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GENERAL INSTRUCTIONS <br />I. If form has been partially completed by preprinting, disregard instructions directeJ m entry of Thai in formation ;J rradv preprinted. <br />_. F.mer "PERMITTEF. NAME/MAILING ADDRESS land facility name; location, if Jiflzmnt ): "'PER ALIT lq Uh1HER," onJ "DISCHAARGE <br />NUMBER" where indicated. IA separate form is required (or each discharge.) <br />3. Enter dates bzginning and enJing "MONITORING PERIOD" covereJ by form where indicated. <br />a. Enter each "PARAMETER" as specified in monitoring requirements of permit. <br />3. Enter "SAM1IPLE MEASUR~.MENT" data for each parameter unJer'QUANTITY" and "QU.ALITY" in units specified in permit. <br />"AVERAGE" is normally arithmetic average (gzumel tic n~erage for bacterial parametenl of all Semple measurements for each parameter <br />oblaineJ During "MONITORING PERIOD:' "M1tAX111UM" anJ "MINIMUM" arc normally extreme high and low measurements <br />ohtaineJ during "MONITORING PERIOD." INOTF to municipals with szconJary trralmeni rcyuirc mint, enter 30 Jay average of sample <br />measurements' under "AVERAGE" and enter maximum 7-J:ry average of sample measurements obtained During monitoring period under <br />"MAXIMUM". <br />6. Enter "PERMIT REQUIREMENT" (or each parameter under "QUANTITY" and "QUALITl"' as specified in permit. <br />7. Under "NO. FX" enter number of sample measurements During monitoring period that exceed maximum (and/or minimum or 7~day <br />average as appropriate) permit requirement for each parameter. If none, enter "0". <br />8. Enter "FREQCENCY OF ANALYSIS" both as "SAMPLE MEASUREMENT" (aaual frequency of sampling and analysis used During <br />monitoring per.od) and as "PERMIT REQUIREMENT" specified in permit (e.g., Enter "CONT." for continuous monitoring, <br />"I /7" (or ono day per week, "I/30" for one day per month, "I/90" (or one day per quarter, etc.) <br />9. Enter "SAMPLE TYPE" both as "SAMPLE M1tEASUREM ENT" (actual sample type used During monitoring period) and as <br />"PERMIT REQUIREMENT." (e.g., Enter "GRAB" for individual sample, "?4HC" for ?4-hour composite, "N/A" for continuous <br />monitoring, etc.) <br />tisatd 3a3N a~od> <br />10. WHERE VIOLATIONS OF PERMIT REQUIREMENTS ARE REPORTED. ATTACH A BRIEF EXPLANATION TO DESCRIBE <br />CAUSE AND CORRECTIVE ACTIONS TAKEN. REFERENCE EACH VIOLATION BY DATE. <br />1 I. If "no discharge" occurs during monitoring period, enter "NO DISCHARGE" across form in place of data entry. <br />I?. Enter "NAME/rITLE OF PRINCIPAL EXECUTIVE OFFICER" with "SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT;' "TELEPHONE NUMBER" and "DALE" at bottom of form. <br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. <br />14. More detailed instructions for use of this DISCHARGE A10NITORING REPORT (DD1R) 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. Illg: 40 C.F.R. 122.22). Failure to report or failure to report truthfully can result in civil penalties not <br />to exceed $10,000 per day of violation; or in criminal penalties not to ex teed $?5,000 per day of violation, or by imprisonment for not more than <br />one year, or by both. <br />.---------------------------------------------UN0735 3tl3H CllOd <br />3213H <br />dWtl15 <br />3~Vld <br />--------'---°-'---------------------°-------aatNi 3a3N a~od <br />.~~~ <br />3113H 37dV15 <br />