|
- Paperwork Reduction Act Notice
<br />s~
<br />lratblic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as m average per response for some major facilities,
<br />with>f weigEted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />i1[stNctions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the wllection of information. Send comments regarding the burden estimate or any other aspect of
<br />lA$ collectioe of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Hrdnch, PM-223, U.S. Environmental Protection Agency, 401 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 />b.~JF form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />i a.• ; ~Iready preprinted.
<br />~.
<br />Z.`-doter 'Permittee Name%14aiting Address (and facility name/~ocatign, +f different)," "Permit Number," and
<br />~' ,"Discharge Number" where indicated. (A separate form is required for each discharge.) '
<br />'' 3. ,Enter dates beginning and ending 'Monitoring Period" covered by form where indicated
<br />4.;Enter each "Parameter" az specified in monitoring requirements of permit.
<br />5.'°En[er "Sample Afeasurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />;~ "Average" is normally arithmetic average (geometric averages for bacterial parameters) of all sample measurements
<br />.for each parameter obtained during "rLfoniroring Period"';" aximurn" and "Minimum" are normally extreme high
<br />.and low measurements obtained during "honitoring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-day average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "Maximum.
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specsed in permit.
<br />7.'Under "No Fx" enter number of sample meazurments during monitoring period that exceed maximum (and/or
<br />rminlmum or 7~ay average as appropriate) permit reggirement for each parameter. >f none, enter "0".
<br />$.~Enler "Frequency ojAnalysis" both as "Sample Measvrment" (actual lrequenry of sampling and analysis used
<br />• Sduring monitoring period) and az "Peronir Requirement" specsed in permit. (e.g., Enter "Copt," for continuous
<br />.monitoring, "1/7" for one day per week, "//30" for one day per month, "1/90" for one day per quarter, etc.)
<br />,.
<br />Q.EntGI "Sample Type" both az "Sample Measurement" (actual sample type used during monitoring period) and az
<br />`"Permit Requirement," (e.g., Enter "Grab" for indiv~al sample, "14HC' for 24-hour composite, "N/A" for
<br />;wntinuous monitoring, etc.) `
<br />~O~;VYhere violations of permit requirements are reported, attach a brief explanation to describe cause and cortective
<br />=~ ;actions taken, and reference each violation by date.
<br />~,ff"tin discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />~2.,En[er "Nnme/1'itle ojPrincipal Executive Officer" with "Signature ojPrincipn! Executive Officer ojAuthorized
<br />:: iAgent," "Telephone Number," and "Date" a[ bottom of form.
<br />'Mail signed Report [o Office(s) by date(s) specified in permit. Retain copy for your records.
<br />More detailed instructions for use of this Discharge Monitoring Report (DMR) fornt may be obtained from Office(s)
<br />specJed inpermil.
<br />. Legal Notice
<br />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 />it penalties not to exceed 610,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
<br />_,:
<br />5.-
<br />•4.
<br />
|