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1''aperwork Reduction Act 1`iotice
<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 facilities,
<br />with a weighted average for major and minor facilities of tr 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 Boarding the burden estimate nr any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Polic;
<br />Branch. PM-223, U.S. Environmental Protection Agency, 401 u Street, SW, Washington, DC 20460; and [o the
<br />Office of Information apd Regulatory Affairs, Office of tiianagement and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard insfrticfi~ns ~iFected~at entry o~ that~nformation
<br />already preprinted. - ~ . ~. . ; i ^ + _ "~ _ ._+ ,_~ ~, ,,
<br />2. Enter "Permittee Name/!Nailing Address (and facility nameAocation, if different);' "Permit ,~h~mber;' and
<br />"Drseharge Number" where indicated. (A separate Earn is required for each discharge.)
<br />3. Ester dates beginning and ending "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter' as specified in monitoring requirements of permit.
<br />5. Enter "5ample Measurement" data for eachparameter r_n•1er "Quantig" and "Quuliry" in units specified inperm;t.
<br />"Average° is normally arithmetic average (,eomerric average for bacterial parameters) of all sample measure-
<br />ments nor each parnrrre!er obtaineu during ";1~loritorin„ "Brio.!"; "Sfazimum" and ",lfinimurl" are r.ormrlly ex-
<br />tr.:,nc hig'n and lo~.v measurement; ^h taiucd d ~rin~ ",Ihntitoriny Peri cc--'." ~Ya[c to municipals r~ith seeoudary
<br />t;~arntent recr'r~rr~enr: Fnfcr .:0-da;' a~~ucne of sam~l~ meaautcmenr; under ". ':rerage" ;aid Borer macimum
<br />7-day avrra3e of srm;ple measur~,ncn[s uhtai~.ted durir~r ~o,, tormg pstud a:roc, "gfarirnu~m.')
<br />6. Enter "r'rrrnit P~~q~~i~te~:,~,t" fns ~2cL pars:ne;cr under ~;:~t~ nrm' ar ~ "fhrtlip" ~u ;peciti. d in n,~nnif.
<br />7. Cnd~r 'A'u L.c" ec::~~ number n ` ~-~;i_ ~,,~..ou;,;r.i~.n, ,.-hur.itori r I+r.~,~~i th:.~ ex _~-d ^:,~_imam 1 : ~d'or
<br />r~„~ninun c; 7-d,i° •r;erag. as .:ppiopria[e) pen^ir tcyu_~ amen[ for each parameter. ft nor,c, era°r "ra.'
<br />3 Enter " ~r[ciurvey' of.- :altsis' both .~; S r ,^'e %~.leastm ~nert (acnial t~yucncy of ~umplin', ar ; anah~:, c<e~
<br />d'1P.rg C.-, 0.',i'Cpf.i,_ [lu IUC) and 35 "%'C,'ni! keCl21(!enlPnt" :~pJCititd in pCCnlli. 1C.4-. F.nCCL "~~o:L," :9r conhn•at:us
<br />t-:onirorS„?, "! ~7" for one day pc. •.~cek, "I/30" for om• ." ,~ ~:°r ,n~.r,[h. "(."n," ;ur onr ,Inp per yuci ter, ~•Ic.1
<br />9. cote; "Sample Type" .oath a- ~,~~. ~ nlcirsacn.ent" r ~, ..d i ~ ,',. c,p ~ , . ~~' . , r t rocitnrng p,.nod anG a,
<br />Pe~~ny';te~7~ltrem~nt," (e.g., F_'nn-~ 'Ccib' fa: a:dot^Ju 1. ~antple, ?Ji1C" ;nr ~.~h :cr m~~iposiCe. "'t'/~'i" Par con-
<br />tinuous mom*cnn~, etc.)
<br />10_ Where v'oCations of Hermit requirements ate reported attach ~ brief explanatiun to de er:Le car~~e ,nG :assocs. e
<br />zc.io„s .otter., and re2Crtrv_c e~~_h vr~le[io~. 'ov date.
<br />lr. II "no di,cha*3~" ~,cru~s Guru,., _.,~i,,itrr~r~ _.erio•, er.~~t '_ir. I)..„-har,~ , r~ vs i,e., ~~~, ?L^,re ~i r.;[s en*r,.
<br />r' L'nte, ,i; ~ ~'' .. - ,
<br />_ .. _, rli Uf ~.r::'!i a' h _ C°. ~rf~ .:rte '4 ~ ;~~, _. .y '!I', t_`. J(IIl%' ~~f1 C ~.<. _
<br />.'~°ell !," :. _n$r7n~ ~~ll^a Rr'r; %r,ti "J<<rc .,[ InLCUm Ot ..n'_
<br />,a. p_I::.~ s~;ncd 4er,or[ hr Clnce~s; by:I,t,eQ.; ,;+cri~ed i„ per..;-,:. ice.ai^ c_p '_ [ ~. a~~~`,.
<br />j,. 7.i07C ~i'w: lCi 1P.Si ^~Ch.]C"= CG_ J•C nC I' _~ r::]CI~r~~ , "~')ni F7 r~.T.~ ~~) .i ~, fl G'7)' _ . ..,~^Cd lfJl't (i-
<br />?ice(s) ~pect:ed m i;crn;a
<br />%h_, iCy0i_ G ~._'.UiCe~ i ~ ~:.,: (l3 l _... !J„i. ~--!'.1; - ' i. ~. I ~,_ :.) r ,' ~ - V '~ _ ,i: ICt~_.., tWP, .~„ .._.
<br />_ ~.- n ~..ii , t,.l':r :.o' t c-._.~ .. ';' . ' ~,a ~r ~I:r . ~~n, .., _ ~ rni :a ~ .-~r 'S. ~~ _...
<br />ar a atiin, r~ - ~ in,~,~ ianr~~~~nt Ru ~ ~ i~_a~~e i - ...~ , ~_ by ':.r; I-.
<br />r - - - _,.-1 i = _. _, .
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