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Paperwork Reduction Act Notice f 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 es an average per response for some major facilities, with a weighted average for major and minor facilities of 18 hours per response, including tune for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments 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; end to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. General Instructions t.'~f)' form has been partially completed by preprinting, disregard Instructions directed at entry of that information ' atre~dy preprinted. _ . 2.`Eoter "Permittee Name/l~failing Address (and facility namellocation, ff tlifl'erent)," "Permit N>rmber," and ;'Discharge Number" where indicated. (A separate forth is required for each discharge.) ;.. n '. 3. Enter dates beginning and ending 'Afoniroring Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample ,lfeasurernent" data for each parameter under "Quantity" and "Quality" in units specked in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Monitoring Period'; "Maximum" and "Minimum" are normally eetreme high and low measurements obtained during "Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30-da}' average of sample measurements under "Average," and enter maximum 7-day average. of sample measurements obtained during monitoring period under "Maximum.') 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Fx" 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. !t none, enter "0". 8. Enter "Frequency ojAnalysis" both as "Snrnple Measurment" (actual frequency of sampling and analysis used during monitoring period) and as "Fermi( Requirement" specified in permit (e.g., Enter "Cant," for continuous monitoring, "!/7" for one day per week, "//30" for one day per month, "//90" for one day per quarter, etc.) 9. Enter "Sarnpfe Type" both as "Sample Measurement" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "d4HC' for 24-hour composite, "N/A" for continuous monitoring, etc.) l0. 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 disctrarge" occurs during monitoring period, enter "No Discharge" across Corm in place of data entry. 12. Enter "A'ame/IYtle ojPrincipa! Executive O~ceP' with "Signature ojPrincipal Executive Officer ojAuthorized Agent," "Telephone Number," and "Date" a[ bottom o(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 Discharge Monitoring Report (DMR) form may be obtained from Otce(s) specked in permit. Legal Notice This report is required by law (33 U.S.C. 1318; 40 C.F.R. 175.27). 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)