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Paperwork Rteduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as nn average per response for some minor facilities, to I10 hours as an average per response for some major facilities, with a weighted average for major and minor facilities of 18 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 Hranch, 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 'Permittee ,Vame/I~failing Address (and facility namellocation, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending "Alonitoring Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter ".Sample tifeasvrernenr" data for each parameter under "QuanrrN" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average for bacierial parameters) of al! sample measurements for each parameter obtained during "Afon;torirg Period"; "4laximum" and "1vlinimwn" arc normally extreme high acad low measurements obtained dunng ".tonitoring Period." (Note to municipals with secondary Vealmenl requircmenC Enter 3U-day average of sample measurements under "Average;' and enter maximum 7-day average o(sample measurements obtained during monitoring period under ".4faximum. 6. Enter "Permit Requirement" for each parameter under "Qvonriry" and "Quality" as specified m pcrtni[. 7. Under ",Vu Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) pcrniit requirement for each parameter. It none, enter "0". 8. Enter "Frequency ojAnalysis" both as ".Sample ;~leasurnrerrt" (actual frequent} of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in permit. (e g., Enter "Cant," for conti_uous monitoring, "I/7" for one day per week, "Ii30" 1'or one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Type" both as "Sample ,lfeasuremenr" (actual sample type used during monitoring period) and as "Perrnir Requirement," (e.g., Enter "Groh" fur individual sample, "2JHC' Cor Z~L-hour rnmposite, "N/A" for continuous monitoring, etc.) 10. Where violations of perntit requirements arc rt:ported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation oy d:.te. 11. U "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/Title ojPrincipa! Executive Officer" with "Signature ojPrincipal Executive Officer ojAulhorized Agent," "Telephone Number," and "Date" at bottom of form. 13. Mail signed Report to Otiice(s) by date(s) specified in permit. Retain copy for your records. 14. Mare detailed instructions for use of this Discharge A-fonirorrng Report (DhfRJ form may be obtained from Office(s) specJed in permit. Leal Notice 71ris 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 $25,000 per day of violation, or by imprisonment for not more than ono year, or by both. EPA Form 3120-1 (Rev. 08-95) ' _-t