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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 ~6ours as an average per response for some minor facilities, to 110 hours as ao average per 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 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 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 'Permittee Name/Mailing Address (and facility name location, if different)," "Permit Number," and "Discharge Number" where indicated. (A sepa.-ate form is required for each discharge.) 3. Enter dates beginning and coding 'Monitoring Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitoring requirements oCpermit. 5. Enter "Sample Afeasuremenr" 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 Cor each parameter obtained during "Monitoring Period"; "Maximum" and "Minimwn" are normally extreme high and low measurements obtained during "A•foniroring Period." (Note to municipals with sernndary treatment requiremem: Enter 30-0ay 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" Cor each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "Na Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7~ay average as appropriate) pertnil requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalysis" both as "Sample Measurment" (actual frequency of sampling and analysis used during monitoring period) and as "Fermi( Requirement" specified in permit. (e.g., Enter "Cool," for continuous monitoring, "1/7" 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 Measuremen(" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "14HC' for 24-hour composite, "N/A" for rnntinuous monitoring, etc.) 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and cortective 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//'ille aJPrincipal Executive OJj,'cer" with "Signature ojPrincipal Executive Officer ojAulhorized Agent," "Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in permit. Retain rnpy Cor your rernrds. 14. More detailed instructions for use of this Discharge Monitoring Repot! (DMR) form may be obtained from Office(s) specJed 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 x10,000 per day of violation; or in criminal penalties not to exceed E25,000 per day of violation, or by imprisonment for not more than orie year, or by both. EPA Form 3320-1 (Rev. 08-95)