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<br />Public reposing harden for this collection c ° im`or /nation is estunated _o vary f: or_-. a range o:` " ~ ha ~-s is an
<br />average per response for some minor faci~~iies, to 110 hours as an st'erage per response ;cr sorry ~_ ~jor
<br />facilities, with a weighted average for majc • aid minor faciliries of 1 S hours pe- response,'~c'ucirg ~im~ for
<br />reviewing instructions, searc'ning existing 3ata sources, gathering zn'. maintair_ing the oa'z :_:z~ea, srtc!..
<br />completing and reviewing the collection c°. '_afon.]ation, including suggestion tar reriucir.g 'ilis be-c:ey fo'
<br />Chef, Information Policy French, P'?t-22:'., U.3. Environtnental Frctection />,gezcy, 4OI ;!•: 5trc~t, g.vd. i
<br />~3/as'tington, DC X460; and to the ^,f ce c "-lu`ormation ~d 2egulato,-y tluai,s, Bffice of?Cerage.-._3^_t tad
<br />1-ludget, Washington, BC 20503. i
<br />~....w.... ~ (:.... .~.La).... ....w ~.. .....!...v
<br />1. If form has been partially completed Sy pr, ,;tinting, disregard instruction directed at c]try of th~' ~r;cr,nz''on r.'rerc~y
<br />preprinted.
<br />2. Enter "Perrrittee Name/Moil%ag Address (~'-d facili.y aameAacation, if d: ~erent)," " f.:rmif Nu:-:h r; ;" ar; 17r•.:he;~ e
<br />lJur,:,5et" edrere indicaM.d. (r: separta fog s requited for each discharge.)
<br />3. Enter dates beginning and editing "tY,orritori~ o Perk ~" covered'uy form where indicated.
<br />4. Winter each 'Parameter" as spcci5ed in man'' oring requirements of germit.
<br />5. Enter "Sa,npls Measurement" data for each ~r -amcter wider "Qrra:rt%ty"and Quality"+rs . pecified is - _Reit ,_.,. - age" is
<br />normally ari[ltmctic average (geometric eve : Sc fo.- Bacterial parameters) cf aL sa np'e ~ casurecaui's ~o- ea: •. pa tme!~_-
<br />obiained during "i/loniloriug Period"; "d.. i.; u,;t" and Mi ;imer7" aze normally r.; t~e.a:: lig6 rnu .err mr]su -d .i c. Gs
<br />Obtained Z]nng "iP_OnltOrinr,' Per%od". (NO(: U "~IlL LQpals V/lt7 SeCOadaPJ I:-C32IDCni ffi, S1rP.ml.•tt: ~r, r:: 30-_1~ ,VCrr~:
<br />of sample measurements under "/iverage," .. en :r maximum 7-ciay average of sz ]pl:: measrac _r :'t. o~ ,.'_ec dun r„
<br />monitoring ~... iod under "!/~aximum. ")
<br />6. Enter "Per„,it Rsgr/%rement"for e%_ch pararc e; wldc r "Ouar~ity" and "Quality" as specif ed in pcmit.
<br />7. Under "No Ez" enter number of sample me-su-e~nr.*Li i ~tinl; monitoring period that :xcced mstiunur ;indlc' ~.ri~.IT
<br />or 7-day average as appropriate) permit regL `-anent for each parameter. ?f none, enic- "0'.
<br />8. Enter "Frequency of Analysis" both as "Se.. p!e 1/'euurement" (actual frequency of sanpling aad • ^al,vis set c:u.irg
<br />monitoring period) and as "Pe.-.zit Reourr2r„zat" specified in permit. (e.g. Enter "Co, ~," fo: continuct_ monit..ri:;,;, "li7"
<br />for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, e' ~.)
<br />9. Eater "Sanple Type" both as "Sample i~ew .r_;ne;r!" (actual sasp'.e type us:d during monitoring ~eric.d; and u 'Per,-i%_
<br />2guirement," (e.g. Enter "Grab" for individual sample, "141iC" fo,- 24-hour composite, 'i~'41" for cortinurus
<br />monitoring, etc.)
<br />10. Where violations of permit requirements rr,. reported, attach a brief explanation to dcse_u. cause a d wtreeive acucr.s
<br />to be taken, and reference each violation by c'ate.
<br />l I. if "no discharge" occurs during monitoring i.: tied, e;rter "No Discharge" across form in place of da a eLtry.
<br />12. Enter "Name/title of Pr%rtcipal Executive Off~ce;•" with "Signature of Principe! Executive Ojr7cer of Aut'~orizecl
<br />Agent, ""Telephone Number, "and "Date" at L-ottom of form.
<br />13. Miail signed Report to Office(s) by date(s) s; ccified in permit. Retain copy for your r: cords.
<br />14. bore detailed instructions far use of t'nis !'isclu:rge Monitoring Report (DAgj) for n may be obtzi-ed tra r Cffice;s)
<br />specifed in permit.
<br />This report is required by law (33 U.S.C. 1318; ~0 C.F.R. 125.27). Failure to report or failure to report tr..:~]_lly c~a r:sul*. it
<br />civil peadties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 ;er day o` vi_lation,
<br />or by imprisonment for not more than one year, o: both.
<br />ERA ]Form 33Y0-1 (C3ev. 03/49)
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