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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a range of ]0 hours as as
<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 (acililres of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, garhenng and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments 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 Wasbington, DC 20460; and to the
<br />Office of Information avd 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 Qrat information
<br />already preprinted.
<br />2. Enter 'Permittee Name,~lailing Address (and facility name location, if diH'eren[)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'hlonitoring Period" covered by form where indicated.
<br />4. Enter each "Paronieter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Aleasvrement" data for each parimelcr under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (gcol:utric average for bacterial parameters) of al. sample measurements
<br />for each parameter obtained during ";tfarotorirg Period"; ".tlaxinw,n" and "bfinimmn" are normally extreme high
<br />and low measurements obtained dunng ".4fonitonng Perod." (ivote to municipals with secondary treatment
<br />reyuirement: Enter 30-day average of sample measuremens under ",4verage," and toter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "iLlaximum.'J
<br />6. Enter "Permit Requirement" for each parameter under "Qumuiry" and "Quality" as specified in permit.
<br />7. Under ",4'u Ex" enter number of sample measurnents during monitoring period that exceed maximum (utd/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnolysis" both as "Semple AleancrmenY' (actual frequenn of sampling and analysis used
<br />during monitoring period) and as "Fermi! RequirenienP' specified in permit. (c.g., Enter "font," for continuous
<br />monitoring, "liT' for one day per week, "/i30" 1'or one day per month, "I/90" for one day per quarter, etc.)
<br />9. Enter "Smnple Tvpe" both as "Sample :lleasurement" (actual sample t}pe used during monitoring period) and as
<br />"Fermi( Requirenicnt," (c.g., Enter "Grab" for indnidual sample, "1JHC'" for 2~-hour composite, "h%A" for
<br />continuous monitoring, etc.)
<br />10. Where tiolations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dale.
<br />l 1. L`. "no discharge" occurs during monitoring period, enter "No Discharge" across farm in place of data entry.
<br />12. Enter "Narne/fitle ojPrincipa! Executive O~rer" with "Signature ojPrincipa! Executive Officer ojAurhorized
<br />Agent," "Telephone Number," and "Date" at boll om of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge M1loniroring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Leal 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 penalties not to exceed SI0,000 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 Forte 3320-1 (Rev. OS-95)
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