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<br />Public reporting burden for this collection c ~ infor-tation is estimated :o vary ~~~m ~ range of 10 haul as an
<br />average per response for some minor fzciMies, to ? 10 hours as an average er response fo_ so: tc _jor
<br />facilities, with a weighted average for majo_ and minor facilities of lZ; tours per response, iiclud:ng'ime for
<br />reviewing instructions, searching existing ~ata sources, gathering ~-+c~ maintain ag the ~ ate ceedc3, sac,
<br />completing and reviewing the col]ection o information, includi._g suggestion for reducin„ E_is burner, to
<br />Chief, Information Policy 3ranch, °U: 22~ U.S. Environmental Prctcetion F_gercy, 4O::v= Steel, S.6'V.
<br />~Jashington, BC 20460; and to the Cffoe o'. Information a_d Regulatory F.i"~air, Office of lv;a agement a~ad
<br />Pudget, 'JJashington,l?C 20503.
<br />
<br />1. ?f form has been partially completed'ty pr__ rinting, disregard insYuction directed r.i entry of Thd ^:ormat:on -L-early
<br />prcarinted.
<br />2. ?rater "Perrrittee Nonre/ivtoiling ~'ddre.rs (a 1 facili'y name~iccation, if dif`crent)," ": en,tit Nu;,~i~_;;" and 'Dis=haroe
<br />Number" v.~here indicated. (A separate form s squired ;or each discharge.;
<br />3. Enter fates beginning and edirng "/~lo,titori „Period"covered by form where i ndicn.:,:L
<br />4. inter each "Parameter" as snec~ed in man oring requirements of cet-mit.
<br />5. Enter"S~rmp/eirleasurement"data foreac~..~rnJCCte-,ender'~LTltlry"az.r~hratity"sr,::ci~icd:r r..-r-'_ `,'va~ge"..,
<br />normally arithmetic average (geonetrc ave..~ge for bacterial par~,~,eters) of el] srm ~L: r. e surenie •-~ `cr e:.:i ~ ;tr :rae~a-
<br />obtained during "ionitoring Period"; "i.fe ir.um" and rLunirrtt,,:" are ao~a'ly e;_'sr. -.e hiL- aid lov.~ ;rr~snrmens
<br />obtauted during "i/,'-~niMring Period". (A?ot~ to mun~cipaL v~ith secondary trah,eot c: uiremoat: " ' :: 30~ iy , ~rrage
<br />of sample mezsurement, under "AveraEe,"rid cote- rnaximutrt 7-day average o° saz~p'e mast --:_ _ s abt.'~:d Puri t;;
<br />monitoring period under "iulaximum.")
<br />6. Enter "Pen~it Requiremen!" for each parmcter under "Qreantity"and ^Quelity" as specified in permit.
<br />^, . Under "No Ez" enter number of sw-nple mer:arerilcnt daring monitoring criod that . ;c_ed marcima-t trrc'/: nrn_
<br />or 7-day average as appropriate) permit regc -ement for each parameter. I'_'none, entr* "0". .
<br />g. Eater "Frequency of Analysis" boot as "So,.:ole :r,~asrrremz,tr" (actual frgaency of sampling and ^~ta'}ais raed during
<br />monitoring period) and as "Pernit Requires. _,rt" specified in perm+t. (e.g. ~atr "Cony,":or contincous monitr-irl, "I/7''
<br />for one day per wee'.:, "1/30" for one ray pe- -nonth, "//90"for one day per quarter, etc.)
<br />9. Enter "Sa.npk Type" both as "Sornple Mea~..rement" (sctual sample type used during monitoring Pc =rd) ar d s ':'en.•%t
<br />Requirement," (e.g. Enter "Grab" for individual sample, "14HC" for 24-hour co.nposite, "?'~6"' for continucis
<br />monitoring, etc.)
<br />10. ,Vhe.e violations of permit requirements arc sported, attac`. r_ brief explanation to dasc.-ib; catse a-_ cutrccl've r cticcs
<br />to be taken, and reference each violation by crate.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across font in place ofdatr. ;,; trj.
<br />12. Enter "Narte/Title of Principal Execut%ve Officer" with "Signature of Principal E.racutive Oixer of AuRSorizec'
<br />Ages. ; ""Telephone Number,"and 'Date" at I:ottom of form.
<br />13. Mail signed Report to Office(s) by date(s) s.: ~cified `.n permit. Retain copy for your r.:cords.
<br />]4. More de[ni]ed instructions for use of this ^ischarge Monitoring Report (Dlvf/~ fa-m nay be obtained from Cffice;s)
<br />speciSed in pemtit.
<br />:Legal l~To~ee
<br />This report is required by law (33 U.S.C. 1318;':0 C.F.&. 125.2; ). Failure to report or fai:ure to report trufriilly can rsult in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day cf violation,
<br />or by imprisonment for not more Ulan one year, or bout.
<br />1rPA For® 3320-1 (2ev. 03/99)
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