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Paperwork Redact:ion ~.ct 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 t10 hours. as an average per response for some major facilines,
<br />with a weighted average for major and minor facilities of i8 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 cometents n~garding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agenry, ~ Ol ;V> Street, SW, Washington, DC 20460; and to the
<br />Office of Information znd Regulatory Affairs, Office of iviaragement and Budget, Washington, DC 20503.
<br />~ener~I Instructions
<br />1. If form has been partially completed by preprinting, disregard instruc[ipns dGrecfed~; C9try o~ th~t~rfoiirtaGion .a ,~,
<br />already preprinted. ~ - ! ' ' 4 ` "`
<br />2. Enter "Permihee Plame/Arlailing Address (and facilil;~ namf gocation, ii different);' "Permit ,Number," and
<br />"DrschGrge Numbe!' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ",ti,`oniroring Period" co~~ered by formwhere indicated.
<br />4. Enter each "Parameter' as sper.6ed i, monitoring requ~remens of permit.
<br />5. inter "Sample,~Leasurement" data Poe caet pararneterunder "Quantity" and "Quality" in units spe~ificd in permit.
<br />".Iveroge" is normally arithmetic a~,rrage (geometric e•,crage tar bacterial pac;meter;) of ~!:; :ample mcasure-
<br />ments _or .;ads par; meter obtained dun.ng ";.~Icritorin; P,°rioa": ",1lcuimum" and ",btinimcon" are normaiVy ex-
<br />rr eme high and lou' measurements r•ht.lm~d durir~ '~ ~'-~lticrrinq °r;ioc!." Q;orc to m•.~niripa;s :;ith seconriury
<br />treatm^.it renuire,~ cam F.ntcr tiq-d.;~ aver2;;z o%sam,le n•~_a,~-cmens under "~:'.~erage," .rnd er,.cr m,i~i-num
<br />7-day average of csnplc. measur~mrnts ~~tnil-:cd durum. -..o-:•i~.o-rg pe: od undo "'~indm~nr.")
<br />C. En:~r "Penn;[ Requ,r~mcnP' fo- mac ~ prr,,,m,~ter ~,.ndrr ! ~asKr." an:: "!)ucrli~i' ^_s ~ ~oal~ed in permit.
<br />,. Lnder"`,n ~x" .nt_'r ru*±~~-e ' <:~:~ p'c n'.~.-~ute,;~~~'.t ' irl ~ '~,niio ~~. , _ ~ IoC t,t,.~ c;:cec.'. ma_i:.,um ~:r~.:;'ar
<br />r^~:nirw..t er 7-c'.;~ ~ ~ ~'ar,, as -pert ~n .a ~ ~ ilcrmit ~ : cccn , i m~,eter. It ron~, cnu~r 'r)."
<br />V b'n:e; ': -cu,~rnr/ n':inuhcis' untie ~ , S:nnpl~ .c ~.t~~ °e-;." ~~usl fsy~._ c,' '`;amnlin~ ..d ;,naiys!, used
<br />during mouttorieg :le rio.l) and as "Fzmri[ N~°quf~ernrnr" -~l c~:r~] in nermi:_ (r.e., Enter "C~urtr" ;~r cGnCin~.:ous
<br />moni[ot~;t3 "1/T' t .r anc Oc; ?cr vrc~'--. "!«lJ" for nn, ~~ ; r ra.~n:'^..'~./,%~?'-" icr ~nr d~rr per yu~rl<r, elc.l
<br />r`. enter 'San=~leTyy:~ r.;h~,'.°^,n,~'°-'~sure;,-.~r~r..._rd-':'.';';qtr.u>c,lc.uri~;-'~,,Irocn,pur.ad)and;~
<br />~, ~. ..r ~ uh,. _ ,
<br />Pmn.:' .2°-;aisrenu~nt;' (~_.g., P.^,_ „~ 'or ~ ~di.illu;~ rnq~.c. 'Zdl(C" f(`r'_~:-hou: cemposl;c, "~'L;" for am-
<br />tinuous monitonnq, etc.)
<br />10. When. c~olations ofper*r,it requirements are r;•ported,,~r ich t %'rici e~=:o1;+n.atinn r~r!r.rr:hr cause ard:errcer~~.e
<br />~c.i~.1-s _z!-:r rr and rcG-~ _ :c ,,ran ~~olalil•-: 'i; dat..
<br />t'~. I` n0 duet ar; .'cer'.~r., sun ~r.ton~-aI~'; or.,_-d, e.'.*'~~:c ~:~~'mr". '.c~.-o;.=':~r'n ~~.i ~L cr n: r';:.e ecL~.
<br />i' E^[e-'hmr~.r-'~/tF cF Pr.n.c~aar ,~.'--,.- ~)h;c~'' :rl ~ 'S-t ~':- ~~.:i~-J ~- ~~rrile ate-c.~- ,. _.~ ,
<br /> -Ig.r~~.. "~-r. l,-,;hone:~m~ahcr,'. .~,1 u;:~" -F~nitorr, ci i, n-..
<br />i 3 ^, _~ ,'3n°r' ~.e,~oi, ro O£;iee(;) ~p ,'~ ln' ..ci led .r, ~, ~ u'. ~~.Ialn _.,p.. ; ~ i.~ ~ ru;.
<br />1~. :blot. ~t idred ns77 . --n~ for aSc. Ot l!i~ ; L ,c,..u~. 5 hr itr~r., .:'pu'' n'•. ~ ~ -.~ rl iY of . ,.t.t~d ~.n~. i O`-
<br /> lice(';) :~eciried in perr~i-t.
<br />_ `.viii ~t . f l .
<br />,~ .;U.' ~ .OUlrgl li, la, ,. ;ii I, ... .~ ':~ ,..' 1. ., i. , u ~: t OI ~:1 illr~' 'i0 icl, ~. i.. r:.. _~..
<br />`C~u .. i.: ,i' L:Cb n. ~C` i '_`r. e! 1.! ~I' ~ ~ l .,. .... -, ... ~ ". I. .~.. rl'~ ~,1 ..'C ~ ..,.I ::.. " _.
<br />x:.41„GC'n,: h;-imr•iso ..,._ ,,tn,~r.: ..~„'„ _.ot+. -
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