**SIU -** **CIU Compliance Report when EPA or State is the Control Authority**  **Required by EPA Regulations**  **- 403.12(e) and (h)** 

**Example Data Entry Form**  [ **Note:** Users will also be able to batch this data into this form via a spreadsheet or CSV file. ] 1. SIU/CIU NPDES Number < system generated> 2. Start Date of Reporting Period (YYYY- MM - DD ) 3. End Date of Reporting Period (YYYY- MM - DD ) 4. NPDES Data Group Number 8 <system generated> Non -Significant Categorical Industrial User (NSCIU) Certification to Control Authority : [ Note : Click on the above box if you are certifying that you are a non -significant categorical industrial user (NSCIU). If you are certifying that you are a NSCIU then you will be presented with a statement to certify and submit. The remainder of this for m is for SUI and CIUs. ]**Effluent Monitoring Data**

**INSTRUCTIONS:** Please use the Monitoring Location drop down list to view the monitoring requirements and limits that apply to your facility . [Note: For each NPDES ID there may be more than one monitoring location (or “Permitted Feature ID”) for each SIU/CIU . ] Monitoring Location: **E ffluent Monitoring Data**  **(Data Entry by SIU/CIU)** Parameter Quantity or Loading Quality or Concentration Number of Exceptions Frequency

of Analysis Sample

Type Average Max Units Min Average Max Units

* Sample Measurement * * Permit Requirement * * * * * * * *

* Sample Measurement * * Permit Requirement * * * * * * * *

* Sample Measurement * * Permit Requirement * * * * * * * * * Note: These data on limits and required monitoring will be auto- populated when the user makes a selection with the above Monitoring Location dropdown list. These data will only be viewable by the SIU/CIU . Check here if no discharge at this monitoring location for entire reporting period

### Standard Signature Block and Certification Statement for CWA Reporting (in compliance with CFR Parts 3, 122.22, and 127). **Narrative Condition and Permit Schedules INSTRUCTIONS:**  Please use the following table to enter dates and create attachments to this form for any Best Management Practices (BMP), special monitoring, or additional reporting requirements that might apply to your facility. Please check the box in the “Add Attachments” column to attach any BMP compliance statements, additional monitoring activities, or reports to this fo rm fo r each unique narrative condition. Narrative Condition Number Narrative

Condition Description Code Narrative Condition Event Schedule Date Actual

Date Add

Attachments (as necessary) * * * * * * * * * * * * * * * * * Note: These data on narrative conditions and schedule dates will be auto- populated and only be viewable by the SIU/CIU . [ **NOTE:** Narrative conditions and schedules specify additional requirements in addition to the effluent monitoring requirements and mig ht include Best Management Practices (BMP), special monitoring, or additional reporting requirements (e.g., toxicity reduction evaluations). Where the narrative condition contains a schedule or a reporting requirement, ICIS – NPDES considers the condition to be date- based. An example of a date - based narrative condition would be a requirement for the SIU/CIU to submit progress reports to the Control Authority by a certain date for the construction of a wastewater treatment system . Narrative Conditions that d o not establish a schedule or reporting are considered non - date- based (e.g., requirement for the SIU/CIU to develop and maintain a Best Management Practices (BMP) plan ).]

SUBMIT REPORT