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<br />Public reporting bodes for this collection o-~ i,-[formation is estimated :o vary £ om z range of ; 0 voa-s as an
<br />average per response for some minor facit ties, io 110 hours as an average :er response fo_ sane mc;or
<br />cil:'ties, with a weighted average for major :.utd minor facilities of 1 S 'to _-s pe. response, irc.'nd~tg t= re For
<br />reviewing instructions, searching existing rata srnuces, gathering and .1 ainti: nir_g the des ~. rocce3, 'ad
<br />completing and reviewing the ccllection of in''ormation, including suggestion or reducing '~~is ber~en, to
<br />Chief, Information Policy Branch, Piv=-22~. U.~. ~nvirormental Frotec7on F.~ency, X01 Ib_ S~eot, S'In/.
<br />~tzshington, DC 2C~'.6C; and to flee Qffice o"'nforrrtation and Regulatory Aaihs, ;.ffice of 1'.-iaiag_mcnt Ord
<br />3udget, Washington, BC 20503.
<br />
<br />1. 'f form has been partially completed by pn tinting, disregard instmetion d'cceted at e.r'sy of iL t :r~u:matico :read,
<br />preprinted.
<br />2. Enter "Pernit:ee No;ue/A'.ailing Lddress (r. _ facility name/location, if di'-~erant)," " P_ -mit Nu;aher," and "Dis:;roroe
<br />Ni:raF,er" v: here indicated. (A separate `arm : ; tcquir;.d for each discharge.)
<br />3. Enter dates beginning and editing "turn titor~ ; Perir.c"' coven;d by farm where +ndicaUd.
<br />k. Entzreach "rararietar"as srccifed in non:.~.ing requiremt~ts of permit.
<br />5. Enter "Sample i~leasurearent"data for e'^.'.~ : ry~ticte- nr der ~Qr~7iitlty" Fn'i ~t'_^~1!y" ~S ~ i0CIt7Cd Ll CCT P t. '. a'C7 .,^e" IS
<br />normally arithmetic average (geometro avl, : gc for bacterial parameters) o"all samp' : r.-.;asurem::.*_~ for eza- pry mere-
<br />obtained during ";vlonitoring Per'od"; nL..',av.a" and lri.•iwvn" are ncrntzll er';;--.e high an~'oa' wc-su*~;,e-'s
<br />obtained d'arieo "Moni.'nring ; eri:d". (floc o nun~cipals with secondar; 7eatrtcr.: rcgsrement: Ec[c. 30-cry .^eret,.
<br />of sample measurements under "Avera;e," : -~t enter maxim~~ 7-day average of sa-ple measurem,:r.;s oEGti red dun: •;
<br />monitoring period under "Maximum.")
<br />6. Enter "Per,7it Requirement" for etch par°.~::cr under "Quantity"and "Qualif,~"as spccifi:d in permit.
<br />7. Under "No Es" enter number of sample men arctnent during monitorng period that exceed maxin-um (and/. mi-in; r
<br />or 7-day average as zppropriate) permit requi; :meat `or each parameter. If none, enter "0 ".
<br />8. Enter "Fregerency of Analysis" boat as "So, .ole i/.~.ts,~:ement" (actual frequency of sazsling aaa zn lysis ~,aed during
<br />monitoring period) and as "Penait Requires-,: -,-rt"specified in pertait. (e.g. Eater "Cora; "for coatinuocs monia~ing, "!/7"
<br />for one day per week, "1/30"for one day pe:.nanlh, "1/90" far one day per gearter, etc.)
<br />9. Enter 'Sample Type" both as 'Sample l.~eas~~:enent" (actual sample type used during mcnitoring fariod) and is '':~enn~t
<br />Requirement," (e.g. Enter "Groh" for individual sample, "24HC" fo: 24hour cortposi[e, :11/i ' for coy. auocs
<br />monitoring, etc.)
<br />10. When violations of permit requirements are reported, attach a brief explarla$on to describe cause red carrec_ive actiars
<br />to be taken, end reference each violation by ;:ate.
<br />1 I. If "tnr discharge" occurs during monitoring period, eater "No Discharge" zcross font ~:n pence of data entry.
<br />]2. Enter "Nan, elfitle of Principal Executive Officer" with "Signature of Principal Executive Olj .er of Autl»size~±
<br />Agent, ""Telephone Number,"and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your teen: ds.
<br />14. N,orr, detailed instnrctions for use of this Gsscharge Monitoring Report (DhfR) farm may be obtained from Office(s)
<br />specified in permit.
<br />:'legal 1olotlee
<br />;'his report is required by law (33 U.S.C. 1318; 40 C.F.R 125.27). Failure to report or failure to report tr. ':-filly can r=salt is
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 cer day of vicla6on,
<br />ar by imprisonment for not more than one year, or both.
<br />FPA Forrrr 332!}1 (6Lev. 03!99)
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