|
Paperwork Reduction Act Notice
<br />1'ubI1C remrfino 6nrrlen fnr tFie r.~I, 1..~ttr,C. .^,f mfoFralC,n ~, ~.Sii GCiiw i~~ ~nr; fiOrn a Idn Vr~ ni Ili hnn.._ ~.: y.
<br />urwa6c yc. ,wNuuse iL~ sumu minor iacluUes, to I IU hours as an average per response for some major faciGtirs, ~
<br />wah 2 :vc:gL•!..:.' nvcrag:: for major and miuul ixuiuics ui 18 hours per response:, includme lime for reviewing I
<br />' instructions, searching cxtsting data sources, gathering and maintaining the date needed, and ~-ompleting and ~~
<br />revtewing the collection of information. Send wmments regarding the burden eshrnate nr any nthrr ?mr^'. cf '
<br />this collection of information, including sueges[ions fur reducine this harden, to Chief, Information ^ohcv
<br />~, ;3rm',ch, P:ri 223, U.S. ~rvironmentai rnlirxtmn Agency, 401 M Street, SW Washington, DC 20460; and to the ~
<br />Office of Information and Regulatory Affairs, Office of btwtagcnteot and Budget, Washington, UC 20503.
<br />i
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard inctructinnc dirnrted at en!rf of that information
<br />already preprinted.
<br />2. Enter "Perminee M1'nmealnilino .-lddress (and facility tlame/IoCatlon, it d:?crcn[)," "Penni( Number." and
<br />"DScilurgr :CuulSer" where :ndicatctl. (A separate form is required for each discharge.)
<br />3. Entu tialcs beginning and ending "1lonlh,rurg !'eriud" covered by Corm where md:catcd.
<br />4. F.nlcr ~,ch "Ilorunrlrr";u .cho ifmJ w monitoring rcgwrcmentsofpernut.
<br />d. enter '~.~anrpie 1 Rv~~urernrnl' data for each parameter under "Qurmlirv" and "(hrnli0" in wtils specified in permit.
<br />"Avernge" is norntall~ arithnictic ar~crage (gcontcuic arcrage for bactenal parameters) of all sample measurements
<br />for each parameter ubiaincd dating `:Ilnrernnns; PennU°'; ".4larimurrr" and ".tlinrnmrn" arc nutntally ealreme high
<br />and low measurements obtained dunng ".lion tfuruiX /'crrod " (Note to municipals with sccondan treatment
<br />reawrcmcnt Fnter l0-d~,•~ ? '^r^gc of cy^.:^!e mcas,lr:r.!ena '+cd,r "Jtr..age~.° and enter m.t~.i: 7-may average
<br />of sample measurements obuuned dunng monitoring period under ".t lazirnunr.
<br />6. Enter "FrrmU Reyuiremen(' for each parameter undcl "Uunnnrv" and "Duality" as specifies in permit.
<br />7. Under '^~u Ez" enter number of s'tmp{e mi:asurments durine monitoring prtind the! c~c^^i mauimum (and/or
<br />minimum or ~-dn\' _. ^nec ,^,- .^.rp(orr....^_) ; ,,.,., ,.y,: ,.,~.~r: fcr Z..Ci'r parumttct. IC iluir,,..,uiU "0".
<br />3. Ertcr "I'.'cqurny~ ~~' ~t,:,.h •:." L.,;I! .-; "'d-r•-;d~. :.:ru...•m::::" (au:-:i lrequc::_; .- s:::rp::ng a: ana:ysis sea
<br />during monitoring period) and as "Peruui Regaircuu•ul" specified in permit (e.g~, Eider "( tin(,"ufor eOnlinuoos
<br />motutornR, "/ •;" for tine Jay per week. "; ;D" for nn' da~~ ncr ?•nr.lh ~' i orr' frr ~r~.~ n,. ~ _. gtt:~tler, etc )
<br />:. .., .e. ..~r,q ,. .:(•. v~,u vi ": uinr(n; ~,;. u...d, urt'r,r ~.aiaei ali niiiii it fri ii~w uiri ii r; liitiih lurllle pefunij ann a
<br />"Fermi( Reyu/renrent," (c g.. Enter "Groh" for individual sample, '`_'dH("' fu: 24-huur composite, ".\•.1" for
<br />continuous momlorin~, e!c )
<br />10. Where violations of permit requirements am reported, attach a brief explanation to describe cause a»d corrective
<br />actions taken, and reference each violation by daft.
<br />l1. U "no discharge" occurs during monitoring period, enter ".\'o Discharge" across form in place of data ante
<br />12. Enter ",Yame/I'irle oJPrincipal Ezecurive Officer" with ".Signature ojPrincipal Fxecurive O~cer ojAurhorized
<br />.4gent," "Telephone Number," and "Dare" at bottom of form.
<br />I3. Mail signed Report to OH"ice(s) by date(s) specified in permit. Retain copy for yow records.
<br />14. More detailed instructions far use of this Discharge Afomroring Repot( (D,LfR) loan may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for no[ more than one year. or by both.
<br />EPA Farm 3320-1 (Rev, 08-95)
<br />
|