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Paperwork Reduction Act Notice Public repoRing burden for ibis Collection of information is estimated to vary from a range of 10 hours as eo average per response for soma minor fay`i~tYtes, to 110 hours as an average per response for some major facilities, t~i-a weighted average for major and minor facilities of 18 hours per response, including time for reviewing -giAc9gna; searching existing data sources, gathering and maintaining the data needed, and completing and revrrvvrng the collection ofvrformation. Send comments regarding the burden estimate or any otber 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 aad ReEvlatory Affairs, Office of Management and Budget, Washington, DC 20503. General Instructions 1. If form has bean paRially completed by preprinting, disregard instructions directed. at entry of that information rilready preprinted. 2. Enter "Permittee Name/Itfailing Address (and facility tmmNlocapen;-f~elli~'~[ytY)!?l+.cWRe+r+oit!+~Imlbgt~tlerp' "Discharge Number" where indicated. (A separate forth is required for each discharge.) 3. Enter dates beginning and ending 'Monitoring Period"covered by form where indicated. 4. Enter each "Parameter" as specked 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 far bacterial parameters] of all sample measurements for each parameter obtained during "Monitoring Period'; "Maximum" and ",'Minimum" are normally extreme high and low measurements obtained during "Monitoring Period." (Note [o municipals with secondary treatment requirement: Enter 30~ay average of sample measurements under "Average," and enter maximum 7-day average of sample measuremenu obtained during monitoring period under "Maximum. ") 6. Enter "Permit Requirement" for each parameter under "Quantity" send "Quality" as spetified in permit. 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed ma+timum (andlor minimum or 7-day average:ts appropriate) permit requirement for each parameter. iTnone, enter "0". 8. Enter "Feequenry ojAnalysis" both as "Snrnple Measurment" (actual frequency of sampling and analysis used during monitoring period) and as "Fermi! Requirement" specified in permit. (e.g., Enter "Cant," for continuous monitoring, "l/T' for one daj per week "f~30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter ".Sample Type" both ss ",Sample Afeasurernenr" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "74HC' for 24-hour composite, "N/,4" for conunuous monitoring, etc.) ]0. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actintts 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. 12. Enter "Name/I'itle ojPrincipal Executive Officer" with "Signature ojPrincipnl Executive Officer oJAuthori~ed Agent," "Telephone Number," and "Dale" at bottom of forth. 13. Mail signed Report to Office(s) by date(s) specffied in permit. Retain copy for your records. 14. More detailed inswctions for use of this Discharge Aonitoring Report (DMRJ form may be obtained from Oiice(s) specified in permit. Legal Notice This repoR is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to repoR 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 (RCY. 08-95)