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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated tQ vary from a range of 10 hours as ea
<br />aver{tge per response for some minor facilities, to 110 hours as av average per response for some major facilities,
<br />tyitit~a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />~instrtrctions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />viewing the collection of information. Seod 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 />Branch, PM-273, U.S. Environmental Protection Agency, 40l 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 ,
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<br />`x1~Jf form has been partially completed by preprinting, disregud insWFtiovs directed at entry of that information
<br />F 'arready preprinted.
<br />€+.7,.?Enter ."Permilree NameMailing Address (and facility nartte/location, if differenq," "Perini! Number," and
<br /><_ ?"T~i,ycharge Number" where indicated. (A separate form is required for each discharge.)
<br />~:.3. inter dates begitming and ending 'Moniloring Period" covered by (orm where indicated. -
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<br />4,'•~ater each "Parameter" as specified in monitoring requirements of permit.
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<br />5. Enter "Smnple Measuremen!" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />~~ "Avernge" is normally arithmetic as'emge (geometric average for baMerial parameters) of all sample measurements
<br />~~ ~_for each parameter obtained during "Moniloring Perlad ; "Maximum" and "Minimum" are normally extreme high
<br />and,low measurements obtained during ".ionitoring Period." (Note to municipals with secondary treattrtent
<br />~., requiremem: Enter 30ilay average of sample measurtments under 'Average," and enter maximum 7-0ay average
<br />of sample measurements obtained during monitoring perdo~ under "Maximum.')
<br />'6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7.,Under "No Fx" enter number of sample measutments during monitoring period that exceed maximum (and/or
<br />minimum or ^, -day average as appropriate) permit requiretnent for each parameter. If none, enter "0".
<br />);8.-Enter "Frequency ojAnalysis" both as ".Sample Meaevrrnenl" (actual frequency of sampling and analysis used
<br />:during monitoring period) and as "Permit Requiremen!" specified in permit. (e.g., Enter "Cont," for continuous
<br />monitoring, "I/7" for one day per week, "I/36' for one day per month, "1/90" for one day per quarter, etc.)
<br />9.'Enter "Sample Type" both as "Sample bfeasuremenr" (actual sample type used during monitoring period) and as
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<br />Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC' for 24-hour composite, "N/A" (or
<br />"'-continuous monitoring, etc.)
<br />}~D. -Where 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 />11i. U "no discharge" occurs during monitoring period, enter "Na Discharge" across form in place of data entry.
<br />Enter "Name/title ojPrincipal Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />'~ Agent," 'Telephone Number," and "Date" at bottom of form.
<br />1$: Mail signed Report to Otlice(s) by date(s) specified in permit. Retain copy for your rxords.
<br />(4. More detailed instructions for use of this Discharge Monitoring Report (DMR) form tray beobtained from Office(s)
<br />specifed in permit.
<br />Legal Notice
<br />'~ port 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 />~1 iv civil penalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 575.000 per day
<br />~iolatiov, or by imprisonment for not more than one year, or by both.
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<br />E~A;Forvt 3320-1 (Rev. 08-95)
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