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Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of l0 hours as an average I~er 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 18 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 comments regarding the burden estimate or any other aspect of this collt~tion of information, including suggestions for reducing this burden, to Chief, Information Policy Branch, J'M-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 fora has been partially completed by preprinting, disregard instructions directed et entry of that information already preprinted. - 2. Enter "Permiltee Name%'Llai/ing Address (and facility name location, if different)," "Permit h'uruber," and "Discharge Number" where indicated. (A separate form is required Cor each discharge.) 3. Enter dales beginning and coding ".monitoring Period" covered by form where indicated. 4. Enter each "Pnramerer" az specified in monitoring requirements of permit. 5. Enter "Sample tileacurenren!" 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 for each parameter o,[ained during "Monitoring Period'; "Maximum" and "hfinirrrum" are normally extreme high and loa• measurements obtained during "Afoniroring Period." (Note [o municipals with sernndary treatment requirement' Enter 30da}• average of sample measurements under "Average," and enter maximum 7~ay average of sample measurements obtained during monitoring period under "Maximum.') 6. Enter "Pc•rrnir Requirement" Cor each parameter under "Quantity" and "Qun(ity" az specified in permit. 7. Under ".No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-tfay average az appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalvsis" bosh az ".Sample Measurrnen[" (actual frequency of sampling and analysis used during monitoring period) and az "Fermi! Requirement" specified in permit. (e.g., Enter "Con(," for continuous monitoring, "1/T' for one day per week, "//30" for one day per month, "//90" for one day per quarter, etc.) 9. Enter "Sample Type" both az "Sample tifeasurernen!" (actual sample type used during monitoring period) and az "Pernut Requirement," (e.g., Enter "Grab" for individual sample, "24HC' for 24-hour cromposile, "N/A" for COntIrlnOUS monitoring, etc.) 10. When. 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 discharge" occurs during monitoring period, emer "No Discharge" across forth in place of data entry. 12. Enter "Name//'itle ojPrincipa/ Executive OJJrcer" with "Signature ojPrincipa! Executive Officer ojAuthorized Agent," "Telephone Number," and "Dale" at bottom of form. 13. Mail t:igned Report to Office(s) by date(s) specified in permit. Retain copy for your records. l4. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(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 peoalties not to exceed 510,000 per day of violation; or in criminal penalties oot to exceed 525,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form :1320-1 (Rev. OS-95)