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Paperwork Reduction Act Notice Public reporting burdeo for this collection of information is estimated to vary from a range of 10 hours as an average per response for some minor facilrties, to 110 hours as an average per response for some major facilities, with a weighted avemge for major and minor facilities of 18 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data Deeded, and completing and reviewing the collection of information. Sand commenta regarding the burden estimate or any other aspect of this collection of information, including suggestions fur reducing this burdeo, to Chief, Information Policy Branch, PM-223, U.S. EnviroDmental Protection Agency, 401 M Street, 5\~ WashingtoD, DC 2046D; 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 'Permr(tee h'nrne:LlailinR Address (and facility name location, if different)," "Pen+ri( Number." and "Di.cchnrRe Arumher" where indicated. (A xparate form is required for each discharge.) 3. Enter dates beginning and ending ':4foni(nring Period" covered by form vt here indicated. 4. Enter each "Parameter" as specified in monitoring requirements of pernril. 5. Enter ".Somp(e Afeosvrement" data far each parameter under "Quantity" t,nd "Quality" in units specified in permit. "Averagge" is norntall\ arithmetic average (gcomctnc avcm;c for bacteria] parameters) of all sample measurements far rzch parameter obtained during ".1 /nn+lnring Period"; ".1laxrmum" and "A9in;mum" arc normally extreme high and low measurements obtained during "lfcniwring Pennd" (Note to municipals with secondary treatment requirement: Enter 70-day arcragc of sample measurements under "Average," and enter maximum 7-da} arcrage of sample measurements obtained during monitoring period under "dlarimum. ") 6. Enter "Permit Requirement" for each parameter under "Qunn(i(y" and "Quality" a< specified in permit. 7. Under "No Fr" enter number of sample measurments during monitoring period that exceed maximum (.and/or minimum or 7-day average as appropriate) permit requirement Cor each parameter If none, enter "0". 8. Enter "Frequency oj.4nalysis" both as ".Sample .1~/eosurmenr" (actual frequency of sampling and analysis used during monitoring period) and as "Per++rt1 Renuirer+rent" specified in permit. (e g., Enter "Cant." (or continuous monitoring, "1/7" for one day per week, "1.'30" for one day per month, "hn0" for cne day per quarter, etc.) 9. Enter "Sample Tvpe" both as ".Sample Measmemen!" (actual sample t}'pe used during monitoring period) and ac "Permit Requirernen(," (e.g., Enter "Grob" for individual sample, "2df/C"' Cor 21-hour composite, "N/A" Cor continuous monitoring, etc.) 10. Where 1'iolations of permit requirements are r_ported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. U "no discharge" occurs during monitoring peri ~d, enter "No Discharge" across form in place of data entry. 12. Enter "Name/1'itle oJPrincipa! Executive Officer" with "Signature of Principe( Executive OjTcer ofAuthori.-ed - 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 ux of this Discharge Monitoring Report (D.I~1R) form may be obtained from Office(s) specified in permit. Legal Notice This report is iequired 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 Dot to exceed S10,000 per day of violation; or in criminal penalties Dot to exceed 525,000 per day of violation, or by imprisonment for Dot more than one year, or by both. SPA Form 3320.1 (Rev. 08-95)