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r t Paperwork Reduction Act Notice Public reporting burdea for this'{rgJ(esrtdgq of information is estimated to vary from a range of t0 hours as m average per response for some minx~`~~~lilies, to 110 hours as an average per response for some major facilities, with a weighted average for major and minor facilities of 18 botns per response, including time for reviewing instructions, searching existing data"s~uices, gathering and wing the data needed, and completing and reviewing the collection of information. Send comTmenls re atditig the burden estimate or any other aspect of this collection of information, including suggestions {~ reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and 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 'Permiltee Name/Mailing Address (slid facility name/location, il' different)," "Permit Number," and "Discharge Number" where indicated. (A sepdr9te form is required for each discharge.) 3. Fetter dates beginning and ending 'iLfonitoring Period" covered by form where indicated. 4. Enter each "Pnrameler" as specified in monitoring requirements of permit. 5. Enter "Sample Measuremen!" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is'normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Aonitoring Period'; "Maximum" and "A~imimum" aze normally extreme high and low measurements obtained during "Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under "Average," and enter maximum 7~ay average of sample measurements obtained during monitoring period under "Maximum.') 6. Enter "Perrnlt Requirernenr" (or each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No F_x" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. if none, enter "0". 8. Enter "Frequency ojAnalvsis" both as "Sample H/easurment" (actual frequency of sampling and analysis used during monitoring period) and as "Perrrri! Requirernenr" specified in permit. (e.g.; Enter "Copt," for rnntinuous monitoring, "I/7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Tvpe" both as "Samp/e Measurernenr" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC' for 24-hour composite, "N/A" for continuous monitoring, etc.) 10. Where 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 during monitoring period, enter "No Discharge" across (arm in place of data entry. 12. Enter "Namer/'itle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAuthorized Agent," °Telephone Number," and "Date" al 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 (DA1R) Conn may be obtained from Office(s) specified in permit. Legal 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 510,000 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. 08-95)