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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to-eat'y from a rmge of IO hours as an
<br />average per response for some minor facilities, l0 110 hours as an average per response for some major facilities,
<br />wi~;a _vgeiybted average for major and migiof. facilities of 18 flours per response, including time for reviewing
<br />instructions, searching existing data sourcesr gathering and etaintaining the data needed, and completing and
<br />reviewing the collection of infomtatioo. Send commettSy,~ng the burden estimate or any other aspect of
<br />this collection of information, including suggrstions fgs: acing this burden, to Chief, Information Policy
<br />Brrlnch, PM-223, U.S. Enviroamenfal Protection Agego~ 4Ol M Street, SW Washington, DC 20460; and to the
<br />Offi~e of Information and itagulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />3 ~~ General Instructions
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<br />. Jf. form has been papally completed by preprinting, disregard instructions directed et entry of that information
<br />~Y P~Printed.
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<br />'f. ter "PenAitree Name..i4ai/ing Address (and facility namdlocation, if different)," "Perini! Number," and
<br />Disc~+arge Numbei' where indicated. (ASeparate form is required for each discharge.)
<br />dates beginrting and ending 'Afonitoring Period" covered by form where indicated.
<br />"Puranrerer" as specified in monitoring requirements of permit.
<br />~' T9. ref "Sample Afeasureuirnt" data for each parameter under "Quan6ry" and "Quality" in units specified in permit.
<br />~ "Average" is normally arithmetic average (geometric average for bacterial parameters) of ali sample measurements
<br />-der each parameter obtained during "Monitoring Period"; ",Lfaximum" and ".4lrnimum" are normally extreme high
<br />~ apd low measurements obtained during ",lfoniroring Period." (Note to municipals with secondary Vestment
<br />requirement: Enter 30-day a1•crage of sample measurements under "Average," and enter maximum 7-day average
<br />nfsample measurcmcnts obtained during monitoring period under "Mnximurn.')
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<br />;~&, :Enter "Pennir RequiremenP' for each parameter under "Quantity" and "Quality" as specified in permit.
<br />r7: ,Under ",Vo Er" enter nuc^ber of sample measttments during monitoring period that exceed maximum (andlor
<br />mtinimum or 7~ay average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />!~sEnler "Frequency oJAnalvsis" both as "Sample Measururenr" (actual frequenry of sampling and analysis used
<br />r ; ;during monitoring penal) and as "Pernrir Requirernenr" specified in permit. (e.g., Enter "Cons," for continuous
<br />monitoring, "I/7" for one day per week, "//30" for one day per month, "l/90" for one day per quarter, etc.)
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<br />`~.''-Finer "Sample Type" both as "Sample MeasuremenP' (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC' for 24-hour composite, "N/A" for
<br />'# continuotu monitoring, etc.)
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<br />$1, 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 />t`~: ?U"no discharge" occttrs during monitoring period, enter "No Discharge" across form in place o(data entry.
<br />~. inter "Name/title ojPrincipal Executive OJTcer" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," 'Telephone Number," and "Dare" a[ bottom of form.
<br />Mail signed Report to Office(s) by date(s) specified in pern»t. Retain copy for your records.
<br />Legal Notice
<br />,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 />t }14 civil penalties mot to exceed 510,1100 per day of violation; or im criminal penalties not to exceed 525,000 per day
<br />elation, or by imprisonment for not more than one year, or by both.
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<br />More detailed instmclions for ttse of this Discharge Monitoring Report (OMR) form may be obtained front Office(s)
<br />specJed in permit.
<br />3320-1 (Rev. 08-95)
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