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<br />Public reporting burden for this collection of information is _: ura;~, ..a •r:~ ', . , rr. -.ge nt i(` oi.rs 0.. 1n
<br />1 .. _ -- .. _ -.-. _ J
<br />~PL_ ,._ ,. f:1f .. .Il,n, InElr,u l:~~ .1C ~d ~E ,. r i,L_ . I -
<br />^I.mr.L, ''~: -22J ~ .Li. a: h~nnme::i.l, ~ ...~~.?I^. Y•~E C~- ., y - --_ - .. __ ~~ r' _J I :: _ '! I .'1 I' ~ ~' ~i
<br />Sx of'aForr+atiua aal: ^eguiafc~y r,f:'^.;ls, OTcs o`J~~t r Ll: .~,,:c, t-•"'' -:~+~('~
<br />General Instrifcti~~~~
<br />1. IF form has been partially completed by preprinting, disregard instructions dlr.;cted at entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee Nome/Mailing Address (and facility name/localior, if c.~icren[),` "Prr!ni! Number," and
<br />"Discharge Number" where indicated. (A separate form is reouired for eact. di;chmge.)
<br />3. Enter dates beginning and ending itfonitoring Period" rnvcred by fora v'+u:rc i ~c icated.
<br />4. Enter each "Parameter' at specified in rnoni:o~ng:Ea+urerr+c, i_ of .:'~-'.`
<br />~. Entcr':Sampfe i~1e~s-urear~nP' data for ~<1ch o~-+ ':,rn , "= '.7 rc:,.'.. Ir' .h' • u :~'e .
<br />"i dercve" is no-maliy arithmcGc a.c : ge (~..: ,r:~_,,;c ~.rr.r:~'~ ~ ~°c~ i~ .~ ~) .:c rct~ ::':,~ .
<br />for eadr palamEic:' cb~aincd dluirg `l.'oritr,^n~ ,''.•rir..;'. , c~r;,,:.:. 1 .. '1.y'.. .-,. '
<br />an'_ law mE•ascr;2~r~; cbtai„cd duri,lg'...'nniln.;rg '1-:' .' ;:' o ~.' r:;,,rl:;, ~._ ..
<br />rrtai remerd: Enter 30-day ave .:ge of sample mesa, e::c : a~:'Ier '' . r::.~~ . - .. .,i n 7 ,
<br />of sample measurements obtained during mcnrtorn; p..ied ! Lri "; 6n.i;..u„ .'7
<br />6. E.:ier "Nonni! Req-firer:at" fo; eats pL~mcter acre: "Q"c c. ,v` and '~; tli.. -, ;z ~ In c:uil.
<br />7. Under "No F.r" e>rt:r aurn'ser cf cxmpie mcase.~aenL ~ :. .~,.c•'~r ~!; . ~ - .._.:. ::i ~.~~1 (l; .c
<br />minimum or 7-day ave,~,F,e as a;;propliate) pcnnit requi-er cu' for c::'• ^ ^[: .t ~ ..= ra c, E- : "0''.
<br />8. Eater "A~eq+!enc~ ajAnahcris" rloPt ns °;n.r:ple :r;er~ ~.-,.1:. :'" (n.-i: r~ 'rr.' ~ r Gf .•.,,:::.. ; r~ i-._ ~ - . _
<br />ct:,;ag r,.otito;ing t~ .cd) a,d as%P.-rnlil 2egvire.r,e.d' . _ :~fu.?. i. :~i' n' c' ,.. :-..,
<br />!
<br />montoring, "1/T' for one day per week, "l/3G" far one cay oc rolls, I )IJ" a ~ - _ , :: c.
<br />~,~..r, e c.'.
<br />9. Er.icr "Sanvple Type° bo[', as "Sample ioJeasu,ems:rt" (:r.:,.c sti ; 1. ) ~c _ 'I~ = ;; aos+• ~ ~ ; ncr:.G~ r !;
<br />"Yennit Rerp!irement," (e.g., Enter "Grab" for individua: samp'c, "!ll(' ~ %.-'•ou: '.:.~~osite, "N•?'~' `c
<br />alntinuous monitoring, etc.)
<br />10. 1~"Here vio?ations of permit requirements are reported, af~ cl . a brief cx•;Ia.~. t ; 1 ;o dcsc, the ca+: sc ar.d correcrwe
<br />actions taken, and reference each violation by date.
<br />l 1. if "no discharge" occurs during monitoring period, enter "rVo Oi.:cherge" across fern in olnce of data entry.
<br />i2. Enter "Name//'itle ojPrircipal Esecutiva Officer vrith "Sfr natr.,- oJ.'ri;;c~J~i !i-~..r,iivc :)J~ce;• ojArr;wr!ted
<br />A„eat," "Telephone Number," and "Date" at'oottom oCform.
<br />13. Nail sigaed Report to Office(s) by date(s) spceiEed in pcrn:it. Retain r~. y :hr y, : uxords.
<br />14. K:ore detailed instructions for use cf lass Discharge Ivionitor~r;; Report (7,L•T.~ : -n msy be cot-'ined from OCfia.(s)
<br />sfiecificd in permit.
<br />Lega11e1otice
<br />This report is required by taw (33 U.S.C. 1318; Ed C. F.°.. 175.21). F.ri u a o rr.:.~ ' o `~tlr;ti [o noon tn!rhfi,ll} rsn
<br />result in rivil penalties no[ tc E :teed ~lO:OCC per day o% :•iolsEoa; 1 . ~ c imtr ei ;,-. ,. ' i"s :rat ; a.:~.~ ] >Z:,O.^.C ,err .:1 ~,
<br />of violation, or by imprisonment for not more t6?n one ~exr, ar by both.
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