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Paperwork Reduction Act Notice <br />Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as an <br />average per response for some minor facilities, to ] 10 hours as an average per response for some major facilities, <br />with a weighted average for major and minor facilities of l8 hours per response, including time for reviewing <br />instructions, searching existing data sources, gathering and maintaining the data needed, end completing and <br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of <br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy <br />Brsnch,.PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the <br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions <br />1. If form has betn partially completed by preprinting, disregard instructions directed at entry of that information <br />already preprinted. <br />2. Enter 'Permittee Name/Mailing Address (and facility name/loralion,ff different)," "Permit Number," and <br />"Discharge Number" N•here indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and ending 'ilfoniloring Period" covered by form where indicated. <br />4. Enter each "Parameter" az specified in monitoring requirements of permit. <br />5. Enter ".Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. <br />"Avernge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements <br />for each parameter obtained during "Monilorirg Period'; "Maximum" and "iLfinimurn" are normally extreme high <br />and low measurements obtained during "tifo,vitoring Period." (Note to municipals with secondary treatment <br />requirement: Enter 30-0ay avemge of sample measurements under "Average," and enter maximum 7-0ay average <br />of sample measurements obtained during monitoring period under "Maximum. J <br />6. Enter "Fermi! Requirement" for each parameter under "Quantity" and "Quality" az specified in permit. <br />7. Under "No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or <br />minimum or play average az appropriate) permit requirement for each parameter. If none, enter "0". <br />8. Enter "Frequency ojAnalysis" both az "Sample lvfeasurmenr" (actual frequency of sampling and analysis used <br />during monitoring period) and az "Fermi! Requirement" specified in permit. (e.g., Enter "Conn," for wntinuous <br />monitoring, "t/7" for one day per week, "1/30" I'or one day per month, "//90" for one day per quarter, etc.) <br />9. Enter ".Sample Type" both az "Sample Measun~rnen!" (actual sample type used during monitoring period) and az <br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC"' for 24-hour composite, "N/A" for <br />continuous monitoring, etc.) <br />10. Where violations of permit requirements are rt•,ported, attach a brief explanation to describe cause and corrective <br />actions taken, and reference each violation by date. <br />11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. <br />12. Enter "Name//'itle ojPrincipal Executive Officer" with "Signature ojPrincipnl Executive Officer ojAuthorized <br />Agent," "Telephone Number," and "Date:' a[ bottom of form. <br />13. Mail signed Report to Office(s) by date(s) specil3 ed in permit. Retain copy for your records. <br />14. More detailed instructions for use of this Discharge Monitoring Report (DAfR) forth may be obtained front Office(s) <br />specified in permit. <br />Leval Notice <br />This report is_required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report tmthfully can <br />result in civil penalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed E25,000 per day <br />of violation, or by imprisonment for not more than one year, or by both. <br />EPA Form 3320-1 (Rev. 08-9~ <br />