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Paperwork Reduction Act Notice
<br />Public reporting batten for this collection of information is estimated to vary from a range of 10 hours as nn
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a we~gh[ed average for major and minor fay:ili[ies of IS hours per response, including time for reviewing
<br />insttvctioos, searching existing data sources, gathering and maintaining the data wended, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this colledtion of information, including suggestions for reducing tlvs 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 Ifformation and Regulatory Affairs, Office of Management wad Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of tbat information
<br />already preprinted.
<br />2. Eoter 'Permirree Nome/ilfailing Address (and facility name/location, if different)," "Permir Nvrnber," and
<br />"Discharge h`umber" inhere indicated. (A separate form is required for each dschage.)
<br />3. Enter dates beginning and ending ".Lonitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />S. Entcr'lSample.4feasuremenr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is norntall} arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ",Lloniroring Period"; ",tlarimwn" and "d/inimum" are normally e.+nreme high
<br />and low measurements obtained during ".llrnitcring Period " (Note to municipals tivith secondary treatment
<br />requirclnent Enter 30~ay average of sample measurements under "Average," and enter maximum 7-day atcrage
<br />of santplc measurements obaned during monitoring period under ".llazirnum.')
<br />6. Enter "Permir Requirement" for each parameter under "Quantity" and "Quality" as specified in permit
<br />7. Under i"No Es" enter number of sample measurments during monitoring period that exceed ma~cimum (and/or
<br />minimtjm or 7~ay average as appropriate) pcrntil requirement for each parameter If none, enter "0".
<br />8. Enter "Frequency oj.anar}ais" both as "Smm~/e ,tleasvrmen!" (actual frequency of sampling and anal;ai; used
<br />during 'monitoring period) and as "Peru,ir Requirement" specified in permit. (e.g., Enter "Coot," for cont.ncous
<br />monitohng, "//7" for one day per week, "1190" for one day per month, "//90" far one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as "Sample .Lfeasm~emen!" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grob" for individual sample, "2IHC" for 24-hour composite, ",V/,9" for
<br />conlintious 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. U "no cscharge" occurs during monitonng per.od, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Ti!!e ojPrincipal Executive OQ;'cer" with "Signature ojPrincipnl Executive Officer ojAulhoraed
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Aloniforing Report (DMR) form ntay be obtained from Office(s)
<br />specified 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 in civil penalties mot to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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