Laserfiche WebLink
~- <br />~c~;y%y'.°".J~l.3T~3C L~e~3,.Ydaa.=z ~n~ ~Tc'.^i]~Y <br />Public reporting burden for this collection of inlormation is estimated to vary from a ranee of 10 hours as an <br />average per response for some minor lacilife,, to I10 hours as an average per nsprnse for same ,valor <br />facilities, with a weighted average for major and minor I'aciliiies of 18 hours per responv. including .inc for <br />reviewing instructions, searching existing da.a sources, gathering and maintaining th. dxta neecrl and <br />completingand reviewing the collection of inlermation. Send comments reearding the burden estimate or ar~ other <br />aspect of this collection of ~nform:ttion. including suggestions for reducing this burden, In Chief, 'c':~rnatior. <br />Policy Branch, PM-?33, U.S. Environmental Protection Agenc). 401 M Street. SW', Washington. DC '_O;FO; and <br />to the Office of Information ertd Regulatory Affairs. Offtce of Management and Budget. Rlshington. DC '_O50? <br />~iCIiC'1'~1 ~)1~~$fl ~C$i®Yi5 <br />I. II form has been partially complete) by preprinting, disregard instructions directed zt antry of IL-ul n;brm.u lur <br />already preprinted. <br />'_. Enter "Pennittee Name/A•Iailmg AJdress (and facility name; location, if differenU,` "Permit K+. ~tSer,' and <br />"Discl+arge Number" where indicated. (A sepet.~tc Ibrm is required for each discharge.! <br />?. Encer dates beginning and ending "~Ylonitor'~ng Period" covered by form where ihdicated. <br />4. Enter each "Paramrrer- as specd'ied +n monitorine requirements of permit. <br />~. Enter "Sample Measurement" data fur each parameter under "Qu:utrirr" and `Qualm" in wits spuifi~J ~n {'r°mn. <br />"Average" is normally ari[hmetic average leeomet~ic average (or bacterial paramete'sl of all sample i~:asurec.:nt• <br />for each parameter obtained durine "J4orrirnring Period`; "Ada.cinrum" anJ ",1-lminmm~' arz nonnalh :~..icme n~~f <br />and low measurements nbt;u ned during ",yfoniroring Period: IM1ote to municipals aith~ sewn as^. trcah cu' <br />requiremcne Enter ill-da}~ average of sample measurements under 'Avn:vge." anJ enter mazimun ~-hty a~~~-cge <br />of sample measurements obtained durng mnnitori ng period under `iLla cimum') <br />6. Enter "Pennir Requirement' for each parameter under 'Qu:rnrity' and "'Q+ralit}•" ns spccdied in pernti: <br />'. Under 'No Ex` enter number of s:unple measurements during monitnri ng perod Iha[ exceed masin un lay d'ur <br />minimum or 7-day overage as appropriate) permit reyuicement for each parameter. If none. enter "0~~. <br />5. Enter `Frequency oT Analysis" both as "S:unple Measurement' (actual frequency of sampling and .,ralysio used <br />during monitoring period) and as "Pennir Regmrement- specified in permit. (e.e.: Enter "ConL~" ~~nr cmt[.r~.mu, <br />monitoring. "l,~T Ibr one day per week, `l,'JO" fur one day per month. "l,'9U- for one d:q~ per quartr~ ar.) <br />9. Emer `Sample Type" both ^s "Sample ~19easurernent' (actual sample type used dm'ing montorinc -.e coil! anJ a, <br />`Permit Requirenrerrr.' (e.g.. Enter `Grrb" Ibr individual sample, "?dHC" for 24-hour composite, "~~ ~ ter" for ,:on- <br />tinuous monitoring, etc) <br />10. Where violations of permit requirements are reported, auaeh n oriel' explanation to desenbe cause unc corrcane <br />actions taken and reference each violation by Jnte. <br />I I. If "no discharge' occurs during monitoring period, enter "Nrr Disdtarge" acros's form in place of data :~tuy. <br />I3. Enter "Nmne,~Tirle of Principa! Errcutiye Ol7Fcer" with '_ti ignarure o! Principal E.tecmive O(l icer ~+( Augrrrierl <br />Agent." `Telephone Nwn5er,~' and `pare" .u bottom ui form <br />13. Mail signed Report to OII'ice(s) by date(s) ,pecified in permit. ReWfn copy Ibr your records. <br />Id. More detailed instn+rtinn+ for use of thi. Lisch.erge hloniroring Report IDMR1 fi~i n na}' be ohnun.d fern^~ OI- <br />(ice(sl specified m pcnnit. <br />Le~a(~ 1~I®$flee <br />(his report is required by law (33 l;.S.C. I?I8~ 40 C.1 R. I?5.77). Failure to report or failure to repot. t:uddr.l'~y co•~ <br />result in civil penalties not to exceed $10.000 pzr day n( siolation: or in a~iminal penuhies not to escc:d 525IU,U f.r <br />d.+y of violation. or by imprisonment lin~ not mot: than one yeas. ~ by both. <br />LPA Form 3320) (Rev. 9-881 <br /> <br />