*****************PAPER WORK REDUCTION ACT NOTICE*****************
*                                                               *
* Public reporting burden for this collection of information    *
* is estimated to vary from a range of 10 hours as an average   *
* per response for some minor facilities, to 110 hours as an    *
* average per response for some major facilities, with a        *
* weighted average for major and minor facilities of 18 hours   *
* per response, including time for reviewing instructions,      *
* searching existing data sources, gathering and maintaining    *
* the data needed, and completing and reviewing the collection  *
* of information.  Send comments regarding the burden estimate  *
* or any other aspect of this collection 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 pre-printed.

 2.  Enter "Permittee Name/Mailing Address (and facility name/
     location, if different)," "Permit Number," and "Discharge
     Number" where indicated.  (A separate form 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 require-
     ments 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 for
     each parameter obtained during "Monitoring Period";
     "Maximum" and "Minimum" are normally extreme high and low
     measurements obtained during "Monitoring Period".  (Note to
     municipals and secondary treatment requirement:  Enter 30-
     day average of sample measurements under "Average", and
     enter maximum 7-day 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 Ex" enter number of sample measurements during
     monitoring period that exceeded maximum (and/or minimum
     or 7-day average as appropriate) permit requirement for
     each parameter.  If none, enter "0".  

 8.  Enter "Frequency of Analysis" both as "Sample Measurement"
     (actual frequency of sampling and analysis used during
     monitoring period) and as "Permit Requirement" specified in
     permit.  (e.g. Enter "Cont," for continuous monitoring,
     "1/7" for one day per week, "1/30" for one 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 "Permit
     Requirement", (e.g. Enter "Grab" for individual sample,
     "24HC" for 24-hour composite, "CONT" for continuous
     monitoring, etc.)

10.  Where violations of permit requirements are reported,
     attach a brief explanation to describe cause and corrective
     actions taken, and reference each violation by date.  

11.  If "No Discharge" occurs during monitoring period, check
     the box for "No Discharge".  

12.  Enter "Name/Title of Principal Executive Officer" with
     "Signature of Principal Executive Officer or Authorized
     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 use of this Discharge
     Monitoring Report (DMR) 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 $10,000 per day
of violation; or in criminal penalties not to exceed $25,000
per day of violation, or by imprisonment for not more than
one year, or by both.