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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 m average per response for some major facilities,
<br />with a wgighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing [he collection of information. Send comments 2garding the burden estimate or any other aspe;,t of
<br />this collection of informatton, including suggestions for [educing this burden, to Chief, lnformatioo Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S\4 Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of M1tanagement and Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permiflee Nanre/Ivlailing Address (and facility namellocation, if different)," "Permit ,Vumber," and
<br />"Discharge :1'umber" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending ';4fonirorrrrg Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Afeasurement" data for each parameter under "Quantity" and "Quality" in urtils specified in ]x;rmit.
<br />"Avern e" is normally arithmetic average (geometric avenge for bacterial parameters) of all sample meas~tremants
<br />Cor eac~i parameter obtained during ",tlnnitori,vg Period"; ",tfaximu,n" and ",tlurbmm" are normally exveme high
<br />and loly measurements obtained during ".1lcnitonnq Period" (Note to mutucipals with secondary lra~[menl
<br />requircptenc Enter 30-day average of svnple measurcmcnls under "Average," and enter maximum 7-da} accmgc
<br />of sample measurements obtained during monitoring period under'S4lazimum.
<br />6. Enter "Permit Reyvirement" for each parameter under "Quon(ity" and "Quality" as specified in permit.
<br />7. Under "No Ex" rioter number of sample measurments during monitoring period that exceed tnaxitnum (and/or
<br />minimum or 7-day average az appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnolysis" both az "Sa+nple Afearurnrent" (actual frequency of sampling and arralysis Iced
<br />during monitoring period) and az "Permit Requirement" specified in permit. (e.g., Enter "Cons," for continuous
<br />monitoring, "!!7" Car one day per week, "1 i30" fur one day per month, "!!90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both az "Sample ,4feasu+•ernenl" (actual sample type used during monitoring period) and az
<br />"Permit Requirement," (e.g., Enter "Grab" 2br individual sample, ":~Ff1C' for 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations oC permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />I l . If "no discharge" occurs during monitoring period, enter "Nu Discharge" across form in place of data entry.
<br />12. Enter "h'ame/1'iNe ojPrincipal Executive Officer' with "Signature ojPrincipal E.recuttve Officer ojAuthorized
<br />Agent," "'Telephone Number," and "Date" at bol tom of form.
<br />13. Mail signed Report to OBice(s) by date(s) specified in pernut. Retain copy Cor your records.
<br />14. More dgtailed instructions for use of this Discharge Monitoring Report (D,L1R) form may be obtained from Office(s)
<br />specifie(I in permit.
<br />Legal Notice
<br />'Ibis 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 im civil penalties 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 not mare than on: year, or by both.
<br />EPA Form 3310.1 (Rev. OS-95)
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