|
p~~:;~;~~work ~e~•:~~~~or~ Act Ii~otice
<br />burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />r
<br />~( SOllle 1)JlnOt facilities, to 1I0 hours as an average per response for some major
<br />~r. per rea minor facilities of l8 hotus er res nose inclutiin time for
<br />acuities, with a weighted average for tTIflJOI P P ~ g
<br />~Rdctions, searching ex' sources, gathering and maintaining the data needed, and
<br />COmp eting and reviewing of infoanation, including suggestion for reducing this burden, to
<br />Chief, Inf c , PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />460: and to the Office of Information and Regulatory Affairs, Office of Management and
<br />'Budget, Washington, DC
<br />Ce~~~p~,~ In~tr~~~~o~4
<br />i 1. If form has been~opmplattetl by preprinting, disregard instruction directed at entry cf tbat information already
<br />pr ri i
<br />• .nl~ittee NamelMai!!ng Address (and facility uame,9ocation, if different)," " Fernrit Nunrber," and "Disci!argz
<br />NumEer" where indicated. (A separate form~for each discharge.)
<br />3. Enter dates beginning and editippg Period"covered by form where indicated.
<br />4. Enter cach__"p ~ ed in monitoring requirements ofpetmit.
<br />r,"'"~rtt'ytt 5'imFL :dssu.~,nznt"data for each patameterund.:r "~uaan';~"and Qttalir "as sperSed in peratit "Avrr.r,_"is
<br />no naliy a-ithmetic average (geamctrc a~er.~.ga nor bac,tial parstnztcrs) of all sampl : rncasarrmenls For each parz•;ic,c;
<br />o~tained during 'id~nito~ing F.,~s..f; "A1~r~„u~.,t" aad ~blinimum" are normally ex•.rm~ Nigh and low measu~'emenLs
<br />obtained during ",.~-•,rih,rin; ,'_rivJ". (Nett W r~unieipals will[ sccondnry treatmr, t ~;:,u rmem: linter 30-dny ;,re sgc
<br />otsamplc ireasurer:~euls under "Ar,~. ," sod enter nztxin;u n 7-day a~rr~gc of s~m;~ie rrr~surcments obtained r;•,,i»6
<br />monitoring G ~'"ltf~rirnw,t.")n,
<br />k "r ~• iVgtP~`"2nd ~7i%v"tESprcifie; i~~ .nit.
<br />_6,~ ,~1fii)i, ~r,,_,:c _or each paramUer r.nuc.r "i ~ "~•_ pc
<br />{~i--
<br />7. 'vi,c ur "ido Pa" enter num6cr o:C sam;~L r..: wrcment ,'tiring moni:oc ~g ? ~nud fiat c ,c :ed mt+s_;mam (ancVer ri_'-twa
<br />or 7-day average as app: e; ; i~l~) p:nni: tequiremert 17 , cach psmn-.ctcr. ? F none, enter "0".
<br />8. Enter "F, '; ,, -nay ,,f;1.. 'r,:.." bulb as "S~~nr !r :.:.r~r,r_ ~- .•:rt" (ac:cal frcq::_ac} ; f s: mp:ing and analysis .~scd curing
<br />noniioting,period) ar.~ a.. "i'.,-„rrt k~~air~r,:~m"specified in permi! (e.g. i ; _, -, n: " ~'cr continuous muni!o~rg, "1/7"
<br />fgieVe~y per ~:. rc':, '1/30" for oae day p,: nwn[h, "I.9p" fer ut:c r;ay per q:ranc;, e:c.)
<br />S'
<br />9. 'i7t_; 'Sa,,,Flz Tjy~"both as 'S~a,, I~ ,:1_asurenr.nt" (~aual sample tl;~e uscil c!urir,•~ moo uturing pe'iod) and as "Tr»ait
<br />ff. l~!!'3nelrl,' 1:-tter "i;i'1!" fJC IndlrlciL~i s:.m IC, "2Hi%,"' fe- 24-ttow~mmoasit.:, '~Vl,'
<br />d (c•6• ~ p 'for conLinaous
<br />monitoring, etc.)
<br />1C. `1'lrere violations of ;xr,*til ~ equGements e*c ~, pcr[:d, attach a brief expl~-•_tio,~ to cescibe eau<e and corrective actions
<br />to be taken, and reference cach violation by dale.
<br />11. ! f "no discharge" ocews during mnnitorino }~criod, enter "No Dischargu" across for„t in place of data entry,
<br />12. 8n;er "1VamJTills of PrirrciL.ll F.a::olive O~~_~r" a•itL "Sig~:airre of Frin_ii'.d Trczta'e O~i~ar of Astho:iaed
<br />Agent, ""Telzrhnnz Numl+ar,"and "Ltd" at bottom of form.
<br />13. Mail signed Repot to Office(s) by date(s) specified in permit. Retain copy io; your rew;cu.
<br />I4. Akore detailed instructions for use of this IJis~harge ,L(untro:ing !4:F~R (D,1fhJ form may to obtained from Office(s)
<br />specified in permit.
<br />~.~~c~t T~OtiCe
<br />71ris n-port is requved by law (33 U.S.C. 131F3; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not mote than one year, or both.
<br />EPA Forty 3320-1 (Rev, 03!99)
<br />
|