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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of uforrmtion is estimated to vary from a range of f0 hours es an
<br />average per response for some minor facilities, to 110 bourn 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 existing data sources, gathering and maintaining the data needed, 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, 401 M Street, SW Washington, DC 20460; and to ;he
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregazd instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee Name/,t1ailing Address (and facility namdloration, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'itfonitaring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample ,Lleasurement" data for each parameter under "Quantity" and "Quali(v" in units specified in permit.
<br />"Averoge" is nornutlly arithmetic average (geometric average for bacteria! parameters) of all sample measurements
<br />for each parameter obtained during ",Lfunitori~rg Period'; "Afazimum" and ",Lfinimum" are normally extreme high
<br />and low measurements obtained during ".ifcnitoring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-0ay average o: sample measurements under "Average;' and enter maximum 7~ay average
<br />of sample measurements obtained during monitoring period under "A4aximurn.'J
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) pern iit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency of Analysis" both as "Sample ,Lfeosurment" {actual frequency of sampling and analysis used
<br />during monitoring period) and as "Pennit Requirement" specified in permit. (e.g., Enter "Cant," for continuous
<br />monitoring, "1/7" for one day per week, "/,30"for one day per month., "1/90" For one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample Measurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" fi)r individual sample, "14NC' for 24-hour composite, "A'/.4" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements :tre reported, attach a brief explanation [o describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrlncipal Executive OjTrer" with "Signature ojPrincipa! Executive Officer oJAuthorized
<br />Agent," 'Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report [o Vice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discha.~ge Monitoring Report (DMR) form may be obtained from OBire(s)
<br />specified in permit.
<br />Legal Notice
<br />7Lis report i.s 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 perukies not to exceed x10,000 per day of violation; or io criminal penalties not to exceed $25,000 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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