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<br />1. IEt~nn has at+
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<br />2. Ep[8'r~P.ermiitee Name/Mailing Address (and facility name/location, if different)," ".`Permit
<br />Number" where indicated. (A separate farm is required for each discharge.) ' ~
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
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<br />4. Enter each "Parameter" as specified in monitoring requirements of permit. i '. • :`+ ' -
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<br />~. Enter,'Sanrp/e Measurenrenr"data fir each parameter under "Quantity" and Quality" as specified in permit.: "Average" is''=
<br />normally arithmetic ar•erage (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained.during "Afmriroring Period"; "dfarimum" and Mininnrm" arc normally extreme high and']ow measurements .
<br />obtained,dutirig__'Monitoring.Peciod~.(Nnte [o-inunicipals_with secondary treatment requiremenk:-Eriter:'30-dap.avetage :,
<br />of sample ineasuremen[s under "Arernge,"and enter maximum 7-day average of sample measurements'obtain_ed,during
<br />monitoring period under 'ilfarimum.")
<br />6. Enter "Permit Requirement"-for, each parameter under."Quantih'"and "Qualirr" as specified in permit. -'
<br />7. Under;"N_o Ex" en[e~ number of sample measurement during monitoring period that exceed maximum (and/or minimum
<br />or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". - ~ L; "-
<br />8. ; En[ec`'Fjre"gtrhpcy ojAnalysrs" both as "Sample, Measurement" (~ctua~ frequency of sampling artd analysis used ~uririg
<br />monitoring period) and as "Pernrir Requirernenl"specified in permit. (e.g. Enter "Conn," for continuous monitoring, "I/7"
<br />far ogre day per week,-"1/30" for one day,per month, '.'!/90" for one day per quaver, etc.); - ~ - a ''
<br />9. ' ~ ~ntei "Sgmple;Type" both as "Sample Measw•ement" (actual sample type used during monitoring'period) and as "Permit
<br />• -~~- -
<br />.~Requirem~ti/,:".~ (e.g.' Enter "Grab"'for individual sample, "14HC" for 24-hour composite, "'rb/A" for continuous
<br />monitoring,=etc.) I ~ ~ ~
<br />10. Where ,violations of permit requirements are reported,, attach a brief explanation to describe cause and corective actions
<br />,to 6e•takerr, and reference each-violation by dated-- -~-.- '-- -~ - --- --•- ~ - ~- -
<br />_ I `, ~: .
<br />I I . ~If "nadisch' ~i 'occur d{uingfq"oni ~ S' g pg d,'; h~rg " ~crtiss' forin.in, place ofdata entry.
<br />~ arge: sL lobo I rio entei~'No Disc e
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<br />12:~Enter "Namb/Title; of_ Prir~ipakF'xerT.t~dve;~t~ieer; with' ^Si'grranire ~f Principol_ExBC~t+~~O~cer of Authorized
<br />Agent, ""Telepho`ne Numbed" anfi"Da(9"at houogi of form. ~.; ` ? ° - - " , ° ' , ~ N I ~-
<br />13.'1]Naaz Isigned Report-to Office(s) by da4e(s) specified in pertnif-Retain copy for`youi records-` -~
<br />I4: More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Otlice(s)
<br />'sQecrfied in permit. ~ ~ 1
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<br />Legal Notice
<br />~ p l ) ~ ~~ ~ I I { - '
<br />This report is regtSiFed by law (33 U.S.C. 1318; 40 C;F.R. 125.27). Failure to report or failure to report truthfully can result in
<br />civi~'.p@fialties not,'tio exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of.violation,
<br />or by impnsonmen for not more than one year, or both. ~ ~ y
<br />' ' 1 W I ~ ~ , ~ ~ ... C Ili
<br />f1 I ~ i 1 ~ L 71
<br />EPAr Fdrm 3320.~ll (Rev. 08/95) I ~. 1 ~ o :`'
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