Laserfiche WebLink
Paperwork R:eduction Ate°I V~.;~. if: e <br />Public reporting burdzn Err this r~~l ltaioo of infi•rmanun is eslimatul iu .,i,y ~nr ran~z of 10 ~,,uc: as an <br />average per response for .,erne mm~ a facilities, to 110 hours as an averagz p: r r~ -,~~ ~n+:. fur .gym,: ma;or fa:'.ilines <br />with a weighted average for ma}or anJ minor facilities of l8 hour.+ p~:r rc~lun~~~, ~.n~~ludtn~ uen., for r.;~iewing <br />instructions, searching existing da!a sources, gathering and mainniimng I+ d:0.u nz.•dzd, and cnmplehug ad <br />reviewing the collection of information. Send cormnents regarding thz bur}eo : •urnete ur anv other :aspect of <br />this coltection of infortnaliun, including suggestions fur reducing this bu.deu, w Chief, Inlotatation Policy <br />Branch, PM-223, U.S. Envrronmenld~.l Protection A.geocy, 401 M Street, SW Wa~;hingtun, DC 7(1460; anJ to the <br />OFI-ice of Lrformation and 12egulatory Affairs, Office of Management and Bud;et. W i~hmgton, DC 20503. <br />General Instructions <br />1. If form has been partially completed by preprinting, disregard instructions direaed at entry of that information <br />alrrady preprinted. <br />2. Enter "Permittee Name.:44ai(ing ,Address (and facility name location, if di(ferenQ," "Permit Number," and <br />'Discharge Number" where indicated (A separate form is required for each disch:ageJ <br />3. Enter dates beginning and coding ':4/oniroring Period" covered by form where indicated. <br />4. Enter each 'Parameter" as specified m monitoring requirements of pernut. <br />5. Enter "Sample A-leasvrer~r~ n!" data for each parameter under "Quantity" an.l "(iualitr" m units specified in permit. <br />"Average" is normally arithmetic atrrage (geometric average for banenal liar rncler,) of all sample measurements <br />for each parameter obtained during ".lloniloring Period'; "Afaximurn" .u+d "li;;i riu+u" arc normally e~areme high <br />and low measurements obtained dtring "alunitoring Period." (Not:: to ^i,inicipals with secondary treauncnt <br />requirement Enter 30-dav average of sample measurements under " Irergr;~," tnd enter mavmum "!-,lay average <br />of sample measurements obtained during monitoring period under ",tlax;uiu~+r "~ <br />6. Enler'Permi! RequiremenP' for each parameter under "Quantity" and "Qrm1,rV" ,LS slwcificd in ?ermit. <br />7. Under "No Fs" enter number of sample measurments during mondoring perod `.gat c~tted mss:irr.um (atn}/or <br />minimttm or 7-day average as appropriate) permit requirement for aach paramde: 1` conc. enter "0". <br />8. Enter "Frequency njAn.zysis" both as ':Sample alensvrnrenr" (actual .`rerlucnc} +~` svnplin;g and a~~llysis r:..:d <br />during monitoring penal) and as "r'enuit Requiremen!" specified in pernut (e.};. Enter "(~)nl," fie! wntinacis <br />monitoring, "(/7" for one day per ~a•eek, "li3U" for one day per month, "/ ~0" fo~ one d.ry per quarter, c::.) <br />9. Enter "Sample Type" both as "Stnnp(e ,LfeasuremenP' (actual sample hZ"; +sed drrv~c monitoring period) atul s <br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "'~H"" For .'; hour composite, "A'!A" for <br />continuotrs monitoring, e[c.) <br />10. Where violations of perrrut regturenients are reported, attach a brief esplanaU?n to tlscribe cause and correcti,z <br />actions lake0. and reference each violation by date. <br />11. If'no discharge" occurs during monitoring period, enter "No Discharge" acrrss form in place of data eiary <br />12- Enter "Name/I'ille of Principal Fxecuhve Officer" with "Signature o11'rmrrp,r~ Iir:virve OyTicer q.'.?uthnrc; d <br />Agent," "Telephone Number," and "Date" a[ bottom of form. <br />l3. Mail signed Report to Vice(s) by date(s) specified in permit. Retain cop? for your records <br />14. More detailed instntdions for use of this Discharge rLloniforing Report (U'.fl•J form m.:y be obtained from Office;:) <br />specified in permit. <br />Legal Notice <br />This report is required by law (33 U.S.C 1318; 40 C.F.R. 175.27). Failuro to report nr fai'are to report truthfully c:m <br />testtlt in civil penalties not to exceed $ l0; J00 per day of violation; or in criminal :~znahios no' to excx i S25,G(Kl pet d:.. <br />of vio4tioa, or by imprisonment for not more than one year, or by both. <br />IEPA Fotm 7J20.1 (Rev. OS-95) <br />