Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as ea
<br />average per response for some minor facilities, to 110 hours az an average per response far some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searcFiog e;:isting data~sourties, 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, Infortnahon Policy
<br />$ranch, PM-223, US. Environmental Frotection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />OfRce of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregard instructions directed at entry of that infotmttion
<br />already preprinted.
<br />2. Enter 'Permi(!ee Name/Mailing Address (and facility nante/locatioq 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 '~tfoniroring Period" covered by form where indicated.
<br />4. Enter each "Paranreler" ss specified in monitoring requirements of permit.
<br />5. Enter "Sample h/easuren ent" data for each parameter under "Quantity" and "Quality" .n units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurzm~ents
<br />for each parameter obtained doting "Afonitoring Period"; "Maximum" and "Alin,ntum" are normally extreme high
<br />and low measurements obtained during "bfomtortng Period." (Note [o municipals with secondary treaunen[
<br />requirement: Enter 30-dry average of sample meazurements under "Average," and enter maximum 7~ay average
<br />of sample measurerents ub4vned during monitoring period under "Maximum.
<br />6. Enter "Permit Requirerue.rt" for each parameter under "Quantity" and "Quality" as speciCcd to permit.
<br />7. Under ".Yo Ez" inter number of sample measurntents during monitoring period that excezd maximum (and/or
<br />minimum or 7~ay every@e as appropriate) permit requirement for each parameter If none, enter "0".
<br />8. Enter "Frequency ojAnn/ysis" both as "S'nmp/e Afeasurnrent" (actual frequency of sampling and analysis used
<br />during monitoring period) and az "Pencil Requvernent" specified in permit. (e.g., Enlzr "Coot," for continuous
<br />mottoring, "1 i7" for one day per week, "l%JO" Cor one day per month, "I i90" for ene day per quarter, etc.)
<br />9. Enter "Sample Typr" bot t az "Sample ,tfeacurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirenienr," (e. g., Enter "Grab" for individual sample, "24/fC" fur 24-hour composite, "h;:9" for
<br />continuous monitoring, et:.)
<br />10. Where violations of pern'it requirements am reported, attach a brief explanation [o describe cause and corective
<br />actions lacer, and reference each violation by date.
<br />11. [f "no discharge" xcurs daring monitoring period, enter "h'o Discharge" across fornt in place of data entry.
<br />12. Enter "Narne/Tille ojPriitcipal Executive Officer" Hith "S'ignature ojPrincipa! Executive Officer ofAuthorzed
<br />Agent," "Telephone Number," and "Dale" a[ bottom of form. ,
<br />13. Mail signed Report [o Office(s) by dare(s) specified in permit., Retain copy for your records.
<br />14. More detailed ins[rucuons for use of this Discharge Monitoring Repot! (DMR) farm tray be obtained from Office(s)
<br />specified ir. permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. I318; 40 C.F.R. 125.27). Failure to report cr failure to report truthfully aan
<br />r~cult in civil perrtitizs nni to excezd 510,000 per day of violation; or in criuunal penalties not to e><ceed 525,000 per clay
<br />of violation, or by impiiranmem for not moro than one year, or by both.
<br />'.FA Form 332Gi (Rev, OR-95)
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