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Paperwork Reduction 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 1 LO hours as an average per response for some major facilities, with a weighted average for major and minor facilities of 18 hours per resporse, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Szod comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing [his burden, to Chief, information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; end to the 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 'Perrrriltee h'ame.~Llailing Address (and facility name/location, if tiifferenl)," "Permit Number," and "Discharge .Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending 'itfonitoring Period" covered by font where indicated. 4. Enter each "Parameter" as specified in monitoring requirements of permii. 5. Enter "Sample Afeasurement" data for tzch parameter under "Quantity" end "Quality' in units specified in permit. "Avernge" is nortnall}~ arithmetic average (geometric average for bacteria] parameters) otall sample measurements for each parameter obtained during ".llonirnru+g Period'; 'S19aximurn" ar~d ",b/inimum" are normally extreme high and low measurements obtained during ".1/onitoring Pzrind." (Note to municipals xilh secondary Veatntent requirement: Enter 30~1ay average o'sample measurements under "Ave.oge," and enter maximt:m 7-da} a;eragc of sample measurements obtained dunng moniWrisg period under ",'~/arin.um. 6. Enter "Permit Require•rnent" for each parameter under "Quantity" and "Quality" as specified in pcmtit. 7. Under "No Er" enter number of sample measurtnems during monitoring period that. exceed maximum (and/or minimum or 7-day average as appropnatc) peer tit requ!rement for each parameter. If none, enter "0". B. Enter "Frequency oj.-0nalysis" both as ".Saml:/e .tlearurmenl" (actual frequency of sampling and analysis used during monitoring period) and as "Permit Rer, uirerrtenr" specified in permit. (c.g., Enter "Cons," for continuotu monitoring, "//7" (or one tiny per week, "I'30" for one day per month, "!/90" for one day per quarter, etc.) 9. Enter "Sample Type" bath as "Sample .Ileasurenrent" (actual sample [}pc used during mottiloring period) and as "Permit Requirement," (e.g., F_nter "Grab" fir individual sample, "?dflC' Cor 2~-hour composite. "P!/f"' for continuous monitoring, etc.) 10. Wham violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. If "no discharge" occurs daring monitoring peri~>d, enter "h'o Discharge" across form in place of data entry. 12. Enter ",Name/I'itle ojPrincipa! Executive O~~rer" with "Signature ojPrincipn! Executive Officer ojAuthorized Agent," "Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. 14. More detailed instructions for use of this Dischcrge hfoniloring Report (DMR) forth may be obtained from Office(s) specified in permit. Lel;al 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 result in civil penalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. US-9S)