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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 ed average per response for some major facilities, .. reilh, a weighted average for major and minor facilitieggf 18 hours per respoolse,_iutauding time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing sod revrewing the collection of information. Send comments regardjng the burden estimate or any other aspect of this collation 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; 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 'Permittee h`ame/Itlailing Address (and facility nameAocation, if different)," "Permit •'~umbcr," and "Discharge Number" where indicated. (A separate form is required for each discharge.) 3. Enter dales beginning and ending 'Monitoring Period" covered by form where indicated. 4. Enter each "Parnmerer" as specified in monitoring requirements of permit. 5. Enter "Sample •lfeasurement" data for each parameter under "Quantity" and "Quality" in units specrfed in permit. "Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measttrenten[s for each parameter obtained during ".4lonimring Period'; ",Llaxinrurn" and ",4finimwn" are normally eelreme high and low measurements obtained during "bonitoring Period." (Note to municipals with secondary treatment regairemenl Enter 10-0ay average of sample measurements under "Average," and enter maximum 7-day average of sample measurctncnts obtained during monitoring period under "il4aximurn. 6. Enter "Pennir Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under ",Vo Ex" enter number of sample measurmcnts during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". 8. Enter "Frequency ojAnalysie" both as "Sample A•feasunnent" (actual frequency of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in perntit. (e.g., Enter "Corer," for continuous monitoring, "/~7" for one day per week, "//30" for area 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 "Pervnit Requirement," (e.g., Enter "Grab" for individual sample, "24NC' for 24-hour composite, "•N/A" for continuous monitoring, etc.) 10. Where violations of permit requirements are reported, attach a brie( explanation to describe cause and corrective actions taken, and reference each violation by date. ] 1. L` "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Nanrei?/t!e ojPrincipa! Executive Officer" with "Signnlure ojPrincipo/ Executive O~cer ojAulhorized Agent," "Telephone Number," and "Dare" a[ 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 Monitoring Report (DMR) form may be obtained front Office(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 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)