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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 per response for some minor facilities, l0 110 hours as an average per response for some major facilities, with a weighted average fo- ~. Qtf' raq@ntinor facilities of 18 hours per response, including time for reviewing instructions, searching eziS ' ' ' to sources, gathering and maintaining the dale needed, and completing and reviewing the collection o(v' ~ lino. Send comments regarding the burden estimate or any other aspect of this collection of informa~ii§CF, including suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. ~rNironmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management imd Budget, Washington, DC 20503. General Instructions 1. =I fPro' has been partially completed by preprinting. disregard instructions directed at entry of that information a~r8ady preprinted. _ --_- . -. 2. Enter "Permittee Name/1LIniling Address (and facility name4ocation, if diH'erent)," iil~eb'mif -I~iiFbe~":~1 "Discharge Number" where indicated. (A separate form is required. for each discharge) 3. Enter dates beginning and ending 'iLlonitoring Period" covered by form where indicated. ' 4. Enter each "Parameter" az specified in monitoring requirements of permit. , 5. 'Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) o(all sample measurements for each parameter obtained during "A4oniroring Period ; "Maximum" and "Minimum" are normally extreme high and low measurements obtained during ",Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30~ay average of sample meazurements under "Average," and enter maximum 7-day average ofsample measurements obtained during monitoring period under "Mazimurn. 6. Enter "Pennit Requirement" (or each parameter under "Quantity" and "Quality" az specked in permit. 7. Under "No Er" enter number of sample measurments during monitoring period [1r~ut exceed maximum (and/or minimum or 7-day average az appropriate) permit requirement for each parameter. If none, enter "0". B. Enter "Frequency oJAnalysis" both as "Sumple ILleasurment" (actual frequency of sampling and analysis used during monitoring period) and az "Fermi! Requirement" specified in permit. (e.g., Enter "Coot," for continuous monitoring, "I/7" Cor one day per week, "I/30" for one day per month, "!/90" for one day per quarter, etc.) 9. Enter "Sample Type" both az "Sample Measurement" (actttal sample type used during monitoring period) and az "Permit Requirement," (e.g., Enter "Grab" for individual sample, "24NC' 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 "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/Title ojPrincrpal Executive Officer" with "Signature ojPrincipal Executive Officer ojAuthorized Agent," "Telephone Number," and "Date" at bottom of form. 13. Mail signed 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 m:ty 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 penalties not to exceed 510,000 per day of violation; or in criminal penalties oat 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. OB-95)