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Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as m average per response for some minor facilities, [0 110 hours as an average per response for some major facilities, with a weighted average fo: major and minor facilities of IS hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collrx[ion of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chiuf, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Alanagement and Hudget, 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 'Permitlee Name%L/ailing Address (and facility natnellacation, if diffemn[)," "Permit Number," and "Discharge Number" where indicated. (A separate Corm is required for each discharge.) 3. inter dates beginning and ending "ronitoring Period" covered by form where indicated. 4. inter each "Parameter' as specified in monitoring requirements oC permit. 5. °nter "Sample tifeasuremerP' data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic a~~erage (geometric average :or bncle~ia] parameters) of all sample measurements or each parameter obtained during "Afonimring Period"; "Afiiximum" and "A9inimum" are normally exUeme high and low measurements obtained during ",t4oniroring Period." (Note to municipals with secondary Vcatment :egtrircmenL' Enter 30-dap average of sample measurements •~nder "Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "Alarimum.'J 6. %nter "Perini! Requirement" for each parameter under "Quanri,y" and "Quality" as specified in permit. 7. Under "No Fx" inter number of sample measurments during monitoring period [hat exceed maximum (and/or minimum or 7-day average as apprcpriate) permit requirement for each parameter. If none, enter "0". B. Hn[er "Freguenry ojAnolysis" both as ':Sample ~tifeasurrnen!" (actual frequcnry of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in permit. (c.g., Enter "font," for continuous incnitoring, "I/7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Same/e Type" both as "Sample A~Ieasuremenr" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" Cor individual sample, "241/C' for 24-hour composite, "N/A" for continuous monitoring, etc.) 1C. 7/here violations of Hermit .equirements are reported, attach a brief explanation to describe carne and corrective actions taken, and reference each violation by date. 11. If "no discharge" occurs during monitoring period, enter "Aro Gischarge" across form in place of data entry. 12. L•nler ".Name/Tille ojPrincipal Executive Officer" with "Signature ojPrincipnl Executive OlTcer ojAuthorized Agent," "Telephone Number," and "Date" a[ bottom of forth. 13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for }•our records. 14. More detailed instructions for use of this Discharge Afonitoring Report (DMRJ form may be obtained from Office(s) specified in permit. Legal Notice T7ils 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 e:eceed x10,000 per day of violation; or in 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. 08-45)