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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 110 hours as an average par 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 comments regarding [he 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; 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 a[ entry of that information already preprinted. 2. Enter "Permittee NameMailing Address (and facility namellocation, if diBbrcnt)," "Permit Number," and "Discharge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and coding ",4lonirn"ing Perrod" covered by form where indicated. 4. Enter each "Parmnerer" as spceiFied in monitoring requirements of permit. 5. Enter "Samplr Afracuremrnt" data for each pat tmeter under "Qvnniity" and "Quolih" in units specified in permit. "Average" is normally arilhnulic average (geometric average far bacterial parameters) of ali sample meanuements for each parameter obtained during ",tlomtnrrr.¢ Period"; ".Afoxinmm" and "Afinimum" arc normally eatrcmc high and low measurements obtained during ".tlonimring Period" (Note to municipals with secondary treatment rcquircmenC Enter 30tlay average of sample mrasuremens under "Average," and enter ma.~cimum 7-day average of sample measurements obtained during monitoring period under "Afarimum. 6. Enlcr "Permit RequiremenP' for each pat arteter under "Quantity" and "Quality" as spcdllcd to permit. 7. Under "h'o Er" enter number of sample mcasunnen[s during monitoring period that exceed ma~timum (and/or minimum or 7-day average as appropriate) permit regmrcmcm Cor each parameter. If none, toter "0". 8. Enter "Frequency oj:lnalysis-" both as ".Snmf~le ;'v/ea.curnrent" (actual frequenc}~ of sampling and analysis used during monitoring period) and as "Permit Requirement" speeded in permit. (e g., Enter "Cool," for conti.uous monitoring, "li7" for one day per week, "I~30" for one day per month, "//90" for one day per quarter, etc.) 9. Enter ".Sample Ttpe" both as "Sample afeasurr•menr" (actual sample type used during monitoring period) and as "Perini! Requirement," (e.g., Enter "Grab" for individual sample, "1~lNC' Car 24-hour composite, ".V/q" for continuous monitoring, c[c.) 10. Where ~~olations of permit requirements are rr:ported, attach a brief explanation to describe cause and ecrreclive actions taken, and reference each violation by date. t 1. if "no dtscharge" occurs during monitoring period, enter ".No Discharge" across form in place of data entry. 12. Enter "Namell'itle ojPrincipal Executite Officer" with "Signature ojPrincipa! Executive Officer ajAuthcrized Agent," "Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records. 14. More detailed instructions for use of this Discharge Afonitoring Report fDA1R) form may be obtained from Office(s) specified in permit. Le;~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 t10,t700 per day of violatian; 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. c EPA Forro 3320-1 (Rev. 08-95)