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' - Paperwork Reduction Act Notice -.:~; Pub4c reporting burden for this •ggl(ection of information is estimated to vary from a range of 10 hours as an av~r4Be per response for some minor facilities, to 110 hours as en average per response for some major facilities, v~8`Ir s Weighted average for major end minor facilities of 18 houri~er response, including time for reviewing t linos, searching existing data sources, gathering and. otatpt~atnmg the data needed, and completing and iF~~Ytpg the collection of information. Send comtne~sYC~dfding the burden estimate or any other aspect of collection of information, including suggestigns-1f3~'reducing this burden, to Chief, Information Policy ~~~ , PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; end to the O r~`e of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. i:; _ __ ~: { General Instructions t~.3f form has been partially completed by preprinting; disregard instructions directed et entry of that information already preprinted. - 'Permittee Name/Mailing Address (and fa~1tty name location, if different)," "Permit Number," and xrge lbumber" where indicated. (A separa(e fot9m is required for each discharge) dates beginning and ending 'Monitoring Period" covered by form where indicated. each "Parameter" as specified in monitoring requirements of permit. "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. rge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements :h parameter obtained during "Monitoring Period"; "hlaxitnum" and "hfinintum" are normally extreme high tw measurements obtained during "Monitoring Period." (Note to municipals w~lh sernndary treatment ;meat: Enter 30-day average of sample measurements under Average," and enter maximum 7~ay average ple measurements obtained during monitoring period under "Afarirnum. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. "No Fx" enter number of sample measurments. during monitoring period that exceed maximum (and/or tm or 7~ay average as appropriate) permit requirement for each parameter. if none, enter "0". ~t3.;Enler "Frequenry ojAnalysis" both as "Sample Mearurmenl" (actual frequenry of sampling and analysis used ~' jdudrrg mgm[oring period) and as "Permit Requirement' specified in permit. (e.g., Enter "Cant," for continuous ~; :monitonng, "//7" for one day per week, "I/30" for one day'per month, "//90" for one day per quarter, etc.) ~Ente{-"Sompfe Type" both as "Sample ~Lleasurement" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for imdiv~dual sample, 2JHC' for 24-hour composite, 'N/A" for continuous monitoring, etc.) _ ~,, 14, jWhere violations of permit requirements are reported,-attach a brief explanation to describe cause and corrective ;actions taken, and reference each violation by dale. ~; If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place ordain entry. f~;Enter "Name/1'ifle ojPrincipa! Executive Officer" with "Signature ojPrincipa! Executive Officer ojAuthorized "Agent," "Telephone Number," and "Date" at bottom of form. 9i- _. ~i: Mail signed Report to Office(s) by date(s) specified in perniit. Retain copy for your records. More detailed iiulructions for use of this Discharge Monitoring Report (DA4R) forth may be obtained from Office(s) specified in permit. ~ Legal Notice )rt is required by law (33 U.S.C. 1316; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can civil penalties not to exceed 510,01)0 per day of violation; or in criminal penalties mot to exceed 525,000 per day on, or by imprisonment for not more than one year, or by both. Form 7320-1 (Rev. OS-95) .. ,