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~- Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an average per response for some minor facilities, [0 110 hours as en average per response for some major facilities, ~ with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing I ias[ruc[ions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions fur reducing this burden, to Chief, Information Policy i 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 Management and Budget, Washington, DC 20503. General Instructions 1. if form has been partially comple'ed by preprinting, disregard instructions directed a[ entry of that information already preprinted. 2. Eater 'Permi((ee Name%tlailing Address (and facility ttacneJloca[ion, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate Corm is required for each discharge.) 3. Enter dates beginning and ending ':Monrtoring Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitoring requirements oCpermit. 5. Erter':Samp/e dAeasuremrnt" data ;or each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average Cor bacterial parameters) oCall saniple measurements for each parameter obtained during ",ifoniroring Period"; "afaxirmurr" and "dfinimum" arc normally e,~ttreme high and low measurements obtained during ",lfonitorrng Period." (Note to municipals tieilh secondary treatment requirement: En!cr 30-dav average of sample measurements under ".overage." and enter maximum 7~ay average of sample measurements obtvned during monitorng period under ",Maximum.') 6. Enter "Parrett! Requirement" for each parameter under "Quan(iry" and "Quality" as specified in permit. 7. Under "No Ex" enter number of sample measurmcnts during monitoring period flat[ exceed maximum (and/or minimum or 7~ay average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Feequenry ojAnalysis" both as "Sample .4leasurmen(" (actual frequency of sampling and analysis used during monitoring period) and as "Permit Requirenren(" specified in permit. (c.g., Enter "Coat," for continuous monitoring, "//7" for one day per week, "1/30" for one day per month, "l.'90" for one day per quarter, etc.) 9. ?ntcr ".Sample Type' both as "Sample .Measurernenr" (actual sample type used during monitoring period) and as "Perini( Requirement," (e.g., Enter "Grab" for individual sample, 14H(" for 24-hour composite, "A%A" for continuous monitoring, etc.) 10. 'vVhere 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 Cischorge" across form in place oC data entry. 12. Enter "Namefl'itle ojPrincipal Executive Officer" with "Signature ojPrincipa! Executive OJjcer ojAurkorized Agent," "Telephone Number," and "Dale" at bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in permit. Retain rnpy 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 a 10,000 per day of violation; or io 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 (Rev. 08-95)