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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 sorce minor facilities, to 110 hours as an average per response for some major facilities, with a weighted average for major and minor facilities of l8 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, 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, Washingtom, DC 20503. General Instructions 1. If form has been partially completed by preprinting, disregard instructions direcled~at entry of that information already preprinted. 2. Enter "Pern+rttee A'nnre!tlading Address (and facility nameAocalion, if diH'erenQ," "Permit Number," and "UrscGnrt;r 4"rember" wh~:re indic~tcd. (A separate form is required Cor each discharge.) 3. Enter dales beginning and ending " 1lnnimring Period" covered by form where indicated. 4. Enter each "Parameter" a specified in monitoring requirements of permit. 5. Enter "Sonrple .4leanrrerarru" data fur each parameter under "Quantity" and "(luolity" in units specified in permit. ".gvrrnge" is normallc ai uhmeUC average (geomMric average far bacierial parameters) of all sample measurements for each pammeter u6taincd during ".ilumtormg Penorf'; ",ilaxmmm" and "aLnunam" are normally extreme high and low measurenrr.ts ob;a~,red during ".1lnmturrng Period." (Note to municipals with secondan treatment requirement: Enter 3t~-ciao accragc of sample measurements under ",dverage," and enter maximum 7day average oCsample measurements obttinad during monitonng period under'Sl/nrimum. "/ 6. Enter "Pernrir Reyuiremrnr" for each parannclcr under "Quantify' and "Qua'ity~" as specified m permit. 7. Under "No F_r" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as aparopriate) perntit requirement for each parameter. If none, enter "0". 8. Enter "Freyuencl~ oj.4nnlysis" both as "Sample hleasvrment" (actual (rcqucnc}' of sampling and analysis rued during monitonrg period) and as "Fermi! Requrrerneur" specified in pcnnil (e.g., Enter "Cont." for continuous monitoring, "/ '7" for om: day per week, "I'30" (or one day per month, "1:90" for one day per quarter, etc.) 9. Enter ".Sample Type" bcth as "Sample ,lfcasurerrrenr" (actual sample ppc used during monitoring period) and as "Permrr Reyuirernenr," (e.g., Enter "Groh" for individual sample, "?dHt"' for 24-hour composite. ",1'.:4" for continuous monitoring, lac.) 10. Where violations of perail requirements are reported, attach a brief explanation to describe cause and corective actions taken, and reference each violation by dale. 11. It"no discharge" occurs during monitoring period, enter "No Discharge" across fornt in place of data entry. 12. Enter "N'ame/Title ojPrincipal Executive Officer" with "Signatare ojPrincipal Executive Officer ojAuthori:ed Agent," 'Telephone Number," and "Dare" at bottom of torn[. 13. Mail signed Report to OITce(s) by date(s) specified in permit. Retain copy for your records. 14. More detailed irutrnctiotrs for use of this Discharge Aloniroring Report (DA1R) form may be obtained from O[fice(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 rcaul[ in civil penalties not to exceed S10,lwo 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. 08-9!.)