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-- - s'~•rwurk Re~~ at;ion Ae~t Nice - -- --- ~-
<br />PuhGc :. purhn "urdrn f r this : - Ilectwn of infonnai .a is a;tituated to • a _ 'mm a range of 10 hours es an
<br />aeuaez o.r rc:;,oa°.e ~.r ~ ._ ,. , . .,:,i:~:;r,, to i 10 ~.:~,rrs as an average per rz pon:~~ for some major tacilitiz•:,
<br />with x c;zighte.l avzt64e ., - :r:,.:..,:: ir:r. ~r (acililics of IS hours per rep~ie,:, including time for nv;ewimg
<br />in~trvet~or;, ,~::.::h::.m e> _ .. .._. gathanoq :,.n~l maintainin;; 'he ~~ a ne,•dr:d, and armpletiitg and
<br />re.~izw:r~ the :ot:wt;,.n ,.1 :.~do;r.,..~io:;. ]end cu:;:...-. ~~~arding [he b~rdes zstimz.te or any other aspect of
<br />this'eellrction :'.f mfcrm:.r..~r,, mc;udtng ,u~ gzstium- ~ ~ '..'...:m~ this 'urdrn, to Chief, Information Policy
<br />Branch, PM-223, J.S. Er,v,mamental Prot~ctwn Agca,; ~~1 ;d Street, 57V V.+a;hingom, DC 20460; and to the
<br />~~ Officr of Inforctstion and F,: gu;ate y A.`fair;, Office of Management and Budget, Washington, DC 20503.
<br />General Instrx~ctions
<br />1. If form has been partiaGy completed by preprinting, disregard instructions directed at entry of tlia[ inforrmlion
<br />already preprinted.
<br />2. Enter "Permitlee .Name+7lladirg Address (and facility munellogtion, if diH'erent)," "Perini! Number," and
<br />"Discharge Number" where indipted. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ';ionitoring Period" covered by Corm where indigled.
<br />4. Enter each "Paramere," us specified m monitoring rcquircments of permit.
<br />5. Enter "Smnp.'e .tlea.cu; crr.ent" ri~ta for qch pammeler under "Quantity" and "Qvali!•r" in units spectfed in permit.
<br />".,vernge" is normalk :uiGrmei;c average (geometric avemge for bacterial parameters) of all sample measurements
<br />for cacti par.,meter ota ~:ed duttirg "Monitoring Period"; "hlasimum" and "rLlinimum" are normally extreme high
<br />and low mcasaremems obtained during ",monitoring Period." (Note to municipals with secondary trptment
<br />requircmerc Enter 3'.7-'_:;v average of sample measurements under "Average," and enter maximum 7~ay average
<br />of sample measuremeos attained during monitoring period under "Maxirrrum.
<br />E. Enter "Perm t Feyuirr:r:rnt" for each parameter under "Quantity" and "Quality" as spxified in permit.
<br />7. Under ",No Ez" enter cumber of somple meantrntents during monitoring period That exceed maximum (:md/or
<br />minimum or 7~:ty aversLe as appropriate) permit requirement for pch parameter. If none, enter "0",
<br />8. Eater "Frequency ~f ~+-~!)~s,s" both as ".Sm+rple Measurnre,at" (actual frequency of sampling and analysis used
<br />during monitoring period) and a "Perntit ReyuiremenP' specified in permit. (e.g., Enter "Coot," for continuous
<br />monitor.ng, "1+7" (or .n.e Say per reek, "N30" Cor one day per month, "ha0" for one day per quarter, etc.)
<br />I
<br />9. Enter ':Cmnpie Ttpe" be~h as ".Camp/e afrasuremenr" (actual sample type used during monitoring period) and as
<br />"Permit Reyu:remerr." ,c.g, Enter "Grab" for individual sample, "7Jf/C' for 24-hour composite, "N/A" Cor
<br />rnntinuous momtoring, e, c.)
<br />10. 1,\•'here vdolat.•ons of IkrrSt requirements are reported, attach a brief explanation to describe pose and corrective
<br />actions taken, and reference each violation by date.
<br />11. if "no discharge" ocaus i tiring monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter ".h'ame'f,de oj'Pr,nnpa! h_~recutive Officer" with "Signature ojPrincipn! E.recutive Officer ojAvthorized
<br />Agent," 'Telephone!! uu,ter," and "Date" a[ bottom of (arm.
<br />I3. Mail signed Repo to O'Tice(s) by date(s) specified in pemtit. Retain copy for your ra;ords.
<br />14. Afore detailed inslruc•:ic as for use of this Discharge dlunitorb~g Report (DMR) form may be obtained from OOice(s)
<br />specified in permit.
<br />Legal Notice
<br />"this sport is requited by ;'".r (3.3 U.S.C. 1318; 40 C.F.R. 125.271. Failure to report or failure to report Wthfully can
<br />resttit ~ civ.I penalties not c. c:.ceed E 10,000 per day of violation; or in critnin:ai penalties not to exceed S25,OlXl per day
<br />of v iolatien, or by im frisormect for nut more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 0 :-9°)
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