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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, disregazd instruction duetted at entry of that information already
<br />Preprinted.
<br />2. Enter "Permittee Name/Mailing Addrass (and facility oame/location, if different)," "Permit Number," and "Discharge
<br />Number' where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and editing "rYlcniroring Feriol"covered by form where indicated.
<br />4. Enter each Parameter" as specified in monitoring requirements ofpermit.
<br />5. Enter "Sample N1e~surement" data for each parameter under "~umrtity" and Qualiq~" as specified in permit. 'Aver~gd"is
<br />normally arithmetic avn~agc (geomet-ic average for bacterial parameters) of all sample mcasurc~tcn[s for each p~+r Teter
<br />obtained during ",Llcnit•;ring Period"; ",Ll~simum" znd Minimum" are normally e>;trcme high and lmv measurement,
<br />obtained durtitg ",tLni!,rina Pe,i;i". (;tote to municipals with secondary treatment rcyuircmcni: En+cr 30-day z~re~age
<br />of sample messo emc+tts order '%,~~avdz,"and enter cazimum 7-day average ofsa>t_;'z m~-~surcm.n's obLrined ds~ng
<br />monitoring period under "!vfarimtm.")
<br />u'. Enter "Pe:;ni! k.r~uir~+n_a1"`or eac_~ parameter under "~h~.,;!,'n•"and "Qrralih~" as specified in re-m`t.
<br />7. Under "]1r-~ Tr" cn!,_: munhcr of snnnle nr_u;rvemeat during ir~unituriny ; enod Il:at e;cucd mc~:imum (o,idror mi ~'nm'!
<br />c. 7-dzy cve~zsc as a ~prcprizte) pemit requir, erd for each par,Jneter. if none, cater "fi ".
<br />R. ~:nicr "Fr,;q-:~n_y •y'',Lvlps.`s" both as "S_,:;;!. F.1 ~_n+,rs+„e;u" (actua_1 fraqucnc; ~~~ s° aping : ~d znalysis csed drr'~g
<br />moritorng prod) c.ta as " =.,,.it R_.l!ri;zrn.-a r" specified in permit. (e.g. Enter ' _~~:r!,"for continuous mani:arin~, "1/7"
<br />G:: one da y p_r c =e'c, "1/30" for one day par month, 'V/90" for one day per quarter, etc.)
<br />S. >=n'cr S~en-!!' TJY-"bath es "S.+,:rr/e r:; •_n u.z,,;.n,"(cccual sample type uacd during monitorno periuc~) H rr' r , _. „Tit
<br />f:Zyuirentrar," (e.o. Enter "Groh" for individual szmiac, "29fi^" for 24-hour co.nposile, "A%A" fcs cor''~~rous
<br />monitoring, etc.)
<br />l0. \Vhere violations of hermit requirements arc reported, attach a brief explanation to describe cause and coy ~ xtve . c":r
<br />to betaken, and reference eaci~ violation by date.
<br />1 I. If "no discharge" occurs dw trig mor ito~ing period, enter "No Discharge" across form in place of data enhy.
<br />12. Enter "iYam:/Tide of Principal Fsactrtire r~a~r" with "Sis~rvature of Po-irsip~! F.ra_utivr O~_•sr or ; udr. %_°:+
<br />Agent, ""Teleph~~ne Aumhrr, "and 'Date"at bottom of fo[m.
<br />13. Mail signed Report to Office(s) by date(s) specified i^ permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DM/~ form may be obtained frcm Cu:c~(~)
<br />specified in permit.
<br />I..egal Notice
<br />77tis report is requred 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 Form 3320-1 (Rev. 03/99)
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