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Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as m average per response for some minor facilities, to 110 hours as m 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 Branch, PM-223, U.S. Environmental Protection Agency, 401 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 has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permirree Name/A4aifing Address (and facility namellocation, if different)," "Permit Number," and "Discharge Number" where indicated. (A separate form is required (or each discharge.) 3. Enter dates beginning and ending 'Monitoring 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 aritametic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Monitoring Period ; "Afazimum" and "Minimum" are normally extreme high and low measurements obtained during "Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30~ay average of sample measurements under "Average," and enter maximum 7day average of sample measurements obtained during monitoring period under "Maximum.') 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-0ay average as appropriate) permit requirement for each parameter. Tf none, enter "0". S. Enter "Frequency ojAnaiysis" both as "Semple zLleasurment" (actual frequency of sampling and analysis used during monitoring period) and as "Penult Requfreruent" specJed in permit. (e.g., Enter "Coat," for continuous monitoring, "1/7" 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 "Sample Measurement" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "24HC" 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. l 1. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/Titfe ojPrincipa! Executive OjTcer" with "Signature ojPrincipa! Executive O~cer ojAuthorized Agent," "Telephone Number," and "Date" at bottom of form. 13. 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 bonitoring Repot! ~DMR) form may be obtained from OB'ice(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 x25,000 per day of vio]alioo, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev, 08-95)