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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as are
<br />averagz per response for some minor facilities, to 110 hours as m average per response for some major facilities.
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />' instructions, searching existing data sources, guttering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send co.~mtents regarding the burden estimate or any other aspect of
<br />[his collection of information, including suggestions for reducing this burden, to Chief, information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of ]reformation and Regulatory Affairs, Office 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 [hat information
<br />already preprinted.
<br />2. Enter 'Permi!!ee Name~?llaiiing Address (and facility name location, if different)," "Permit Number,' and
<br />"Drscharge Number" «ltere indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending 'Afnniraring r'eriod"covered by form where indicated.
<br />4. Enter each "Pnrametrr" az specified in monitoring requirements of permit.
<br />S. Enter ".5'ample .tlcrzruremenr" data for each parameter under "Quantity" aid "Quality" in units specified in permit.
<br />"Average" is normally aritlunetic average (geometric average for bac!erial parameters) of all sample measurements
<br />for each parameter obtained during ".Vonrmring Period"; "1laxrmvm" and ",ifinimurn" arc normally extrcmc high
<br />and low measurements obtained during ".tfouiloring Permd." (Note to municip;ils Frith secondary treatment
<br />requirement Enter 3t!~ay aycmge of sample measurements under ".lrerage," and enter maximum 7-dzy a~cragc
<br />of sample measurements obtained during monitoring period under "dfaximum.
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ".Vo Er" enter number of sample mea;urmcnts during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average az appropriate) permit requi•ement for each parameter If none, enter "0".
<br />8. Enter "Frequency of Analysis" both az "Samf,Ie .tfeasurrnen!" (actual frequency of satnpling and analysis used
<br />during monitoring period) and as "Fermi( Requirement" specified in permit. (e.g., Enter "Cool," for continuous
<br />monitoring, "1/7" for one day per week, "1/30" for one day per month, "//90" for ane day per quarter, etc.)
<br />9. Enter "Sample Ttipe" both az "Sample ,Lleasuremen!" (actial sample type used during monitoring period) and az
<br />"Permit Requirenrenr," (e.g., Enter "Grab" for individual sample, "24HC" For 24-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 "Nanre/I'ille ojPrincipal Executive Officer" with "Signature ojPrincipnl Executive Officer ojAuthorized
<br />Agent,", "Telephone Number," and "Dare" at bottom o(form.
<br />13. Mail signed Report to OfLce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instmMions for use of this Discharge Monitoring Report (DMR) form may be obtained Crom O8"ice(s)
<br />specified in permit.
<br />' Legal Notice
<br />This report isl required by law (33 U.S.C. 1318; 40 C.F.R. 175.27). Failure to repoR or failure to repoR truthfully can
<br />result in civil penalties not to exceed S10,1NJ0 per day of violation; or in criminal penalties not to exceed ;;25,000 per day
<br />of violation, dr by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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