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Paperwork Reduction Act Notice
<br />Public reporting btuden 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 I10 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 btuden, 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 />]. If form has been partially completed by preprinting, disregazd instruction duected at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name/location, if different)," " Permil Number," and "Discharge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. En[er dates beginning and editing 'Monitoring Period" covered by form where indicated.
<br />4. Enter each "P~rameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sl+np7z Nfz~sw~ement"data for each parameter under "Quvrtity"and Quolity" as specified i^ permit. 'Aver.rge" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each pa;-ameter
<br />obtained dw-ing 'Sblcnifortrrg Period'; "Maxirmun" and Nfrninrmn" are normally u[retme high and Icw measurzments
<br />obLined during "disnitsring Period". (Note to municipals with secondary treatment re: urrement: Enter 30-day average
<br />of sample measurements under "Ava~.~;;e,"and enter nasimum 7-day average of sanp'.e measwements obtauted dw-ing
<br />monitoring period under "ivlaximum.")
<br />6. Enter "Fe+~ni.r ReOui.~nrant" for each parameter under "iu.o~riry"and "Quo7ip," as specified in permit.
<br />Z Unacr':"r, F,.r" enter nu~bc-oCsample measurement during mo^itorimg ;::.riot: Eat ,. eceed maximum (and/or rain'arum
<br />or 7-day average as appropriate) permit requ~rcmcnt for each parameter. If none, enter "D".
<br />3. linter "Fr~~re.r_y ofA+rilpr`s" Loth as "S~r,+F./~ ,Lf~zatn _;;rrnt" (actual freyu~ncy o''samp;ing and analysis :sod during
<br />monitoring perod) e.nd as "P~nnit Re./uir~~n+er!"specified in permi'.. (e.g. Fn[er "~ ;nt,"for continuous monitoring, "1/7"
<br />C.:: one day psr week, "1/30" for one day per month, "1/90" for one day per qusrt:.r, dcJ
<br />°. ;=n~er "S~+nE !s TyFe"born s "S~mF!r ,Lfz,rvrzm~u!" (actual sample type used durng monitoring pcricd) and as "F.;mi!
<br />Relrrirdm~ut," (e.g. L-nter "Grab" for individual sample, "14N::" for 24-hour composite, "N/A" far continuous
<br />monitoring, etc.)
<br />r 0. 1'/'oere violations of permit requiremerts are reported, attach a brieF czplanatio^ to describe cause and corrective actions
<br />to be taken, and reference each violation by date.
<br />11. IF "no disciiarg.^." occurs during monitoring period, enter "No Discharge" across fo~n im place oCda[a entry.
<br />12. Enter "N~rne/Title of Principal F.,recutive C~c_r" with "Signature of Principal Exz;utir~ G~cer of Autlrcrised
<br />Agent, ""Talzphone Number, "and 'Date" at bottom of form.
<br />13. Ylail signed 2eport to OFfcc(s) by date(s) specified in permit. Retain copy for your records.
<br />l4. More detailed inslnrctioms for use of this Discharge Monitoring Report (DMA form may be obtained from OCGce(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 or failure to report truthfully can result in
<br />civil penalties nut 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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