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Paperwork Deduction 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
<br />facilities, with a weighted average for major and minor facilities of I8 hours per response, including time for
<br />reviewing instructions, searching existing data sotuces, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />general Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Pernlittee Noma/~Lloiling Address (and facility name/location, if different)," "Permit Number," earl "Discharge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. L-nter "Sample ivl~asurznent"data for each parameter under "Quantity" and Qtraliry"as specified i^ pernc[. 'Arerloe" is
<br />normally arithmetic average (gcomet~c average for bacterial paramc[ers) of all sar^ple measuremen`s for each prrar.eicr
<br />obtained during "ivlon;toriag Per%.~'; ";/.~xi;aaa;" and .L>inimurl" aro normally c~trcmc lrigtt and low mcasuremco~s
<br />obtained during ";vJoauc;~ng P.rr--(". ?;ore to mvni:ipzls ~~:it1i second£ry tTE31~ :gt ~enuircmCni: rntY,r 30-day a4f.'J~L'
<br />of sam ~Ie me: surcn:ents under ".+v~,.~b ~," and enter maximum 7-day average of sample mcu.uremenu obtained du inG
<br />monitoring period under "idasimum.")
<br />6. L-n:cr "P,..~.tit Reyt,irs,aNnt"for each pr:reme[cr ~md,•r "'ih~e;tlir,"and "Qu_~Iiry" e; s =cci(ied in perm;:.
<br />7. Under "No Ex" enter number of sample r.~_csircmc~f during monitoring pcried Ibe-t ~::ce~d m:~ci:~um (:mcaur ,nin'mu ~
<br />or 7-day average as appropriate) permit rcyuirere,u ~o: each pa,~meter. li gone, enter "0".
<br />8. Enter "h;~;u_n~ offLulys%s" bout as "S_•,,;; le ;:-;.: ~s~rra,;lea;" (actual ."rc ucrcy c "scropling and analysis used duri~~g
<br />moniturns pcnod) and as "P~n;lit R.r~ui; ~-,u.,;;"cpe:ified in pcnni[. (e.g..°nt~r "~~:n', ' _er curdinuous ~aonitoring, "l; 7"
<br />fur one day per wee'-Y "1/30" for ane day pc: mond:, "1/90" for one day pe; quarter, etc.)
<br />4. "nier 'Sa,nple TyFa"bath as "S~„tFl~ iv; sn,-e„t.rt" (actin] sample type used :wring cunitoring period) and as " ..,;,Iit
<br />R.yui;~nttr," (ag. Enter "Groh" for Lldividuai sampl., '74h'~" fu. 24-hour canposiie, "iJ/A" far continuous
<br />monitoring, etc.)
<br />10. C'hcrc violations of p::rmit requirements arc reported, ^'ach a br'ef explanation to desnibe raise and cor-,:,ctivc ac;`o:~s
<br />to be ta',ceu, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "\o Discharge" across io1IIl in place of data cotry.
<br />12. Eater "Na;ne/Title of Principal Fx~cutive O~_ei~" with "Sigrr_~tura of Pri,tcip~! Exeartiv: Officer of Ate1b-,r~scl
<br />Aaant, ""Telephone Number, "and "Dote" at bottom of form.
<br />13. iNail signed Repart to Office(s) by date(s) specified in permit. Retain copy for your ruords.
<br />14. Ivlore detailed instructions for use of this Drschargz Monitoring Rpon (DMRJ form may be obtained fmm Office(s)
<br />specified in permit.
<br />Legal Notice
<br />TLis 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 result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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