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<br />Public reporting burden for this collection c` informr.tion is es_i:nated to vay fi-or i range of I ~ hoes as an
<br />average per response for some minor `aci ties, ".o ! 10 ilours as an average per -esponse fer acme major
<br />facilities, with a weighted average for majo :~ ~d rinor facilities oY 13 'loots pet •c~ ,onse, iIICa ding :.ne for
<br />reviewing instructions, searching exist ng -z:a soirees, ga'~nering a-td naintair.i tg the data reedcd, rnd
<br />completing and _wiewing the collection orir°on7ation, including sugg~stior for reducing ii!is bwder. toy
<br />Chief, Information Policy Branch, Pi•/e-227; U.S. Environmental F;otectica t'•.ge cy, 4.01 iv.-. St•ca, S.lh1.
<br />Washington, );~C 20460; and to the Cfiice o C?niomr.tion and Regul~".ory 1~ffai!s, ~`5ce of c• ~ t~~emcnt and
<br />Budget, ~,tashington, BC 20503.
<br />,. ~. , q
<br />]. If form ha:: been paYially completed by pr~ptintirg, disregard i~slmctior. i -.:~ted ! e ,:y of the nia7nrt an eirer~y
<br />preprinted.
<br />2. Enter "Permi6ze Narrre/nfaili,rg Arldmrs (r-c; ,'scility namc.locatian, if d.`ffcrz~-)," " . ;nit i!§n„r.,•," ale 'D%s::'ra,;yz
<br />Number" vrhere indicated. (A separate form s req~ irerl for c~ch dischazgc.)
<br />3. inter dates beginning and editing "ironhor: „!'e.,c_t"covered by form v:he-c indict [~1
<br />~: inter each "Parameter" as specified in mon+' ring rco.tiremcnts of permit.
<br />5. T;nter "Sar,:plr iv,"°asurz,nanl"data for etch arrerer untie; "~erm.tity" .-d ti >Ait)~' _s ,;,ci,ie~ in ;,:Tit. ".•~v.r,,~Se" is
<br />normally triLimetic avc,age (geometric avc-.ge "c hr: erial naramrters) o's'l ssm I, r~asureme-t, or each n' _mrcr
<br />obtained during "lviorritoring Period'; "i,;.. 4n^,a" ; nd iriair.,ur.." are ^orraay r :. _ c high a-;: ~~~ mcasu~:mc•+s
<br />obtained during "idonitcring; Period". (blot. to utu~ici~als with sccandan,~ tr.:almcr t r~.a.irement:.;c =: 30-.:cy tvem~e
<br />of sample measurements under "Average," :'c en'c--naximum 7-day avc.~ag, of srrrp _ measurc,zr s oba`acd ew~rg
<br />moni[orin€; period under "Maxi .num.")
<br />6. Enter "Pznnit Requiremznt"for each patarz_'c, rn 'c; "Qua;, hN" w,d "Quolih,~" rs s~c~i~,d in pen-'t
<br />7. Under "A'e Es" enter number of sample me :,u ~mc~i during modtoring period that _xceed maxim;!rr (rsd~'c rt timum
<br />or 7-day average as appropriate) permit req~ 'remert for each parcmeter. If nose, ent=. "0 ".
<br />8. Enter "Frequzacy ojAnolysis" both as "Sc - p1e iv'_ ^.%vrement" (actor 1 frequcrcy o - say apling art; ar sl, sis sec: dun ig
<br />monitoring; period) and as "Pzrntit Reyuirer, ant" spec'.fied in permit. (e.g. Ent_r "Ca -, '' mar contin.rccs :ran t. ri-r ~, '7/7"
<br />for one day per week, "I/30"for one day per morth, "1/90" for one day par quarter, e!L.)
<br />9. Enter "Sarnp(e Type" both as "San. p(z irlea~, •reme.~!" (actual sample type used during manitoring ne= ,1j ar.c a: 'Pen;.it
<br />Reyr~irzn~mt," (e.g. Enter "Grab" for ir:ividua! sample, "14ffC" for 24hou_- ca rposite, "itr/,"' for co_ inuous
<br />monitoring, etc.)
<br />10. Where violations of permit requirements a*u reported, attach a brief explaaat on to dese~ibe cause anc correc.ive actions
<br />to be; taker, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form it place of dr.tr. e thy.
<br />12. Eater 'Name/Title of Principal Eseczrtiv ~ce.•" with "Signature of Principal _' :ecutive :~r..•~'r cj Arrrirorized
<br />Agent,""7elephoneNumber,"and "Dale"a'. Bottom of form.
<br />13. Maif signed Report to Office(s) by date(s) specified in permit Retain copy for your rccc~ds.
<br />le. More detailed instructions for use of this Discharge Monitoring Report (Di/~ f~mr nay be obtained from Office{s,
<br />specified in permit.
<br />.~~~;~1 r~~~T~
<br />This report is requ"ved by law (33 U.S.C. 1318; h0 C.F.R. 125.27). Failure to repcrt or fai'ure to report ~ ~±hfully cat -asn'± in
<br />civil penalties not to exceed $10,000 per day o-violation; or in criminal penalties not tc cac:ed 425,000 per day of violatic~,
<br />or by impriso:~ment for not more than one year, or both.
<br />EPA Form 332-1 (Rev. 03/49)
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