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Paperwork Reduction Act Notice
<br />R~blc reporting burden for this collcction of infOnnatiuu is estimated to vary Frnm ~•. rs~c~ ct 10 F.rnv~ :.. ~,..
<br />avc,vge per response for some minor tacrlihes, [0 110 hours as an average per response for some major facilities,
<br />with a weighted avenge for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and rnainlaiaing the data ner_ded, and c.^.mpl~[ing and
<br />reviewing the collection of inforrmtioo. Seod comments regarding the burden estimate or any c[h:.r aspect of
<br />this collection of information, including suggestions for reducing [his burden, to Chiaf, ]nfurvmiion Policy
<br />Branch, Pivi-2'[3, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Informa[ioo and Regulatory Affairs, Office of Managemeol and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed a[ eaLy uC that infu, motion
<br />already preprinted.
<br />2. Enter 'Perntitfee h'ame%Afai(ing Address (and Cacility tlalne/loealion, if dil3erenQ," "Permit Num.ber," and
<br />"Drscharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter darts beginning and ending "Afoniroring Period" covered by form where indicated.
<br />4. Enlu each "{'aran+eler" as specified m monitoring requirements of permit.
<br />S. banter "J'amp/e dfeasrrremcnt" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bactenal parameters) of all sample measurements
<br />for each parameter obtained during "Monitoring Period'; ",t/nximum" and ",t4mi+num" are normally extreme high
<br />and low measurements obtained during "A9oniroring Period." (Note [o municipals µith secondary treatment
<br />requirement Enlcr 30-day avcmge of sample mcaswemenis urrdcr ':~iverage," and cnie; mavimum 7~ay average
<br />of sample measurements obtained during monitoring period 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 measunncnls during monitoring period that exceed maxirourrr (and/or
<br />minimum or 7 day average as appropriate) pcnuit icyuin:+uem far each parameter if none, enter "0".
<br />R. Fntrr ";veyuenc, uj .-i.^.olycris" bath as "Smnple .tleasurr,+rnt" (aci~al frequency of sawpiing and analysis used
<br />during nronilonng period) and as "Permit Requirement" specified in pemrit (e.g., Enter "('oar," for continuous
<br />monitoring, "1/T' for one day per v~cek, "//JO" for one day pea ment7:, "1/gyp" fcr cne day per quancr, etcJ
<br />9. Enter "Sample Type" buih as "Sample nfeosuremenr" (actual sample type used during monitoring period) and as
<br />"Per+nir Require+nenr," (e.g., Enlcr "Grob" for individual sample, "24/Il"' for 24-hour composite. ",ti'~A" for
<br />rnntinuous 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 dale.
<br />11. U"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Ti(le oJPrincipa/ Executive Officer" with "Signa(ure ojPrincipnf Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" al bottom of form.
<br />t3. Mail signed Report Io Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />14. More detailed instructions for use of [his Discharge Monitoring Report (DMR) Corm may be obtained from Offce(s)
<br />specified in permit.
<br />Legal Notice
<br />This 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 to exceed $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 />EPA Form 3320-1 (Rev. 08-95)
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