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~~,e~-urorc Ret~~"wct~~ ~cz i~c~tzce 1 Public reporting burden for this collection o~ inlbrmation is estimated to vary from x range of 10 hot n as an average per response for some minor laci!i~ies, to I10 hears as art average per -csFonsc for so~•c iaau- facilities, with a weighred average for major and minor facilities of 18 hours per respo~xe. includ~~g me `r reviewing instructions. searching existing data sources, gathering and maintaining the data nceC_d. and competing and reviewing the collection of infurmtnion. Send comments regarding the burden estimate ur : ~~ otter aspect of this collection of inlormation, including suggestions far reducing this burden, to Chief. Ini ~rmauon Policy Branch. PM-2?3, U,S. Environmental Protectimt Agent\'. SDI M Street. SW, Washington. DC' 'u n(J; and to the Office of Information and Regulator> At7ain. Office cf M1tanagement and Budget. 1Vashineton. UC ?001 f;en~ral !r,ist~-tsctg~ae~~ I. II form has been partially completed by preprinting, disregard instructions directed at entry of ihrt informatior already preprinted. ?. Enttr "Permittee Name/Afailing Address (and I'acilny numeilocation, i( dil'(erentl." "Permit A m,ber." acd "Discharge ,Number" where indicated. (.4 separate ti~rm is reyuircd Poe each dischargr.l 3. Enter dates beginning and rnding "Mmurnrng Period" covered by form where indicated. - 4. Enter each "Parameter' as specified m monitoring reyuiremenis of permit >. Enter "Sample Measurement" data for eoch par,,mrter under °Quanliry" and 'Quulitl" i.i amts specir.ad in pcrmi. ".Average" is normally arithmetic averoee Igeomet tic average for bacterial parameter.) of all sample mzusu re men'. for each parameter obtained donne "d-lumutring Period-. `~Lfaxinrunr" and "Alinimum" are nonnall} extreme higl and low measurement; obtained during -Llonituring Ptnorl.` (Note to municipals c.ith sewn der treat men requirement: Enter 30-day average of ,a i,:ple measurements tinder ~~Average." and anter maxBnum ~-da; nve rage of sample mea;urcments obtained during monitoring period under 'M11axinmm:') 6. toter "Fannie Rcyuirement" for each parameter under 'Quantity" end "Quality' as speedicd m permit. 7. Under `No Ex" enter number n( samnle measurements during monitoring period that exceed m, ximam O+nd 'a' minimum or 7-day average as appropnatel Cermit requirement (or each parameter. If none, emer "0~. S. Enter "Frequency of Analysis' both as "Sample ~Icasuremeni (actual frequency of sampling and ., to ysis u,ed during monitoring period) and as "Permit Requirement" specil ied in permit. (e.e., Enter "Coal." I'nr cunti ~.vou~ monitoring. "Ij7" (or one day per, meek, `L~JO" for one day per month. "f; 90- for one day per qua rttr, ctc.1 9. Enter `Sample Typr" both as "Sample A1rasurement` (actual sa topic type wed during monitorine he ~icdt and a, "Permit Requirement.' (e.g., Enter "Grub" for individual sample. `2dHC"' for ?4-hoar composite, "M1'-A" for coc- tinuous monitor ne, etc.l 10. \Nhere violations of permit reyui tenants are reported, a0ach a brief ex planation to describe cau,e anJ tore xti~e actions taken, and relertnre tach violation by date. I I. If "nu discharge" occurs during monitorine period. enter "No Discharge" across form in place of data to -y. 12. Enter "Nrnne,~Tirle u% Principal £xecmivt O(%icrr" with "Signature n7 Princip:d Eaeturive O((icer n:~ lutlrnnzrd Agent,' 'Telephone .Number,` and "D~te- m bottom of torn. I J. Mail signed Report to Office(s) by date(s) ,pacified in pennh. Retain copy for your acoMs. W. Vlore detailed instruction for use of this Discharge A1onitoring Repine (DA4R) form may be obtaintd fmm Of- fice(s) sptcilled in permit. .Legal Notice fhis report is required by law (3) U.S C. 1718, )0 C.F.R. I?y?7). Failure to report or fadurt to icpnn truthful ~ cat ra,dt in civil penalties not to tuetd $10.000 per day of violation: or in criminal penaliic, not to excc,d 52iA:10 p:r Jay of violation. or by impnsonmtm fm' nut more than one year, or by both. FF'A Form .)320-I (Rec. 9-R 81