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Paperwork Reduction Act Notice
<br />NIn•.Ir reMir ing hu.,lrr. %nr chc cui'o.: ;::n o' in %u: mni: ~a :.. ote:u8t..i io t.-.:~`:..:::._. - - .. -
<br />I:: o_ ~ i..:urn u dr
<br />evera~+e ner remnnse far some minor facilities, to 110 hours as an average per response for some rnafor facilities,
<br />with a wciehtrd average for major and wont facrhties of i8 hours per response, including time rot reviewrog
<br />instnrerinns, searching existinn data sounes, gathering and maintaining the data ms~dad, and completing and
<br />' rrvipwing the enlleatinn of information. Send comments regarding the burden estimate or any oche aspect of
<br />[his collection of information, including svggeshons for rrducinn this burden, [o Chief, Information Policy
<br />Branch, Ph9-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC %0460; and to the
<br />Oftce of Informatton and Regulatory Affairs, Office of Management and Budget, Washingwo, DC 2003.
<br />General Instructions
<br />1. If fo.~ has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already prcprinlcd.
<br />~ Fitter 'Permiuee Nurne.Afailing Address (and facility namcJlocaUOn, if di$erenl)," "Permit .rs'umher." and
<br />"Discharge A'urnher" ~chere mdreated. (A separate form is required for each discharge.)
<br />3 F.ntcr d,u. hcgimm~g and end+ng ",t hrrr:~rur,~ Permd" cot cred by fornr where indicated.
<br />4. F.mer each "Parameter' m specified ur moni~onng regwremcnts of permit.
<br />5. Enter ".1Lnrplr,t/casvrrmcnr" ddW for each paramner under "Quonn.v" and "~hmlrn" in units ~pecirled m perrtti[.
<br />",4 veroge" is nornrall} arithmetic a~cragc (gcometnc average far bactcnal paramclers) of all saruple measurements
<br />(or cacir pararucler obtained doing ".llunitrrror,q 1'crr~~"', "11wun:urr" and ",llrnimun;" arc norntall} e~7reme Iugh
<br />and toe measurements obtained during ".Unnrturrn,Q Penud" (Note to municipals otlh secondary treatment
<br />reywrcnrcnt Enter ~!)-d.rV .n C: Jbc ui Sdrn yic rir~J:,;. r_iire ilt5 JfIdL- ".fr'.:".:t .'," :Iti r"'°' :n;: ;:mom 7-0av a_vrra nl_•
<br />of sample mettsuremcnls obnnincd dwing monitonng period under ".tlaa~unum "1 J
<br />6. Enter "Pt•rnu! Rrq:urrmen!" for r~~ch parameter render "l7uamrh" and "(Juohly" as spec~r~e~ m petnnt.
<br />7. Undo ^,~:,r" ::1..: „umbel Of ::.T.pil' me urn ~t~ during n,nnitnrin~ ncnnd ,L. ~ exceed maximum (and/o-
<br />mtmmum or !-u:n^avuragc :u appu:priatrj pcraiii i~y~d:un~ni f~, n;ct, rar..a;t:cr ;:'none, c,..... "^"
<br />tl. Enter "Freyrrcvrcy u/`frrrurne:.r" both y np7, ..,.....r,.,, is ,..,. ..cy;.. :~,~~ ~~;, -;',- ,..,cd
<br />dunng momtonng period) and as "Fenno kequrrrnrenr" spccifmd~m puwii'~ (eg',~Enter "t'ont,'' rr. continuous
<br />uwnuoi; o "1 7" .v: o;u d..; p.:., _;};. ' ~ ? ~" fc: _.. , r..... .. "r ''r `r" ~. „ac doe ner .:.. ~ . cis 1
<br />9. Enter "s~arn !r %t•nr" both '[5 '.Worn o' lleacureuu'nr innuar s.rm is nv~ used uauu ~ ,::u,:,,..:... - ~ .'• ._' °'
<br />P r P p .. A b N'~..,..., ..~....,.:
<br />"Pernur Regvirenr,•n!," (c g, Enter "(irnh` far indnidual sanrplc, "?JI(("' for 2d-hour composite. ".\'.I" for
<br />conlrnuoru mumlmmg, clc.)
<br />10. 1L'here vioiaUOns of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dale.
<br />I I. )f "no discharge" occurs during monitoring period, enter ",No Drscharge" across fon» in place of data entry.
<br />12. Enter "Name/1'itle ojPrinctpal Executive Officer" with "Signature ojPrinc!pnl Executive Officer njAuthorized
<br />Agent," 'Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to OfTce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afonitoring Report (DMR) form may be obtained from Ol'fce(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 report or failure to report truthfully can
<br />result in civil penalties not [o exceed 510,(X10 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 />
<br />EPA Form 3320-1 (Rev. 08-95) ,. y
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