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 respovse for some minor facilities, to 110 hours es as average per response for some major facilities,
<br />wish a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining [he 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, Information Policy
<br />Bunch, PM-223, U.S. Environmental Protection Agency, 401 NI Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Manageatent and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partixlly completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permiltee Name/Mailing Address (and Cacility tuune/location, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate (otm 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 />S. Enter "Sample AfeasuremenP' data .or each parameter under "Quamity" and "Quality" in units specified in permit.
<br />'Averoge" is normally arithmetic a~~erage (geometric average : or bacteria] parameters) of all sample measurements
<br />.or each parameter obtained during ",t4onirnring Period"; ",1'lirximurn" and "hfini,»um" are normally extreme high
<br />and low measurements obtained during ".4funiloring Period." (Note to municipals with secondary treatment
<br />_equirement Enter 30ttay average of sample measurements ender "Average," and enter maximurn 7-day average
<br />of sample measurements obtained during monitoring period under "Maximum.')
<br />6. L-nter "Permit Requirement" for each parameter under "Quanri,~" and "Quality" as specified in permit.
<br />7. Under "h'o Ex" enter number of sample measurments during monitoring period that exceed maximum (andlor
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. ]f none, enter "0".
<br />E. Enter "Frequency oJAnalysis" both as "Sample ~Lleasurrnen!" (actual frequency of sampling and anal}'sis used
<br />during mom[oring period) and as `Permit RequiremenP' specified in permit. (e.g., Enter "Copt," for continuous
<br />monitoring, "1/7" for one day per weak, "l/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample Measurement" (achr.7) sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, ":4HC" for 24-hour composite, "h'/A" for
<br />continuous monitoring, etc.)
<br />10. `Nhere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry.
<br />12. Enter "Name/title ojPrincipa! Executive Officer" with "Signature ojPrincipa! Executive Officer ojAurhorized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Aonitoring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report 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 />result in civil penalties not to exceed 810,000 per day of violation; or i^ criminal penalties not to exceed 825,000 per day
<br />of violation, or by imprisonment for not mare than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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