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I <br />GENERAL INSTRUCTIONS <br />I. If form has tern paniall) complete) by prcPriming. disregarJ inslrurlioro~dircctN at entry of thin information :JrcaJ)' preprintN. .~ <br />_. Finer 'PFRMITTEF. N,{AfF/MATT-ING ADDRESS tend ta<ility namc/localion, if JiRercnt l." "PERAfIT NUAINF.R' and "DISCH.1RGE <br />NL'A1HF. N.' there inJi<ateJ. to separate form is rcquirN for each dixharge.l <br />?. Fntrr J:rt¢s MFinninp and ending `MONITORING PERIOD" coserN by (arm There indinted. ' <br />1. Fmrr each -PA RAAI F.TF.R' as specified in monitoring rcquiremema of permit. <br />!. Enirr 'SAAIPLF. AfEASURF. AIENT data for each Wrameter unJcr 'QUANTITY anJ "QUALITY' in units spe<ifed in permit. <br />-.{VFR.{GF." iv normally arilhmnic avenge tgeometric avenge for bacterial parametenl of all ~smple mrawrcmenls for each Parameter <br />ohtaineJ JurinF 'MONITORING PERIOD" `MAXIMUM` and 'M1N1MUA1' are normally extreme high and low mesaurements <br />ohnined during 'MONITORING PERIOD.' rNOTF. to municipals with smondary treatment requirement. enmr ?IWay avenge of ample ~~ ~, <br />meaattremenls under `AVERAGE' anJ enter maximum 7-Jay average o! sample meausrcments obtained JurinF monitoring period under <br />'AfAXIMUAf'. <br />6. Enter 'PF.RAIIT REQUIREMENT for each paramner undtt `QUANTITY' and 'QUALIT'Y' as specified in permit. <br />7. L'ndtt 'NO. FJ(" enttt number of ample meawrcments JurinF monitoring 1+eriod (hat esceed maximum land/or minimum or 7-0ay ' <br />a+enge as apProPriatel Permit regUlRnlenl tar each Isanmeltt. If none. enlR "B". <br />A. Enter FREQUENCY OF ANALYSIS' Fah as `SAMPLE MEASUREMENT Ixtml fn:quenq of sampling and analysis uxJ JurinF <br />monitoring period) onJ u 'PERA1fT REQUIREMENT specified in permit. le.g.• Enter `CONT.' for rnntinttous monitoring, <br />'I/T' for one Jay per reek. 'I/30` for one daY P<r month. "I/9n' for one day Per gwntt, etc.) <br />9. Enter "5.{MPI.E TYPE' both as `SAMPLE MEASUREMENT laetwl ample qT+c used During monitoring ItttinJl and as <br />'PF.RAIfT RF.QUIREAIF.NT' Ie.F., Enter TiRAB" for inJividwl umpk. ".1H! for :411our comP~te. 'N/A' for continuous 1> <br />monitoring, etc.) <br />~~ _ 11/Yli 7YlM 01011 <br />IU. N'H F.RE VIOI.ATIUNS OF PERAfIT RFQUIREAIENTS ARE RF.PORTI:1). -{TTACH A BRIEF F.XPI.ANATIOV TO DESCRIBE <br />C{USE .{NU CORRECTIVE ACTIONS TAKEN. REFERENCE EACH v101.:\TION BY UAT'E. ~". ~; <br />11. If "no Discharge' o<cvn during rtanitoring Period_ emcr `NO DISCHARGE: across form in plate of Jan entry. <br />1.. F.nler "NA A1F/TITI.E OF PRINCIP.{I. EXECIffIVF OFFICER` ++ith `SI(i\:\TURF. OF PRINCIP.{I. EXECUTIVE OFFICER OR <br />.{UTH(1R17-F.D AGENT.' `TEI.I~PfIONE NL'AIBF.R" arW 'DATE- at h+ttum of form. <br />I?, Atail signed RePnn to Offvehl hr Jatatxl sptcifiN in permit. Retain copy- for )art re<orJs. <br />li. More JttailN imtructioru for use of Ihiv DISCHARtiF MONITORING REPORT ID]1R1 form may fe uhuinnt from 0f11cels) <br />sPecifiN in permit. - <br />LEGAL NOTICE <br />This rcyort i. require) by tar 1?7 US.C. I?IR: ltl C.F.R. 1.x,:71. Failure tr+ rrpun nr failure to r<pon Truthfully can rc.ult in rivil pewlties trot <br />m ascml $Ill.lxal pct Ja) of vioLT'ton: or in criminal prnah4~ not to escccJ S.SJIIaI per Jay of +blmioo. or hr impriwninem for opt more than = <br />one year, or h)' Mth. <br />awooaa craw aloe <br />7g13N <br />dWr15 <br />3~rld <br />OYIX1 aYaM n101 <br />3a3H a~drJ.s <br />