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Paperwork Reduction Act Notice
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<br />' ,,.r age ^_r rr<i•on.r Fur ",me mj^n* f3cilitie~ ro 110 hu~!rs 3s en 2r•^_rage er yes osse for s..,.,c m..`~ 1 f~r ~htizs, ~
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<br />wrth a wer~htrd avernge Far mrijor and minor t4rcilitizs of 18 hours per response, including time for reviewing
<br />ngr.,p_r~uc, s~rch~rg zzating daL~. sources, gathering and msin Liamg the daL errdcd, a:,J conipldiug end
<br />rev'-•°!^~ rhr rpller lino pf infnrm~rinn. $r.^.d COI^.^.:rnrg ra arrljn rttC 1)nrden C.a{.^,'WtC Gr aLy Gti,ci anpcCi Uf
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<br />~ this collxr[cn of information. ~,dudin¢ sug_rzstio~s for reducu,Q this buidza, to Cuief. infnrmaririn Pohc~ ~
<br />' Brunch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the ~
<br />' Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />:. If for ;as bzzn pa~rially completed by preprinting, disregard instiucliow directed xt miry of tba[ information
<br />already preprinted.
<br />2. Enter "Permrr!ee Nnme!A1mh.ng -Address (and facility name/location, if diH'erenp," "Perm:; ,,^.'ur,;he,-" and
<br />"Dischnr/{e ~Snrrher"where indicated. (A separate form is required Cor each discharge.)
<br />3. Entry dates beginning and cndmg '3krnrlorwK Perrod" covered by form where indicated.
<br />4. Emcr each "1'arnm, mr" as sncrticd m monitonng requirements of permit.
<br />5. Enter ".\'nmplr ,tleoeurennmt" data for each parameter under "Qunntity" and "Qunlity" in units specified in permit.
<br />"avergKr" is nomtally anOtmetic average (gcomclnc average for bacterial parameters) of all sample measurements
<br />for each parameter obuuncd dunng "alunrtr,nnQ l'erind', ".1foxinmm" and ",tlrru;nurrt" are norntally extreme high
<br />and lore measurements obtvncd during ".1/oniruring Period." (Note to municipals with sccondOry treatment
<br />rcquuemenl. Eulcr 4~1-day ,n~~ragc of s:uuplc m:.rsurcwcnU wrdcr "Average,' .:nd enter maximum 9~a} average
<br />of sample measurements obtained during mondonng period under ".1~axmtunt.'J
<br />6. Enter "Permit Requirenu°nY' for each paramctcr under "Quartih" and "Quality" as spccS_ .n permit.
<br />i. Uudcr ':'vu ci" vertu uwrWU of swupic urcasw urcuis dwiug mwriiw ing period floss cac.er: tuauwwu (audivi ~_
<br />minimum or 7-da}~ average as appropriate) permit requirement for each parameter. If none, cn;~r "0"
<br />t5. Enter "Frequency o/ Anoltsrs" both as "Amnpie ;tleaerrment" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Perna! Rrquirenrent" specified in ocrmil. (e. e., Enter "(bnt," for continuous
<br />mwuiuriug, "1. 7" (ur one d:n per wcci.. "l::iir" fur uue d:n per uwwir, "i L'u' fur one day per uu.rrl:i, ziz.i
<br />9. Enlcr "Smnp/e Tt~pe" both as "Sample .ileaeurcrnent" (actual ;,~mplc t}pe used during monitoring perod) and as
<br />"Permrt Requirement," (e.g., Enter "Groh" for tndrvidual sample, "_'1N("' far 21-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. U "no discharge" occurs during monitoring period, enter ",No Discharge" across form in place of data entry.
<br />12. Enter "Name/filte ojPrincipal Executive O~cer" with "Signature ojPrincipnl Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dare" at bottom of farm.
<br />13. Mail signed Report to 06ce(s) by date(s) specified in permit. Retain rnpy for your records.
<br />14. More detailed instructions Cor use o[ 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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