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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 eo
<br />average per response 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 18 hours per response, including time for reviewing
<br />instructions, searching ezis[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, to Chief, Information Polic;r
<br />Branch, 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 />1. If form has been partially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already preprinted.
<br />2. Enter "Permittee NameMniling Address (and facility name/location, S diHerenl)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending 'Afoniroring Period" covered by Cornt where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requrremen[s of permit.
<br />5. Enter "Sample .4fensurenrrnr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average Igcomctric average far bacterial parameters) of all sample measurements
<br />for each parameter obtained during "d;onirormo Prriorf'; ",llarimum" and "A;inrnmm" arc normally extreme high
<br />and low measurements obtained during ",tfa,noring Period." (Note to municipals faith secondary treatment
<br />requtremenl: Enter 30-0ay average of sample -neasurcmcnts under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "Afaxim vm.'J
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "A'o F_r" enter number of sample mcasurments during monitorirg period that exceed maximum (and/or
<br />minimum or 7-da}• average as appropriate) pcrrtti[ rcquircment for each parameter. If none, enter "0".
<br />B. Enter "/-requency ojAnalysis" both as ".imple .tfea.eurnrent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Conn," for continuous
<br />monitoring, "1/7" for one day per week, "130" :or one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter ".S'ample Type" both as "Sample .4leasurenrent" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" Cor individual sample, "?41/C" for 24-hour composite, "PI/.~" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are sported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by d;tte.
<br />11. If "no discharge" o_cttrs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Title ojPrincipal Executive O~rer" with "Signature ojPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone .Number," and "Date" al bottom of form.
<br />13. Mail signed Report to O13ice(s) by date(s) specilied in perntit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (D,L1R) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to repoR or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 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 />EPA Form 3320-1 (Rev. 08-95)
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