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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of. 10 hours as o0
<br />average per response for some minor facilities, to I10 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time.for reviewing
<br />~~ instructions, searching zxis~ing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, [o Chief, Information Policy
<br />Branch, PM-223, U.S. Eov,:ronmental Protection Agency, 40l M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed et entry of that information
<br />already preprinted.
<br />7.~1M `~•i'ermittee fame :11niLng Addirss jand "facility name location, if dilferenQ," "Permit Number," and
<br />"Discharge .4'mnber" v. hrrc indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning anj ending "dfnnitoring Perod" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter ",4ample dlensurement" data for each parameter under "Qunnti(~" and "Quality" in units specified in permit.
<br />".4veroge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".lfomtonng Period"; ",lfarimum" and ".i/~nununt" are normally extreme high
<br />and low measurements obtained during ",tloniroring Penod." (Note to mwucipals vrith secondan' treatment
<br />requirement: Enter .;0-day average of sample measurements under "Average," and enter maximum 7~ay average
<br />of sample measurements obtained during monitoring period under "afoxunurn 'q
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quahh" as specified in permit.
<br />7. Under ":Vo Ex" enter number of sample mcasutmcnts during monitoring period that exceed maximtun (and/or
<br />minimum or 7-da}' average as appropriate) permit requirement for each parameter If none, enter "0".
<br />8. Enter "Frequency ujAnnltsis" both as "Sample dleasurmen!" (actual frequene}' of sampling and anal}'sis used
<br />during monitoring period) and as "Fermi! Requiremen!" specified in pernut. (e.g., Enter "Coral," for continuous
<br />monitoring, "I'~" for one da}' per week, "l•30" for one day per month, "!.'90" for one day per quarter, etc.)
<br />9. Enter ".Sample Tvpe" bosh as "Sample .lfeasuremenP' (actual sample type used during monitoring period) and as
<br />"Farrar! Requirement," ie.g.. Enter "Grab" for individual sample, "?4f/C" for 24-hour composite, "N,:4" for
<br />continuous monitoring, e.c.)
<br />10. Where violations of perrut requirements are reported, atmch a brief explanation to describe cause and corrective
<br />actieos taken, and reference each violation by date_
<br />11. U "no discharge" occurs during monitoring period, enter "h'o Discharge" across farm in place of data entry.
<br />12. Enter "1Vante//'ifle ojPr,ncipa! Executive Officer" vvi[h "S'ignature ojPrincipal Executive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Report to A8 ice(s) by date(s) specified in perntit. Retain copy for }'our records.
<br />14. More detailed instructions Cor use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s)
<br />specked in permit.
<br />Legal Notice
<br />Thus 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 />reatult in civil penalties no[ to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />E{'A Form 3320-1 (Rev. 08-95J
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