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<br />,~+(~ ~ Recii.fction Acr rtict~ l
<br />'^.~hhc r°,~rtn.g hurl ~r f ~ ., . , ... ~.~ ,;f mf .::~, c, is es(inuted tt. var, 4um a range of 10 hburs as :m
<br />+. r r-> v,n;r r..,r ~ . at ;;. I;.. i' t : to , +~ in ~r:; es ao average peer r•pons~ for some major facilities,
<br />with a ..t:gntai o~er_ge :..::;;.,;~:~ _:.d ::a.,:r ~.._. _.ti ,~t iF Ituurs per rtspor:.t, including lime for!reviewuig
<br />inslrua:ons, starching existute dam,:: aum..~, ~ ,;..1 ncrirtainiog .ht L,ta n~tded, and completieg and
<br />reviewing iha collection of mforraiion. ::..~ ...,;,:.,.,._. ~tl;arding the burden estimde or any other' aspect of
<br />this collection of infornt:tition. in:lud rg c,g„ti.,~r. v~r roducmg this uirdeu, to Chie(, Information Policy
<br />Branch, PA1-223, U.S. Er.~..;~~:ut,. i,.,l rrot.xtioo Agency, 401 fd Street.:1V \J"_slinglon, DC 20460; and to the
<br />Office cf Information and (<.~guiato•y Attaus, Office of Nlanage.ment and budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been parially coorpleted by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permittee ,Vmne ,l/aiGng Address (and facility name/IopUOn, if diH'ert:nl)," "Perini( Wumber," and
<br />"Discharge Number" ~; here indicatdl. (A separate form is required for each discharge.)
<br />3. Enter dates beginning a:;d ending "A/oniroring Period" covered by form where indicated.
<br />4. Enter each "Paraure•fe:" s specified in monitoring requirements otpermia
<br />5. Enter "Snnrple A/easu. emrnr" data Cor each parameter under "Quantity" :utd "Quality" in units specified in permit.
<br />".4vrrnge" is normall} sntltmeuc average (geometric average for bacterial parameters) of all samplemeastrrements
<br />for each parameter otsas:cd dining "Afuvitonng Pennd'; "'A/arimum" and "Alinimum" are normally extreme high
<br />and low measuremen!s ebtaiucd during ",tluniroring Period." (Note [o municipals with sewndar}• treatment
<br />rcquircmenc Er,tcr 3n~'av average of sample measurements wider ".tverage," and enter maximum 7day average
<br />of sample measuremens obtained during motitoring period under "Maxmvunr. `7
<br />F. Enter "Permu Require ~r,,nt" for each parameter under "QuanJlty" and "Quality" as specified in permit.
<br />?. Under "No ir" enter t~cniuer of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7~ay aver::ge as appropriate) permit requirement for each p¢trame[er. ]f none, enter "0".
<br />3. Enter "Frequency ojAr.:d~.ws" both as "5'nn+ple .1lensurnrent" (actual .frequency of sampling and analysis used
<br />during monitoring pe:iol) and .~ "Pcr+uit Requireuu•nr" specified in permit. (e.g., Enter "Con(," for continuous
<br />monitoring, "1~7" for ire .lay per week, "1 X30" for oue day per month, 1!90" for one day per quarter; etc.)
<br />9. Enter ".Smnpie Ttpe" rnr:.h as " v:c+tple ,L!easure+nenP' (actual sample t}•lre used durng monitoring period) and as
<br />"/'errnil Requ~remcrr," ,_.g., Enter "Grab" for individual sample, 2aHC' for 24-hour composite, "N/A" for
<br />continuous monitorq;, etc )
<br />10. Where violatie:u of i:c,mit requirements are reported, attach a brief explanation to describe pose and corrective
<br />actions taken, and reference pch violation by date.
<br />1 I. 1f "nu discharge" xo:rs during tnortituring period, enter ",tiu Discharge" across form in place of data entry.
<br />12. Enter ",\'arne/I'itle cj i'+:ncipul Executive Officer" with "tiil;nature oJf'rincipa! F~•ecu(ive O~eer oJAulhorized
<br />.4gen(," "Telephone ~'un,5cr," and "Date" at bottom of form.
<br />13. Rtail signed Report k+GRice(s) Ly date(s) specified in permit. Retain copy for your rcrords.
<br />14. hfore detailed instmui~ns for use of this Discharge Afoniroring Report (1)MRJ form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is require.{ by I~.•.v (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully cart
<br />result ;n civil rcnaltics tint u ~.iteed 510,000 per day of violation; or in crimrinal penalties not to exceed (25,000 per day
<br />of violaticn, nr by irrCriscrn:ent for net more than one year, or by both. .
<br />EPA Form 3310.1 (Rev. Or.-'!5J
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