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)
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