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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of '.3 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for *educing this burden, to Chief, Information Polio;
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW, Washington, DC 20460; and to tha
<br />Office pf Information afrd Regulatory Affairs, Office of Management and Budge[, Washington, DC 20503.
<br />General Instructions
<br />1. If farm has been partially Fompleted by preprinting, disregard instructions directed at entry of tharinformation
<br />already preprinted: -
<br />2. Enter ;'Pumittee Name/~blailing Address (and facilit;- !.ame;'location, if different)." "Permit ;Number," and
<br />"Discharge Number' where indicated. {A separate form is ; equired for each discharge.)
<br />3. Enter dates beginning and ending ",monitoring Period' cm,ered by form where indicated.
<br />4. Enter each "Parameter' as specified i m~nimring requ rc:rnen[s of permit.
<br />5. Enter "Sample.-ti7easttremenr" data for each parameter under "Qunntiry" ant "Qaalir~" in units sped ed in permit.
<br />"Average" is normally ari[hmeLC average (geometric a:e-ag~• for bacterial pa;am:.:er,) of a;l sample me<uure-
<br />ments for each par:uneter obtained during ",tilonitomt~~ Petted"; "!4edr;artm" and "Minimum" are normaib! ex-
<br />treme high and lo~.v measurements o~.traia€d during ".t(crtirorLtg Period." (~:m° u mnniepals ~ti~th secondary
<br />treatment recuirement: Enter 30-d n!; aver~g,° of sample measurem~•t,s unc!er ". i~.~ercge," ^ad enter ma-:imam
<br />7-day average of ~:rmple measuremen~~s obrain.~d duuna. t onitorin;; p.r,od under "trncarun~.")
<br />., ..
<br />enter ern[t eq,urrrncnt for eac!~ prranteter '~.n~er ';lsanr°4r and ._~~a if; ~" vxahed in permit.
<br />.Under".ti'nI'z".~n(ernu,abero_r.^-~p'errea.ur.:rar,t;.'. '~~* r,:n~tu:c~,itenad:r,cez:u'dnr._ ~~~r~ m~.4,r
<br />r-i;.unun u: ~-d.r~ . _ra;e as appropuaie' ; .:emit m_;,t ~t~. ~en~ f rea~lt i,ar;:metct. 't ncr.e, enter' )..`
<br />,. R~~_cr "i=ran,e2.e,~ nJ 4,nhiis' t:,tn ;._ "~ctm~;c Afra.iur..,~~,nt ,:Huai fre~ reney r,f s::.;op~ing a .a anaa~s: c~ei
<br />:Firing m.niroc^~~. f~-t .,f1 ~:, ~ ~ ,~yr,°q.t Requrrement" >~iectti~eri n permit {~ ^, --rr_r "C~i.~r ^ `.-tr cont~m~ec•:
<br />;remtanr:;,"U, ~~ ot.ec. ,ird.crt. .flf"`,orr.._. ;pct~io,,,l'i.'r .,. ,,.~ay;;_r:~.,t..eruc.~
<br />9. Enter'~Sc.n~p<'e 7~1;~" b~~rh a:. "San?n%r '-,'dasrremerl" (t ~_[ :aI sample :;~~ -..>e::..~-ing ~;:ani:rrt.~ ~ penou~, .u:.: ,.
<br />".'ennif Rdu~•~.ir=.ncn(" fc. ;-, ~:~, .r ".';'al%' .or ~=di~ndu.: ~, mplr. "'-S;IC"' gin; '-;-h~~ur coi.r~a~i;e. ".~'- {" Yoe ca;~-
<br />iim~ous monitoring, etc.)
<br />'_~ Where ~rtoh~tions r•" c~rr,ir reeuir~ -,,~,;;s ,~ rc~~orted, ~'.ca ~ i _ ~x~_',,r~:'iun :u '~,ci il~~ eaus_ :nd carn•_tt.c
<br />~~, . ,,r ,a;_cn, act! rc'zr.ncc etch nol?ri.:~._ . , , ue.
<br />1'. li "no d~s.ha-g_' ;:errs dunn,~, no.r:u ~ ~ xri~ad, ccn~r V,; , ~ ~~- . -' .:crows iw .. n ~~Ircc ~. :a err:,.
<br />i, I. ,.... ';da:;.~/~rrr;. of r;~,~c~~ar Ix<<._e . )f :.~" .v t - . ~. ~:~~ : ., : f.~r ~' _ ~~~ure Ojr~-.. .:.rh ~. - -
<br />_9;;nr••" '..p^Unc t~-Lit iiGPr,'' _~~I"date' £r V:n[tum of ~_~pl.
<br />t3 i,;: si,, .d R-marl Co rafix(. ., ,'.reel- -Fr--reed ~.: ;~ n.,. hay^.,t~ r.t t ., ..,-u.r,+
<br />l ~l. ,lore: G..'.I td ....: rllC.!O~l- fOr '_<e r: Yh'S (~LSC%7:b;~.' :Gl., I:OL:,{ ~C~f`U'.` ~D'~:fi .. _ c `~.P~-mod trUT Or-
<br />t,
<br />'e i': iui: U ,.I f [J .,. (.SJ 1..5.t~. 'l ~ ') .. .. .- ~ - f.. :,1 r~U [ ,. .. .!If 'ef .rlJ t:..'_i.. ,
<br />c ...: ;t:r~- .. ;m_ ~_,...~ ~ ~: tar nc.[ - ,. -., .-..; ~~r _ }~ ;r.F.
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