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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 es o0
<br />average per response for some minor facilities, to } jp. boors a$ artaverage per response for some major facilities,
<br />with a weighted average for major and tgiposfg~{jgfi o~[_l~boufs_per response, including time for rlvittwing
<br />instructions, searching existing data sources, gat¢[~irrg and maintaining the data needed, and completinQ'wd
<br />reviewing the collection of information. Send commepL~iegarding the burden estimate or. any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Rolicy
<br />Brsnch, PM-223, U.S. Farrttrortmemtal Protection Agency, 40l M Street, SW Washington, DC 20460; end Co the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washimgton, DC 20503. r .
<br />General ~i~structions
<br />f:;i~torm has been partially completed by~preprinting, disregard instructions directed at entry of that inforrnatioo
<br />-af[eady preprinted. .- ..~_ ..
<br />~•_~ter "Permittee Name/Mailing Address (arid fariility 'iramelloption, if different)," "Permit Number," and
<br />'Di'scharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Eot~r dates beginning and ending 'Alonitoring Period" covered by form where indicated.
<br />_.
<br />4. Rnter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Afeasurement" data for each parameter under "Quantity" and "Qunfiry" in units specified in permit.
<br />"Average" is normally arithmetic average.(gcometric average for bacterial parameters) of all sample measurements
<br />for each perimeter obtained during "Monitoring Period"; "Maximum" and "dlinimum" are normally-extreme high
<br />and,.low measurements obtained during "hlonitorirg Period." (Note to municipals with secondary treatment
<br />regruretitent: Enter 30-day average of sample measuremems under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during mon(toring period under "Maximum.
<br />6. Enter "Pernrir Requirement" for each parameter under "Quantity" and "Quality" as specked in permit.
<br />7. Under "No Ex" enter number of sample measuements during monitoring period that exceed maximum (and/or
<br />-minimum or 7-day average as appropria(e) permit requirement for each'parameter. If none, enter "0".
<br />8. Enter "Frequencv ojAnalysis" both as "Sample Measurvrrent" (actual frequency of sampling and analyst's used
<br />during monitoring period) and as "Permit Requireuren!" specified in permit. (e.g., Enter "Coot," for continuous
<br />monitoring, "1/7" for one day per week, "1/30" Cor one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample ,'Measurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" fiprindividual 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 />• "8c-ionstaken,andreferenceeachviolal+enbydate -.- - _-. _ ,.,,. _r, „
<br />11. If "no discharge" occurs during monitoring period, enter "Nu Discharge" across form in place of data entry.
<br />12. Enter "Name/Title ojPrincipa! Executive Dicer" with "Signature oJPrincipn! Executive Officer of Authorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />l3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />l4. More detailed inslnrctions for use of this Discharge Monitoring 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 cen
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
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<br />EPA Form 3320-1 (Rev. 08-95)
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