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Paperwork F.eduction Act Notice Public reporting burden for this collectioo of information is estimated to vary from a range of ]0 hours as an average per response for some minor facilities, to 110 hours as an average per response for some major facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect mf this collection of information, including suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 204b0; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. General Instructions I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permiftee 7Jame/Mailing Addresr (and facility name/localion, if different)," "Permit Number," and "Discharge Number" where indip[ed. (A separate form is required for each discharge.) 3. Enter dates beginning and ending itfoniroring Perrod" covered by Corm where indicated. 4. Enter each "Parameter" az specified in monitor.ng requirements of permit. 5. Enter ".Sample ,tfeasurernent" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normal l}' arithmetic average (grniaetric average for bacteria] parameters) of al' santple measurements far each parameter obtained during "Afonitanrg Periad"; "Alaximwn" and ".tfinirnum" arc normally extreme high and low nreasuremznls obtained during ".llnmturing Periad." (Note io municipals with secondary treatment regwremenl Enter 30-day average of sample measurements under "Average," and enter maximum 7~ay average of sample measurements obtained during momtoring period under "afaximum.') 6. Enter "Permit RegviremenP' for each parameter under "Quantity" and "Quo/ity" az specified in permit. 7. Under "h'o Ex" enter number of sample mea:urnrents during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement Cor each parameter. If none, toter "0". B. Enter "Frequency oj.4na/ysis" both az "Sam/:/e ,'LfeasurmenP' (actual frequcn~~ o` sampling and analysis. used during monitoring period) and az "Pennii Renuireurent" specified in permit. (c.g., Enter "Coot," for continuous monitoring. "//7" for one day per week "1'30" far one day per month, "l/90" for one day per quarter, etc.) 9. Enter "Samp/e Ttpe" bosh az "Sample .Lleasuren+ent" (actual sample type used during monitoring period) t:rfd az "Permit Requirement," (c.g., Enter "Grab" far indi+~dual sample, "1dHC"' for 24-hour rnmposite, "NiA" for continuous monitoring, etc.) 10. Where violations of permit requirements are n:ported, attach a brie! explanation to describe cause and corective actions taken, and reference each violation by date. 11. If "no discharge" occurs during monitoring period, enter "H'o Discharge" across form in place of data entry. 12. Enter "Name/Title ojPrincipnl Executive O~cer" with "S'ignature ojPrincipnl Executive Officer ojAuthorized Agent," "Telephone Number," and "Dare" at bottom of form. 13. Mail signed Report to OfLce(s) by date(s) specified in permit. Retain copy for your records. 14. More detailed instructions Cor use of this Discharge Monitoring Report (D,ti/R) form may be obtained from Office(s) specJed in permit. Legal Notice 'Ibis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure [o report or failure to report truthfully can result in civil penalties mot to exceed 510,000 per day of violation; or in criminal penalties not to exceed 625,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)