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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 10 hours as an i,
<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, disregazd instruction duetted at entry of that information already
<br />preprinted.
<br />2. Enter "P_rmitree Narne/tLfailing Address (and facility name location, if different)," "Permit Number," and "Cischarge
<br />Number" where indicated. (A separate form is required Cor each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Par~rn~ter" as specified in monitoring requirements of permit.
<br />5. Enter "SJnrple b~•~sur~~+nar!" data for each parameter under "Quontit)r"and Qualirv" as specified in permit. 'Aw_r~ge" is
<br />rcrmally arillunetic average (gcoc~etric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained during ",Ylsni!oriug Period'; "Macnnum" and Minimum" arc normally extreme high and low measurements
<br />obtained doing "Io-:,nit;, i,rg Period". (~Jote ?o mwucipals with secondary treatment requiremnnt: Entc: 30-day avcraoe
<br />of srmplc meesurcmcr.~s under fv_r1b.t,"nod eotcr maximum 7-day average of sample messuremen:a obtained duin;;
<br />monitoring period under 'SYlaximum.")
<br />6. Emcr "''e.-rr%t !m /uirznt~nt"for each parameter undc.- "GUanlit)r"and "rtra(iry" as spxificd in per„i'.
<br />7. U ~d_r ".`.'•. Tc" ,.s numSer of sr,,,p'e measuramenr during mon;to~n~ p~nnd ;~, ~[ c ;coed m,~~:i.nwn (and'or miriiuum
<br />c. 7= y avur~~c a : thprc; rate; pe>Tit reyuircment for each parameter. '.f Wore, e ilu "0".
<br />P. S~,:c,- "!':: j,~~rL) :J,•le>FSS"both 2s "S~naL •'vlv.~ur•errem" (acL~.l f:.:yucrc,• a">i!mpling end en.~lysis used d~-rng
<br />~r;onito~'ng her cdl sna as "Pe.-~,rit 2.tuiranaN"specified in pcrtnit. (c.g. Enter ""'~,n!," fur coniinuou n'.onito~ird, "i/7"
<br />f : are acy p:r c; ec'ri, "1/30" for one day per month, "1/90" for one day per quarts:, cte.)
<br />9. EnL•r "S r.ry !t T}(r" boCi as "S~„rfl~ 1.%aasr~-.:meul" (zrtual sampla type csed durng mooitcr~ig periu^) anti as "mss, rui%
<br />IL•~~uirrnrc,r," (e g. '?ntcr "Groh" fur urdi~idual sample, "14H~" for 24-hour composite, "N/r"' for continuous
<br />monitoring, etc.)
<br />10. ~'/here ~, iota: uns of permit requirements are ~cportcd, afuach a brief explanation to d_scribu cause and corrac?ive actions
<br />to be ta;:en, and reference each violation by date.
<br />11. 1f"no discharge" occurs d;.ring mnttoring period, enter "No Discharge' across form in place of date entry.
<br />12.°_r~.er "N,~mJTitL• ~J Fri,rcil-al F..~~~.;utire G~~s" with "Signaurre rj Prin_if~/ Eszwliv~ Gffcsr of Autha~izad
<br />gig mt, ""Telephone Nu,nter, "and 'Date" at bottom of form.
<br />13. ~^.ail signad Report to O Tce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed inshvctions for use of this Discharge Monitoring Report (GMI~ form may be obtained from OfLicz(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 of failtue 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 Form 3320-1 (Rev. 03/99)
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