... :^ as
<br />"Permit Requirement," (c.g.. Enter "Grnh" for individual sample, "?Jllt"' for 24-hour composite. ":~'A" for
<br />cortinuous mor.ilorin`, etc )
<br />l0. Whcrc violations of pcrnut requircmcnts arc reported, attach a brief cxplanuion to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Title ojPrincipa! Executive Officer" with "Signature ajPrincipnl Executive Officer ojAutharized
<br />Agent," "Telephone Number," and "Date" at botlotn of fonn.
<br />13. Mail signed Report to Ollice(s) by date(s) specified in permit. Retain copy (or your records.
<br />14. More detailed instructions for use of this Discharge Afonitoring Report (DMR) fonn may be obtained from Office(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 io 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 3720-1 (Rev. 08-95)
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