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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 en average per response for some minor facilities, to 1 ] 0 hours as m average per response for some major facilities, with a weighted average for major and minor facilities of l8 hours per response, including lime 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 imformation, 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 et entry of that information already preprinted. 2. Enter 'Permi((ee R'ame/Mailing Address (and facility name location, if different)," "Permit Number,'' and "Discharge Number" where indicated. (A separate Corm is required for each discharge.) 3. Enter d9tes beginning and ending 'Afonitoring Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitorng requirements of permit. 5. Enter ".Sample A4eacuremen(" data for each parameter under "Quantity" and "Qunli(}~' in units specified in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements Cor each parameter obtained during "Monitorirg Period"; ".4faxin+um" and ".'vlinimwn" arc normally extreme high and low measurements obtained during ".1lnnitoring Period." (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under "Average," and enter maximum 7-0ay average of sample measurements obtained during monitoring period under "Afaximmn. 6. Enter "Permi(Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under ",Vo FX" enter number of sample measurntents during monitoring period that exceed maximum (and/or minimum or 7-day average az appropriate) permit requirement for each parameter. IC none, enter "0". 8. Enter "Frequency oj'.Analysis" both as "SmnF~le tifea.~vnnent" (actual frequency of sampling and analysis used during monitoring period) and as "Fermi! Requirement" specified in permit. (e.g., Enter "Con(," for continuous 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 Type" both as "Sample Measurement" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" fir individual sample, "24HC' Cor 21-hour composite, "N/A" for continuous monitoring, etc.) 10. Where violations of permit requirements are r~:ported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. tt "no discharge" occurs during monitoring peri~~d, enter "No Discharge" across form in place oC data entry. 12. Enter "Name/Trtle ojPrincipal Executive Officer" wish "Signature oJPrincipal Executive Officer oJAu(horized Agent," "Telephone Number," and "Date" a[ bottom of form. 13. Mail signed Report to Office(s) by date(s) specif ed in permit. Retain copy for your records. l4. More detailed instructions for use of [his Discharge Monitoring Report (DMR) form may be obtained from 06ce(s) specified in permit. Legal Notice 'ILis 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 u civil penalties not to exceed x10,000 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)