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~, ~~p~>r~®~°k Ytedli~c~a®;~ ~~~ ~t~~Il~~ 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, to 110 hours as an 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 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 for reducing this burden, to Chief, Information Policy Branch, PAYI-223, U.S. Environmental Protection Agency, 401 M Street, SW, Washington, DC 20460; and to the Office of Information apd Regulatory Affairs, Office of,NIanagement and Budget, Washington, DC 20503. 1. If form has been paztially completed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter "Permittee Name/Mailing Address (and facility name/location, if different);' "Permit Number;' and "Discharge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending "Monitoring Period' covered by form where indicated. 4. Enter each "Parameter' as specified in monitoring requirements of permit. ' S. Enter "Sample i/.'easurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measure- ments for each parameter obtained during "1/.onitoring Period'; "Maxim~~m" and "Minimum" aze normally ex- treme high and low measurements obtained during "ivionitorirtg Period." (Note to municipals with secondary t•_at.a2nt requirement: Enter 30-day average of sample measurements under "Average;' and enter maximum 7-day average of sample measurements obtained daring monitoring period under "ivlazimum.") 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "TIo Ex" enter number of sample measurements oaring Y,•ionitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. 1f none, enter "0.° 8. Enter "Frequency of Analysis" both as "Sample ivieasurement" (actual frequency of sampling and analysis used during monitoring period) and as "Pem!i[ Require,nen!" specified in permit. (e.g., Enter "Coot;' far continuous monitoring, " 1/7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sarnple Type" both as "Sample iv;easL[ren, ert" (actual sample type used dining monitoring period) and as "Perch*RequiremenY;' (e.g., Enter "Grab" for individual sample, "24HC' for 24-hour composite, "N/A" for con- tinuous monitoring, etc.) 10. Where violations of pe -7i' r~~p; *ements aze reported, attach a brief explanation to describe cause and corective actions taken, and reP~snc_ aac:1 triolatlon by date. 11. If "no dischazge" Deno, du ~ n%; monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/Title of fit%cipni Executive Oj}'icer" with "Signature of Principal Executive Officer of Authorized Agent," "Te/ephone Number," and "Date" at bottom of form. 13. Mail signed Report to Office(s) by date(s) 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 Of- fice(s) specified in permit. ~; ,tE~ar l~T~~~~tE 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 $10,000 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 (Rev. 3/99)