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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 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) <br />