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Paperwork Reduction Act Notice w Public reporting burden for this collection of information is estirmted [o vary from a range of 10 hours as an average per response for some minor facilities, to 110 hours as m 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 instmclioos, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regazding the burden estimate or any, other aspect of this collation of information, including suggestions for reducing this burden, to Chief, 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 Management and Budget, Washington, DC 20503. General Instructions 1. [f form has been partially completed by preprinting, disregard instructions directed et entry of that information already preprinted. 2. Enter 'Permi((ee Nomc~:Almiling .4ddress (and facility naztte/locatior4 if di$crenl)," "Permit Number," and "Discharge Number" whrre indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ends ng ".llnnrtonng Perrod" covered by Corm w here indicated. 4. Enter each "Pmrmnretei' as specified in monitoring requirements of permit. 5. Enter "Sample A4ensuremrnt" data for each parameter under "Qunnrirt" and "Qunli(y" in units specified in permit. "Ayernge" is nomtallt~ arithmetic average (geometric average for bacterial paramdcrs) of all sample measurements for each paramder obtained during "dloni(oring Perrod"; "afarrrnunr" and ",tliniunun" arc normally extreme high and low measurements obtained during ".tfomrorrng Perrod" (Note to municipals with secondary treatment requirement: Enter 30-day avzragc of sample measurements under ":h•erol e," and toter maximum 7-day average of sample measurements obtained during nronitoring period under ".lfmximum.'q 6. Enter "Permrt Regmrernenl" for each parameter under "QunntiN" and "QuabN" as specified in permit. 7. Under ",Vo Ex" enter mmibcr of sample measurntents during monitoring period that e~cecd maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency oJ.4nolvs+s" both as "Snmp/e hfeacunnenP' (actual frequeng of sampling and analysis used during monitoring period) and as "Permit Requiren+ent" specified in permit. (e.g.. Enter "Coot," for continuous monitoring. "1 7" for one day per week, "h~0" for one day per month, "1.90" for one day per quarter, etc.) 9. Enter "Smnp/e Ttpe" bosh as "Smnple ;tfeosuren+enP' (actual sample h'pe used during monitoring period) and as "Permit Requirernenr," ie.g., Enter "frmb" for individual sample, ":aHC"' for 24-hour composite, "A`;A" for rnntinuous monitoring, eic.) 10. Where violations of pen;rit requirements are reposed, attach a beef e.~cplana[ion to describe cause and corrective actions taken, and reference each violation by date. 11. If "no discharge" occurs during monitoring period, enter ",Vo Discharge" across form in place of data entry. 12. Enter "Name~Ti!le ojPrrncipal Executive Officer" with "5'ignm(ure ojPrincipnl Executive Officer ojAu(horized Ages(," "Telephone Numrier," and "Da(e" at bottom of form. 13. Mail signed Report to Ot3 ice(s) by date(s) specified in pemtit. Retain copy for your records. l4. More detailed instructions for use of this Discharge tifoniroring Repor( (DA1R) Form may be obtained from O@ice(s) specified in permit Legal Notice Ttus 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 re:tult in civil penalties not to exceed f 10,000 per day o(violalion; 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. EI'A Form 3320-1 (Rev. 08-95)