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Paperwork Reduction Act Notice Public reporting burden for tl»s collection of information is estimated to vary from a range of 10 hours as m average per response for some minor facilities, l0 1 l0 hours as an average per response for some major facilities, with a weighted average for rrtajorand 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 r. tilts collection of information, including suggestions for reducing Wis burden, to Chief, Information Policy 13rpttch, PMr223, U.S. Environmental Protection Agency, 40l M Street, SW Washington, DC 20460; end to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. General Instructions 1. If form hes been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permi(tee Name/11~ailing Address (and facility name/location, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate form is required (or each discharge.) 3. Enter dales beginning and ending 'iLloni(oring Period" covered by form where indicated. 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements Cor each parameter obtained during "Monitoring Period'; "Maximum" and "Mini,nurn" are normally extreme high and low measurements obtained during "Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30~dav average of sample measurements under "Average," and enter maximum 7day average of sample measurements obtained during monitoring period under "Maximurn.'J 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specked in permit. 7. Under "No Es" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7~ay average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalvsis" both as "Sample Afeasurnenr" (actual frequenry of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Copt," for continuous monitoring, "I/7" for one day per week, "1/30" (or one day per month, "//90" for one day per quarter, etc.) 9. Enter "Sample Tvpe" both as "Sample rLfeasuremenr" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC" for 24-hotu 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. l I. If "no discharge" occurs during monitoring period, enter "No Discharge" across Corm in place of data entry. 12. Enter "Name/title ojPrincipal Executive Officer" with "Signature oJPrincipn! Executive Officer mJAuthorized Agent," "Telephone Number," and "Dare" at bottom of form. 13. Mail signed Report [o Office(s) by date(s) specified in permit. Retain copy for your records. 14. More detailed instructions for ttse of this Discharge Monitoring Report (DMR) form may be obtained from OIl3ce(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 510,000 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. OS-95)