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'~c4~~'>?prC.n:(, r`.~~a£CL~IC~`.12"~ ~,6,'i I~lTl3izr^.,', <br />Puhhc reporting burden for this collection of information is estimated to vary from .i ranee of 10 hours as an <br />average per response for some minor facilities, to 110 hours as an average per response for sent major <br />facilities, with a weighted average far major and minor facilities of IS hours per response, including time tnr <br />reviewing instructions, searching existing data sources. gmhering and maintaining the data needed. std <br />completing and reviewing the collection of inlormmion. Send comments regarding the burden estimate o ;ny other <br />aspect of this collection of information, including suggestions for reducing this bu~]er. to Chief. In101'mellnn <br />Policy Branch. PM-??i, U.S. Environmental Protection Agency. 101 M Streit. SW', \l'ashington. DC '('-160; and <br />to the OI(ice of Inlbrmation and Regulator} A(lairs, Office of ~lanaeemrnt and Budget. Washington. DC ?Oi0). <br />Gc~cra~ lnst.~r~:ctz©r~~ <br />I. II form has been partially completed b} preprinting. disregard instructions directed at entry of tha: information <br />alread}• preprinted. <br />3. Enter 'Permirree Nume~A•lailing AJJres., (and facility name; lorwon. if Jd(erenU.' "Permit A',unber." and <br />"Discharge Number' where indicated. (A separate form is required (ur each discharge ) <br />3. Enter dates beginnine and ending "rNoniruring Period" covered by form where inJicatrd. <br />4. Enter each "Parameter" ^s specd'~ed in nu tutoring requiremznH of permit. <br />5. Enter "Sample Measurement" data fur ea,1 pa r,imrter under "Puanriri" and "Qudlir~ ' ,n units sper ~ ;d in permn. <br />"Average" is normally arithmetic average Igrnmatrc average for bacteria' parameters) of all sample measurrmer.;s <br />lur each parameter obtained dunng "Nfon,roring Perin)-: ',L(:reimu+n~' and "hlinrnun7f are nonnall~ ;airrn~; hich <br />and low measurements obtained dunng 'M1tnni(w ing PenoJ.~~ (lore ro municipa's With secnndur7• trcatme-t <br />requirement: Enter .0-d:+y average of sample measurements under "Avervge." and enter maximum "-day n~eruse <br />of sample measurements obtained dunng monitoring period under "M11a.eimunr.") <br />6. Enter -Fermi! Requirement" for each parameter under "(luaruity" and "'7luuld}'' as speed`;) in prrcfn. <br />7. Under `No Ex" enter numbzr of sample mcasuremenu during matiuiring perod tho' exceed m;r.~nmm land,. r <br />minimum or 7-day avemee us apprnpnatel permit requirement for each parameter. If none, enter'U`. <br />S. Enter "Frequency n( Analysis" both as '~.4urnple Measurement" (actual frequency ul sampling and : nal}vs use: <br />during monitoring period) and us "Permit Requirement" spree) red in permit. (e.e. filer "Coot," for ernes nuous <br />monitoring. "I,'T for ono day per rvee4., `l.'.70- for one der} pzr month. "1; 9U" for one der} per yuarzr, etc.) <br />9. Enter "Sample Type" both as ':Sample ,M14rasuremenr" (ucwal smnplc type u,rd during monitoring pariodl and vs <br />`Pernrir Requirrmrnr.- (e.g.. Enter "G rd6` for individual sample, "?4HC' for 34hour zompositz, "'n~A" for con- <br />tinuous monitorine, etc.) <br />10. \4here violations of permit requiremems are reported, attach a brief esplan:uion to dcacribe cause and cor-ecti~e <br />actions taken. and reference each violation ~~ Jute. <br />I I. If "nu discharge' occurs during mnnitori eta period. enter "Nn Disc Barge" across soon .n place of data crtry~. <br />13. Enter "Name,~Title M~ Principal trecmitr Ofl rcer" with "Sirnamre of Principal t+ecerite Ofi ice! n'' AurBnrimJ <br />Agent"'Telephone fs'umhrr,` and "Dare`.a 6nltum ul form. <br />I?. Mail signed Report to Ofl icelsl h} date(s) ,pecif ied in pznnit. Retain cup} for }our rcordc. <br />Id. More detailed mstructiun, tar use oY the, Ui;char,e ,lfommring Report IDMR) Ilan ma} br oht~ur;d tent. Of- <br />fice(s) specil ied in permit. <br />Legal Nc~ace <br />this report is required by laH (33 E'.S.C. IiIR: J(1 C.F.R. R5.'_7). Failure to report or Inilure to repon irutl~l'.illy c_n <br />result nt civil penalties not to r~ceed $If/.000 per der} of violaunn: or in criminal pen;iliie, not to esc. zd 'i35.0a0 per <br />der} of violation, ur by imprisonment stir nut mare than one yzar. o. by both. <br />FPA Form 3910.1 IRev, q-881 <br />