ML20203L338
| ML20203L338 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley |
| Issue date: | 01/31/1998 |
| From: | Brandt R, Orndorf D DUQUESNE LIGHT CO. |
| To: | NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| References | |
| NPD3VPO:0815, NPD3VPO:815, NUDOCS 9803050447 | |
| Download: ML20203L338 (34) | |
Text
_ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ - _ _ _ - -
'Af Telephone (412) 393-6000 "1?%*?*
Shippmgport. PA 15077 0004 February 25,1998 NPD3VPO: 0815 Document Controf Desk U.S. Nuclear Regulatory Commission Washington, DC 20555 l NPDES Monthly Report, EPA Permit No. PA0025615 l
l
SUBJECT:
Beaver Valley Power Station, Unit No. I and No. 2 BV-1 Docket No. 50-334, License No. DPR-66 BV-2 Docket No. 50-412, License No. NPF-73
Dear Sir:
Enclosed is a copy of the NPDES Monthly Report as submitted to the Penruylvania Department of
- Emironmental Protection.
Sincerely,
/
gA' PrD. Brand
- Division VA . dent Nuclear Operaus_.s and Plant Manager i
SLV/tts -
cc: D. A. Orndorf J. A. Cool I [;,, ,'c e)
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R PDR N The Nuclear Professionals M
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'Af Teiepnone <45 3 393-6000 Nuclear Group P O Don 4 SNppmgport. P A 15077 0004 February 25,1998 NPD3VPO: 0817 6
Attention: "DMR Clerk" Department of Emironmental Protectica Bureau of Water Quality Managemem 400 Waterfront Drive Pittsburgh, PA 15222 NPDES Monthly Report, EPA Permit No. PA0025615 Gentlemen:
NPDES Monthly Report for Duquesne Light Company, Beaver Valley Power Station for January 1998 is submitted for your consideration.
Sincere
./
ob' R. .' Bran (a Dhision Vice President Nuclear OperwLons and Plant Manager SLV/tts cc: D. A.Orndorf J. A. Cool J. Arias Central File
- w. The Nuclear Professionals
'Af Telephone 1412) 393 6000 Nuclear Group P O Box 4
$hippmgport. PA 15077 0004 l
February 25,1998 NPD3VPO: 0816 United States Emironmental Protection Agency Region III, Pennsylvania (3WM53)
Water Permits Branch Wster Management Dhision to,1 Chestnut Street Philadelphia,PA 19107 NPDES Monthly Report, EPA Permit No. PA0025615
Dear Sir:
This letter forwards a copy of our NPDES Monthly Report as submitted to the Pennsylvania Department of Emironmental Resources, Bureau of Water Quality Management.
Sincerely
/ - +/[
. Brandt D'ivision Vice President Nuclear Operations and Plant Manager SLV/tts Attachment cc: D. A. Orndorf
- 1. A. Cool
- 3. Arias Central File w
7 The Nuclear Professionals
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EPA Form 3320-1 (08-95) Previous editions may be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USEDJ Cggia/~eg1( 5.-U3;.i% , , .PAGE =
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! Pubh; itparting burden for this sollection of information is estimateJ to ury from a range of 10 houn a an
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! wah a wtighttd avenge 1,o n,apir and nonar f aulitnw of 18 h%rs jwr rupon.c. includmg hme f ar re newing j instru tons, scanhing emung data mura , rathering and nWutammg tbc data ntvdcJ. a,J tompletmg anJ j senew mg the cullm oon of mfunnauon. Send uinmmnts trymdmg the bmden estinute or any othes aspa t of ,
this wilestion of inf,,rmation, inslujing 'uggntmns for redudr:p thn hmden, to Cluel, intannatmn Policy j thamh, PM 223, U.S. Envannmental Protation Apency,401 M Street, SW Wohington, DC 2040; and to the i Offin of inhumauon and Regulatoiy Af f airs Oltke of Manap nwnt anJ BuJpt, Washington, DC 2050L i General Instructions
- 1. If form has been partially coinpleted by preprinting, dhregard instructions dureted at entry of that intornwtion already preptmted.
- 2. Entir " Permit:cc Namc Ma:Ime .lMrcw (and faahty namelocation, if different)." "Per mit Nu mber," and "De 4aye Number" where mdaated ( A wparate form n regmred for each dmharrel 3 Enter dates lxf inmng and endmg "Alonitamg i'ctmd" covered by form where mdicated 4 I niet cAh " Para"wn r" as speufied m nunutonny requaements of pennit
- 5. Ehkr "Si%I'/e A[UsuermcIl!' data [ct cAh para'neier utider "(hanhty" and "(Mabit" in (trul% spceibed ill pCnIHL "in rag" is nannally .uithmetu ascrag: (cametne m er y : for bA terial p.nameters) of :dl s:nnple measurements for ca, h p. unneter cNaincJ danng ".tana w li < "Atcnn" m" and "Almimm" are noun,d!) cxneme Ingh
- md 1,m meastu em;nts ONained dermg *A!"n;tio my Pi rn (Note to mmuapals unh tecendary treatmcui rLQWrCmCut' I[nlel 30-d.n aVCidgc Of Lini[!e liCaWrclaients b ?i $!W/stgi " arid ef!hr IMa\kmuN Eda) ascrhfe of sample measmcmenh obt,uned dunng nuantanar pern.d under "Afaumum ")
- 6. Enter "Pcinit Rc:jurrcment" for cah parameter war "Owmntv" and "(hahtt" n specined in permit
- 7. Uada "No h" enkr number of sarnple na surnc:nts dunng monitonn3 penod that eweed omumun tand'or iluunnUtu or Uda) a\ clap,e as appo[rlak) permll rJqlurement lo( eaCh palamner If n0nJ, entCT "&
S Emcr "/ rcrjucm3 of .inalyd both as "s . 7 c Alc.uurn.cnt"
/ (actual frequency of satophng and analysis used dunng mon @ ring penod) and as "Pcrmu Requn ena nt" specified m pernut (e g s Enter "Gmt," for continuous mommring. "! " for one day per weck, "19U" for one day per memb, */ VT fo, one day per quarter, etc )
- 9. Enter "Namele 1)/ c" both as "Sa> t le Mcaurement" (x;tual sample type used during monitonng perod) and as
" Permit Reparcmera." (e g Enter " Grab" for indwidual sample S.llif'" for 20 hour composite, "N'A" for conimuous momtoring, etc )
- 10. Where violations of penuit requiremen!s are reported. anach a brief explanation to descobe cauw and cerrective
[ achons taken. and reierence cach wolation by dak s
- 11. If"na discharge" occurs during monitonng period enter "No Dnchayc" across form in place of data entry.
- 12. Enter "Vame Title of Prmarol 1:tecutne O!!!cer" uith " Signature of Prmc:;ml hecutwe Oficer of tutimri:ed Agent *
- Telephone Number," and *Date* at bouom of torm n,_
- 13. Mail signed Repon to OfHects) by date(s) specined in perm:t itetam copy for your records
- 14. Mate detaded instructwns for use of this Ducharge Atomtonng Report (DallO fann may be obtained from OfG;e(s) specified in pennit Legal Notice This report n in;uired by law <33 U.S.C.131R; 40 C.F.R.125.27). Faiture t or f ailure to report trmhfully tar, result m ciul penalties not to exceed $10,000 ger day of unlation, or in tnmine , ..alues not to eweed $25,(M per dn of violation, or by impnsonment for not more than one ycar, or by both.
EPA l'onn 33201 (Rev. 08-95)
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EPA Form 3320-1 106-95) Previous odstrons may be used. (REPLACES EPA FORM T 40 WHK:H MAY NOT IBE USED.) ; g ;. j i / ,; g i y ; .- 7 + ; r PAGE ;OF l ' l .n. _ . . _ _ _ ___m.___._______
Paperwork Reduction Act Notice !, Pubbe reporting burden for thii, tollection of infornation is estimated to vary from a umge of 10 hours as an aserage per testense for some minor facihties, ta 110 hours n an as crage per requnse for some major faahties, i l with a wupbted ascrape for major and nunor fa,ihhes of l!i haua per inpunse, mJuJing tme for resiewing , j instructions sean hing emtmg data sources, gathering and tru:intaining the data nented, and completing anJ
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l review tng the ew n of mfornwtion. Send wmments scyardmy the burden ratimate or any other aspect of ' I this collechen of nu imation, mcluJing suggestions for reducing this burden, to Chief, Informahon Policy thanch, PM 223, UX Environurntal Prote tion Apncy,401 M Stmet, SW Washmrton, DC 2040; and to the Of tice of Infonnahon and Regulatory Af fairs, Odit c of Management and BuJpt, Washington, DC 20303. ! t General lustructions
- 1. If form hn twen panially complcted by paprinting, dmegard instructions directed at entry of that mformation already preprmted.
- 2. Enter "Permntre Vame Afadmg Addren (and facdits nanu.' location, if ddierent)," " Permit Nenbor," and "Docharge Number" w here indicated (A separate form is required foi cach d&harge )
3 Enter dates tvginnmg and endmg "Afomformg Period" coscied by form where indicated.
- 4. Enter each "Parmncter" as specified m monnoring regmrements of pctmit.
Entcr "Samp!c 3/c wement" data for each parc.meier under "guimrity" and "gua!@" in units specified in permit. M 5 "Arer ge" is untmally anthmetic average (geometric au rare for bacterial parameters) of all sample measurements for erb paramaer obuined dunng "Atomorme Pcro !" "Afmomm" and Almnmm" are normall3 extreme high and low measuremenn of tamed danng "Atomtermy Pirmd" tNate to municipals with secondary treatment requirenient: Enter mday average of sample measmements unJer "Arcragr." ;md enter muimum 7-day ascrage of samph measurements obtained during momiming periad unJer "Martmum.S ti Enter "Pernar !?c<jmrenu nt" far each parameter unir "guant:ty" and "Unahty" as specified in permit.
- 7. Under "No I r" cnte r numh:r of sample measurnunts during monitoring period that exceed maumum (and-'or minimmu or 7-de as erare as appropnate) g errrt requ i rs.oent for eash parameter if none, enter "0"
- 8. Emcr "Frcquency of An 2/M loth as "hampk ife.wment" (acttal frequena of sampling and analysis used danny momtoring period) anj as "Permu Regmn ment" specified in permit le g , Enter "Gnt," for continuous mondoring. * / '" for one day per ucci, "/ JU" for one day per month. "I SD" for one day per quarter, cic )
- 9. Enter "Samp!c 7);><" both as "hple Alemcremen!' (actua; sample type used during monitoring penod) and as
" Perma Rcquirement " (e g., Enter "Giub" for inJnidual sample. "2,t/IC" for 24-hour compoute. "N A" for contmuous monitoring, etc )
1R Where sit,lahons of pc.uut reqmtements are reponed, attach a britf esplanation to dewile cause and torrectne actions taken and reference each twlation by date. I1. If"no discharge" occut. danng monitoring period, enter "No Dacharge across form in phee of data entry
- 12. Enter "Naw 'lule of Prmcipal Executne Omcer" stth " Signature of Prmcipal Executwe Okcr of Auth:>rced Agent * 'T6 ;hane Number,* and *Date" at bottom of funn.
- 13. Mail signed Peport to Office (s) by date(s) specified in permit. Retain copy for your records.
- 14. More detailed instructions for use of thu Dncharge Atomtaring Rr;> ort (DAf/O form may be obtained from Oflicc(s) specified in permit Legal Notice ilus report is required by law (33 U.S.C.1318; 40 C.F.R.12127) Failure to report or failure to report truthfully can result in civd penalties not to exceed $10,0N per day of violation; or in cnminal penalues not to exceed $25,000 per day of violatio;t, or by impnsonment for not nure than one year, or l'y both.
1 EPA Form 3320-1 (Ren OMS)
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1 PERMIT l REQUIREMENT SAMPLE MEASUREMENT PERMIT l REQUIREMENT l SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT s MAvg PERSONALLY ER AMsNfD AND TELEPHONE DATE AM FAMfuAR WITH THE WFORMADON SUOMYTTED MEREM; AND SASED ON MY INQUIRY OF THOSE INDtVfDUALS IMMEDIATELY RESPON98tE FOR 5: )yjd y r g', ~- [ OSTAINfNG THE INFORMADON,1 SELtEVE THE susMITTED WFORMATION IS i ,. TRUE, ACCURATE AND COMPLETE. 8 AM AWARE THAT TH(RE AR{ SIGNeFICANT PENALTifS FOR SUBMITTING FALSE INFORMATION, apeCLUDING , , . L' li t2 ri i 8 L I~ ) Ild t1/1[C y 1 O ,i - y J l .',> _t **4 7 THE POS9BauTY u.S.C. e i sie. C? Fierf m.= m .,M- AND IMP 9tISONMENT m.,,SffmicaM to U Sr>C 9.,1001
. = s ro.ANDcoo33 ssGNATURE OF PR#oCIPAL EXECUTfvE 3pg CODE. M1MBER YEAR l"MODAY T*fPED OR PRINTED w or====== : er a.ew a e a==m, w s y.srs i OFFICER OR AUTHORIZED AGENT l
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettschments herof EPQ Form 3320-1(08-95) Presous edenons may be uSed. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ? p . / , ,. g 1 g ; f , j L PACE ;OF
L d-I PaperwoEk Reduction et Notice- .
.Pubiic reporting burden for this collectkm of infornutihn is extinuted to vary from a range of 10 houn; as an ,
aserage per tesportw for some mint facilities, to 110 hours as an average per response for some nujor failities, with a weighted average for major and minor facilities, of 18 hours per response, including time for reviewing - l instructions, scarthing existing data sources, gathering and maintaining the data needed, and completing and rfYicWing the_ Colledion of infonDation, Send commenlS regarding the burden CStimate or &nyIother aspect of i thislcollestion of infornuition, ineladmg suggestions for reducing this burden, to Chief, Infornution. Policy ,
., -IJranch, pM.223, U.S. Envimnmental Protechon Agency,401 'M Street, SW Washington, DC 20460; and to the -
Office of Information and Regulatory Af fairs Ofthe of Manegement and Budget, Washington, DC 20503, , i L_ _ _ _ - _ _ _ - . General Instructions L'If form has been partially completed by preprinting, disregard instructions directed at entry of that information l'
!aheady preprinted
- 2. Enter " Permittee Namc3/admg Addren (and facility name/ location, if dillerent)," "Permet Nennber." and ~
" Discharge Number" where indicated. (A separate fann is required for each discharge ) ,
3 Enter dates lxginning ind ending "Afonitdring Period" covered by form where indicated 41 Enter cach " Parameter" as specified in momtering requirements of permit. j I 5, Enter "Munple A!rosurement" dhta for cach parameter undct " Quantity" and *Guahty" ht units specified in permit.
"Averaxe" is normally arithmetic average (geometric merage for bacterial parameters) of all sampic measurements
, for ach parameter obtained during "Alomiormft fermd"; "A/aximum" and "Almimum" are normally cytreme high and low measurements obtained during "Afonitaring Pcriod" t.bte to municipals with secondary treatment i regmrement: Enter 30 day average of samp!c measmements under " Average," and enter maximum 7 day average of sampic measurements obtained during monitoring period under "A/aximum. ") ,
6._ Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit. .; 7, Under "No in" enter number of sample measurments during monitoring period that excced nminir.i. tand'or , minimum or 7-day average as appropriate) penuit requirement for each parameter. If none, enter "0". ;
- 8. center " Frequency of Analysu" both as " sample Aleasurment" (actual frequency af sampling and analysis used -!
.during mondoring period) and as " Permit Rcrfairement" specified in pennit - (e.g., Enter " Cont," for continuous - ,
monitoring, "1/7" for one day per weck, *160* for one day per momh, "U90" for cue day per quarter, etc., l R Enter " Sample 7)pe" both as " Sample Alca3nrement" (actual sample type used during monitoring period) and as '
" Permit Requirement,". (e g Enter " Grab" for imlividual sample, dMUC" 'for: 24-hout composite, "NA" for
~ continuous hionitoring, etc )
~
10,1Where iiolations of penhit requirements are reported attach a brief explanation to describe cause and corrective' > actions taken, and r:ference cach violation by date, , i1. If"no discharge" occurs during manitoring period enter "No Discharge" actoss form in place of data entry. ,
- 12. Enter "Namel Title r>f Prmcapal Executne O!)icer" uith "&gnature of Prmcipal Executivi Oficer of<tuthart:ed
' Agent," ' Telephone Number,' and "Date* at tettom of form '
L l'3; Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records;
- 14. Mo*e detailed instmetions for use of this Discharge A/onitormy Report (DA/10 fonn may be obtained from Office (s) specified in permit. :
1 , Legal-Notice l l
, This zeport is mpired by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to report truthfully can j - result i'n civil penalties not to exceed $10,000 per day of violation; or in r riminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.
i i F.PA Form 3320-1 (Rev. 08-95) i
~.._.._._. _ .___ _ _ ._ _
E MM PERMf7?EE NQME/QDDRESS and.srerery Narater.n a(PWu r) NOTIONAL POutrTANT orSCMARot EuwtNcrnON SvgTfw (NFDES/ Form Approved. iAJIJ OtSC E MONITORWG REPORT (D ,A;*
'. ;.w ! OMS No.20404004 4 NOME _;A5 - 4 aLI :*I <c r . .; ,
- r , -as ., . (LL; 1; Approval expires OS-31-98 I
g 33 J!kiL O ii a <UpT f - F' ' L
..5; PERMfT NUMBER OSCHARGE NuM8eR
,. -i>
'; ; ; ~ '
- ,:i 1 .nw -
MONITORING PERSD . I" U YEAR MO DAY YEAR MO DAY --
'# #*' ,,^d " '"
TO - ~ LOCQTCDN FROM - - s >. - d: : r "i 120 21) 122-231 124-25) 126-273 128-299 130 311 NOTE: Reed M W ore @ % % form. f3 Ces ontyi QUANTITY OR LOADING I4 ced ontys QUANTITY OR CONCENTRATM N O. F"E N "C' SAMPLE PARAMETER 146-53) (S
- 6 19 138-469 446-631 t%619 oP EX ANay99 TYPE 132-371 AVERAGE MAX 1 MUM UNITS MiNtMUM AVERAGE MAXIMUM UNITS , vie ,,,g, ,3 m SAMPLE L "!
MEASUREMENT l' " ~" '
'** ' '" '* - * ' " " - '^^'
-o 6 s PERMIT
_- ,a . ~ L, REQU!REMENT *
.*I# 1EKIMJ! JJ t , i. & i SAMPLE t i1 '
.' > MEASUREMENT
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PERWT '
! U; .i t - I. - REQUIREMENT .'$! 0*!L: 9A 3
- , - . .< - SAMPLE L * ">
, , . . MEASUREMENT
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PERMIT w , 1a , ,. : REQUIREMENT .D 1i 5 : '; Z : A1 T/L
~-
S AMPLE i * " >
. . i. & - MEASUREMENT PER M "
i k . . . ._ / i LJ REQUIREMENT ,Vc<:A' %*IJ3' /L SAMPLE MEASUREMENT PERMIT REOutREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT I CERTIFY UNDER PENALTY OF LAW THAT e HAVE PERSONARY fRAMWED AND TELEPHONE DATE NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER AM FAMruAA WITH THE fNFORMAT10N SUOMtTTED MEREN: AND BASED ON MY WOUIRY OF THOSE #NDtvtOuALS fMMEDATELY RESPON98tf FOR
,-"iV i( U
- t';t : ( r ~ .f OSTAIN'NG THE INFORMATION, t SEUEVE THE SUBMITTED gesFostMATION IS ,
TRUE. ACCURATE AND COMPLETf. 8 AM AWARE THAT THERE ARE
-,i t C . M
- I '~ ;4 13S?t' 9GNeRCANT PENALTIES FOR SUBMITTr dG FALSE INFORMATION, #NCLUDING e~
, * ' O 1 '., f '
94 THE POS981UTV SKWAF 91001 8tE OF33 P9NNOPAL EXECtJTIVE U.s C. e isis. e .OF s,FI.NE.AND sw m IMPRISONMENT. SEE IS U.S.C. AND g NUMEKR YEAR ( MO DAY TYPED OR PRINTED ans er mennman - _ _
.; er aww see,we a maame mer=eien,se r a y rusmi se se s ro,oop OmCkA 08t AUTHOftt2ED AGENT g COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s// artschments heref r .
EPA Form 3320-1 (08-95) Previous edittoris may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) )' 31/ , .; 1,;
- 4
; PAGE 0F
_ _ _ _ _ _ _ _ - T
J - , 8~_ i
..public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an average per responw for some minor facihties, to 110 hours as an average per response for some major fardities, withla weighted average for major and rainer facilities of 18 hours per respmse, including tinw for resiewing instructions, starching existing data sources, gathering end maintainmg the data neeJed, and i.ompleting ud reviewing the colledian of information. L Send comments regarding the burden estirnate or any other r.pect of this collection of informatmn, including suggestions for reducing this burden, to Chief, InfortMson Policy Bransh, PM 223, U.S. Environmental Protection Agency,401 M Street, SW Wuhington, DC 24160, and to the Office of Information and Regulatory Affairs. Office of Management and Budget, Wahington, DC 20503, l General Instructions liIf form has been partially completed by preprinting, disregard instructions directed at entry of that'information already preprinted.
- l. 2. Enter "Permittes Namc3/ ailing .4ddrexx (and facility namc/ location, if different)," " Permit' Number,". and I~
"Oncharge Number" w here indicated. ( A separate form is reqidred for each discharge )
l L 31 Enter dates twginning and ending "Alanitoring Period" covered by form w here indicated.
. 4. Enter cach " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Alca3nrement" data for each parameter under "Quan!<tf and "Guahrj" in units specified in permit.
"Awroge" is normally arithmetic avesage (geometric average for bacterias parameters) of all sample measureraents for each parameter obtained during %mtoring Periof'; "Afaumum" and "Afmimum" are normally extreme high and low measurements obtained durmg "A/onWg, Period" (Note to municipals with secondary treatment requirement: Enter Eday average of sample measurements under ",1 verve " and enter masimam 7-day average of sample measurements obtained during monitoring period under PAtaximum ")
- 6. Enter "P-rmit Requwment" for each pammeter under "Guantity" and "puality" as !,pecdied in permit.
- 7. Under "No Ev" enter number of sample measurments during monitoring period that ex: ext maximum (aind'or minimum or hiay as crage as appmpriate) permi'; requirement for each parameter. If nonil cider "0" f8f Enter " Frequency of Analysis" bJa as " Sample Aleasurment" (actual frequency of samplingind analysis used .
during monitoring period) and as "Termit Rcquirement" specified in permit (e g., Enter " Cont," for continuous monitoring. "lJ" for one day per weck, "1/30" for one day per month, "bW for one day per quarter, ete,) 9.- Enter "umple ~" both as " Sample Alcasurement" (actual sample type used during monitoring period) and as
- " Permit Requk .nent " (c g , Enter "Genb" for individual sample. "2,f!IC" for 24-hour composite, "N'il" fot continuous monitoring, ete )
10.;Whetc violations of permit requirements are reported, attach a brief nplanation to describe cause and corrective _ actions taken, and reference caia violation by date. I1. If "t c discharge" occurs during monitoring period, enter ,"No Discharge" across form in place of data entry.
- 12. Enter *NameTitle of Principal Executne Officer
- sith " Signature of Principd Execunve Officer of Authorized '
Agent," Telep)wne Number
- and "Date* at bottom of form;
- 13. Mail signed Report to Office (s) b' y date(s) specified in permit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Afuniforing Peport (DAIR) form may t: obtained from 00icc(s)
, specified in permit.
Legal Notice This report is required by law (33 U.S.C.1318; 40 C.P.R.125.27). Failure to rer. ort or fadure to report truthfully can result in civil p-nalties not to eneed $10,000 per day of ciolation; or it. criminal penalties not to execed $25,000 per day of vitdation, or by imprisontnent for not more than one year, or by both.
)
EPA Form 3326i1 (Rev 08-95)
m . , PERMr* IE NWE/A1)ORESS(7me.defersterNeam'LacenagedE-ene a:ATiONAL s=OLLUTANT OtscuARot EUM*NAvvose system (NPDES / Form Approved. NAME - A i~ *1Li C - 19 l _. i i ,1 -) . OtSC E MONITORING REPORT (DM ,. g , ; . ; . , , _. F : CMB NoMN _S ..v. . . . z. , m a A-o e %oSm.ss ~ 2.t i Y-- ' .-- PERMIT NUMBE0 DiscwARCE asVMsER - r ; .x ,, 3 .n I i- i 4
- i+ .. 7'
- A ,J .,
MONITORING PERIOD YEAR MO DAY YE AR I MO DAY ,' , , LOCATION FROM - --
- TO j m -- d-- #5 " *..
- II ' ,^ h ; - !t 'l i JH> g2gggp g22 23) gg45 gg,_27; ca-291 (3agt; NOW R**d NM We* W% % %-
PARAMETER 43 M On4f QUANTITY OR LOADWG I4 % on&s QUANTITY OR CONCENTRATKW NO. 'REouw eV SAMPLE 14 6-S 31 15
- 6 19 (36-45) 446-531 ts+619 oF (31-371 M ANALYsS TYM AVERAGE MAXIMUM UNITS MINtMUM AVERAGF w XIMUM UNITS , ens, ,,,,,, qm
. . .,, . ,. ... ~, gguptg . :; - - c -~
p , T +- * , .. r' s A - MEASUREMENT , N 4-
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SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT
~
S AMPLE , MEA SUREMENT a
- PERMIT '
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e etRTIFY UNDER PEN ALTY OF LAW YHAT S HAVE PsRSONARY ER AMWED AND TELEPHONE DATE AM FAMILJAR WITH THE INFORMAtlON SU8MITTED HEREN: AND S ASED ON MY INQUfRY OF THOSE INOfVfDUALS IMMEDeATELY RESPON98LE FOR MV i i O;ndOrf OSTAINfNG THE INFORMATION, f BEUEVE THE SUBMITTED SNFORMATION IS , p
'g ,
TRUE, ACCURATE AND CC'dPLETE. I AM AWARf THAT THEME ARE ' '- Chetil di r V H diu qC r 9GNIFICAuT PENALTIES FOR SUsusTTING FALSE mFOmMAftON. GNCLUDMG 4 { '7 #'igj.M9j} ue
'* (; *1 %
'3 THE POS981UTY u.S.C. OF FINE,AND s 131o. spense. maser3MPRISONMENT.
e seesM m.y SEE 19 U.S.C bien,se es se91001 se s AND 33 70.000 SN3 NATURE OF PRWeCFAL EXECUTfvE gg TYPED OR PRINTED andarm m ,=-- -s ta.ew s maam .wr s y ras OmCER OR AtJTHOfMZED AGENT CODE NUMEIER l YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# strechments here/ EPA Form 3320-1 (08-951 Presous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ,[ 3.4 / f L g } g (.L , ,, PAGE ,OF
h
-e-*--*tsuios-*ws.W4->ss==..A--e.em.,wt _ ... == en = e am e> sw -ua s we=m w e's.a , --
--m Paperwork Reduction Act Notice ~
~
!a ' INbbe wpinting burden for this collection of information is estinated t:> vary from a range of 10 hours as an 2 aversp per response for some minor facditie.s to 110 hours at an average per respono for some uujor facilities,- j_ with a weighted average for rnajof am! minor facilities of 18 hours per revone, including tima for reviewing
- instructions searching' existing data sources gathering and maintaining th(data nuded, and completing and reviewing the colledion of infomation. - Send comments regarding the bordca e4imate or any other spect of
! this cohection of inform < tion, including suggestions for reducir.g this burden, to Chief, Infornation Poicy Hrunch, PM4223 U.S. Environmental Protection Apney,401 M Street, SW Washington, DC 20460; and to the
. Office of lofonnation and Regulatory Affairs, Office of Mknagement and Budget, Washington, DC 20503, j _ _ _u._., .
. . , , _ -- , ._. _ J 1 .
t F
. General Instructions
' l. U form has been pr tially completed by preprinting, disregard instructiontdirreted at entry of that information
, altnady preprinted 4 2. Enter " Permittee Namcalailmg Addren (and facility namellocation, if dilictenk" "Perrmi Number," and "Docharge Number" where indicated ( A separate form is required for cach dischargy -
1 i -4 - 3. Enter dates begmning and end;ng "Afonnoring Permd" covered by form where indic.ica, l 4 sEnter exh "Parameta" as speedied in monitoritig requirements of permit. Y
- 5. Enter " Sam;>!c 3feasurement" data for each paramet.1 under *Guantity" and "Guality" in units speciGed in pernst "A wrage" i4 normally anthmetic -average (geometric average for bacterial parameters) of rJi sampts measurements for tach parameter nbtained during "Alonitoring fyrrorf% "Afarimum" and "Afinimum" are rntmally extreme high and low measurements obtained during "Alomtormy Period" (Note to mumcipals with secendary treatment -
requirement: Enter 30-day awerage of san:ple measurements under "1wrege " and enter maximum 7 day average' of sample measure.nents obtained during monitoring period under "Alarimum ")
- 6. Enter "ferndt Requirement" for each parameter under "Quanaty" and "Gualirr" as specitied in permit. -
- 7. Unider 'Vo Er" cnter number o sampic r rneasurments lduring ngntitoring period tat exceed maximum (and/or minimum or 7-day average as appropriate) permit rcquirement for each parameter, if noac, enter "0".
- 8. Enter " Frequency ,f Analym" both as "8am;:le Afrasurment" (actu'd frequency o rsampling and analysis used during .momtoring period) and as "Permir Requirement" specified in pennit - (e g., Enter " Cont," for continuous monitoring, "lm for one day per weck, " # 21" for one day per month */=V0" for one day per quarter, etc_)
- 9. Enter " Single 7)pe" both as "Sanple Areasurement"lactual sample tjpe used otting monitoririg paiod) and as .
*rermit Requirement," (e.gi, Enter "Grah" for individual sample, "NI/C" for 24-hour composite, "N0t" for
. continuous monitoring, etc.)
- 10. Where viobtions of permit requirements are reported, attach a brief explanation to describe cause and corrective
~
actions taken, and reference each violation by date.
- 11. If."no discharge" occurs during rnonitoring period. enter "No Discharge" across form in ph.ce of data entry 12,-- Enter "Name Title of Principal Execunve Offerr" wnth *Sognature of Principal;Erecutive Of]icer of Authori:ed s Agent, " Telephone Number," and "Date" at bottom of form <
13, Mail signed Report to Of0ce(s) by date(s) specified in permit. Retain copy for your recoran
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DAI/O funn may be obtained from OfDec(s) specified in permit.
Legal Notice
'nds report is required by law (33 U. S . . C 1318; 40 C... F R 125 27) Failure to re[xnt or failure to report truthfully can
. . j result in civil penalties not to exceed $10,000 per day of vioiatic.n; or m enminal penaldes not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by hoih.
i EPA, Form 3320-1 (Rev. 08-95)
"r
PERMITTEE NAME/ADOPESS(Nedri ema, sea.Leere==(DWew) NAT:ONAL 70L1UTANT DECHARGE EUMMATH:ps SYSTEM (MPDESJ Fems Apgwoved. NAME i i - 4 L J. i f* L ,1 I *O'ar A SIAi1gg N MOSIITORING REPORTg, 2yj, ;g7;3 3 y , T SMS No.2040-0004 - i' , J . >'1 4 < -v _ ~xs .vi n ( 5 !) n E ') $ ) AppFevelyssNres.OS-31-98 ADORE $1 AT!L; Da11D 07 11 L U 9 T' PERMIT NUMBER DrscusacE zuMsER f - E i!* A L
- 4 I P F 1 :: 2 0 U PA ILe77 3 U G F.
MONITORING PERIOD FACIU'Y ~ YEAR MO - DAY YEAR MO DAY .s
$ g'.
LOCAT ON FROM - TO - -- ' U3 ", 5 '"
,' y, , # " b L,lU; D A \ i is :; n 3 0i (' ggggy, gyg.g3, gg4_gg, ggy gy, ggg gg, g3g3g; N M M M W ore & % term, 13 Cent Ontyi QUANTITY OR LOADING I4 ce,d onsys QUANTITY OR CONCENTRATION h0. REQUENCY PARAMETER SAMPLE 146-531 (54 611 136-459 446-531 164-619 Or 132 371 EX AngyS,5 TYPE AVERAGE MAXIMUM tfNITS MINIMUM AVERAGE MAXIMUM UNITS ,,us, e, ,e
' ' '~ ' '""**
. SAMPLE 4 *eJ MEASURE *AENT W4 ?L 1 0 ,) PERMIT " V""; * * ' ' ' " e3 9*d ** ' u n J.U < t. d n i ' dP
^
;f .bL>I ,1 ea iA.O. REQUIREMENT c M 7:1?Ud c' A I I a, u r .w v
- SAMPLE ~~ ' """'
5ea, 4 i 4. 91 . ! 'J)
- nja ;li 41?' -! FLA3. MEASUREMENT !
>t : 2 9 1 v D a;rUni -*. 4 "" v e ""+>W- b W ev Mc *unL: L a il; PERMIT i F Li M vnDs; iALJ REQUIREMENT ;O AV3 OAIL! n4 nb> a*%
,,_ 4 -s , ia& A .- SAMPLE ""' ' " ' *
( 11)
) ? I >hL MEASUREMENT ,
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PERMIT ""' '*' ' ' ' ' ' ~ >=3 A.i> +tt:6 acAn L,+af , JJ_ ^.hU REQUIREMENT ;ooG "O AiG .l k J T HA1 r. 5 / L mu ;;. a _ , SAMPLE ' ' ' "' ' t AU i s V A 1 k., :i L : MEASUREMENT u u t ,, i v pgg y n , -r - . . , a. , '-r u,, y,, < u r, s, , , o ,, a i .t - _e1 2 d> J A LL REcutREMtENT N' AY?4AGi 5 A X .I E U M iG/L SAMPLE MEASUREMENT PERMfT REQUIREMENT SAMPLE ! MEASUREMENT PERMIT REQUIREMENT 1i SAMPLE MEASUREMENT
- PERMIT REQUIREMENT 1 J
NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTtFY iMOEA PtNALTY OF LAW THAT s HAVE PERSONAL 1Y ERAMessED AND TELEPHONE DATE
- AM FAMfuAR WITH THE #dFORMATION SUSMITTED HEREIN: AND SASED One MY BNOUIRY OF THOSE IMOlvlDUALS fMMEDtATELY RE9POat98tf FOR l l
OSTA:N1NG THE INFORMATION,1 SEUEVE THE SUBMITTED INFORMAflON f5 TRUE. ACCURATE AND COMPLfT E. t AM AWARE THAT TpfRE ARE /s e, e USV1 d NUWfi-t SIGNIFtCANT PENALTIES FOR SUSMITTING FALSE INFORMATION fMCLtOtteG i
, .1 '~.,,,. is . ,' .',r,. THE POSSIStuTV OF FtNE AND sMMuSOseMENT. SEE 18 u.S.C. I 1001 AND 33 'ta !O3.%7}] 4A 'O 2%
u.s C. E 131s. #Rensmes ansser swee se=see mer hicAmne snee w se srom S90 NATURE OF PRifeC8 PAL EXECt/TNE ip TYPED OR PRINTED ew er mes==eC - - : eFase-sea a ===ns ow a roeraf OFFICER OR AUTHORRIZD AGEfff g NUMBER YEAR MO DAY COMNiENTS AND EXPLAP'ATION OF ANY VIOLATIONS (Reference s# errschments heref 92.i: iJh1SU f vi CLO4, f; . 3/A!L4DL* f:L.9~, ? .6 C ~ U 2 *. L ;;.;}10Al J i L G H I *, E AhC J C s'ti f L s u !; L Y
//L X 1 h t.l !dM E l
, ccis < : ;c DIL _ i An n t P L .; 1:4 . .L:t 'hA~ rLns P A T *i A N. t. uActah
- p a r f. I v u a an k a n y. t .
EPA Form 3320-1 106-95) Previous ed.nons may be used. IREPLACES EPA FORM T-10 WlGCH MAY NOT BE USED.) J G j j / / j y a 10 P _; j A PAGri ,OF
T
- > l
. ~ . - . - - . - . _ -
- - ., -... _ - _ ._.~ _ -.. - _. . - +_ .-
I - Paperwork Rediletion-Act Notice . ; i j Puhhc reporting burden for this collee: ion of infor ration is evinated to vary from a sange of 10 hours e an i averriye p"t re*ponse for some t,inor failities, to 110 hours as an average per responu for wme inajor facihties, f with a wr ghtedi average for major and nunor facilitica of 18 hours per raponse, imluday Ltue for reviemng { l inttructio ,% vanhing cristing d4ta muren, pthering 'nd maintaining the data ntulad, and completing and revienng t% colic 4. tion of intornwion, Send umunent, regarding tim buidert ulinute or any uther uget of i- , this collettion of information, induding mgpstions for reducing this burdco, tr, ('hief, Information Pohey . , . firamh, PM 273. U1 Environnwntal Protatmn Agency,401 M Street, SW Wa<hin,t m. DC 20460; and to the j Office of Infortnation and Regulatory Af fairs. O! lice of Managtment and Budget. Wuh:ngton, DC 20$0), i - l General Instructions I, if form h,oi bmn putjally templeted by pretirinting, disregard instructions dirneted at entry of that infornwilion [ alttady preprintal
- 2. Enter Tr miure Named /ading Addrcu (and facihty name/ location, i( different)," Termit Number " and -
j "Diarharge Number
- whcre indkated ( A separato form is ratuired for each diu harge.)
- 3. Enter dates beginning and ending *A/onitoring TermdNovered by forrn w here indicated
- 4. F.nter ca(h Taramrte r" as goalicd in monitoring requirements of pertnit.
4 i 5, Enttr "Nampic Atennnement" data for each parameter under "puantitF pnd '(Junhty i1 umts specified in permit ,
"-hrracc* is nomuth arithmetic nerage (geometric merare for bacterial parameters) cf all sample mcamicments for each parameter obtained dur i
, lowtormg Period",
- Afar!wid and 'Ahniumnt" tre normd) extreme high 1 and low ~asmements obtained during *Ahnutormg Permd *' (Note to municipal + mith xcendary trcmment
!cquirern Enter Wlay average of sr,anple memarciacnts imda%crage
- and enter madmum "I day merage of sampi surements obtained durmg momtoring period under "Alarimum *)
6 Enter " Pet, a Reymmem" Ior exh parameter under puanmy* and "guahty" as specified in permit, 7L Under 'No Fr* cnter number of sample measunnen:s during monitorf tg penod that execed inadmum (ar,1'or mininmm or 7-day merage as oppropriate) permit requirement for cach parameter. If noac, inter *0" 8, Enter Trcpemy of Analnu* teth as "Namph Alcasurment* tactual fraluency of sampling and . analysis used ! daring momtoring pciiod) and as Tcrmit Requnement" specified in,penmt (e g , Enter ht," for continuous - monitonng. */& for one day per seck, "100* for one day per month, /W' for one day pe quaner, Ltc ). ,
- 9. Emer
- Sample hpc" both m "Samp/c Afrawrement* (actual sample type used during monitonng pstiod) and as Tcrmit Repirement ". (e g., Enter "Goh" for individual mmpic, "N//C" for 24 hour composite, 'Nc4" for continuam monitonng, etc )
10c Where dotations of permit requirements are repord attach a brief esplarculon to dmribe cause and coetite actions taken, and reference each violation by date. 11jlf "no disdritre* onut s during momtering period, nier "No Discharge" acrost form in place of data entry L _t2 Emcr *NameTitle Prmcircd Executive Qfpcer" unh *Signaturr af Principd Executive Ofictr <>f:turhorned Agent,' "Telepimne ' umber,' and *Date* ut bottom of form. 11 - Mall signed Report to Office (s) by date(s) specihed ia permit Hetriin copy for your recc>rds.
- 14. More detailed instructions for use of this Dluharge A/sdiormg Report (DAI/O fonn may be obtt ined fr6m Office (s) -l specified in permit t
Legal Notice
'!% repmt is required by law (33 U.S.C.131R; 40 C.P.R 125.27). Fadure to report or failure ' vport truthfully can tesultjn civit pmaltin not to e3ceed $10,000 per J_sy of violation; or in criminal penaltia not to euced123,000 per day of viol tion, or by,intrisonment for not more than one year, or by both.
- FJ'A Form 33Wt (Rev. D8 95) .
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$ I i EPA Form 3324-1108-95) Previous eh mov be tsood. IfEPLACES EPA FORRE T-40 vpeC89 atAY 950T SE USED.) L9q;/9.,C1;;- A ] .; _
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, , g as a- - - , . < - . .. m e s mi. %-.e.v..< wm..-i, .,~+ +.-rr. . =*ng -- e % -# es-,-m f Paperwork Reduction Act Notice .
l 1 l public repmtmg burden for this illectmn ,f mfornuition n ntimatal ta very from a range of 10 hours as an an,a n ,r ,.naor-,,minorfwuu,tonouna - ,nna n ,,w -fn,mcu+ra n , I with a weightW sverge far major and sninor idhtia of 18 houns pur naponse, including time jur reviewing . iro.tructions, watching uisting data wurm gathering and ruintaming the data tmird, and completing and i inicanig the udlntkm of inimuuition. Stre l mmment eq aeding the burden utirm.to or any other aapoet of j ti,i, udln tion _of infornation, iruludmg surgntions for reducing this burden, to Chief, fr.fmmation Prdicy Uranch. PM 223, U.S. linvironnwntal Psoteuion Agency. 401 M Street, $W Washingtori, DC ?0K,0, and to the { Offke of infoniuhon and Regulatory Affair % Ofike of Hamgenwn; and fludget, Wahington, DC 2050L j _ - . _ ... _ ... _ _ , .-- m._ _ General Instructions l l
- 1. Il form hn teen partially compkted by prepnntmg, dbregard im.trwtions directed at - "y of that infonnation j ainsdy proprinted. l
' etmit l
- 2. Enter */'ermitice Name 3/aihng .f ddren (and facihty namc/ location, if dific! cut)," */ N6mber,* and l l
"Dmhorxe %mber" where indicated (A separate fonn is tcquired for cach d 4harr.e ) '
F l 1 Umcr dates bepmiing and endmg 'M"m/orms Permd"uncred by fann M cre inucated, , I
- 4. Enict car b Tarameter"in sp&t6cd in momionny requircments of permin
{ S I:nter "Nampic Atemurement* data for cash parameter under *(humtttf an3 *Uuality" in units specified in permit l
%rw* n normall> arnhmetic aserage (peomcut inerare for baterial parameters) of all sample measurements i for cm h parametu obbined durmf; "Momloring I'crim/^. "Utnma,' and " Minimum" are normally epteme hiy,h !
anJ low sucasu.emenn obhuned during "Mmntormg l'oint * (Note to tounicipals mth econdary treatment ! tupitement; I:nter Md ty as crage of sample me.uuttments under ".finage " and enter matinmm hb) avera};c I of Mmpic measurenwnts obtaincd during monitonog penod under "Mamnum,*) ( i o I A Emcr Tomit Regwrment" for cast' parameter under "Guant/If and *puohly" as specified in permit [ f
- 7. Under "No Ft* enter nandier of Mmple measutrucati during umnitoring perud that escoed maxirnum (and'or {
minimum os hhy metage a appropri uc) pennit requuonent for exh parameter. If none, enter *0*. j
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As Fnter *Frrgatomy of.f rmintf loth as "Sampic Momurment" (actol frequcncy ol s mptirip and analpis used f during tuonttoririg perud) and as */' omit Revourmrnt" 3pecified in permit (e g , !!nter 'T ontf for continuous -1 momtoting_ * /"" im one day per weck; */M for une da,$ per month. "/W for one d 33 per quarter, etc ) ! t 4 Entet Wsjite 7)f/ both as "Nemitle Urmurement" (actual sampic Igv ined danng momtoring penod) and as > Termit Regt.orrmentf (e g , linter
- Grab
- for indhidual umple, "N!/C" for 20hom compmite. "N A" lbr -l conhnuous momtonngsetc ) t 10, Nherc siolations of pctndt requittments are reponed. alla h a brief cAphnahon to desuibe cause arid conecthe .
actions taken, and sefuence cach violation by date. !
- 11. .lf "no dhtharge" occurs daring monitonng laiad, enter *No Dm haege" acmss form in place of data entry, f l
- 12. Vmet %dhtte c/ Prmaps! becuine Oficer" with "Signatm , Prinhpol Eucutar Q91cer ofilutho? ired l Agent * "Iclephant Vumber " und *Date" at banom oflotm. j i
11 Mail signed heport to Offict(s) by daico) snecified in pernut. fletain copy for your secords 14, More detailed hatnetions for use of this tw hange ifonitarmg Repor'(DMR) fr rm may be obtained fmm Office (s) ! specifieJ in permit ;
-1
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Legal Notice j f Thh report is raguired by la (M U.S C. 1318; 40 C.FA 12%,27). Failure to nport or fadure to report truthfully can f e _ rnuit in avd penaltin not toptred $10,000 per day of vi darian; i or in criminal penalnes not to nceed $25,0rX1 per day i of siolation, or by impnwnmerit for not note th4n one year. or by tuth s I EPA, Form 33201 Utn. Oth95) I
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- i Paperwork Reduction Act Notice : .
i , pal he rf pettiny lund. n f;4 this (< din to,n of infurimin.n is e stint.tcd t:a si.ry f non a range of 10 loiurs a sin e mp pcr re p4nv for mmr nun >r la ihtas ta 110 hours us m in t rm; p r n pinte for wmr uvjta f a ditin, v.ith a va g hh d au no f .: napt ml rmnm ta;ibho of 18 h, un p r respon.c m;luJmg tm.c for scuc a mp no not to m, v a hmy e mtny, d& m n e w, pderme and in.untahang the dm r c< 1 J, and wmpictmg so ! n m 4 mg tht uh h-n of mf or n An. Vnd toman nb. n pidw tlw burdin estmate or any othct a ;wt of tim, : oth , ton of mlor m hon, in hiding tu,;rNe m for ruhu mg thn haf Ji n, in Chhf, Inf oinutbn Pob.) liruto h, PM M, !! \ l notormn otal Pn.to hon Ap n ), El M Stra t, hW % Janrton,1)r 20100, and to tk Of f ne of inhirm Jmn ml Hernhtory Alf ans Of fu e of Enap tncnt imj DuJp t. Wa&nyton, DC 20$0L I General lustructions t u io,m u u pu m n, m n w a ry p,<pnuhng. d % ,a msn m uoim th, # a ai <nn, oiistiro n m hen SheaJy pn ponted l 1:nter "I'r i nnurr N ome A!_nt.ng iddirn (anJ fiuht) hame/lwatmn. tI (hfiercht)." *!'er ma Vimber," and "In.u knye WM" u ht te mln atui i A s p trate f arni n IcquircJ for exh dm h arc ) T I nit t d da tt rmonm and t uling 'Aforntonng Termd"sourcJ h fo mr ulu re in.hsated
- 1. F btu t as b " Anamclo" a speafit J m ununtaring retpuruncuts of pernal.
't i nu r N . 4 iIcmm "o r# d d t for uh paran.ctc r unlci *I hanat" and *rN/,n" in mun ycofied in pcraut
*turm, n omm dly ,adhnauc mer.ute irtone tm mer vc for tmen d nancu rs) el at umple measuf onents
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. h [ifianch ! tdl d rn d d'Ulu,l' "'/<D. 8f l$ 115 './' , " t ! 11.F u!Y a hd "' != % f'!'!'d O f C f n pr outl) C.\lrC114 hM and Im oc r un m. nk obt;nncJ dann "3!"na "mg h o s! # t 4tc h tumum 'pah u nh w< un lan in auncta n quu cment inrrrinda mcu_ cf oinpt: tm. .ran t m, nu und a " h er,'re." anJ cnu r ina umain %by au r as of ,.nnplc nmunasias ot taned dancy ta<autonor p noJ unJc. "Atamaan 9 r, i.n:ct "/'ci m i! reni % # far t h h paum tcr unJ cr "( %ntay " and Tulen * :n sps ifwd m b rnut 7 Un.hi W li" snur nor act of mnp e i e,: asumm ats during monnonny p md that cuecd madmum bm,t or nonunum or ' day m aap as appivpiutc) p un.t requm mcnt i.a t a<h paramact if nanc. cntt r *0" 8 l'idtl */ ? rg n! % 6 (*# IN d:T O" IH M h M * \ < t 9/ I? k/tdthrmt O! (Xlu d flCQUCnJV eI (alDlditie, 3nJ anh!)hb UWd danng mennonng nid) and . "A ma !n pa wn if spurwd in p;rnut (e r I nter N 'oraf for conunnons n;ona an n g. */ " fer one day p1 ucck "I F for one day per mnath. "I M fer enc d n o r qu ater. ck )
9 1 nier % nelt / spc" to:h as "Lm/ ic 3ft e m m nt" (actu d s uuric tspc used danng mmulong peruW and as
",l't t mil /Yr jh remrNI[ (e y, l' nk t NIta!? fdf kodh hh T. SainplC. $ N /[l' [Or 4-hottr WinptMle, T.l" TJI cononoons mcnHann4 ch )
10 Whoe s 'v11tions
. Of p; mal tr p nctncnts are reported. htLh a btKf cs[danatian to dc%f d*: cause and currestnc
- u hens t.d en. and rcimen,c cas h s mlation by dit:
1I. If"no dm harre" ouun dutmp moiulonnr pernwl, enter *L 1W hcree" acrou form in place of data entry 12 F nter Kame Tale u) rwn ipal Deatn e 09her" u ah "%enanse of Prrm ind 1^tn unce W!h er of :\ Aormd
. lcenll ' Telephone kmberl nnd *D.ne" at bottom of for tn L1, hLul nrned litpart to OITicc(O by dak(s) spet ified in pctnut Octain copy for sour records.
- 14. Marc detaded imiiucuans fer use of this l% hwgr t/.maunny &/m' WT/!D fenn may be obtamed fnun O!1i;co) f pCGficJ iri per unt Legal Notice This tiport h inteiral by hw 0.1 II 5 C 131N 40 C.I FL 125.27) I adure in repu-t or f ailure to rep.ut tnablo!!) can n udt in civd penalars not to act ed $10 A0 p r dr.y of s sbuon: er m unnanal peralnes not to ewerd $3 AO p r day _
ef nohtum, or by,imposanment for not tyn than one yre, et I y tub. FPA l'orm 3320-1 (Rn. OMS)
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1 Paperwork Reduction Act Notice .
. Public reporting burden for this m!!cchon of information is estmated to vary imm a rangs of 10 huura n an avtryo per reymw for mme ininor fmihnes, to l10 hours as an avernte per rtmunse for 9 erne trwjor facihties., } with a weghted netage for uwjur and minor fatihtm of 18 houn pr reiparo.c, including tirne fur inje ung ! instruchons, searching emting data souwes, gathenng and rnaintaming the data nented, and mmpleting and
{ revsewing the wilation of information Send wnunents regarding the burden estinse or any other upri of this odic < tion of infornution, including suggestioni for rnf acmg tlas burden, to Chief, Informahon Pohcy lhamh, PM 223, US. I nvironmental Pn.hxtion Agem y,401 M Street, SW Wadungton, DC 2040; ed to the nrrice of Information and Regulatory Afinirs, OfIke of Managernent and 13uJget, Washington, DC 20503. General Instructions - 1, if form ha han partially compltted by preprinting, disregard instructiora dirstal at entry of tiud information already proprintn], 2.I!nter *Prrmr/Ier Nome 3/amng Adderrr (and facihty name/ location, if different)," " Permit Number " and
*Dacharge Number" where indicated (A separate form is required for cach dsharge )
1 Enter dates beginning and coding "Ahmlionny Perial"cmered by fortu where it'dicated
- 4. Enter ex h *Parumrrrr" as spnified in momtoring tequirements of pomit.
- 5. Potet "bnp/c Afcowremcnt" data for cach paraneter under '(Anmrity" and *()uahty" h units speafled in pernut.
Anragr* is nornully ardhmetic merage Irmmetric merage f or bactenal parameters) of all sample measuremerits
' far exh parametrr eblimed danng "Atomronng PanP, "Alaunm" and "Ahmmum" are norimd!y cureme high and low mensmont:nts obtamed dming "3/omtonny Period" (Note to municipals mth secondary treatment requucincnt: Emer Tn-day average of sample measurements under *.lvreogr/ and c'ner mavimam 7-day incrage of N1rtlple InCasorcIntnti obtained ddHng mondnting period under "Alaumpt *)
6 - Emer Trrmit Reptrement" for each par.uneter und:t *pwmtv and *Gualar as spedfied in pennit.
- 7. Undjr "No 19" cnier number el s.unple measurmenu during mondanng perkd slut eseced madmum (anNor minimum or 7 day averagt as approprule) pennit rcquuement for each paranuder, if none, entet "0" ELEntir "Frepemy of Anahm" both as "Langle Afeawrment" (actual frequency of samphng and analysis trsed +
dining mondoring period) and as Trima R yacment" spccified in pennit. (c g Enter " Cont? for continuous nionitoring, "lJ' for one day per werk, */ dir for one day per month, "I T0" for one day per quarter, etc ) 9.'"Pumit Futer *Nami>!e Re juiremort/7)pe" (e gtoth as "Lmple
, I?nter *GraA' forAlcamrement" (actual individual s.uuple. % sample typ!//f7 fotnsed during 24&ur conyiosde, 'N A" mo...oring for peri 1
contumom monitonng, etc.)
- 10. Whoe siobtions of permit inpurements are reported. auach a brief explarction to descrdie cause and correctne actions taken, and reference cach violation by date-
- 11. If "no discicuge" occurs danng monitoring permd, enter "No Ducharge" across form in place of data entry-
- 12. Enter *Name Tit lc of Principal bec utwe Oficer' with *Signan.re a:(Principol Feen,tive U.kcr ofAuthon:ed Agent / 'Teleph<me Number," and 'Date' at bottom of form.
13c Mail signed Report to Ollicefs) by date(s) specified m perndt Retain copy for your recordt 14; More detailed instructions foi use ofil a 15 charge Afonitarmg Report f DA/R) form ma3 be obtained from 01Tice(s) specified m pertmt. Legal Notice
= RL report is requim! by law (33 Uus.C 1318; 40 C.F.R,125.27). Failure to report or failure to report truthfully can result m civil penalties not t_o nend $10,000 per day of violaticmi or m crinurud penalties not io exceed 525,000 per day of violation, or by impnsonnwent for not more than bne year, or by luth, i
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- 11. If "no dnth;up' n ons dunng maratonne peno.1 cnter "G 1% exc' a.h n f ann m place J data entry 12.1 un *Namc 'lnle c1 i'in , a? ! te utm m, r e e u ah *:qvam , ' t'm :;n ! ne a m e <1;!L.cr vi htu;:c !
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- 14. spcuncd Mme dataded inutwau:n im use vf tha !W hmic \/m v;y !?crer! llMI!a form m n be obtamcJ from Ofnccte in per nut.
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1 A :) if MEASUREMENT 738 7 63 0 r7 W6 aadu i s < PERMIT vi *- 4 40 z .:,, '/ - + 3 v u v.; t i ?.L : ;dAa
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' ass sam'muna wTM TMt meonasanose suomeTTro Meatn: aw easro o.= .-
esv #eQuesty OF WooSE puOrwtDumLS measEDsaTtLY mEgmosegeLE post cetassmeeG THE WW 18FWaTions. I stutyt TME sumamTTED seasosensartons IS f WV 1.4 L,fUdOf Tmut. ACCustaff e4D CoherLitt e ass mapeastt Twat YMeitt ant } # M anacasst semmLM son sumamTTweG FALSE WorosumaDOP*, WeCLUDWG L,.,.cni a t ry Ifat.sne r s.m.e T possesuTv oc ruwe ano .- ~._ . sT. set to u.s c. e soot aseo 33 + 1.,,:. ,M 3 - 31,6 3 %, , , ,
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- OPRCER Oft AUTHORf2ED AGEWIT CODE 88Utd8ER YEAR MO ! DAY COMMENTS,APfD EXPLAN ATION OF ANY V10L. A.TIOP.S (Reference et effech, mertts here,#
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1-r ? .~n J h r' s (* ri , - EPA Form 3320-1 (OS-MI Previous odetsorte mey be used. tREPLACES EPA FORM T-40 W99CH MAY NOT SE USED.) ; $ e,f g p , . , . 3 ;,, PAGE ,cy
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-...._....q Paperwork Reduction Act Notice .
Public repning burden for thh mile; tion of informatmo is estimecJ to vary from a ntnge of to bvun, e an j average per response for mee ruinor facditios to I triinurs e an aurage pr respnwe for t.ome nujor faohtiet, l
} with a weightad mersp fos m.aye ivad minor kthiia of 18 hours per raparu, imluding tarne for reviewing j
!' inurittionn,'sierthing emtir g data mittes, gathering and amintaining tb data needed, and sompletmg and trviewing the milMmn of infonrWion. Send wmnents segarang the burden n.imi.to or any other asyct of tlos collwoon of infortnahoa, imluding sugpstons kr reducing thn burden, to Chief, Infmmation Policy lharv.h, PM 223. U.S. linviromnental Protalmn Apncy,401 M Stnwt, SW Washingtor: DC 20s@; anJ to the Offne of infortmtion anJ f(egulamry Af fairs Ollice of Managarnt and 13udpt, Wuhiegion, DC 20503, General Instructions 1 If form he been partially wrnpleted by perpriming, diugasd instructions dimcted at critty of that infornwti<n already preprinted.
2c *Enter Ternnitcc Name %ilmg Ad/rru (and facility name/lccation, if diflerent)," Tamil Nianber," amt i Diuharge Number
- where indicated (A separme fann a required for cach dmharge ) ,
I Llinier daics beginning and ending "3/omtormy Pom# cm.hd by form w here indicated i
- 4. Imici cach Turimwirr* us speufied in moraiontig requartmems ofWonit l
- 5. I!nter *Kmp!c 3/enmerment" data for cach puaineter un&r *puantay* and "puahti" in mots spcined in permit.
"Arrrogr" a nornully anthmetic metape (rcomenie m crage for haeteral parameters) of all sampb: measurements far cach paramcter ohdned danng "Alemtarmy Per/mr, "himum" and "A/mimum" arc normall) eweme lugh and love measurements obtained dunng "Alonnonny Pr%f" (Note to ruunicipals with secondar) trea: ment recoirement linter 3D-day merap of Larapie memurements under ".f rerage." and enter muimusa kla) aserage c:f sampic measuremcals chtained durmg tuonitonng period uruler 'Atatimumfi
- 6. Enter To nm Reqmrrment" lot each parammt under "Quonnry" und "puolar as specified in permit.
- 7. Under'"No IV enter numter of sample meamrments dosing monitoring Frnxi that exceed inaxiumm (end/or '
udnimum or 7-day a crage as appwpriatc) perunt rcymrement for each parameter if none, enter "0". +
- 8. Enter *Frrpenry of Analpl# both m "%mple Atrawemar (actual freque.ney of umpling and analpts usui during momtosing penad) and as *nrmd //cqwremene specified in grmit (e g , Enter "C ont,' for continuous morntoring */#* for ene day pcv week.
- lwr' for one day per month. "F90" for one day per quartcr, etc ) ,
% Emer 'Lojile 7)pc" toth as "Lmple ifrawrement" (actwd sample ty med during monitoring period) and as a 1*romtr Requiremen! " t'e g , Futer " Grab" ~ far indindual. sample, d..lllC" for 24 hour composito, 'N ?!" foi continueus suomtoring, ete )
- 10. Wherc siolMicru of pamit requirements are reported, attach a brief explanation to describe cause and (orrective actiom taken, and refereme cash violation by date i1.-if"no discharp" occus dunny momtont.g period, enter 'No Dachn9:c* across form in pla;c of data entry 12c Entet *NameTalc <f Prmural laenahe OLRecr* with *knatee of Pnncipall hen, rive O!?icer pf Author icd Agent
- Telephone Number
- and *Dare' m bottom of form.
- 13. Mail signed Report to O.Ticco) by date(s) spcined in permit Retain copy for your records
'4. More detailed imtructiam for use of this Dacharge Atenitormy Report (DA//U fonn nuy be oteined from Omec(s) speci6cd 'in permit.
Legal Notice f This report ts mptised by law (33 U.S.CJ 1318; 40 C.F.R,125.27). Failure to report or fadure to report truthfully can
-- = ttsuit in civil penalties not to excud $10h30 per day of vio!. tion; or m criminal penalties not to exceed $25,000 per day _-
of violation, or by impnwnment for not more than one year, or by both.
.. EPA Form 33:0-1 (Rey,495) r s -a,w-
MRhiffTEE NAGEJA008e3mr au,s z,, voisi wr anATio at ea s ti reasst oiscMasoss etms aview si'tTsas (M'OESt Form W NAtf J L A e' ;
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== _ es s NUteER YEAR MO DAY TYPED OR PRefTED era.c s em..w sv.-ss OFMCER OR AUTHORIZED AGENT CODE COMMENTS AND EXPLANATION OF ANY V10s.ATIONS (Reference ed erredaments herop EPA Form 3320-1 106-J51 Previous editions may be used. (REPLACES EPA FORM T-40 W9GCN MAY NOT BE USED.3 c a v , ; / , f ;; , , % 1, ; 4 PAGE 0F
- n- - . , . - - .A . - . . - . - - - ..n ^_---..._-_x...._ _
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I Paperwork Reduction Act Notice ! Public trparlin[ huldrn her ddN t oMc(th,n O{ m[ornphon is rdHuhlm} ( i s alfI loin a ran[r 0! IU hieyth DN Rn avnage pr te p nw for some tuinor le ihhe , t i 110 h:mn as an as ersge per re p mse for s.ome myor f a ibhes 4dh R %tlyhttd d*Lidpi Ior ibJy tt !Cn! D a nGr IA ilitit % (;l lb !4%4fL [Li IC tp 'n % . in,lOd trif tlu tt b 6r rt k d'A lf' armo uttin o u w hmg ri wirp data a rn os s radu nny anJ maintaming N data r.orded, anJ umiplet' g vid j ra c ing the udhs tion of mf ornutmn- Send tonmr nts n pudmp the bu Jt.n eshnute or any olha as, s t of tba c olh ttmn of in tonamn, in.hiJing *.uggmaions for irJom mg thn bord n, to Ch:ct, hd nnnuun l' ' :) ihan, h, pM 223,1l1 1.nvuormn nt l ers tu tion Aren,y, 401 M Sun t, $W Was hington, I'C 2060; tnd to the Othee of infornutmn an i Rerulatory Athurs Othn of mnagenent xnj BuJytt, Washmpton, DC 2050L General Instructions
- i. n h,un he un naamny mmea by en t,ndme, dm,egra imous,,e di,aa a enny or uma info,n#n ahtady preponted.
2 Enter
- A rmittee bn Afm/mg 1dhen (and facihty na rnc/lau.tio n, if differenO." "Per md Wm h er," and
'lh ban e %m! rr" w he re mJn ated ( A separate form is requurd for exh discharge )
1 I mer daics begintung an i endmg Mfomtor me h rmd" cmcred by form where indcakd l I!nk t c A h */'ar d'th te e ' ai sp?Lifhd in nlamlOllbg rCgWicinenlS oI WrInll, f 5 l ntt I " 5 l'"plc i fca u r en'i r '" d !!:1 f if c t 'h paf 3facter int kr "()u;P.htt" ans! "(b 1/dlt" in n!als 5peOOed in pcnnit i " tw < ^ n nonu d!) arnhmetn. ascrye (p unenu merare for Laaen:d p:uan chon of all vonple n tamrements hd f- E h [ ilanKh1 n!"Mn. d dunnf U l. J . e r i " ' l 's " O ~ , "\ / li UC am" and 3! rrin ,'q" are nointdly c stretne lugb an:1 lau nE t')!!C nh ols n! d m l b d d g ! ! n g ! /. + ;;/i> ,i /kr o[ * ( S !!C 10 In u ti. lpa! s u ith LCCOndar) I f( auhe b t n qwrcun ' Enkt Wn metan of my L manuttuunts nnb " tirrag," and o.ter tunnnom 7-day aserag 4 of untk m: nuiemeats oNa.ncd dunny nun.toring pcncti under "Afaumum ")
- 6. l'nNr "/'rt var lirpai me'a" for a h paraa eter uuJci "pmud it" anJ "pual:ty" as speuGed in pernut
- 7. UnJer *No ll" cur m.uber of vunp'e me amnums danny momionng penal that ( und maunaan On.d'er 1.ini fhu n t O! d1, ik cTagJ a5.t[pn'pflatt } }Killut rCQUlf clhCol l0f cm.h paralhckr l[ Thin:J. f ot( I "U" R.Enkt "/ rr.p mo of blyu t" tolh m "s n; l Almunwrt" (adual ficquency of samphng and analy sa used dining moratanng pcinku :md as "Pernot /M;vumat" speufud in penna (e g , l'nter *('ont," f ar continuaus momterint,. "1. " for one de g c uci "I W for om J n per momh. "/ 90" for one day per qu u-rer, etc )
. 1 c m c, s w yze n cn o o-rs s!. _ , _ , o m a - p u yn uma den , m o en y - o ana m
" A mn Rep n3 w t t " (c r, 11ntes *t bab" for indaiju d san p!c, "N!!F for 2 4-hour compOute. "N.1" for contmuous momionny. etc )
- 10. Whcie Wdations of perunt tequnement> arc repenJd, dlaCh 3 brGI c.\p! Wahon to dCViibC Cau < anj ~2oncila c
;h holis thkCf), and ICIC!cike CaCh \lGlal100 b) date Il. If "n3 dI%!LLrfe" os.t nii duf tnf ul0nttOf top pCrhKl. Cnt0r
- Yo /WM [ XacrDM f0Iru in [daCC Of d3ta Cutty
- 12. tintet *%ame Ttt!r q! !' raw: pal laect,rn e (!!)L er* u sth "kgnan re of Prmortd l :cunce Q!!wer pt .tu!%n:ed
, .1pnt * #7c!c;&ne Number," and "I1 ate" at banom oi fonu 11 M:ut ragatd Hcpon to Of 6cc(s) by datcu) specihed m pernut Retain cupy for your records.
- 14. Mare detaikd ingruaiota f ar use cf this th hmyc Afr:normg !!cjwt (/MI!O form may be obtamed frcm Ome;(s) sp ohed m Fumt Leoal 6 Notice lha trpert is retpired by law (31 U.S C.111N 40 C.F,R 125.?7) I ailure to repnt or fadute to report innhf ully can rendt m avd penslhes not to cuecd $10,000 per de of violation; or in (nminal gwnalun not to csce<J $3 Ain ps r de et siobtien. er t-), impnsement f or not more th an onc y ou , or by tuth.
l l l'I' A Foren 33201 (Res. OMS)
rimerTTEE MAME/ADDPES::W hsher mM (W mATu: mat pouuTAmt OscMAmoE summesAnces svs Ew INPDES/ Form Approved MAME .4'* .r s' A L L L ! r ;! 4 T - . A T ! .; % DISC gE MOWORING REPORT ,L;g, ,;, , >T OMS h 20 N gagg ^ eJ= :; . - e . . . , . . - ;: u ;) Approvel.o&_ CS-31-98 A ! .' > ; " I! .,! PERMIT NUMBE^t pscwAmoEmtmaetR - Ii;w
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4 d 4 + 4, I. & ,.r 4 e,.' MONTTORING PERIOD FACEfTY YEAR! UO IDAY YE AR 4 VO iDAY -- LOCATION FROM -g -j - TO j -j - 1' 'I i " b 5
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- 12azt 122 2s 12s-zsr 12s.27p 12s-2sp 13aJrp NOTE: Reed iraetruesone before completing thie form.
PARA 6 R (3 Cent onM QUANTITY OR LOADING toCeautOiM QUANTITY OR CONCENTRATION NO. "E" " SAMPLE 14 6-5 % v54-619 t 'MS2 746-5M 153 619 cv tJJ-37 EK AmAlv,s TYPE AVERAGE MxXtMUM UNITS M3NIMUM AVERAGE MAXIMUM UNITS sur ,w, ,,m SAMPLE MEASUREMENT
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SAMPLE MEASUREMENT PERMIT REQUtREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT , REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e cERTirv unoER PENALTv Or (Aw THAT e MAvE PERsONAuv Em Anm=Eo Amo TELEPHONE DATE Aas FAamuAR WITM TME peFORasATIOes steamTTED MEvtEpe: AND sASED 088 esv esouWtv OF THOSE seDuv DUALS sasteEDATELY RESPONSSLE FOR 00TAfsemeG THE *NFOResATIOss, e 'SEUEVE THE SusamTTED smFORwAT10se 15 I Da t; { .j 17 pct y; TRUE. ACCURATE AssD COamrLETE I Aas AWARE THAT TMERE ARE 90ms4+ CANT PfesALTtES FOR SUsamTTimeG FALSE sNFOmasATIOes. atCLtOpsG 3o1.nt*'3
~
o 9 THE posseoTv Or enet Amo se#PsusOnesENT. sEE 1s U.s.c. t 1001 Amo 33 *1- -, ' , '- $
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U S c. e iste. ameaenee esmew emese messunse see, micausse shes se er sto. cop 880 NATURE OF PRmcrAL EXECUTIVE ,g TYPED OR PRINTED eae ar memen : __ : er enewee e mene .w s ms OrriCER OR AUTHORIZED AGENT q SfUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATtONS (Reference of artschments heref I k e
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EPA Form 3320 1(08-95) Previous odetsons may t*e used. tREPtACES EPA FORM T.40 WHICH MAY NOT BE USEDJ *
' s
-- . 4 ;i PAGE ,OF
I i
. _ _ _ _ _ _ .. _ y Paperwork Reduction Act Notice .
Public reportmg burden for this colheion of informatum is esturated to vary from a range of 10 hours e an I ascrage per re>ponse for wne minor fauliUc% to i10 hours u im meerage pet reporw for t.ome major faulitic% l with a weighted avesage for nujor and rninor fa,ihuc+ of 18 hours per treponw, incluJing tinw for reviewing e instructions wrthing existing data murces, gathenng and maintaining the data needed, and complcting and j seviewing the en!!n tion of infomation. Scud comment < eepardmg the burden talmate or any other ay,ect of this cothdion of information, induJmg suggestions for reducing this borden, to Chief, Information Policy ! Liranch, PM 723, U.$. Lnwronmental Protation Ayeney,401 M Strut, SW Washington, DC 20%0; and to the , Offiic of Informahon and Regulatory Affairs, Of fice of Managunent and 13udpt, Weshmyton, DC 20503, l General Instructions
- 1. lf form ha been parbily completed by preprinting, disregard instructiorn dirwico at entry of that information already preprinted. l
- 2. Enter *Permuter Namth/aihng .hMren (and facshty namenocation, if diffcrent)l "Permu Number l and "Imcharge Number" where indicated ( A separate form n required for cach dmharge )
4 1 Enter dates begummg and endmg M/onuoring Perrod" covered by form where mdicated 4J Enter cach
- Parameter" as specified in moniiming requitements of pernut. ;
5 Enter "Nonple Aleayrrment" data foi exh parameter under "(4cntay" and 'puahty" in units specified in ivrmit.- 5terrage" n nornuth anthmetic average (geometric aver:se for knierial parametris) of all sample measmcments l for exh pammeter obtained during S/omforing Period"; M/atim nn" and 9bmmum" are normath cureme high ; and law memmcm:nts obtained during M/omformg Period" - (Note to municipah with secondary treatment ' regmrement- Emcr 30-day userage of sunple measurements under "Aerege." and enter inaximum Nby overage i of sample measmements obtamed during moniloring pcnod under *A/aomumf/ l k Cmcr *Pernd Requirement' for cach parameter under *Quanutf and "Quahty* as specified in permit, 7, Under "No li" emer number of umple measurments dunng monitoring period that escced maximum (ami'or c minimum or 7-day in etage as appropttate) pernot requircrnent for cach param Rr. If none, enter "0". 1 K. Enter "Frcquemy of dnalyus* both as "Samjdc Alcawrment" (acitol frequeng of sampling and analysis Used ' during momtoring penod) ani as *Pnma Reqmrrment" specified in pen Jt. f c g . Enter " Cont," for continuous
' momtoring. */ 7" for one day per week, "F39" for one day per month. "/W for one day per quarter, etc.)
j~ 9?Foter "Nunp/c 7 3/ # bmh as "Nmnf e lAlcawrement" (actual sample type used during monitonng period) and as "Permu Requircment " (c g., Enter *Grah" for individual sampicc "NHC for 24-houi composte, TA" for continuous momtoring, etc.)
? _
j- - 10.=Where siolanons of rmit requirements are rerted, attach a brief explanation to describe cause and correctne
- - actious taken, and rc cience cach violation by date.
L ! 11 c !f *no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entsy, l- [ 12. Enter "Name Tale of Principallhewtive O$cer* uith "Sigmnure of Primipal Exccutive Ojpccr of.hahorned l Agent? Telephone Number and "Date" at bottom of form ; l- " ! 13; Mail signed Report to Of"ects) by dde(s) spcified in pennit = Retain copy far 3our recordt 1 l 14, More detaikd instructions for use of this Dmhaqc Alanuaring Rcport fDAIR) form may be obtained from Office (s) l specified in permit. L Legal Notice His repmt in rn;uired by law O.) U.S.C. 1318; 40 C.F.R.12127). Failure to repott or failure to report truthfully can
. wult in dvil penalties not to exceed $10,MO per day of vintation; or in criminal penahin not to cuecd $25,000 per day ,
j 'of uoladon, or by imprisonnent for not more than one year,6r by both.
+-
l L i i l EPA l'orin 3320-1 (Rev. 08-95) I.
PEmeerTTEE MA4AE/AD0fC3WFe**w gfDth .w mATsomat pouutanT erscwamor guammaanom systees (MADES7 Form Approved. NAasE mf if !. r s' i 1. L i i FOd E! "7) ;J4 t#0MTomeeGppORTy 7 2 ;. ieIL 4 One too.2 DMO.0004 g a gg i.% E;A >+ 4. ;s. t. . , (2i; J5) Approwel eigmege,LS-31-Se 4!!3; vf.4iI Cr.40m tf PERT 4T N mm I ~ fIAAL
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-i REQUIREMCNT 1 f ] SAMPLE I MEASUREMENT I PERMIT -I REQUIREMENT 5 AMPLE ! MEASUEEMENT i PERMIT , REQUIREMENT , i Twv umota reinatTv os (mur w it a wave pensonauv tmammato mac psAaAElnTEE POWNCFAI EXECUDVE OFFICER *anC'=raamuan wwTw Twe esecsumaTio'w suonovTro wesen; ano easen om TELEPHCNE DATE any asoudtv or Twogt oOMOuALS statefDeATElv Int 1PowestLE 904 OSTApsusO Twf esFosumaTsoas. t ofUEVE TleE suerTTED em8CasamTgoes as , j
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- TYPED Ost PMW4TED .aa er . .-era.e s m.m. aw a ,.sres OFRMA OR AUTMosutED AGES 57 CODE l 88U4ABER YEAR MO ; DAY l l COMMENTS ANO EXi1.ANATION OF ANY VIOLATIONS (Reference af effechments herof i
i EPA Form 3320-1 tOS-Mi P*eweeus edstione mey be used. tREPLACES EPA FOftM T-40 WHICH GAAY 9eOT BE USED.I o -s . ; e, ; / 9 . L. >- f;% PAGE OF
i v._.a, +. . . - - - - - - . _ , , - . . , . , -n.._..
., - .-- . _ - . . , - - -.__.-ng_, m .,
l Paperwork Reduction Act Notice ' 1 Pubbe reportmg borden for thn mllation of mformstion is cAtimatal to very from a range of 10 hourm an ' l
, aserage pr rnpome for some minor facihtic% sa l10 housk as, an escrage per verpon',e for mme uujer failitir%
l with a weighted antarr for nWor and sninor facihtaa of Ili hours p(t respon% iruluJing tirne for arviewing j instrudiorn, s,e.mhing nistmg data wurett, gathermg and maintaming the data nwded, and mmpleting kna i
' reyewing the collectuut of infomation. Scud mnumntai scgardmp the burdrn utimaic os any.othrt ap t of th6 milection of inforumtion, intimling e,aggutium for redudny this burden, to Chief, Infunnation Pobey 1 i lhamb, PM 223,111 Environtmntal Prota tion Agency. 401 M 5treet, SW hhington, DC 20460; and to the >
[ Olhee of Infornoition and Regulatory Af fairs OlDre of Management and liodgd. Wehington, DC 20$03, t l - .. - - - . . .. - - - . . - . i L General Inst ructions '
- l. If form tas lwn panially mmpleted by preprinting, dn. regard instructium directnl at entry of that infornation, ,
ulroady prepsintal. ' l 2.' Enter "Permittre Namc Alading Addun (and faciht) name/ location. tf hfferenth" " Permit Number," anc . .
#D/3 charge Number" where indicated (A separate form is required for each di charge )
- 3. Pnter dates beginning and coding "Alamtaring Period' cm cred by form where indicated.
J f 4 Entes cach " Parameter" as spxined in momtontig requirements of pernut.
- 5. Entc "N.myile Alcmurement* data for each parameter under "Quanrdy" nwl "puahry" in imits specified in perialt
- %vragr" is normally arithmetic ascray (geometric averare fut bad *ial puameters) of all sample rncasurements a' for tach turanreter obtamed dming "Atomformg Prrio#, *3/aumw and "Alminmm" are norm
- dly ntreme high and imr inmusements obtamed thuing "Afonuormg Pcemd * ( 'ote to suunicipals with r.econdary treatment 4
itquHeintnt: EldCl Edd) DVeraqe of killyde ineMuretnChls UrtdCr %f!0gr[ at d enter titusinium %d3) ascritgC l of r.ampic mesutements obtained danng momtormg pt lod under " Alarum.nr. ') a Enter *rcemu nequormmt" for emh parameter under "Quantav" and "pualdy" as specified in permit.
- 7. Under "No F1* ruter number of nunple meaunnems during inanitoring period that eweed umsinmm (and'or
+
'minituunt or 74tay asetage as appropriate) pcrnut requirement for each parameter If hone, entra "E _
~ M Emer "Frequeny of Arm /mf loth as "Namj@ A/cawrment" (actual ficquency of smuphng and analpis uwd donng monitoring penoJ) and as " Permit Rcqunement" speci0ed in pernut (e g, Enter %nt? for continnous momioting. */ ;"' for one day per week * / lu" for one day per inouth "/30* for one day per quarter, etc )
r 9. Futet "Sampk Tire" luth as
- Sample AreauarmWn" (actual sample type used during monitoring period) and as
>Armu Requ!rrment " (e.g Enter "Grov* for individual samp!c, "N/K' for 24-hour coinpmte. " Nil" for continuous monitoring. etc )
- 10. Where violations of }vrndt requattucnts arc reported, attach a brief explanation to describe cause and mnectise actmn$ takesh and reference each violatinn by date. .
I1. If *no dixtunge* occurs during monito:ing perad, enter To Ibcharge" ac mss form in plaw of data entry,
. i2. Entet *Name Title of Princip<d Freadne Qlycer* uith "Signatve of Principal Crtative Oficer of Authorned Agent! 'Teirphone kmber: and 'Date" at tettom of form. <
- 13. Mad signed Report to Omce(s) by date(s) specified in permit. Retain copy for your records 14, More detailed instructions for use of this Discharge Monnori rg Report (D3fR) form may te obtained from Of0x(s) speci0ed in permit Legal Notice Uds irport la required by law (33 U S C s1318; 40 CF.R.125.27). Fadure to report or fadure to report trwhfully can
- tenuit in civil penattin not to neced $10,000 t'es day of siolation; or in crindn.al penalties ru to nceed $25,000 per day ,
of violatian, or hv,imprimnment for not more than one year, or by tuh. EPA form 3320-1 (Rev. 08 95) , i _,__..._..___---..-_.,___,-..._---m.,_.- , . . . . _ , - - . , . - . .
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i Papernrk Reduction Act Notice i le rtf'*rkjr![ bor CU sEr Ibli {( if3 $ f r) Of n b f t rl .4!lun D O' !!!nknd !;) % Pry fliHil & rhafC f f lb fp-Qth My Rll in t r&[0 jg ( (e p 2tM f.4 MemC ndS4 ja dilla t' p l ll> }U'or$ bi En Ab riJf r jV i it jbin k It4 6 IHF (Rh 'l fis iblif s w oh as wortA d c inire f ar rWot and mano f aahha of t h hours h r n :.ponw uuluJmy L.na for scorwing ne t nu tiont, , < <fary t w nsq data touro s , uht rmg an i nu nhamng dc data ne Jcd. anJ c ompttmg anJ i trumme de udintnin of mlar natn n % od a mwra, eq nohng de bord n e ttm.ec or eny othe r epn e of da irdle ima of mforrstmn, istuJuig sum <ti .ns fe nJo mg Ods bma n, to Clocf. Infornutmn Pohoy ihan h, PM @, U h I nvaennn nt.1 Pmininn Arem y,401 M Miert, $W W2.hington, DC 2040. and to the Ollit e of Infonnalem ind 14tpbimy A8 hun. OJfit of Wrurat s t and buJcet, Washmgton, DC 20503.
! j General Inst ructions t a num u wn puie u.sacd 83 pupnnhnc,d m ga mstm honsducaca e enn ofouainr-mamn talrC4dy ptrj4 tfiltd, 2 Crau "h nmiter Ya" r Wa lty ch! h < u imJ Liuh:3 n mrdlo abon, if ddb ttat)," "A rWI Nr.m tcr/ and "t h u harg umter" u ha c mths ahd ( A cpandc form n ic<pued fur ex h ibwheap )
L 1 oter d on tqouuny aa i twhny SI-mte n.a Aimr ws ucd b 3 fonn u bue mdu;at J 4 I nit i C A h " fan t"n b I a kht hf u d ih niandoline tbpuliluenl4 b[ p linit-
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-0.J h .a ni. an nu m s ohl oicJ dia uf "if - , r m.c n n > J " W ce to muni;ip.ds unh saondary tre_amcot su}uacmim I and F -dt3 m ta_ d tuvic nu uscm m b undt: "lii o crf "anJ cnkt mnunum bby :n crag; c f samil e nr:asen m,.at, of t.un, d donne inandonne p rio l unir 9/aump /
6 E nK r *n imu F. .pon "a "t" ha ( A h pmar R t unii "Us vmty" and "Uu an " e sp;dkJ m perndt T Un ict * \' I t" uam nun,ba et v mpe nw ,mmaas t'unny inonnoon;; p ied th st tw ed nue. unum Oudor a n h d n aan or 7 -d a e t r y. as q; n,pn A) ranut requacmem la er h praamchi If a t catcr V M. E nter h :9 rm .s < r !n4 m" bot h as "N ; !, t/c m"ncni" (m tual fnyo na of amphng and analpis ed Junny una,uing p;nodt and a4 "A nno . i en unt" spnified in panut it g . I okt 7 ', ra,* for t ominuous t w ruliding */ " lars% d a pcf uc_L."1 i loi One da) pct t1wth. "/ # for en-; J ty p r quaiter etc ) V l'id Cf WJ"tp/c lyf-r' both th $1mf * $ / ls d a!, ner:l" (,iitual Agnide type u%d dating mof ulpri/.?, period) ; nj a ,
"Armt/k urm,v"teg f 1:ntt r "t i A" f a inJniju d tuopt "/J/it ' for 2 4-hour wmp'ss, "X (" for conunwus monnonnr. ch )
10 Whi \lebhae 0! peni a 1:quirenants arc icpotkd ahAh a i ntf espbnanen la d N nbe Ouse and 04tcstnc a, norn 14 ca, and :cfauu c cA h ualahmi b3 d uc
- 11. If 'n i dinh. ore" osuns dunng mandonog perod ci,Rr *Vo th hver" a rod form in pke of data entry 12 I rnet %me Tn!e of 14an !Pa! l'un Mn e (W cr" u n h % cruw e o.f b: aiu! Tm utter Odu ct af.h!han:cl Agent * "le leplu a*r Number l and "!mic" et boMom of form
- 13. M.nl ugucd ittput ta Offi t(s) by dat:(s) speiibcd m p:rnut Retain wpy for y our iccordt
- 14. Mme detaded instnwaans f or u.se of this Ih large !!miar:rg !& port (IWlo fenn nuy be oH:nncd f ann O!Tr;cN qwficJ m p;inut Legal Notice ms e,i nyama oy a m o s.c omo e ex em ram i, mr+r uuc h, ter unmen>mn iesult in uvd p n.dha not to exmd $10.0 o p1 day <d unLhon, or m anninal p nalna not to ew d 5 Wo pcr de of notatiqn, or by impownnnt for nat nere than o: : y t u , or b:, ba h .
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SAMPLE MEASUREMENT PERMIT REQutREMENT g NAME/ TITLE PRINC3 PAL FXECUTIVE OFFICER craviev umote etmaLTv or t.aw Ts.a7 i MmVE Fre90mmuV EEmafetD AfdC TELEPHONE DATE ans sammumm wwrw Tut mesomasaticas susaarTTro weatse asso sasto ces tav meOUnev # TMOst auDMcNALs noterDuattty at9Poss98LE 7081 OSTameneG THE seposadaficat. I sturve Twt SugaarTTTD eM8cmepa110s: es . v avid gErnde,, Taut. accumait ano consestTv s aan awaat Twar Twent ant , Luo ef s i *; C ry ai*m N1 ; <* r 9,GmpFK. asst PthaLTMS 7 4 possesuTv FOR sVPastTTueG os swet asso a wa T. s FaL$t susFo8WeaTiOss, gasCLt.CuerG 7_- t s. > v u s c. e t ris. sw ennser e .epewone ==.,tt is us seen,s an c. s,toot en ano 33 s som SnoseATURE OF PmiseCFAL EXECUTWE ,- ~ g TYPED OR PRWTED .=a ar _ er mer e _ .w s ,.=re s .FFICER Ost AtJD0004 ZED AGENT g l 98UtdBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference m#effechmeerfs heref EP,*L Form 33201 (OS-98bl Previous editions may be used. EREPLACES EPA FORM T-40 WHK:H MAY NOT BE USEDJ ;t, *;/- ;;y ,_ . ; .. PAGE ;OF
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Paperwork Reduction Act Notice . P,abh; reportmy burden for thii collection of mformation as estirnated to vary from a range of to hours as an averap Fr revmw for uime minor fedlibes, to 110 hourt, as an averap per repose for umw stujor fuihtws, with a weightid aurap for major and aunm h.ditica of 18 hours per respmac, mduding tine for reviewing
; its.tnnrmrn, wrshing emhr g dabi wur es, pthering at#d reintaining the date. necdal, and Gunpiding And
! rniemng thgeolks tion of mfi.ruuition. knd cannwata repnhny the limd< n niin te or any other aspat of tids wthfien af informanon, irn.luding syyn.tians for redxmg this bmden, to Chirf, Infornation Pohey l liranch, PM 223, US Environmental Protn tion Agency, 401 M Street, SW Washingtoa. DC 2040, and to the l Office of InfonmCon and P.egulatory Aff airs, OfTac of Managtrnent and Hudget, Washington, DC 20501 l
\ Genera! Instructions l
- 1. If fo#m nas beu partially compkted by prcprintira, disregard instrAtmns directal at entry of that information stready pnprinted.
2.futer
- Permit /cc Yamedlashny .iddecu (athi failty name/ location, if dpierent)," "Pcinnt Number
- and ,
?Is Aarge Nenber where indicated . (A separate fonn s required for each disclntge )
1 Entes dates begianing end endmg %rntoring Period"wered by form where indicated
- 4. Enkt ah *i'aranet<r* u specified in monitoring requiremeats of pennit. j
' Fmo %pk A/caarimc# <* data for each parameter under "Quanhty* and Tuahtr* in units speciGed in pennit,
- terrogr* is norm:dly anths w'.ie antage (geometric merage foi bacterial panuncters) of all saniple meawrcnents i for exh paranatcr ebtained during *Alanarmg Peruf #Afatomm* and 'Afmimmn" are norma!!y ot, 1 bigh an.l. low mtnutene.nts obt ain ed durieg "Alondoorry Penod ". Wote to suunntp.ds with reendary matment _
nyutTfi' lent; Futer 30. day ave.1ge of sarnple meamicments under *<f verage
- an.1 enter mnimuru 74hy rnriage ;
of smnple incanuements obtainec dunng momiming period m. der *Muimum ")
- 6. Enter *Permu /kpitemem* foi can parameter under *(hmnnty" and 'Vuahty* as specined in pernut. l
- 7. Undct *No /n* enter numlet of sauple mcaurm:Ns daring inomtorieg penod that cured maximum (and'or !
minimum or 7-day attrap as appropnate) permu in;uirement for each paremeter if none. cnter "0". IL Pwer "/wgitene) g.lrudym" both as *Namp/c Alcamrmcru" (actual heqaena of samphng and anahsis used ! darmg monitoring penal) and as *Pavac Rrqunyment" spectned in penmt. (e g , Enter Tont,' for c5minuous ! I monitonng, */C' for onc day per weck, */10' for one day per momh. */ 90" for one day per quatter, etc )
- 9. Fmer "Lihk Dpe" teth as *Na>npk Akaerment" (actual sample type used dming monitoring period) and as
*Pe rr*in &pirement,* (e g . Enter *Genh* At individual stunple *RfK for 24 hour componte, "NM* for {
- continuous momtonng, etc ) ,
j 10 Whoe3iolations of penmt requiements me reported, auxh a bncf oplanation to cacobe cauw and correcthe i ardons taken, and reference cas h violation by daic !
- 11. If *na dischmge" occurs during enoultonng penod. emer 'No Dischage* across form in pkcc of data entry.
12: Enter "Name Totte of Prtnctjal Decunve O[]icer* wub
- Signature of Principal Decutive Oj!icer of As,thomea Agent * *Teler}nme Number." and *Date" nt bouom of for:n
- 13. Mail signed Report to Offke(s) by date(s) neciGed in pernui Retain mp3 for>our records
- 14. More detaihM instructions for uw of this Dacharge Momtormg Rc/wt (DMR) form may be obtained from Officc(s) !
speciDed in peimit. ! Legal Notice j i
- This report it nyuired by law (D USC. 1318; 40 C.l~ Pm 125.27). Failure to report or fdure to report trvttfully can _{
result in chil perutties not to exceed $10,000 per day of violation; or in criminal penalties not to excew! $25,000 per day } of v{olatk,in, or by imprisonment for not more tbn one year, or by both, j
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Ptiyi5vork Reduction Act Notice . I Public regertmg burden for thin m!lection of infornation is estimated to vary imm a range of 10 hours as an average pe r respmw for none minor fuihhes, to !10 hours e an n erage 3r ropanw for wrne nojer failities, with a weighh4 norage for major and minor fadhtics of 18 hours per topone, imludmg time for reviewing inn.frintiona, winhing exis,tmg data bources, gathenng and mamtsining the data nnda and wmpleting and reviewing the collu tion of information. SenJ wnmenu, regardmg the burden otimate or any other spect of this colic (tion of mfornution, indudmg buggesilum for seduting this burden, to Chief, Information ptdity Draiph, PM 223, U.S. Environmental Protation Agemy,401 M Street, SW Wathington, DC 20160; and to the Office of Infornation and Regulatory Affairs, Of fge of Management and flodgtt, Washington, DC 20$03, General Instructions I, if form has lun partidly completed by preprinting, disregard instnxtmns diented at entry of that information . already prepunta
- 2. Enter *Permittec Name:Afathng Addros (and factlity snruellocation, it different) *
- Permit Number," and
*Dbcharge Nur ..cr" u here indicated ( A separate form is required for exh dadorge ) -
l
- 3. Enter dates beginning and endmg *Alomformg Permd" covered by form where indiated
- 4. Enter cach "Paramerci" as specified in monitoring requacments of permit.
- 5. Enter hple Alcauncmmt* data for each parameter under *(?uantu..* and 'punhtf in (mitt spmfied in permit- i
%ra# is normath arithmetic average (geometric ;nerare for baderial parameters) of all sample measurements
- for each parameter ob!ained donng "Alammimg rnhr'; 'Alatimwn" and 'A/mimum" are normally extreme high
( and low rneamiemcuts obtaaied during "Aloniformg Permd? (Note to umahapals with secondary treatment requirement: f:nter 30-day average of sample measurements unJer tf rcrage,* and enter inatimum hiay average of san >ple rmnurements obtamed during momtaring period under *Alaumum ") l 6. Entei *Perrmt Rrquirencent" for each paramescr under "Quannri" and "(>uohty" as spenfied in pernot , (- 7. Under "No &" uter immtwr of sampic meaunnents daring snonitoring period that cured nutximum (md'or I ! ininimum or 7414y average as appropnate) permit requirement for cach parameter; if none. (nter *0". ft. Fntcr
- Frequency oti!nalym" ' aoth at "Nample Ma3urmcm' (actual frequcnq of sarnphng and analpis ined ,
during monitedng penodi and as "Pomit Require mnt* specified in perunt (e g., Enter " Cont " for continuous nu,mtoring. * / -"' for one day per we(L "P30" for one da) per month, "U90" for one day per qturter, ele ) I 9. Enter *Nample 7)pe' hub as "Nample Alcmurcmcnt" (actual sample tvpc used during monitonng period) anJ as [ "Permu Rrgwrrment * (c g, Enter *Grah* for indisidual umple, 5//C" for 24 hour composite, "N A" for i coratinuous monitoring, etc ) : 10 Wherc violanont of perna requirements are reported, attach a brief exptMonos to desenbe cause and corrective
~
' actions taken, and reference cach siolation by date, l -
Il. If "60 di%hargc* occurs during tuonnering period, enter *No Dirharge* adoss farm in place of data entry , l !?. Enter *Name *ntit q) Prwiju! thecutive Ofccr* uith
- Syn,Are v) Prmt',W herutnr Offcer bf Authnri:cd -
Agent," "Telcjke Numbcr " and *Date" at bottom cf form. (
'13. Mail ugned Report to Office (s) by date(s) specified in pesadt Retain copy for yota ierords. ;
- 14. More detailed imtructiorts for use of this Dixharge Alenitormg Refwt (DAIR) form may be obtained fmm Office (s) speafied in permit.
l Legal Notice
-This report is iequired by law 03 U.S.C.1318; 40 C F.R.125.27). Failure to report or fadere to report truthfully can irnh inijvd pmaltles ma to ctewJ $10AX10 per day of violation; or in enminal penaltws not to escud $25,000 per day of viohtion, or by imprisonmerit for not unre than one year, or by both.
l EPA Form 20-liRev. 0845) i
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e ! Public reporting burdro for this udlection of inforuuition n ettinatal to vary Imm a range el 10 hours e an ; i average per retynw for some minor f aulities, to 110 hours e an neuge or inpmw for ustne tnajor faulities, i with a wripbled asemgo for major r,nd minor latilitics of 18 houn per reipone, indudmg tune for reviewiny i iratructiom,, *. rara , aistmg data w>urm, yarbering And owintaining the Ata needed, anJ completing and 5t newirig the wikdion of infootation. Send wnmwnts reprJmy tha burden rutin. ate or any s>ther avpext of j this collatiori t f infonuation, traludir g suggestiom for reducing this burden,19 Chief, Infmmatmn Pohty ) Braith, PM 223, U S Envuonmer.tal Prote. tion Agency,401 M $treet, SW hhirgton, DC 2040; md to the l Office of infontudion and Iteplatory Af f ans, Opiw of hapment and Dmiprt, Wehig..sn, DC 20$03, l
- _ _ ._ ..._., ---. . . _ .]
General liistructioris 1 I, if form has been partally wmpleicJ by preprinimg, disrepid instructions directed a catry of that informati.w altrady prrprinted, 2c Entn *frimuler Ahme-Madmg /tdheu (and faciht) name/kxation, if difTerent)." " Permit Number ' and .
" Din haryr Lnher' where indn.ated. (A squrate form is requecd for each disharrej L !!nkt d ocs lquador and coding %intaring PereI%cred by fann wbere indwated
- 4. !!nter each "lbsameter" n spccifwd in nwmtont,g mquircmcats of permit.
i Enkt "kng!c Mrawicwnt* tbta for cah paranicitt under *(humtdy* nnd "(Naldy" in unitt spttilhiin permit.
" brrage" is noinully arithmetic au rage (gcometric merage for backnal paramekrs) of all sant c imeasurements for exh paum.dct obmined dming "homtormg period"?"Alaarcum" and *Mmtmmn' arc n,imally noeme ldgh and law meurements obtmned donng *Muwformy Formd * (Note to municipals with secondary tre,umem ,
reqmrcisnt: Enter 30-&v average of sample meamuments under "/hcrap,* and enter maximum hiay average of wmple measuremenu obtamed danng monitoring gwriod under *Maumum *i k Emes *Perent Rcqwrevent* for tach patanxta unkt *Qu,mnt;' and ' Quai 4* su spxitied in pernut L Un&r "Ab lY vnkt number of sample meamtments dming monitonrg period that euced maximum (avdor-ada.mmm m 7-day nerage m apprornate) penmi requirement for each param-ter. If nont entes 'O'.
' R. Pnter "Frcqwmy of Anaksis' both as *Nimp/c Meaturment" (acttn! hequery of sarnpling and analpis psal
- doring mondoring penoJ) and as ,*Povat Requirrmrm" specifi J in permit (c gi Enter *f .mt," for continuous .
vmmtoving *//'" lar one dn pc week. ") c,W for one de per mm */40" for one day per quarter, etc )- used during monite.nng perial) and as t Fmer "Perent %np/c ?)pe' both Rcquirement,* (e.g asEnter WyJe "Grah" Mrawrement" for inicidual(actual f. ample, :.ampk,
". typt/iC" for 20hout composite, "NT for cont:Ducus monitoring, tte ) "
KL Whcre siolatiom of perms respeiternents are reported attach.a buef caplmation to dxnbe cause am! corrective-wtions takco, and referenet cach vialanon by date. I1g if 'na digharge" octurs during monitanng period, utter "No Dncharp" across fann in place of data entry.
- 12. Ennt "Xwne$rle of hmoral hecutne tWicer* uith *&gnature of Prmcip:d theatwe G!?her of Artthoriud
[ Agent
- 7elethme Number,' and 'Date* ut battam ofiorm iL Mml signed Rgtort to Officc(s) by date(s) specified in pamit Retain copy for your records I 14, More detailed intrudions for uw of this Din-harge M<mitonny Report (DMR) form ina) be obt!4ined from Oflice(s) specified in pernut.
Legal Notice This report is entuired by law (33 U.5,C Ollt; 40 CSA 123,27). l'ailure to report r failure to report truthfully can _ , result in uvit penalties not to c md $10,000 pu day of viohition; on in criminal penalties not to cuecd $25,000 per day of violatiqn. or by infrimoment for not more than ene ycA or by both.. 1:PA, I%rm 3326,11Rev. OM5) _ ,
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Paperwork Reduction Act Notice , Pubhc reportir@ burden for this collection of iriformation is estimatcJ 6., vary imm a range of to hours as an , average per resporu for some minor inihties, to 110 hours as an averuge per response for some major facilities, w th a weigkcd nerage for najor and udnor facilities of 18 houni periespmse, ire.ludmg time for reviewing
-indructions, wanhing euuing data sourc% gathering and maintaining the data needed, and compiering uh!
_j; rnidwing _the collection of infonnatiuo, Sem! < omnwnts regardmg ae burden estinate or any nther aspect of tW collection of information, including suggestiora for reJueing this buden, to Chief, Information' Policy Brash, PM;273, U S Environmental Protntmn Agency,401 M Street, SW Washington DC 2(460; and to the , Office ofInfonnation and Regulatory Allairs, Oln(e of Enagement and Budget, Washington, DC 20503.
.- - -.-. - .- - ._ -- .- . - =- -.----.----_.--.E General Instructions l'. 'If form has been partially completed by preprinting, disregard instructions directal at entry of that information aheady prepnnted.
2/ Enter ."Permirrec N,vnc3 failm;; Addren (and facility name/locanon. if differen4"
- Permit Number " and
- " Discharge Number" where indicted (A separate form Is required for cach dischatge )
L Enter dates beginning and cudmg "Almutormy Period" covered by form where indicated 4.- Enter cach " Parameter" as speciDed in momforing requirements of permit.
- 5. Enter "Namp!c Mcaturrment" data for each parameter under "Quantay" and "Guahty" in units specified in permit.
"Arrraxc' is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained dunng "Alomformy PerW, "Afnumum" and "Aftaimum" are nonnally extreme high and low meawements obtained during "Alanitoring Penod" (Note to municipals with secondary treatment requirement: Enter 3n-day average of sample measurements under " Average * 'md enter maximum 7 day ascrage of sampic measurements obtained during monitering period imder "Afatimum ") =
bc Entc "Permet Requirement" for each parameter under "guantity" and "Quahry" as speciGed in permit. 7f Under "No (Cr" enter number of satuple measurments during monitoring period that exceed masimum (and'or - tuinimum or 7-day awrage as appropriate) permit requirement for each parameter; if none, enter *01 t Enter "/+cquency <f Analm# both as "Samp/r Alcawrment" (actual frequency of sampling and analysis used dudy monitoring period) 9nd as " Permit Requirrment" speciGed in permit. (e g, Enter _" Cont " for continuous memtoring, "ld" for one da) per weck, "Idu" for one day per month, "F90" for one day.per quarter, ete ) 9.L Enter "Lmple 7ype" both as " Sample Alcasuremet" (actual sample type used during monitoring period) and as
" Permit Requirement * (c g Enter " Grab" for individual sample, "NHC" for 24 hout composite, "N/A" for continuous monitor;ng, etc.)-
10, Whcre violations of permit requirements ;re reported; attach a brief c3.planation to describe cause and corrective actions taken, and reference each siolation Irj date. 1Im If "no discharge" occurs during momtoring period, enter "No Dacharge" across form in place of data entry.
- 12. Esnet *Name'Ta:e of Prmcipc! Erecutive Ofpcer" with " Signature of Principal Erecutive OJ)iccr ofAuthori:ed -
( Agent
- 7elephime Number
- and "Date" at bottom of form
- 13. Niall signed Report to OfEce(s) by date(s) specified in permit Retain copy for your records.
14,; More detailed histrt;ctiens for use of this Discharge Afonitoring Report (DAIR) form may be obtained rom Ofnec(s) specified in permit. ) Legal Notice : I This mport is required by law (33 U.S C.1318; 40 C.F.R.' 125.27). Fw1ure to report or failure to report truthfully can ) result irt civil penahies not to execed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day l
. of violatipn, or by impnsonment for not more than one year, or by both.
ESA Form 3320-1 (Rev. OF-95) I
PERMrTTEE NAME;ADDPESS W Fores,um,L., go.,4 no NATiOes.AL POLLVTAevt DeScHApor Euan=Ano- WStrM (N8 DES / Form Approved NAME M MNMG ##,#,U7d . ,OMB No.. N
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L26-27142W299 43G STI NOTE: Reed intruc%one before LWhpietm 'tue form. 120 211 122-231 124-25I 13 Cwd On/rf QUANTITY OR LOADtNG I4 Cert Ow r f CUANTITY OR CONCENTRAM N O. '*f f " SAMPLE PARAMETER I46-53! 154 699 IM451 I45639 v54619 O* (32-371 i U AssALYSr, TYPE AVERAGE MAXIMUM UNITS MINtMUM AVERAGE MAxrMUM UNITS m3, ,e ,,m 4 SAMPLE -- l ; l} MEASUREMENT PERMIT 3r no ,:. oc , j av 4. , , ,,, ,; 7 gj ,37, REQUIREMENT . - ., J, ,
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1 n S? MPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT s etRTiry UNDER PENALTY OF LAW THAT f MAVE FfRSONALLY EXAMekfD AND TELEPHONE DATE NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER AM FAMIUAM WITH THE sedFORMATION SUBMITTfD HEREiN; AND BASfD One MY INQUfRY OF THOSE INDIVfDUALS IMMEDeATELY 8tfSPON99tE FOft 1), t v 1.! a r M ,,7 f OSTAsksNG THE sNF08%sATION. 6 SEutVE THE SUBMITTED NFORMATION IS ^ T RUf. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE StGNtFtCANT PfMALTitS FOR SUBMITTWG FALSE INFO 8EAATION. *0LUDeNG ; "1.a g .y^ T.%'? 4 ap (;; ; ~%
^ in;iSC r" !!"t?idIfarm > '
THE POS980TV OF FINE ANO eMPRISONMENT. Sff 10 U.S C. t 1001 AND 33 eneemw eaoao sro m 54GNATURE OF PRINCIPAL EXECUTWE TYPED OR PRINTED u S.C.
.as t 13 t e. aRsammee senser or mane.= . - -
e=se seamee
- er see s =.amemerm.a a y *re=.i OmCER OR AUTMRIZED AGENT CODE MIMBER YEAR MO DAYg COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refererice e# errechments here!
's EPA Form 3320-1 108-95) Previous editiOris may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE . OF
' j1 vi.
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h 4M- dh hah 4 ?-W5-%amba .ard W .gr p # ad -*->A-w -.opetys.n- -.me+.y, mu e w h um ted, er -pa.wa-eMa e , e e--e aw , pes em,3.,. wp a tragn.ri:- ga-qmap>+4c.m==.-i-e-e,N e<m mes.- .-ve-6 ma e s- r^amemu.hiek, Paperwork Reduction Act Notice . j
\
s- 3 Public reprting burden fdr this m!!cetion of information iS estinatcJ u vary from a range of 10 hours as an i l l aveisge gr inpunse for wme minor faabhes. to 110 hours ai an avmpe per rerponse for sorne nujor facdities, l
- with a wighted antage fos uajor and minor failitiea of 18 hours Fr respurae, inch > Jing time for reviewing
- irntrwtiorn, wnhing esting data sources,-gathering and maintaining the data necJed, and comphtmg and
- reviewing die c<.llweion of information. Send comments roya Jing the burden estimate o, nny other ageet of this mflection of infornution, includirsg suggntions far-reduung this burden, to Chief, Information Policy _
Ilranch, PM 123 U.S.1:nvironmental Protection Ager.cy,401 M Street, SW Washington, DC 2040; and to the F- Of fice of Infornahon and Regulatory Alfairs, Office of Management and Budget. Washmgton, DC 20503, I L _ __ . _ ___ _ _ _ , _ . . - - . _ _ __.._.____-.---,----d i 1 General Instructions
- l. li form hu E en partially completed by preprintmg, disregard instrwtions direi;ted at entry of tbt information nitrady prepad.- 3 2 Enter "Pomittre Name. Afadmg Addren (and facility name/locahon, if ddTerent)," " Permit Number," e.nd 4 "Dacharge Number" where indicated ( A separate form is required for each discharge )
- 3. Enter dates beginmng and ending "Afomtormg Pern/" covered by form w here indicated i 4 Enter cach " Parameter" as specified in monitoring requirements permit.
- 5. Enter "Samr/r Arcavuremera" data for cach parameter under " Quantity" and "punhty" in units specified in permit.
"Aruace* is nornully anthmenc average (geometnc ascrage for bacteritd parameters) of all sampic measurements for exh parameter obuined during "Alamrarmg Period"Afaximum" and "Ahnimum" are normally extrem: high and looncasmements obtained during "Ato atormy Period." (Note to rnunicipals wil smondary treatment.
requirement! Enter 10-day avenge of sample meannements undct "Acrage " and enter mnimum kby average
- = of saa ple measurements obtained during monitoring period under "Atreinmm ")
1
- 6. Enter " Permit Requirrment" for cach parameter under " vmnry* and "Guahry" as specified in pennit.
l 7, Under."No fr* emer number of sample memunncnts uuring anonitoring' period diat exceed maximum (and/or
. minimum or 7-day aserage as appropnate) permit requirtment for each peameter. If none, enter "/)",
{
+
R Enter " Frequency p/ Analfrix* both as "Samp/c Aleasurment" (actual f iuency of samphng and analysis used ... . dming monuoring period) and as " Permit Requirement" speciDed in petat. (e g., Enter " Cont." for continuous -
+
momforing. */J" for one day per week. "I'30" for one day per month, "130" for one day per quarter, etc=) A Enter %mpte npr both as "Samp!c Afrasuremen!" (actual sample type used during monitoring period) and as "Pmmt Requirement," (e g Enter "Grd" for individual sample, "24/II' far 24-hour composite, "NT for i . contmuous inonitoring, etc ) 10dWhet violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each siolation by date. l 11; if "no dischargc* occurs during monitoring period, enter "No Discharge" across form in place of data entry,
- 12. Enter "Name 1tle of Principal Execurwe Officer
- with " Signature of Princi;>al Executwe Opicer ofAuthor::ed r
' Agent " " Telephone Number," and "Date" at bottom of form
- 13. Mail signed Report to OITice(s) by date(s) spe.ified in penmt: Retain copy for your records.
- 14. More &Wied instrucuans for use r,f this Discharp Alumturing Report (DMR) form may be obtamed frora Office (s)
, specified in permit. 14 Legal Notice i 1
- 'This report is required by law (33 U.S.C.1318; 40 C.F.R 125.27). Failure to report or failure to report truthfully can .
~ result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day I of vidation, or by impnsonment for not more than one year, or by both.
l . EPN Form 3320-1 (Rev, OM5)
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LOCATM FROM . 1( c; To e -j ;j . . s: _ s a ( . . - '. I j (2t>2ri 122 2% 124-25e 426-271 120-299 ID3rl NM Reed k*mtnons before GUey % form. l
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~ PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERV T REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OUICER e CERTwv uNDER etNAtiv Or (AW THAT e HAve etRsONAuv exAMatD AND TELEPHONE DATE AM FAMtUAR WITH THE INFORMATION SUBMtTTFD MfRim; AND SASED 04 MY INQUtRY O~ THOSE INOMDUALS - MEDeATEL Y RESPON98tf FOR O8TA;NING THE INFORMATION. I SEufvE 1 SueMITTED INFORMAT)ON t$ s y D3Vi* UT! ! O T' [ TRuf. ACCURATE AND COMPLETE. t A AWARf TMAT THERE ARE f f, ,
SK NIFtCANT PENAtTtf S FOR SUeMITTvNG ', 4LSE sNFORMAftON. 8MCit.lDeNG
- i. } O M i 9 *., t V !1:1 S E4 t* l' THE FOSSBruTV OF PN( AND IMP 8BSONMENT. Sff 18 U S.C. t 1001 AND 33 SIGNAM M NAL EMN' L * ' ' "i ~i - 5 '. l l 'd
- 4ff U.S.C.1 1319. #Wemasse saishr erwee esonnes msY entwo fbees se so i70,000 AAE A TYPED OR PRINTED ew er ==== - _. reme. ae=enenavse. ares orricER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY l COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Referernes s# strechments herof
[ ;,.- , $N % 10 .Nie !>; y ?0 d r
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EPA Form 3320-1 108-951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE .OF
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--eqh 4mm4gayw.w + %m., a m 3 .aa.--,wc.mwee ,tw = annee < s..se ste t a-a app unehr.s.4.=.ter prN i ewha.te m,n e .z -az= t'm w wwa-rwwas ,-.-.- .- A wqre w g W e *r , i = a Paperwork Reduction- Act Notice Pubbe reportmg burden for this collation of information is estimated to vary from a range of 10 houts as an
~ average per responw for mme minor facilities, to 110 hours as an average per response for vnne major f atihties, with a weiFLtni aurage for major and minor facilities of 18 hours per rope.mx, in; baling time for reviewing irntructiota, warchtny etis. ting data 6.ourco, gathering anJ maintaining the data needed, and completing and reviewing the collection of information. Send commenta icgarding the burdca estimate or any odier asynt of thh collution of infornannn, includmg surgntions for rcJucing uds burd-n, to Chief, Infornation Policy tirash, PM,223 U.S Iovironmental Psotection Agrocy,401 M Strert, SW Washington, DC 20460; and to the Offke of infornation and itegulatory Af fairs. Of fwe ot' Management and Iludget, Washington, DC 20503. General Instructions lilf form has teen partially cernpleted by prepnnting, disregard instnwtion dinxtal at entry of that information already preprinted.
- 2. Enter "Permstree Namc3/m/ing Address (and facihty name/ location, if different)." *Permir Number,' and
*/#scharge Number" where indicated ( A separate form is required for each discharge )
1 Enter dates beginmng and ending " Alm"aring Period" covered by form where indicated 4 Enter each " Parameter" as specified in monitoring requirements of permit. 5, Entc; "Mv"jde Alcaturrment* data for each parameter under "Quantay" and "Gunhty" in units specified in permit
- twroge" is normally anthmetic average (geometric average for bacterial parameters) of all sample measurements
- for each parameter obtamed during *Atimuormy Penof, *A/aumum" and "Afm! mum" are normally extreme high and low measurements obtened during "Afonitarmy Period" (Note to unmicipals with secnudary treatment i reQuiremCnU Unter 30-day average of sampic metsurements under 51wrage," and enter maximum 7 day average of sample measurements obtained during monitonog period under *AIaximum."/
ti Unter "Pernot Rcqum ment" for cach parameter undet " Quantity" and "Guahtv" as spectned in permit. 7f Under "No EP enta number of sample measurments dunny monitoring per.od that exceed maximum (anwor minimum or 7-day average m appropriate) permit requirement fc r each parameter If none, enter "0"
- 8. Enter " Frequency cf Anaipa" tmth as :"Lmpic 3/easurment" (actual frequency of sampling and analyss used
- daring morntoring period) and as "P.nnit Requiremcnt" specified in permit (e g., Enter "C<mt," for continuous -
momtoring. "!? tot one day per weck, "P30" for one day per month "/S0" for one day per quarter, etc.) 9.- Enter "Lm/ e d Apr* both as " Sample Afrasurement" (actual sample type used during monitonng period) and as
" Permit Requirement," (c ga Enter " Grab" for individual sample, "NIIC" for 24-hour compmite,1"Nel" for continuom monitoring. etc.)
- 10. Whem violations of pennit requiremems are reported, attach a brief cuplanation to describe cause a. errective actions taken, and reference each violation by date.
I1. If"no discharge" occurs during monitonng period, enter "No Discharge" across form in place of data entry. 12 Enter "Name Title of Princrimi Faecunve Officer" unth "Mgnature of Principal Executwe Officer of Authori:ed
' Agent " " Telephone Number " and "Date" at bottom of form
- 13. Mail signed Report to Office (s) by date(s) specifiem in permit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Afonitormg Report (DA/RJ form may be obtained from Office (s)-
specified in permit Legal Notice His report is reluired by law (33 U.S,C.1318; 40 C,F,R.125.27). Failure to report or failure to report truthfully can ruult in civil penalties not to exceed $ 10,000 per day of violatmn; or in criminal penalties not to exceed $25,000 per day of siolation, or by imprisonment for not more than one y:ar, or by both. .
, EPA Form 3320-1 (Res. 08-95)
PERMf77EE NA ME/ADORESS W Fensw, he terame= (DdI-=e mATIONAL PeuuTANY teso.ARoe ruwNAncee ww tWDES1 Form App,,ved. simE )gg,c, g;L;,g 7 ,Lp 7;77g N
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, SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUtREMENT SAMPLE MEASUREMENT FERMIT REQUIREMENT NAME/ TITLE PRINC1 PAL EXECUTIVE OFFICER I CERTnFY UNDfR PENALTY CF LAW THAT s HAVE PERSONAuv ER AMINED AND TELEPHONE DATE AM FAnmuAR WITH T'If theFORMAftON sugamTTED HERElme: ANO SASED Oss MV INQUIRY OF THOSE tNDtvtDUALs meMEDtATELY RESPONS$tt FOR Oavi43 dindOr[ OSTAasetNG THE 4NFORMATION. ! GEufvE THE suermTTED eNFORMAftOss is TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE + j" * < g SIGfmF4 CANT PfNALTtfs FOR sOBMtTTING FALsf INFORMATION. P8CLOOppeG Ch 4+N i S;E 75/ $4P.AgOT <1y~
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THE Pos9esuTV ce FmE ANo esPRrsONMENT. -e, set to u.s.c. aw see soot se s ANo ss, ss00sATURE OF PRueCfPAL EXECUTIVE u.s.c. e 1sie. a%asmes answ swee micese to.oux 8M/MBER YEAR M. DAY TYPED OR PRINTED mas er mees =wse _ _ . - eraerwess e monew aas s rewas "" XER OR AUTHORIZED AGE 9fT y COMMENTS AND EXFLANATiON OF ANY VIOLATIONS (Reference a# ettschments here) EPA Form 3320-1 (06-959 Previous edittorts may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE
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average per segmv for $nene mirmt Iacilitws, to 110 hours as m netage per responw for some major facilities, j i with a weighted average. for nujor and minor facihtin of 18 hours per rexpome, induihng time for reviewing instractinrnJ wrching existmg data munes, gathering and nuintaining the data needed, and complctmg and gviewing the collwi m of infonnation. Send wrnnwna upidmg the burden e>.tinate or any other a>:peet of this collwtion nf inforuution, inckding mggestions for redwing this burden, to Chief, Infonnation Policy
- thanch, FM 223. U.S t.nvironmental Protation Agens),40! M Staret, SW Washington, DC 20460; and to the Office of infonration ad Reguletary Affairo Office of Management and Bud,4et, Washington, DC 20503, t 1
l q_ . ___ . - _ -- ,__ _ . - - - _ _ - - . .- . _ --_ m . _ _ . _ - _..,.--._.-_..s General Instructions
-1. If fann hu tan partially wmpkted by preprinting, disregard instructions directed at entry of that information already prepnnted.
- 2. Enter *Permater Name A/. ntmp Adderry (and facihty namellocation, if cfferent)," " Permit Number " and ,
% charge Number" where indicated ( A separate form is required for caeb discharge )
- 3. Enter datesleginning and endmg '3fondorme Permd ' covered by fann where indicated 4
4 Enter eac h
- Parameter" as spccified m momtoring requirements of permit.
- 5. Enter " Romp!e Alcmuremcet" data for each parameter under " Quant;ty" and "Ouahty" in units specified in permit.
"Arrrage" is nonnally anthmetic nterage (geometric merage fot. bacterial parameters) of all sarnple measurements ;
j- for each parameter obtained during'3/omtermy Permd", "A tarimum" and "Afmi"mm" are normally cMreme high 5 4 and low measurements obtained dunng "Ak>m!" ring Period" (Note to municipah with secondary treatment tcquirement Enter 30 day average of s.unple menurements under 'Oh crage " and enter maximum 7-day merage of sampk me.nuremems obtaincd dunng monitanng period under " Alm / mum. ") 6 Entcr *Per mi Repirement* for cach parameter und:t " Quantity" and
- Qual ty" as specificd in permit.
- 7. Under *No lY enter number of sample .mcasurments during monitoring penod that exceed maximum (and'or minimum or h!ay average as appropriate) permit requirement for each parameter. If none, enter "0" 2
, R Enter "Frepe,cy of Analpa* both as "Nample Alcau.rment* (actual frequency of samphng and anidysis used during monnonng penod) and as " Permit Requirement" specified in permit (e g., Enter "Gmt," for continuous
- monitoring. "I 7" for one day per w cck, "/Mo* for one day per month, "//90" for one day per quarter, etc.)
% Enter " Sam;>!c 7)pe* both as "Sampic Alemurement" (actual Me type used daring monitoring penod) and as "1 remit Repirement," (c g , Enter "Grah" for indisidual "3/IIC"' for 24 hour composite "N/A" for entinuous monitonng, etc )-
10nWhere violations of perinit requirements are reported. attach a brief explanation to describe cau<,e and conectisc
- actions taken, and reference each violatiem' by date.
- 11. If"no disc!urpc" occurs dming monitoring penod, enter "No Discharge" across form in place of data entry,
' 12, Emcr *Name Totle of Prmopal Decume Oficer* unth "S:gnature of Prmcipal lhecutwe Oficer of Authomed
.] gent " " Telephone Number," and "D,ac" at bottom of form
) ' 13. Mail signed Report to Office (s) by date(s) specified m pernut. Retain copy for your records- :
; 14 More detailed instructions for use of this Discharge A/omtvemg Report rDAfRi fornt may be et,tained from Office (s) ; specified in permit.
4' Legal Notice: This report is required by law (33 UAC. 3318; 40 C.F R.125.27). Failure to report or failure to report truthfully can restit in civil penalties not to exceed $10,000 per day of violation; or in criminal peratties not to exacd $25,000 per day of violation, or by imposomnent for not more than one year, or by both. EPA Form 3320-l'(Rev. 08-95)
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PEmemTTEE NAME/.t.DORESS time.de Fardwp hee ! NADONAL ponuTANT EpSCwARot amme Anon svSTEM (NPCESJ Fosm Apswoved (D W ows N2.ME N N RGE N N REPORT (O W - . . 004 No.2040-COC4 u, LY VG*l 1 . .;- 12- ! *' !9 7-!9' ].a: IwLae .cu Y j
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.t . _ . 1s SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER a cERnFv uNoER PENALTv of LAW THAT e HAVE PERsONAuv ExAMMED AND TELEPHONE DATE AM FAMauAR WITH THE INFORMATIO86 SLAIM3TTED HEREm: AND SASED Oss My MOueRY OF THOSE WDeWDUALS IMMEDIATELY RESPON98LE FOR D W 1tl O r11d e rl' 087AmmG THE m%ADON. e BEufW THE mmD mWADON 4 y / ./
TRUE. ACCUP. ATE AND COMPLETE. I AM AWARE THAT THERE ARE , "* . 't SIGMFtCANT PENALDES FOR SUSMfTTmG FAW WFORMADON. MCLUDmG C h e r i f3 t J '>' M.'i rwdc r THE POS983uTV OF FWE AND IMPetSO8 SPENT sense,. mer SEEmISmiU.S.C e , w7 -.1 # # $ ,e u s.C. e i is. m e,Mer ei e se91001 AND 33 se sro.opo SiONATURE OF PRNOCIPAL EXECtJTNE g TYPED OR PRINTED .=r er man.s.m n : .- .-er seew.es e awes as s reeres OFFICER OR AUTHORIZED AGENT g NUM8ER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIU;-=* ONS (Reference a# ettschments beref EPA Form 3320-1 (06-95) Previous editions may be (as8d. (REPLACES EPA FORM T-40 WieCH MAY NOT BE USED.) ,- JU. "i/ y r ? i U S ' .!J4 PAGE 1 OF _
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i Paperwork Reduction Act Notice 1 .
- Public reporting burden for this collection of infornution is estimatrJ to vary from a range of 10 hours as an .l l ,
average per trymw for sme minbr facilities, to 110 hours as an average per respmse for semie nujor facilities, l with a weighted ascrage for major and minor facilitier of 18 hours per response, indudmg time for reviewmg instructiorn, varchmg uisting data sources, gather;ng and nuintaining the data needed, and pompleting and l ; reviewing the co!!ntion hf infurnution. Send unnments reprdmg the tuden estimate or any;other aspct of
, this milecti6n of information, including nggestions for reducing this burden; to Chief, Information Policy Iltan:h, pMQ21 U.S. Environmental Pmtection Agency. 401 M Street. SW Wash ngton, DC 2040; and to the ..
Office of Informatmn and Regulatory Aff ain, Office of Management and Budget, Washington, DC 70503. l f- L2_ _ _- _ . . _ _ 3 General Instructions-I
't. If form ha teen partially completed by preprinting, disregard instmetions directed at entry of that information already peeptintal.
- 2. Enter *Permittcc Name 3/a:Img Address sand facihty name/locaNn, if different)." " Permit Number," and -
"Dacharge Nmnber" where indicated ( A separate form is required for cach discharge )
J
- 3. Unter d,,tes beginning and en6ng "Afomformg Period" covered by form where indicated
- j. 4. Enter each "Paramercr" as specified in monitoring requisements of permit.
$ 5. Enter " Sample Alcawrement* data for each parameter under "Guanmy* and "Guahty" in units specified in permit
- trerage" is normally arithmetic average (geometric merage f or bacterial panimeters) of tJ1 sample measurements
, for tw;h parameter obtained danng "A/uniturm,g Perm.f. A/arimum" and "Almimum" are normally extreme high , . and low ;mcasurements ch!ained during "A/omforing PersoJJ (Note to municipals with secc"dary treatment .
. requiren ent. Enter % day average of sampic measuremems under ".Iverage," and enter maximtm. 741ay average of sa:nple measurements obtamed danng munitcring por md under "Alaumum. ")
- - 6
- Enter "Penmt Hrqwrement" for each parameter tmder
- Quantity" and " Quality" as specified in pernut-
. - 7? Under "No Er enta number of sampic measurmeats during monitoring period that exceed maximum (and'or . L ndnimum or 7-ay aserage as appropriate) permit requirement for each parameter If none, enter "0"; 8 Enter "Frcquency of.ina!>sh" both lu ' Sample A/easurment" (actual frequency of sampling and analysis used during monitoring period) and as # Permit Rcquirement" specified in pennit.- (c g , Enter 'Omt," for continuous
- _ momtoting. */? for one day per week,;"idd*' for one day per month "b90" for one day per quarter, ete )
- 9. Emcr "Sampic 7)pc" both as "Mvnp/- A/casurement" (actual sample type used during monitonng perioJ) and as
- Permit Requirement,' (e.g:, Enter " Grab" for individual sampic; "NI/C" for 24-hour composite. "N61* for contmuous monitoring, etc )
. I' . Whcte violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
.: actions taken, and reference each violation b) date, p - Il 1f "no discharge" occurs during monitoring period, enter "No Discharge' across form in place of data entry.
_ 12. Enter *Name Torie of Principal Erecutive Officer
- uith *Sgnature of Prmeipal Decutive Oficer ofAuthort:ed Agent," "Telephane Number," and "Date" at bottom of form.
l ! - 13. Mail signed Report to Omce(s) by date(s) specified in permit. Retain copy for your records. 1-..- More detailed instructons for use of this Discharge Afonitoring Report (DA/RJ fann may be obtained fmm Office (s)
- .specified in permit.
t Legal Notice Y j Thip repost is rapired by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
- -of violatipn, or by imprisonment for not more than one year, or by both.
EPA Form 3320-1 (Rev. 08-95)
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SAMPLE MEASUREMEP7 PERMIT REQUIREMENT SAMPLE MEASUREMENT PER%7 REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER s CtRTIFY UNOfR PfMALTY OF LAW THAT I HAvf PERSON Aliv f *AMmfD AND TELEPHONE DATE AM FAMfuAR VIATH THE INFORRAATK)ef SUpastTTED HEREN: MD SASED ON . 1 MY INQtA8tY OF THOSE INDIVIOUAL S NAtatDsATELY RESPON9SLE FOR /. oeTAINWG THE INFORmAATION,1 SEUEVE THE SUSestTTfD eNFORh4ATION r$ David C C th. LOT [ TRUE, ACCURATE AND CohePLETE. s mas AWARE THAT THERE arf -/ j[. - 7_p - ( ,
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- THE POSSHpuTY OF Fmt AND Ih4PRISONaatNT. SEE 18 U_$ C.1100
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c 3 i? 3 - 51 1 a' dB .$ urc. e .3ie. sFease enshr wi sso. coo scopeATURE OF PRuotsPAL EXECUTfvE TYFED OR FRINTED .aa er me mu.= -n - - .r s.e -~e m.mn. mer.auAm. .a s es # hee se s.1 AND 33 OmCER OR AUTHopt2ED AoEfti COOE UMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# strechments hers/ p ue [u ijajn s wi/95 EPA Form 3320-1 (08-951 Previous adhions may be used. (REPLACES EPA FORM T40 WHBCH MAY NOT BE USED.I PAGE OF cs- # E / 9 n u i j ';- 0 9 3 4 1
l Paperwork Reduction Act Notice '
, pubhc rquit.ng burdr n for thh collutw.n of mfornunon o. c4tinerJ to vary f rom a range of 10 houn. as an mrage per re' pee for wme minor he thhey la i10 hauni u an neryc per re:pmw for ww twjor faubtics l wdh a mghhd unge for nWor and mmc r faMues of IS Luars per scaponx, mcludmg tune for reurwing j m u ms tion, mkng exiamy data wurce s paherug ed numtaming the d.ita rec &d, and wmp!thng anJ l review mp th: udicotim of trdu m.au rt hend u mments regardmg the burden o.tmute or .my other aspa t ot !'
I ths d!s tion of mfowien, mmluding egge aions for redu n:r thn burden, to Chief. Inf arrnation Pohcy
, Brah PM-123, U.S Enuronna nhd Protoction Agency,401 M Stra t. SW Wanngton, DC 2m0; and to the j Olike of infornurmn and Regulatory Attaus Of tke of Mmpenant ar.J BuJret Wadungton, DC 2201
{, General Instructions 1 1 If imm Ln twen partully completed by prcprinting, disregard instructions daccted at entry r.f that infornutmn aircady prepnnted.
? E mer "Permuter Vmer \ /m/mg ,td Iren (and faahty nameMacahon, if ddictent)," "!'ctmn Nr.mber," and "Dncharge hmber" where indgatcd ( A scparate tonn is required for ca.h dsharge )
1 Emcr d des benmning and endmg 1/omtarme PrimT coscred by form where indgated I
- 4. Enter cac h " Par..m. .cr" as spculied m monaanng requuenents et pernut.
5 Hutt ' -pic M < w.r!" data for cal }w neter under "pa e.n" id "Oulaj " in tauts specified in peruut E l t c * ., M normdIt mthtW:tk a\Cf.( ! (p31mCtrK aser3pc for baJterial pMatnctelp Of all hainple tTxasurernerits for cd p: ' met r 4 ' uned dennn %n.rwy P mf "Alanmn.m" and "A /n mmn" are wrnully esucmc high anJ ion meaunon . W :uned duruy: S t. Is y P em!" (We ta munutpak unh ssendan uc. ament nqmrtment Lmer W n a crm _ of sun;& mm acns nts nntt " h craxe." an:1 cmcr maximum Lday merwc-c I of s;m ple menoiemenh oMuned dunng mamionng penad under "3/admum ". k Emer " Perma /?q:rement" tot each paranrJer un la "Oaantuy" and "Omddf as specifred in p.:rnut l 7 U nia
- Yo /i" ( nier Hu mkt of Lug!c nMa4iu menb (ht.Mg m0nitonny perhN1 that e.sce+cd ina\lmum Omd/of ndnuoum or Lday au-rap as approprutc) pt runt retpun m;nt for each par.uneter if none, enter *T L Emcr "!% qung o! .!na.)sn" Idh as ".m:r!c A!camemnt" (a;tual inmency of samplini and ana!pa und l during mondoring penm!) and as " Perma in.p t cn nt" sptcified in perunt (e g., Enter "C 'ont," N continuous tuonnaring, "i ~"' ter one day pcr week "I 3 " for ene day pcr month. "I 97 for one day per quart .. .ac ) l
% Enter "Nample ly;s " both as " Nom;:le 3/came.nent" (a;tual s:uuple type used durmg mandonng perux!) and as "Pomu Rceremem," (e g Enter " Grab" for indtudual sample, "N/IP' for 24-l aur tompemte "N .t" for l conunuous monitanng, ctc )
l 10 Where violanens of pernut requirements are repened, attach a boer explananon to desenhe cause and concctise aenons taken and reference ex.h uolauca by date l 1 Il If"no dacharge" occurs durmg monitonng penod, t nter "No Dmhargc" acrow fotm in place ef data entry.
- 12. Ynter "Na>ne Tale of Pww;m! Dn utn e Offwcr" w nth "Syna!ure of Prm i;'a! Dec utur QTccr of,1utharned 1 igent." " Telephone Number
- and "Date" at bottom of farm 1
- 13. Mail signed Report to Office (s) by date(s) sp:cified in pernut. Retam copy for your records.
- 14. More detailed instruchons for use of this thhage Alenormg Report (D3/!O form ma) be obt.uned from Office (s) specified m pernut.
Legal Notice This report .s required by law (33 U.S C.1318; 40 C,F R.125.27). Failure to report or failure to report truthful y san result m ciul penalties not to exceed $10,0M ptr day of uolahon; or m cnminal penalties not to emd $25,000 per day of violahen, or by impomnnwnt for not more than one year, or by both, l EPA Form 3320-1 (Ro. 0%95)
"L , *- C 4L PERMfTTEE NAME/ADOREES aaskinFarekspAmme! EfDu!bremer seATiONA POLLUTANT Or$CHARGf fUMMADON systgM (!WPDES1 Form Approved.
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4 '. 1, L 3 . REQUIREMENT ;xo yg gj; ;331 3;j gj; tJAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e CtRinFY uNoER PfMALTV OF LAW THAT I HAVE PfMSONAC Y EKAMWED AND TELEPHONE DATE r
,48 FAM1UAR WITH THE stFORMATION SUeMsTTED HEREW: AND SASED 08e ~ !
Mr INOtARY OF THOSE INOrVfDbALS IMMEDtATELV R($PONspeLE FOR 2 # D.'A V i d OI'DddrI O # # ' " " ? TRA ACCURATE Afi3 COM'PLETE I Ant AWARE THAT THERE p-ME $e ~%. a f <. , SPONIFtCANT PfMALTIES FOR SUDMITTING FALSE INFORMATION. UtCLUDeteG pxxn4 ett ry )[a na f" ' 3 17 1O$=$I'1 44 M) M Tw u.s POssreiun
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.asurIMPRISOesMENT.
an samasses SEE 18 U.S.C.,91001 mer mica,m, ANDcoo aa. so se svo. 33 SIOfsATunE OF PRueC3 PAL ExtCUTIVE ARE A TYPED OR PRINTED masorane w - w or anwe== e maaen.aad a restas OFFICER OR AUTHORS 2ED AGEfti CODE MfMBER YEAR MO DAY l COMMENTS AND EXPLANA1:ON OF ANY VIOLATIONS (Reference a# Miechments herof i
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e n ! i. T :A L .} ! EPA Form 33201 IF'-95) Prevfous editions may be used. (ftEPLACES EPA FORM T 40 WHICH MAY NOT BE 'JSED.I . PAGE OF . m L # d / 9 b G l ',c L - O > J - 1 m _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _
! Paperwork Reduction Act Notice i i PutOc trpor*.ng burden for thi* oh tmo of inforn.ation n eshnuted to ury from a range of 10 haun n an swraye p<r inpmv fm wue imnor f a:ditin, to 110 hr m o an as crage per re<pinse for sorre inajor fai ddm, t . Alth k % Cap}dtd it'.truge hir DJah* BLd minor [d.kIlth*5 O[ lb hi/ul$ pr rOjonse, in.IWdmg tiUle far irsic%mg j trisi n.K ll> Jnt , ?-nta bing *(Istir g d3ll WJf t es, {alht ring ad numIainif,g (Le data necdcJ, arid templetmp ed ro nwmg the col!u nan of infornation, ScaJ wmnaas regardmg the Ludt a catinute or xn> ather apret of this colleau.n ni mf .mutum, (n. ludmg suggeaions for irdus u:g this tvnden, to Chirt, infomution Polrcy i
!!rm h. PM42R U S Envuotam ntal Prs tion Agerwy , 401 M Street, SW Wehington, DC 23461, and ta the 0;;Re of Infontachn and Regulatory . ,i<,.rs, Olbte of Managen at and Budget Washington. DC 20503.
General Instructions
- 1. If fenu be hetn putially tompleted by preprintmp, dusepard instnutions diruted at entry of t%t intornution elrexdy prcpnnied
' Unter
- Permar, e N ow A !aihn e A d !rc u (and f acihty rumellocanon, tf d3fTerenn." "Pernut Emt er," and
*/ w harxc hmN r" w here nubcated ( A separate form n req ured .'or each ducLarge ) /
3 Ur.tcr dates bepnmng and enlu.g "A!" stormg Perm!" cm cred by form where indicated i s 4 Enter ca;h "/Vamrrrr" as gined in motatutmg rcqmrtments of pernut. 5 Emcr "% mpk.Uc mmml" data for cach p aametcr under *(bnty* and "()na!ny" in uruts sgu0 J in permit
" !rdae " di nOful.dh ardhmch; ascrage tgNDCtlle a\Crage h?r h3Cl0rlal FM.HnCler9 of all S3Phl0 mca$drCmen!S f g erb panuuar huncd danns 'Af mt ; Pa n '"' " Uom m* and "A/.oi: '" " are numulls extreme high m1 hne m-casmemens obtain d danny "um. ne l'cem/ " Nic to umnupals with secontn treatmem requue! Ment I$hier h!-das .h(rag Of Ltmp!c mC " Urenr;nh Und0r "di rrgc " ;M d CntCT In-~tsinHUu 7-day average of Mnipk 1DCaiureminis OhiainCd dmmg mond,MiGC punDd unEr "3/aunnun ")
6 Enter "Permd Rupin mou" for cach puamctet ut. der "( hunio" and "(h Idy" a; specined m pentut. 7 Unju "No li" entet number of sampl me normenn dunng matdtunng gnod tht euced rtadmum (ami'or muunana or NW :nerage as apprepnate) grunt requ mment for each pararacter if none, enter "D' R f'nter "Frequcrus of.!nalt' f both as hpic Ucarmen!" (xtual frequency of samphng and analpis used danny mora:snng gnW and as " Perma Requerw er" specifhd m permu (e g Enter " Con!," for continuous monnotutg. "I '"' f ar one day per ucek,"! 30" fa one day per month "! 00" for one day per gaartet, etc )
% Enter "Namv!c 7 tp " Vth as "Nay/e Alcaremcm" tactual ample type used dunny monitoring penod) and as "Pcemu Re,pwrmco." (e g, EnNr 'Grah" for inJ%ijual sample. 'N/IC" for 24 hour compmite "X J" for continuous tunnitonny ct; )
10 Whcie Wolatim of pennit requircruents are repmed, attach a brief exphuauun to descnbe cause and correctise a;tmns taken ar.d reference cash twlata,n by date. I1 If "no discharge" wcurs dunng memto ng p:riod enter "Yo IWharge" across fonu in place of data enu)
- 12. Enter "Name Tule pf Pr.n::pa! Frecutn e r M!h er" unh "%gnatu v vf Pr:ncipa! !:recutna Oj&er of luthon:cd Agent * "leic;,hane Ember," am' "Ihnc" at bottum of form.
- 13. Mail signed Repen to OfGC ts) by date(s) speciDed in pernat Retain copy for your records
- 14. Mate detaded insructions for use of this LWharxc 3/omform; Rcrort (D3f!O form may be oblamed from OfEce(s) speciDed in penrut Legal Notice Tus repirt is required by bw @ U.SJ' 1118; 40 C.F.R.125.27). Fadure to report or islure to rep >n truthfully can ruult in ovil pmalues not to rund $10,000 Fr day of violation; or in enmme penalties not to enced $25 Om per day of violation, or by impn,onment for not more than one year, or by bsah.
EPA Form 3320-1 (Res,08M5) j
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rEmerrTEE NAnanAOorasstwem,w v% e ATo.At OuveANT uses.A .ae nas=amN s%Ttw (APDEM Form Approved NAasE - a a . v.., ,, .. n,N .e w<+- OtSCHARCE an A8CNETOfWs0 REPORTn-l (DAM,/ w,.4
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;. 7 T v - =;v ,- L % u y 12021) 922-231 124-75 t2527s 120-2ss 43S3sr M M & be*RFee'I*'E*'iohtm-PARAVcTER (3 h on&# QUANTRY OR LOADING I4 N Di&f QUANTITY OR CONCENTRATION NO. "'CU'*C" sAsssPLE t%531 (54-699 e30-459 44663r t'id-6 99 or 132-31/ EX ,,,gy,, TYPE AVERAG ! MAXIMUM - UNITS MIMMUM AVERAGE ' MAXIMUM UNITS ,,us, ,a ,a nyaEAtin SAMPLE m .: u- aeno: , ne ng ,, 4 q ( 13) 4 ,, , s MEASUREMENT
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MEASUREMENT l PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT - REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e crRTiFv uNorR etNativ OF law THAT e MAve etRsONAuv em Aamento ANo TELEPHONE DATE AAA FAANUAR WITH THE sNFOsth:ATION SutherTTED HERElse; Asst) BASED Oss MY 8NotM8tY OF THOSE IseDIVIOUALs samasEDIATELY RESPONSIBLE FOR , 1 DayLJ Orndori, OsTAm*G THE **0RaaArtON. s se stvt Tws suonNTTED mFoRasATions is j jy ,
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I AAA AWARE THAT TMfRE ARE TRuf. ACCURATE AssD COesPLETE. tl fr r -I ' Cht.*.1218 C Ty IIT iM$d T
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9GNtFICANT PfMALT!fS FOR FUSediT71860 FALSE InfFORh4ATION. sarCLtesse +g*% d3 3,),*y3 A gq ' p' ' 7$ THE PossuesuTY OF f1NE ANC InsP8tSO8stPtNT - u.s.c. e uts. sRea.ans. sier sn ssauesmer
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- o. cop f,10seATURE OF PRNOCIPAL EXECUTWE '
TYPED OR PRINTED ew e m m - _ rara.r sm.mmemwsy ras OFFICER ost AUTMonszte AGE 0ff ,l 88UtsBER CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# strechments here/ fj ", %y p t #g, ; , rr r 4It- '
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EPA Form 3320-1 (08-36) Previcus odetsons may be useo. tREPLACES EPA FORM T-40 MGCH MAY NOT BE USED.I. PAGE . OF
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4 . , Paperwork Reduction Act Notice , l i Pubu reporting burden for this c611ection of irdomution is estirnated to vary fmm a range of 10 hours as an I average per responw for wme minor facilititw, to 110 hours an an average per response for home major facil ties, ; with~a weighted average for nujor and minor facihties of 111 hmas per mepense, including time for n: viewing mttnxtions, warthing uisting data sourns, gadmnng and maintaining the data needed, and completing and -
~ '
1 reviewing Ow mliccian of irirmmation Send wmment* regarding the burden o.tinate or any othcr~ aspect of 1 tha milection of mfornation, includmg suggestiony for reducing tha bmden, to Chief Information. Policy i , Branch, PM.223, U.S. E,mronnwntal Protection Agency; 401 M Street, SW Washmgton, DC 2040; and to the OIRee of Infunnatmn and Regulatory Affairs Of 6ce n' Management and Budget, Washington, DC 20503,
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l General Instructions [ 1, If form hu han partially completed by preprinting, disregard instructiorn direded at entry of that informatiou 4 already preprinted,
- 2. Enter Tmmiter Name Alailmg Address (and facihty name/ location, if different)? Termit . Number," and '
t 1 *thstharge Number" where indicated -(A sepuate forrn is requhed for each discharge ) i ! 3. Enter dates beginning and endmg "Montrormg Pcmur covered by form u here indicated.
. 4,LEnter each Torometer" as speoned in momroring requirements of penmt.
! $ Enter "Smnple A/caxurcern" data ft r each parameter under "(bantity" and " Quality" in units specified in permit. ! "Awrane" n normally inithmetic average (geometnc aurage fe,r bactcnal p.uameters) of all sample measurements for each parameter otgained during "Momformg Permdt "Mamnum" and "Mmimum" are normally eureme high i and law- measwements obtained dunng "Monitormg Period" (Note to municipals with secondary treatment l reqmrement Enter 30-day averar.c of sample measurements under " herage," and enter maximum 7-day ascrage ! of sample measurementuhtained during monitoring period umler "M.mmum. ") 1 C ri. Enter Termit Requirement" for each parameter unuct "Guantiff and "gualitf as specined in permit. 4 7 UnJer "No la" enter m:mber of sample measunnents durirg monitoring period that exceed maximum (and/or Linimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0"<
- 8. Enter " Frequency of Analuis" both as " Sample Ucasurment" (actual frequency;of sampling and anahsts used during mcnitcring perixif and as Vernut Requirement" specified in penmt. (e g , Enter " Cont? for contmuous momtoring, "l? for one day per week, */ M* for one day per month, "U90" for one day per quaner, etc.)
E 9c Emcr hrp!< Dre" both as "Sampic Measurement * (actual sample type used during monitating period) and as-Termit Requirement " (e g, Enter " Grab" for individual sample, "24HC" for 24-hour composite. "XeA" for continumis momtoring, etc.)
- 10. Wher( **iolations of permit respirements are reponed, attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date.
I1, if"no dizharge" occurs dunng monitoring pericd, enter "No Ducharge" across form in place of data entry, t2,: Enter *Name Title of Principal lhecutive Ol]icer" with " Signature of Princircd Executnv Of]icer ofAuthori?ed Agent," 'Telephanc Number: and "Date* ut bottom of form. 13i Mail signed Report to Office (s) by date(s) speciGed in permit. Retain copy for your records. 14 More detailed instructions for use of this Descharge Monitormg Report (DMIO fonn may be obtained from Office (s) specified in permit.. Legal Notice > This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can
< result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.
. EPA Form'3320-1 (Rev. 08-95)
PERufTTEE NAME/ ADORES 5 /FMarabe h imema== qrphr 'tANAL ROuuTA88T DN*ARGE fLA**tTM)H 8"'Snw INPDES1 Form ApprM. N '.mAE . j .. y i. - v sy ~ , , . , .i} a h, ON m m N T[,% . . . , , . - .-7 OMB No_m400004 f.UORESS W.4i. . (;i; - ~. ) .. w ,
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120 211 422 231 12* 25I 126-271 428-291 130 311 PARAMETER r3 cerd ontys QUANTITY gga OR gL,OAD!*fG I4 Cerd Omfrs QUANTITY OR CONCENTRATM)N NO. ***0UD*CT SAMPLE gag.g3, 9 13n-ass 14J 531 t%s ti cc 432 37/ EX ,,,,ty,, nM AVERAGE MAXIMUM UNITS M:NIMUM AVERAGE MAXtMUM UNITS ,.7,2 ,e ,g m SAMPLE - 2 : 4 x
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SAMPLE MEASURrVENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PfMALTV 07 LAW THAT f HAVE PERSONAdv fMA4mEO AND TELEPHONE DATE AM F AMILIAR 1MTH THE MFORMATION SUBueTTED NfREIN: ANO SA%O 0*e MY 8NQUIRY OF THOSE INOtVIOUALS IMMEDeATELY RfSPOtrTELT FDR OSTAINmG THE INFORMATION, a BELtivf THE SUBMITTED INF08WATION TS j f 11 w4 ,i , e 7,j g 7 '. TRUE, ACCURATE AND COMPLETt. 8 AM AWARE THAT THERE ARE 4 e,'- ) 9GN!FtCANT PfNALTIES FOR SUBMITTING FALSE thPORMATION thCLLlDr8Q i ,, j s . . 7i, , , . . THE POS98:UTV 07 FtNE AND IMPRISONMENT. SEE 10 U.S C. 91001 A8dD 33 SIGNATURE OF PRt8tCIPAL EXECt/TNE 4 , 3' TYPED OR PRINTED u S.C. mas ert me 131s. menawees
- - - arser :erser-ewee s.enuses s- me,
-w awa,we mee a, em $ # 9.000 a r arms ofTst.ER OR AUTHosu2ED AGE 9TT MJMBER YEAR MO OAY g
COMMENTS AND EXPT ANATION OF ANY VIOLATIONS (Reference s# errschments heref J EPA Form 3320-1 (08-95) Previous edinons may be used. (REPtACES EPA FORM T-40 VW?%CH MAY NOT BE USED.) . , PAGE .OF 3 1.at er, .~ ' 34 . i
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Paperwork Reduction Act Notice - i
'Pubhc repmhng burden for this collection of infurnution a estimated to vary from a range of.10 hours as an average per soponse for wme minnr facihtie.s 14 110 hours as an average per ruporne for some major facdities, with a weighted average for major and minor facilities of 18 hours per - ,'ons.e, i.neluding time for reviewing 2]
l instmctions, warthing existmg data sources, gathering and maintainin, ae data neuld and completing itnd ] ~ reviewing the collation of infarnu. tion. Send cdmments reptding the burden estimate or any other a.spect of ' j this cotiution of infomation, including suggestions for redacing this burden, to Chief, Infornwtion Policy 1 2 ( Branch, PM-223, U.S. Environn ental Protection Agercy,401 M Street, SW Washington, DC 20460; and to the l I #
' Oflice of Infdnution and Reguldory Affairs, Office of Management and Budget, Wehington, DC 20503.
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General Instructions 1: If form hu been panially completal by prrprinting, disregard instructions directed at entry of that infornation alrear'y preprited. 2, Enter "Permurce Namedfadmg Address (and facihty name/ location, if difTerent)," " Permit Number," and . l "Diuharge Number
- where anJied ( A separate form is required for cach discharge.) -
- 3. Emet dates beginning and Wing "Atonnermg Permd" covered by form where indicated l
4c Enter cath " Parameter" as specified in monitoring rcquirements of permit. l 1 i Enter "Nampic Alcawrement" (bta for cach parameter under "(Juantay" and "Quahty" in units specified in permit,
*c ta rage" is nmmally anthmetic average (geometric average for ba:terial parameters) of all sample measurements for cach parameter obtamed during "Atomtormg Period"; "Afawnnm" and "Atmimum" are normally extreine high -
j i and low meamrements <Mamed during "Alonnormg Permd" (Note to municipals vath secondary treatment , requiremem: Enter W!.n avetage of sample measurements under "-f reraxc." and enter maximum 7-day average j of samnic measurement'; obtained danng monitoring penod under "Alaximum "J . > [ 6. Enter ' Permit Reqnnecment" for each parameter under "Guantay" and "Quainy" as specified in permit. 7f Under "No Fr" unter immber of sample nicasurments during monitoring penod that execed maximum (and/or ] 1 mininnmr or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". l
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- 8. Entcr *Fecquency et Anulyus" beth as "Smnp/c Alcamrment" (actual frequency of sampling and anabsis used 1 F.. damng monitonng period) and as " Pernor Requirement" specified in permit _ (c g, Enter " Cont," for continuous ;
monitoring, * /C" for one day per weck. "Ido" for one day per month, "130" for one day per quarter, etc,) ) i
- 9. Enter
- Sample 7)pc" toth as "Nample A/easurement" (actual sampic type used ,iunng momtonng penod) and as J 6- = Permit Regwrement," (e g . Enter " Grab" for individual sampic "N/IC" for 24-hour composite. "N<A" for j conhnuous nionitoring. etc.)
l l 10. Where violatious of pennit requirements are reported attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date. l
- 11. If"no discharge" occurs dunng momforing perid enter "No Discharge" across form in place of data entry.- l 12.- Entet "Name:Tule of Prmcipal Evenawe Offcer" with
- Signature of Principal Erecutwe Ofcer of Authort:ed ~
(tgent," *Telejdrone Number," and *Date" at battom of form. l 13. Mail signed Rt. port to O!Tice(s) by date(s) specified in pennit. Retain copy for your records.
- 14. More detailed instructions for use of this (vtcharge 3/onitoring Report (D3fR) form may be obtained from Office (s) specified in permit
[ . Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $2.5,000 per day , of violation, or by imprisonment for not more than one year, or by both.
. EPA Form 3320-1 (Rev. OR-95)
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t PERMf71E NAME//.OORE55 4=e e Ford,ha.I.emme s'DA e mATiONAL PetLUTANT EneRGE ELAsmAnON sw NJ Foe Approved. j
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A 3, . % .L. . - ~w ,u_ ADOREss i . v . .na - _ PERMIT NUMBER I - g D9 CHARGE tRastEn (sa m nf.- i
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e 4 .,d' ' MITM PERIOD "" m . t FACILITY YEAR MO DAY YEAR I MO DAY LOCA A FROM -
', , , , TO 9%l .; *; rea , gibts(pat p% c nr 3; ,. , a 1: <> i;y ; (20 211 122-239 124-259 126 272 120-299 130 311 NO N ***$ s * ***-
13 cord on4# (10ANTITY OR LOADING I4 carit onept QUANTITY OR CONCENTRAM* NO. 'atoufNcv SAMPLE PARAMETER I4 & 5 31 164 619 IMI 146 539 (54619 or (32-37; EX mygrs TYPE 7 AVERAGE. MAXIMUM UNITS MINIMUM AVERAGE RAXIMUM UNITS ,Em , u ,- ,,m ;
, r > L,1 A,, , IC1AL SAMPLE noee: mu :ny gem ( ; g) j MEASUREMENT a v .> v c f ?L, g,jg ; , ; PERMIT ocoene n r; r e r. y .; r o c e. g.s gg ig ,gggg3 ;gg ,y, ,
j;g REQUIREMENT _n ; ,7. m y ,, y y z .;j._ > SAMPLE ; 3. c n m ;. o g e ;
'LCA, IJ .n i U 15 ut MEASUREMENT
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PERMIT gggpq 3 ;_ p e p 7 ar enon . 9;;e g e c necon ~+5 . g g ;g y . , 3 7 ; 4, y y;[ REQUIREMENT - y ,,, s,, , , , 3, p .7 , . . ;,,, j[ SAMPLE I ! MEASUREMENT PERMIT , REQUIREMENT SAMPLE ,
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MEASUREMENT PERMIT j REQUIREMENT ' I SAMPLE - MEASUREMENT ! i' PERMIT . REQUIREMENT SAMPLE , i MEASUREMENT PERMIT i REQUIREMENT SAMPLE ! MEASUREMENT l PERMIT , REQUIREMENT NT ME/ TITLE PRINCIPAL EXECUTIVE OFFICER NALLY EXAasmED AND TELEPHONE DATE sAMCERTiry FAMIDAA UNoER WITHPENALTv Os (AW THAT THE #8FOmasATION e MAM PERSOEREIN: SusMtTTED 8 AND BASED ON MY INQtARY OF THOSE #sOfVfDUALS ImaMEDIATELY RESPoseSISLE FOR 3
,.iM V 1 d i J T Tid O I" 1c OSTA sseasG THE sesFOmasATION, 0 SEUEVE THE Susee:TTED teeFORMATION IS # # -
y TRUE. ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE [ /4 /. 4 '
"/ i CIMT11 S L ry nJD41 g*11' SeGNa8' CANT PENALTIES FOR SUtaasTTlNG FALSE 898FORMATIOed IseCLUDeteG THE POS$stauTV OF Fett #880 seAPRISOesMENT. SEE 18 U.S C. 91001 AseD 33 i* i 1. t i =1 i* 17
- U.S.C. t 1318. h anmer snese seausee may meetse mies asp as sto. cop SIGNATURE OF MAL EJEECUTIVE I TYPED OR PRINTED .ad er m.e==en - cors.e- s m.mR. es , ras OmCER OM AUTHORIZED AGENT CODE NUMBER YEAR MO DAY g l COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# sttschments heref i
/} ' i 'l , : 4-EPA Form 3320-1 (06-95) Previous estions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF C0107/10,J105-0pj. a. 1
1 , Paperwork Reduction Act Notice . l Pubic reporung borden for tlas colin: hon of mfornahon is utmuted to vary fnam a tange of 10 hours as an ! nerye p r ic> pinv for = < rmoor f aahtm , m i10 Ivurs to an average per rcsymse for wmc majw fauhtin, wah 8 wryhtrJ na% c for mann and nunor f aahim, of 18 ho us ptr rcepme, aduding time for revmamg nM ru , t i ms , sendang exista g da:a snura s, gath-r.ng anj rantainmg the data tweded, iimi compittmg and . n ve rweg the coHramn of n.f omanon. Vnd wmnwnts ecyarJa,y the bmden nnnate or any other asps:t of l thm udlahon of infenmhort mJuJmg sugge . tons for reducing this burden, to Chkf, Infanuatmn Polny Bransh, PM 223, U.S linvuorr, ;cual Protatma Arm y, 401 M Street, SW Washmpton, DC N4W; and ta the ; Offe of Inforn.auon mJ Regulainry Alte. Otfge of mnagement anJ Budget, Wnhington, DC 20303, i+ e+ y ,,
.d. - _2 General Instructions 1 If form La ben partiaHy completed by preprintmg, diwegard instructions duested at en ry of that infunration aheady preponted.
? Entre T anunce Vo".e 3 /,ulmg cld.!re n (and fxJay namcilacation, if difTerent) " "Per mrt Number " and
"/>ach,:rge LmAcr" u hue mdwated ( A wparate farm a required for cach dasharge )
1 Fucr d ocs b;guuung and endmg S/om!ormx Permd" cmcied by form where indicated 4 Enter eat h Taram,i. F as speaficd tu momtanne. requacments of pernut.
% Ento iamp5 !!s o .rce cin" data for cash paramek t under *@wn! n" and "Polaf m umts spenfied m permit
" f u raf is namaH3 anthmctw ascrag (gcometne ascrar fm bacteri.d parameters) of all umple nmurements fer exh p >;unna ( ' t.umd dunng " Tim lang Tceml" " i l< : w >< and "3/mmusi' are n um:dly extreme lagh and hnv mn.un nem , okoncd Junng "31 torny !hl" (N' lo muniapals with secondan trc dment rupurcmem Euer m-dn averm of san pe me suremuus under ".iu ' age." and enter masmmm 7-day aserage of sange meaaoum ms okoned dunng mondonny, p:nad under "Almanm.")
b Ec.ter Terms Regn en" for cxh paramdu i adct "Wm0h
- and "Gualay" as s;vofied in pernut
- 7. Un iv "No I O cnttr number of omy4 inmunneMs dunny monitanng penod that euced maximum (and or nununam or Lday as erar,r as appmpn u ) p;nmt rcqmrement far each p.nameter if none, enter "0" R. Fiatt "lirmiwno v/ .trialon" b;th as "Nawic ifrauament" (actu d frcquenes of sampling and analyus ustJ durmg motmuung penod) and as Tcmo Ncqun cent" specifkd m pcrnut (e g , Enta " Cont," for continuous mcunonag ' I ~ far one day per week, "lX fm one day per month "Imo" fc r one day per ginrter, etc )
- 9. Enter '%mp!c Ope" both as "Nef ic TImure; s "t" ta;tnal s:uup!: hpc used dunng monitoring period) and as Terma Requ remem." (e g , Enter WP far indaidual sample "2> R' for 24-hour composite, W A" for ConhntlaOS motuloung, etC.)
- 10. Whae slotations of p.nnit reqmrements are reponed, attx n a bnef explanation to des:nbe cause and cmrective actmns taken, and refereace cach sinlanon by daic
- 11. If "no dvharge" occurs during monitoring penod. enter "No Dacharec" across fonu in place of data entn.
- 12. Enter "Namr 7ale ej Pnncipa! Ewcutne 0;]icer" uith "Swnature of Pnnc?pa! Frecutwe Qccr of 1uthon:ed
. lgem." " Tele;>hane Number
- and "Date" nt bottom of fann
- 13. %il sign;d Rejert to OITice(s) by date(s) specified in permit Reuin copy for your recordt '
- 14. More det;uled instmctions for use of this Dacharyc Alo*munng Reprt (DAIR; fonn may be obtained from Of1ke(s) specified in penuit Legal Notice
'this report is requited by law (33 U S C. . 131F; 40 C F R 125.27). Failure ta report or failure to rep rt tru:hft.My can result in civil penalties not to exceed $10,000 gwr day of , e :lation; or in enminal penalnes not to :(ceed $25,000 per day of siolatm,n, or by impusonment for not more than on yat, or by both.
EPA Form 3320-1 (Ret OMS) 1 l
. __. .. _ ....... .. .._ .._. ... . .. - . ~.....t -~e.~ s c o.~ t au un e nun us: va ,vy,v ~1nstructions: ^
g( Year: ,c c/g
- 1. Complete monthly and submit with each DMR. Attach additional sheets and conments as n eded for completeness and clarity. Permittee: JA!/MEJ A!F L /6/7 6er 1/ 'V
- 2. Studge production information will'be used to evaluate plant Plant: rc w e. 4 /4 w r fc w r.ff,:..w ..
perfonnance. Report only sludge which has been rceoved 'rnm NPDES: ts; c.oznes . digesters and other solids which have been permanently removed Municipality: w/r,m-rc< r & c a // from the treatment process. Do not include sludge from other County: f,5A v X plants which is processed at your facility. -
- 3. In the disposal site section, report all sludge leaving your for sludge that is incinerated:
facility for disposal. If another plant processes and disposes Pre-incineration weight = dry tons
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of your sludge, just provide the name of that plant. If you Post-incineration weight - dry tons dispose of sludge from other plants, include their tonnage in the disposal site section and provide their names and individual dry tonnage on the back of this form.
- 4. If no sludge was removed, note on form.
SLUDGE PRODUCTION INFORMM:0N { prior to incineration) HAULED A5 LIQUID SLUDGE HAULED A5 DEWATERED SLODGE (Conversion (Tons of (Gallons) X (% Solids) X Factor) - Dry Tons Dewatered Sludge) X (% Solids) X (.01) - Dry Tons 39999 a .0000417 3.34 .01 TOTAL = TOTAL . DISPOSAL SITE INFORMATION: List all sites, even if not used this month Site 1 Site 2 Site 3 Site 4 vitomn a > i+, m * % Name: m %i: reg.trnwrtw1 Permit No.: Tel 0o 2 of t 6 Dry Ions Disposed: 3 343 h: (check one) . Landf111 Agr. Utilization
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Other (specify) Cgunty: 99 4/g4. m n CilffniSTgf perfr[g hqy QJz-M3-Fll3 (SSR-1 3/21/91) WJrrKure Iltle Dst e / Telephone
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' Instructions: Year: e ug <
1.- Complete monthly and submit with each DMR. Attach additional (/rh3c 7 sheets and corrments as nIeded for cunpleteness and clarity. Permittee: JA!/A>ES A'E L //M r e/ ipV
- 2. Studge producticn infermation will be used to evaluate plant Plant: rg wa t/ 4e4 t ' f ue r . f o rp e .
performance. Report only sludge which has been removed from NPDES: m vozpus - digesters and other solids which have been permanently removed Municipality: w n st- m r & c u it from the treatment process. Do not include sludge from other County: r, p ita 1 plants which is processed at your factitty.
- 3. In the disposal site section, report all sludge leaving your for sludge that is incinerated:
facility for disposal. If another plant processes and disposes Pre-incineration weight - dry tons of your sludge, just provide the name of that plant. If you Post-incineration weight -
~
dry tons dispose of sludge from other plants, include their tonnage in the i disposal site section and provide their names and individual dry tonnage on the back of this form.
- 4. If no sludge was removed, note on form.
SLUDGE PRODUCTION INFORMATION (prior to incineration) ! HAULED A5 LIQUID SLUDGE HAULED A5 DEWATERED SLUDGE (Conversion , j (Tons of (Gallons) X (% Solids) X Factor) - Dry Tons Dewatered Studge) X (1 Solids) X (.01) - Dry Tons
'hoco 0.05 .0000417 0.97 .01 i TOTAL -
TOTAL = DISPOSAL SITE INFORMATION: List all sites, even if not used this month < 51te 1 Site 2 Site 3 Site 4 s ott o ~ n w s.,. 4% Name: SG.>%c renrnci'rtz.e.it Permit No.: f>} co z onz 5 r Tons Disposed: Dry D.9 7 lype: (check one' Landf111 Agr. Utilization Other (specify) County: es4/a (SSR-1 3/21/91) S i g'ifa tu re ' ~ / Clllini litle sri 3' IMr%[R h&h Qlz-393-$ll3 Uate / Icicpnone}}