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Paperwork Reduction Act Notice <br />Public repoRing burdee for this collection of information is estimated to vary from a range of 10 hours as m <br />average per response for some minor facilities, to 110 hours as an average par response for some major facilities, <br />with a weighted average for major and minor faz;ilities of 18 hours per response, including time for reviewing <br />instructions, searching existing data sources, gathenng and maintaining the data needed, and completing and <br />reviewing the collection of informatioo. Send comments regarding the burden estimate or any other a_sput of <br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy <br />Branch, PM-223, U.S. Environmemtal Protection Agency, 401 M Street, SW Washington, DC 20460; aad to the <br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions <br />I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information <br />already preprinted. <br />2. Eater 'Permittee ,Vame%A9ailing Address (and facility namellocation, if different)," "Permit Iv'umber," and <br />"Discharge Number" where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and ending 'itfonitoring Period" covered by form where indicated. <br />4. Enter each "Parameter" as specified in monitoring requirements of permit. <br />5. Enter "Sample Alca.curement" data for each pa-ameter under "Quantity" and "Quality" i^ units specified in permit. <br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements <br />for each parameter obtained during "Ainnitnriug Period"; ".Alarimuut" and ';lfinimum" are normu_Ily eaZrcme high <br />and low measurements obtained during ".llonitoring Period." (Note ro municipals criih secondary Vea(ment <br />requirement: Enter 30-day average of sample measurements under "Average," and cuter n4•tximum 7-day average <br />of sample measurcmcats obtained during monitoring period under "A4azirrvm. <br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as spxified in permit. <br />7. Under ".Vo Ex" enter number of sample measurmcn~s during monitoring pe~od that exceed maximum (.and/or <br />minimum or 7-da} average as appropriate) pemut requirement for each parameter. if none, enter "0". <br />8. Enter "Frequency aj.4nolysis" both as "Sample ,t7easurment" (actual frequency of sampling and analysis used <br />during monitoring period) and as "Perini! Requirement" specified in permit. (e.g., Enter "font," for continuous <br />monitoring, "//7" for one day per week, "1 X30" for one day per month, "1/90" fo- one day per quarter, etc.) <br />9. Enter "Sample Ttpe" both as "Sample .lleosuremem[" (actual sample type used during monitoring period) and as <br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "2J1lC"' for 21-hour composite, "N/A" for <br />continuous monitoring, etc.) <br />10. Where 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 />11. ff"no discharge" occurs during monitoring period, toter "No Discharge" across form in place of data entry. <br />l2. Enter "NameiTitle ojPrincipal Executive O~cer" with "S'ignature ojPrincipn! Executive Officer ojAuthorized <br />Agent," "Telephone Number," and "Date" at boi tom of form. <br />13. Mail signed Report to Office(s) by date(s) specie ied in pernrit. Retain copy for your records. <br />l4. More detailed instructions for use of this Discharge Monitoring Report (D.tIR) form may be obtained from O6ice(s) <br />specified in permit. <br />Legal Notice <br />This report is required by law (33 U.S.C. 1318; 40 ('. F. R. 125.27). Failure to report or failure to report truthfully can <br />result in civil penalties not to exceed x10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day <br />of violation, or by imprisonment for not more than one year, or by both. <br />EPA Fotvt 3320-1 (Rev. 09-95) <br />l <br />