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<br />Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as an
<br />average per response for soma minor facilities, l0 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of IS hours per response, including time for feviewing
<br />ins[nrctions, searching exasting data sources, gathering and maintaining the data needed, and completing and
<br />re~~iewing the collection of information. Send comments regarding the burden estimata or any other aspect of
<br />this collection of information, including suggestions for redu.ing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Prot:,ction Agency, 401 DQ 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 Instr~ictions
<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 Name/lllai/ing Address (and facility namellocation, S different)," "Permit Number," and
<br />"Discharge .~'umher" where indicated. (A separate farm is required for each discharge.)
<br />3. Enter dates beginning and ending ",lloniroring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as spccified in monitoring requirements oCpcrmit.
<br />5. Enter "Sample .Llrasuremenr" data for each parameter under "Quanur}" and "Quality" in units specified in permit.
<br />"Average" is normally aritlanetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during "alonitoring Perod'; ".t!aximum" and ".Vini,num" are normally extreme high
<br />and low measurements obtained during ",tonitoring Pervud" (Note to municipals tsilh secondary treatment
<br />requirement. Enter 70-da} average of sample measurements under "Average." and enter maximum 7-da} average
<br />of sample measurements obtained during monitoring period under ".tlaxiurune.')
<br />G. Ester "Permit Requrremenl" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "No Fx" enter number of sample measurments durirg monitoring period that exceed maximum (and/or
<br />minimum or 7-da}' average as appropriate) permit requirement for each parameter If none, enter "0".
<br />8. Enter "Frequencv ojAna!}'sis" both as "Sample ~L1eacurment" (actual frequency of sampling and anal}~sis used
<br />during monitoring period) and as 'Fermi! Requirement" spccified in permit. (e.g., Enter "Coot," fbr continuous
<br />monitoring, "I/7" for one day per week, "I/30" for one da} per month, "1/90" for one day per quarter, etc.)
<br />9. i=nter ".Sample Tvpe" both as "Sample ,tleasurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "2JKC"' far 2d-hour composite, ",N/A" for
<br />continuous monitoring, etc.)
<br />10. '~Vltere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each x~olation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrincipal Executive Officer" w~lh "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Of13ce(s) by date(s) specified in permit. 2etain copy for your records.
<br />l4. More detailed instructions for use of this Discharge Monitoring Report (D~L1R) form may be obtained from O(1"iice(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 to exceed f 1q,000 per day of violation; or in criminal penalties not to exceed x25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
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<br />EPA Form 7720-1 (Rev. 08-95) ~~
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