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Pa•rwork =.~ducti,c:i~ Act N,tice:
<br />Public r onicg bonito 6: ;.., '~•aion of information s e:::inuted to vary f tom a range of 10 hours as an
<br />avuair ^~:r n~~~"~:.; ~ ..r • ~ .:_i~i::~s, l0 110 hu~,:rs as an average iaar r~~ponse for some major facilities,
<br />v,:lh a vs c:g`:z.. sv;... ~~ . _ _ , .._:,: cr,nor facilities of 18 hot[cs per rc:epona, including time for teviewing
<br />instrutt.,us ,c::nh.:.;~ ~?.• ~ _ ~._ .,urx~, ^athering and n.~i •=gig the data net+fed, and completing and
<br />rocicw:%~_ :ae ~cllw;ion of i;,for,W4on. :: a..i cur:uuents mending the burde: aatin..te s any other aspect cf
<br />this co(ic:~tion .~f informatron, includin;, .,_ .L:n•~ for rerluciog [his inrrdc^ to ~~rief, Information Policy
<br />Branch, P~1-^.27, U.S. Envirorunenal i'ru:;.:rion r,r.nv~, ;O1 Al Street, SV/ N a:hing:on, DC 20460; and to the
<br />Office of Information and Regulatav Affairs, Office of 6lanag;ernent end Budget, Wachinglon, DC 20507.
<br />General Instrluctions
<br />L [f form hes been partraily completed by preprinti_rg, disrrgard instructions directed al entry of [Nat information
<br />already preprinted.
<br />2. Enter "Permittee ti'ame Afailing .4ddresc (and facility name/location, if different)," "Permi! ~'Jumber," and
<br />"Discharge Number" whrre indigted. (A separate Conn is teyuired for each discharge.)
<br />3. Enter dates beginning and ending "Afonitaring Perod" covered by form where indigted. ,
<br />4. Enter each "Parameter" as sp.°ci.icd in monitoring requirements of permit ,
<br />S. Enter "Smnp(e ,{fe~;~,.r+.~•uf ~zLa for each parameter under "Quantity" :md "OualirJ' in units specified in permit.
<br />".tvrrogr" is normally an:htr.c.:_ average (geometric average for bacteria] parameters) of all sample measurements
<br />for each parameter obtainoj dmiug ",tloniloring Perod'; "Afaximum" and "A/inimum' are normally extremt•high
<br />a::d Ie+v mcasuremerls ubtairr:.l during "Aluni(oring Period." (Note to municitals with secondary treatment
<br />requirement: Enter 3J~ac average of sample measurement:: under "iherage,' and enter maximum 7-day average
<br />of sampl°_ mcasttremeuts obtatne:: during monitoring period under "Maximum. ")
<br />b. Enter "Perna! Gequirrmenr" far Etch parameter under "Quantity" and "Quality" as specified in permit.
<br />'. Under "Vo s" entry t,umbe;r of sample measurements during mamtoring period that exceed maximum (and/or
<br />minimum or 7-day aver.;g: as appropriate) permit requirement for each parameter. If none, enter "0"L
<br />8. Enter "Frer)uercy of -I,.,il)s,.c" both as "Sample ;Llensurmenr' (actual fn~ucnry of sampling and analysis used
<br />during :nomtoring period) and .~~ "Permit Requirement" speecified in permit. (e.g. Enter "Coat," for continuous
<br />monitoring, "1 ~7" (or ?ne day IK. ecck, "1130" for on: dory lxr month, "l%90" for one day per quarter, etc.)
<br />9. Enter "Smmple TtPe" bosh as "Srmtple Afeasurement" (actual sample type usrxl during monitoring iperiod) and as
<br />"Permit Requiremerx," ;e.g., Enter "Grab" Cor individua sample, 4HC' (or 24-hour composite, "N/A" for
<br />wntinuous monitoring, etc.)
<br />10. Whcte violations of µr.r,t req;.i;ements are reported, attach a brief e:~planation to describe cause and corrective
<br />actions taken, and ref~rvnce each ~•iolation by date.
<br />1 I. If "no discharge" occurs ••Suring monitoring period, enter "A'o Discharge" across form in place of data entry.
<br />12. Enter "A'amr.rl'iile of /1 ir.cipal ^recutice Officer" tcith ".Si,gnafure ojPrincipal Executive OjTcer oJAuthorized
<br />Agent." 'Telephone A'un.5er," ar,d "Date" at bottom of form.
<br />13. broil signed Report Ir• C~fTce(s) by date(s) specified in pernut. Retain copy for your rrxords.
<br />l4. b4ore detailed icstrucuots for use of this Discharge Alorriloring Report (DMi2) form .may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />TF.is report is required by :.w (33 U.S.C. 1718; 40 C.F.R. 125.27). Failure [n report or Failure to report truthfully can
<br />:~su{r in viva penaL'iz, net ..~ ~_:.c~;ed 1':0,000 }Kr day of violation; or io crirninul penalties not to exceed 525,000 per day
<br />cf violatioo, or by imprisur.r..u.t for ou[ more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 0?-~S)
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