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Paperwork Reduction Act Notice Public reporting burden for tl»s collection of information is estimated to vary from a range of ]0 hours as an averege per response for some minor facilities, to 110 hours assn average per response for some major facilities, with a weighted average for major apd. p4por jacilif per response, including time for reviewing instructions, searching existing data sources', galbe' salt' inlaining the data needed, and completing and reviewing the collection of information. Send rtls~regarding the burden estimate or any other aspect of this collection of information, including suggestltps for reducing this burden, to Chief, Information Policy Branch, PM+~23, U.S. Environmental Protection Agency, 401 M Street, SW Washinbton, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and Budget;l'Sra$hington, DC 20503. General Instructions 1. If fprm has'beea partially completed by preprinting, disregard instructions directed et entry: of lhaT'information already Preprinted. . 2..`Eoter "Perinittee Name/Jldailing Address (and facility namedocaGon, if different)," "Permit Nrtmber," and "pi5charge Number" where indicated. (A separate Corm is required for each discharge.) - 3. Enter dates beginning and ending 'Monitoring Period" covered by form where indicated 4. Enter each "Parameter" as specified in monitoring requirements of permit. 5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit. "Average" is normally arithmetic average. (geometric average for bacterial parameters) of all sample measurements Cor each parameter obtained during "Monitoring Period'; "Maximum" and "Minimum" are normally extreme high and low meazurements obtained during "Monitoring Period." (Note to municipals with secondary vestment requirement: Enter 30~ay average of sample measurements under "Average," and enter maximum 7day average of sample measurements obtained during monitoring period under "Maximum.) 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az speci<ed in permit. _ 7. Under "No Ex" enter number of sample meazurments during monitoring period that exceed maximum (and/or minimum or 7-day average az appropriate) permit requirement for each parameter. >f none, enter "0". 8. Enter "Frequency ojAnalysis" both az "Sample Measunnent" (actual frequency of sampling and analysis used during monitoring period) and az "Pernrir Requirement" specified in permit. (e.g., Enter "Copt," for continuous monitoring, "1/7" for one day per week, "//30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Type" both az "Sample Measurernenr" (actual sample type used during monitoring period) and az "Perini! Requirement," (e.g., Enter "Grab" for individual scruple, "24HC' for 24-hour composite, "N/A" for continuous monitoring, etc.) 10. Where violations of permit requirements are reported, attach a Drief explanation to describe cause and corrective actions taken, and reference each violation by date. 11. !f "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. l2. Enter "Name//'itle ojPrincipal Executive Officer" with "Signature ojPrincipal Executive OjTcer ojAuthorized Agent," "Telephone Number," and "Date" at bottom of form. ', 13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain rnpy for your records. 14. More detailed instructions for use of this Discharge Aonitoring Report (DA4R) form may be obtained from Office(s) specified in permit. Legal Notice Tltis 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 110,000 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 boll;. EPA Form 3320-1 (Rev. 08-95)