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- -~ a•f-~~'orlC Rc ill(aiton Ar~lr. N•icte-- -- - • -
<br />'r'~hi~c _;a ::r ~, i-~;~.r ( _..,..,f mfornreti~m is estimated to vary from a range of l0 hours as :an
<br />avec„gr nor r-~.;.:,:~.< ;r s . as ..... ,.,,..,~,. , to ' P ;..ats as an average per -e::ponse for some major facilities,
<br />with a Hetghle.i ovc: ge :.. ,re;c': :mJ nllnJ:' ..:ci.. .~ ;F'.:ooa,rs per rtspoa:e, including time for reviewing
<br />in>truc;:.ua. r~:.^zhir•r ax~~ '..'. ,,,;: r::~s. ~_., _ „i„i meintainutg the i,la needed, and completing artd
<br />review';::he c„~:;x;; ;t~ a.. ...,,,r.. _.,c... .,~,:d wnrr~.c.,:, rr„arding the }suda^ ectirrude or any other aspect of
<br />this culirction of in5:rm....~„ :~ ....~ -„ ~=gestions t~.r redutirg that: 'rardeu, to C_'hief, Information Policy
<br />Branch, PM-223, L'.S. Er:a.: ~~:.,_t.~:,l Pro:xGcn Agar.; , •}C1 1d Street, SLV lrshinflon, DC 20460; and to the
<br />Officz of Infomtatior, end kegu;aWry Afra.;a, Office of \1ana;ement and IIudgat, Wasi~inglon, DC 20503.
<br />General Instructions
<br />I. iF form has been partiaify completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permi((ee NameG4lnih~:g Address (and facility namdlop[ioal4 if diH'en;nl)," "Perini! 'Number,' and
<br />"Discharge A'umber" where indicated. (A separate form is required for each dischareeJ
<br />3. Enter dates beginning and endit~g 'Stfonitoring Period" covrred by form where indicated.
<br />4. Enter each "Parameter" ss specified in monitoring requirements of permrL
<br />5. Enter ".Sample tlfeosu.'rr•.oa" data for each parameter under "Quantity" .and "Qualify" in !roils specified io permit.
<br />".;rernge" is nentnally a: _tlu-ne: c a~~erage (geometric av~eragc for bactenaJ parameteis) of a)1 sample measurements
<br />for each parameter able. ~cd durng "Alonitoring Pennd'; "Alarimum" and 'Alinimam" are normally extreme high
<br />and low measurements obtained during ",lfunrmring Period." (Note to municipals with secotldary treauaent
<br />requirement: Ertcr 3 1„c} average of sample measurements wader "Average," and enter maximum 7~ay average
<br />of sample measurements obtaircd during monitoring period under "Masrmum. "J
<br />F. Eater "Permit rcyuirur;er,t" for each parameter under "Quarnrity" and "Qualify" as specified in permit.
<br />'. Under ",Vo Ex" enter umber ~f sample measw'ments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day av:r_ge as appropriate) permit requirement for each parameter. If none, enter'0".
<br />r'
<br />8. En[er "Frequer:cv r f Ar:=lya.s" Goth as ".Sample ,tleasurmen(" (actual frequenry of sampling and analysis used
<br />during monitoring perioc) ands "Pennil Requirement" spaded in permit. (e.g., Enter "Cool," for continuous
<br />:nenirorng, "1 ~7" for ,r,c day per .~cck, "1 r3D" for one day per month, "1!90" for one day per quarter, e1cJ
<br />9. Enter "J'mnple Ttpe" ho.h as ':+uruple Aleasvremenr" (actual sample 4Fe used durng monitoring period) and as
<br />"Pu~mir P,cqu;renrrrr." ;eg., Eder "Groh" for individual sample, "~4HC' for 24-hour composite, "N/~I" for
<br />continuotu monitoring, e:c )
<br />]0. Where violaions of ::er.:rit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each ;~olation by date.
<br />I L 1 "no discharge" occ; rs .Wring monitoring period, enter "No .Discharge" across form in place of data entry.
<br />I2. Enter ".\'ame'T,t(e ~jl'r.ncipnl F:-ecutive Officer" with "Signature oj(•'rincipa! F~ecu(ive Officer ejAu/hori~ed
<br />Agent," "Telephone )\•'un.her," :wd "Dore" at bottom of form.
<br />Z 3. 1'Aail signed Report fo C!T. ice(s) by date(s) specified in permit. Retain copy for your roxrds.
<br />l4. A1ore detailed instrtrci:;:s !or use of this Discharge,tfonirorirrg Report (,7MR) form tray be obtained from Office(s)
<br />specified in perm.
<br />Legal Notice
<br />This report is requin:d by F;w t33 C.'.iC. 1318; 40 C.F.R. ]25.27). Failure to report or Failure to report truthfully can
<br />~esuir is •:tstl pena[t:e, act u a,.ceed $ iO,OfA per day of violation; o~r in criminal penalties not to exceed 525,000 per day
<br />e(~ iolatica, or by im frisa:r_nc~. t for m~t more than one year, or by both.
<br />EPA Foran 3320-1 (Rev. 0<-i
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