2021 Multi-Sector General Permit (MSGP) - Appendix M

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2021 MSGP

Appendix M – Discharge Monitoring Report (DMR) Form

Appendix M - Discharge Monitoring Report (DMR) Form
Part 7.2 requires you to use the electronic DMR system to prepare and submit your Discharge
Monitoring Report (DMR) form. However, if you are given approval by the EPA Regional Office to use
a paper DMR form, and you elect to use it, you must complete and submit the following form.

NPDES Form 6100-29

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2021 MSGP

Appendix M – Discharge Monitoring Report (DMR) Form

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460
MSGP INDUSTRIAL DISCHARGE MONITORING REPORT (DMR) FORM

NPDES
FORM
6100-29

OMB No. 2040-0004
Exp. Date: 7/31/2026

A. Approval to Use Paper NOI Form
1. Have you been granted a waiver from electronic reporting from the EPA Regional Office*?

 YES  NO

If yes, check which waiver you have been granted, the name of the EPA Regional Office staff person who granted the waiver, and the date of approval:
Waiver granted:



The owner/operator’s headquarters is physically located in a geographic area (i.e., ZIP code or census tract) that is identified as
under-served for broadband Internet access in the most recent report from the Federal Communications Commission.



The owner/operator has issues regarding available computer access or computer capability

Name of EPA staff person that granted the waiver:
Date approval obtained:

/

/

* Note: Note: You are required to obtain approval from the applicable EPA Regional Office prior to using this paper DMR form. If you have not obtained a
waiver, you must file this form electronically using the NetDMR at http://www.epa.gov/netdmr/

B. Permit Information
1. NPDES ID:
2. Reason(s) for Submission (Check all that apply):






Submitting monitoring data (Fill in all Sections).
Reporting no discharge for all discharge points for this monitoring period (Fill in Sections A, B, C, D, E.1, and G).
Reporting that your site status has changed to inactive and unstaffed and there are no industrial materials or activities exposed to stormwater (Fill
in Sections A, B, C, D, and F.4 (include date of status change in comment field).
Reporting that your site status has changed to active and/or there are industrial materials or activities exposed to stormwater (Fill in all Sections
and include date of status change in comment field in Section F.4).

C. Facility Operator Information
1. Operator Information:
Operator Name:
Mailing Address:
Street:
City:
Phone:

State:
-

-

ZIP Code:

-

Ext.

E-mail:
2. DMR Preparer (Complete if DMR was prepared by someone other than the certifier):
First Name, Middle Initial, Last Name
Organization:
Phone:

-

-

Ext.

E-mail:

NPDES Form 6100-29

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2021 MSGP

Appendix M – Discharge Monitoring Report (DMR) Form

D. Facility Information
1. Facility Name:
2, Facility Address:
Street/Location:
City:

State:

ZIP Code:

-

County or Similar Government Subdivision:

E. Discharge Information
1. Identify monitoring period:



Check here if proposing alternative monitoring periods due to irregular stormwater runoff. Identify alternative
monitoring schedule and indicate for which alternative monitoring period you are reporting monitoring data:

 Quarter 1 (January 1 – March 31)



Quarter 1:

 Quarter 2 (April 1 – June 30)



 Quarter 3 (July 1 – September 30)

From

/

To

/

Quarter 2:

From

/

To

/



Quarter 3:

From

/

To

/

 Quarter 4 (October 1 – December 31) 

Quarter 4:

From

/

To

/

2. Are you required to monitor for cadmium, chromium, lead, nickel, silver, or zinc in freshwater?
3. What is the hardness level of the receiving water?

(mg/L)

4. Does your facility discharge into any saltwater receiving waters?

YES

NPDES Form 6100-29

 YES (Skip to 3)

 NO (Skip to 4)

NO

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2021 MSGP

Appendix M – Discharge Monitoring Report (DMR) Form
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY WASHINGTON, DC 20460
MSGP INDUSTRIAL DISCHARGE MONITORING REPORT (DMR) FORM
Note: Make additional copies of this form as necessary.

F. Monitoring Information
1. Nature of Discharge:

 Rainfall (Complete line items 2.a., 2.b., & 2.c.)

2.a. Duration of the rainfall event (hours):
3.a.
Discharge
Point ID
(list the same
3digit
discharge
points
identified on
the NOI form

OMB No. 2040-0004

3.b.
Check if Any
Discharge
Points are
Substantially
Identical
to Other
Discharge
Points Listed

3.c.
Check if
No
Discharge

 Snowmelt

2.b. Rainfall amount (inches):
3.d.
3.e.
Monitoring
Parameter
Type IM, BM,
ELG, S/T, I,
O*

3.f.
Quantity or
Concentration

2.c. Time since previous measurable storm event (days):

.
3.g.
Units

3.h.
Results
Description

3.i.
Collection
Date

3.j.
Exceedance
solely
attributable to
natural
background
pollutant
levels per Part
5.2.6.1

3.k.
Exceedance
due to run-on
per Part 5.2.6.2

3.l Exceedance
due to an
abnormal
event per
5.2.6.3

3.m
Exceedance
but discharge
does not result
in any
exceedance
of water
quality
standards per
Part 5.2.6.5

3.n
Aluminum
Exceedance
demonstrated
to not result in
an
exceedance of
your facilityspecific criteria
per Part
5.2.6.4.a

3.o
Copper
Exceedance
demonstrated
to not result in
an
exceedance of
your facilityspecific criteria
per Part
5.2.6.4.b









































 Substantially
identical to
discharge
point:

Substantially
 identical
to
discharge
point:

Substantially
identical to
discharge
point:

Substantially
identical to

discharge
point:
* IM - Indicator monitoring; BM - Benchmark monitoring; (ELG) - Annual effluent limitations guidelines monitoring; (S/T) - State- or tribal-specific monitoring; (I) - Impaired waters monitoring;
(O) - Other monitoring as required by EPA

4. Comment and/or Explanation of Any Violations (Reference all attachments here)

NPDES Form 6100-29

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2021 MSGP

Appendix M – Discharge Monitoring Report (DMR) Form

G. Certification
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing
violations.
First Name, Middle, Last Name
Title:
Signature:

Date:

/

/

E-mail:

NPDES Form 6100-29

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2021 MSGP

Appendix M – Discharge Monitoring Report (DMR) Form

Instructions for Completing EPA Form 6100-29
Discharge Monitoring Report (DMR) for Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit
OMB No. 2040-0004
Who Must Submit A Discharge Monitoring Report to EPA?
Facilities covered under EPA’s NPDES Stormwater Multi-Sector
General Permit (MSGP or permit) that are required to monitor
pursuant to Parts 4.2 and 8 of the permit must submit Discharge
Monitoring Reports (DMRs) consistent with the reporting
requirements specified in Part 7.1 of the permit.
Completing the Form
Obtain and read a copy of the 2021 MSGP, viewable at
https://www.epa.gov/npdes/stormwater-discharges-industrialactivities To complete this form, type or print, using uppercase
letters, in the appropriate areas only. Please place each character
between the marks. Abbreviate if necessary to stay within the
number of characters allowed for each item. Use only one space
for breaks between words, but not for punctuation marks unless
they are needed to clarify your response. Please submit original
document with signature in ink - do not send a photocopied
signature. Photocopy your DMR form for your records before you
send the completed original form to the appropriate address.
Section A. Approval to Use Paper DMR Form
You must indicate whether you have been granted a waiver from
electronic reporting from the EPA Regional Office. Note that you
are not authorized to use this paper DMR form unless the EPA
Regional Office has approved its use. Where you have obtained
approval to use this form, indicate the waiver that you have been
granted, the name of the EPA staff person who granted the waiver,
and the date that approval was provided. See
https://www.epa.gov/npdes/contact-us-stormwater for a list of
EPA Regional Office contacts.
Section B. Permit Information
Provide the NPDES ID (i.e., NOI tracking number) assigned to the
facility for which this DMR is being submitted.
Indicate your reason(s) for submitting this DMR by checking all
boxes that apply. The reasons for submission are defined as follows:
• Submitting monitoring data: For each storm sampled, submit
one DMR form with data for all discharge points sampled.
Select this reason even if you only have monitoring data for
some of your discharge points (i.e., some discharge points did
not discharge). If you select this reason you are required to
complete all Sections of the form.
• Reporting no discharge for all discharge points for this
monitoring period: Indicates that there were no discharges
from all discharge points during this monitoring period. If you
select this reason you are only required to complete Sections
A, B, C, D, E.1, and G.

•

Reporting that your site status has changed from inactive to
active and/or there are industrial materials or activities exposed
to stormwater: Indicates that your facility is currently active (See
Part 4.2.1.3 of the permit for more information). If you select this
reason you are required to complete all Sections of the form and
include date of status change in the comment field in Section F.4.
Section C. Facility Operator Information.
Provide the legal name of the person, firm, public organization, or
any other entity that operates the facility for which this DMR is being
submitted. An operator of a facility is the legal entity that controls
the operation of the facility. Refer to Appendix A of the permit for
the definition of “operator”. Provide the operator’s mailing address,
phone number, and e-mail. The operator information in this Section
should match the operator information provided on your NOI form.
Provide the name, organization, phone number, an e-mail address
for the person who prepared this DMR form.
Section D. Facility Information
Enter the official or legal name and complete street address,
including city, state, ZIP code, and county or similar government
subdivision of the facility. If the facility lacks a street address,
indicate the general location of the facility (e.g., Intersection of
State Highways 61 and 34). Complete facility information must be
provided for permit coverage to be granted. The facility
information in this Section should match the facility information
provided on your NOI form.
Section E. Discharge Information.
Indicate the appropriate monitoring period (Quarter 1, 2, 3, or 4)
covered by the DMR. “Alternative” monitoring periods can apply
to facilities located in arid and semi-arid climates, or in areas subject
to snow or prolonged freezing. To use alternative monitoring
periods, you must provide a revised monitoring schedule here. If
using alternative monitoring periods, identify the first day of the
monitoring period through the last day of the monitoring period for
each of the four periods. The dates should be displayed as month
(Mo) / day (Day). See Parts 4.1.6 and 4.1.7 of the permit for more
information.
If you are submitting benchmark monitoring data, identify if your
facility is required to collect benchmark samples for one or more
hardness-dependent metals (i.e., cadmium, lead, nickel, silver,
and zinc). If you select “yes” to this question provide the hardness
level of the receiving water (in mg/L)). If you select “no” to this
question, you must identify if your facility discharges into any
saltwater receiving waters.

• Reporting that your site status has changed to inactive and
unstaffed and there are no industrial materials or activities
exposed to stormwater: Indicates that your facility is currently
inactive and unstaffed and there are no industrial materials or
activities exposed to stormwater (See Part 4.2.1.3 of the permit
for more information). If you select this reason you are only
required to complete Sections A, B, C, D, and F.4 (include date
of status change in comment field).

NPDES Form 6100-29

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2021 MSGP

Appendix M – Discharge Monitoring Report (DMR) Form
Instructions for Completing EPA Form 6100-29
Discharge Monitoring Report (DMR) for Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit
OMB No. 2040-0004

Section F. Monitoring Information
For the reported monitoring event indicate whether the discharge
was from a rainfall or snowmelt event. If you select “rainfall” then
indicate the duration (in hours) of the rainfall event, rainfall total (in
inches) for that rainfall event, and time (in days) since the previous
measurable storm event in line items 2.a-c. For both rainfall and
snowmelt monitoring, you must identify the date of collection for
the monitoring event in column 3.i. of the table. If the discharge
occurs during a period of both rainfall and snowmelt, check both
the rainfall and snowmelt boxes and report the appropriate rainfall
information in item 2.a-c. To report multiple monitoring events in the
same reporting period, copy this form and enter each monitoring
event separately with data for all discharge points sampled.
Identify all the discharge points from your facility that discharge
stormwater. Each discharge point must be assigned a unique 3digit number (e.g., 001, 002, 003), and should match the discharge
points identified on your NOI form.
If any discharge points are substantially identical, check the box in
3.b and identify the discharge point that the discharge point in 3.a
is substantially identical to. In 3.d – k, you only need to provide
benchmark monitoring data for one of the discharge points if it is
substantially identical.
For any discharge point for which there was no discharge during
the monitoring period, check the box in 3.c.
In 3.d, identify the type of monitoring using the specified codes, in
parentheses, below:
• (IM) – Indicator monitoring
• (BM) – Benchmark monitoring
• (ELG) – Annual effluent limitations guidelines monitoring;
• (S/T) – State- or Tribal-specific monitoring;
• (I) – Impaired waters monitoring; or
• (O) – Other monitoring as required by EPA.
In 3.e, enter each “parameter” (or “pollutant”) monitored. For BM
and ELG monitoring, use the same parameter name as in Part 8 of
the permit.
In 3.f., enter a sample measurement value for each parameter
analyzed and required to be reported. Enter “ND” (i.e., not
detected) for any sample results below the method detection limit
or “BQL” (i.e., below quantitation limit) for sample results above the
detection limit but below the quantitation limit.
In 3.g., enter the units for sample measurement values (i.e., “mg/L”
for milligrams per liter) for each parameter analyzed and required
to be reported. For monitoring results reported as ND or BQL this
space will be left blank and the units will be reported in Column 3.f.
3.h. must be completed for any monitoring results reported as ND or
BQL in the “Quality or Concentration” column. For ND, report the
laboratory detection level and units in this column. For BQL, report
the laboratory quantitation limit and units in this column.
In 3.i. identify the sampling date for each parameter monitoring
result reported on this form.
3.j. Exceedance solely attributable to natural background pollutant
levels: Check box if following the first 4 quarters of benchmark
monitoring (or sooner if the exceedance is triggered by less than 4
quarters of data) you have determined that the exceedance of
the benchmark is attributable solely to the presence of that
pollutant in the natural background for that discharge point and
any substantially identical discharge points, or for impaired waters

NPDES Form 6100-29

monitoring, the presence of the pollutant is caused solely by natural
background, provided that all of the conditions in Part 5.2.6.1 are
met.
3.k Exceedance due to run-on: Check box if you can demonstrate
and obtain EPA agreement that run-on from a neighboring source
(e.g., a source external to your facility) is the cause of the
exceedance, provided that the conditions in Part 5.2.6.2 are met.
3.l. Exceedance due to an abnormal event: Check box if one single
sampling event is abnormal and you have immediately
documented per Part 5.3 that the single event was abnormal and
met all other conditions in Part 5.2.6.3.
3.m. Exceedance but discharge does not result in any exceedance
of water quality standards per Part 5.2.6.5: Check box if you can
demonstrate through an analysis that an exceedance triggering
AIM requirements does not result in any exceedance of applicable
water quality standards, provided that all the conditions in Part
5.2.6.5 are met.
3.n Aluminum exceedance demonstrated to not result in an
exceedance of your facility-specific criteria per Part 5.2.6.4.a:
Check box if you can demonstrate through an analysis that an
aluminum exceedance does not result in an exceedance of your
facility-specific criteria using the national recommended water
quality criteria in-lieu of the applicable MSGP benchmark threshold.
3.o Copper exceedance demonstrated to not result in an
exceedance of your facility-specific criteria per Part 5.2.6.4.b:
Check box if you can demonstrate through an analysis that a
copper exceedance does not result in an exceedance of your
facility-specific criteria using the national recommended water
quality criteria in-lieu of the applicable MSGP benchmark threshold.
Where violations of the permit requirements are reported, include a
brief explanation to describe the cause and corrective actions
taken, and reference each violation by date. Also, this section
should include any additional comments such as are required when
changing site status from inactive and unstaffed to active or vice
versa. Attach additional pages if you need more space.
Attach additional copies of Section F as necessary to address all
discharge points and parameters.
Section G. Certification Information
DMRs must be signed by a person described below, or by a duly
authorized representative of that person.
For a corporation: By a responsible corporate officer. For the
purpose of this Section, a responsible corporate officer means:
(i) a president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function, or any other
person who performs similar policy- or decision-making functions for
the corporation, or (ii) the manager of one or more manufacturing,
production, or operating facilities, provided, the manager is
authorized to make management decisions which govern the
operation of the regulated facility including having the explicit or
implicit
duty
of
making
major
capital
investment
and
initiating
and
directing
other
recommendations,
comprehensive measures to assure long-term environmental
compliance with environmental laws and regulations; the manager
can ensure that the necessary systems are established or actions
taken to gather complete and accurate information for permit
application requirements; and where authority to sign documents
has been assigned or delegated

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