HYDRO27280

• Permit No: C1981008
• IBM Index Class Name: Hydrology
• Doc Date: 5/2/2001
• Doc Name: 1st Q 2001 DMRs
• Permit Index Doc Type: DMR’s
• Media Type: D
• Archive: No

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Public reporting burden for this collection o!~information is estimated to vary from a range of ] 0 hours as an
average per response for some minor facili :ies, to 110 hours as an average per response for some major
facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
reviewing instructions, searching existing rata sources, gathering and maintaining the data ^eeded, snd
completing and reviewing the collection of information, including suggestion for reducing this burden, to
Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 Vi S'se~t, S.W.
Washington, DC 20460; and to the Office o_"Information and Regulatory Affairs, Cffice of R~ianagement and
Budget, Washington, DC 20503.

1. If form has been partially completed by preprinting, disregard instruction drrected at entry of that in oimaron aUeai.y
preprinted.
2. Enter "Permittee Name/lvlailing Address (ard Facility nameilocation, if different)," " Pernrit Numh~,;" and "Dis_har~e
Number" where indicated. (A separate form {s required for each discharge.)
3. Enter dates beginning and editing '7Ylonitori~~g Period" covered by form where indicated.
4. Enter each "Parameter" as specified in monitoring requirements of permit.
5. Snter "Sample Measurement" data for each parameter under "Quantity"and Quality" cs sreci6ed in permit. ".{ve, age" is
normally arithmetic average (geometric average for bacterial parameters) of all sample measurements fcr eac;~ parameter
obtauted during "Ivfonitoring Period'; '7Ne• imum" and Minimum" are normally ex~reme high ann lov: measu :menu
obtained during "Monitoring Period". (Note to municipals with secondary treatment rec uirement: enter 30-E ay : vera,c
of sample measurements under 'Average."and enter maximum 7-day average of sample measurements obta :red during
monitoring period under "Maximum.")
6. Enter 'Permit Requirement" for each parameter under "Quantity" and "Quality" as specif ed in perm:.
7. Under "No E.r" enter number of sample mea,urement during monitoring period that exec od maximum (tnd/or mieimu:n
or 7-day average as appropriate) permit requi remeot for each parameter. If none, enter "0 ".
8. Enter "Frequency ojAnalysis" both as "Sonrale N~asurement" (actual frequency of sampling any ana'ysis used during
monitoring period) and as "Permit Requirement" specified in permit. (e.g. Enter "Con'," for continuous monitoring, "1/7"
for one day per week, "I/30"for one day per month, "//90"for one day per quarter, eL.)
9. Enter "Sample Type" both as "Sample Measurement" (actual sample type used during monitoring period) and as "Permit
Requirement," (e.g. Enter "Grab" for individual sample, "24HC" for 24-hour composite, "N/A" for continuous
monitoring, etc.)
:0. Where violations of permit requirements arc reported, attach a brief explanation to describe cause and corrective actions
to be taken, and reference each violation by date.
] 1. If "no dischazge" occurs during monitoring period, eater "No Discharge" across form in place of data entry.
12. Enter "Name/Titfe of Principal Executive Officer" with "Signature of Principal Executive Officer of Aut4orizsd
Ageni, ""Telephone Number," and "Dale" a[ bottom of form.
13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
]4. More detailed instructions for use of this ~,ischarge Monitoring Report (DMR) form may be obtained from Cffice(s)
specified in permit.
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This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or fai:ure to repoR trut~ifnlly can result it
civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
or by imprisonment for not more than one yeaz, or both.
EPA Form 3320.Y (Rev. 03/99)