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Pape~ir~ri;. ~tec3uctio~n Act Nr)'icf•
<br />Public reporting burden fur this cuautioc of inlormatioi. is tslimated i.: „a, c:vge of ;fi ,.~u~.. v ..r.
<br />average per responst for some minor tac;;ities, l~ 110 ho~,rs ac an average , :r i;: en,~ nor wine tru~or fa_ilihes,
<br />with a weighted average for major anu nunnr facilities of IS hours per ~~ p: :,. :ni .,ding time fur rgv~iewing~
<br />instructions, searching existing data sources, gathering .J~~ :~t:anlainin-_ ~- . _ ^e::-~ ut,' aanpletng and
<br />reviewing the collection of information. Send comment ~vciing the b..nlcr ,iim.,o ~, a:,y oLer axct of
<br />this collection of inforrnatioo, including suggestions tb; red~ei~;; this hart.: r io C"uef, lufi,nnation Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, ~;~. D', Street, 5~~~+ `Na:,hingb ~,n, DC 20460; ao.: to [he
<br />Office of Information and Regulatory Affairs, Office of M1lanageme.. and 8cdgat, Washington, DC 20503.
<br />General Instructions
<br />1. If form has bees partially completed by prepriatitra, disregard instrrrctioas direclec~ at entry of that information
<br />already preprinted.
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<br />2. Eoter 'Permitlee Name/Mailing Address (and facility trameJlocation, if different)," "Permit lumber," and
<br />"Discharge Number" where indicated. (A separate form is req~trired for each tiis:harge J
<br />3. Enter dates beginning and ending 'Monitoring Period" covered by Conn a here indicated.
<br />4. Enter each "Parameter" az specified in monitoring requirements of permit.
<br />5, Eoler "Sample Mea+vremenP data for each parameter under'QuantiR" and 'liualify" in units specifiaJ in perndt.
<br />"Average" is normally arithmetic average (geometric average for bacieriaJ parmeters) of ali sample measurements
<br />for each parameter obtained during "Monitoring Period'; "Marrmum" and ".t.'+nimura" are normally e;dreme high
<br />and low measurements obtained during "Monitoring Period." (Note to municip;ils with secondary treaimcnt
<br />requiremem: Enter 30~ay average of sample measurements under "Averagr," and toter maximum 7-Jay average
<br />of sample measurements obtained during monitoring period trader "Maximurrr ')
<br />6. Enter "Permit Requirement" Cor each parameter under "Quantity" and "Quality" az specified in pemut.
<br />7. Under "No Ex" enter number of sample meastuments during monitoring period chat exceed maximum (and/or
<br />minimum or 7-day average az appropriate) permit requirement for each parameter 1!' none, enter "0"..
<br />S. Enter "Frequency ojAnalysis" both az "Sample Measurment" (actual frequenry ci sampling and analysis used
<br />during monitoring period) and az "Perrrrit Requirement" specified in permit. (e.g. Enter "Cont,° ~° continuous
<br />monitoring, "f/7" for one day per week, "I/30" for one day per month, "1 90" for one day per quarter, ei.:.)
<br />9. Enter "Sample Type" both az "Sample Measurement" (actuall sample type used du::ng monimring ~e:iod) and az
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, : ~JIIC" for :'.4-hour composgtr , "?Jir," for
<br />continuous monitoring, etc.)
<br />]0. Where violations of permit requirements are reported, attach a brief explanation to describe cause ar d correctiv:
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form n place of data er tr}•.
<br />12. Enter "Name/f'itle ojPrincipa! Executive Officer" with "Signature ojPrincipat E.recutive Officer ,'Authorizvn
<br />Agent," 'Telephone Number," and "Date" al bottom of form.
<br />13. Mail signed Report to Oeice(s) by date(s) specified in perntit. Retain wpy for your rrx-rords.
<br />14. More detailed inslrnclions for ttse of this Discharge Monitoring Report (D6lR) i'otm may be obtained f: on Orfices)
<br />specified in permit.
<br />Legal Notice
<br />'This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Feilurr•. to report or failure to report tutbfully car
<br />result in civil penalties oot [o exceed $10,000 per day of violatioo; or in criminal peoalties rot to exceed $'t~ .00:, peg r:~;~
<br />of violation, or by imprisonment for not more than one year, or by both.
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<br />a,:.,
<br />EPA Forte 1320.1 (Rev. OS-95)
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