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Paperwork Reduction .Act Notice Public reporting burdee for this collection of information is estimated to vary from a range of 10 hours es m average per response for some minor facilities, to 110 hours as an average per response for some major facilities, ~ithta weighted average for major aDd minor facilities of 18 flours per tespoDSe, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data Deeded, and completiDg and reviewing the collection of informatioD. Send comments regazding the burdeD estimate or aDy other aspect of this collectioD of information, including suggestions for reduciDg this burden, to Chief, InformatioD Policy Branch, PM-223, U.S. EDViroDmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the Office of Information aDd Regulatory Affairs, Office of Management aDd 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 NameMailing Address (and farility namel~ocation, if different)," "Permit Number," .and "Discharge Number' where indicated. (A separate fomt is required for each discharge.) 3. Enter dates beginning and ending 'Monitoring Period" covered by farm where indicated. 4. Enter each "Parameter" as specifed in monitoring requirements of permit. 5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in petmut. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Monitoring Period'; "Marinrum" and "Afinimum" are normally extreme high and low measurements obtained during "Monitoring Period." (Note to municipals with sewndary lreatme:nt requirement: Enter 30-day average of sample measurements under "Average," and enter maximum 7day average of sample measurements obtained during monitoring period under "Maximum. 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7~ay average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalysis" both as "Sample rLleasurmenl" (actual frequenry of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cons," for continuous monitoring, "//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 Measurement" (actual sample type used during monitoring period) and as "Permtl Requirement," (e.g., Enter "Grab" for individual 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. If "DO discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/title ojPrincipa! Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized Agent," "Telephone Number," and "Date" at bottom of form. l3. Mail signed Report [o Office(s) by date(s) specified in petnrit. Retain copy for your records. 14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from OBice(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 510,000 per day of violation; or in criminal penalties not to exceed (25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)