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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 (or some minor lacilities, to I10 hours as an average per response for somz major facilities, with a weighted average for major and minor lacilities of IR hours per response. including time for revizwin~ instructions, sea« hing exisuo~ data sources, gathering and maintaining the data needed, and completing and reviea•htg the collection of information. Send comments recording the burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden, to Chief, Information Policy Branch. PM-2'1, U.S. Errvironmental Protection Agency. 401 M Street. SW, Washington. DC ?0460; and ul the Office of Information and Regulaurn Affairs. Office of Management and Budget. Washington, DC 20501. General Instructions I. It term hos been partially completed by preprinting. disregard instructions directed at entry of that information already preprinted. ?. Enter "Perrnittee Namejblai/ing Address (and facility name/location. if different)." "Permit Number." and "Discharge Number" where indicated. (A separate lurm is required for each discharge.) ~. Enter dates beginnine and ending "Alnniroring Period" cohered by form where indicared. -0 Enter each "P.7rnmerrr" us specified in monitoring requirements of permit. 5 Enter ".Sample M17easurement" data fur each panuneter under "Quanrirl~~' and -Qualifa~" in units specified in permit. ':Areruee" is normally arithmetic areraee (geomettit overage (or bacterial parameter) of all sample measurements for each parameter oMained during '7Vuni(orin,' Period-; "Ma.rinnun" and 'Afininwm" are normally extreme high and law measurements obutined during "M1loniroring Period: (Note to municipals with secondary treatment rcquircmem: Enter 30-day average of sample mrasm~ements under 'Aver:age." and toter maximum 7-day average ul' s;unple measurements obtained during monitoring period under "Mu.einrurn.`) 6. Enter "Perri( Reywrement" for each p81'a )octet under "Qaanrlf L''~ 8nd "Qllalil}''~ aS StICCII led in permit. 7. Under "No E.r" enter number of sample measurements During monitor ng period that exceed maximum (and!or minimum or 7-day averuee as appropriate) permit requirement for each parameter. I( none, emer "0". J. Enter `F requemry' n( .Analysis" both as 'Sample Measurement" (actual Frequency of sampling and analysis used during monitoring period) and us' "Permit Reymrement- specil ied in permit. (c.g., Encer "Cont.' fur continuous monitoring. "!; 7" fur one day per week. `1: i0" for one day per month. "l; 9U" fur one day per quarter, etc.y y. Enter "Sample Typr" both as "Sample Aleasu rrmem- (actual sample type used during monitoring period) and as `Fermi! Requirement.' (e.g.. Enter "G rah" for individual sample. -7dHC" for ?4-hour composite. "N./A" for con- tinumrs monitoring, rtcJ 10. Where violwions of permit ream remznts are reported, attach a brie) es planation to describe cause and corrective nctiuns taken. and reference each violation by date. I I. If "nu discharge' occurs during monitoring period. enter "No Discharge" across form in place of data entry. 13. Enter 'Name,~Tide n! Prncipal Erecutitr Oflicer" with "Signu0rre of Principal Esecurive Officer of Authorized Agent," -Telephone Number,- and `D.ur~' at bottom ul form. I ~. Mail signet Report ¢+ Office(s) by date(s) specified in permit. Retain copy for your records. la. :More detailzd instructions for use of this Dlscharge Al<mitnring Report (DMR) form may be obtained from OI- fice(sl specified in perm[. Legal Notice this report is required by law Q3 U.S.C. 131R; 40 C.F.R. I?S.?7). Failure to report or lailure [o repot) truthfully can result in civil penalties nn[ to exceed 510.000 per day of violation: or in criminal penalties not to escecd S?5.000 per dac 01 violation, or by imprisonment lur not morn than one year. or by both. i EPA Form 3320-I (Rev.9-881