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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
<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 Name/Mailing Address (and facility name location, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate forth is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Paramzter•" as specified in monitoring requirements of permit
<br />5. Enter "Smn1-la bleasurzrnznt" data for each parameter under "Qumviry" and Quality" as specified in permit. "Avarag~" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sampic measurements for each parameter
<br />obtained during "~Llrnirrring Pari;,~'; "i~Lzrimum" and ~niurmn" are normally catremc high and low measurements
<br />ohtained during "l.f~.nit-.riirb P:ri:d". (Note to municipals with secondary treatment requirement: F.ntcr 30-da} avcr~~z
<br />of sample measurements under 'Rvarooz,"and enter maximum 7-day average ofsarn.~le mcaswcments obtained during
<br />monitoring period under "Nfazim:un.")
<br />u. Enter 'Pan~rit,i,~,rui,•ar,e~,rt"for each parameicr under "Qwntih'"and "Quality" as specified in perest.
<br />7. Under "G'-, Cc" entry number of sample mcaswrnent during monitoring period L'7at c,ceeed maximum (andtcr min~mnm
<br />or 7-day ave ~gc as z ~propria[c) permit requirement for each parameter. If none, enter "C".
<br />8. enter "Fr.>ia.>n_y ~.fAnalysis" bath as "S.~n, !s 1v.'~~.~r;,-s.:r~•ru" (actual frequency o'sampling and analysis used during
<br />monitoring rered) and as "P~nait Ra.7uirznu.u" specified in permit. (e,g. t=utee "~orrt," or continuous monitoric~, "1/7"
<br />fo-one day per ~.tcek, '7/30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. nrer "Say.:,ter: T}r r" bot;i as "SzmFl.; i .~'a511;'~1;12n!" (actual sample type used during monitoring ner'od) and as "Pe:;ni!
<br />R_quirzrrz.rr." (c.g. Enter "Groh" for individual sample, "24H::" for 24-hour composite, 'SV/A" for continuous
<br />monitoring, etc.)
<br />10. `1/here violations cf ~emrit requirements are reported, attach a brief e;cplanation to describe cause and corrective actions
<br />to be taken, and reference cacti violation by date.
<br />1 ;. If "no disclrargc" occurs during monitoring period, enter "No Discbargc" across form i^ place of data entry.
<br />12. Enter 'Name/Titl~ uj Princiral F..c~attiva G~c~r" with 'Sig»anrre of Prin::ipa1 £xcculiva Offtczr cif Autltoriz2u
<br />Agent, ""Tzlaphrnrz Number,"and 'Date" at bottom of form.
<br />l3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from O,`ficc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 13] 8; 40 C.F.R ]25.27). Failwe [o 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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