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Paperwork Reduction ATotice Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as en average per response for some minor facilit~~~ 1 ]0 hours as an average per response for some major facilities, with a weighted average for major and minoi-~e{itie-s of 18 hours per response, including time for reviewing instructions, searching existin; riat:. sources, 6~9ug and maintaining Che data needed, and comple'.ing ~d reviewing the collection of information. Send coiuptants regareiag the burdeo estimate or any o[he; sped of this collection of information, including suggestionSs{or reducing this burden, to Chief, :nformafion Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 i/, Street, SW Washington, DC 20460; and to the Office of lnform:tion and Regulatory Affairs, Office of Management and Budget, Washington, DC X503. General Instructions 1. If form hss been partially completed by preprinting, disregard inswctions directed at entry of that information already preprinted. 2. Enter 'Perini(tee Name/,t~lailing Addrlss (and facility name location, if different)," "fermi( Nun+ber," and "Discharge Number" where indic8tp'~'separate form is required for each discharge.) 3. Enter dates beginning and ending "Moni(oring Period"covered by form where indicated. 4. Enter each "Pnrame(er" as specsed in monitoring requirements of permit. 5. Enter "Sample Measuren+en!" data for each parameter under "Quantity" and "QualrN" in units specked in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained doing ",Lloni(oring Period"; "hlaxin+um" and "Afinimum" arc normally extreme high and low measurements obtained during 'Sffoniroring Period." (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under "Average," and enter maximum 7-day average of sample measurements obtained during monitoing nciod under "Afaximurn.') 6. Enter "Penni(Requirc•men(' for each parameter under "Quantity" and "Quality" as specsed in permit. 7. Under "No Ec" enter numoer of sample measurments doing monitoring period [hat exceed maximum (and/or minimum or 7-day average as appropriate) permit requirerttenl for each parameter. if none, enter "0". 8. Enter "Frequency oj.9nalyss" both as "Samp/e ,tlcasvrn+ent" (actual frequenry of sampling and analysis used during monitoring period) ane as "Perini( Requireu+enr" specified in permit (e. g., enter "Conn" for rontinuous monitoing, "; n" for one a::y per week, "//30" for one day per. month, "l/90" for one day per quarter, etc.) 9. Enter "Smnp/e Type" both as "Sample Afeasurement" (actual sample type used during monitoring period) and as "Permit Requiren+enr," (e.,., Enter "Grab" for individual sample, "2~1NC"' for 24-hour rnmposile, "N/A" for continuous monitoring, etc.} 10. 1i'ltere violations cf permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. If "no discharge" occurs during monitoring period, enter "N'o Discharge" across form in place of data entry. 12. Enter "Nan+e/Title ojPrincipal Executive Dicer" with "Signature ojPrincipal Executive Dj~cer oj.9uthorized Agent," "Telephone Number," and "Date" at bottom of Form. 13. Mail signed Report ro Office(s) by date(s) specified in permit. Retain copy for your records. 14. More detailed instntctions for use of [his Discharge Aloni(oring Report (D.'tfRJ form may be obtained from Office(s) specified in permit. Legal Notice 7ttis report is reyuirul by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can resWt in civil penalties act to exceed 510,000 per day of violation; or io criminal penalties not to exceed 525,00(} per day of violation, or by irprisonment for not morn than one year, or by both. EPA Fotw 3s20-1 ('Rev. 08-95)