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<br />°ublic repotting burden for this collection ci _nforma'don is estiaated to ray fro T. s. range of 10 hot:r, as an
<br />average per response for some minor faci'_:r°es, t;, 110 hc•.trs as as average r.:- :-spouse fo:- scxa rLr-or
<br />facil_ties, with a weighted average for najot _ ad tr inor facilities of 1S boas per rs: oase, iilc" ~.liag aar. 1:cr
<br />reviewing instructions, searching exist;lg ~ ,^a sc ~ -ces, gat;te-ing at3 rnaintziaing the c.aia ne~r_,e1, t sd
<br />completing and reviewing the collection of ia°o„tation, i_idurirtg s•~ggesricn ..°or :educing This bwi.ea, to
<br />Chief, Information Policy Branch, Pi\/V-223: J.S. P:_ivironlneatal ~~otcctioz /,,ge.::y, 40i ?; Street, S.~r/.
<br />~;/ashington, BC 20~~60; and to t'ae Of1GCe a"n`orraa°ion and Regulato.y ; _'~'air, :fTice of Ade-agF;r. it aad
<br />Budget, Washington, DC 20503.
<br />
<br />1. li form has been parrally completed b,~ pn,.::ntin„ disreganl irsJUCtio~ cs:eted ;:':.. 'it' of [ha'. ' _ c.~ ,a~:.n ,.!react'
<br />Preprinted.
<br />2. Suter "Perni!tee Name/ivlai!ir;g f;ddress (c -facility . ~ne/loeatioe, if di "fc;Jnt),'' " P,r.,;ri! T.ur.r;•z, ,' crd ' '%~sr'cr-;:e
<br />tY:emb_r" where indir^.ted. (.A scpaate fnm i, rcqurcd for each discharge.;
<br />3. enter dates beginning and editing "N.o;ritori; ,; Perini"covered by corm whore indicated.
<br />~. Winter each 'Parameter" as speci ied in mov'-.rir~ :cgL!iremenls of )~rnit.
<br />5. inter "Sar,;ple Measurement' darn for c .ch : ~mm~fa under "(7uautity"end Cir~l.^j" : s ~;,~cifie;; i- r_ ~a t. ..:~2: -ge" :
<br />,~orma!ly aritlS,-netic average (geomeMe av~ .,e F-r cecterial y arar. eters) of c.Ii ecm?'_ n;zsrremer :. "~r each pcr:met r,
<br />obtained during "ionitoring Perioa"; "i•ie;u:, •,a" r ~.d Mirinun" are ao~nally e ~.-~ high ^rd I~ •:: m° ;c.:~:1e.
<br />abtaiaerl during "i/onitoringPeric t". (?lore to nru _c: als wita sego:dar;~ tca+..ne7 -~c~ 'remeat: ttr:r 30-:cy r~ _r2•
<br />of sample measurements under 'Avange," r 'dent-- maxim~im 7-day average of sa.~ rl . cicasure .:~ ; nbta~-cd. Leri..,l
<br />monitoring period under "Maxin, um. ")
<br />6. Enter "Petit Requ%rement" for each garamsrter unc er ''Quan'ity" anG. "Quality" as spa~Sfi; d it ?r '.
<br />7. Under "No F,x" enter number of sample mez~uremcnt during monitoring period that ;.:c::d ma;:ir'c a (arUo- s: -tom :'-
<br />or 7-day average as appropriate) p; rmit regL i cment or each ~:aramcter. If none, enter `0' .
<br />g. Enter "Frequency ofAnolysir" bosh as "Se ;~/e N~ ~.:~reme,tt" (ac~ual fnequcncy o° ~rc~'.L~g and an lysis ~ se3 iur.~ g
<br />monitoring period) and as "PeraiJ Regcirec,_a1"sEeci fled in p:rrsit. (o.g. Cntcr "Cant, `fur continL.o_ , manis~.ir,;. "I/; "
<br />for one day per we:,k, "1/30" for one day pe ,-tonth, "1/90" fur one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sarrtp/e i/]e21 ~re.Ye,•t" (actual sample typo uses during rrc ~ :raring retied) an; as ",'era?
<br />Requirement," (e.g. Enter "Grab" for in~ividual sample, "24HC" for 2~hour cn pnsite, 'i\'//.` for cot :aec~a
<br />monitoring, etc.)
<br />10. Wlhere violations of permit requirements arc reported, attach a brie: explanation to dcst be cause arc; cor-re.:ivt sc>~oro
<br />to be taken, and reference each violation by date.
<br />11. if "ao discharge" occurs du,-ing coniwring ;:;;,icd, otter "No ]Jisctarge" across `arm ' i ;-;ace of data entry.
<br />12. Eater "Namelfitle of Principal Fxecum- OfjScsr" with "Signanere of Principal Lrecutive Ofj"cer of Aurnorize.l
<br />Agent, "'Telephone Number,"and "Date"at Bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) s?aciaed is permit. Retain copy for ;you: r a: ds.
<br />14. More detailed instructions for use of this ~rscharge Monitoring Report (Divl/ZJ fc -m lay be ohtzc ed iinm O1Tice(a)
<br />specified in permit.
<br />~~~~~ r~~at~C~
<br />This report is required by law (33 U.S.C. 131 g; ^.0 C.F.R. 125.2Ti. Failure to rapo t or ~ it ire to report trot tfully can result in
<br />civil penalties not to exceed $10,000 per day o'+~iolation; or in criminal penalties ant to r.:c:d $25,000 nrr day of violaton,
<br />or by imprisonment for not more than one year, er both.
<br />E1'A Foem 3320.1 (Rev. 03/99)
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