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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 1 10 hours as m average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and
<br />reviewing the rnllectiov of information. Send comments regarding the burden estimate or any other aspect o,`
<br />this collection of information, including stiggestioos 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 />1. if form has been partially completed by preprinting, disregard instructioos directed at entry of that infcrmation
<br />already preprinted.
<br />2. Enter "Permtrtee ,\'arne/ilfailing Address (arid facility namelloration, if different)," "Perri( Number," and
<br />"Discharge Number" where indicated. (A separate farm is required for each dschage.)
<br />3. Enter dates beginning and ending "Monitoring Periad" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample bfeacuremenP' r:.ta for each par ureter under "Quantity" and "Qualitt" in uniu specified in permit.
<br />",9verage" is norntall}~ arithmetic average (georactric average for bacterial parameters) otall sample measrrements
<br />for each parameter obiaincd during ".4fundnring Period"; "llaximurn" and "Alinimmn" are norntally exVeme high
<br />and low measurements obtained dunng "Jlonitoring PeNnd." (Note !o municipals with secondary treatment
<br />requirement' Enter 30~ny a~•crage of sample measurements under "Average," and outer maximum 7~ay average
<br />of sample measurements obtained during monitoring period under "Maximum.
<br />6. Enter "Permit Requiremen!" for each parameter under "Quantity" and "Quality" as spcc~ed in pertnil.
<br />7. Under "Iv'o Er" enter number of &~mple measurmcnts during monitoring period that exceed maximum (and/or
<br />minimum or 7-0av average as appropnale) pcriul requirement Cor etch parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnnlysts" both as "Sam,~le Mencurmen(" (actual frequency of sampling and analysis used
<br />during mot»loring period) and as "Permrt Requirement" specified in permit. (e.g., Enter "Cons," for continuous
<br />monitoring, "l ~7" for one day per week, "I/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Tt:oe" both as "Sample ,tfeasw amen(" (actual sample type used during monitoring perior:) and as
<br />"Permit Requiremen(," (c.g., Enter "Grab" :or individual sample, "2JHC' For 24-hour rnmposite, ",V/,9" for
<br />continuous monitoring, etc.)
<br />l0. Where violations of permit requirements are reported, attach a brie( explanation to describe catrse and corrective
<br />actions taken, and reference each violation by date.
<br />11. U "no dschage" occurs during monitoring period, enter "Na Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrincipa! Executive Oj7cer" with "Signa(ure ojPrincipa! Executive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />l4. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Ollice(s)
<br />specified in permit.
<br />Legal Notice
<br />'T'his 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 iv civil penalties not to exceed X10,000 per da!r of violation; or in criminal penalties not to exceed 825,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3720-1 (Rev. 08-95)
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