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<br />Ptwlic reporting burden for this collection of information is estimated to vary frost a range of 10 houus as zn
<br />avenge per response for some minor facilities, to 110 hours as an avenge per response : o.• sore -najor
<br />facilities, with a weighted average for major and minor facilities of ~ 8 hours r,er ~esponse; including tir_e for
<br />reviewing instmctions, searching existing data sources, gathering and mai:eta:ping the c~a nec.~iec, aad
<br />rompletiug and reviewing the collection of information, including suggestc~ for reduc:~g t~is burden, to
<br />chief, Information Policy Branch, PV-223, U.S. Environmental Frotection Agency, 4'01 ai St-~:~t, S.B.
<br />Washington, BC 20160; and to the .^,ffice of reformation and Regulatoy Aa~rs, Cffice cf i~ rezge:le+rt and
<br />3udget, Washington, DC 20503.
<br />
<br />'. If fern has been partially completed by 1.reprinting, disre,~,ard instruction ~rectcc at entry of fin: informrtior akendy
<br />preprinted.
<br />2. Enter "Parmittee Name/Iboiling Address (and facility nr.me/Iccation, if different)," " ~'errtit Nu;;,~=-r;' any "Girch~roe
<br />I:rumher" vnc~re indicated. (A separte forte is regnircd For each discharge.)
<br />3. :inter dates beginning and editing "i,4onito~~ tgPeriod"covered by form ~~cere indicater .
<br />4. Enler each "Aarameter" as specified irr mcc toning requirements of permit.
<br />5. ,':rater "S,1rtpla Me~suremenP' data for ccci wameter w der "Quantity" and Q~r.rlir~" y, specified :~ 1..: nit. '.1 v~.'.~g~" is
<br />normally zrithmetic average (geone[,ic avc~gc for bs.eterial pa:-ame[ers) o; all sam_ la mcaswem.nt~ fcr eat; r ~r_rr:i:r
<br />obtained during "l~l~mita•ing Pe+iod"; "br_ri+;tunt" end i:d:nimun" are normally e:;scme hig: act ]c^i ~r~ast rments
<br />cb~ained durir+g "lvla+itoring Period". (Ale's to municipals trite secondar; treatmna'. r_:.ruireme~ : ~~-ter 3;1 ]ay .a~~~re f.e
<br />of sample measurements under "fiverage,"red cn[ :,- maximum 7-day 2vcrage of sc _rp e measerer:nL ett_inc: du-rag
<br />monitoring period under "Maximum.")
<br />5. Eater Permit Requirement" for c^ch pazam• tar order "Quantity"and "Quality" as sF cci.i~d in peg-u;t.
<br />7. Under "No Ex" enter number of sample mersuremeot during monitoring period teat exceed rrtar:imen (anti;: e;niur:-n
<br />or 7-day average as appropriate) permit requirement fnr each parameter. If none, enter "0".
<br />8. Winter "Freque+rcy ojA;rolysis" both as "S-:;.;cle i~;~as:r;emznt" (actual frequency o'se apling a-.d •~ra~ysis a.,ed ciuri~g
<br />monitoring period) and as "Permit Regr~ire.~tent" spxified in permit. (e.g. Enter "Co,-a,"for continueus monitoring, "1/i"
<br />for one day per wee§, "1/30" for one day per month, "1/90" `or one day pe-quarter, e:c.)
<br />9. Enter "So~rple T,•~pe"both as "Sample Iveesurement" (actual sample type used during ¢onitoring perinr:) air' as 'Pern-t
<br />Requirement," (e.g. Enter "Grab" for individua' sample, "14HC" for 24-hour composite, "+t'/~I" fcr con inuocs
<br />monitoring, etc.)
<br />10. Where violations of permit requirements aro reported, attach a briefexplanation to descibe cause a+-d carr.:'ive attic-s
<br />to be taken, and reference each violation by dzte.
<br />11. rf "no discharge" occws during monitcring period, enter "No Discharge" ecross fora n grace o`data er'ry.
<br />12. Enter "NameJTitle of Principal Executive Officer" with "Signature e,~ Pri:tcipa; Executive O~:e: of Aur;.orized
<br />Agent, ""Telephone Number, "and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your rxords.
<br />]k. More detailed instructions for use of this Discharge Monilorina Repost (DMR,) fo m may be obG.ined firo-r Cfficc(s)
<br />specified in permit.
<br />~~~~~1~ ~©~~~E~
<br />This report is requi-ed by law (33 U.S.C. 1318; h0 C.F.R. 125.27). Fzilure to repoR or fai'ure to report tr. Guully c n r_sult ir.
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,OCD er day of violation,
<br />or by imprisonment for not more than one yeaz, or both.
<br />~~A E+ar•~ 332iJ-1 (LBev. p3/99)
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