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PaRer~ork Reduction Ac't Njgtice _ _ _ _ _ f-~'..N_ ... ..s~ .- .. .~~.~-~ ..- Public reporting burden for this collection of information is estimated t0'vely' from a range of 10 hours as ao average per response for some minor facilities, to 11D hours as an average per response for some major facilities, with a weighted average for major and. minor facJ,litje~,of }$~rS per response, including time for reviewing instructions, searching existing data sources, galhering'l+fid Maintaining the data needed, and completing end reviewing the collection of information. Send comntcpQS?egarding the burden estimate or any other aspect of this collectioty of information, including suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 40l M Street; SW Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and•Badget, Washington, DC 20503. _~.__. _.r~.... _ . General Instructions l..If form has been partially completed by preprinting, disregard instructions directed at entry of that idformation already preprinted. _. 2. Enter "Permittee Name/A•failing Address (arid facility name/localion, if diH'erent)," "Permit Number," and "Discharge Number" where indicated. (A separate form is required for each discharge.) 3: )sitter 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 pormit. "Average" is normally arithmetic average (geometric average or bacterial parameters) of all sample measurements Cor each parameter obtained during "Monitoring Period"; "Afarimum" and "Minimum" are normally extreme high and low measurements obtained during "Aonitoring Period." (Note to municipals with secondary trealmepl requirement: Enter 30~ay average of sample measurements under "Average," and enter maximum 7-0ay average of sample measurements obtained during monitoring period under "Maximum. 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specified in permit. 7. Under "No Fx" enter number of sample measuements during monitoring period tltat exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each'garame[er. U none, enter "0". 8. Enter "Frequency ojAna/ysis" both as "Sample ~Lfeasurment" (actual frequenry of sampling and analysis used during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cant," for continuous monitoring, "1/7" for one day per week, "f/30" for one day per month, "1/90" for one day per quarter, etc.) 9. Enter "Sample Type" both as "Sample Aeasurement" (actual sample type used during monitoring period) and as "Permit Requirement," (e.g., Enter "Grab" for individual sample, "14HC" for 24-hour composite, "N/A" Cor continuous monitoring, etc.) ]0. Where violations of permit requirements are reported, attach a brief explanation [o describe cause and corrective actions taken, and reference each violation by date. l 1. E "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12. Enter "Name/Title ojPrincipa! Executive Officer" with "Signature ojPrincipa! Executive Officer ojAulhorized Agent," "Telephone Number," and "Date" a[ bottom of form. 13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. l4. More detailed instructions for use of this Discharge Aonitoring Report (DA4RJ form may be obtained from 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 violatioh; 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)