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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 facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including lime for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments 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, 401 M Street, SW Washington, DC 20460; end to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 2D503.
<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 "Permittee Name/IL1ailrng Address (and facility namellocation, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A sepa~te form is required for each discharge.)
<br />3. Enter dates beginning and ending 'hfoniroring Period" covered bq form where indicated.
<br />4. Enter each "Paranrerer" az specified in monitoring requirements of permit
<br />5. Enter "Sample Afeasuremenr" data for each parameter under "Quan;rty" and "Quality" in units specified in permit.
<br />"Average" is norntally arithmetic average (geometric a~•crage far badcriai parameters) of all sample measurements
<br />for Cach parameter obtained dunng "blonitoring Period"; ",t/arimuru" and '4llmunum" arc norntally extreme high
<br />and low measurements obtained dunng ".11oni1orinq Period." (Vote to municipals with secondary Lrzrtn:ent
<br />requirement: Enter alt-day avenge of sample measurements under "Average," and enter maximum 7~ay a~:eragc
<br />of sample meazuremcitls obtained during monitoring period under "hfarimum.')
<br />6. Enter "Permit RequiremenP' for each parameter under "Quantity" and "Quality" az specified in permit.
<br />7. Under "No Ex" cuter number of sample measurments during monitoring period Hutt exceed maximum (and/or
<br />minimum or 7-day average az appropriate) permit requirement for each parameter if none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both az "Sanple S1eawrmenP' (actual frequency of sampling a.7d anal}sis used
<br />during tonitoring period) and az "Permit Rer,~virernent" specified in permit. (e.g., Enter "Coat," for continuous
<br />monitoring, "l/T' for one day per week, "Ii30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Tt/,e" both az "Sample .~lcasurernent" (actual sample type used during monitoring period) and as
<br />"Permir Regvirernenr," (e.g., Enter "Grab" for individual sample, "14HC' for 24-hour composite, "1//A" Coc
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry.
<br />l2. EnlCr "}/nme/I'itle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAulhorized
<br />Agent,'" "Telephone Number," and "Dare" at bottom of farm.
<br />13. Mail signed Report to Offce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (D.L1R) form may be obtained Crom Office(s)
<br />specified in.permil.
<br />', Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 (:. F. R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil ~ertalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for no[ more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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