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~~ _ Paperwork Reduction Act Notice
<br />?lilq,,, ICINII )III' i'Vll'.,:: LLi! lll~'_.v.i~_tl!4: ~.:. u!I VI1:!Al:: ii, i] Ollll:al[;U lV \'dl\ iWW - Id,:,~.. j 1:~1
<br />_ r11 ,lI rV aG an
<br />average per response for some minor facilities, to 110 hours as en average per response for some miior facilities.
<br />with a weighted average for motor aad minor facilities of i8 hours per response, including pmz for mviewiog
<br />instructions, ssarchin,~ existing data sources, galherinx and maintaining the data needed, and wmnleting and
<br />reviewing the collation of infotmnlioo. Send comments rogard ing [he burdtn estimate or any other asneaa of
<br />this collection of mforma[im, includme suavestinns for reducinn this hurdrn, to f'hirf, InfurmaLCn Pe!icy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to [hz
<br />Office of Infurmaliun anJ Regulatury Affairs, Office of Managzmenl and Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form hoc peen partially completed by preprinting, disregard instructions directed at entry of rht inform=bon
<br />already preprinted.
<br />2. Enter 'Permi((ee ,4'ame::tfailinR .4ddress (and facility namC/location, if diffcrcnQ," "Perini! Number'." and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and ending ".4fonitorrng Pcnod" covered by form where indicated.
<br />4. Enter each "Pnramercr" as specdicd in monnonng regwrcments of permit.
<br />5. C-ntcr "1'an~/r/v SR•ncurrmrnr" data for each parameter under "~hrnnrirr" and "Qunlih'" in units specified in permit.
<br />".I verng,.~" is normalh arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for carte paia:ric(cr obtained during ".1;unrmruig /'.riorf', ".t/arunl,m" and ",lhninwn," arc normally cxircme high
<br />and low measurements obtained during "1lonnwvi,~ Prriud" (Note to municipals wuh secondary treatment
<br />•liii CiiiCm fin(Ci ~'?:-dv. -~ -` Gf .i.: iii u,,..:SUri illu:ii' ndi '.?iv 8iid Cii'ti :lla\iiiiiiiir
<br />'i3 ittt alga,' Ida}' a~u-ig::
<br />o(samplc mcasurcmcnts oblaincd~duiing monitoring pcnod under ".Lfarimum. ")
<br />6. En(cr "Prrnur Requrement" for c~ch parameter under "OunnGrv' and "(lualirv" as spcaficd In ncrtnil.
<br />7 I,J order "\'o I'.r" Cnb_r nl!mbcr Of c•\q~ple np_w iy rn p_nl. dnriRg nlnn_Ipn ono pe[!Od Ihat ....rr:_r: •. axlmUm (and/nr
<br />.L•JI,LUIiI V. '- d~ al u.i~~.u applGp .u~l N"u ,~yl. ~uua.w rv, ~.a~i Ne au~.,~~ ,v: .... .. .
<br />.,. ~r,t ,,rya of .. a; :;~~ both :..,;;;p,. ..~_ ., .rrn~ (::^,.... :.,:;iu ~~ :;p:::;g :a;:::j$ us°.~
<br />V during monitoring period),and as "Perron Requu•rnirnl" specified m^pcnnil.~l(c.g~,,Enler "font,"for ebniinuous
<br />n`e.^.no:~n './ 7" for , ..~ :'., n... l+: q; , r ;r;.. n.. u,. ,~ n_" .„o„?il :n^ i:...,!r_ nw per qua.n.' , c+~.
<br />L• Y.' 1' '
<br />Y. Eiller "Jn/nplP /lpe~ bulk iLS .lnnrplP J/evteu'r/uuu 13C111a1 Sanlpic np~ ~neu Unnllg mOtlllOn Pg pu rt~ai) rilti ,i.
<br />"Perms Requirement," (c. g., Enter "(7rab" for individual santplc. "'JfIC" fur 2d-hour composite, "1'A" ful
<br />cwdiuuuus uwuiwliug, ac.)
<br />10. Where violations of permit requirements arc reposed, attach a brief explanation to describe cause and corrzclhe
<br />actions taken, and reference each violation by dale.
<br />11. If "no discharge" occurs during monitoring period, enter ".4`o Discharge" across form in place o(da[a entry.
<br />12. Enter "Name/I'ide of Principal Ezecutrve Officer" with "Signature of Principal F.xecu(ive Officer ojAu(hori:ed
<br />Agent," "Telephone ,4'urnber," and "Date" al bottom of fonll.
<br />13. Mail signed Report to Office(s) by dale(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (DMR) form may be obtained from Office(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 oot 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 I,y both.
<br />
<br />EPA Form 3320-1 (Rev. OS-95)
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