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- Paperwork Reduction Act Notice Public reporting burden for this collection of information is esiiim4ted to vary from a range of',10 Nouns as w average per response for salve minor facilities, to 110 hours a~ average per response for some major facilities, with a. weighted average ftif. pot facilities of 18 hours per respouse,_iacluding time jo tR, g instructions, searching existingurces, gathering and maintaining the data needed, and c~ and reviewing the collection of informauo~. Send comments regarding the burden estimate or w ~ _ ~ t oC this collection of information, including suggestions for reducing this burden, to Chief, ~ on F~olicy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, D ~ 460; and to the Office of Information end Regulatory Affairs, Of~of Management and Budget, Washington, DC 20503. .rd 1 _ ~ General Instructions 1. If form has ~beeo partially completed by preprinting, disregard instructions directed at' entry of that information -a~eaay preprinted. - 2. Ehter "Permitlee Name/Mailing Address (and facility name/location, if difi'erent)," "Permit Number," and "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" as specified in monitoring requirements of permit. 5. Entcr "Sample Measurement" data for each parameter under "-Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (gedrdetric average for 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 to municipals with secondary treatment requirement: Enter 30~1ay average of sample measurements under "Average," and enter maximum 7~ay average of sample measurements obtained during tnoni[oring period under. "Maximum. 6. Enter'PPrmit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7day average as appropriate) permit requiremen[Tor each parameter. If none, enter "0". B. Enter "Frequency ojAnalysis" both as "Sample Aeasurment" (actual frequency of sampling and analysis used during monitoring period) and as "Permit Requirernen!" specified in permit. (e.g., Enter "Cant," 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 Tvpe" both as "Sample ,Ifeasurernent" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "241iC' 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 dale. 11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/title ajPrincipal Executive Oi7icer" with "Signature ojPrincipn! Executive Officer ojAulhorized Agent," "Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Office(s) by dates} specified in permit. Retain copy for your records. 14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may 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,(X10 per day of violation; or is 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. OS-95)