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<br />Public repo. ring burden for this collection of'nfoa~ation is estimated to vary £om z range o_ 1 C hcti=a as an
<br />zverage per response for soma minor fzcilil'es, to i10 hcitrs as an average ; e° ~=spouse "o. sorile ~nr~or
<br />facilities, with a weighted ave_age for ma?or -nd minor facilities of lg L-ovs per;•esYonse, in_;ulirg tine 'or
<br />revietning instructions, searc'uittg a ;fisting ~ _ta sources, gathering z,_d mai.-rta.ai: ~,; the dr.• ne.dzc:, and
<br />completing and reviewing the collect~oe o =aiotr_ation, ucluding suggestion icr reducing f-~s l•[1:de~, to
<br />Chief, Information Policy Branch, 1=iv.-i23 J.S. )raviroamental Protection R.gency, 401 II 5t•eet, S.-.~J.
<br />dUash~ngton, );C X460; and to the ;i; ice of ~n:o.r~ation and 2egulatc_y P_ffai_-s, C' ice of A~iar age men: t 7d
<br />3udget, Washington, I)C 20503.
<br />a-, .fir.-a--~~f-°,-~T•~~
<br />1. If :orm has been partially completed 1•y pre;.:intins, disregard instruction :;.,toted a: ent y of tha*. iioriation E -ead,~
<br />preprinted.
<br />2. Enter "Per„ritl.e Nan. e/,Yiai/ir+g flddress (z^ ~. ;aciliy nameQocation, if dif~erent;," " Pe- :nit Nu,~irs,•," trd "1%i~•: ';aria
<br />iJumber' whecc indicated. (P. sepuate form i, ;Equi,-ed for each dischugeJ
<br />3. °_nter dates beginning and ed.ting 'Srdoni:orir Pe: +cd" covered by form why a indicated.
<br />4. Enter each "Parameter"as specified in r.ioni:cring r.quiremeuts ofpcrmit.
<br />5. °_nter "Samplz I.leost'rement"chta far crca - ~ 7et rr uade: "',~ua.rtity"and ~ua:i;y" 3 s*; :cified in ~r rJt. ''f, v,:,. ire" i.;
<br />normally arithmetic average (geomc;ric -vim.;c for bacterial par..m_ters) o: a'I r_n31e .ncasuremer,c ". r eeo_ par rmetc-
<br />obtained dur.'ng "ivla;itoring Pend"; ':i ~ : •..,•. •~id ,~ii,.tura" sro nc sa:1y cx'. -~ :high a,.~_ 'aw m ~ su-.. nenb.
<br />otcined during "i.:onitoring ,°e;zou". (:?a:.~ mc-~oiprls ~•:ith secondary tro2rtent .c ireme.it: ~- ~ r y g
<br />3~-d•. c.em ~
<br />of sample measurements ~.nder "fvzr.ge," :.d enter rra;cimum 7-day avc~ge of sar: '.e measr_-eme-.L o ~4.i .e~ ; uri E
<br />monitoring period under '4Ylaxin:~;r.")
<br />6. ?nter "Per„7a.7squirement"far each ns"amel.r .~nd_ "~rrmrtity"and "Qual+iy" rs 5-o::ifcd in permit.
<br />7. Under "No Fx" eater number of ^"mplr, r ;:: L a-rc.rt c:Lrinb monitoring p:,riad t;~at c::c_ .d ma;:in-u * a rd/o:~ r<i u* w n
<br />ar 7~ay average as appropriate) permit requi-cment f or each parzmeter. if no ±e, enter "0' .
<br />S. 3ater "F:-vyuen~~ ojAnalysis" bath as "Sa;.. ole 's"rcaereme rt" (ac6~a1 fie: uency of earn ding 2nr t r "ys_s used ~uria~
<br />monitoring period) and as "Pen;tit Ren, t~irer, _ r!"specified in permit. (e.g. Enter "Co. t," `c continuous ~nonitcriLg, "Ir`
<br />for oae day per week, "1/30" for one day ne.-. nontu, "1/90" far one day per quaker, e[c.)
<br />S. Enter "Sample Type" both as "Sample Iviecs, .•eme;;!" (actual sample type used during me iltoring pe-~c d) ~d 3: ",'enr;
<br />,~:ouirement," (e.g. Enter "Grab" for intividua] sar_ple, "14HC" for 2~r-hour conposite, "i!r/~:" fo* cou nuo.>s
<br />monrtorng, etc.)
<br />10. tilhere violations of pemvt requir-:men[s a .-eportel, attach a b.ief explana.ion to dcscri~e cause ~r_' ccrree~ve rctiors
<br />to be taken, and reference each violation by r ste.
<br />1. If "no discharge" occurs during monitoring period, onto `No Discharge" across form .a p' ice of dam e- trp.
<br />12. Cnter• "Namelfitie of Principal Executive G1ji„er" crith "Signanere of Arincipai Fa:ecutive Ofl.:;_r of Aut.rorize_.'
<br />Agent, ""Telephone Number, "and "Date" at ~ atom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy fur ye m recoc~is.
<br />14. Mon; deGtiled instructions for use of this Discharge Monitoring Report (DIv1I2) fog .,ay be obtained from Office(s)
<br />specifed in permit.
<br />This report is required by law (33 U.S.C. 1318; r0 C.?.fc. 125.27). Failure to report o: fa;;ure to report trrfrfully c_n asult in
<br />cirl penalties not to exceed $10,000 per day of ~io]ation; or in criminal penaltes not to e;:cc:d $25,000 :::.r day of violation,
<br />or by imprisonment for not more than one yeaz, ar bath.
<br />IuPA Fortin 3320-1(12ev. U3/?+9)
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