|
e'a~ I! ; ,~~tsr~{ lied+a~:'.°'!n A(:1: ~~cc~:tiif~e
<br />
<br />
<br />~,utt a ~..~:~h!~J air:_to ~ :r,,:;.: ,
<br />
<br />n~,.i::~~a:~:e Ihr ~uil:~l:.:n .. ,,.i.:.... .
<br />
<br />Gram h. Pi.1 X23, il.S G.•. :n I, o.. ~ ri
<br />Offixnf Intixmaticn.rnd ~ .gc.mc...)
<br />. ~~ ., ~t ~,.,(,,;m..ti,,n is zstirnatrJ t~ :.u~• (tom a range of IO hours iu all
<br />, .. ..~ ." ` :+n evera~e per ~esF:once for some major faciiities,
<br />.: ~~ a•u Iv. ~'.. ~ ~ -~ ~nurs pr• rr ~t"r.i~•z, cneluding time for reviewing
<br />..` .. ., ,..;L,i u.:~ r, n Ir...i ncerJrd, and completing end
<br />__, J ~~;mor~uL; rognr~,':~.e .... a:!c: ~,tirrute or any other aspe.^.t of
<br />r.~r.'iun+ fur rrducmg ~lu~ I~..d.ri, to Chlef, lnformatioa Policy
<br />:,n:. lion :lgrncy, 401 M Street ;,'! 'r,'vhington, DC 20460; and U) [he
<br />leirs, Otfice of M1lanagement ami 3: Sct, lVa;hington, DC 20503.
<br /> General Instruction
<br />I. IF form bas been partially cnm.{': ~uul by preprinting, disregard instrmaions directed at entry of that information
<br /> already przprm[ed.
<br />2. Enter 'Pennirtee ?,'o~~,..i'tlciGr,K Iddress (arid facility rtame/locaeicn. if di6erenq," "Permit Number," and
<br /> "Discharge .4'unrhrr" ~•. h_re ic~.in:, CCd (A separate form is required (or each rscharge.)
<br />3. Enter dates begrnnir,g .: 1 cna' t=, '.t L,nrruring Period" crovered by form ~. here indicated.
<br />4. Enter each "Pararr~r:c. ` _; 6p:r i: :[1 m monitoring requirements of per nit.
<br />5. Enter ".Smnple,lL•.•~ I ~1::a;;h pnramcler under "Quanlu/' and "Quality" in ttnnts specified in permit.
<br /> ".)rernge" is norr •'I, .. ..::~ac (geometric average for baeicnal par::meters) of all sample measurements
<br /> `,reach pararacle: +'.` ~ ~1'~nitrn'm}; .^rrn„f, "A/oxi•rrum" an.l ",Vin4nunr" are no[mally extreme high
<br /> and low measure -:: c,:!~}g "Vonnur.r,K /'ermd" (Note IJ municipals with secondary treatment
<br /> raluiremcnr. Enter 7' _ ;.f ~:imple mr6L cn,alns under "dveroge." and enter maximum 7-day average
<br /> of sample measurc.rlc...: ~.5.;_a_.I : gyring monitoring penod under "Afmi,n rnr. ",
<br />v. Enter "Per,nr( F,cy:n,, ~:: ,:" ~-,~ :a:nt i~r under "Quantity" and ":' u..l~0%' ar specJed in permit.
<br />7. Under ".\'o E'x" es!u • , ... .. ._~ ,Nle u!casurmcnts during monit~aiu period that exceed maximum (and/or
<br /> minuuum or 7-dav av~_L.. ~ _ _ . ,ci;~le) permit requirement for each panamcl.er If none, enter "0".
<br />3. Gne: 'Trrquencv :,f ,~ "`,~,nrp/• :./ca,urnrenf' lacnral frequency of sampling and analysis used
<br /> duru g monitoring pc. ~:: ; :: ' "': r•nrt Hryuurna•nP' s,,cclfied in pcrrnit. (cg., Enter "Goof," for continuous
<br /> monho~ ing, „/ 7" `or .'• ~ .. k, "1 .:n" (a one d::} t cr month, "/ '9;1" for tine day per quarter, etc.)
<br />~.%. iJn~ti ':Sur::ple T)~F:;" ~.~. - . ~.~',• ikasureun•n(' (actual sample t7Pe usal during monitoring period) and as
<br /> '1', rrnn Reyuirrm~n. " e, F ~ r:a "~ %rab" for indroidual sample, "'J//C"' for 23-horn composite, "ti/A" for
<br /> continuous momtor;n {...u )
<br />10. t~4lere 'aol:aions ~ r , - t ,:. ,. ~cncias arc IepOrted, attach a bncf C\plana:IDll to describe cause and corrective
<br /> actions taken, and ref_re I~.c eac}' : lo;atien b}' date.
<br />i?. !(",:o discharge' a:c. rs .' .,:. ~ :' =i.i~,l:mg pi:riod, enter ",Vo Discharge" across form m place of data entry.
<br />12. Enter ".':ame•Ti(le u~ r`„•riG:.; ,._n,.~e Ujficer" frith "S'i,gna(ure ojl'rmcipul Execv(ive Officer ojAuthorized
<br /> Agcnl " '7elephone A~:,~~'; r, ...•_ "Uaa•" at bouom of form.
<br />13. ~,f;iil ;igred Report tc C•':!_e(s)'uv ~..nr.(s) specified in permit. Retain ropy Gar }our records.
<br />l4. Alorc detailed inslruc,.o a :ia ;• . „'!.:; Discharge :tlnni(nnng Repot( (T'Al'RJ Corrn may be obuained from Office(s)
<br /> spenfied in permit.
<br /> Legal Notice
<br />"pis rrp~nt is req::i,rd },y ..: (i': t'.~ ~ !l!s; .;0 C.F.R. 125.27). Failure t.. rcporl oR failure to repoA Wthfully can
<br />~• >uit is •.i. ~~ +,~na'!irs nut ~, . t:: , d ; : '.,~ i_' ;;~r a:y of vu:!ation; or in orinunl,i p:nallie:; not to exceed 525,000 per day
<br />c f vicia4c•n, or oy imprisoi ^~t a, (.,r r,l ~• .. ~: than one }'ear, or by Fwth.
<br />F.t'A t'orcr 339-1 (c2ev. G , . `t
<br />
|