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~~r ::'i D. 's"9 ~}. .. J. .: _i Ci...~f~Y f'=.i.~ LAC :- v........,
<br />~ ?ublic reporting burden for this collection of information is estimated to vary from a range o:~ JO hnu. • :.i an
<br />average per response for some minor facilities, to 110 hours as ar average per response for ,ome major ft.ciliues,
<br />' with a weighted average for major and minor facilities of 18 hours per response, including time for rr. ic.rin
<br />instructions, searching exiting data sources, gathering and maintaining the data needed, and eomp'.r~ ag and '
<br />I reviewing the collection o: information. Send co:;nnents regardine the burden estimate or any other aspcc of
<br />[his collection of information, including suggestions for reducing this burden, to Chief, Inforntatiun P.tlicy
<br />Branch, PM-223, Cf.S. environmental protection Agency, 401 VI Sttect, SW, \Yashington, DC 20460; an, t~ ih.:
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, \4'ashineton, DC 20'03.
<br />~ir~Il~'ii24 ~ST:,r9~~'fi9~'~~~i3~
<br />I. Jf form has beet partially completed by preprintine, disrcga:d instructions directed at entry of than :.tlurrration
<br />already preprimed.
<br />2. Enter "Permitee Name/rNo!ling Address (and facility name/location, if different)," "Permit ,\'r„n! cr, "and
<br />"Discharge Number" where indicated. (A sepcrate form is required for each discharge.)
<br />3. Enter dates beginning and ending "hfanitorimg Period" covered b}'form tt here indicated.
<br />4. Enter each "Parameter" as specified in monitoring reyuirementa of permit.
<br />5. Enter "Sample Measurement" data for each parameter under "Quantity" and "Quality" in writs sp`cit'sxl in ferrnit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measure-
<br />ments for each parameter obtained during "/~ onitoring Period'; "d9aximum"and "ldinin, ~ m' ar_ norma'ly e>;-
<br />treme high and low measurements obtained oaring "A9oniroring Period. " (t.'cte to -:unicipals v. i.` s _ro ~dst3
<br />treatment requir:rant; Enter 30-day average of sample measurements under "Arzruge," ani enC- maumum
<br />7-day average of sample measurements obtained during n-onitoring period under ",4~a.tirnnnr. ")
<br />6. Enter "Permit Requirement"fur each ~aramcter under "Quuntirv"and "'Qualirv" as specified in perr.~it
<br />7. Under "No Ea "enter number of sample measurements during monitorine period that exceed mavin ^m (a td; or
<br />minimum or 7-day average as appmpr'ate) permit requirement (or each parameter. If none, enter "0 '
<br />8. Enter "Frequency ojAnalvsis" both as "Sungrle.'Neasuremenr'" (actual frequency of sampling any : tahai.: used
<br />during moniwrng period) and as "Permit Requirement" specified in permit. (e.g., Entc "Can, "far conti:wuus
<br />monitoring, "li 7" [or one day per week, "l/30" for one day per month, '7/90" for one day per quarter, etc.)
<br />9. Enter "Sample'Tvpr"both as "Surnple ,Measurement" (actual sample type used during moni'onnc p<: iod) : nd as
<br />"Permit Requirement. " (e. g., Enter "G,-ab" for individual sample, "14HC"' for 24-hour composite, rs,'4 " fu- con-
<br />tinuous monitorng, eat.)
<br />10. R'here violations of perm`.t requirements ar ~eported, attach a brief explanation [o desribc cau.e and corra_titt
<br />actions taken, and rference each violcrion by ;late.
<br />1 L [f "no discharge"occu's during moni'oring period, cuter "A4r Di.rc/range"across form in p'arc of clot- c^n'}.
<br />12. Enter "Nom 'Title~rfPrincipa!£secu!iveOjJirer"tt ;h "SienutureajPrincipniL:i•ecuticeOjjicerof.'.c~hnr%.,erl
<br />Agent, " "Tr.: p,5one Nanrher, "and "Date" at bottom or I on-:.
<br />13. wTail signed Rcpott ~~ o Office(s) by date(s) spec tied cn permit. Retain copy fur your records.
<br />14. store detailed instrtctions for use of this Discharge LionitorJ,g Repurr /D.i1Rl torn: may '~c obtaii.ad '-urr Of-
<br />fice(s) specified in p:nnit.
<br />. J4 i'J 1. \ 1.. .::...'J.
<br />V
<br />This report is reyairc,: bt lav. (3J ;:.S.C. 1318; ;0 I-.-.2. IZ5.2?). 1=ttil,tr ie ep~ ; nr failu:; to rpcrt iro h all _c•t
<br />rv,tat in cavil pt:c~:.ir r.ci o exc;cd $IO.C':0 p:r uat• .•i LEI: ;+, :; nr'n cdr:in-~l •,•r•i t t4•, tot w c+:..;1 5". •,..': _ u
<br />o(~. iala[iun or by itn rivr. ~t.~t rcr not morn than u: ~ y cat, ur by both.
<br />-= r`` ~ .,r-t 3327-: (: xv. >-721
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