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i ~ <br />aperwork Reduction Act Notice I,I <br />Public repoRing bur en f or this collection of information is esr.imated to vary from a rang of 10 hours as 3n <br />average per respunst fo: some minor facilities, to l 10 hours as an average per respuns for some major <br />facilities, with a wei hted average for major and minor facilities of 18 hours per response, ~nciuding time for <br />retietcing insvuctioi s, searching existing data sources, gathering and maintaining the data needed, and <br />completing and revi wieg rite rollection of inlomtatior., includirrs suggestion ft~r reduci~t ~ this burden, to <br />Chief., information olicy Hr[mch PM-223, U.S. Environmental Protection Agency, d(Ip M Street, S.V~'. <br />Washington, DC 20A 0; and to [he Office of Information and Regulatory Affairs, Office of~ Management and <br />Budget, V~'ashington, DC 2050 ~. <br />~- IGeneralInstructions ItJ <br />L If t~arnt has been rtially comple.ed 6y preprinting disregard instnr~_rion directed at entry of that information already <br />prelxinted. <br />2. Enter "Pennir(ee . me~,19a/i~r,g AJdress (and facility name.(location, if difTerent)," "Permit Number," and "Disch~nge <br />rVurnber' where in icated. (A sepais[e Form is required for each discharge.) <br />3. En[cr dates beginni g and ethting " LCorritoring Period" covered by form where indicated. <br />-~. F.ntr:r each "Param ter" as specified In monitoring regttrements of permit. <br />5. Enter ".Sample ,Nea urernem" data 'br each pammeter under "Quuntih~" and Qnalih•" as specified i permit. "Average" is <br />normally arithmetic average (groin ~[ric average fur bacterial parameter:) of all sample measureme tts for each parameter <br />obtained during "b ommrin„ Perin d": ",LJarimum" and Minimum" arc normally extreme high a~td low measurements <br />obtained during " rniun•in~ 1',•rioJ". (Note to municipals with secondan treatment requirement: Enter 30-day average <br />of sample measure enn; under ".4reruge."and enter maximum 7-day average of sample measurements obtained during <br />monitoring period u tder "bkrrJ+ewr.") I <br />6. Enter "Permit Reya rement" for each parameter under "Quoruire" attd "Ouulin'' as specified in pernhit. <br />7. Under "No Ex' ent number of sample measurement during monitoring period that exceed maxirt~um (and/or minimum <br />or 7-day average as , ppropriatei permit requiremem for each parameter. If none, enter "0". <br />8. Enter "Frequency r <br /> monitoring period) <br /> for one day per wee <br />9. Enter "Smnp(e Typ( <br /> Requirement," (e.g <br /> monitoring, etc.) <br />10. Where violations o. <br /> to be taken, and refs <br />1 L If "no discharge" oc <br />l2. Enter "Name/Title <br /> Agent, ""Telephone <br />13. Mail signed Report <br />14. More detailed instr <br /> specified in permit. <br />Analysis" both as "Sample Measurement" (actual frequency of sampling andl analysis used dwring <br />id as "Fermi( Requirement" specified in permit. (e.g. Enter "Corr(," Cor continu~tus monitoring, "i!7" <br />"I!30" for one day per month, "J; 90" for one day per quarter, etcJ <br />both as "Sample A9easuremen(" (actual sample type used during monitoring p nod) and as "Perini[ <br />Enter "Grab" far individual sample, '74HC" for 24-hour composite, /A" for continuous <br />>emtit requirements are reported, attach a brief explanation to describe cause $nd corrective actions <br />:nce each violation by date.. I <br />us during monitoring period, enter "No Dischazge" across form in phce of data entry. <br />Principal E.ecutive O]~cer" With "Signature of Principal Executive O~cer of A:rthori_ed <br />tuber,"and "Date" at bottom of form. ' <br />Office(s) by date(s) specified in permit. Retain copy far your records. <br />ions for use of this Discharge Monitoring Report (DMR) form may be obt~ined from Office(s) <br />Legal Notice <br />This report is required b law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure [o report or failure to report tt1uthCully can result in <br />civil penalties not to exc d 510,000 per day of violation; or in criminaE penalties not to exceed $25,000per day of violation, <br />or by imprisonment for n t more than one year. or both. <br />EPA Foctm 3320-1 (Rev <br />