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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 15 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 reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, <I01 M Street, SW, Washington, DC 20460; and to the
<br />OfSce of Information a{id Regulztory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />general Instructions
<br />1. If form-hits been partially completed by prepririt~rrg, disregazd instructions diFected gat entry of that information
<br />already^pteprirrted. ~ ~~ - -
<br />2. Enter i"Permittee Name/d4aiiing Addmss (and farliry ~ame/location, if different)," "Pemrit Number;' and
<br />"Discharge Number' where indicated. (ri separate form is required for each discharge.)
<br />3. Enter dates beginning and ending "Afonitoring Period" covered by farm where indxated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Rfeasurernent" data for each parameter u,nr•er "Quantity" and "Quality" in units specified in permit.
<br />"Averaga" is normally arithmetic average (geometric a~reiage [or bacterial parameters) of all sample me: sure-
<br />ments for each parameter obtained during ".E7onitnriny, 1'erbd"; ".;Instmum" and ",tlbiimctrr." are normally ex-
<br />treme high anJ Irn,~ measurements obtained during "~I?~-•~ito~i~:g Penod." tAo'c [o municipals •aith secondsrv
<br />treanneni requirement: Enter 30-day avu-igz ni` samfac :mcasur~_mcn_s under ",+~r~~nr;e," and enter maximum
<br />7-day average of sa:mplc measurements obtained duet..; !~,tomrorirg pcrod under ":'~racimum.")
<br />6. Lnter "PevnaFerµ~irrmrni" for eadl par:unetur under "Gaa.it;r;" and "f),t,alir}" u ±p~..~fled in pcnroit.
<br />7. Under "'F'o Ex" enter m~rnhcr rt -ample. r-n;,as~,;emen tr ~i!rin r5onin+ena period - ,.. ~zceed ,n z._i,:,um land,'or
<br />minimum or 7-day a,'cra,~e s eppr~priate) permit reyu~~ ~ ^-rnr for ca.h p :ear^.ci<~. If ncae, enter "n"
<br />3. Fn;ar "H'rcri~~e.~!c off': ;,-alys'is'~ ha C' as 'Sairple Aicas~~ . ~ eri" (auntal fr~quer,. / 'i ~,amplin~ aria anal}~si5 used
<br />during rnomtormg psiod) and as "?,°nnit IYequirement specified in permit. ;,..~;-, L:u[:r "[:nit ° Coe continuous
<br />~non!toring, "iiT' fog o~te dap pu week, "L'.TO" for one ~ y Per month, "IIC0" , r one d .'. oer yuattc~r, etc.)
<br />9. cater "Smnp(e Tyye" b,ith as ";e„anlr .'-Ir.~st~reaieut" (,.._~d _.•nrplc tyac Ir.eJ .. ~. ,., ;, ~n:'urng pzriod) and a.,
<br />"Hermit ,4:nvire,nent " (e.~ . Ente-'~~^ob" `or `idic~.d~zal .;nple,'.2;rfC" for "_' cnrr ct~~~-tpositc, ",'v'/r1" far con-
<br />riuuaus mnnitu ring, etc.)
<br />10. Vdheretiolarions of permit requirements ate reported, ~~.~ ~ ~c}~ ~ hr'efetn_ Iana`ion t~~ de-crhe ~_suse, nd .arr2cti~z
<br />uznni~ :.,~~n, and refrrr_nc~ e:.a: virlaoun. b; dare.
<br />~ ~. I: "ne d~schargc~" n.t~,in dutin~ ~.~,or.i orin~, rercd, ruts ": ~~. Jtsc~u-•;d" a~rc~s Para m r~,"rte n'darn zrrry.
<br />~~ L.il i[r ~.Vi: r'7P, 7ti!, rf °r L:Zf4~l ~_i:C ,a r '7~ti, !' ~!I t ;u;; ~, ,~ i'TIn UtJ':l l':'°"!nP C7Jl'.CP,' JI -~"I,:Olt=did
<br />.iaei7r,~ ~~ ~l ~.'rt~Unr ?:lttpj]C, ~'~ ?~~~~ "(Jute ~ h'1 C[om Ot f0-!P
<br />r1 _'~ 5,g^tl. {jen~71! t0 `J ~f.~.e (Sj be i! ]tr~'1 `?°CL.:'~ ~' ,.~ ll't 3'll cop.! ~Vi ~OCr f: enl'i~, S.
<br />ld. i.iore de~adtd S•siruc:itn, for ,~._ aC di ~~i di:;rq , ,, ~~ a A_s hcpct " J'.1;7j G~rri m.,• ;e ob'~ :rd rrum Of-
<br />tice(s) specited in permit.
<br />I ~...:epOr[ ;~ ray LLirc(' _ .-. ; 11 ~ ,i.C. '~3. "- "; ~.i' Ir, l~.. _"~ :.~ .~~ . ,.~~ ,. ~ ,~~ rcpa~'t trt~tFlu ~ a9
<br />~~
<br />rc;,,l:.r, a`~iI n~^~J tu~~ 1r,~ ~~.i "-.:.arc u.: ~; o',. , ~ . - . ~ _ -~, ~r' ..i':._.. ~ c~:c°cr ~'-5._~~i.7 ~.cr d:;
<br />. ~ c__.:cn. ,t_ r impri.,o~nrnr tr e n,^-, t or,~_ ~~,..., ~ i_r.
<br />., roam J:~~~-I .._. ~ ,
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