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<br />Pcblic reporting border. for this collection of information is estimated to van fron a range of 10 hour, as an
<br />ave:a~c per ~esponsc for some minor facilities, to I It hours a~ ar r rerage pcr response for some major facilities, ',
<br />i with a weighted average for major and minor fa~iliiies of It hw s pcr response. including :ime for rcvic+vine
<br />i in~trrctions, searching existing data sources, gathering a tJ nu r.,aining the data needed, and completing and ,
<br />i t. .-,ving the collection of information. Send comments r,"ardin;~ the burden estimate. ur ary other aspect of
<br />[h~s collection of information, including suggestions fur reduciu_ his burden, la C`ic(, Information Policy
<br />Branch, PA1-223, U.S. Cmironmental Protection .'agency, AOI IsM1 Sucet, S\h', \1'a,hinetcn, DC 2C4fi0; and to the i
<br />Ol'ficc of .'ni ormation a td Regulator. Affai -s, Of lice of \4anagcment and Huc' ect, W,ahingl on, DC?05(13.
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<br />1. !f corm vas been panially cortplet~d ay preprinting, disregard instructions directed a' cn ry of that information
<br />alr_ady preprinted.
<br />2. Er.tcr "Pennitee r\'aa+e/.14ai/ing i'ddress (and facilii>• name locanun, tl' differertl," "Perrni/ A'umher, "and
<br />"Uischar~e rVronber" where indicated. (A seperate form is rcyuircd for each discharge.)
<br />3. Enter dates beginning and encing ";btoni(orirrg Period" covered by form where indi:a.ed.
<br />4. -nter ea:;i "Parun+errr" as specified in monitoring requirement, of permit.
<br />5. crt[e "Sample i+7earurenrenr" data for each parantecer under "Qtmnh(; "arc "Quu!„y" is units specified in permit.
<br />':4veraee" is normally arithmetic average (geometric average far bacterial paran:rtc-s) of all sample measure-
<br />ments fcr each parameter obtained during ';'f/oniloring Period"; "a7axint+un"and ;'rrininrunt"are normally ex-
<br />treme high and tow measurements obtained during "99orriroring Period. " ('.'::::~ t : ~uc;c; .a's wit'r: szcoadary
<br />i•eatme.rt :cyu:rement; Ente: 3(1-day average of sample measurements under "A^eragc, "and enter maximum
<br />7-clay a.'.-age of sample measurements obtained during monitoring period under "dlusirmrm. ")
<br />6. Enter "Permit Requirentenl" lur each parameter under "Ouanrilr"and "Oualirc" as s xcilicd in permit.
<br />7. Under ",\o Ez"enter number of sample measuremcros during monitoring period the' esceed masimwn (and'or
<br />minimuri or 7-day average as appropriate) permit requiremem for each parameter. If none, cote- "U. "
<br />S. Enter "Frequency ojAnalyris" both as "Smnple .Y/easuremenr" (acnral frequency of +ampling and analysis used
<br />during moniwring period) and as "Pernrir Requirenren!"specified in permit. (e. g., Enter "C'one, "for continuaus
<br />monitoring, '7/7" for one day pcr week, "!/30" for one day per month, "1 /90" For one day per quarteq etc.)
<br />9. Enter "Sample Type" both as "Sumple ~ffensurerrrenr" (actual sample rype used durine monitoring period) anc as
<br />"Permit ,Qequiremenr. " (e.g., F.nier "Grab" for indis;dual sample, "24HC" for ?4-ho~:r composite, "N/.-! " t~~r mn-
<br />tinuous monitoring, ec J
<br />10. \\'here siclaiions of permit requirements are re,~oncd, attach a brief explanation to dcscribd cause and corrective
<br />actions ta:cen, and reference each ciulation by date.
<br />1 I. if ''no discharge' occurs during monitoring period, enter ',VO Dircl+urge" evens, torn in pla r of data corn.
<br />2. Enter "Nanre/TiNeafPrincipalE.recuriveOJJicer"with "5'ignatureoJPnncipclE.rec-u:i+~eOjJireroJ.luthnri;,ed
<br />Agenr, " "Telephone ^lunther, "and "Date" at bottom of lane.
<br />3. 'vlail signed Report to Office(s) by date(s) specified nn permit. Retain cope for >our re:urds.
<br />4. 'vlore detailed [nstrur ions for use al this Discharge,i/onitorin,G Reporr /DMR! form ma} be obtained f: om Of-
<br />fice(s) specified in per.~tit.
<br />.JV~'.. ~`~~~.., i.
<br />This renon is required by la+. (33 U.S.C. 1318; ;0 E.F.R. 125.P). 1=~ilurr :a report ur Izilu-e :u report :nthl ally can
<br />result is c vil pe t tl~ic~ c~rt io coved S10,Ct;0 pe ~ ua'i ~~[ s io~atlo~: ar i~t c-im~nal ptr.alnc. r, u u excccc! 5'_' .:'.;l;I I•.cr da}
<br />of vio:ztiun ur i~} imprisonment `or not more than oue year, or by bash.
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