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~ - - - _ - Pa • work Reduction Acll ''tT• v~: - ---- - ----, ' -
<br />Public reporting burden for this collection of informal c. s zstirnated W v.rry S ~m a range of i0 Guuc, as ar. '
<br />average per rrsponse for some minor facililizs, to ; .C 60.,:: a, .m average per re:.ponse for some ma~ar fariR(~.s.
<br />with a weighted averagr Fnr major ant, minor facilimes of 1S hours per ns;~"~nse, including tim,~ f.~r re. r. ~ .~
<br />instnt~tions, scathing existing data sources, gathering attd maintaining tt .. art' .I ;a ~a .;:: uq,l.•ti .g ...
<br />reviewing the collection of infonnalion. Senti comments regarding the I_u .z .. .:;,~~ ~ .:r :,,.; nt',:- . ~ ...:, u`
<br />this collection of information, including suggeslioos for reducing this ht. ~..c C ;., , i:,:,.:n,~ticu Polizy ~!
<br />Branch, PM X23, U.S. Environmental Protection Agency, 40'. IN Street, ~h F,rse i.-,gt ~- ~:A 2'W60; an" W the ~,
<br />I Office of Information aAd Regulatory Affairs, Office of Manxgememt and Guy ;;et, `:asbugton, DC 20503.
<br />Genera- Instructions '
<br />1. if form has been partially completed by preprinting, disregard instntc[ioos directed at entry of that Information
<br />already preprinted.
<br />2. Enter 'Permittee Name/Meiling Address (and facility ttarr,eAocation, u different)," "Permit Number," and
<br />"Discharge Number" where indipted. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'Monitoring Period" covered by form where ir.dicatzd.
<br />4. Enter each "Parameter" as specified in monitoring requirements of pernut.
<br />5. Enter "Sample Measurement" data for each parameter under "Quantity" ;,rrd "Quality" in units specified in pernrit.
<br />"Averoge" is normally arithmetic average (geometric average :for bacterial p:uaineler:~ i of all sample mtasurements
<br />Cor each parameter obtained during "Monitoring Period'; "Maximum" and ":1L riurur~i" are normally gg Veme high
<br />and low measurements obtained during "Monitoring Period." (Note oo mer»cipals with seconddrr trea0neiu
<br />requirement: Enter 30~ay average of sample measurements under "Avenge." and rater maximwn 7-iay average
<br />of sample measurements obtained during monitoring period under "Maximum.
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Ounlity" az sprificd in permit.
<br />7. Under "No Fx" enter number of sample measunnents during monitoring period Urat exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement Cor each parameter. If none, enter "u".
<br />8. Enter "Frequency of Analysis" both as "Sample Measurrnen[" (actual frequency of sampling and a:,alysis used
<br />during monitoring period) and as "Perri[ Requirement" specified in permit. (e.g., Enter "C.'ont,° fos continuous
<br />monitoring, "//7" for one day per week, "1/30" for one day pct month, "l, 90" fo• one jay per quancr, et :.)
<br />9. Enter "Sample Type" both as "Sample Measurement" (actual sample type useu during monitoring pe iod) and as
<br />"Perini[ Requirement," (e.g., Enter "Grab' for individual sample, "2JHC" For :•4-hour composite, "!•.%a" fir
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported. attach a brief explanation to describe pose ar d rotrecti•;t.
<br />actions taken, and reference each violation by date.
<br />11. ]f "no discharge" occurs during monitoring period, enter "No Uisrharge" across forth in place of data et try•.
<br />12. Enter "Nome•~Tit/e ojPrincipal Ereculive Dicer" with "Signature oJPrincipal Executive Officer ,_-hutho:iz~d
<br />Agent," "Telephone Number," and 'Dare" a[ bottom 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 instmctions (or use of this Discharge Monitoring Report (L511R) form niay be obtained frorr.:3ificels)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.271. Failure to report or lailure to report [: at6fu~ly ca~a
<br />result in civil penalties not to excced SI0,000 per day of violation; or in crimm;d penalties not to exceed x25,000 per tL.y
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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