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Paperwork Reduction Act Notice
<br />Public reporting burden (or this collection of information is estimated to vary from a range of 10 hours as an
<br />average per tespoose for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 16 hours per response, including lime for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data Waded, and completing and
<br />reviewing the collection of information. Send a~mmen[s regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 40l M Street, SW' Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form, has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permi(tee R'ame:ldailing Address (and facility namellocation, if diH'erent)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ';4fomtnring Period" covered b}' form where indicated.
<br />4. Enter each "Pnrameler" as specified in monitoring requirements of permit
<br />5. Enter "$ample Afeasurement" data for each paramder under "Quantity" and "Quality" in units specified in permit.
<br />"Avernge" is normalh arithmetic average (geometric avemgc for bacteria; parameters) of all sample measurements
<br />for each parameter obtained during ",'~lnnrmnng Periurl"; ",tfar(munr" and ",lfuunmrn" are norntally extreme high
<br />and low measurements obtained during ".ifoni(oring Periud." (Note to municipals with secondary lrea.tment
<br />regwrcment Enter 30-0a}' average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under ",1:aximunr.'J
<br />6. Enter "~ermi(Requiremenl" for each parameter under "Quantity" and "Quality" as specified in pennil.
<br />7. Under "No Er" enter number of sample measurmems during monitoring period that exceed maximum (and/or
<br />minimym or 7~ay average as appropnate) pcrrnit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency nj.4nolyais" both as "Sarnr~le .'Nensvrrneni" (actual frequency of sampling and anal}•sis used
<br />during hnoniloring period) and as "Permit Requirennn(" specified in permit. (e.g., Enter "Copt," for continuous
<br />monitoring, "1 /7" (or one day per week, "!/30" far one day per mont;t, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as ".Sample .4~easm•emenl" (actual sample t}•pe used during monitoring period) and as
<br />"Perniil Requvemenr," (e.g., Enter "Grab" for individual sample, "1.1HC"' for 24-hour composite, ",~%A" for
<br />continulpus monitoring, etc.)
<br />10. Where ~iolauons of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actionsjtaken, and reference each violation by dale.
<br />I1. U "no discharge" occurs during monitoring penod, enter "No Discharge" across farm in place of data entry.
<br />12. Enter ameiTitle of Principal Executive OJJ'cer" with "Signature ojPrincipa/ Executive Officer ojAuthorized
<br />Agent, "Telephone Number," and "Date" al 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 dhtailed inswclions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s)
<br />specili~d in permit.
<br />i Legal Notice
<br />'Ibis report isle required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties no[ to exceed 510,000 per day of violation; or in criminal penalties not to exceed S25,000 per day
<br />of violation, ~r by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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