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Paperwork Reduction Act Notice Public reporting burden for tlvs collection ~of information is estimated to vary from a range of 10 hours as as average per response for some minor facilities, to 110 hours as ao average per response for some major facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for v~6wing instructions, searching existing data sources, gathering and seintaining the data needed, and coif-and reviewing the collection of information. Send comments regarding the burden estimate or any otfier itspect of this collection of informatics, including suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 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. [f form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permittee Name/Afailing 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 'Motiiforing Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample Afeasurement" data for each parameter under "QuanriN" and "Quality" in units specified in permit. 'Average" is normally arillmrelic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "i~foniloring Period'; "Afaximunt" and "hlinimurn" are normally extreme high and low measurements obtained during "Afonitoring Period." (Note to municipals with secondary treatment requirement: Enter 30-dal average of sample measurements under "Average," and enter maximum 7-0ay average o(sample measurements obtained during monitoring period under "Maximum. 6. Enter "Permit Requiremeni" for each pammeter under "Quantity" and "Quality" as specified in permit. 7. Under "No Ex" enter number of sample measurnents during monitor.:tg period that exceed maximum (and/or minimum or 7jlay average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojRnmvs~:r" both as "Sample Measurment" (actual frequency' of sampling and analysis used during monitoring period) and as "Fermi! Requireu~ent" specified in permit. (e. g., Enter "Cons," For rnntinuous monitoring, "//7" Cor 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 tifeasuremznt" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grob" for individual sample, "24HC"' for 24-hour composite, "N/A" for wntinuous 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. 1f "no discharge" occurs during monitoring period, enter "Tro Discharge" across form in place of data entr}•. 12. Enter "Naute~l'itle ojPrincipal Executive OjTcer" with "Signature ojPrincipn! Executive Officer ojAutharized Agent," "Telephone Number," and "Date" at boll0m of fornr. 13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. 14. More detailed insirnctions Car use of this Discharge Monitoring Report (DA4R) 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 insult in civil penalties not to exceed x10,000 per day of violation; or in criminal penalties not to exceed b25,000 per day of violation, or Ly imprisonment for not more than one year, or by both. EPA Form 5320-1 {Rev. OH-95)