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1. <br />GENERAL INSTRUCTIONS <br />I. If form has horn Iunially ss+mpkteJ by Drepriming. disregarJ instrunions~dircclN at curry of that information :JrnJy prcprinrcJ. <br />_. Enter •'pFRMIITEF. N.1MF./MAILING ADDRESS land facility namc/location. if JiBercntl"PER \IIT NUMBF. R:' and •'DISCHARGE <br />NUMBER" There indicated. t.A srNrate form is requirN for each discharge.) <br />?. Fnrcr Ja~+ hrginninF surf enJinF -h10NITORING PERIOD" coserN by form where indintN. <br />4. Enter each 'P:\R.A\1 F.TFR' as specified in monitoring rtquircmrnts of permi[. <br />!. Emrr 'SARIPLF. AIEASURF.RIENT' data for each parameter undrr'QUAN717Y'anJ "QU.1L1'TY' in units specifed in pcrnrit. <br />-AVFR.IGF.' is normally arithmetic avenge Igeomctric avsa'age for hacterial paramacrsl of all +ample masurcmrnts for wch parameter <br />ohtainN JurinF 'h10NITORING PERIOD" 'MAXIMUM' and 'MINIMUM' are normally ectrcme high and low mowremenls <br />uhtaineJ during 'MONITORING PERIOD." iNOTE Io municipals rilh accondary trolmcnt rcquircment. curer ?U-Jay average of sample <br />meaaurementx under -AVERAGE" anJ enter maximum 7rL1y average of sample meawrements obtainN During monitnrinF period under <br />-h1AXIMl'hY. <br />R. Enter -PF.Rh11T REQUIREMENT for esch panuneter under 'QUANTITY' and 'QUALITY` as specified in permit. <br />7. UnJer "NO. F.X" enter number o! sample meawrcments during monitoring period tlut exceed maximum land/or minimum crt 7day <br />aaerage as appropriate) permit requirement for each parametp. If none, rnttt "0-. <br />g. Enter 'FREQUENCY OF ANALYSIS hoth as `SAMPLE MEASUREMENT' laetwl frrouenry of sampling and analysis usN JurinF <br />monitoring period) surf as 'PERAfIT REQUIREMENT specified in permit ie.F.. Enter 'CONT.' for continuous monitoring. <br />-I/7' for one day per .~eet '1/JO' for one daY per month. '1/90" far one daY per quaver, clc.) <br />9. Enter -5.1MPI.F TYPE' hoth as `SAMPLE MEASUREMENT' factual simple type usN JurinF monitoring peritxll and as <br />-PERMIT RF.UUIREMF.NT: le.g.. Enter -GRAB" for inJiviJUal sample.'.'.aH!- for :4lrour snmpndte.'N/A' for xrontinuous <br />monitoring, nc.l <br />__ ~ __ ___ ~ __ IlaYl1 fY1N 01011 <br />IU. K'NERE VIOI.ATIUNS OF PERAfIT RFQUIREh1ENT5 ARE REPORTED. .ATTACH .~ BRIEF EXPLANATION TO DESCRIBE <br />CAUS~:.ANU CURRECfIVE ACTIONS TAKEN. REFERETiCF. EACH VIOL:\TION P\' DATE. <br />I I. If "no Ji.charge ocsvrs during monitoring period. enter -NO DISCHARGE' acroav form in plxe of data entry. <br />7=. Enter "N.{MF/fTTLE OF PRINCIP.Af. F.XEC(~TIVF. OFFICER' .. ith -SIGs:\TURF OF PRINCIPAL. F.XF.CLrTI\'F OFFICER OR <br />AUTHORV.F.D AGENT.' -TELEPHONE NUMBER" amt 'U.AI E" m honour of form. <br />1?. Mail aigmd Repnn to Olficelvl hp Jatetsl xpscifieJ in permit. Retain cop)' for your recorJs. <br />W. rlnrc JcIaiIN instructions for use of this DISCHARGE. h10NITORING REPORT ID)IRl form nay k ohuinN from OTicelsl <br />speeifiN in permit. <br />LEGAL NOTCE <br />This upon is requirN by la.' Ill U.S.C. I\IF; an C.F.R. I:S.:71. Failure to report or failure to rtpun truthfully nn re.ult in civil prnaltin Trot <br />to eaceN f 111.Ihq per Jay of violation: or in criminal prnahia~ not to excreJ SIS,aYI per Jay of violatton. or hr imprisunltxnt for not more than <br />one year, or !h'tnth. <br />ON0~1a IYIM 0101 <br />3a3N <br />dWY15 <br />3~Y1d <br />0YIN1 IYaN 0101 <br />3tl3N 31d'al5 <br />