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<br />F`aperv~roriC R.etlec*i~~~. Ac ~:.:~lotice `~
<br />~ Public relnning burden for this collection of information is es[ima.[ed t: •:aq~ from a range of ]0 hours as an
<br />-verage pu- r~sf,e,csu fn.' sow e tumor facilities, to 110 hours as sr r~~err-t;c :zr rest.onse (or some major facilities,
<br />I •:ith a weigF~:ed average for -°jor and minor facilities of 18 hours per ~ :,ponsa, i¢cluding time for reviewing
<br />insln:cGons, ce::~bir~e c:;is'~o;; dzh~. scurces, gathering and mainla~riay `: dsbi needed, and completing and ~
<br />' .e~~iewd~tg tl'. cellecin,: of^"nTatiun. Sand comments rogariug c :~de~ csii.T^L nr any other as)recl of
<br />ibis colleaico ..f inforna[irn, includurg suggestions fnr rec!-d,.; 'v~ ~.~~~c~ee, to C'~e~, !nformatien Polcy
<br />'dra¢ch. PM-227, U.S. Environ meo[a Protection Agency, ~O1 Si 5: tee:, .-;, cNrsaingto n, DL 20460; and to he
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<br />Office of 'nfnrmxtion and Regulatory Affairs, Office of ?•'anngeme rt a¢d - ~dgei, ':arashiegto¢, DC 20503. i
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<br />General Icy ;: °~..~cftior~s
<br />. iF form has been partially :ompleted by preprinting, disrega.~C iostr.~ ~~~ors eirected at entry of [hat i¢formatio¢
<br />already preprinte~.
<br />2. E¢[er "Permittee .1'ome.LJci/i~tg Address (and facility narn~~Acca!~-~~, if c:i3'crent)," "Permit ,Vumber," and
<br />"Dirchurge ?umber" whc-e indicated. (A separate form is regr.iizd fo ~ ach discharge.)
<br />3. Enter dabs beginning and ending 'SHatitoring Period" covered by forty •:: sere indicated.
<br />4. Enter eact'i'ararae!er"ass;:ccified'nmonitoringrequircmcrvsofpcr;it.
<br />7 Enter "Semple 6,2•e.+-rren art" daa far each parumctr under "1 •anlihi rod "Qve!ih," in units speci.~ed in permit.
<br />:: very Ke' , ~ o"ri•t]'; ~ i~h-:_C~c:t~~-age (geo r^.etnc acciagr, b' bectc '~ ~a'2 mdeR) of aL' s: mple mt:asurem:rh
<br />fcr each ;u r2:~e!r:r eIlaircr during "'.~~rnitorirg P~o~ivd", ".Iloriu+mr,' ,d ^,:',nimum' are no;^nally e.ctreiac high.
<br />and 'pct, ~mevurr;~:-.ts eb'.ee~ during `;lforilonng Prr,oo'.' (Vc to tnunicipr~ls with seenndarp U:2uma,:
<br />rcquiremen+~ E:+'er '0-d t~ ° ~c~~gc ~`' w,:nptc me^srr_menls ~irdcr " :~.~e,~ege," and enter :+av mum 7-.}a~ a"~era„c
<br />cf sample me~suremcros rE!eined durng monitoring period under ",'Jai ,emu.;i.'~
<br />u. Enter':'rrm,+ Reyvt:~arrr„!' :orca~l~ parameter ~!ndcr "Quonti,y aid "Q~rnlify" as sp+-~~ied in ~ennit.
<br />7. Under "`.'n ' rntrr :. , ._- o' s ~n-1c me:_surments ~u ing non.~ta'ng peiod ti'at crosd rrurximum (ard/er
<br />rr.ini~nun or 7-day at a-a~c 's ~p ~rop~at-) Permit rcquiremer' far cac` ~c'amctrr. it none, enb:r "G"
<br />3. crle~ "F~eq,.rncv nfA:~-h~.cis" 'aa'.F• as ".S'nn:ple .lleanu•ment' (acW-! ~-equcnc} of sampling and analy,ls ,rsx'.
<br />during moot L•rin~ pc*~ec) ~~c rs '.~erni~ Heq vtrement" specif eG `r. -~,n:[ (e g., Sac "C bnt," `or rnrlinuous
<br />coon aotir g, ' i ~7" fa or . ;~ pert, ecr;, "1 r3G" for ore day per n'onth, ' 9G' nor one clay per gcartcr, clc.)
<br />9. Enter lCcmp'^ T pr" bo!'~t rs "Snr::ole ,Ueasvrement" (erlual s~.nple ' ~~: tsu_ d.ui t;; monitoring pcriedl and as
<br />"Pc-m! .fey.:irerarr'," (_.;;., Entc~ "(irnb'~ for ind+cidual e:~rple, ~? 7(C"ror Z1-hour composite. "?':1" fa!'
<br />comin coos monitoring, c'.c.)
<br />IJ. Wh~re :iala~ions of per. :ii ~equir_; eats are reported, a'.tach: bete r :tlrradnn to describe :ause and caTertivc
<br />actions taken, an:'. reference each violation by d:.tc.
<br />I i. 1`"ro dis.harge" occ:ors during monitoring period, emer "A'e Dischargr' across fom in pace of dzta entry.
<br />"n. Entu: "N~me/fitlc oJPri,rcipe! £.:eCU:`ve Officer" vilh ".Signature q'Principal Fxec+.~ti:~e C~cer af.1ulhori~ad
<br />Agent," "Tele,~hcne ~t'nmber," and "Date" at bot.om of form.
<br />i 3. T.tail s,gned Report In CI`c~(s) by d: te(a) specified in permit Regain copy for your records
<br />l~. A'fo:'r. rletniled instructions fs asc of Uus Dischnrge A9aritoring Report rD,tIRJ form may be obtained from Office(s)
<br />specified in pcrrcil.
<br />Legali Nol:ice
<br />Ta`s repor^. is re~uir.:d by late ;33 J.S.C. 138; 40 C.F.R. !25.Z7). ?ailur. [o report or failure [o report truthfiilly can
<br />:cs-.:I[ in civil pc¢ahies not to e>.a:~.l ;``10,000 ner day of violation; or is cyan: psi :;eealties not to exceed S25,D00 per day
<br />of +iolation, or by impr.sonment for not -Wore than one year, or by ho~h.
<br />s;F;;. Farm 732}-1 (Rev. CE-95;
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