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~~s~~.~:~w~rk Re~u'~tion Act l~Totic
<br />Public reporting burden for this ccllection of information is estimated to vary from a range of 10 hot.,-s as an
<br />average per response for some minor facilities, to 110 bows as an sverage per respor.se for soJnc major
<br />facilities, with a weighted average for major and manor facilities of 18 hours per t esponse, including lime for
<br />reviewing instructions, scorching existing da*a sowces, gathering znd mainaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to ii
<br />Chief, Information Policy Branch, PAl-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to time Office of Imormation and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />general Instructions
<br />1. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permitt~e Nama/li4.riling Address (and facility o<mme~ocation, if different)," "Permit Munrber,^ and "Dischrnge
<br />Nun:Fer" where indicated. (A separate forth is required for each discharge)
<br />3. Enter dates beginning and editing "ivlaritoring Fz, is.y"covered by form where indica[ed.
<br />4. Enter each "F,nufn_ trr" as specified in monitoring requirements of permit.
<br />5. l;n[er "SumFL rlf~-/.auarnsnl"data for e::ch paia~ncicr under "~hr4rrri;,"and ~hrll;n~".u specified in permit- "Ana:_g~" i::
<br />norna'ly arithntctir average (gcomet~ic a~~cr. ~c fnr L-::c;ari~i pa amc:urs) r.fcll s:unpl: ~nasuremcnts for cacti prrmeter
<br />ebt~iccd during ",tf rvr,ring F~•risd"; ",LL :i„ rm" ccd i,luru,"r,.r" arc nunnaly c;,~r, n: ;:igh rnd pow rneasurv~aenls
<br />obtainc! dung "Af =c;-.,i,r- Frri,d". (TVntc to :..u-lc~i ads v: rah scccnd:.7~ tcatmc :' : •u~rcmcrt: Lnter 3G-day ev~c~cgc
<br />Of ti'71 ~11C ni..i~G:"Cn:: :!", iindeT "A I'~;'~~,:."a,d Ull[' -~ ~.,:~ iLirn 7-d.:y a!'CragC er S._rr l'e mCas'!rCm:.nt5 OJta.lg L' d'~r, -(',
<br />monitoring period under '4W¢rimvm.")
<br />5. _.:.. "; .,r~7R ;sir,,,var";c eachparam::ic lrnl.- _ „r;~.^an "[,~~!i;y "- "~,
<br />"as r..~ci~,e.. -e.-~,it-
<br />7. L'nd_r "n'. .. c~~te; cumber of samp'c r r'caiCm ~^'. ~i~T~ 1:'L- i0'.l+-.~' ~nae 1' ; .. .IX:C{i ma::a il'~~n (7 ~]d/Or PIJi ;Jn'
<br />e- , d:.} ova Wig,:,., epproprieL) -:rmit rev~r'~ ant ~,~ rcpt: pm~meter. :f ~ioac, e~tcr "0".
<br />°. ~n r'/~;s.,,,,t,,,,~ih,alpsis"i;oth a, 'S /• .', . ~ ....,.-."` (:c(.~r' G~ouc• cy c`,~i„!ieg and analysis used dr~i~i~
<br />maniacrrgr=r:od)rndas"F',;.:it;2`;,r,i,.;,~-~~^sncci!;,di~~ en.. (;;~ f:r'.c-".-, .'i~crcon'auo~.ismoniiori~~-,r, "!lI"
<br />fcr o ,e day ;r- s:•c.:':, "1/30" for anc c.y j;er moo"•, "; /90"' for or..: day l.zt queYer, N~.;
<br />T}~. ,":~oGi rs "S.,.r~l~ ,1! .~. ; _~, ...I;"( ^tr l =..m; 'c iy f:e w d dv.ing mo ,i tonng pe~ad) ono zs "^,_ r~
<br />~~~1!Ir,?,it_Jr." (e.g. ~-.ntcr ".i(~'f-" fnr i:,:i;l'IC.: ui ..:-f 7h'_. "~ir~" fC` 2'--.'C.:' Cnmp~5l i.C, °~V//" eLr CO'I-~'~CIiL
<br />monitoring, e:c.)
<br />10. ?'."icrc violations orpemit ILquirmnG: ~ : r~,.cCe', abaci a iricf c,:p'a JaCU~~ L. d: rc:iSc cease and cerrctivc actions
<br />to be taken, and reference each e'dation b}' chic.
<br />1. If "no discharge" occurs du:-iog mani:nt~rl~, pc~u~, crLv "No D~tu'ia.rde" ::errs; `..r.r. is lilac: of data n:Py.
<br />12. L-eter "N_mt:lTitfa cf ,^rfaci. a Fx~ 7,ti~.'.r ~;j ._ vviti~ 'S~,,,r~tc~.r ~~J h~,~_il-~r Exearl%~_ i(ji.:rr of iiutf:-~riz~l
<br />Ac ent, ""Tefzpdoa ~ NumFr. ; "and "1 ~r~ " at ho tl om o f fora.
<br />13. Mail signed Repent to Cfiice(s) by date(s) specified in p_nJit- Retain cony for yow rxoni.,.
<br />14. Mcrc detailed instructions for use o; this Lis:fv„~: i•+f,aitorino R_7o:T TP.41;) form may be obtained %-om 0(Iicc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.P.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 more than one yeaz, or both.
<br />EPA Form 332Q-1 (Rev. 03/99)
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