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Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of f0 hours as an average per response for some minor facilities, to 110 hours as as 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 pn:pria[ing, disregard instructions directed a[ entry of that information already preprinted. 2. Enter "Permiltee Narne/1Mailing Address ;and facility name/Ixation, if diff'erent)," "Permit Number," and "Discharge Number" where indipted. (A separate form is required for each discharge.) 3. Enter dates beginning and cndirg 'Afonitorin,; Period" covered by Corm where indicated. 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample ~t-/easurement" data for each pvameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average for bacteria] parameters) of all samplC measurements for rash parameter obtained during "Monitoring PertoB'; "Afaxim•rm" and ".'Minimum" are normally extreme high and law measurements obtained during "hfoni(oring Perod." (NotC to municiaals vnth secondary treatment requirement: Enter 30-day average of samplt:'measurements trader "Averoge," and enter marcimum 7-day average of sample measurements obtained during moo Loring period under "Maximum. ") 6. Enter "Permit Requirement" for each parameter under "Quonlity" and "Quality" as specified in permit. 7. Under ",'Jo Fx" enter number of sample mr•tsurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalysis" both as ".Sample Measurrnenr" (actual frequency of sampling and analysis toed dtuing monitoring period) and as "Permrr Re.ruirentent" specified in permit. (e.g., Enter "Cont." for contnuous monitoring, "1/7" for one day per week, "//30" for one day per month, "//90" for one day per quarter, etc.) 9. Enter "Sample Type" both as ".Sample ~1~easvrement" (actual sample type toed during moritoring period) and as "Permit Requtrement," (e.g., Enter "Grab" 1'or individu2l sample, " 24HC' 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 corrective actions taken, and reference each violation by date. 11. )f "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. l2. Enter "Nome/litfe oJPrincipal Executive O~~ er" with "Signolure ojPrincipnl Executive Oj~cer oJ.4uthorized Agenr," "Telephone Number," and "Date" at bottom of Cornt. I3. Mail signed Report to Office(s) by date(s) specified in permit. Retain rnpy for your records. 14. More detailed instructions for use of this Discharge Monitoring Report (D.t~R) form may be obtained from Offce(s) specified in permit. Le;;al I~a~tice 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 $10,000 per day of violation; or in cricunal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3720-1 (Rev. 08-95)