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o ~, o Public reporting burden for this collection of information is estimated to vary from a range o_° 10 hours as an average per response for some minor facilities, to 110 hours as an average per response '°or some major facilities, with a weighted average for major and minor facilities of 18 hours per -espouse, includi ig time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information, including suggestion for reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 iv1 Street, S.VJ. Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Managemer_t and Budget, Washington, DC 20503. -._ o 1. If form bas been partially completed by preprinting, disregazd instruction directed at entry of tha: iz ormation aUeady preprinted. 2. Enter "Fermittee Name/Mailing Address (end facility name/location, if different)," "Permit Numlv,;" any "Dischargz Number' where indicated. (A separate form is required for each discharge) 3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated. 4. Enter each 'Parameter" as specified in monitoring requirements of permit. 5. Enter "Samplz Mzasurement"data for each parameter under "Quantity" aid Quolity"as specified is E _rmit. AL,rogz" is normally arithmetic avenge (geometric average for bacterial parameters) of all sam rle measureme ~ is for each ptnmeter obtained during "Monitoring Pzriod"; "Aii:uimum" and Minimum" are normally extreme high and row measurements obtained during "Monitoring Period". (Nat.: to municipals with secondary treatmert requirement: Enter 30-day avenge of sample measurements under "Averagz,"and enter maximum 7-day average of sample measurerrcrts obtained during monitoring period under "Maximum.") 6. Enter "Permit Rzquirement"for each parameter under "Quantity"and "Quality"as s~ec~fied in penni:. 7. Under "No Ex" enter number of sample measurement during monitoring period that exceed maximum (andior minimum or 7-day avenge as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency of Analysis" both as "Sample Ivlzasuremznt" (actual frequency o` sampling and ana'ysis uses during monitoring period) and as "Permit Requirement" specified in permit. (e.g. Entet "Cent, "for continuou; monitorir„ "I/7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter 'Sample Type" both as "Samplz Measurzmznt" (actual sample type used during monitoring neriud) and as "Permit RequirzmznJ," (e.g. Enter "Grab" for individual saznple, "14HC" for 24-hour ccmposite, "IJ/.5" for continuous monitoring, etc.) l0. Where violations of permit requirements arc reported, attach a brief explanation to describe cause and corrective actions to be taken, and reference each violation by date. 11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data a rtry. l2. Enter "Name/Title of Principal Executivz Officer" with "Signature cJ Principe! Executive Ot,Tiaer cJ Audrori.:ed Agent, ""Telephone Number, "and 'Dole" at bottom of form. l3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. 14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office(s) specified in permit. ]Legal loT®~~~~ This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure [o report or failure to report truthfully can -esult in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisorunent for not more than one year, or both. EPA Form 3320-1 (Rev. 03/99)