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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 m average per response for some minor facilities, to 110 hours as an average per response for some major facilities, with a weighted average for major and minor facilities of 16 hours per response, including time for reviewing instructions, 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 far reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 HI Street, SW Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. General Instructions I. If form has been partially completed by preprinting, disregard instructions directed et entry of that information already preprinted. 2. Enter 'Permittee Name/IMailing Address (and facility narnellocaaon, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending ':14oniroring Period" coverer! by form where indicated. 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample Aleasurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average for bactc:ial parameters) of all sample measurements for each pazame[er obtained during "/vlnnitoring Period"; "Af,zrimum" and "Afinimum" aze normally extreme high and low measurements obtained during ",Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30day r::erage of sample measurements under "Average," and enter maximum 7~ay average of sample measurements obtained during monitoring period under "Maximum. J 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Er" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day averr.ge as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Freguencv ojArralysis" both as "Sample /vleasurvnent" (actual frequency of sampling and anal}'sis used during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cant," for continuous monitoring, "1/7" for one day per week, "!/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Type" both as "Sample A.feasurettrent" (actual sample !ype used during monitoring period) and as 'Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC" for 24-hour composite, "N/A" for continuous monitoring, etc.) 10. Where violations of permit reSuirements are reported, attach a brief explanation to describe cause and corrective actions 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//'itle ojPrincipa! Executive OjTcer" with "Signature ojPrincipa! Executive Officer ojAuthorized Agent," Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Office(s) by dart(s) specified in penttit. Retain rnpy for your records. l4. More detailed instructions for use o_` this Discharge Afoniloring Report (D~LfR) form may be ohtained from OBice(s) specified in permit. Legal Notice Tlils report is required by law (33 U.S.C. 13]8; 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 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 Farm 3320-1 (Rev. OS-95)