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.Paperwork Reduction Act Notice
<br />~_v .
<br />Public reporting burden for this collation of information is estimate¢~tAry from a racge of ]0 hours as m
<br />average per response for sbree.rpinor facilities, to 110 boars as an avers response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, includv.~ :ime for reviewing
<br />instructions, searching existing data sourcls,' rmg anrj~tnaintaining toe dais needed, and comple~ing and
<br />reviewing the colla[ioa of information. Sendnts arding the burdea estiata[e or any other asps[ of
<br />this collation of informs[ion, including suggestions fipf'cmg this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protalioa Ag~ey,'401 iv; Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office oflvlanagement and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions dirated at entry of that information
<br />already preprinted.
<br />'~: &.4tet "Permittee NameQl/ailing AddrQSS (and facility name/IopLiOn, if different)," "Permit Number," and
<br />" rscharge Number" where indicated. {A separate form is required for each discharge.)
<br />3. Enter dates beginning and ,:nding 'Monitoring Period"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Same/e Aleasureme.~,l" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally a:itltnteuc average (geometric average far bacterial parameters) of all sample measurements
<br />for each parameter obLtincd during "Aonitoring Feriod'; "tifazimum" and "dfinimum" are normally extreme high
<br />and low measurements obtained during "Monitoring Period." (Note to municipals with saondary treatment
<br />requirement: Enter 301. average of sample measurements under "Ave. age," and enter maximum 7-0ay average
<br />of sartiple measurements of wined during monitoring period under "Maximum.')
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "No Er" er.[zr num,;cr of sample measurrnen[s during monitorng period that exceed maximum (and/or
<br />minimum or 7-day average us appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAna!vsi.r" both as ".Sample ,L,'eosurment" (actual frequency of sampling and analysis used
<br />during monitoring p;.riod) and as "Perna! Requirement" spaified m permit. (e.g., Enter "Coot," for continuous
<br />monitoring, "1,'T' for one d:y per week, "li30" for orte day per monlJt, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample T/p-°" Dort[ as "Sample ,Lfeasurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "24ffC" fot 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of pennii requirements are repo,Yed, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. [f "no discharge" occurs doing monitoring period, eater "No Discharge" across form in place of data entry.
<br />12. Enter "A'ame/f'itle ojPrincipa! Executive Officer" with "Signature ojPrincipal Executive Officer oJ.9uthorized
<br />Agent," "Telephone Numbe; ," and "Dale" at bottom of torn[.
<br />13. Mail signed Report to Office(s) by dart(s) specified in perntit. Retain rnpy for your raords.
<br />14. More detailed instructions f or use of this Discharge Monitoring Report (DMR) fotTrt may be obtained from Office(s)
<br />spaified in pernu[.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. i3I8; 40 C.F.R. 125.27). Failure to report or Failure to report truthfully can
<br />result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />rf violahoa, c- by imprisonment (or not more than one year, or by both.
<br />-EPA Form 3320-1 (Rev. OH-93)
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