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. Paperwork Reduction Act Notice ~' ` '~. ;
<br />' _ Public reporting burden for this collection of infmtnati'pn is ~ ~i_ -f9`vary'4from a triage of: l0 hours as ao
<br />a~versge per response for some aunor facilities, fq + -' par response for some major Facilities,
<br />with a v~ighted pyfritje f~,~pa, jo! rs der. ,including time for reviewing
<br />- ~iastAreeoae„ satncb~3Si~tirlj'~ ~rces, ga maintaiw,j= n;eded, and completing and
<br />revi%wmg the 4o1Jet'diop:aa. Send comments regatdiog_~ _ estit4ate or nay other aspect of
<br />thin ~collectioo of infornu6os;+'feludiag suggestions for redtuio~_ eo, to Chief, Lrformatioa Policy
<br />Brtirjch, PM-223, U.S. Environmental Protection Agency; 40t;#''~'~pet, SW Washington, DC 2l'Y160; aadto the
<br />' Office of Labornwtioo and Regulatory Affairs, Office of M arnd Budget, Washingop; ~'10503i '
<br />= is _ k_;
<br />Gen~'1 Insxruc~a;.;:. . } , .~
<br />1. If lbrm has been partiallFcoaopl~d by preprintirt~ t;` 7nstructiaa~e birecfeld at entry of that iaformetioa
<br />alroadY P =~----_ - - - _ . -
<br />2: Enter P~uf~ee Name/Mailing .9ddnira ~ - eAacation,. -~ ~t)," "Permit, Number," and
<br />:. pischarge Number" where indicated (,Ar~ejwt_5te fo requited fw ; .)
<br />3. ~ttrer dales beginning and ending iNoni(girriod" rnvered'by forth. while indigted. P
<br />' 4.'En6er each'"~?eter" as smonitoring requirement of pe._ ~' ~ >-
<br />,;.,_
<br />5. Ender " e Measurement" data~i~~h parameter under' ,City."- ^Quality" in units sp in pttmit.
<br />"AV,erage" r :.normally arithmetic ttii (geometric eve ~ ) of all sample measurements
<br />-for each paratoe-eT obtained during iter' .rind'; aximum'.~ Wnlum" are namally.extreme high
<br />an_d_ low measurements obtained during" Period." (Nolte,. 'cipals avit6 secondary treatment
<br />' ?eguiremeM: Enter 30da ge of camp eats undtt 's1' "and enter max~rttttpt 7-0ay average
<br />'; of sgmpletpeastremsn(.s 31~ing mo ~ rind under "MaYlm~y' "~ _ '
<br />. .; --±+ ,
<br />3 ~.'' 6. Enter. •Peieit Requirement" for Ege~,parameter under "Quatndty" and'Qraa~((~,,g6 specified inp ~ ;
<br />. § ~ - i :~
<br />7 i Uader''No: Ex" enter nurtibei' 01' {e measurments moni
<br />a~bp duyytg" toring'1hat exceed maximum (andior
<br />~, minihtOgi-or 7~ay avtragpepflate) permit regetre gkstctt paramt9er:"+It~ane, enter'0".
<br />"` ,5.: Enter "FivegYiency ojAnolysis" both as "Sample A4 ~ actual uenry of sampling and att~ysjs'-used
<br />?: '~;xtltsing~irteditoring period) and as "Permit Regltirenr ed iq fr-, (t.g., Enter "Coat," for continaons
<br />+~ OretritoArt$; ," 1/7" for one day per went; ;FIt130" fQr one day per mpntf4 JJ9Q~'or one day per quarter, etc.)
<br />9. £ttler "Squ1y)te. Type" both as "Samp~easurement" (actual sample- • during monitoring period) and as
<br />"Pentyit Requhtrnient,' (e.g., Enter'+t9rirb" for individual samp 21=fiber cemppsde, "N/A" for
<br />:+icdrNinbousdwaitoring,etcJ ,. _~ ., _'
<br />10."Wt1ere'vio(ations oC permit c .b,are reported, attach a brief~~loa to describe cause and corrective
<br />. actroas taten, and reference akfi by date.
<br />:. ~ ,~~;_
<br />Ci ~If "tto (1tsCharge' occurs;during monitoring period, enter "No DisrhargeE`trm in plan of data entry.
<br />12..,EntGF-"Nacre/fide ojPria~cipal Executive Ocher?' with "Signature oak' ~ ~' Ertcufive Officer ojAutharized
<br />-:, Agent,' 'Telephone fYumbcr," and:'Date" at bottom of form, -,.,_ , } 'r t; ' ' ` '
<br />13. Mail siggod Report m Ol3icx$j (grsdate(s) spe~edw pemut. ~-Refe(u Y ~~ TOOOrfds..
<br />16. More detailod instnrctionrforlr~ot'tliis Discharge Monitoring Report y ~ racy be obtained from O6ice(s)
<br />speed in permit. _ ~ '
<br />' v Leal Notice _- ~;~-'~~~._
<br />13ia gport is retired by law (33 U.S.C. 131g; 40 C.F.R. 125.~n. Failure.~3eporf of failuro to report truthfully can
<br />resYlt'in civil pena4tios not b exceed f10,000 per day of violation; or in crimuiaF~ialartietnot to exceed j25,000 per day
<br />of yir~tion, or by imprisonment for not more than one year, or by both. ,
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<br />! J,.F~; Form 3320-1;(Rev. 08-93) '
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