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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 m average per response for some major fag~t~sr with a weighted avenge for major and minor facjlities~of 78'hours per response, including time fdr~og instructions, searching existing data sources, ga~jering and maintaining the data needed, and comp and reviewing the collection of information. Send comments regarding the burden estimate or any othE'r°aspect of this collection of information, including suggestions for reducing this burdep, to Chief, Information Policy Branch, PM-223, U.S. Environmental P[otection Agency, 40l M Street,SW 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 information already preprinted. _. _ , 2. Enter 'Permittee Nan+e/Mailing Address (and Cacility name location, if different)," "Permit Number," and "Discharge.A'umber" where indicated. (A separate Corm is required for each discharge.) 3. Enter dates beginning and ending 'Monitoring Period" covered by form where indicated. 4. Enter each "Pnrarneter" az specified in monitoring requirements of permit. 5. Enter "S'ample MeasurentenP' data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Monitoring Period"; "Maximum" and "Minirnurtr" are normally extreme high and low measurements obtained during "Monitoring Period." (Note to murticipats with secondary treatment regpirement: Enter 30-day average of sample measurements under "Average," and enter maximum 7~ay average of sample measurements obtained during monitoring period under "Maximum. 6. Enter "Permit Requirement" for each pammeter under "Quantity" and "Quality" az specked in permit. 7. Under "No Ex" enter number of sample meazurments during monitoring period that exceed maximum (and/or minimum or 7-day average az appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequenty oJAnalysis" both az "Sample Measurenent" (actual frequency of sampling and analysis used .during monitoring period) and az "Pernrir Requirement" specified in permit. (e.g., Enter "Coot," for continuous monitoring, "1/7" for one day per week, "t/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Type" both az "Sample Measurement" (actual sample type used during monitoring period) and az "Permit Requirement," (e.g., Enter "Grab" for individual sample, ":4NC' 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 taken, and reference each violation by date. 1 I. if "no discharge" occurs during monitoring period, enter "No Dischorge," across form in place of data entry. 12. Enter "Name/I'itle ojPrincipal Executive Officer" with "Signnture ojPrincipal Executive O~eer ojAuthorized Agent," "Telephone Number," and "Date" at bottom oC form. 13. Mail signed Report to Office(s) by date(s) specked in permit... Retain copy (or your records. 14. More detailed instructions for use oC this Discharge tiloniroring 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 failure 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)