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1'~•;'i~j'elr h SEt~.~litctilon Act N•~c'e -_ _ ... __
<br />Pubbc ron~xt¢g bor.:, r ' : ;i : ~ . _ _, _` :nfonnatn•n is eatinated c ~ rem ~ range of 10 hours as an
<br />avuzge ?~-r rrr; oru r ~: s . :~r ~,. ... .... , .u I IG h:~.n~ c; an rvzra~_e rzu r pea ~~ for some major,tacilities,
<br />vetch e ,.z:rh:a; o'.uage 1_: aWp.....,~ :,~.~r tacaiu>> ... .., ..:zrs per r~spat_:;, including time for heviewimg
<br />in..tr::c::~:ns, s~::r.h;,-, _. ~x,> : „,. „~~:,,:., eath:r~-:g r,:,.laining the daa oaeded, and compl~etmg and
<br />raviz~'ing the .;uiizc.aan ;,( .r.tu,n.~:,on. Scud wuwtu.. , n l;ciag the Garden estirtu~te or any otheitas~act of
<br />this coCzction of :nfcrnrauun, meludir,g suggz::iun: r..r .,~ a.-, Wis hurdrn, to Chief, Informatiom Policy
<br />Br:wch, PM-223, U.S. En~.ronmzntal Prut"et:un Pg~:'-. , '.G. ~4 Slrezt, S'rV V/ashingtom, DC 20460; and to the
<br />Office of Information and Rzguiatury Affairs, Officz ~(:;lanagzmen[ and Budget, Washington, DC 205D3.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter '..°ermittee ,4'ame.:llailing Addrexr (and facility attncllopGom, if different)," "Permit ~Jurnber," and
<br />"Discharge ]Dumber" cohere indicated. (A separate Corm is roquired for each discharge.)
<br />3. Enter dates beginning and cndmg ",1lunitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" s specified in monitoring requirements of pemit.
<br />5. Enter "Sarrrple .11esu; e:,~ent" c ;a for each parameter under "Quantity" .urd "Quality" in units specified in permit.
<br />"average" is normalh z.alu~etic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter ot~a.n;d d•~:~ng ",lonitoring Perurd"; "'Alarimunr" and 'dlinimmn" are normally extreme high
<br />and low measureutects ~b[air:_d during "Monilor~rg Period." (Nutt to municipals with secondary treatment
<br />requirement: Entc: 3J-::av aczrage of sample measurements under "Avarage," and enter maximum 7~ay average
<br />of sample measuremcuts obtained during monitoring period under ".Llazi~num.
<br />c. Eater "Pernut Regwror:rnr" for ;ach panrmeter under "Quantity" and "Quality" az specified in permit.
<br />7. Under ".Vo Ex" toter r.:~nber of sample mcasunnents during monitoring period that exceed maximum (and/or
<br />minimum or 7~ay avrrge as appropriate) perncit requirement for each p:uameter. If none, enter "0".
<br />8. Enter "F}egvrncy rij:ir.nlysts" ooGr az "Smnp/e bleasurrnent" (actual frequenry of sampling and analysis used
<br />during monitoring pe~od) ands "Permit RequiremenP' specified in F~_rmit. (e.g.. Enter "Cons," for continuous
<br />monitoring, "/ T' for one day per •.ceek, "1130" for one day per month, "!.90" for one day per quarter, etcJ
<br />9. Enter ".Sample Ttpe" bath as "Saurple .Lfeasurement" (actual sample t;qx used during monitoring,period) and as
<br />"Fermi! Requirement," ,. e. g., Eater "Grab" (or individual sample, "14HC' for :?4-hour wmposite, "N/,4" fer
<br />continuous momtoring, etc.)
<br />10. Where ciolaUCns oC penuit req.:;reroents are reported, attach a brief e:eplanauon tc describe pose and corrective
<br />actions taken, and re[crcace each violation by date.
<br />l l . IC "no discharge" occurs curing monitoring period, enter ",Vo Discharge" across form in place of data entry.
<br />12. Enter ",ti'ame;Ttle uJ Principal Rxecutive Officer" with "Signn(ure ojPrincipa! E.cecutive O~eer ojAuthorized
<br />Agent," 'Telephone A'un,b~r," and "Date" al bo0om of form.
<br />13. Matt signed Report to OiTCe(s) by date(s) specified in pernrit. Retain copy for your rceords.
<br />l4. Ptorc dcailed irutnrc ic;s for use of this Di,cchnrge.iloniroring Report (DtifR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This ,epcrt ~s required by l.,v (33 U.S.C. 1318; 40 C.F.R. 125.20. Failure to report or Failure to report truthfully can
<br />result a crv d 1'.enaltizs cot .~ , t.cezd SL),000 prr day o(viulanon; or m criminal penalties not to exceed 525.000 per day
<br />of violation, or by imprisur me~'.t for net more than one year, or by both.
<br />a
<br />EPA Forro 3320-1 (Rev. 0.,-9`)
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