EXH0755027166

PCHBPollution Control Hearings Board of the State of Washington

1. If form has been partially completed by preprinting,disregardinstructionsdirected at entryof that information already preprinted. 2. Enter "Permitter Name�Mailing Address (and facility name_location,if different)," "Permit Number," and "Discharge Number" where indicated. (A separateform is requiredfor each discharge.) 3. Enterdates beginning and ending "Monitoring Period" coveredby form where indicated. 4. Entereach "Parameter" as specified in monitoring requirementsof permit. 5. Enter "Sample Measurement" datafor each parameterunder "Quantity" and "Quality" in units specified in permit. "Average" is normallyarithmetic average (geometric average for bacterialparameters)of all sample measurements for each parameterobtained during "Monitoring Period"; "'Maximum"and "Minimum" arenormally extreme high and low measurements obtained during "Monitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day averageof sample measurements under "Average, "and enter maximum 7-day average of sample measurements obtained duringmonitoring period under "Maximum. "') 6. Enter "Permit Requirement" for each parameterunder "Quantity" and "Quality" as specified in permit. 7. Under "No. ofExceedances" enter number ofsaraple measurementsduringmonitoring periodthatexceed maximum (and/or minimum or 7-day average and monthly averageas appropriate)permitrequirementfor each parameter. If none, enter "O." ' 8. Enter "Frequency of Analysis" both as "Sample Measurement" (actual frequency of sampling and analysis used duringmonitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Cont, "'for continuous monitoring, "1/7" for one dayper week, "1/30" for one day permonth, "1/90" for one day perquarter,etc.) 9. Enter "Sample Type" both as "Sample Measurement" (actualsample type used duringmonitoringperiod) and as "Permit - Requirement," (e.g., Enter "Grab '"for individualsample, "24HC'"for 24-hour composite, "'N/A"for continuous monitoring, etc.) 10. Whereviolations of permit requirementsare reported,…
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