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- i ., _ Paperwork Reduction Act Notice
<br />Public reporting burden for this colleAhhh~foa of information is estimated to vary from a range of.~Phours ~s an
<br />average per response for some minor facilities, to 110 hours as m average per response for some major faclities,
<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 cVmments regarding the burden estimate or any other espact of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Envim~~u~,~ntat Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regttlapry Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
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<br />~~+~f,form has been partially completed by preprinting! disregard instructions directed at entry of that information
<br />,,,r~~i°ready preprinted.
<br />'PeMttttee Name%tifailing Address (and facility namellocation, if differenQ," "Permit Number," and
<br />urge Number" tvhere indicated. (A separate form is requited for each discharge)
<br />~~ttel,(dates beginning and ending 'Monitoring Period" covered by form where indicated.
<br />nler each "('arameter" as specified in monitoring requirements of permit.
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<br />~ple[,"Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />:dverage' is normalk arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />-rter each parameter obtained during "Monitoring Perod'; "Maximum" and "Afinimum" are norntally extreme high
<br />' and Ipw measurements obtained during "bfoniroring Period." (Note to municipals w~lh secondary• treatment
<br />i lequirertt$irt: Enter 30-day average of sample measurements under "Average," and enter maximum 7-day average
<br />9Ysabplemeasurements obtatncd during monitoring period under "bfazimu+n.
<br />Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specified in permit.
<br />:=Undei "No £x" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />i firiniritum or 7-day average as appropriate) permit requirement for each parameter. !f none, enter "0".
<br />~ Enter., "Frequency ojAnalvsis" both as "Sample Measure+ent" (actual frequenry of sampling and analysis used
<br />:during monitoring period) and as "Permit Requirenrenr" specified in permit. (e.g., Enter "Copt," for continuous
<br />rhoniloring, "1 ~7" for one day per week, "f/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />'Enter "Sample Type" both az
<br />"Permit Requirement," (e.g.,
<br />continuous monitoring, etc.)
<br />"Sample ,Measurement" (actual sample type used during monitoring period) and az
<br />Enter "Grab" for individual sample, "24HC" for 24-hour composite, "N/.4" for
<br />~tltere 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 />7f "no discharge" occurs during monitoring period, enter "No Discharge" across forth in place of data entry.
<br />~8ttter "Name/1'irle of Principal Executive Officer" with "Signature of Principal Executive Officer of Authorized
<br />Agent," "Telephone Number," and "Date" a[ bottom of form.
<br />Mail signed Report to t~ce(s) b}~ date(s) specified in permit. Retain rnpy for your records.
<br />More detailed instructions for use of this Discharge Aonitoring Report (DMR) form may be obtained from Office(s)
<br />specked in permit.
<br />Legal Notice
<br />ort 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 mot to exceed $10,000 per day of violation; or in criminal penalties not to exceed 525.000 per day
<br />ion, or by imprisonment for not more than one year, or by both.
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<br />EP~,Form 3320-1 (Rev. OS-95)
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