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Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimrtted to vary from a range of 10 hours as as average per response for some minor facilities, to ! 10 hours as oo average per response for same major facilities, a weighted average for ,vajor aad minor facilities of 18 htwts (tat response, including time far reviewing ...." . ' "' ns, seart~iipg existing data sources, gathering aad, g the data needed, and completing and reviewing the cpl~ction of information. Send comments g the burden estimate or any other asput of this collection of information, including suggestions for. cing 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. if form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permiftee Name%Llailing Address (and facility nameAocation, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending iLfonilorimg Period" covered by form where indicated. 4. Enter each "Paramerer" as specified in tgtini[oring requirements ot`permit. 5. Enter "Sample Measuremer~!" data Cor ~(clt parameter under "QunntiN" and "Quality" in units specified in permit. "Average" is normally aritltmeuc.8vei~e (geometric average fpr bacicrial parameters) of all sample measurements for each parameter obtained during "A-funiroring Period ; "Maximum" and "Minimun;" are normally extreme high and low measurements obtained during "Afoniroring Period." (Note to municipals with secondary treatment requirement Eater 30-day average of sample measurements ender "Average," and elver maximum 7-0ay average of sample measurements ob wined during monitoring period under "hfaximum.') 6. Enter "Permit Requireme.ar' for each parameter under "Qunnriry" and "Quality" as spec:ified in permit. 7. Under "No Fx" enter num~er o: sample measurmen[s during monitoring period that exceed maximltm (and/or minimum or 7-0ay average 3s appropriate) permit requirement for each parameter. ff none, enter "0". 8. Enter "Frequency ejAnalysis" both as "Sample hfeasurnrenr" (;tc[ual frequency of sampling and analysis used during monitoring period) and as "Permir Requirernenr" specked in permit. (e.g., linter "Conk" for continuous monitoring, "1/7" for one day per week, "1/30" for one day per motltJr, "I/90" for one day per quarter, etc.) 9. Enter "Sanple Tvpe" both as "Sample Mensuremenr" (actual sample type used during monitoring period) and as "Perrrrit Requirement," (e.g., Enter "Grab" for individual sample, "24HC" for 24-hour composite, "N/A" for continuous monitoring, etc.) 10. R'here violations oC permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. IT "no discharge" occurs during monitoring period, enter "No Discharge" across form in. place of data entry. 12. Enter "Name/I'itle ojPrincrpa! Executive Dicer" with "Signalw•e ojPrincipn! Fecutive Officer ojAuthori."ed Agent," "Telephone Number," and "Date" at bottom of Corm. 13. Mail signed Report to Office(s) by date(s) specified in pernri[. Retain copy for your records. 14. More detailed instructions fcr use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s) specsed in permit. Legal Notice This report is required by law (33 lI.S.C. 13tH; 40 C.F.R. 125.27). Failure [o report or faiPure to report truthfully can result in civii penalties nc[ .o zxceej $10,000 per day of violation; or in criminal penalties not to exceed X25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. OH-95)