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• GFNFR:\I. INSTRUCTIONS • <br />I. If fm in has hero paniall+ romplrlcJ by prrprim ing. JicregerJ inslnla ions JicecrrJ ;tl entry of Ih;n inform;iliun ahraJy prcprin0.•J. ~ ' ' ~-~ <br />'. Fnlrr "PI K\11 FTPI' V1\IF/\L.\II ING ADDKFSS fand farilih name/Iui:J ion. d Jil(crcm1.~' "PFKA117' NL'?1HF'K,"',md 'DISCI(\RGF <br />Nl'111SF R" ++hcre inJir:~teJ. IA srp.u nlr fui nt i. iryuirrd for each Discharge.) <br />1. I'nirr Jeers beginning ,inJ rnJme "AIONFI UKING PFRIUD" a'urcrttl by (arm where inJirarrd. <br />d. I nlrr c.i:h 'I'\K~\A1h~(I'R" ;~. spri ificJ m monitoring Iryuircmrm, of prrmir. <br />9. Fnru 'S:1 \tl'I F AIF:\SI'KFIIFN T` d.ila (ol carh parameter under 'O(UNl-ITY"anJ "Q U:11 ITY" in units sprnfirJ in prrmir. <br />~'.\\I~R.\GF" is not mall) milhmel is aarraer Igrumen it ;~+rr;tgr fur bacterial parametrr~l u( all sample nuasurrmrnls foe each par. r <br />ohleinr,l Jm me "\10N1IOKIVG I'I~RIUU." "\14XIA1l'\7` anJ "A11NIAfUU" are nnrm.illc eslrcmc high and low mrasuremr Ns <br />nbLiinrd Jwing "\i(IN ITOKING PFKIUD." INU"11= ro munirip~h wish +crunJury treatmem rryuirrntenl. rnlu 1a~Ja) as ci age of eantplc <br />manor totems undri ":\VI~N:\C+F.. :md cnlri masimnm /-J:n' :nrragr ui crmple mr:wucmenls uhraincJ during mnnilnnng prricd unJcr <br />"\IASI\1 L'U~'. <br />fi. Fnrrr "PFK\IIT RFQUIRFIIENT` fur each parameter unJcr "QUr\NTITI"' nnJ "QUr\I IT7"' as ,periheJ in permit <br />7. C'nJer `N(1. F.Y" rmcr numha of sample mrastnentn ors During muniroring perioJ than csercJ masimum tanJ/rn nunimum or 7-Jay <br />;n eragr as ;ipprnprie let pre mil icyuire ntrnl (or rash parameter. I( none. enter "11". <br />R. Fntrr `FREQL'FNCI' OF AN 11 )'.SIS"' both as "S:I RI PI F AIF:\SURI~\IENT' raa7u:J (rcyurnry of sa ntpling anJ :malysis uud During <br />monilorine prrioaU .mJ as "PFR\IIT RFQl11KFA1FNT" specified in permit. Icg., Enter "CONT." (or cuntinnaus monitaring. <br />'"I/7"' (nr nor J:t per wtt•A. "I/!Il' for one Jay per month, `1/911' (nr one J;n~ per quanrr, etc) <br />9. Fmrr "S\\II'IF IYPF"' hulk as ':S:\\IPLF Al F:1SUKEAIFN7`" lacutal ti:rmplc qpr usrJ During monuoiing pcnoJl .m.l ,is <br />"PFR\11T KFl?UIKF\IFNT." le.g.. Fntrr '(i H:\R" for inJicidual xa mplc. '"'_J HC`~ (oi '_J-hour a+mposirr. "N/.\~' (or rominuous <br />mannaring, etc. t <br />~15tl1i 3tl3H Q}OJl <br />IU. R'HFRF \lOI :\TIUNS OF PFR.\IIT RFQUIRFMFN'LS .4RF RFp(1k7FD. \ll A(H:\ IiKIEF F.C PI .INATIUN 70 ll1~~( KIRF <br />CAL'SF .\NU CUKkFC"11\'F ACl"IONS f;\KFN. Kh EERFNCp 1:\(~H \'101 \TION Bl' U.\l E. <br />I I. I( 'nu .li+durr" or.un Jwinc inonih+ring prl iud, corer 'NO DFSCH.1 K(il ~~ arm+s form in plan of J:va enu y. <br />I'_. Fnlri "\ \\1Pj FITI P r)F PKInCIP ~\I F\ECl'TIVF OFFICER" ++ilh "SIGN \1 l'KF OF I'KIN(II'.\I I SFC I'TI\'I OFFICER OK <br />\L'FII(tK 1/I~U .\GFN I"' "(EI PI'1IONF NL'\1RPK" :mJ "UAIF";H hnann ul (ul m. <br />I?. \I;ul signed Krpnn to Ulli:rlsl h) dalrl sl spccirird in prrmir. KrCtin cap) (ur amu rc:nnls <br />la \lo~e drt.i ilrJ insu nrlions fm use ul this DISCHr\RGF \IIINI"I (IKING RPpORT ID\IKI furor nt.n he phLiinal I~"m Olll.risi <br />spai ilirJ in pci mil. <br />LFG:\I NOTICE <br />This rrpori is rrquircJ by lax I I} (; S,C. 111 v: all C.F.R. I_~'l 1. Failu rc rr. irpuir ui (aihur Io irPoil nwh(ulh .nn iraJi in .itd prn;JUe. not <br />to rs. reJ SltlAUU per J,p ul siolalimr or in rrimin;d pena114•s nor m rsrn•J ~'~PUU pre Ja+ ul +iulalinn. of ht mipus,m in.m lax mq moir Ih.~ <br />one tear, m~ M hoih. <br />r1 <br />L_J <br />aHO~3s 3i13H a}oa <br />3lJ3H <br />dWV15 <br />37 V'ld <br />OtlIHl 3M3H Ol0! <br />________________________________________ <br />3H3H 31dtl15 <br />