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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 10 hours as an
<br />average per response for some minor facilities, to 110 hours u an average per response for some major facilities,
<br />with a weighted average for major and minor fae~es of LS hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathi~ntd maintaining the data needrd, and completing and
<br />reviewing the collection of inFormatioo. Send comments re~ari.ing the burden estimate or any other. aspect of
<br />this collection of information, including suggestions For reducing this burden, to Chief, Information policy
<br />Branch, PM-223, U.S. Enviroatg~gtal Protection Agency, 401 M Street, SW Washington, DC 20460; aodto the
<br />Office of information and RegttlafLry Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
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<br />1. If form has been partially :ompleted by preprinting, disregard instructions directed at entry of that information
<br />alnrady preprinted.
<br />2: Enter 'Permitlee Nmne/Il4ailing Address (and facility ftarttefhxation, if tliffen:M)" "Fermi! -A4unber," .aad,••~.>-a.ur ,
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.) •~ -,- ,-
<br />3. Enter dates beginning and ending "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measuremen"' data for each parameter under "Qua.ntity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geemetric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during "hfonitortng Perrod'; ";Idarimurn" and "Afininrum" are normally extreme high
<br />and low measurements .obtained during "Monitorng Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-dav tverage of sampfe meas~-cncns under "Average," and enter maximum 7-day average
<br />of sample measurements oEutined during monitoring period under "'Maximum. 1
<br />6. Enter "Permit Requirement" for each parameter under "Qr~nnriry" and "Qualityf' as specified in permit.
<br />7. Under ",No Ex" enter number of sample measwmenls during monitoring period that exceed maxinttun (and/or
<br />minimum or 7~ay. average as appropriate) permit requirement for each parameter. if none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both as "Sonrple Measurnrent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Perini! Requirement" specked in permit (e.g., Enter "Cant," for continuous
<br />monitoring, "1/7" for one dal per week, "I/30" for one day per month, "l~90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" bosh a; "Sample Afeasurement" (actual sample type used during monitoring period) and as
<br />"Pernrir Requirement," (e.g., Enter "Grab" Cor individual sample, "1•!HC" far 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements arc reported, attach a brief explanation to describe cause and corrective
<br />acliotl~laken, and reference each vio]ation by date.
<br />I I. Tl "no discharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry.
<br />12. Enter "Name~/'itle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive OC~cer oj.9ulhorized
<br />Agent," "Telephone T'umber," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(:;) by date(s) specified in permit Retain copy Cor your retards.
<br />14. More detailed instructions for use of this Discharge A•fonitoring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />77ris report is required by law (33 Lt.S.C. 1318; 40 C.F.R. 125.27). Failure [o report or failure to report [rttlhfully can
<br />result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed E?5,000 per day
<br />of violation, or by imprisonment for pot more than one year, or by both.
<br />EPA Ferm 3320-1 (Rev. OS-95)
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