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Paperwork Reduction Act Notice <br />Puhlic *eport~g burden frr this cullectioa of information is aaimat~J to vary f:um a ranee nr lu hours as an <br />average per response for some minor facilities, to 110 hours as en average per response for soma major facilities, <br />with a weigh4:d average for major and uunur facili(ics of 18 hours per response, including [tme for reviewing <br />instructions, searching existing data sources, gathering and maintaining [he data Deeded, and cnmplet!og and <br />reviewing the collection of informatioo. Send comments regarding the burden estimate or any other aspect of <br />this collection of information, including suggestions for reducing this burden, to Chief, lnform:tion Policy <br />Branch, PM-223, U.S. Environmental Pndechon Agency, 401 M Street, SW Washington, DC 20460; and to We <br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions <br />1. if form has Iwem partially completed by preprinting, disregard instructions directed at entry of that information <br />already preprinted, ,_, <br />2. Enter "Permittee NnrneMailing Address (and facility namellocation, if different)," "Penni( Number," and <br />"Discharge A'umber'~ where tndtcated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and ending "Afoni(nring Period" covered by form where indicated. <br />4. Enter each "Porunreler'" as specified in monitoring requirements of permit. <br />5. Enter ",Smnpte Aleo.rtrremen(" data for each parumeter under "Quantity" and "Quality" in uttits specified in permit. <br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements <br />for each pammeter obtained during ".liunilnri;rg Period'; "Afarinvuul' and "tifinimurn" are normally extreme high <br />and low mcasurcmcnls obtained during ".L/uniloring Period" {Note to municipals with secondary Vcatmcm <br />requiremen!: Erl!Cr 30-may aeemge of sample mc:"urcmcnts under ".avrrogd," a;rd enter maximuw 7aiay average <br />of sample measurements obtained during monitoring period under "Afaximum.'J <br />6. Enter "Perm! Heyuirement" for each parameter under "Quantity" and "Qua/ity" as specified in permit. <br />7. Under "h'o F..r" enter number of sample measurmen[s during monitoring period that escccd mWdmum (and/or <br />minimum or 7-day avcraoc as appropriate) permit rcquircmcnl for each parameter. If none, cnicr "0". <br />°. Ent:. "Frey.:,-nr; rj:lnelois" bulb as "Smr:pie .itiraevrmenr" (actual ..equc. g ~ ylieg ~~a :.ru,:ysts used <br />during monitoring period) and as "Peruri! ReyuireruenP' specified in permit. (e.g~,IEntcr "Coot," for continuous <br />monilorin "I/7" for one da r wick, "l/30" for one da rr month, "/•y0" for ene d~,,, ~~~ •~^~cr ct~ ~ <br />S. Enter "Smrrp/e Type" uou: as "Smeple ;~icusm-eurrm" (actual sample type used during monitoring period) 2nd as <br />"Permit Reyviremenl," (e.g., Enter "Grab" for indicidu,tl sample, "?dHC" for 2d-hour composite, "A7A" for <br />rnntinnous monitoring, etc.) <br />10. Where violations of permit rcquiremenls are reponcd, attach a brief explanation to describe cause and corrective <br />actions taken, and reference each violation by date. <br />11. If "no discharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry. <br />12. Enlef "Name/I'itle ojPrincipal Executive Officer" with "Signa(ure ojPrincipnl Executive OJrcer ojAuthorized <br />Agent," "Telephone Number," and "Dale" a[ bottom of form. <br />13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records. <br />14. More detailed instructions for use of this Discharge Monitoring Report (DMRJ form may be obtained from Office(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 [o exceed 610,000 per day of violation; or in criminal penalties not to exceed E25,000 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) <br />