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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 1 IO hours as m average per response for some major facilities, <br />with' p weighted average jQr major end minor facilities of 18 hours per_resQonse,.indu~ng time for reviewing <br />instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and <br />reviewing the collection of information. Saud co[narents 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 />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; ead [o the <br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions ' t <br />1. If form has been partially completed by preprjnting, disregard instructions directed et entry of that information <br />already preprinted.. _-- .. _. _._ ' <br />2. Enter 'Permittee Name/itfailing Address (and facility nameJlocation, if diH'erent)," "Permit Number," and <br />"Discharge Number" where indicated. (A separate form is required for each discharge.) <br />- ~ _. ._ <br />3. Enter dates beginning atld ending 'Monitoring Period" covered by form where indicated. <br />4. Enter each "Parameter" as specified in monitoring requirements of permit. <br />5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. <br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample; measurements <br />for each parameter obtained during "Monitoring Period'; "Maximum" and "Minimum" are normally extreme high <br />and low measurements obtained during "Monitoring Period." (Note to municipals with secondary treatment <br />requirement: Enter 30~ay average of sample measurements under "Average," and enter maximum 7-0ay average <br />of sample measurements obtained during monitoring period under "Marimurn.') <br />6. Enter :'Permit Requirement" for each parameter under "Quantity" and"Quality" as specified in permit. <br />7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or <br />minimum or 7-day average as appropriate) permit regdiremenl for each parameter. U none, enter "0". <br />8. Enter "Frequency ojAna(ysis" both as "Sample Measurment" (actual frequenry of sampling and analysis used <br />during momtoring period) and as "Pernfit Requirement" specified in permit. (e.g., Enter "Coot," for continuous <br />monitoring, "//7" for one day per week, "f/30" for one day per month, "1/90" for one day per quarter, etc.) <br />9. Enter "Sample Tvpe" both as "Sample Measurement" (actual sample type teed during monitoring period) and as <br />"Permit Requirement," (e.g., Enter "Grab" for individual sample; "14HC" for 24-hour composite, "N/A" for <br />centinuous monitoring, etc.) <br />!0. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective <br />- -acliens taken, and reference each violaNOn by data: -~ ~ -- r~ • • <br />11. if "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. <br />12. Enter "Name/title ojPrincipa! Executive Officer' with "Signature ojPrincipa( Executive Officer ojAuthorized <br />Agent," "Telephone Number," and "Dale" al bottom of Corm. <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 Monitoring Report (DMR) 7orm may be obtained from Office(s) <br />specJed in permit. <br />Legal Notice <br />Ibis 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 pene)'ties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day <br />of violation, or by imprisonment for not more than one year, or by both. <br />.. <br />ro <br />EPA Form 3320-1 (Rev. 08-95) <br />