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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 m}ttor f>cilities, to 110 hours as an average per response for some major faoilities, with a weighted average for me~and miner facilities of 18 hours per response, including time far~i~iving instructions, searching existing data sources, gathering end maintaining the data needed, and etlmplet®g and reviewing [he collection ~ormation. Send comments regarding [he burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chief, Information Policy Hranch, PM-223, U.S. Enviromcental Protection Agency, 401 M Street, SW Washington, DC 20460; end [o 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, disregazd instructions directed at entry of that information aUeady preprinted. _ . 2. Enter "Permittee Name/llfailing Address (and facility namellocation, 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 avemge for bacterial parameters) of all sample measurements for each parameter obtained during "Monitoring Period ; "Mazimunr" and "Minimum" are normally extreme high and low measurements obtained during "tifonitoring Period." (Note to municipals with secondary veatment requirement: Enter 30-day average of sample measurements under 'Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "Mrtrimum.') 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Ex" enter number of sample measurments during ntoni[oring period that exceed maximum (and/or minimum or 7-0ay average as appropriate) permit requirement for each parameter. Tf none, enter "0". 8. Enter "Frequency ojAnalysis" both as "Sample tifeasurment" (actual frequenry of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cant," for wntinuous monitoring, "1/7" for one day per week, "1!30" for one day per month, "J./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, "14fiC' for 24-hour composite, "N/A" for continuous monitoring, etc.) 10. Where ~~olations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. ff"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Namellitle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive O)Tcer ojAuthorized Agent," "Telephone Number," and "Date" a[ bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your rewrds. 14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s) specified in permit. Legal Notice 'Ibis 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 510,000 per day of violation; or io criminal penalties not to exceed 525,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. OS-95)