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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 an average per response for some minor fac lines, to 110 hours as an average per respomse for some major facilities, with a weighted average for major and ninor facilities of 18 hours per response, including lime for reviewing instructions., searching existing data sot rces, gathering and maintaining the data Deeded, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this eollecfion of information, includiq; suggestions for reducing this burden, to Chief, Information Policy Branch, PNI-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 If form has been partially cotaple[ed by preprinting, disregard instructions directed at entry of that information already preprinted. 2. Enter 'Permittee .Name-.Clotting Address (and facility namelloealion, if diH'erent)," "Permit Number," and "Dischmge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dates beginning and ending ;Clcniroring Period" covered by form where indicated. 4. Enter each "Pararae(er" as specified it monitoring requirements of permit. 5. Enter ".Sample .4fcasurement" data Cor each parameter under "Quantity" and "Quality" in units specked in permit. "Averngz" is normally arithmetic aver age (geometric average for bacterial parameters) of all sample measurements (or each parameter obtained during "; fonrtoring Perioa'"; "Afarrnrum" and "h/ininrum" are nomtally extreme high and low measurements obtained during "Monitoring Period." (Note In municipals with secondar} treatment requirement. Enter 30-day avemgc of sample measurements under "Average," and enter maximum 7 day average of sample measurements obtained duri tg monitoring penod under "Marimurn.'J 6. Enter "Permit Requiremen(" for each Parameter under "Quantity" and "Quality" az specified in permit. 7. Under ",Vo Es" enter number of son ple nteasurnrenls during monitoring period that exceed maximum (and/or minimum or 7-0ay average az appropriate) permit requirement for each parameter. Ll none, enter "0". 8. Enter "Frequency ojAnalysis" both is ".Cmnp/e Measvrmenr" (actual fraluency of sampling and analysis used during monitoring period) and az "Penni( Requirernenr" specified in permit. (e.g., Enter "Conn" for continuous monitoring, "li7" Ccr one day per week. "130" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Snnrple Tvpr•" both az "5'amplc .ileasurentenr" (actual sample type used during monitoring period) and az "Permit Requirement," (e:g., Enter "Grab" Cor individual sample. "14r/C" for 24-hour composite, "N/A" for - continuous reonitoriag, etc.) ~~~-~ 10: ..Where vloFnGorts of permit requirements are reported, tdlach a brief explanation to describe cause and corrective actions ttdcen, and reference each violation by date. 11. U "no di<-.charge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. l2. Enter "Name/title ojPrincipar Fsecutive Officer" with "Signature ojPrincipal Executive Officer ojAu(horized -. Agent," "Telephone Number," and "Da.'e" at bottom of form. 13. Mail signed Report to Otlice(s) by dates) specified in permit. Retain copy for your records. I4. More detailed instructions for use of this Dischmge Monitoring Report (DMR) form may be obtained from Ofl'iice(s) specified in permit. Legal Notice This report is nxryired 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 pt:nahies not to exceed S 10,000 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. 08-95)