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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 m
<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 time for reviewing
<br />instructions, searching zxisting data source.;, gathering and maintaining the data Deeded, and completing and
<br />reviewing, the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of informa[ioa, including suggestions fur rzducing [his burden, to Chief, Information Polity
<br />Branch, PM-223, U.S. Enviroomzntal Protection Agzncy, 401 M Street, S\'V Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Of.ice of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions dirx[ed at entry of that inforrnatioa
<br />already preprinted.
<br />2. Enter 'Permillee Nome%4failing Address (and Facility nante/location, if different)," "Permit Number." and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dales beginning and ending ':4onitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter ",Sarnple.tleasurement" data far each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normalh arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter oUtaincd druing ".\fonilnring Period'; ",1laxrmurn" ar.d ",Llinimum" arc normally exlrem. high
<br />and law measurements obtained during ".tfnnitoring Prnnd." (Note to municipals wish secondary' treatment
<br />requirc(nenl: Enter 3U-dry average of sample measurements under "Average," and enter nraxrmum 7-da} average
<br />of sample measurements obtained during ntoni{oring period under "A-laxin:um.'J
<br />6. Enter "Permit Requirement" (or each parameter under "Quantity" and "Quality" az specified in permit.
<br />7. Under ".Na Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-da}• average az appropnate) permit requirement for each parameter if none, enter "0".
<br />8. Enter "~requenc7• oj.4na(ysis" both as "Sample .4feacurment" (actual frequency of sampling and anal}sis used
<br />during monitoring period) and as "Permit Renuireurenr" specified in permit. (e.g., Enter "Goof." for continuous
<br />monitoring, "l,'7" for one day per week, "1.~3t7" for one day per month, "//90" fa' one day per quarter, etc.)
<br />9. Enter ".ample Tvpe" both as "Sample ,Lfeasuremenr" (actual sample type used during monitoring period) and as
<br />"Permit Requirerrrent," (e.g., Enter "G'rab" for individual sample, "1JNC"' far 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 Ialten, and reference each violation by dire.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />l2. Enter "!/ame/fille ojPrincipa! Fecutive O]Tcer" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />Agent," i"Telephone Number," and "Dote" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specited in perntit. Retain copy for your records.
<br />14. More d~tailed inswcuons for use of this Discharge Monitoring Report (DbfRJ form may be obtained from Office(s)
<br />specifi 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 $ IO,Q00 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. 08-95)
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