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GENERAL INSTAUCTONS <br />I. If form has ken )unialh errrrpkted h)• preprinting. durt4'rJ instrua~iotu~dirte[N at entry of that information :tlrcaJY Drcprinted. <br />I. Fmcr 'PF.RMITTEE NAME/MAILING ADDRESS land facility namc/lacatioa if JiRercntl' -iPERMIT NL'M flF.R.' and 'DISCHARGE • <br />NLAtflF.R' +here indiavted. IA stlonte form b requiml for each diseharge.l <br />7. Finer Ja0.~ RginninF and ending 'MONITORING PERIOD' covered by form +~heR itrdiated. <br />a. Enter each -P:\RAMFTE R" as sporified in monitoring reauircment, of permit. <br />!. Enter -SAMPLE. MEASURF.AfENT data for each wrameter under'QUANTTfY'anJ 'QU.ALITY'in uniu spaaifkd in permi[. <br />'AVERAGE.' is normally arithmetic avenge Itewrwtrk average tar haaerial wruneteral M all vmple mriwremrnta for each wratne[er <br />oMained During -MONITORING PERIOD' 'MAXIM Uhf' and 'MINIMUM- are normally atreme :nigh and lore meaauremenu <br />uhtained during -A1ONTTORING PERIOD' rNOTE to municipals ri[h snvntlary trea[mrnt requiremem. enter 7Uylay avenge of sampk <br />measttrernenta under 'AVERAGE' attJ inter maximum 7-Jay aasn~e of ampk measurements obta incd during moni[nring pttiod under <br />'M.AX1MUh1-. <br />R. Enter 'PERMIT REQUIREMENT for each patatnner under -QUAN'TI'T'Y' and 'tZUALITY' u specihd in permit. <br />T. Under 'NO. FJC' rnter number of ample rneaatrements durnS monnoring Period that tatted m:taimum land/or minimum or 7-0ay <br />aaenpe as aPProprutel permit repuirtment far each wtvnnet. If erorre. rnter -0'. <br />t. Emir 'FREQUENCY OF ANALYSIS- 6wA as 'SAMPLE MFaSUREMENT tactual freauenq~ of nmpling and analysis usW during <br />monitoring period) and as 'PERMIT REQUIREMENT ryeaiRed in permit Ie.{.. Enter YOM:' far contintwrb monitorin{. <br />'I/T far titre day per Feet 'I/7~ for one day per ttton[R 'I/90- for one daY per 9iuner. ete.1 <br />9. Trder SAMPI.F TYPE' holh u -SAMPLE MEASUAEMENT lacteal Ample type used during monitoring perinlt and as <br />-PERMIT RF.VUIREMF.NT.' tag.. Emer 'GRAB' for individual sample.'_aHr= for :4hour asunpaaue. 'N/A- for a»minuous <br />monitoring elc.l <br />________~~_________~____~____ taaru atnw abet <br />10. N'HF.RE VIOI..ATIUNS OF PERMIT RFQUIREAIENTS ARE RFPORTF.U. ATTACH .A BRIEF F.XPI.ANATION TO DESCRIBE <br />CAUSE ANU CORRECTIVE ACTIONS TAKEH. RF.FERENCF. EACH VIOI ~TION RI' U.ATE. <br />11. If 'rto Discharge oaten during moni[orin`` perod, rnter 'NO DISCHARGE acroa. form in Plaat of data entry. <br />1.. Finer 'N.AhI F./T1TI.F. OF PRINCIPAI. F.ICECUTIVF OFFICER" •:ih -SI(:N.4TURF OF PRINCIPAI. F.XECLTIYF OFFICER OR <br />ALryNORI7F.D AGENT.' 'TEI.I:PFIUNE NU7i1BER' arrl -U.A7 E' at Mttum of form. <br />It, Mail sigtwd RrPnrt to OR-etvl M alauts) rgwcilie+I in permit. Retain copy fm )mfr rnwds. <br />IJ. hlorc sletailN imtrtactiom for tin o<this DISCHARfiF. MONITORING REPORT tDSIRI form rruy k oMained from ORta(tl <br />slreeifieJ is permit. <br />LEGAL NOTICE <br />Thif rcpon is repuircd by lar 177 US.C. 17iK: JO C.F.R. I_3.:T 1. Failure to report or failure b rcpun rrtrthfu:ly can result in aril pntaltita not <br />m eveeed SItIAMe) per Jay of cipLstion: or in criminal pamahiati not to <~eecJ S]RnMI per daa of ripluiOll atr by imPriwninem for not more [hart <br />one }'eat, or I,1. Mth. <br /> <br />awO~aa arlw O1W <br />stow <br />•NYlf <br />7O~J <br />artwa craw awe <br />7Y7H 71a•'elf <br />