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Paperwork Reduction,Act Notice Public reporting burden fqq~~this collection of information is estimated to vary from a range of. /O hours as an avenge per re:ponse'~r'~iee minor facilitiesburs as an average per response for some p~ajgr faeilities, with a weighted avenge for tny~jn~,ap~ip~ tes of 18 hours per response, includittc_fioe }or reviewing instructions, aarching existing data sorizrs~, gathering and maintaining the data needed,"wand completing and reviewing the collection of information.'?~jad comments regarding the_yurdenrstimate or any other aspect of this collection of information,;itcluding suggestions for reducing thi~•bu[deo, to Chief, Information Policy Branch, PM-2:3, U.S. Envitonmeatal Protection Agency, 401 MStreet,-5W Washington, DC 20460; and to the Office of Information and Regulatory flffairs, Office of Management and Budget, Washington, DC 20503. General Instructions k.: If form has been partially completed by preprinting, disregard instructions directed et entry of that information aGeady preprinted. .-- 2.-$pter 'Perrni((ee Name/Mailing.r/ddress (and facility nameAaCatton;'tl"tB8'ereM)," "P~rmif 1fldm3er," ahd - " "Discharge Number" where indicated. (A separate Corm is required for each discharge.) 3. Enter dates beginning and ending 'Monitoring Period" covered by form where indicated. 4. Enter each "Parame(er" az specified in monitoring requireme0yc of permit. 5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in ptxmit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each pa~ameler obtained during "Monitoring Period"; "Maximum" and "Afinimum" are normally extreme high and low meazurements obtained during "Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30~ay average of sample measurements under "Average," and enter maumum 7~ay average of sample measurements obtained during mQglloring period under "Maximum.') 6,. Enter "Perini! Requirement" for each parameter under "Quantity" and "Quality" az specified in permit. 7. Under "No Ex" enter number of satitple meazurments during monitoring period that exceed maximum (and/or minimum or 7<lay average az appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalvsis" both az "Sample Measurmen(" (actual frequenry of sampling and analysis used during monitoring period) and az "Permit Requiremen!" specified in permit. (e.g., Enter "Copt," for continuous monitoring, "1/7" for one day per week, "l/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Tvpe" both az "Sample Afeasurernenl" (actual sample type used during monitoring period) and az "Permit Requirement," (e.g., Enter "Grab" for individual sample, °24HC' for 24-hour composite, "N/A" for continuous monitoring, etc.) l0. Where violations of permit requiremt:nts.are reported, attach a brief explanauon to describe cause and corrective actions takein, and reference each violation by date. 11. U "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Namelfitle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive Officer ojAulhorized Agent," "Tel'ephone Number," and "Date' a[ bottom of form. 13e-tufail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. 14. More detail<x1 instructions for use of this Discharge Monitoring Report (DMRJ form may be obtained from Office(s) specified in permit. Legal Notice 'I'bis 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 penallties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)