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Paperwork Reduction Act Notice
<br />Public reporting burden for this collec[ioo of information is estimated to vary from a range of ]0 hours as as
<br />average per response for some minor facilities, [0 110 hours as en average per response for some major facilities,
<br />with a we(ghted average for major and minor facilities of 18 hours per response, including time for reviev/icg
<br />instructions, searching existing data sources, gathering and maintaining tte data needed, and completing and
<br />reviewing the collectron of information. Send camments 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; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />L If form has been partially completed by preprinting, disregard instructions directed at entry of [hat information
<br />already preprinted.
<br />2. Eater `Pemmi(tee Nome/1v/ailing Address (and facility ttameJlocation, if different)," "Permit Number," and
<br />"Dischgrge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending itloniloring Period" covered by farm where indicated.
<br />4. Enter etch "Paran+erer" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Aleasuremen(" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />".4verngge" is normally anthmetic average (geometric avemge for bacterial parameters) of all sample measurement,
<br />for eachh parameter obtained during 'Yvlonitrrrir;g Period"; ".tlm'irnue+" and ",tlur+rnum" arc normally extreme high
<br />and loµ~ mcasuremenls obtaned during ",tlonilorinR Perod." (Note to mumcipals with secondary lrer~tmcnt
<br />requirement: Enter 311-day avemge of sample measurements under "Average," and enter maximum 7~ay average
<br />of sample measurerrien(s obtained during monitoring p, rind under ",tfaximum.'J
<br />6. Enter "Permit Requ+remen(" for each paremelet' under "Quantity" and "Quality" as specified in permit.
<br />7. Under ~'No Ex" ante, number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) pcmtit requirement for each parameter If none, enter "0".
<br />8. Enter "J:'requency oj.4nalysis" both as "Sample Measunnen(" (actual frequency of sampling and anallsts used
<br />during monitoring period) and as "Peru+i! Requireu+ent" specified in penni[. (e.g., Enter "Cant," for rnntinuoas
<br />monilocing, "!~7" for one day per week, "I X30" for one day per month, "I/90" for one day per quarter, etc.)
<br />9. Enter ",Sample Tvpe" both as ".Sample ,tleasuremen(" (actual sample type used during monitoring period) and as
<br />"Permit Requiren+enr," (e.g., Enter "Grab" for indi~~dual sample, "14HC' for 24-hour composite, "iJ~ii" for
<br />continupus monitoring, etc.)
<br />10. Where violations oC permit requirements arc reported, attach a brief explanation to describe catrse and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter ",Vo Discharge" across form in place of data entry.
<br />12. Enter "rJame/fitle ojPrincipal Executive Officer" with "Signa(ure ojPrincipal Executive Oj~cer ojAu(horized
<br />Agent," "Telephone Number, and "Date" at boi.tom of form.
<br />13. Mail signed Report to 06ce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More d$tailed instructions for use of this Discharge Monitoring Report (DMRJ form may be obtained from Office(s)
<br />specifi in permit.
<br />'~ Legal Notice
<br />7Lis report is'required by law (33 U.S.C. 1318; 40 <..F.R. 125.2''1). Failure to report or failure to report truthfully can
<br />result in civil Qettalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, w by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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