|
<br />Paperwork Deduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some majorfacilines,
<br />with a weighted average for major and minor facilities of ?8 hours per response, including time for reviewingt
<br />instructions, searching existing data sources, gathering anc maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for ;educing the burden, to Chief, Information Policy
<br />Branch, PM-223, US. Environmental Protection Agency, 401 Li Street, SW, Washington, DC 20460; and to the
<br />Office of Information altd Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If farm has been partially completed by preprihting, disiegazd tnstnictiQns d$eete`eptry o~ that=information-.
<br />already preprinted. - '~' . -
<br />2. Enter :'Permittee Name/.Yiaaing Address (and facility namenocation, if different);' "Permit Number;' and
<br />"Diseharge Number" where indicated. (A separate form s required for each discharge.)
<br />3. Enter dates beginning and ending "Monitoring Period"' co~.cred by Form where indicated.
<br />4. Enter each "Parameter' as specified in monitorng requi emerts of permit.
<br />5. Enter "Sample ltfeasurement" data for each parameter u.uLr "Quantity" and "Quazliry" in unia specified in permit.
<br />"Areragn" is normally a~thmetic average (gzometric ace~age for bacterial parameters) of all ;ample measure-
<br />nenfs iar each parmetzr obtained Burin; ",4fa+iitwing Period": "dfasimum" and "Minimum" are normally ex-
<br />treme high anti fow me:~iur~mencs obtained Buono "d:~, ritnrirtg Period." (Note to municipals with secsmdary
<br />treatment ~e,,aire.;zer;~-: %.ntcC 30-day adera~e of sa-np e ,:~~~,~s.;~ene~ts under ':-ivearge;' and enter maximum
<br />.-day averagz of samp;~ measurem.r.[s o~rtained duria, -.nri;or,ng perioA under ' llae~~;lum.")
<br />b. Ln~er "Pr;r-. (1 Rrgvirerneat" fay each }-araiacr.: ~.,nder '~(2~.rr:¢'Q~' and "Qualip~" L; <E;eatizd in permit.
<br />7. Under"`'a F," ente' ~~ ~r,lier otstmple -uusu,em~n~, ~~ nr~ f~unimria pe,iaC r;~~t ~~ceed midmum (emd!or
<br />mirimum o. --0ay average u anprupi ~,.t~) o.tmi[ r~~,..;,._ :cn~, for each paurtn~[~r. If ncr.~~, enter "0"
<br />°. Euo,:r "rrU,:~,~e~~ry of:L~aly~sis" i~oria a> '~~tn_n'd ,',ist,u.:~i°rn~' 'actae. f~equer~,. of ,zmhli.~e and analysis u:ed
<br />during mmiiterin~ period) and as "Pent=it Rerviirement" ~-~~.cifi•~d in permit (~.,.. Enter "Cont." [or continuous
<br />monitorire,' [ ~T' `or anc r, ay pet ^.ce4:, "t; ,0" for nn:' J.~y ~;~er r~ont`r."(,iri0" r~r „nc ,I i; eer yus:rcr, rte)
<br />9. cn~z - "Sanipfe Type', hoth >_, `Snmaie =lear,urernent" (u_; ael sample type u>~-" ,,. i~ ~g - ..~ :onnl; peric~) and .~
<br />.'emrtr Tegrircmc~~t;' (cam;., Th:er "';.eh" fur ~,ndi~~du~'. ,- r "7 ~ "' - ' umposite, ,~,: ~° for eon-
<br />iinuous mon~t~rin~, ccc)
<br />.~. _
<br />10.E"Where violations of permit requi:cm?t-ts are reported, ntt°ch a brief r,?ilana^on to rye=.crl-c ca~i~c and <orrecr~.c
<br />acnnrs ~~:: n, and a`er~nce each ~:idatiun by darr_.
<br />; ~ "no Jig-h ' nerir, d t_-n~ nro~.irur! n~riq~', "nr~ r -~,o , :a .~.~~u_:: Cori-. ~lac~ .~r tea ectq'.
<br />;' l:~t.- n'~ure.',~t'r f 'r. ~e~"f ,_..,. d.a .., - ',l Prr.~tint I•,ccarv, Olt:~_r ~~~ Autho~::._
<br />.1~et~t '~r?cnRnrre_.u,-r;h~ `3ni1"Date".., ~~'omu(;or„r~
<br />o , ,
<br />I? 1~: _.i~.: ~ K~pert t'~~ t)rfce(s) b}' date(~i nc ~ _,_ ~ ~~r,nrir. ~._ ~ in ~op~~ torcou; rrcunl;.
<br />1s. ,o.ur. de.a -ed „_t.tr. ions `or ,,~c of _ri Lsri 2,r-~ Il. , ~; a, .~.i /.',Sort It)?1?; `o~ ~.. _ a or.,inr.1 In•m O[-
<br />is: (~l soe~;fied :n ?rro~it.
<br />legal i~v;~!i~i
<br />T;-r,a .eps ~ i.. .u~rr~_ - „v ;3., l_"_ C~. 3' t; C I.R_. ;'_~ '_~ ). f~~ ..a ,. -~ r.~~~i . „ ,,, _ .. '.o rc-p v, . ;n L::r: ..
<br />~It 1.. C-.,~ ,^...n -;..: ;i1' ~. ...~ __,i ~~ U,.~''t~ 4~~ Oi'-u'.l:i JfC Or ::1 fClll'1 '.'I ~'.'. .- ~ NCR: Ce,; J~~.'gltl pCl ~ .
<br />fi"Infl-.OI;, Vr Jy ;mp~~.-.."~.-. .: _.. _ i-l ni:~; ;rl', "_hV I]OtI'
<br />
<br />
|