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<br />;?ubl_ic repotting btuden for this collection cf information is estimated to vary from a range o' IC hers ss as
<br />average per response for some minor fac;~ities, to 110 hours as an average per respoLSe °or sot<a ,,-_ajor
<br />facilities, with a weighted average for ~najc • and;_rinor facilities of 1G hours per r sponse, iac_udiil„ ime for
<br />reviewing instructions, searchiag existiag c'ata sources, gathering anti maintai.~-ung the d~,a ne-~.ed, saG
<br />completing and reviewing the collect±oa cf information, including seggastion fc: redeci:.g Iris '~~•rdea, ro
<br />Chief, Information Policy Branch, 1=V-223, 'J.S. Environmental Protection ~'gcacy, 401 ';I StTEet, S.~%!.
<br />'v~'ashingtoa, LTC X460; and to the Office of information and Regulatory F:`:ai.s, Office cf?.':[:rage,. -ea: anc:
<br />Budget, bUashington, DC 20503.
<br />
<br />1. If form has been partially completed by pre_rinting, disregard instruction directed at ~.r:ty of 4a' irfo~a:for. atrerdy
<br />preprinted.
<br />2. Enter "Pernittee No;:re/ivloiling Address (~ ~d facilit;• nameAocation, if di'e,ent);' "Permit Nur•1 ~q" any ''D;sc.',c,;;r
<br />Ne~mfier" where indicated. (A scpur'e forri is required for each discharge.)
<br />3. Enter dates ;:eginn~ng and editing "61n•±itori. ~ Perk:!" covered by form r.~iie.c `odic. tc:
<br />4. Enter each "Parorreter"as specified in ran o'ing requirements of permit.
<br />5. En[er"S¢,;rpLidaasuremeri"dtta:o,-eech :aramet°run3er"~iuantity"e~dQr•ulity'as-pscifiedin-:.rr-~.t. ~:r,~age"'s
<br />normally arithmetic avenge (geometri ~ avr. ~c c. b: eterial parameters) of all sample --~easurm~: rc io ~ esc •. p; r. meter
<br />obtained nVa'ig "M~nitosirg ?mod"; ". L.:i;avm" and idr•~imu,.r" are nornaIly c tTc,~ac ;nigh rnl o,v n-asu:.-.vans
<br />obtained during "i/lonitoring Period". (i`?o~: to ~acicipats ~~iith secondary t-zatmen. re1u~rement ~r e 3d-!~°y ..vcr~-
<br />of sample rnasuremeats under "Average," nd ent:: maximum 7-day rvc,age of sa,cp'. mrasL•cn ~ W nb~.inec du ii,~,
<br />mostoring period under "Mazinum.")
<br />5. Enter "Pe;;,,it Requirerren+" for each parameter render "~iuanriry"and "Qaaliry"eS S~ '.CI" led in p^*r'i.
<br />7. Undo: "No Ex" enter number of samr~e me ~ s u-emrnt during monitoring pe.icd tbat ,zrad maxi, .u a (aadr~:- a f air u~
<br />or 7-day average as appropriate) permit ream: emeat for each parameter. if none, cntir "0".
<br />!;. Enter "Franuertcy of Ara/ysis" both ac "Ser~pL rb~~srrameat" ;actual fmquency o'sa npling and a,ri~sis .ised dw-n,
<br />monitoring period) and as "Pernir R.quire...n!" specified in permit. (e.g. "r'cr "Ccr ~," or cortincc~a moni:cri;:~, "1/7'
<br />for one day per wce'c, "1/30" for oae day per month, "1/90" For one day per quarter, a c.)
<br />9. Enter "J'arnple Type" both as "Sarni le Wizen-rzmear" (actua; sample type used du_i~g r. citoring = rio3) and as °r'er,;,it
<br />Reguiremant," (e g. Enter "Grab" for ir:'ividual saaple, "24HC" fc- 74-hour co:nposi[e, "i.%'" for co_tinucu
<br />monitoring, etc.)
<br />IC. Where violations of permit mquin;ments arc reportej, ~Yach a Urief explana5on to crscribe cause and :otrective =ctiana
<br />to be ta_'cen, and reference each violation by care.
<br />11. if "no discharge" occurs d,uing monitoring period, enter "No Discharge" across farm in place of da*.a n[ry.
<br />12. En[et "Nar,7e/Title of Principal Ezecvtivs Officer" vr_th "Signahtre of Priincppa% E.recutive Officer of Authorized
<br />Agent, ""Telephone Number, "and "Date"at bottom of form.
<br />13. Nail signed Report to Office(s) by date(s) specified in permit. Retain copy for your r_cords.
<br />14. More detailed instructions for use of this Cischarge Monitoring Repor! (DMf~ fo m may be obtained frosu Ciice(s)
<br />specified in permit.
<br />~~J~~~~ ~C~®~~'~
<br />'Ibis report is required by law (33 U.S.C. 131 g; 43 C.F.R. 125.27). Failure to report or fai urc to report t_ ;:fully c n result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penaltes not to exceed $25,000 per day o:` violation,
<br />or by imprisonment for not more Phan one year, o- both.
<br />CFA Forte 332[}-1 (Ctev. 03199)
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