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<br />' ~ Paperwork Reduction Act Notice
<br />Public reporting burden for Ibis collection of information is estimated to vary from a range of 10 hours as an
<br />avteiage per response for some minor facilities, to 110 hours as en average per response for some major facilities,
<br />wi~9 weighted average for major and minor frciliuc; of 18 hours per response, including time for rajiswing
<br />instructions, searching existing data sources, gathering end maintaining the data needed, and completing pod
<br />reviewing the collection of information. Send conurents regarding the burden estimate or any other aspect of
<br />this collection of information, including surga;tions for reducing this burden, to Chief, Information P-0licy
<br />Branch, PM-223, U.S. Eovtroomental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Iafonnatio:~ and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503:
<br />General Tnstr. notions
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<br />i.~fform has been partially completed by'preprinting, disregard instructions directed at entry of that information
<br />~S~eady preprinted _
<br />2, Enter 'Permirtee ,Vnmervfailing Address (tutd facility name/locauon, if different)," "fermi! Number," and
<br />~, ~ :'fii.rcha,-;e Au;r:brr" where indicated. (A sepa[ate fpt;,rt ~ required for each discharge.)
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<br />3.-kuler dates beginning and ending ".lfoniruring Periort'oovered by corm where indicated.
<br />4. ~nlzr each "P:rarrerer" as specified in moni!oring rcquiren:cnts of permit
<br />5, $pter ".Sample .f:rasu.emc•:!P' data fvr each parametet Wilder "Qumrtity" and "Quality" in units specified in permit.
<br />"Avrmge" is nota~~lly art`:mztic average (gaometdo"xv.rage for bacterial parameters) of all sample measurements
<br />Eor each para:uc;cr ch(ainrd dmin~ ".l,nnuonng P,i~", ",4fa:amum" and "Afmimurn" are normally extreme high
<br />r -and 1aa measurem.:,ts ooG.inrd dunnt "1!m,:tori»g Pe"cod" (Note to mm~icipals with secondary treatment
<br />i tequiiemc:a: Winter ;t.-t1a~ acer,~~~c of ~aruplc, ~r,asnr~n:ants under "Average," and enter maximum 7-day average
<br />of satfiple mea;urrtn_!ac ohta~oer: dariu~ tncniturin~ paned under ".4faximum.
<br />~6. Enter "Pennir <cyarrcment" for rash pasts^ter un.i•:r " -uon(ir}%' and "Quality" as specified in permit.
<br />;7, ifnd2r "~.'n >r" eater nw•rb:r ct stmple ut,:asur.ncnts dunng mon;toring period that exceed maximum (and/or
<br />'. ' thinitttam or '% nay average as aporopnatz) pe-ni[ rc4uirement for each parameter. If none, enter "0".
<br />t~: Enter, 'S~rryuc-~• ~ ~ / A".a'~,~.+" :: th as "k.mpie ,Vensun^enr" (actual frequenry of sampling and analysis used
<br />t.~ durn ~:onit.: i ,% cried a ~' ,: '!':emir .2e uiremenr" s ified in r nit. a Enter "font," for continuous
<br />- monitoring, "1 ~~" for one nay' peg .,ezk, "/:3t'" for one day per month, "i%90" for one day per quarter, etc.)
<br />`~ Enter ".Sar.•rF.S T;-pe" bath as ".C~tnp!e nfen.;r.rca:^ru' (actual ample type used during monitoring period) and as
<br />~`' ,,"Pennii Regtcrrmerr," (e b. Ewer 'r;rab" for individual sample, ?JHC' for 24-hour composite, "A%A" for
<br />' continuous monitoring, etc.) ~"'
<br />;Where violation; of permit requirements arc rcporied,
<br />'anions taken, and reference tacit . iolatiar. by date.
<br />~Ii` "no discharge" occurs di:ring mori[oring 1.eriod, enter
<br />attach a brief explanation to describe cause and corrective
<br />Nn Drrcharge" across form in place of data entry.
<br />!: Enter ".WmneTitle oJPrincipa! E''reculrve O~".ce!" µ•tth ".Signature oJPrincipa! Executive Officer oJAulhorized
<br />•'' ilgenl," "Telephone Number," and "Nate" a: bottom of form.
<br />Mail sig,red Report to Office(s) by date{s) specified in permit. Retain copy for your records.
<br />More detailed mstrunions fvr use ,t this Uischarg. ?.fonitr,ringRrport (DMR) form may be obtained from O6ce(s)
<br />specified in permit.
<br />~;egal 1\Totice
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<br />'r~ort is rtquired by law (33 U.S C. 13:8; 40 C.F.R. I^_5.27) Failure to report or failure to report truthfully can
<br />~t ~ civil peralties not rc exceed S 11,000 prr d.y of ~ iviatiou, or in mminal penalties nut to exceed $25,000 per day
<br />ti"toNttion, or by impnsonmeot for nv! more char, cae dear, or by both.
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<br />E~".Fdrm 3320-1 ('itec-. OA-95)
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