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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 l0 hours as an
<br />average per response for some minor fecilities, to ] 10 hours as m average per response for some major facilities,
<br />4"ulh a weighted average for major and minor facilities of l8 hoots per response, including time for reviewing
<br />boos, searching existing data sources, gathering and maintaining the data .+errled, and completing and
<br />~g the collection of information. Send comments regarding the burden esti,~te or nny other aspect of
<br />this collection of iafotmatioa, including suggestions for reducing [his burden, to Chief, information Policy
<br />Branch, 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
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Perntittee Name~~lailing Address (and facility name/locatio4 if different)," "Permit .Nun+ber," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending itfonitoring Period" covered by form where indicated.
<br />4. Enter each "Pararneter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measuren+ent" data for each parameter under "Quantity" and "Qunlity" in units specified in permit.
<br />"Average" is normally anthmetic average (geometric average for bacteria] parameters) of all sample measurements
<br />Cor each parameter obtained during ".'ifonitoring Period"; "Afaximum" and "blin+n+um" are normally extreme Vtigh
<br />and low measurements obtained during "monitoring Period." (Note to municipals µith secondary trea[rnent
<br />requirement: Enter 30-d:ty average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measuremetts obtained during monitoring period under "Alaximum. ")
<br />6. Enter "Permit Requireme.at" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "No Er" enter nt,mber of sample measuements during monitoring period that exceed ma+dmum (and/or
<br />minimu,r or 7-day average as appropriate) pernti; requirement Cor each pazameter. L`. none, enter "0".
<br />8. Enter "Fr,~quency ojAnalysis" both as "SarnpM Meosur+nent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Pervr+i( Requirement' specified in permit. (e.g., Enter "Con(," for continuous
<br />monitoring, "li7" for one day per week, "/!30" for one day per month, "Ii90" for one day per quarter, etc.)
<br />9. Enter "Sanple Type" both as "Sample hleasuremenP' (actual sample type used during monitoring period) and as
<br />"Permit Requirernent," te.g., Enter "Grab" for individual sample, "14HC' for 24-hour composite, "N/A'" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions take4 end referer.cc each violation by dale.
<br />11. ll "no discharge" occurs during monitoring period, enter ",M1`o Discharge" across form in place of data entry.
<br />12. Enter "Ncme/Ti(le ojPr;ncipa! Executive OJTcer" with ':Signature ojPrincipal Executive Officer ojAu(hm•ized
<br />Agent," "Telepho.ne,Numner," and "Date" a[ bottom of form.
<br />13. Mail signed Report to OP_ice(s) by date(s) specified in permit. Retain copy for yotU records.
<br />14. More detailed instructions for use of this Discharge rtfonitoring Report (DMR) form may be obtained from Offire(s)
<br />specified in permit.
<br />Legal Notice
<br />Tltis report is required by law (33 U.S.C. '318; 40 C.F.R. 125.27). Failure w report or failure tc repot. truthfully can
<br />result in ci~i! penalties no[ to er teed $10,000 pee day cf violation; or in criminal penalties not to exceed S?5,000 per day
<br />of violation, o+ by imprisonment for not more than one year, or by both.
<br />EPA Form 3310-] (Rev. QR-95t
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