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Paperwork Ilteduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including lime for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data Wended, and completing and '
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 40i M Street, SW Washington, DC 20460; and to the
<br />Offrce of Information and Regulatory Affairs, Oflice of Management and Budget, Washington, DC 20503. ~
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter ~'Permittee .NnmeiAfar/ing ,9ddress (and facility name/location, if different)," "Permit ,number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter drtles beginning and ending "~L1oniloring Period" covered by form where indicated.
<br />4. Enter tech "Parameter" as specified in monitoring requirements of permit
<br />5. Enter "Sample ,1feasuremenr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />".9verage" is normally anthmetic average (geometric average for bacterial parameters) of all sample meazurements
<br />for each parameter obtained during ",lfamtoriug Pcrin~'; ".tlaximum" and ",tlmtmu,r," are norntall}' extreme high
<br />and low measurements obtained during ".Llorrironng Period." (Note to municipals pith secondary tre~~tment
<br />requirement: Enter ?U-day average ol'sarnplc measurements under "average," znd enter macimitm 7-riay average
<br />of sample measurements obtainal during monitoring period under ",ldarin.um.')
<br />6. Enter "Permit Requirement" far each parameter under "Quantity" and "Quality" az specified in permit.
<br />7. Under "Nn Ex" enter number of sample measurmen[s during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average az appropriate) permit requi cment for each paameter. ff none, enter "0".
<br />8. Enter "Frequencc ojAnalysis" both as ".Sample ,Lfea.^vrrnen!" (actual frequency of sampling and analysis used
<br />during monitoring period) and az "Permit Rcquirrnunl" specified m permit. (c.g., Enter "Copt," for continuous
<br />monitoring, "//7" for one day per week, "I/30" for one day per month, "1%90" for one day per quarter, etc.)
<br />9. Enter ".Sample Type" both az ".Samp/e ,Lfeasuremenl" (actual sample t}pe used during monitoring period) and as
<br />"Permit' Requirement," (e.g., Enter "Grab" far individual sample, "2dHC" for 24-hour composite, "P.7A" for
<br />continuous monitoring, etc.)
<br />10. Where violations o[ permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />l 1. V "no discharge" occurs during monitoring peri ad, enter "No Discharge" across form in place of data entry.
<br />1?. Enter "Narne/I'it/e ojPrincipa! Executive O~,:er" with "Signature ojPrincipa! Executive Officer ojAulhoriced
<br />Agent,"',"Telephone Number," and "Date" a[ bottom oC (orm.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More d tailed instructions for use of this Discharge Monitoring Report (D~l1R) form may be obtained from Office(s)
<br />specitie~ in permit.
<br />Legal Notice
<br />Ibis 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 E10,000 per day of violation; or in criminal penalties not to exceed x25,000 per day
<br />of violation, oq by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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