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Paperwork Deduction 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 minor facilities, to I ]0 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 the data needed, and completing and reviewing the collection of information. Send a>mments regarding the burden estimate or any other aspect of 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 20460; and to [he 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, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permittee NameMailing Address (and facility namellocation, if different)," "Perini( Number," and "Discharge Numher" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending 'i1 fonitoring Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitor.ng requirements of permit. 5. Enter "Sample Mearuremenr" data for each pammeler under "Quantity" and "Quality" in units specified in permit. "Average" is normall} arithmetic average (grortetric average for bacterial parameters) oCali sample mean~rements for each parameter obtained during ",Nonitorirq Yeriod"; "Afaxtmurn" and "Alinimunt" are normally exvcme high and loµ~ measurements obtained dunng ".llo.aimring Period." (Hole to municipals with secondary treatment reyuiremenl: Enter 30-day avemge of sample ineasurcments under "Average," and enter maximum 7~ay average of sample measurements obtained during monitoring period under "Afazimum. 6. Enter "Perini! Requirement" for each pararnetcr under "Qumt(ity" and "Quality" as specified in permit. 7. Under ".4'o Er" enter number of sample mea~umtents during monitoring period that exceed maximum (and/or minimum or 7~ay avemge as appropriate) pern'.it requirement for each parameter. If none, enter "0". 8. En(cr "Frequency ojAnalysi.s" both as ".Sarnfile .Neasurntent" (actual f~cquency of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cant," for continuous monitoring, "l/T' Cor one day per week, "1 '30" Cor one day per month, "I/90" for one day per quarter, etc.) 9. Enter "Sample Type" both as "Sample .Lfeasurentent" (actual sample t}pe used during monitoring period) and as "Perm(! Requirement," (e.g., Enter "Grab" for inditidual sample, "l~1HC' for 23-hour composite, "1J/A" for continuotu monitoring, etc.) 10. Where violations of permit requirements are sported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by d:ne. 11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of da:a entry. 12. Enter "Namerl'itle ojPrinc(pol Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized Agenf," "Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in perntil. Retain copy for your records. l4. More detailed instructions (or use of this Dischnrge Afoniroring Report (D,1~R) form may be obtained from Ollice(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 $10,000 per day of violation; or in criminal penalties not to exceed 525,(100 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. OS-95)