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Public reporting bcrdeu for to , collecuun of infcnnation is esCmated to son from a range of 10 hoc , u- an
<br />average per response for sums minor Facilities, to; .0 hours as an average per response for Some major `.r.ili .es, '
<br />with a Heighten areragc fur major and m nor farliries of IR hours per response, including time (or rc~i-~.:ing ~
<br />instructions, searching axisting data sources, gathering and maintaining the data needed, and compl.N .g and
<br />reviewing the collection of in "urmation. Send comments regardme the burden estimate or any other as~cct of
<br />this collection of information, including vcggest.ous for reGucing this burden, to Chief, Information Policy i
<br />Branch, YM-223, U.S. Environmental Protection Agency, 401 Al Street, SV1, R'ashing[on, DC 2tyt60; anc to the !
<br />Office of Information and Regulatory Affairs, Office of Managemem and Budget, Washing[on, DC 205113.
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<br />1. If form has been partially completed by prep:i,tting, disregard instrucr.ons directed at entry of that information
<br />already preprinted.
<br />Z. Enter "Penui[ee Nenre/Mfa[ling Address (and facility namcilucation, if different)," "Fermi[ i\'u„7ber,"and
<br />"DischargeNun:•ber" where indicated. (A sepetate form is required for each discharge.)
<br />3. Enter dates beginning and ending "hloni[orbtg Period" covered by corm where indicated.
<br />4. Enter each "Paranre[er" as specified in monitoring requirente-tts of permit.
<br />5. Enter "Sarnple AAeasuremenr" data for ezch parameter under "Quantity" and "Quality" in units specifi_d in parmit.
<br />"Average" is normally arithmetic accr~ge (geometric average for bacterial parameters) of all sample measure-
<br />ments for ezch parameter obtained during "Aionitoring Period"; "Maximum" and "Minimum" are normally ex-
<br />treme high anc low measurements obtained during "rYlonirorirrg Period. " (?otote to municipals viah sccar~an
<br />7:r_teert rc_ire~t~~t; Enter 30-da1~ average of sample measurements under "Average," and enter rcz~imum
<br />7-clay average ol'sample measurements obttined during monitoring period under "Maximum. ")
<br />5. Enter "Fermi[ Reyuirentertt" for each parameter under "Quantity" and "Quality" as specified in penrit
<br />7. Under '7Jo E.r" enter number of sample mea;.trements durine mortitorine period that exceed maximum (acdi or
<br />minimum or 7-day average as appropriate) permit requiremcct for each parameter. If none, enter "0. '
<br />9. Winter "Frequency o;'Analvsis" both as "Sarnple ,Y/easure~nenr" (actual frequency of sampling and znaly:is [,sed
<br />during monitoring period) and as "Pernrit Requirement" specified in permit. (e.g., Enter "Cone, "for xntinuou,
<br />monitoring, '7/7" for one day per seeck, "1 /3l)" (or one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample Aleasurenrenr" (actual sample type used during monitorine pcrio: j a.td as
<br />"Fermi[ Reyniren:en[."(e.g., Enter "(?rah" for individual sample. "24HC' fur 24-hour composite, ".Vi.1' lot cun-
<br />tinuousmonitoring, ect.)
<br />10. 41'hcrc yiolaunns of permit requiremen s azc repcned, attach a bticf c~r!anation to describe cttusc and a ra;'ve
<br />actions taken, and rferencc each v olutiun by date.
<br />11. [f "no discharee" uru~, c 't Ong n:uuitoring period, enter '.Ne Discharge" acros Corm in plax o`d.[t, entry.
<br />12. Enter "Name/T'ida ~ r ~--r r•' . /ral E.'xecu[i ve Oflicer" wil h "Si,4namtre of Pritrri~al E~~erur~ yeJ„beer r,'~. , rr;rori; ed
<br />Agent. " "Trlcp;rum \:,n;.,cr, "and "Cote" at botrom of loon.
<br />73. \1; it si,,:.mod Root t.~ C tI ~~~;s) ;,c dz'..(s) s~eri'i:d mt permit. Retair. cope fe-your rocords.
<br />1d. l[ore ve,ailed inst.t ~:~ur,t~ "~r ~,. ,~(~h•, Disc.' ~!~ce,l4uniroring Report iD.!ANJ form mad he o~taicul ~~ nn Clf-
<br />fice(s) specified in p:nni!.
<br />~.t'~,t~ _'~FJ~~r,'~~
<br />7hi•• spurt is required b . ~~~• ("• -.S.C. !; ++: F.)'.h. 125.x;1. ! .,.,; o repot ur failure ::~ report trot:' uli) an
<br />rc<ult in civil penaltic. m t i e• .d ;ll1 C ` p;- uas of s iolatioir o. .~ u. 'n;il p,naltics not to c•:rced S25,f :: ;xt sh,~
<br />of sio!a(itm ur b>' ~m~ri, n .: -.t r r na ~io~a than c to year, or by bait.
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