• - - PaRerwork Reduction Act Notice
<br />P,ub6c reporting burden for this collection of information is estimated to vary from a range of 10 hours es m
<br />average per fesponse for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18ibtiuts per response, including time for reviewing
<br />instructions, searching existing data sources, gathering:etuttaining the data needed, and completing and
<br />"`riyi~iving the collection of information. Send comme~ egarding the burden estimate or any other aspect of
<br />;.tkiti collectioo of information, including suggestigns for reducing this burden, to Chief, Information Policy
<br />B e, h,'PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />OCe of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />~ has {{b''een partially completed by preprinling;~ disregard instructions directed et entry of that information
<br />prep{mted. .
<br />"Permirree Name/Mailing Address (and facility nameJlacation, if different)," "Permit Number," and
<br />arge Number" where indicated. (A separate form is required for each discharge.)
<br />dates beginning and ending "Monitoring Period" covered by Corm where indicated.
<br />each "Parameter" as specified in monitoring requirements of permit.
<br />~ntgr "Spmp/e Mensuremenr" data for each parameter under "Quantity" and "Quality" in units specked in permit.
<br />,'g~rlvei~age" is normally arithmetic average (geometric avppge for bacterial parameters) o(all sample measurements
<br />actor each parameter obtained during "Monitoring Period"; "Maximum" and "Minimum" are normally extreme high
<br />na~d;low measurements obtained during "Afoniroring Period." (Note to municipals with secondary treatment
<br />~ rEqurremenr Enter 30-day average of sample measurements tinder "Average," and enter maximum 7~ay average
<br />of sample measurements obtained during monitoring pPrlod under "Maximum.')
<br />6. Enle( "Perini! RequiremenP' for each parameter under "Quantity" and "Quality" as specified in penni[.
<br />r7.)Under "No Er" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />~itiniinum or 7-day average as appropriate) permit requjrement for each parameter. ff none, enter "0".
<br />~rfl.;Enter "Frequency ojAnalysis" both as "Sample Measurnrenr" (actual frequency of sampling and analysis used
<br />idurfdg monitoring period) and as "Fermi! Requirement"~ specified in permit. (e.g., Enter "Conn," for continuous
<br />'w' mottoring, "//7" for one day per week, "//30" for one~day per month, "1/90" for one day per quarter, e1cJ
<br />s ~
<br />~9.~$ntdl "Sample Type" both as "Sample A~feasuremenr" (actual sample type used during monitoring period) and as
<br />~; .,"Permit Requirement," (e.g., Enter "Grab" for individual sample, 24HC' for 24-hour composite, "N/A" for
<br />z scontinuous monitoring, etc.)
<br />~. t , -
<br />ut Whale violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />~f r':acG4ns taken, and reference each violauon by date. '~ •
<br />~].:1f "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />RZ:~Enter "Name/f'itle oJPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer of Authorized
<br />`' :_. °Agent," "Telephone Number," and "Date" at bottom of form.
<br />:r :-
<br />!3. Mail signed Report [o Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />~0.
<br />f4. More detailed instructions for ttse of this Discharge Monitoring Report (DMR) form may be obtained from Offce(s)
<br />specked in permit.
<br />Legal Notice
<br />t,ryport is required by law (33 U.S.C. 1318; 40 C.F.R. 125.2. Failure to report or failure to report truthfully can
<br />)t'in civil penalties cot to exceed $10,000 per day of violation; or in criminal penalties not to exceed (25,000 per day
<br />io~alion, or by imprisonment for not more than one year, or by both.
<br />-i
<br />Form 3320-1 (Rev. 08-95)
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