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- Pa• work TKeducti'on Act '~`•..c _- - Public rrporting burden for this collection of informatio: c•stamated to :•ary i on... range of IU bows as an average per response for some minor facilities, [0 110 hr: -~ .:::. average p:r res,.•onse for soma tivjor fa~:ilities, with a weighted average for major aad~.minor facilities : " ~. L hu,.r per ~.~e ~Ixm~:e including time for re~~iewing ~i ' instructions, searching existing data sources, gathering ..u. ma~ctiining t .o ~:.:: ne4•~led, and ::omplating and rrviewing the collection of information. Send wmment:, regurding the ~c,rdre ~stim.uz or any other ~.'pect of this collection of information, including suggestions for redurng this b_udeu, to ('hief, Information Policy , Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, 5\1l \V a iingn~o. JC 20460; m ! to [he ~ Office of Information and Regulatory Affairs, Office of Management and 'i3r~.iget, 'Nash n~[oe. DC ?0503 -~ General Instructions 1. If form has been partially completed by preprinting, disregard. instructions directe:l at entry of that information already PreP~~• 2. Enter "Permi((ee NameiMailing Address (and facility name/location 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 indicatt~. 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Qualih~" in units specified in permit. "Average" is normally arithmetic average (geometric average for bacterial pa' aneters) of all sample measurements for each parameter obtained during "Monitoring Period"; SLfarimum" and "l.f~nimu;n" are normally a:~treme high and low measurements obtained during "Monitoring Permd." (Note to un,nicip:,ls with secondary lreatmem requirement: Enter 30~ay average of sample measwements under "Average," and enter maximum 7-day average of sample measurements obtained during monitoring period wider "Mazinrun+.'~ 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Q~+ali(v" as specified in permit. 7. Under "No Er" enter number of sample measurments during monitoring period t: at exceed maxinittm (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalysis" both as "Sample Aleasurment" (actual trer;uenry of sampling acid cnalysis Irs~ during monitoring period) and as "Penui( Requirement" specified in permit. (e.g.. Enter "('ont," fo. continuous monitoring, "rn" for one day per week, "1/30" for one day per month, "1 '90" for one cay per quarter, t. ;.; 9. Enter "Sample Type' both as "Sample rLleasurernen(" (actual sample rypt: useu during monitoring peiod) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "2aHC" for e t-hour composite, "N,'A" for continuotu monitoring, etc.) ]0. 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 Discharge" across form in place of dew e:.try. 12. Enter "NameiTi(re ojPrincipar F~ecutive Officer" with "Signature oJlh•incipa! E~rcurive O~rcr c.rAu(horiz~•d Agent," "Terephone Number," and "Date" at bottom o(form. 13. Mail signed Report to t~flice(s) by date(s) specified in perntit. Rewin copy for your records. 14. More detailed instructions for use o(this Discharge Manitoring Report (UbfRJ form tray be obtained 6 om 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 Lvthfully cart result in civil penalties not to exceed 510,0110 per day of violation; or in criminal penalties not to exceed 525,003 per dsy of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)