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', Paperwer:~ ~:.edl_lf:ti~~r- Act Notict~
<br />Puhlic rep.,Aicg bunion f : ':,.s ~ ~;ir•.::,.~i ..: :~...:. ~n is rstimaterl t, c!r,' from ; range of 10 hours as tm
<br />'i aca;a;: o~i r~,,;..:.~.~ o: r ..•. '. .., io I !U h ntr~ as an averap< t:.. ~~:poo~~ for some major facilities,
<br />~ wid: a .:ri~.hte.l o\r.:.vo` . _, _._ _...:, iucilit,cc ul lf. hours per :spoke, im:luding time for ra~iewing
<br />~ :r.~truct.~m,. ,.~;~h:c;. ~a~ ,. 2:dt.tni.~ .,:.~J maintaining the lita needed, and completing artd
<br />' mvirw:^g the .;ol:r:.a:on ,.i ... x., .; _.:,,n. .,cad wnur„~:>.._,;;.rdiug d7c cr:rdcr, eatim;te or any other aspect of
<br />this cnlirchon of tnfornt.,>~-, _~~'.,U::;_ ,a;grslioo~ (rr mducuig thf:; ourdeu, to Chief, Information Policy
<br />BrancL•, P`.1-:.2?, U.S. Erg .:a.ue., _.i :'.ut::c,ion Agrncy, 401 M Street ~W \J~shiniioo, DC 20460; and to the
<br />i Office et Infonrvrtion and :.~~_~l;aa~ w ,~.f~ans, Office of !aana;ge:mem[ and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If (orm has been part~a!ly competed by preprinting, disregard instruclioru directed et entry of that information
<br />already preprinted.
<br />2. Enter "Permittee Name..4faibng Address (and facility namefloglior4 if differenQ," "Permit INumber," and
<br />"Discharge A'umber" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'ilfoniroring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample .41mav, ee.; nt" data for each parameter under "Quantity" .and "Quality" in units specified in permit.
<br />".; re; age" is normally anehmetic average (gcornetric average for bacterial parameters) of all sample measurements
<br />for cacti parameter ob;a:,:cd dwEi,g "Aloniloring Period'; "Maximum" :end "Alinimum" are normally ea1reme high
<br />and low measoremccts oiilaiard dwing ",tfoniforing Period." (Note to municipals with secondary treatment
<br />rcquiremenc Enter 30-d:,p avaage of sample mcas;rcmentr wider "Average," and enter maximum 7-day average
<br />of sample measurements e.'otaiued during monitoting period corder "Maximum.
<br />6. Enter "Perm, Rcquiren,. r. r" Cor c.rch parameter under "Quantity" and "Quality" as sfecified in permit.
<br />"'. Under ",\'o Fx" enter cumber of sample measunnents during monitoring period that exceed maximum (and/or
<br />minimum or 7-day avcroc as appropriate) permit requirement for each parameter. Unone, enter "0".
<br />3. Enter "Frequer.cv :~J.I~.~.ly~is" bosh as ".Snrnple Aleasurrnenr" (actual Crequenry of sampling and analysis used
<br />during monitoring perinl) ands "Permit Requirement" specified in permit. (e.g. Enter "Cont," for continuous
<br />monitonng, "1: %" For ~rr c Say per ~.vcek, "liJO" for one day per month, "I %90" for one day per quarter] etc.)
<br />9. Enter ".Semple T<pe" be:h as ':+mnple t!easurcmenr" (actual sample type used during monitoring period) and as
<br />'Permit Requ rrmer:r," seg., Enter "Grob" Cor individutd sample, "~JHC" for 24-hour composite, "N/A" for
<br />crontinuous monitoring, e c )
<br />;0. R'hete violzlions of pe~rait rey.;irements are reported, attach a brief explanalion to describe cause and corective
<br />actions taken, and rcf•:rr^_ce each violation by date.
<br />11. If "no discharge" occcn curing r~anitoring period, enter "No Discharge" across fornt in place of data entry.
<br />12. Enter ",F'ameiTule cJ Po:rrcipal Executive Ojrcer" with '^.signature ojPrincrpaf E~recutive Officer ojAuthorized
<br />.4ger,l," "Te!epl:one r<"un.ber," and "Dale" at bottom of form.
<br />13. lvtatl ,igued Report to Clitce(s) ay date(s) specified in pcrntit. Retain copy for your records.
<br />] 4. tt:me detailed ituWCi;e.s for use of this Discharge Aloni(oring Repot! (DMXJ form may be obtained from O6ice(s)
<br />specified in permit.
<br />Legal Notice
<br />This t~pert is requited by isw t33 U.J.C. 131 g; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />, rsL'ir in ctt it pcna'.ti:a ant 'o a cad $iC,000 per day of violation; or in criminal penalties not to exceed 525,[X10 per day
<br />nl violation, or by imfrsocmert for not ;core than one year, or by both.
<br />EPA Ferro 3320-1 (Rev. 0 =-95)
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