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<br />Public reporting burden for this collection o:' information is estimated to vary from a range of 10 ho-,~s ~s an
<br />average per response for some minor fact:: yes, io 110 hours as an average set .•esponse io ~ some m_jor
<br />facilities, with a weighted average for majo- ? ad minor facilities of 1 S hours per response, including time for
<br />reviewing instructions, searching existing zta sources, gathering and maint~iasg the catz ree:;.d, and
<br />comHleting and reviewing the colIeci:ca o ` information, including seggestion for reducing ti-is bu.•aer , it
<br />Chie ;Information Folicy Branch, PV-227, J.S. Environmental Protection F.ge~cy, 401 :'-: Street, S.i-:/.
<br />l~lashington, DC 20460; and to the Critce c; info_Tnation and Regulatory Affai,s, Cffice of hr.ais;eiteat aid
<br />Budget, Washington, I;~ 20503.
<br />;~,~ .~
<br />1. 'f form has bees partially completed 'ay pr ainting, disregard instruction d~mcted r: entry of thct 'n °o nri'on i_ kdy
<br />prepr:n[ed.
<br />2. inter "Pernittee Name/Moi!%ng /.ddress (a ~ ;facility namerlacation, if diffcr.:nt)," " Pe,-rrit P.rurabr ;" ant' 'D%sc4ar„z
<br />Number" where indicat:d. (A sepazatc form is requird for each cischazge.;
<br />3. inlet dates beginning and editing "lvlo;ritori „Pe~za l" covered by form wl' ~, ~ inc:icated.
<br />4, inter each "Parameter " zs specified is mane' orng requirements of permit.
<br />5. Enter "Sample Measurement" data for each -:rameter ~mder 'Qucatity" s~ Quality" as specified i- y.;-r: L ''.:re. woe"'..
<br />normally crithmetic average (geometric ave.. ,e far bacterial parameters) c f all sampl- r„csuremprts fir rzc ; r~~metc-
<br />obtained during "Monitoring Period"; "i/Ic ir~rnr,;" ar_d if.ri,:ru~.;" are uonat:y e.. rz,.tc high &~d Ie. measur..;ac.i~s
<br />obtaut:,d durir.~ "ivlonitoring Period". (i~bt to mu,iicipils vrith seconder; trzalmert r.c uuement: -'tor :,Oa iy i ter^,.
<br />of sample mersurements undue 'Averuge," .rd eat. maxim,un 7-day average of saw ~Ic measure ~: is .;bta _~e? i1L ig
<br />maait~-ing period under "Mcz;:imum.")
<br />6. Enter "Per-„.it Requiter:, ens" for each pazsmae; u-tde • "Ora;rrity"and "Quoli ry" as spccif ed in parr ~i t.
<br />7. Under "No Ex" enter rmber o; sample me , u•emct.t ''~ it ;monitoring ;period that excc.d ma;:imu ~ (a.cd/c- mirirs. r
<br />or 7-day average as appropriate) permit regoi-ement `or eac~ paremcte;. If none, entc "C".
<br />8. inter "Frequency ojAnalysis" bo9t as "Sa.ao/~ iveas;treme,•t" (acfial fitquency of sanpling ant. rr:i }ris _sel, iur' i;;
<br />monitoring period) and as "Permit Require.,.~~it" specified in pc.~it. (c.g. Eats: "Cora,"for continuots tncnii:.~~~, "I/7"
<br />for airs day per week, "!/30"for one day pe north, "!/90" for cr.e day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Say;tple!veas rre.,iert" (actual sample type used dumb monitoring rer~rl) any as'T-er;,%
<br />Requirement," (e.g. En[er "Grab" for it ~.ividrt: sample, "2417C" for 24-hour composite, it'/,:" for ~a~~nuous
<br />monitoring, etc.)
<br />a). Where violations of permit requiremen`s arc regorcd, attach a brief explanation to describe ezuse and eorrzc_ve cations
<br />to be taken, and reference each violation by .'ate.
<br />11. If "no dischazge" occurs during monitoring ,,::riod, ester "No Discharge" zcross form :n place of dzta cntrj.
<br />12. Enter "Namelfi!!e of Principal Exeaetive Officer" with "Signah:re of Principe; E-ecutive Officer of Aut.'toriz_d
<br />Agent, ""Telephone Number," snd "Date"at hottom of form.
<br />13. Mail signed Report to Office(s) by date(s) s;:ecified in permit. Retain copy for your r~co_ds.
<br />l4. More detailed instmctions for use of this - ischarge Ivlonit~,•ing Report <D~ form may be obtained from Office(s)
<br />specified in permit.
<br />aegal 1`do~ee
<br />Phis report is required by law (33 U.S.C. 1318; `3 C.I'.R 125.27). Failw~e to report or fai;ure to report ~_ _1-Belly c•a rstilt _•.
<br />civil penalties not to exceed $10,000 per day of .iolation; or in criminal penalties not to exceed $25,00 r~r day c `vi ~Luicn,
<br />or by imprisonment for not more than ooe yeaz, or both.
<br />RIPA Foem 3320-1 (Rev. 03/99)
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