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Paperwork Reduction Act Notice
<br />I'uhnc rrnocrl nk. hr: rdrr rnr thi; rnijrclinn rr in lium~+n un ~. r<li ma 4xi ul v"r~ f+n:n ~± r our .,: i~: nngrF as an
<br />average net response for some minor facilities, to 110 hours as am everaee oer resmonse (nr some major facilihec,
<br />with a wei¢hted average far major and minor Facilities of IB hours per response, including time for reviewine
<br />ingtnlrrjOna, SP~R'hlmg a%IShng data sources, gathering and maintaining the data nrrdrd, and completing anti
<br />reviewing the tt,llectinn nF infnrmaton. Send comments regarding [hr hu rdrn rctimate nr any nthe~ aenrrt nF
<br />this collec[irn of information, including suggestions for reducing this burden, to C.'.hief, Information Policy
<br />Brnmch, Ph1-223, U.S. Environmental Proteaaion Agency, 4Ct M Street, SW Washingtuo, DC 20460; wld to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If fern has bxo partially completed by preprinting, disregard instructions direct°.~ at ectry of that icfc.-:;aticn
<br />already preprinted.
<br />Enirr 'Perminev Nmne6Llniling Address (and facility ndme/location.. if different)," "Perini[ A'urnhrr " and
<br />"D,.echnrge ,4'mnber" ~~ here indicated. (A separate form is required for each discharge.)
<br />3. Enter dabs beginning and cuJing ".4G,nw,ring Prriud"covered by funn where wdicated.
<br />4. Enter each "Pornmrrrr" as specified in uwniWrink rcquiremenls of pcrnut
<br />5. Enter ",Cmnple ,11ea.vurenu•nr" data far each paranutcr under "Qumrhrv' aad "Quah(t" in uiuls specified in permit.
<br />".d vero,~e" is normally anthmetic avenge (gcometnc average far bacterial parameters) of all sample measurements
<br />(or each parameter cb>aulcd During ",1/nnaunrre Peru,d', "lfarimun," and ",Alinunwn" are +c,.rally extreme lug:,
<br />and low measurements obtanicd during ".ilnrvtr+rmg Proud." (Note to municipals ~latn secopdary treatment
<br />reymrcnicm Cider .i0-tld) a.'eragc of .gym, lc m:.a~ure:-:._~a, ' nder ".-iverage," and cl:.:.; _. i uum 7-d.ty arcragc
<br />of sample measurements obtained dunng montoring period under ".llaximuni.
<br />G. Enter "F'errrut Requirrmrm" for etch p~c~mner ~mder "Q^enrilj%' 2nd "Qua/,!t%' as specliiec' in pennil
<br />7. Under ',:u F,~x" cotes nui~ ~cr of ,., „~Ic mc.,,urmcna din-,g ,. .. r,g p_.:od tl:al _..___.. .3n or
<br />minimum or 7-tiro al~urctgu as appropnaic) ~cfP.ni r~~y"..~_~ ~co, ri,l exii p>',~,ac.zr. If nuns. "~.,,:...'7.'
<br />x. Enter "rrequency uj:inalysi.l" bosh as "Smnpie .iirmu,~u,c„+' (.,v.•..~J Lcyu~i:[) of sarp,r„g :. ~~--
<br />during monitoring Period) and as "P+•rnui Hrm,irivnrnl" spccifcd in pcrnii. (c.R . Enter '(-nnr,'ufur coniinuous
<br />niuniiuiiuK, "/ , 'lei ul,~ dam} yu' ,: ,.,.6. ~ !;' ~~r .,.,,... ~ p_. ,,.-... , ') ~~.. - ...~^„ t.;;. ~ ._iL .
<br />9. Enter ".Samp/c Trpc" both as ':~'aop(e 1/rr..ltrrrrn<m!•' (~rlu?J sample hp~^ occ;' annoy ulninluuu~ pru+~w ,: ~~ .-
<br />"Pcrmu Requtrernenl," (c. g., Enter "Groh" for indindual sample, ".'alit` for 2a-hour composite. "'~ : i" 'or
<br />continuous mommnng, etc.)
<br />10. Where violations of permit requirements arc reported, attach a brief explanation to desenbe cause and coreclice
<br />actions taken, and reference each violation by date.
<br />1 I. U "no discharge" occurs during monitoring penod, enter ",Vo Uischorge" across form in place of data entq.
<br />12. Enter "Name/I'i(le ojPrincipal Execut,ve Officer" with ".Signature ajPrincipn7 !•:xecu(ive Officer ojAu(horized
<br />Agent," "Telephone Number," and "Dare" al bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in perniit. Retain copy (or your records.
<br />14. More detailed inswctions for use of this Discharge Afoniroring Report (DMR) form may be obtained from Office(s)
<br />speciled 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 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 J720-1 (Rev. 08-95)
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