|
~ o s
<br />Public reporting burden for this collection cf information is estimated to vary om a range o_° 10 hot-s as an
<br />average per response for some minor facilities, io 110 ;Hours as an average er response `or some major
<br />facilities, with a weighted average or majo. and mino_* facilities of 1 S horns per response, i; clyd~ng t'mc for I
<br />reviewing instructions, searching existing rata sowces, gathering snd maint~in'.ag the dr::z ~c~_'~d, anZ~~
<br />completing and reviewing the collection o. information, including suggestion for reducing `tis bu-~en, to'
<br />Chief, Inr"ormation Folicy Branch, PIt~-22. , i;J.S. Environmental :-rctec:ion E~gency, 401 R% °Geet, ~.VJ. '~
<br />Washington, DC 20~'.~60; and to the Cffice c- ~:nformation and Regulztory ~cffai,s, Ci~ice cf:viznagetr2nt ;3c.
<br />budget, Washington, I)C 20503. ~
<br />
<br />1. If fora has been partially completed by pr..~=nting, disregard instruction durc[erl rt entry of that i-formation~Irerly
<br />preprinted.
<br />2. Enter "Permittee Name/d:ailing Addrzss (a ~3 fecility namcrlocation, if dificrmt),` " °~rz~i! N:rr, t~.;" an: "Gi: chha.,vr
<br />Nemher" where indicated. (A separate foam is nequirad for each discharge.)
<br />3. Enter dates beginning and editing "Maritori ~ Period"covered by :orm wl•c.e irdica'cd.
<br />4. Enter each "Parameter" as specified i~~ non' .~~ng requirements of pemrit.
<br />5. Enter "Sm,rple I/leasurement" data for ccch traruet Y under "Qr~:ntity"and Q. 31ity" , s ~ reified :n ~:: ro it. ". i vsrage" a
<br />normally a~zthmetic average (geometric avc : ~c for brc'erial parameters) o`rll sam~l;, c acs r:emect; For ;;a.> ?= -.:me.er
<br />obtained during "Monitoring Period'; "I/ .;.;-urn" aid i.;raicrun" arc: nc„~a]ty e;._une high a,d rr mca;,cerne.-_;
<br />obtained during "Monitoring Period". (mote n: murtici~: als v.~ith secondary trestmee~ re ~~iremcnt: ?: 'e. 30<~a; ~~~er;;
<br />of sa_nple measurements under "Average," .td ente ~ maximum 7-day average of sample measvr7cr s ob[::~nci dung
<br />monitoring period under "Maximum.")
<br />6. Enter 'Pernit Requirement" for each param: ter under "Quaetity" and "Quality" as s cci` ed in permit.
<br />7. Under "No Ex" enter munber of samp! : mc-s-urcment doting monitoring period that oscc.ed maxim r i andre n'nimncn
<br />or 7-day average as approprate) permit regt cement°or each parameter. If none, enter "0 '.
<br />8. Enter "Frequency ojAnalysis" both as "Sa,. ;vle N.:1srr-emznt" (actual frequency of saz~,pling and. c~slysie 'sr_' dung
<br />monitoring period) and as "Pe „ it Requirersert" specified in permit. (e.g. Enter "Con',"for contineou~ manitrr.r„ "It7"
<br />for one day per week, "1/30" for one day pe- month, "//90" for one day per quza'ier, e: c.)
<br />9. Enter 'Sample Type" both as Sample Ivleas repent" (actual sample type used during monitoring periciP and ss 'Per,-iit
<br />Requirement," (e.g. Enter "Crab" for individual sample, "24HC" for 2t,-hour composite, S?r/A" for cortinucus
<br />monitoring, etc.)
<br />10. ~Vhe-e violations of permit requirements aro reported, attach a brief explanation to dose be cause a-.:. connective ,:ctiors
<br />to be taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring Period, enter "No Dischazge" across form n place of data entry.
<br />12. Eater "NamPJTitle of Principal Executive Officer" with "Signahrre of Principa; Executive O,~icer of AutF.orized
<br />Agent, ""Telephone Number," and "Date"at i•ottom of form.
<br />13. Mail signed Report to Office(s) by date(s) s_raci5ed in permit Retain copy for your rxords.
<br />14. More detailed instructions for use of this Discharge lrfonitoring Report (Dlifl~ fa.-m nay be obtizcd from Cfiice(s)
<br />specified in permit.
<br />. ~~~~1~ 1~1~i~~~~
<br />This report is requved by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or f2 ure to report trufnfully can result iu
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to cxcesd $25,000 p:.r day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />E:'A Fortes 3330-1 (Cdev. 03/l9)
<br />
|