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<br />1'agi:r~r~c.~~> .~a.tE%ii;:ii~atl Acd: l~otic~e
<br />~ I
<br />Public rat +Rirg burden f.;r tu;s wltechon tit inton+w:. ~.:a +s ta;ti~natul t ~ _.:~ from a range of '.0 hours as .m
<br />average nor rosponsr for s,.me minor facilities, to 1!U hours trs an aver,,! p~: rc pon~r. for some major facilities,
<br />wish a weighted svercge F~r major aad.rninor facilities of 1R hours pr+ ;:open e, inauding time for reviewing
<br />inzrnmiu~n:;..a:archir.v exi :irg dsra sour.: es, gathac;i .~ _:ctahw;g the d eta needed, and completing and
<br />review;:,g :he wlleciton vi infor-matiun. Send comm.... .:_~;drog the L-~urden estimate or any otheF aspect of
<br />this coli~tion of :a!:nm..iwa, tncludmg sugge;uon~ :, :~c.,,:r;g this burden, to Chief, Inforttaatioo Policy
<br />Hranch, Phf-223, U.S. Environmental Protrti~tion Ao> ~~ ., , .C I nt Street, SW Washington, DC 20460; and to the
<br />Offix of Information and Regulatory Affaia, O`t.ce rl .'.ianagemen[ and Hudget, Wa~hingtoo, DC 20503.
<br />General Instructions
<br />I. If form has been partia'ty completed by preprinting, disregard instructions directed a[ entry of that informatioe
<br />already preprinted.
<br />2. Enter "Permittee Nan;e.•119ailing ,9ddress (and facility namellocaUan, if diH'erenl)," "Permit Number," and
<br />"Discharge .'4'umber" where indicated (A separate form is axluired for each dischart;eJ
<br />3. Enter dales beginning n:.d ending ",monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring rcyuircrncnts of permit.
<br />5. Emcr ".Yample ,t/ewur_ n:ent" data for each parameter under "Quantity" and "Quali y" in units specified in permit.
<br />".overage" is nornvall} anituneuc average (gcomelnc averege for baMerial parameters) of all sample measurements
<br />for etch p,•trarneter obutiaed during "Monitorigg Period"; "dlarimum" and "Afininnrm" are normally extreme Iugh
<br />and Iv'v: meastrremees obtained during ';lloruroring Period." (Note to municipals with secondary treatment
<br />requirement Emer 3,t-::a} average of sample measurements under "A~.erage." and enter maximum 7-0ay average
<br />of san:p!e measttremet.V obtained during monitoring period under "6loximum.
<br />F. Enter "Pcrm;t Requiren:<rt" for each parameter under "Qurmtiry" and "Oualiry" as specJed in permit.
<br />7. Under "No Er" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-0ay averege as appropriate) permit requirement for each parameter. ff none, enter "0".
<br />8. Eater "1=requercv nj.dr.cdvsis" ;ro:h as ':San+ple bf.:nsvnn~nY' (actual frequency of sampling and analysis used
<br />during monaorng period) ands"Perna( Regvrement" specified in permit. (e.g., Enter "Copt," for continuous
<br />montoring, "14" Car v.e day per ~vcek, "1 r30" Cor one day per month, "N90" for one day per quarter, etcJ
<br />9. Enter "San+ple Tvpe" bc.h as ".Sample .Ieasvrement" (aau:nl sample type used dwing monitoring period) and as
<br />"Peruur Reyu;rement," ;a.g., Eater "Grab" for individual sample, ".'4HC" for 24-hour composite, "N/A" for
<br />continuous momtorin„ etc )
<br />10. lVhzre tiolatiens of ;+crnrt requirements are reported, attach a brief explanation to describe rouse and corrective
<br />actions taken, and reFcrcRce each violation by date.
<br />11. If "no discharge" ucr,rs durng monitoring period, enter "No Discharge" across form in place of data entry.
<br />]2. Enter ".'.'ameT.le ojl:~:rc+pa! £xecu(h~e Officer" trrth "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agerl," "Telephone A'ur.:bcr," and "Dn(e" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specJed in permit. Retain copy for your r."cords.
<br />14. More detailed instrut:ica for u>e of this Discharge Afnniwr,'ng Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />'I~is rzpnrt is requirul by !sw t33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report Wthfully can
<br />:esuit s rn ~ I penahi~s net ,~ .:.trvd 310,tb0 per day of violation; or in criminal penalties not to exceed (25,0(10 per day
<br />of violation, or by imprisuemert for rot more than one year, or by both.
<br />EPA Farm 3320-1 (Rev. U ~-): )
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