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Paperwork Reduction Act Notice Public reporting burden fur rhis collection of information is esti mated m vary fmm a rnn~e •_•( 10 hours as ar. average per response for some minor facilities, to 110 hours as an average per res;mnsr_ for some major facilities, with a weighted average for ma)or and intone facilities of 18 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data npdPd, and completing and reviewing [he collection of information. Send comments regarding the burden estimate or sy e!her aspect of this collection of information, including suggc.tions for reducing this burdec, to Chief, Information Folicv Branch, PA1-223, 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. If form has been partially completed by preprinting, disregard instructions diruted et entry of that information already preprinted. 2. Enter 'Permit(ee Narne/Jl1ailinq Address (and facility name/location if difTrrrn!)." "Permit Number," noel "Discharge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending ';tloni(uring Period" covered by font where indicated. 4. Emer each "Pormneter" as specified in monitoring requirements of permit. 5. Enter "Sample A/eusuren,enP' data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally aii(hmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Afonitunng Perod"; "bfarlmurn" and "Minimum" arc nornally extreme high and low measurements obtained during "tifoni(oring Period." (Note to municipals tt~tlt sernndary treatment rcquircmcnt: Enicr 30-dny avc.2gc of sampic mcasurcmcnls under ".i verage," and enter scuimum 7day average of sample mcasztremcnts obtained during monitoring period under "Maximum. 6. Enter "Permit Requirement' for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Fs" cote: nurttbcr of sample mcasurncnL^ during monitoring pericd that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirentenl for each parameter. ?f none, enter "0". 8. Euici "F rryuency uj,tinaly~i~" buiL as "J'umplr ivJruauraieni° (a[iuai fi i:Gu~~ey of sampling and ar~alysts tt5di dunng monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Copt," for wntinuous monitoring, "1/7" for one day per v. ak, "/'30" fo, cnc day per ;nand;, " r;nn" for o.: day pe: quarter. etc.) 9. Enter "S'ample Type" both as "Sample Afensurcmen(" (actual sample t}pc used dunng monitonng penod) and tis "!'ennil Require,rren(," (e.g., Enter "Grab" for individual sample, "2JIIC" for 24-hour composite, "N/A" for continuous monitoring, etc.) 10. 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. If "no discharge" occurs during monitoring period, enter "Nu Discharge" across form in place of data entry. 12. Enter "Narne/Title ojPrincipal Executive Officer" with "Signa(ure ojPrincipal Executive O]Tcer ojAuthorized Agent," "Telephone Number," and "Da(e" at bottom of form. l3. Mail signed Report to Office(s) by date(s) specified in pcrntit. Retain rnpy for your records. 14. More detailed instructions for use of this Discharge A4oni(oring Repor( (DMR) form may be obtained from O6ice(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 610,000 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 Form 3320-1 (Rev. 08-95)