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. -•- Paperwork Reduction Act
<br />Public reporting burden for this wllection of information is estimated to vary from a range of 10 hours as m
<br />avenge per response for some minor facilities, to 110 hours as ao average per response for some major facilities,
<br />wig a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />iestrtictions, searching existing data sources, gathering and maintaining the data meeded,.and completing and
<br />reviewing the collection of information. Send continents regarding the burden estimate or any other aspect of
<br />!hits collection of information, including suggestions for reducing this burdem, 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 />..l•. ~f form has been partially completed by preprinting, disregard instructions directed at entry' Of that infonnatiom
<br />'),heady preprinted. _. _ _
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<br />2.'Emter 'Permittee Nmne/Mailing Address (and fadlity namt'lloraGon, iE di8'erent)," "Permit. Number," and
<br />~~ c ~'Diacharge Number" where indicated. (A'separate foim is required for each discharge) -
<br />t3#„~nter dates beginning and ending 'Monugrtng Perio~' covered by form where indicated.
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<br />`,.k inter each "Pararnerer" az specified in monitoring requirements of permit. ~ '
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<br />f.;. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Avernge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />fol ~cb_parameter obtained during Aonitoring Period"; "Maximum and "Minimum" are normally extieme_high
<br />and low measurements obtained during "Monitorin eriod." (Note to municipals with seaoudhty Vea Yet
<br />' ` requirement: Enter 30-day average of sample neasurents under "Average," and enter maximum 7-0ay average
<br />'. of sample measurements obtained during monitoring j~rtod under "Maximum.') "' -
<br />``p :6. Enter "Permit RequiremenP' for each pammeter under ".Quantity" and "Quality" az speci<ed in permit. .
<br />f'7~. Under "No Er" enter number of sample meazutments~uring monitdring period that exceed maximum (and/or'
<br />minimum or 7-day average az appropriate) pertgit regyjtEynettt for each parameter, ]f none, enter "0"..'
<br />~~. Enter "Frequency ojAnalysis" both as "Sample Measurment" (actual frequency of sampling and analysis used
<br />~: during monitoring period) and az "Fermi! Requirement" specificd in permit. (e.g., Enter "Gout," for wnunuous
<br />e} ~ .monitoring, "l/7" for one day per week, "I/30" (or one day per month, "//90" for one day per quarter, etc.)
<br />Enter "Sample Type" both as "Somple Measurement" (actual sample type used during monitoring period) and az
<br />;"Permit Requirement," (e.g., Enter "Grab" for individual sample, 2JHC" for 24-hour composite, "N/A" for
<br />'~ , continuous monitoring, etc)
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<br />~(,-, Where violations of permit requirements are reported; attach a brief explanation to describe cause and corrective
<br />p". action$ taken, and reference each violation by date.
<br />Tf "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />Enter "Namelfitle ojPrincipa! Executive Officer" with "Signature ojPrincipnl Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" a[ bottom of form.
<br />Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your rewrds.
<br />More detailed instructions for use of [his Discharge Monitoring Report (DMR) form dray be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />eport 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 />in civic penalties mot to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 575,000 per day
<br />lation, or by imprisonment for not more than one year,.or by both.
<br />3320-1 (Rev. 08-95)
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