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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated ro vary from a range of 10 hours as m i
<br />avenge per response for some minor facilities, to 110 hours as an avenge per response for some major facilities,
<br />with a weighted avenge for major and minor Fa~:ilities of 18 hours per response, including time for reviewing
<br />instructions, searching ezis[ing data sources, gathering and maintaining the data needed, and completing and i
<br />reviewing [hz collection of information. Send commenLS regazding the burden estimate or any otfter aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 2046D; and to the
<br />Office of [nformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />Genera! Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Penmittee ,Vame:'Nndtng Address (and facili[}' nameflocation, if different)," "Permit Number," and
<br />"Dischorge A'umber" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ';tlonitorinK Penrod"covered by form where indicated.
<br />4. Enter each "Para»eter" as specified in monitoring requirements of permit.
<br />5. Enter "Smnple,lleosuremenl" data for each parameter under "Quantity" and "Qvulily" in units specified in penui[.
<br />".1 verage" is noimalk arithmetic average (geometric average (or bacteria' parameters) of all sample measurem?nls
<br />for each parameter obtained during 'aforrtnrir~g Perturf'; ".4larimum" and "Minimum" are normally extreme high
<br />and low mcastucracnts obtained during ",1lu nrtonnR Period." (Note 'o mu:ucipals with secondary lreatntznt
<br />rcquircment: Emer 70-day average of sample mcasunmcnts under "Average," and enter maximum 7-day average
<br />of sample measuremeu[s obtained during monitoring period under ",4faximurn. J
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in perntit.
<br />7. Under ".Vo Fx" enter numbev of sample mea;urmcnts during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) pern•it requirement for each parameter V none, enter "0".
<br />8. Enter "Frequency oj.Innlysis" both ns "Sample Afeasurmenr" (actua] Gequency of sampling and analysts used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Copt," for continuous
<br />monitoring, "1/7" for one day per week, "1.30" for one day per month, "1/9U' for one day per quarter, etc.)
<br />9. Enter "$ample Ttpe" both as "Sample dleasvr^menP' (actual sample ry~pe used during monitoring period) and as
<br />"Fermi( Requirement," (e.g., Enter "C;rab" fur individual sample, "24f/C"' for 2~-hour composite, "N/A" fa-
<br />continuous monitoring, etc.)
<br />10. Where violations oC permit requirements are reposed, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. IE "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter ",'Vame/f'itle oJPrincipa! Executive O~,:er" with "Signature mjPrincipnl Executive OJ~cer ojAurhorized
<br />Agent," "Telephone Number," and "Dare" al 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 instructions for use of this Dischorge Monitoring Report (DMR) Corm may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />11ris report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed S 10,000 per day ~rf violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for ool more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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