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Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from n range of 10 hours as rm avern~e per response for some minor facilities, to 110 hours as am average per response for some major facilities, with a weighted average for u~ajor and minor facilities of 18 hours per response, including time for reviewing irstructions, searching existing data sources, gathBring andiit~frttaining the data needed, u~d com2leti;rg me reviewing the collection of information. Send commdnts tri~arGin; the burden estimate or any oiler as;sect of this collec[ior. of information, including suggestions for reducing tuts burden, to Chief, information Policy Branch, PM-223, U.S. Envim~mental Protection Agency, 401 iti Street, SW Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of ;vianagemeni and Budget, Washington, DC 20503. General Instructions 1. -f form has been partially completed by preprinting, disregard instructions directed at entry of that infortation already preprinted. 2. Ruler "Perptittee Name/)tfailing Address (and facility namellaption, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate form is regtrired for each discharge.) 3. Enter dates beginning and ~;riding 'Monitoring Period" covered by form where indicated 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample Measurement" dais for ach parameter under "Quantity" and "QuaiiN" in lulls specified in pernlt. "Average" is normally aritnme5c average (geometric average for bacterial parameters) of all santple measurements for each parameter obtained during "Monitoring Yeriod"; "hfaximum" and "Minimum" arc normally exKreme high and low measurements o~taincd during "Monitoring Period." (Note to municipals with secondary veatmcnt requirement: Enter 30~c; average of sample measurements under "Average," and enter ma.~mum 7-day aventge of sample measurements rbLtined during monitoring. patine; under "Maximum.') 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit 7. Under "h'o Ex" entryr number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average. as appropriate) permit requirement for each parameter. Unone, enter "0". ii. Enter "Frequency ojAnalysis" both as "S'ample I~Icosurment" (actual frequency' of sampling and analysis used during monitoring period's and as "Permit Requi, emerrr" specified in permit (e. g., Enter "('aril," for continuous monitorire, "//7" for one gay per week, "1/i0" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Tvpe" both as ".Sample Measurement" (actual sample type used during monitoring period) and as "Permit Requrrement," (e.g., Enter "(;tab" for individual sample, "2411(" for 21-hour crnnposite, "h'~A" for continuous monitoring, etc.) 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, 2nd reference each violation by date. 1 I. If "ro discharge" occurs during monitoring period, enter ",4ro Discharge" across form in place of daW entry. l2. Enter "Name/1'itle ojPrincipal Executive OJTcer" with "Signature ojPrincipal F.recutive OJTcer of Authorized Agent," 'Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Ofi'itce(s) by date(s) specified in permit. Retain copy for your records. 14. More de ailed instructions for use of ibis Discharge Monitoring Report (D,LIR) form may be obtained from Office(s) specified in permit. Legal Notice This -apart is required by law (33 U.S.C. ]318; 40 C.F.R. 125.27). Failure to report or failure to report Irutbfully can result in civil Penalties not to exceed X10,000 pe: day of violation; or in crimincl peoal[ies no[ to exceed x25,000 per day of violatwc, of by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. OS-95)