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Paperwork Reduction Act Notice
<br />Pahl... Gin ~urdu. fOr tid; .:.:., Ct1Or• :.° .p~'~:Ti,.u.u.". wtli~~.:to: i.~ ~ .. .~.
<br />r::j g . _ alj f: Ulli n Idp~'~ ~ I,j ilpn rc gc an
<br />average per response for some tumor tacdrtres, [0 110 hours as an average per response for some mamr facihtiec,
<br />wirb a weighted averageiur mayor and nunor fnciliuec of i8 hours per response, including time for reviewing i
<br />instructions, searchini? existing data soun~es, gathering and ma'mtaining the data needeel, and completing and i
<br />i
<br />reviewing [he collection of in forma[ior,. Send comments regarding the burden estimate or any other asnrct nF
<br />this collation of information, including suggestions for reducing this hurrien, ro Clurf, Informaien Policy ~,
<br />Branch, PM-223, U.S. Environmental Prola4on Agency, 401 M Street, SW Washington, DC 20460; and to the j
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially cumoleted by oreprinting, disregard instructions directed !!t ?nary of that information
<br />already preprinted.
<br />2. Enter 'Permi!!ce .h'nme«loiling Address (and facility' ttamellocation, if di6'ercnQ," "Perini! ,Number," and
<br />"Disc barge Number" c. here indicated. (A separate form Is required for each discharge.)
<br />3. Enter dales beginning and ending ".4lnniioring Period"cocercd by form where indicated.
<br />ti. L-nlcr cacti '!'nrarnc::r us spccaied !n monrtonng regwremcnls of pcrmn.
<br />5. Entc: '.\'rra;nl.: Slraevrcmrn;" d..°;a for each pammcicr n. car "`h~unuh" and "(hirl+h" in units specified in permit.
<br />": h'croge" ~s nuruaily anthnuhc average (gconulnc at sage for bacterial parameters) of all sample measurements
<br />for each paramctcr obt: incd dunng ",t;nnllunng /':nr,J ; "tlnriruum" a:u: ",J,.:unum" are normally extreme high
<br />and loco mcaswemcnts obtauted during ",1lurvtururv i'eruaL" (Note to nt~mopals wath secondary treatment
<br />:C'qt: ~ .~"..l" c,ll'r ?n '!' -'•~.- Cr •:%`:~ I_ 7w5: '. - .. ~ ^d^ ~:. ,._ - CfitCr ri:dxiiilulll 7~iay a. cr:i~~
<br />of sample measurclncnis obL~incd dunng monilonngre~icd under ",lfaximum. ")
<br />6. Enter "Prrrmt Rcgntremenr" for Each paramctcr under "(/uun(iN" end "Ouulily" as specified m permit.
<br />7 llndcr "'\'u 1•~r" enter number of cnmplr mrnvirrarnts d~~-Inn mo~.:~nring periM that c•~r^v.[ ~~.~n'imum (alcd/nr
<br />aiii:l:T: Ti S.- . -..:.~ ,.. ~-:.t,Z ,.~ .:Yr.=fi.~ i~ w_.-...Z ,,....-,.; ~, ~.- ~..~`, parameter If none. ~:,;~ .:, C:.
<br />... Cn:e1 rrC S':. ':C,' Jj CCLI: .. .... .':~:_ ...._ :'ien:... t.: ...-. ..''-qu t?j of `.... :: y^:::o :: n: ... L'SC,I
<br />'C. .. .. 1::,:
<br />during mondoiiug period) and as "Perna! Rcyu~reuirn!" specified to pc,mit. (e. g., Entcl "('unl," far conunuous
<br />mnnhnnng. " /:7" for one dot' ~ 0~ c;°cl-. "/ ~~l" ro• one r -~~ o~~~- mnn~~ ~~ ~ uq= r,r one day nr~ nnaner, etc
<br />9. Enter ".S'ampie ~ypr... i,uth aJ ~VIn11Lr .~iu],b uru'i.: ~ rr0.1iL11 Jdli iln~ :, •'~ ..,u u naK iuJl111Urlllg pCllvul ..
<br />"Perm( Rrguirernrnl." (e. g., Enlrr "(;rah" Cm iudi;iduul sample, "7Jll("' fog 24-hour composite. "\'•-0" for
<br />L,uli(iiltlGii:: ^:Giiiiur: i:b, ~iC.)
<br />10. Where violations of permit requirements are reported, attach a brief e::planaiion to describe cause and corrx;ive
<br />actions taken, and reference each violation by date.
<br />11. If "no dacharge" occurs during monitoring period, emer ".Nu Discharge" across fornl in place of data entry.
<br />12. Enter "Name~Tide ojPrinclpa! Executive Officer" w'ilh ".Signature ajPrincipnl Executive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Dale" al bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your raords.
<br />14. More detailed instructions for use of this Discharge Afoniloring Report (DhfR) form 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 mot to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Fotm 7320-1 (Rev. 08-95)
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