Paperwork ]Reduction Act Notice
<br />Public 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 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 existing data sources, gathering and maintaining [he 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 burdea, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; end to the
<br />Office of Information and Regu]atory Affairs, Office of 1,lanagement and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permiuee h'ame.!4failing Address (and facility nameJlocation, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate farm is required for each discharge.)
<br />3. Enter dates beginning and ending 'Afoniroring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring rcquiremenu of permit.
<br />5. Enter "Sample Ale°asuremenl' data for each parameter under "(Jvanrity" and "Quality" in units specified in permit.
<br />",4 verage" is normally arithmetic average (geometric overage for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".tronirnriag Period", "-t/azimum" and ",lhnimun+" are normally eettcme high
<br />and low measurements obtained during ".Vunirormg Period." (Note to municipals with sewndary treatment
<br />requirement: Enter 30~a} average of sample mcasuremcr.ts under "Average,' and enter maximum 7-da+- average
<br />of sample measurements obtained during monitoring period under ",tfazimvrn.'q -
<br />6. Enter "Penmr Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ",tin F_r" enter number of sample measumments during monitoring period that exceed maximum (and/or
<br />minimum or 7-da}• average as appropriate) pcn~it requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ajAnalysis" both as :S'n»!v!e rLleosurrnenr" (aqua] frequency of sampling and analysis used
<br />doting monitoring period) and as "Permit Renun•enrenP' specified in permit (e.g., Enter "Conn" for continuous
<br />monitoring, "I/T' For one day per week, "I/30" for one day per month, "l/90" for one day per quarter, etc.)
<br />9. Enter "Snrnple Tvpe" both as "Sample ,Lfeasvremenr" (actual sample type used during monitoring period) and as
<br />"Permit Rerprrremen(," (e.g., Enter "Grab" for individual sample, "LJIIC"' for 24-hom composite, ".V/A" for
<br />continuous monitoring, etc.)
<br />l0. Where violations oC pernut requirements are reported, attach a brie[ explanation to describe cause and corective
<br />actions taken, and reference each ~~olation by date.
<br />I1. If "no discharge" occurs during monitoring perod, enter ".Nn Discharge" across form in place of data entry.
<br />12. Enter "Name/Tille ojPrincipal Executive OJfcer" urih "Signa(ure ojPrincipn7 Executive Officer oJAuthvrized
<br />Agent," 'T'elephone Arumber," and "Dare" at bottom of form.
<br />13. Mail signed Report to Office(s) by dale(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoni(oring Report (DMR) 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. I25.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed $10,000 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 Form 3320-1 (Rev. OS-95)
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