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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 ao average per response for some minor facilities, to 110 hours as m average per response for some major facilities, with a weighted average for major and minor facilities of 1g 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 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; and to the Office of Information and Regulatory Affairs, Office of Management end Budget, Washington, DC 20503. General Instructions I. If form has been partially completed by preprinting, disregard instructions directed at entry of that informatiom already preprinted. 2. Enter "Permittee Nmne%Llailing Address (and facility name location, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate Corm is required (or each discharge.) 3. Enter dates beginning and ending 'Monitoring Period" covered by form where indicated. 4. Enter each "Parameter" az specified in monitoring requirements of permit. 5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally aritlimetlc average (geometric average for bacterial parameters) of all sample measurements (or each parameter obtained during "Monitoring Period"; "Maximum" and "Minimum" are 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 7day average of sample meazurements obtained during monitoring period under "Maximum. 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specified in permit. 7. Under "No Ex" enter number of sample measurnents during monitoring period that exceed maximum (and/or minimum or 7-day average az appropriate) pernit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalysis" both as "Snmple Measurment" (actual frequenry of sampling and analysis used during monitoring period) and az "Permit Requirement" specified in permit. (e.g., Enter "Copt," for continuous monitoring, "//7" for one day per week, "1/30" for one day per month, "//90" for one day per quarter, etc.) 9. Enter "Sample Tvpe" both az "Sample Measurement" (actual sample type used during monitoring period) and az "Permit Requirement," (e.g., Enter "Grab" for individual sample, ":4HC' 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 corective actions taken, and reference each violation by date. 11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/l'itle ojPrincipa! Executive OJTcer" with "Signature ojPrincipaf Executive OJrcer oJAuthorized Agent," "Telephone Number," and "Dare" at bottom of form. 13. Mail signed Report to Office(s) by date(s) specSed in pemrit. Retain copy for your records. 14. More detailed instmclions for use of this Discharge Monitoring Report (DMR) form may be obtained from OH'ice(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 mot to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day of violatiom, or by imprisonment for mot more than one year, or by both. EPA Form 3320-1 (Rev. Og-95)