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<br />Public reporting burden for this collecti~m of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor far lities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instrunior!>, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />rev~evirg the colleciion of information. Sand comments regarding tha burden estimate or any other lspect of
<br />t;tis collection of infarmation, includin; suggestions for reducing Cius burden, to Chief, information °oGcy
<br />Brancb, Pivi-223, JS. Environmental Protection Agency, 401 :vi Street, SW, Washington, DC 2'1:60; and io the
<br />Oiiice of tn~ornat,on and Regulatory Affairs, OCficc oF;'ian:.3cment and Budget, Fashington, IJC Z^503.
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<br />1. 7f iorG? has L-een partially comprered ~y preprinting, disregard instructions directed at entry of tha: information
<br />already preprinted.
<br />2. 'Fore. "Pe,.riree Nano/r;deili,+.g Ad,imss (and facility nsmeAecarion, ii difCarent)," "Permit ,Number;' and
<br />"Disehar-ge ldw:aber" wier~ indicated. (A separate form 's uyuir. d for eadi iischarge.)
<br />3. E~rter dais; beginning and ending "irlonitorinf; Period' co~:ered by form w: ere indicr.ied.
<br />~:. _nter each "?ara„zeter" as specified i r monitoring requirements of permit.
<br />5. rote!"Snc.;~le..Ieasu2rneret"data foi each parameter under"Qunndry"and"Quatir,"in mrits spcciLed in p.rra'[.
<br />"Average" is normally arithmetic average (geometric avert ;~.fnr bar*erial parameters) of all sample measute-
<br />merts far each parameter obt ivied during "rVtanitorir.g Pe^ion' ; "ivlaximurn" and "lv7inir,-,urr," are normally es-
<br />trzme high and law measurements obtained during "rrtoniGxiag Pen.'od." (;Dote to municipals ttith sa ~ ~dar,~
<br />-°s:m~nt ,pnu~re-went: Enter 30-day average of sample measurements under "Average," and enter maximum
<br />7-day average of sample measurements obtained during monitoring period under "rYlaximum:')
<br />6. Enter "Permit Requirement" far each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. LSrder "No Ez" enter number of sample measurements during ronitoring period that exceed maximum (andior
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0."
<br />8. Enter "Frequency of Analysis" both :s "Sample ivteasurement" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Ptmtit Requirement" specified in permit. (e.g., Enter "Copt;' far continuous
<br />monitoring, "1/T' for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample Nfeasurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement;' (e.g., Enter "Crab" for individual sample, "24HC" for 24-hour composite, "N/A" for con-
<br />tinuous monitoring, etc.)
<br />10. Where violations of permit requirem :nts are reported, attach a brief explanation to describe cause and corrective
<br />actions talten, and reference eachviclation by date.
<br />11. If "no discharge" occurs during moo toeing period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Title of Principal Fxerutive Officer' with "signature of Principal Executive Officer of Authorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by d rte(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Of-
<br />fice(s) specified in permit.
<br />_.J d v..il1A.6.
<br />This report is required by law (33 U.S.C. 1:518; 40 twF.R. 125.27), Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for not mere than one year, or by both.
<br />.w
<br />EPA :~ rm 3320-I (Rev. 3/99)
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