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Paperwork ]Eteduction 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, to 1 IO hours as en average per response for some major facilities, with a weighted average for 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 collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing Ibis burden, to l'_hief, 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, Oftce of Management end Budget, 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 'Permittee Name/1Lfailing Address (and Cacility name location, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate forth is required for each discharge.) 3. Enter dates beginning and ending ';4onitoring Period" covered by form where indicated. 4. Enter each "Pararnerer" az specified in monitoring requirements of permit. 5. Enter "Sample Afeosurement" 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 measurements for each parameter obtained during ".1•lonimring Permd"; "Alaznnum" and "~Llinimum" are normally extreme high and low meazurements obtained during "Muviroring Period." (Note to municipals with secondary vestment requirement: Enter 30~ay average of sample measurements under "Average," and enter maximum 7-da}• average of sample meazurcments obtained during monitoring period under "A4aximum.'J 6. Enter "Permit Reyuiremenr" for each paramete- under "Quantity" and "Quality" az specified in permit. 7. Under '"No Ex" enter number of sample mcasurmenls during monitoring period that exceed maximum (and/or minimum or 7~a} average az appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalysis" both as "Sample ,'I~easurmenr" (actual Gequency of sampling and analysis used during monitoring period) and az "Pe•rrnit Reyuirernenr" specified in permit. (e.g., Enter "Cons," for continuous monitoring, "li7" for one day per week, "Ii30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Tvpe" both az "Sornple .4feasurernent" (actual sample qPe used during monitoring period) and as "Perini! Requirement," (e.g., Enter "Grob" for individual sample, "14HC' for 24-hour composite, "N/,t" for continuous monitoring, etc.) l0. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. ff "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/!'itle ojPrincipa! Executive Officer" with "Signature ojPrincipa! Executive Officer ojAulhorized Agent,", "Telephone Number," and "Date" al bottom o(form. 13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records. 14. More detailed ituYruclions for rue of this Discharge hfonitoring Report (DMRJ 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 510,000 per day of violation; or in criminal penalties not to exceed 325,000 per day of violation, dr by imprisonment for not more than one year, or by both. EPA Form 3380-1 (Rev. 08-95)