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<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hoax as an
<br />average per response for some minor fac lities, to 110 hours as an average per response for some Major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time fo-
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection ~f information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PiVI-223, U.S. Environtttental P=otection Agency, 401 ?Q Steet, S.V~'.
<br />Washington, DC 20460; and to the Cffice of Information and Regulatory Affairs, Cffice of ivznagement and
<br />Budget, Washington, DC 20503.
<br />,..r ~•
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of feat in;ormation already
<br />preprinted.
<br />2. Enter "Permtttzz Name/Mailing Addrzss (and facility name/location, if different)," "Permit N:rn,Ier," and "Lis:hargz
<br />NumF.zr" where indicated. (A separate fora is required for each dischazge.)
<br />3. Enter dates beginning and editing '7Yfcnito,~ing Period"covered by form when indicated.
<br />4. Enter each "Porarnztzr" as specified in mo-,oaring requirements of permit.
<br />5. Enter "Sample Measuremznt"data for each parameter under "Quantity"and Quality" as specified in .remit. "Av=rage" is
<br />normally arithmetic average (geometric av. -age for bacterial pazameters) of all sample neasurements "or eaca paramaer
<br />obtained during "tYlonitoring Period"; "/v,~ximum" and ivlinimum" are normally extrc ne high and low measurements
<br />obtained during "Monitoring Period". (Note to municipals with secondary treatmert rcquirement.• "slcr 30-day ave age
<br />of sample measurements under 'Average," and cater maximum 7-day average of sample measuremc~ts ob!e.ine_ during
<br />moci[oring period under "Maximum.")
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as speci ied in perm:[.
<br />7. Under "No Ex" enter number of sample measurement during monitoring period that exceed maximum (and,'or m nimum
<br />or 7-d:ryaverage as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnolysis" both as "Sa-np/e Mzosurement" (actual frequency of sampling and a ia!ysis used during
<br />monitoring period) and as "Permit Require,~,ent" specified in permit. (e.g. Enter "Coat," for contirur as noni!oring, "I/7"
<br />for one day per week, "1/30" for one day pet month, "l/90"for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample Mea:urzmznt" (actual sample type used during monitoring p; ricd) and as "Perna it
<br />Requirement," (e.g. Enter "Grate" for individual sample, "24NC" for 24-hour composite, "V/A" for continuous
<br />monitoring, etc.)
<br />10. Where violations of permit requvements ar_ reported, attach a brief explanation to describe cause sac: corrective actions
<br />to be taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring j.eriod, enter "No Discharge" across form in place of data e.~try.
<br />12. Enter "NamelTitle of Principal Ezecutiv_ Gj~cer" with 'Signature of Principal Executive G~czr of Authorized
<br />Agent, ""Telephone Number, "and "Doti" at bottom of form.
<br />13. Mail signed Report to OfSce(s) by date(s) specified in permit. Retain copy for your rewrds.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DR92J forth may be obtained from C_`Iice(s)
<br />specified in permit.
<br />:Ltegal N®tice
<br />This report is required by law (33 U.S.C. 1318; to C.F.R. 125.27). Failure to report or fay are to report truthfully can result in
<br />civil penalties not [o exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 ~cr day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EFA Form 3320-1 (lieu. 03/99)
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