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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 directed at entry of that information already <br />preprinted. <br />2. Enter "Permittee Name/Mailing Address (and facility name location, if different);' " Pannif Number," and "Gischarge <br />NunrEer' where indicated. (A separate form is required for each dischazge.) <br />3. Enter dates beginning and editing 'iLfvniroring Period" covered by form where indicated. <br />4. Enter each "Parameter" as specified in monitoring requirements of perrttit. <br />5. Enter "Santpls Maasnre ,non!" data for each parameter under "~unrity" and ~JUaliro" as specified in permit. "Avara,~a" is <br />normally ariEtmetic average (geometric average for bacterial parameters) ofali sample measure-rents for each parmeter <br />obtained during ",L/aritoring /'arird'; ",Lfzcinnun" and hliniunun" a^e normally extreme high and low measummcnts <br />obtained during '?.1-.rrirrri;;g P:r:;3". (Voh: to murieipals c-ift secondary treatment requirement: Enter 30-aay avc-age <br />of sample measurements eider "Avara~a,"aid enter muimum 7-day aceragc of sarrnl~ mcsurcments obtained during <br />monitoring period under "Mssimum.") <br />5. Enrcr ';°enait Ra./ui;~um eta" for each parame~cr under "~'uanrit)" an3 "Qualiq~" as epccificd in remit. <br />7. L'ndor "T': Cx" enter number of sample measurement during monitoring ; criod that cxcaed maximun (a.,d/or minimum <br />or 7-day ave.~~e as appropr'atc) permit requirement for each parameter. If Wont, cater "0". <br />8. ::r,tcr "Frewau~y ojAnalysis" both as "Snc~-!a /vlras~~rr,nant" (actual frequency o` sampling and snalysis used ds Ong <br />monitoring period) and as "Pa,r,,it Ra7vira:nant" specified in permit. (e.g. Later ",c,rt,"for continuous manitorin„ "!/7" <br />for one day per wee!c, "1/30" far one day per month, "//90" for one day per quaRC., etc.) <br />9. ~n<er "S.en~pl~ Tyra" bolo as "Sa,npla ,1'faeza~a,aant" (actual sample hpe used during monRo~ng period) and as "M,pn i± <br />R~auir_me,tl," (e.g. Enter "v^rab" for indi~•idual sempia, "24;/~' for 24-hour composite, "N/A" for continuous <br />monitoring, etc.) <br />l0. ^/here violations of permit requirements azc reported, attach a brie`cxplanation to describe cause ant corrective actions <br />to betaken, and reference each violation by date. <br />'. I. If "no discharge" occurs during monitoring period, enter ";Vo Discharge" across form in place of data entry. <br />12. Enter "NamelTill; uj Po•incipal Esecutiva Gfjicer" with "Sigtnnn-e of !'r-in:iFa( Exz_utivs O~~ar of Avtho:izad <br />Agent, ""Telephate Number,"and "Data" a[ bottom of form. <br />13. 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 (G'It9~ form may be obtained from Office(s) <br />specified in permit. <br />Leal 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 yeaz, or both. <br />EPA Form 3320-1 (Rev. 03/99) <br />