|
Paperwork F~eduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours es 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 respoHSe, including time for reviewing
<br />instruction8, searching existing data sources, gat~ering and maintaining the data Headed, and completing end
<br />reviewing the collection of information. Seod comments regarding the burden estimate or any other aspect of
<br />this collection of iHfornatioH, including suggestions for reducing this burden, [o Chief, information Policy
<br />Branch, PM-223, U.S. EovironmeHtal Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of hlforma[ion 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 aPermitlee NameMailing Addresr (and facility name/Iocation, if different)," "Permit Number," and
<br />"Discharge Number" trhere indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending ':1fonrloring Period" covered by farm where indicated.
<br />4. Enter each "Parameter" as specified in monitocng requirements of permit.
<br />5. Enter "Sample ,1leacuremenl" data for each parameter under "Quantity" and "Qualih" in uruts specified in p;,rmi[.
<br />"Average" is normall} arithmetic average (geometric average for bacterial parameters) of all sample meaavemcnts
<br />for each parameter obtained during "Momrorirg Period'; ".4/aximum" and ",1linimwn" arc normally extreme high
<br />and IorY measurements obtained during ".4onitoring Period." (Note to municipals with secondary treatment
<br />regwrcment: Enter 36-day average of sample measurements under "Average," and enter maximum 7-day at•crage
<br />of sample measurcinents obtained during moniUring period under "Afoximum.
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in pemrit.
<br />7. Under °No Ex" enter number of sample measurments during monitoring period that exceed maximum (ancVor
<br />minimum or 7-da} average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnolysis" both as ".Smn/ae ,Lleosurmenr" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Coot," for continuotss
<br />monitoTng, "//7" for one day per week, "1'30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as "Sample .Neasuremenl" (actual sample type used during monitoring period) end as
<br />"Pernrrt Requirement," (e.g., Enter "Grab" for individual sample, "24HC" for 24-hour composite, "1//A" for
<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 dire.
<br />11. U "no discharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry.
<br />l2. Enter "Namellitfe ojPrincipal Executive Officer" frith "Signature ojPrincipa! Executive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Date' a[ boi tom of form.
<br />13. Mail signed Report to Office(s) by date(s) specil ied in pernri[. Retain rnpy for your records.
<br />l4. More detailed instructions for use of this Discharge Monitoring Report (D.NRJ form may be obtained from Office(s)
<br />specsed 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
<br />result in civil ~enalties mot to exceed x10,000 per day of violatiom; or in criminal penalties not to exceed 325,000 per day
<br />of violatiom, or by imprisonment for not more than one year, or by both.
<br />EPA Farm 3320-1 (Rev. Og-95)
<br />
|