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~~~~ Wl: `,~f©~~`a t'(aE ~i;_~1~.0•..1~.::_ L'y~i l~~liil'i".~:
<br />i ublic reporting burden For this collection of ~for~rtion is estimated to vzly froL~ a range of 10 hams s an
<br />aver^~ge cer response for some ninor facilit c;s, to i10 hc'~rs as an zvcage per response fo- come major
<br />facilities, with a weighte3 average far rnajo_ ..d sinor facilities of lg hous per r~sanse, incird7l„ hrle'_'aL
<br />reviewing :nstvctions, sezn;-.ing exisY:ng .a so~]rces, gathering aac: maintaining the da:_ i:e~r7c~, 2i1
<br />completing and mviewing the collectio'i of :~or:.tation, including suggestion for .educing ;pis ~urdon, '.o
<br />Chie ;Information ?olicy ?3tanch, Fil-27.3; J.S. ~n~7iroamental Protection P_g~ncy, ~SO1 ;~~_ ~sce_, 5.'~`.(.
<br />\hlasnington, );C ZC460; znd to the :.mice o". iorsztion and Regulatoy ta=-:zirs, O;rice of R, a_eg~--e ,t z:n
<br />Budget, Washington, LC 20503.
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<br />1. If :orm has been partially completed by pre..inting, dis:ega.d instruction c'~recied at en±ry of that i-Cor,ec'c~ creau;
<br />preprinted.
<br />2. °_ater "Penn(tee Nome/719ailinglc'~,ess (ate ;rciii[y aamerlecation, if dif:erenQ;' " Pe.,:7it Nurrte%,' an:i "Disc'~erg,
<br />iJumber' whe;c indiczted. (A separate fcrm '"s rquir..d far each discharge.)
<br />3. inter dates beginning and editing "AAo7sirr.-i. r : °ric!" covcred'cy form wl:u~ indicate:.
<br />:. Enter each "I'eranetzr" as specified in mo71i: ring rcquiremer.ts of permit.
<br />5. _n[cr 'Som,^!e ivi~arcre,;r2n[' data for c: cS :..: ~etu under "~:fo77liry" and ~u= l:,y"mss s :aided i-i is _ ~ ir. "ti !~r ;e"
<br />normally a7ithme6c zverage (3eon-e[.ic =: ~c-_ ~;,, .-.- „2ricrial p:.r7r°LS) of z!I :ample scrsuren:er ;:, cr eac.7 ~a:~ peter
<br />obtained during ".birn7i(orir:g Perbd"; "r"^ ~,a.;7" aru i3ininrxr a^., nc~nzIl; e, ~ rr~ high and :rnv ~er;w.. ner.:a
<br />O;,ta]ned dwn:g "IhGi1l10,'ri7g 1°dri o;(". (+'!Ot2 7 I. ~'i ~.17DI5 Wiih SCCO'1'~0.,~ IT: ;. ~rTlt,~ "C:~7lrementf ~ ~ r 30-.t_y .:crag
<br />of sample m~asutements under "fivera„a," end enter rilaximum 7-day ave.~g^_ o..° sa plc measu-er]c' ~; oJt<i r . ~~ri g
<br />monitoring period under "ivlaximur,7.")
<br />6. Enter 'Permit Requirement" for each na-rmF'ar urtdi- "~amtity" and "Quoli7~" as sp~eif cd in pern`t.
<br />7. iJnder "No Ex" enter number of szr•:ple mr. r.emc~ .during mop:?oring period tira~ exceed maxiru-: ;aad/x rrv~ ~~~c.r
<br />or 7-cay average as appropriate) pemit rege . en7wt for each parameter. If none, ent:.r "0".
<br />f. Enter "Frequency ojAnalysis" both as "Sa...,~le ~ ~.•sure,aa,;r" (acr]a! L-equeacy cf srnpling anc; e.: ]ysis 1 sed durin,;
<br />monitoring period) and as "Perri( Requirer,;r rt" sp~aified in permii. (e.g. Enter "Con!," for continrou:: nonix.in~, "1/v'
<br />fo; one day per week, "!/30"for one day par month, "I/90"far one day per quarter, etc.) ,
<br />9. °nter "Sample Type" both as "Sample ir,'earrre,:reni" (actual sample type used during mcnitoring f er;,d) za_ as '.'er,;:"
<br />Rquirement," (e.g. Enter "Groh" for in~.vidual sample, "29H~" for 24-hour composite, 'i\;' '' for cosnuccs
<br />monitoring, etc.)
<br />10. Where violafions of permit requirements are n:por;ed, attach a brief explanation to dear.-ibe cause ~ d corrective .^.ctic~
<br />to be taken, and reference each violation by ~ zte.
<br />I I. If "na discharge" occurs during monitoring period, enter "i!Io Bischarge" across form in 71ace of data eLlry.
<br />12. Enter "Namell'itle of Principal Executive Officer" with "Signature of Prircipa? Executive Of~i~er of Au!%.orized
<br />ifger7t, ""Telephone Number,"and "Date"at : cttom of form.
<br />13. Mail signed Report to Office(s) by date(s) s;.~ified in permit. Retain copy for your r.::ords.
<br />]4. IvIore derailed instructions for use of tail Discharge Aloni!oring Report (Dlvll~ fo m may be obtrir.ed from O!~ce(s)
<br />speci5ed in permit.
<br />::~e~a~ rJm~a~~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.tL 125.2'1). Failure to r°part or fzilw-e to report tr.7t]fully :an 'zsult in
<br />civil penalties not to exceed $10,000 per day o''violation; or m enmmal penalies not to ~xcced $25,000 r°r day :;f v olaiail,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 332tE1(Itev.03/99)
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