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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 IO hours as an
<br />average per response for some minor facilities, [n 1 ] 0 hours as m average per response for some major facilities,
<br />with a weighted average for major and minor facilities of IS 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 informatioo. Send comments regarding [he 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 Strezt, SW Washington, DC 20460; and to the
<br />Office of Informatioo and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form hes been partially completed by preprinting, disregard instructrons directed at entry of that information
<br />already preprinted.
<br />2. Eater 'Permittee Name%'lfai(ing Address (and facdity name/location, if different)," "Perini! Nuurber," and
<br />"Discharge.R'uinber" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and coding ".tfonitoring Period" covered by form tjhere indicated.
<br />4. Enter each "Parmneter" az specified in monitoring requirements of permit.
<br />5. Enter "Sample :1lemvremenr" data for each parameter under "Quantity" and "Quolirv" in units specified in permit.
<br />",gveroge" is nornralk arithmetic average (g=ometric average for bacterial parameters) of all sample meas~remcnts
<br />for each parameter oUtained during ".l-lonitori,ag PeriuJ'; ",llaxrmurn" and ".llinimum" are normally extreme high
<br />and low rneasuremenis obtained during "1frnitcring Perrod." (Note to municipals rtiih secondary Irea[menl
<br />regwremenC Enter 30-day average of sample mcasurcmcr.s under "Ave,-age," and enter maximttm 7-day average
<br />of sample mcaurcments obtained during rnonilaring period under "/.fazimum. ")
<br />6. Enter "permit Requirement" Cor each plramctcr under "Quantity" and "Quality" az specified in permit.
<br />7. Under "N'o Es" enter number of sample measumtenls during monitoring period that exceed maximum (.utd/or
<br />minimum or 7-day average az appropriate) permv requirement far each parameter. if none, enter "0".
<br />8. Enter "Frequency ojAnalycis" both as 'l1'onrple .4feasurmenr" (actual frequency of sampling and analysis ttsed
<br />during monitoring period) and as "Fermi! RenuiremcnP' specified in permit. (e.g., Enter "Cons," for continuous
<br />monitoring, "1.~7" Cor one day per week, "1 c30" for one day per month, "1/90" for one day per quaAer, etc.)
<br />9. Enter "Sample Tvpe" both as "Sample .1 frasurenrent" (actual sample type used during montoring period) and az
<br />"Permit Requirement," (e.g., Enter "Grab" for indnidual sample, "?~1f/C"' for 2d-hour composite, "iJ/A" for
<br />continuous monitoring, clc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation [o describe cause and corrective
<br />actions taken, and reference each violation by dive.
<br />l 1. If "no discharge" occurs during monitoring period, enter ",No Discharge" across form in place of da'a entry.
<br />12. Enter ".Name/Title ojPrincipa! Executive O~_•er" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" a[ hotfoot of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge tvfonitoring Report (DMR) form may be obtained from Office(s)
<br />specJed in permit
<br />Legal Notice
<br />This report is required by law (33 U.S.C. ]318; 40 C'.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed x10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than once year, or by both.
<br />EPA Form 33f0-1 (Rev. 08-95)
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