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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 m
<br />average per response for some minor facilities, l0 110 hours as an 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 sou,~ces, gathering end tnaintauring the data needed, and completing and
<br />reviewing the collection of imformmation. 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. Envtroomt:ntal Pnxection 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 instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Pernrittee Name/lllailing Ad<tress (and facility namellocation, if different)," "Permit Numher," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and coding 'ilfonitormg Period" covered by.fotrtt where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter ".Sample Afea.-urement" data for each parameter under "Quantity" and "Qunlity" in units specified in permit.
<br />"Average" is normally ari!hmdic avemge (geometric atcrage for bacterial parameters) oCall sample measurements
<br />far each parameter obtained during ".t foniroring Period': "Afarirnum" and ".4finimum" are normally extreme high
<br />and low measuremetas obtained dunng ",tfoairormg Period." (Note to municipals with secondary treatment
<br />requirement Enter i0-da} a~crage of sample measurements under ".4vera,Ge," and enter maximum 7day average
<br />of sample measurements obtained during monitoring period under ",Llaximum.'J
<br />6. Enter "Pennir Reyuvrrnent" for each parameter under "Quantity" and "Quality" as specified in perm[.
<br />7. Under "No Ix" enter number of sample measutments during monitorin~~ period that exceed maximum (and/or
<br />minimum or 7-day average az appropriate) permit requirement Cor each parameter. II none, emer "0".
<br />8. Enter "Frequency of Ana/ysis' both t~s "Sample ,4/casurment" (actual Crequenc}' of sampling and analysis used
<br />during monitoring period) and as "Pe•mir Requirement" specified in permit. (e g.. Enter "font," for continuous
<br />monitoring, "li7" for one day p:r week, "1130" for one day per month, "I/9G" for one day per quarter, etc.j
<br />9. Enter "Sample Type" both as ",Sample .ifeasurement" (actual sample type used during monitoring period) and as
<br />"Fermi! Requirement," (e.g., :Enter "Groh" for individual sample, "2~lI/C' Cor 24-hour rnmposite, "A~;4" (or
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corective
<br />actions taken, and reference each violation by date.
<br />1.1. If "no discharge" occurs during monitoing period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/I'itle ajPrincipai Executive Officer" tvith "Signature ojPrmcipa! Executive Officer ojAu(horized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />13. Mail signed Report to OILce(s) by dale(s) specified in permit. Retain copy Cor your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DhfR) Corm may be obtained from 06ce(s)
<br />specked in permit.
<br />Legal Notice
<br />7biB 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 />restilR~ti civ' tes not to exceed SI0,000 per day of violation; or in criminal penalties trot to exceed $25,000 per day
<br />of violsslion, or y imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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