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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 !0 hours as an
<br />average per response for some minor facilities, to 110 hQttra as an avengq~er response for some major facilities,
<br />with a weighted average for major and rttinor facilitips~af 18~-Qer tesponse. including tim~et fbr reviewing
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<br />instrucons, searching existing data sources, gathering and mq~imng the data needod, and ~mpleting and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />lfiis collection of information, including stt~gesti~,ts for reducing this burden, to lJhie(, Information Policy
<br />Branch, PM-223, U.S. Environmental,Piolection A;ency, 40I M Street, SW Washingtay'~fC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Managememl and Budget, Wa~ington, DC 20503.
<br />General Instructiw~s
<br />L If form has been partially completed by preprinting, disregard ~glkrtretions directed at entry of that information
<br />already preprinted.
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<br />2. Enter 'Permitfee Name/Mailing Address (and facility nameNacation, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending "Monitoring Perin[{"covered by form where indipted. ~ - r- .
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<br />4. Enter each 'Parameter`*ds.sp~cified inmoniton'ng°ilgtdrenients of permit. -^.1~w
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<br />5. Enter "Sample Measurtihrent"'daL for each parameter under "Quantify" and "Quality" in units specified in ~ .;
<br />"Averggt". ~S normally arithmetic average (geometric average for bacterial parameters) of all sample measu `t,- ~-^
<br />for r obtained during "Monitoring Period"; "~Llnximum" and "Afinimurn" are normally extreme '` ;;3
<br />~ nts obtained during "bfonimring Period." (Note to municipals with secondary treatma `` '
<br />' 30day average o(sample measurements undo "Average," and enter maximum 7~ay average;'" '
<br />jQa" eels obtained during~tonitoring period under ",4faxtmum.
<br />6. Enter 'Perinff quiremenl" for e~patg~meter under "Quantirt" and "~ualiry" az specified in permit.
<br />Fr" enter number of ' e measurments during monitoring period that exceed maximum (and/or
<br />~ or 7-day average as te) permit requirement for each parameter If none, enter "0".
<br />~^ ~~ "Frequency ojAnalysis^ both az "Smnple ,Lfenrurment" (actual Gequency of sampling and analysis used
<br />daring monttoriaig period) and as "Permit Requiremen!" specified in permit. (e.g., Enter "Cons," for continuous
<br />monitoring, "f' for one day perweek, "//30" for otte day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both az "Sample Afeosurement" (actual sample type used during monitoring period) and az
<br />"Permit Requirement," (e.g., Enter "Groh" for individual sample. "?dHC" for 24-hour composite, "N/,9" for
<br />continuous monitoring, etc.)
<br />10. 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 />IlJ~~no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
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<br />lµ'~3nter "Name/Title ojPrincipal Executive Officer" with "Signature ojPrincipnl Execulive OJTcer ojAuthorized
<br />! +Agent," "Telephone Number," and "Dare' 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 inswctions for use of this Discharge Monitoring Report (DMIt) form may be obtained from Office(s)
<br />specified 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 penalties not w exceed 510,00(1 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 />EPA Form 3320. (Rev. OB-95)
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