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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ] 0 hones as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Nome/Maifing Address (and facility nazne/location, if different)," "Permit Numher," and "DLS(:{large
<br />Number" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated,
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "SampL hLasuremenl"data for each parameter under "~hrantity" and Quoli(y~" as specified in per±nit. 'Average" is
<br />normally arithmetic average (geometric average for bacterial parameters) of al] sample measurements for cacti parameter
<br />obtained during "rLlcnir~rinb Period'; "Maximum" and l~finirnuut" are normally extreme high and low measurements
<br />obtained during "Lf.nita•ing Pzriol". (Note to municipals wi'r secondary treatment requirement: Enter 30-day avenge
<br />of sample measurerceats under 'tivsrag~,"and enter ;raximum 7-day average of sample measurements obtained du.~rtg
<br />monitoring period under "i/aximum.")
<br />ti. Enter "Pen;rir Rrquirsment" for each parameter under "~uaurih'"and "Qnalin~" as speci led in perm:.
<br />7. .:ndcr "FJ'. L-.r" eni :r nu^tbcr of sample n~casuremeut during ino~;lati~g 1;,.end that ,:r.eced maximum (ond/cr minimum
<br />or 7-day avcra~c as cppropriatc) permit requirement fur each parameter. 1 f none, rater "C".
<br />R. G~;ter "f•7-_gr•.n_y ,fAn~lpss" Loth °s "S,nr1L rLfaa~u ~„r,:,u" (actty l P.cyuer.c, c` sampling rrd analysis ^sed during
<br />~nonitor;ng n.cod):.nd as "Pd;,nir R.t.;±rir~rn_vr!" spcciFed in pcrm~•. (e.g. Enter "~•,n!,"fur ccntinuous monitoring, "1 /7"
<br />f - one day per week, "//30"for one day per month, "I/90" for one day per yuartc-, c1c.)
<br />9. L•nter "Sawl!e TyFr"bal;r -s "S-rn;rl~ M~~sn -_,;u~.!" (zchal sample h~pc rsrd during monitc=no period) anc as "Psnni!
<br />Ir~.luirznr"r!," (e.g. Later "Oran" far iodivid;;al sample, "14H.:" for 24-.-our composite, 'S\'/A" for con'irtuous
<br />monitoring, etc.)
<br />]0. Whcrc violations of permit reyuiremenu are reported, attach a brief n:pJmtalion to describe cruse and corrective actions
<br />to be taken, and reference each violation by date.
<br />1. If "no disdra-ge" occurs during monitoring period, ea;cr "PJo D~schar~c" arms; form in place of data entry.
<br />12. Enter "Narne/Ti1lz of Frincipa! Exe~utiv= Cffresr" with "Sisoiaur,t of Prin~ir~l F..rz~utivr Offi:er of Aurh:rized
<br />Agent, ""Telephone Number, "and "Dare" at bottom of form.
<br />13. Mai] signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed inswctions for use of this Discharge MonUOring Report (D,L11~ fam 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 result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Eorm 3320-1 (Rev. 03/99)
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