|
1?aperwork Reduction Act Notice
<br />Public reporting burden fur this collection of information is estimated to vard from a range of ]0 hours as m
<br />averege per response (or some minor facilities, to 110 hcurs as an average pe: response fur some major facHilies,
<br />with a weighted average fcr major and minor facilities of I8 hours per rcsocnse, including time for reviewing
<br />instructions, searching existing data sources, gathering and rrvmtaining [he data needed, and completing and
<br />reviewing the collection of information. Sznd conunzas re;;arding the burden estimate.or any other aspect of
<br />this collection of infurtnatioo, including st,ggrstiuns fo: :~iuc~ng this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environrne~ual Protection Agency, 40i 94 Street, SW Washington, DC 20460; and to the
<br />Office of Information :u:d Pegulaiory Affairs, Office of Mana~emwt end Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If fo+m ;:as b.en p~rtia'ly cc;mpleted by preprinting, disregard ins[niRioos directed et entry of that information
<br />already przprintzd.
<br />2. Enter "r~-"n+i!t.c nr.•:'L:,.'n,k~ 4ddre.r.c (and facility namellocaha•. .' dil.'crent)," "Permit Number," and
<br />"L'ec;,.:r~., ''/.,:r;e .v;,cre :n•~ic.dtd. (A _,•.parate form is required for e:;ch discharge.)
<br />3. Enter dcte:, b:r~r+u. ,; a .t .odi .: (..nr;u: n:y : , nod' covered br fur:: '., here indicated.
<br />J. 5mcr each "'nr~-,s, r r" as sp.aliod m mcmtaring requirements of permit
<br />5. enter ".S.,nrp.4 !.!,•, >arcn::.,r' ~ ,; . ,.. ea;L ;-,~r:.~.^.ctcr under "O;:.suip" .u:d "i)ua!iN" in units specified in permit.
<br />:; dernr;:•' s norntatly :, ithm ~ ' ~;~ _~afe !, ~:cmetric average for baGZrial p~unoieters) of all sample measurements
<br />for each i~aram..ter nht:, nc;! ~~ I+ic:. "-tlun ' ~u;_ Penur:"', "Il,.x;nreure" gad ".Irnunun:" arc t,ormally ea-treme high
<br />and lo.~ man.~r°n .' ~ oM:n• ! a nm• "',rwh„+n 1',-~md" (Nclc ?_ municipals with secondary treatment
<br />;ccuirc+r.,nC ! .'d_: +~~-c!at r.erabc ..` satr:N;, r. ;,,r.r:~r:.a:~L- und.r " ~:~_ •~: r." and enter maximum 7-day average
<br />of sample inr(t•ur^.,cil:a ~hlai.:cd dunng urn' ~•, ~.ng ,,;nod u:'d~r ".1;nriunm.. ")
<br />5. Enter "Pernri: iiey„~rrn~rnP' lo+ a.._U pa:m:~r,r. :r.+.,; "Qurrnt+R" and "(ic,,r..,•„ as specified in permit.
<br />7. L'ndrr ",\%rr~::" r~~~•r -~ r~'~'^e o•` c:raple :rc.~s:,.: ~. ins dunng nwr.u~:;i+~g xriod tfst c.eceed maximum (and/or
<br />n:i~irm:," ur ?-dny ~::,.+^_ .~ ;.Nerepnate) ~~.... • roluircment for each na;antater. If none, enter "0"
<br />8. dater "Frw~:. ~:i~~eh c" .~•~! s "~',;,,. ',~n.;sr:!~ci71" (actnai ftcyuency of sampling and analysis used
<br />during mo;:i:: ;in, ~r e,'t ? ' a•. " ;nor Hn;uirenrenf' sN:c;fizd in pcrntil. (e.g., Enter "Conn," for continuous
<br />a'.ommm ,; " ~ ;"' ~ ,:.: +!~• ~ .,;~1, „/ `ar :,a- r!ay per month, „/'90" for one day per quarter, etc.)
<br />9. Enter "Sampb 7.,y,F" both .._ ..::r.;-r~• it .~, :. ... (a._~ual sample t,pc ::>zd during monitoring period) and as
<br />'Penni! P.ega:rrn: •r.r " , e , °n'^r "(~ret'~ ..~ ~ indn-id::al sample. ":4Fi'" (or 23-hour composite, "A'/,4" for
<br />conunuous mcninnirg, clc.)
<br />10. Whete violations of ;;:~',,it rcr,.,:_,neats .:: rponcd. attach a brief zsplaration to describe cause and corrective
<br />actions t:3:cn. sod reference each ~ie~ution by c.dc
<br />1 I. !f"no discharge" a:.urs Burin; r^..m;tonn~. ~•~ iod, r:n;cr ".b'u lJi.ccharge" across form in place of data entry.
<br />12. Enter "A'umeTalc ojPrinnpn~ psecuri:, OJ/;cr;" with ".S+gnarure -~jPnncipa! Execunive Officer ojAunhorized
<br />APenn," "Te?cphorc Nvmber," and "Date" ~; bannm of form.
<br />l3. Mail cigned Repor.:o OlTce/s; by datz(s) spc~ilicd iu permit. Retain copy for your records.
<br />14. More daail,d instructions fc: use of Pius Disr,~m~c!;onilcrin~ iiep.,r: (D.tl,?I form may be obtained from Office(s)
<br />specified in permtt.
<br />~.a~al Notice
<br />This report is required by law (33 U..S.C. 131R; tiD C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result is civil pe~shies out to evicee:] S~i0.000 per dad of ~.ielaticn; or in criminal penalties not to exceed 525,000 per day
<br />ol'violalion, or by imprisurmen: for not more than rn~ ~ ear, or by boD+.
<br />EPA Form 3720-1 IFsev. :t8-9!)
<br />
|