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Paperwork Reduction Act Notice
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<br />Publfe reporting burden for Uris 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 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, gathering and maintaining the data needed, and completing and
<br />reviewing the wllection 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, Informatton Policy
<br />8rgmeh, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
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<br />a. ~f. form has been partially completed by preprinting, disregard )nstnretions directed at entry of that information
<br />~t{ieady preprinted. - _ _ .
<br />+2. 8oter "Permittee NamriMailing Address (and facility name/location, if different)," "Permit Number," and
<br />' "Discharge Number" where indicated. (A separate (orftt is required for each discharge)
<br />`~. inter dates beginning and ending 'Monitoring Period" covered by form where indicated.
<br />;4. inter each "Parameter" as specified in monitoring requirements of permit.
<br />,$. Enter "Sample Afeasuremenr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Avernge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".ffonitoring Period"; "Maximum" and "A.finimum" are normally extreme high
<br />and low measurements obtained during "Aonitoring Period." (Note to municipals with secondary treatment
<br />rtquiremeut. Enter 30~av average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "Alaximurn.
<br />6. Enter "Permit .Requirement" (or each parameter under "Quantity" and "Quality" az specified in permit.
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<br />7..Under ",No Fx" enter number of sample measurements during monitoring period that excced maximum (and/or
<br />- minimum or 7-day average az appropriate) permit requiremen! for each parameter. >f none, enter "0".
<br />Enter. "Frequency ojAnalysis" both as "Semple hlcosurrnenP (actual frequency of sampling and analysis used
<br />1~' ;during monitoring period) and az "Permit Requirement" specified in permit. (e.g., Enter "Cont," for continuous
<br />d . monitoring, "! i7" Cor one day per week, "!/30" for one day per month, "1/90" for one day per. quarter, etc.)
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<br />-Enter "Smnple Type" both az "Semple .Aleasurement" (actual sample type used during monitoring period) and az
<br />~'Penait Requirement," (e.g., Enter "Grab" for individual sample, :4HC' for 24-hour composite, "N/.4" for
<br />.continuous monitoring, etc.)
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<br />~0: 1Vhere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />factions taken, and reference each violation by date.
<br />~. ]C "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
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<br />~,2. Enter "Name/title oJPrincipal Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," "Telephode Number," and "Date" at bottom of form.
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<br />1,3; Mail signed Report to OtFice(s) by date(s) specified in permit. Retain copy for your records.
<br />~~. More detailed instructions for use of this Discharge Monitoring Report (DMR) (orm may be obtained Gom Office(s)
<br />specified in permit.
<br />Legal Notice
<br />~rt 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 />civil penalties not to excced 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />foe, or by imprisonment for not more than one year, or by both.
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<br />Form 3320-1 (Rev. OS-95)
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