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r <br />~r np«, r r~~ !-~ 'r"rO~~~~ ft nik lW~l.~Cf~ <br />Puhlic reporting burden for this ccllecuon of information is estimated to vary from a range of 10 hnu-• as an <br />averaee per response for some minor I~ciidies, (o I10 hours as an average per response for >umB majc <br />facilities, with a wBighted averaee for majo" and minor facilities of 18 hogs per responu. including •inc is <br />reviewing instructions, searching existing d,na sou«es, gathering and muintainine the data reed.d. any <br />completing and reviewing the collection of information. Send cmnments regarding the burden estimate or r...: oche <br />aspect of this collection of informatiot, including suggestions for reducing this burden. to Chief, Inl;~rmnion <br />Policy Branch, PM-233, U.S. Environmental Protection Agency. 401 M Street. SW, Washington. DC' '(?-.HJ; ant; <br />to the Office of Information and Regulatory Affairs, Office of M1lanagemrnt and Budget. R;tshington. J: '_05(I:. <br />V ~^4~1 P'~i ~t. ~Sfis~a E.~+S i.~~i~ <br /> <br />I. II form has been partially completed by preprinting. disre3ard instructions duetted at entry of that nfor r,ition <br />already preprinted. <br />'. Enter `Perrnirree Narnei biailirrg AJdress (and fanhty name/location. it Ji((erent l,` "Ptrmu ,ti unrbrr." dnc <br />"Discharge Number" where indicated. (A sen.irate lixnt is required fur each disch:uge.l <br />3. Enter dates beginning and ending 'Monitoring PeriuJ" covered by form where indicated. <br />4. Enter each "Parameter' as specdied in monitoring requirements of permit. <br />i. Enter "Sample Measurement" data for each pa r.i meter under "Ouantit r" :m tl `Quality' in unit, spcn` z3 in prrmi:. <br />"Average is normally arithntBtic memee 1;~_nmet tic average (or bacterial yarn meter} n` till sample r-r,~,urirem> <br />for each paramecer obtained during "dgonnnrine PcrioJ-: `N:+rinuun` and ',1lininrunf' ..re nonnall} .rt-cme high <br />and low measurements ohtamed during -'haworing PerroJ:~ (\ote ro municipals with secundar. :reatmert <br />requirement: Enter 30-day average of sample measuremens under'rlvrrrge." and Bntc~ maximum ~~duy a~eraec <br />of sample measurements obtained durine monitoring period under "Marinrmn:') <br />6. Enter -Perrnil ReyuiremenY' for eueh pa ra mater under "Quantity" and "Qnelil r'- as spec~fied in permit. <br />7. Under 'No Es- enter number of sample ^icasu rements durng mnnitnn ng period that exceed mas n um land%c r <br />minimum or 7-day average ac appropriate) p.rmil requirement (nr each parameter. If none enter "0' <br />S. Enter "Frequency of Analysis' both as 'Sample Measurement" (actual Irequenc} of sampling and .nial}sis useu <br />during monitoring period) and as "Prnn« Requirement" specified in permit. (e.g., Enter "Coot,- for continuou, <br />monitoring. "1,~7" for one day per wee6, `I 70' fix one day per month, "I/90` (or one d..y per qua«ci. Biel <br />9. Enter `Sample Typr" both as "Sample ,14easurement` (actual sample type used during monitoring periods and cs <br />`Permit Requirement,' (eg. Enter "Grah" Inn individual sample. '"2dH("' for 3d-hour composite. "ti' A' fa rnn- <br />Iinuou5 moni[on ne, r[c.l <br />10. Where violations of permit requirements ;tie reported, attach a brie( esplanaunn to describe caux and corrective <br />actions taken. and reference each violation L•y date. <br />I I. If "no discharge` occurs during mnnnnrine pennd. entry "No Discharge" across (one in place ul data e ur}. <br />12. Enter "Nnme,~Tidr of Principnl trrcuti re Officer' wnh "Signature nl Principal Esecuriva OI'(icer nl Aulharirc~ <br />Agent.''Telephrntr Nwnber,~' and `Date~~ at bottom ul' form <br />I ;. A1ail signed Report to Ofl'~ce(,) b} darebl ~pccified in perm~t. Retain copy for your records. <br />Id. More detailed inslnictiuns for use of this Dischauge Monitoring Hrpnrt IDMR) farm may be oht:nnul (rrn~ OI- <br />fict(s) specified m permit. <br />~eg~l ~I~tice <br />(his report is required by law (33 U.S.C. 131#: 40 ('. F. R. I'_?.?71. Fmlure to repon or tailu re to repnn t-w blot ~. ca t <br />rr,ult in civil penalties not to exceed 5111.00(1 per da} of violation: ur in criminal penahie; not to ercrcd 52 i.(s'10 p.•r <br />dev of violation. or by impnsunntent for not mot,; than one year. ~r b} both. <br />FF'A Form 3320-I (Rer.9-R 81 <br />