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` Paperwork Reduction Act Notice -
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<br />' Public gepoRing burden for this collection of information is estimated to vary from a tange of 10 hours as m
<br />average per response for some minor facilities, to 110 hours as an averag4pec response for some major facilities,
<br />Wilbr weighted average for major and minor facilities pf 18 hours per respbtise, including time far reviewing
<br />idStntctions, searching existing data sources, gathering and maintaining We data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />tf}i~ collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />;HrLtc~t, ~PM-223, U.S. Environmental Protection Agency, 401-M Street, SW Washington, DC 20460; and to the
<br />OCTie of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
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<br />'farm has been partially completed by preprinting, disregard instructions directed et entry of Utat information
<br />„i y preprinted.
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<br />tyr "Permittee Name/Mailing Address (and faaliry narttelloption, if di8'erent)," "Permit Number," and
<br />- ischarge Number" where indicated. (A separate form is required for each discharge.)
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<br />;.3.~nter dates beginning and ending 'Monitoring Period"covered by form where indicated.
<br />id'C~utter each "Parameter" az specified in monitoring requirements of permit.
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<br />,A fitter "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 />~: ~ Yor each parameter obtained during "Mfoniroring Period'; "ttifarimutn" and "iLlinimum" are normally ea4reme high
<br />and low measurements obtained during "tifonitoring Period." (Note to municipals with secondary Veatment
<br />'requirement: Enter 30-day average of sample measncmcnts under "Average," and enter maximum 7-day average
<br />i of sample measurements obtained during monitoring pirtod under "Maximum.)
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<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Qualiry" az specified in permit.
<br />iT.'Undet "No Ez" enter number of sample meaurments during monitoring period that exceed maximum (and/or
<br />'minimum or 7-day average as appropriate) permit requrr~ment for each parameter. U none, emer "0".
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<br />;8'.~nter "Frequency ojAnalysis" both as "Smnple Me`asUrment" (actual frequency of sampling and analysis used
<br />during monitoring period) and az"Fermi( Requirement"~specificd in permit. (e.g., Enter "Cont.' for continuous
<br />monitoring, "//7" for one day per week, "1/30" for on~d~ per month, "//90" for one day per quarter, etc.)
<br />~ jEnter "Sample Type" both az "Sample Measuretnent't(~tual sample type used during monitoring period) and az
<br />.'Permit Requirement," (e.g., Enter-•"Grab" for individual sample,. ?4HC" for 24-hour composite, "N/A" for
<br />~ 'continuous monitoring, etc.) •''~
<br />~: Where violatiorts of permit requirements are reported, attach a brief explanation to describe pose and corrective
<br />.;actions taken, and reference each violation by date.
<br />. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />. Enter "Name/1'iUe ojPrincipa! Executive Officer" with "Signature ajPrincipal Executive Officer ajAuthorized
<br />;Agent," 'Telephone Number," and "Date" at bottom of form.
<br />~i: Mail signed Report to Offce(s) by date(s) specified in perntit. Retain rnpy for your records.
<br />More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />~, - Legal Notice
<br />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 />it pemlties not to exceed 510,(100 per day of violation; or in criminal penalties not to exceed 325,000 per day
<br />or by imprisonment for not more than one year, or by both.
<br />3320-1 (Rev. 08-95)
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