Epa Form 3320-1 (Rev. 10-96) - Discharge Monitoring Report (Dmr) Page 2

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Paperwork Reduction Act Notice

Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an average per response for some minor facilities, to

110 hours as an average per response for some major facilities, with a weighted average for majoy and minor facilities of 18 hours per response, including time

for completing and reviewing the collection of information, including suggestion for reducing the burden, to Chief, Information Policy Branch, PM-223, U.S.

Environmental Protection Agency, 401 M Street, S.W. Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management

and Budget, Washington, DC 20503.

General Instructions

1. If form has been partially completed by preprinting, disregard instructions directed at entry of that entry already preprinted.

2. Enter "Permittee Name/Mailing Address (and facility name/location, if different)", "Permit Number ", and "Discharge Number " where indicated. (A separate form is required for each

discharge.)

3. Enter Dates beginning and ending "Monitoring Period " covered by form where indicated.

4. Enter each "Parameter " as specified in monitoring requirements of permit.

5. Enter "Sample Measurement " data for each parameter under "Quantity " and "Quality" in units specified in permit. "Average " is normally arithmetic average (geometric average foe bacterial

parameters) of all sample measurements for each parameter obtained during "Monitoring Period ". "Maximum " and "Minimum " are normally extreme high and low measurements obtained

during "Monitoring Period ". (Note to municipals with secondary requirement - enter 30-day average of sample measurements under "Average " and enter maximum 7-Day average of sample

measurements obtained during monitoring period under "Maximum ".

6. Enter "Permit Requirement " for each parameter under "Quality " and "Quantity" as specified in permit.

7. Under "No Ex " Enter number of sample measurements during each monitoring period that exceed maximun (and/or minimum of 7-day average as appropriate) permit requirement for each

parameter. If none, enter "0 ".

8. Enter "Frequency of Analysis " both as "Sample Measurement" (actual frequency of sampling and analysis used during monitoring period) and as "Permit Requirement " specified in permit.

(e.g., enter "Cont ." for continuous monitoring, "1/7 " for one day per week, "1/30 " for one day per month, "1/90 " for one day per quarter, etc.)

9. Enter "Sample Type " both as "Sample Measurement " (actual sample type used during monitoring period) and as "Permit Requirement " (e.g. enter "Grab " for individual sample, "24HC "

for 24-hour composite, "N/A " for continuous monitoring, etc.)

10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions to be taken, and reference each violation by date.

11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of entry data.

12. Enter "Name/Title of Principal Executive Officer " with "Signature of Principal Executive Officer of Authorized Agent ", "Telephone Number " and "Date " at the bottom of the form.

13. Mail signed report to Office(s) by date(s) specified in permit. Retain copy for your records.

14. More detailed instructions for use of theid Discharge Monitoring Report (DMR) form may be obtained from Office(s) specified in permit.

Legal Notice

This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or to report truthfully can result in civil penalties not to exceed $10,000 per day of violation or in criminal

penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.

EPA Form 3320-1 (Rev. 08/95)