|
<br />Pu;~lic reporting burden for this collection oinfor,~ation is estimated to vary om r range o~i 1,1 hours as an
<br />average per response for some wino; faciL'':es, to Ii0 hours as an average pe- response fc_ s.^.ms mr'or
<br />facilities, wit)r a weighted average for major .rd t- nor facilities of 1 S L-o?rs per -es.~onse, iLCit~i.ig ~ ;ne _=or
<br />eviewing instructions, searching exili=ng rata sau~ ces, gathsring and ma~nt~~~i-g the dstz nred°d, aid
<br />competing and reviewing fre col]ection of :n`ornation, including suggestion :`or .educing t;i.'s uerden.:o
<br />Chief, Information =olicy Branch, Pity-223; U.S. Environnre~tal Pre2ectiurt F.,;en~y, 40i ;~! Sreec, S.'?I.
<br />~Uas',rtgton, DC 20450; and to fie .^,fi:^e c~..uon.~aiion a-d =tegulatc-y ."~~airs, ~ ="ce of i d~ z.gemr:lt i~.d
<br />Budget, V+lashington, DC 20503.
<br />
<br />1. I. form has keen partially completed by pr. , r;nti t„ disregarti insr7uc[ion d -coed a e- :ry of tha. i t c-mar:on .'reac:;+
<br />preprinted.
<br />2. Enter "FenaitNe Na.ae/i~lai!ingiddrt~~s (a-. faciC.y name/location, if ciffesnt)," " P,:,ai~ Nu::,''ar,' rrd "t%so'-nrge
<br />NwaF.er" where indicated. (A separa4 ;..~ is :re~~ red ..`c; each discharge.)
<br />3. En[er crates Leginntng and editing "i:,'.o,~ilo. %. ,; Per ir.-r" roveres by form wher_ iidicz~ L
<br />~'. Lnter e;.ch "Parameter" as specified in mono rin;; rcZui;cn:ents of permit.
<br />5. En•.er "Sarrplz irleasuremeut"dare fns c .ch ! 3 acts- un:~r ' Qvanrity" rn~; ~.. `a/iy" -. ..cified it _ -. 'n ~ ,: ,zr Vie" `~
<br />normally arithme`. avenge (genmet-`.~ ~ ~c. ,e "_:• ~=.cterial pa .uneiers) o"e'I s-~nplr ,..r aswemcrs '~ e~c'a ? =+e' ,
<br />obtained d:+ring "i/lunitori..g Perio,~'; ";:To.:,.,:+rr" .~~' ;~;i.;i;7crn" are nor all}' ~ _ . ,r; Ivgh ar3 Ir•+;- re. ~u~: tee: `:
<br />obtaiced during ".'vlonitoring Peric,.'". (:•'c[e in m.: llClpals +..th SeC0lGarf treatment -.:c,i iement: ter.?.r ;3-cy r+ ~rago
<br />of sample measurements under "Avzrao~,":.d cn^a maximum 7-c;ay evera~e c`sa ~1,: measunc-c~'; ootn red i~,=,o
<br />monitoring period under "ivlaximum. ")
<br />6. 6nt~r "'er;,rit Rzgvirement" Cor each prtam . e..a:dx "Q;+antity" ?ad "Qtealit)+" as sy,cri rl it pe~'t.
<br />7. Jude- "No Ez" enter number of sample :-.:. !re*n.-; during monitoring rerir•.d liar r.:cc ;d marimu~ (a-tJo- cu•t~t -.
<br />or 7-day average as appropriate) permit rqt~ ~me.r. for each parameter. If none, ent.: "0' .
<br />8. Enter "Frequency oJAnalysis" hota s ' 5~..'?!e alevsurement" (actual fregt•ency of Tarr ding acs .-; yss t :cd ~::>ai;r~
<br />monitoring period) and as "Permit Require., gat" specified in permit. (e.g.:n:er "Con!, " 5 - wn[inr atv tnn~ix s" "IC,~''
<br />for one day per week, "1/3D"for one day pnr month, "!/40" for one day g~ quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample /rfeos. ve,nz;;f" (actual sample type used during me ;ironing c :=c r) rnd as "Per.,+a
<br />Requirement," (e,g. Enter "Grab" for in^wideal sample, '74HC" for i~-hour co7posite, "r?~/~"' for con.nuc.is
<br />monitoring, etc.)
<br />10. where violations of permit requiroments a:~: ;eporte-.1, attach z brief explanaion to desc'1e cause e>=d c; rec~:vc t cticnr.
<br />to be taken, and reference each violation by date.
<br />? 1. If "no discharge" occurs 6uring monitoring pertied, enter "No Discharge" acrcsss farm in p; ,~ of darn c ty.
<br />]2. Enter "Name/TitJe of Principal Executive Officer" with "Signahere of H•i,TCipal Er:cutive O,~lczr of AuLrorizec'
<br />Agent,""Telephone Number,"aad "Date"ar ~~ttomofform.
<br />13. Nail sighed Report to Office(s) by date(s) s? ccifie~ in permit. Retain copy for your u.orls.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (Dlll~ form :ray be ohtairad fivn Office(s)
<br />specified in permit.
<br />• ~~~a~ r~O~~f~
<br />This report is required by law (33 U.S.C. 1318; ~ 0 C.?.2. 125.2'7). Fzilure to report o; fai'sc to report ~:bfilly can result ur
<br />civil penalties not to exceed $10,000 per day of +riolation; o: in criminal penalEcs not to r...c:.,:d $25,000 per day of violaticn,
<br />or by imprisonment for not more than one year, ~; both.
<br />]EZ'A Focm 3320-1 (Itev. 03/90
<br />
|