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'uhlic reporting burden for this collection of . tlormatian is estimated to vary From a ranee of f0 hours as an <br />verage per response for some ntinur facitit!es, uy Illl hours van average per rc,po~sc for some majo- <br />teRities, with a weighted average fur major and minor facilitiei of 1R hours per respon,c. including t ne for <br />;viewing instructions, searching esisuag data sources, gatttrring and rnaimaining rtes data needed. and <br />umpleting and reviewing the collection of information. Send cot7ments regarding the burden estimate or un; caber <br />,pest of this rnllection of information. including sug~astioos for reducing this burdev, to Chief, Infnnnation • <br />olicy Branch. PM-3?;, U.S. [nvironmenta! Protection Agency. qOi M Street. SW'. Washin,"ton. DC 1CJh•'_; a~td i <br />> the Office of Information and Reguiarory ,4ftairs, Office of Management and Budget W.tshington, BL~:C503. t <br />Gene:-ai £nstir~c~s~~§ <br />tl tiirnt has been pnrtialR• completed b>• prepnnting dsregard instructions directed at retry of that inform:,tmn <br />already preprinted. <br />Enter "Permitter Name,%rt}ailinK .lddress (and facility name:torrtion. :f rlrfleren7J." "Prrntit Numhrr.- anC <br />"Discharge Num6cr" where indicated. {A sep.rate form is required for each discharge.y <br />Enter date+ begimm~e and ending `A}uniforirp Period" covered by form where indicated. <br />Enter each "P:rramrrer" as specified in momtoring requirements of permit. <br />Enter ".S,vrrple Measurement" data for carp parameter under "pi+unriry- and '"Quality" in units specif icC in permit <br />"Average' is normally arithmetic average (gznmen-ic average fo: bacterial paramererot el al! 5mnpl: mca~urements <br />for each parameter obtained d~!ring "Atonitorine Period': `A}axirnem" ant! 'Alinrmun•' a-e norrnall> r+Irzntc high <br />and tow measurements obruned during ';t}Onira~irrg Perod'" !\ote to mmricipah with secondary uearmrn! <br />requiremcne F:nter 36-day' average of sample 7neasuremtnR under 'A'errge."' and enter maxinwm 7-day average <br />trf sample measurements obtained during monitoring period under'd}a.ximunr.") <br />Enter "Ferrate Requirement" for each parameter under "Quantity' and "tJuali(r'" as specified in permit. <br />Under 'No Es' enter number oi' sample measuremems du^mg monitoring penud that ;eceed m; simnn tard.tr <br />mininwm or 7•day average es appropriutel permit requirement rnr each parameter. ft n~nc. otter '0-. <br />borer "Frequcttry o! Analysis" both as "Simple Measurement Rtctual frequency u! sanpling and ant.lysi, .sod <br />during ntvnihyring period) and as "Formic Requiremem° specified in permit. {e.g.. Enter "Cent." tit; coot nano. <br />monitoring. "!,'7" fur one d:q~ per work, `L :i0' for one day per month. "1;'40"" tier one day per quarter. acJ <br />Enter `Sample Typc'~ butte as "S:unple rLleiaurernent" {actuat sample type used during nuimturinc period) and as <br />°Yrrmir Regtriremenr." (e.g.. Enter "Grab" for indisidual sample, "2~tHC" for ?4-hour composite, "r\'..•~" for aon- <br />tinuous monitoring, etci <br />Where violaUnns of permit requirements arc reported, attach a brief esplann[ion to descnbe Taus. an[ correr[i,e <br />actions iakrn, and reference each violation by date. <br />If 'no discharge' ensues during monitoring period. enter "r\'o Discharge" across linen in place of Jau+ :nb}. <br />Enter "Name,%Title al Principe! f. rtetrtivr Dflh•rr" with "Jienalurr n! Piiacipd( t"a ecmirr OI(i~er r-1 .lufhnriztJ <br />Agent." 'Trlephurre NuinSer." and `Date° ut hunom of form. <br />Mail signed Report «, O(ficefs} by dateis) specified in peen 1. Retain cop} fur your records. <br />More detailed msuuctinm (i)r use of thin Discharge M1fnniroring Report (UMR) form .nay br obt~ii nrd fron Q(~ <br />1'icrfs} spcrif~ed in permit. <br />vegal Nonce <br />rclxirt ie required by lav, (31 11.S.C, t31'~ 4L' L'P.R. 1?5.?7}. Failure to report ur :ailvre to report inrhti,l, Oat <br />in civil pen;dties not to exceed $Ib,OQD p:r dap of violatit?n; or in rriminat penaUics m+t to esccsl ~':~Ut'p p,r <br />f +:olation, or by impri+on^tent ILr not more than one yaar. or 6p bolA. <br />Form 3.i2Q•t (Res, 4.881 <br />