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Paperwork Reduction Act Notice
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<br />Riblic reporting burden for this collection of infortna[ion is estimated to vary from a range of 10 hours as an
<br />average per response for same minor facilities, to ] ]0 hours as im average per response for some tnajor facilities,
<br />with a weighted average for major and minor facilities of I8 hours per response, including time for )•eviewing
<br />ms[ructioas, searching existing data Sources, gathering and tntintaining the data needed, and compll;ting and
<br />reviewing the collection of information. Send cortunents regarding the burden estimate or any o[heraspect of
<br />this collection of information, including suggestions for reducing this burcten, to Chief, Information Policy
<br />Brwch, PM-223, U.S. Hnviroamental Protection Agency, 401 P~ Street, SW Washington, DC 20460; and to the
<br />Office of Inforuun[ion and Regulatory Affairs, Office of Management and Budge[, Washington, DC 20503.
<br />General Instructions
<br />1. !f form has been paRially completed by preprinting, disregard instructions directed at entry of [hat information
<br />already preprinted.
<br />2. Enter 'Permittee Nnme/Afailing Address (and facility name/location, if different)," "Permit Iv'umber," and
<br />"Discharge .Numher" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending "Alonitnring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of perntit.
<br />5. Enter ".Sample ,tfeosurement" data for each parameter under 'Quantity" and "Qvahty" in units specited in permit
<br />"Average" is normally aritlunetic average (gtrometric average for bacterial parameters) of all sample measurements
<br />far each parameter obtained during "dlonituring Period"; ".lfuimum" and "AI'ni:rmn+" a[c normally eetreme high
<br />and low measurements obtained during ",t/onitoring Period." (Note to municipals with saondary treatment
<br />requirement: En[cr 30-day average of sample measurements under "Average," and toter maximum 7-day average
<br />of sample measurements obtained during monitonng period under ",t9arirnunt.
<br />6. Inter "Permit Requirement" for each parameter under "Quanhry" and "QunliN" as specified in permit.
<br />7. Under ".No Ez" enter number of sample measurments during monitoring period that eacecd maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. U none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both as "Somp/r dfensunnenP' (acntal frequenry of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "font," f6r continuous
<br />ntoniloring, "1/7" for one day per week, "//30" for one day per month, "1/90" for one day per quarter, ate.)
<br />9. Enter "Sump/e Type" both as "Sample ,Lfeasurement" (actual sample t}pc used during monitoring period) and as
<br />'Pernttt Requirement," (c.g., Enter "Grab" for individual sample, "14NC" for 24-hour composite, ".NiA" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />acuons taken, and reference each violation by date.
<br />11. !f "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/title ojPrincipa! Executive Officer" wish "Signature oJPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />13. Mail signed Report to O6ice(s) by dale(s) specified in pernti[. Retain copy Cor your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Repot! (DMR) form 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. 175.27). 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 325,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320.1 (Rev. OS-95)
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