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<br />- - - Paperwork ~~.r3ulction Act Notice - ---
<br />I*.:hRc r~lw~rting burden fur this coilecuun of infunnati~~u .s e•a.intatzd iu ,,.:, ~rom ~ range of !0 hours as a~
<br />":cragz per resf~unsz fur s:,me minor facilities, to I;U hours a: .m average ~: r.; ~oor• for some m:+jur facilities,
<br />with a weighted average ter major and minor facililier.of 1fl hours per r. spurs, incwding time for reviewin;;
<br />instructi.rns sti;uchiag eristu:g data sources, gathering and m ....airing :he ca+a ne~~ied, and completing and
<br />rC~Ie0.lrg titz culiz.;tior of infunratiuu. Sznd comment•~ ~_... diug the burden estimate or any otheraspect of
<br />this collection of information, including suggestiun~ ~ !m'ing this burden, to Chief, Information Policy
<br />Branch, P!v1-223, U.S. Environmental Proircuoa .', •.e , 'C1 I'.1 Street; SW Washington, DC 211460; and to the
<br />Office of Information ardRe~ttlatory Affair,, O.`:"m. of ~lacagement tmdBt~dget, Washington, DC 20503.
<br />General Instructions
<br />1. if form has bean partially completed by preprinting, disrzgard instructions direc[e+i at entry of that information
<br />already preprinted.
<br />2. Enter "Permtt(ee .Name.3failtng AdQQrcrrss (and facility mtmeQocation, if di6'erenl)," "Perini( Number," and
<br />"Dtschnrge Number" vaure indlcated.`x!t separate form is required for ettch discharge)
<br />3. Enter dates beginning and ending "Aonitoring Period" covered by forzn rchere indicated.
<br />4. Enter each "Parame(er" as specified in monitoring requirements of permit.
<br />5. Enter ';\ump/e.ifea.iurrr; ,art" data for each parameter under "Quantity" :md "Quality" in units specified in permit.
<br />",4vern;r" is normally :: ;?aortic average (geometric avem;ge for bacterial parameters) of all sample measurements
<br />`or u.ch parameter obtai,~:~d during "Monitoring Period'; "Afaxlmum" and "A/inimum" are normally extreme high
<br />and law measurements obtair,;:l during "Monitoring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 3+1-cav ave:agc oC sample measurement, under "Average," and enter maximum 7~ay average
<br />of sample measurements obtained during mrnilodrg period under "Mran,rum. ")
<br />F. Enter "Perna P.equire.anr.(" for each parameter under "Quan.!ity" and "Quality" as specified in permit.
<br />7. Under "Vo Er" enter n:e,nbcr or sample mu-tsurrnents dttring monito:~ng period Ihat exceed maximum (and/or
<br />minimum or 7-day aver _e as ap4ropriate) permit requirement far each parameter. !!'none, enter "0",
<br />8. Enter "F-equercy oj.!rrrlysis" both as ".timnple .tleasurmen(" (actual frequency of sampling and analysis used
<br />during monitoring pc.ioc} and as "Perurir Requiren+en(" specified in permit. (e.g . Enter 'Cons," ~'or continuous
<br />monitoring, "1'7" for m.c day per v:eck, "l~30" for one day per month, "1 %90" for one day per quarter elcJ
<br />9. Enter "Smnple Tvpe" b:.•,h as "~runpl: \feasurenu•nr" (achrad sample type uscxi during monitoring period) and as
<br />"Permit Requiremer.+," ,,e.g., r=.r.ter "Grab" for individual sample, "74KC' for '~4-hour composite, "N/A" Car
<br />rnntinuous momtorn3, rte)
<br />I0. Where violaucns of pecnit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. U "no discharge" occ~_rs :i;rring monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter ".\'ame~Gae cjn~.rcrpal F~xecutire Officer" Kith ".Signa(ure ojPrincipn! Executive Officer ojAu(horized
<br />Agent," "Telephone h'm;,ber," and "Dale' al bottom of form.
<br />13. Mail signed Report to Uffce(s) tIy date(s) specified in permit. Retain copy for your rex:ords.
<br />l4. A1ore deailed inswc tic: ~ for usr of tbis Discharge Monitoring Repot( jDMR) form may be obtained from ORir~(s)
<br />specired in permit.
<br />Legal Notice
<br />'I~is rzprrt is required by !..v ;33 U.S.C. 1318; 40 C.F.R. 175.27). Failure to report or failure to report truthfully can
<br />resort in civ.l f.zna{ties out o ~ .:zed 3!0,000 per day of violation; or in crimintd penalties not to exceed 525,000 per day
<br />of v~olaticn, or by :mfrisormer.t for nut inure than one year, or by both.
<br />EPA Farm 3320-1 (Rev. !13-3`J
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