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Paperwork Reduction Act Notice
<br />Public reporting buuden 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 18 hoots per response, including time for
<br />reviewing instructions, searching existing data sources, 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 info_mation already
<br />preprinted.
<br />2. Enter "Permittee Name/Mai/ing Address (and facility name location, if different)," "Permit Number;' and "Discharge
<br />NurnFer" where indicated. (A sepazate 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. En±er "Smnpla h; ~asurrr:ra±t"data for each parameter under "~unrtit)r"and walih~":v, specifiea in permit. 'fluor-r„a" is
<br />~crna'ly arithrr e^c z~, c age (geomeU-ic average for bac?erial psrzme:c.;=) c'a'! sample measu-emcnts for each pare;r,c*.rr
<br />obtained during ";~;,;;i~•,ring 1'~•riod'; ";/,,z:iurwn" 2nd i,-lini„rmr" arc nc-matly ...ctr~lnc high and lo~~ measurements
<br />obtained during ';Y~uit,:ia,y Peria". ('date to mu~'eipsls v.ith =_eeondary irea'ar:c~~[ couiremc~t: I:,ntec 30-day a~~rzgc
<br />of sample mescreme^ts under "Avzra6a,"and enter mz~imum 7-dey ^ac~.ge of son;-,le meas•W cmen:5 o6tainea during
<br />monitoring period under "Masimtrr,r.")
<br />5. : n~cr "P,:,rrit Rr_, ~i;wntr!"far each parameter u1d_r "Qua,vi.} "W._ "Qulri~j" as .~ccificd in pera;t.
<br />7. U~'cr "N; ~~" enter numUcr of sample maasur nr~ daring ~raci;o~ing -prior ' •~(~ :r=d mro:imun !and/or n^n'nn-~
<br />er 7-dzy avc ~ gc as z~propriate) permit requirement for each parameter. .f none, c~~,tcr "0".
<br />^. Fn'^• "FrZt,;•;a,; rfAn~lysis" Loth as "S_•r,;,.r ~ '.f•~ru ~,,,znr" (actual f-;.qu_: cy n'sa:npl~n~ and analysis used du=ng
<br />T1P0~'7'OTng pcrod) and as "Fe: ,-,;ir Re.~un•r,rr.nt" specified in pc..n'?. (e.g. ~:nter ".. ,.ir, " icr continue ~s .~enitorir~, "I/7"
<br />fo, one day per v: ce!c, "1/30" for one day per month, "//90"for oec day per quarter, etc.)
<br />9. I;n,er "S:r,:pl~ Ty~z"both as "Slurp/e ,L'aasr• ~t„s-,rr" (zclual sam le Type used dn-[,,,g -onitor.ng ncrio~) and as "ra,;n i!
<br />R:quiraae,rt," (e.g. ~,nter "Graf-" for individual simple, "Z4!(C" for Z4-..cur composite, "Ar/A" fo, continuous
<br />monitoring, etc.)
<br />10. S`/hern violations of permit requirement, are reported, attach a brief explanation to describe case and corrective actions
<br />to b~ taken, and reference each violation by date.
<br />' 1. I; "no discharge" occurs during monitoring pcried, enter "1`'o Dischazge" across forn n dace of data entry.
<br />12. Enter "Name/TNIa of Principe! Exz,artiv~ G-(/i.-er" with "Si~-,rahna of Prin_ir1! E.rranivs O~~zr of Authorized
<br />Agent, ""Telephone Nwnber,"and 'Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy far your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DMIi) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is requved 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 no[ to exceed $ f 0,000 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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