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Paperwork Reduction Act Notice
<br />Public re¢orting burden for this collection of information is estimated to vary from a range of l0 hours as an
<br />average per response for some minor facilities, to 110 hours u ao average per response for some major facilities,
<br />with a weighted average, for nyy~,Qr-aed minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing-and
<br />reviewing the collectiop gj~jprIDation. Send comments regarding the burdea.estirmte or any other aspect of
<br />~''Fdlhxtioo of information; including suggestions for reducing this burden, to Chief, Information Policy
<br />~, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />~,f~~of Infpsmatioo and Reguratory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />k;:,~ ~ ~ .General Instructions -
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<br />_- ~ fotin has :been partially completed by preprinting} d~regard instructions directed at entry of that information
<br />~~Y PfePrinted.
<br />tg[' 'Permittee NameG'14ai/ing Address (and fgcllity name/location, if diH'erent)," "Permit Number," and
<br />~_ ,y isc¢arge Number" where indicated. (A separate fottn is required for each discharge.)
<br />~ftt8~'tlales beginning and ending "Monitoring Period" covered by form where indicated.
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<br />tenter each "Parameter" as specified in monitoring requirements of permit.
<br />~Ent~r"Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specifed in permit.
<br />"Avemge" is normally aritlunetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during "hfonitoring Period"; "A1arlmum" and ".dlinimurn" are normally extreme high
<br />and. low measurements obtained during "Afoniroring Period." (Note to municipals with secondary treatment
<br />requiremgnt: Enter 30~ay average of sample measurements under ".overage," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "Maximum.')
<br />:li. Enter."Permit .Requirement" for each pazanteler under "Quantity" and "Quality" as specified in permit.
<br />-Under ",\ro Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />•tninimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />'~. Eaten "Frequency ojAnalysis" both as "Sample Measurnent" (actual frequenry of sampling and analysis used
<br />;during monitoring period) and as "Permit RequiremenP' specked in permit. (e.g., Enter "Coat," for continuous
<br />-monitoring, "I ~7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />t~:'rtter "Sample Type" both as "Sample .4easurement' (actual sample type used during monitoring period) and as
<br />"Permit Requvernent," (e.g., Enter "Grab" for individual sample, "14HC' for 24-hour composite, "N/.4" for
<br />continuous monitoring, etc.)
<br />'Whale violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
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<br />9f "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry
<br />Enter "NamelTitle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer oj.4uthorized
<br />"Agent," "Telephone Number," and "Date" al bottom of form.
<br />Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />ort 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 />civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />or by imprisonment for not more than one year, or by both.
<br />3320-1 (Rev. 08-95)
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