Form 5900-01 SIXMON, Six- Month Monitoring Report

OMB No. 2060-0336, Approval Expires
04/30/2012

Federal Operating Permit Program (40 CFR Part 71)
6-MONTH MONITORING REPORT (SIXMON)
Section A (General Information)
Permit No. ____________________
Reporting Period: Beg.____/____/________ End.____/____/_______
Source / Company Name ___________________________________________________________
Mailing Address: Street or P.O. Box ________________________________________________
City ________________________________________ State______
Contact person __________________________________
Telephone (______) ______ - __________ Ext. ________

Continued on next page

EPA Form 5900-01

ZIP__________ - ______

Title ___________________________

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Section B (Monitoring Report)
Summarize all required monitoring, data, or analyses required by the permit for the reporting period.
Describe and cross-reference the permit term and list the emission units (Unit IDs) where the monitoring
was performed. Indicate whether a separate monitoring report is required, and if required, enter the date
submitted. If submitted for the first time as an attachment to this form, assign an attachment ID, mark
the attachment with that ID, and attach the report to this form.
Monitoring, Data, or Analysis (describe and cite):

Emission Units (Unit IDs):
Separate Report? ___ Yes ___ No

Date____/___/________

Attachment ID _________

Monitoring, Data, or Analysis (describe and cite):

Emission Units (Unit IDs):
Separate Report? ___ Yes ___ No

Date____/___/________

Attachment ID _________

Monitoring, Data, or Analysis (describe and cite):

Emission Units (Unit IDs):
Separate Report? ___ Yes ___ No

Date____/___/________

Attachment ID _________

Monitoring, Data, or Analysis (describe and cite):

Emission Units (Unit IDs):
Separate Report? ___ Yes ___ No

Date____/___/________

Attachment ID _________

Monitoring, Data, or Analysis (describe and cite):

Emission Units (Unit IDs):
Separate Report? ___ Yes ___ No

EPA Form 5900-01

Date____/___/________

Attachment ID _________

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Section C (Deviations Already “Promptly” Reported)
Summarize all deviations from permit terms already reported on form PDR during the reporting period.
Copy this page as many times as necessary to include all such deviations. Describe and crossreference the permit terms and report the start and end dates and times of the deviations (mo/day/yr,
hr:min). Use the 24-hour clock. Also specify the date when the written deviation report was submitted to
the permitting authority (If written report required, but not submitted, leave the date field blank). Note
that failure to submit a deviation report, or late submittal, is a deviation that must be reported in the
Section D.
Permit Term for Which There was a Deviation:

Emission Units (unit IDs):
Deviation Start _____/_____/_________ ____:____

End:_____/_____/_________ ____:____

Date Written Report Submitted ____/____/________

Permit Term for Which There was a Deviation:

Emission Units (unit IDs):
Deviation Start _____/_____/_________ ____:____

End:_____/_____/_________ ____:____

Date Written Report Submitted ____/____/________

Permit Term for Which There was a Deviation:

Emission Units (unit IDs):
Deviation Start _____/_____/_________ ____:____

End:_____/_____/_________ ____:____

Date Written Report Submitted ____/____/________

Permit Term for Which There was a Deviation:

Emission Units (unit IDs):
Deviation Start _____/_____/_________ ____:____
Date Written Report Submitted ____/____/________

EPA Form 5900-01

End:_____/_____/_________ ____:____

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Section D (Deviations Reported Semiannually)
This section is for deviations reported for the first time in this six-month monitoring report. Describe and
cross-reference the permit terms and emission units that apply to the deviation. Copy this page as
many times as necessary to include all such deviations. Report the beginning and ending times
(mo/day/yr, hr:min) for each deviation. Use the 24-hour clock. Briefly explain (if known) the probable
cause of each deviation. If any corrective actions or preventative measures have been taken to avoid
these in the future, briefly describe the measures, including when they occurred.
Permit Term (for Which There is a Deviation):

Emission Units (unit IDs)
Deviation Start: ____/____/________ ____ :____

End: ____/____/_______ ____:____

Probable Cause of Deviation:
Corrective Actions or Preventative Measures Taken:

Permit Term (for Which There is a Deviation):

Emission Units (unit IDs)
Deviation Start: ____/____/________ ____:____

End: ____/____/_______ ____:____

Probable Cause of Deviation:
Corrective Actions or Preventative Measures Taken:

Permit Term (for Which There is a Deviation):

Emission Units (unit IDs)
Deviation Start: ____/____/________ ____:____
Probable Cause of Deviation:
Corrective Actions or Preventative Measures Taken:

EPA Form 5900-01

End: ____/____/_______ ____:____

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INSTRUCTIONS FOR SIXMON
6-MONTH MONITORING REPORT

Information Collection Burden Estimates
The public reporting and recordkeeping burden for this collection of information is estimated to
average 221 hours per respondent per year. Send comments on the Agency's need for this
information, the accuracy of the provided burden estimates, and any suggested methods for
minimizing respondent burden, including through the use of automated collection techniques to the
Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200
Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any
correspondence. Do not send the completed form to this address.
DETAILED INSTRUCTIONS
Section A (General Information)
The contact person should be a person familiar with the day-to-day operation of the facility, such as a
plant site manager, who should be available to be contacted by the permitting authority. If there is
more than one contact person, list the others on an attachment.
Section B (Monitoring Report)
Summarize all monitoring required during the reporting period and provide information on any separate
monitoring reports submitted at this time or any time during the reporting period. Each individual
monitoring requirement should be included in a separate row of the table. Copy section C of this form
as many times as necessary to address all monitoring requirements.
Describe and cross-reference the relevant permit term that requires monitoring, data collection or
analysis. Be specific with regard to test methods or analytical techniques used, and the air pollutant or
parameter monitored. The cross-reference to the permit term should be as precise as possible.
Monitoring is a method of assuring compliance with permit terms. Monitoring may include instrumental
or non-instrumental methods, including continuous emissions monitoring, periodic readings of
parameters related to operating conditions, stack tests using EPA reference test methods, vendor or
laboratory analytical testing, manual inspections, visual observations, work practice checks, and
recordkeeping that confirms a requirement has been met.
You may list multiple units if all are subject to the same monitoring requirements. In addition, for
monitoring that applies to the permitted facility as a whole or to all units at your source, you may enter
Afacility-wide@ in the emissions unit column.
Indicate whether a separate report is required for the monitoring described above. If a separate report
was submitted prior to the submittal of this form, indicate the date; if it is being submitted for the first
time with this form, assign an attachment ID in the space provided, mark the attachment accordingly,
and attach the separate monitoring report to this form.
Section C (Deviations Already “Promptly” Reported)
Summarize all deviations from permit terms reported in writing prior to the submittal of this monitoring
report, such as those reported using PDR. Include all deviations that were required to be reported, but
not reported or not reported by the deadline. Note that all deviations that occurred during the reporting
period should either be reported in this section or in section D.

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Deviations from permit terms occur when any permit term is not met, including emission control
requirements and compliance assurance methods (monitoring, recordkeeping, and reporting). For
example, the following are examples of deviations: (1) emissions that exceed an emission limit; (2)
parameter value that indicates that an emission limit has not been met; (3) observations or data that
show noncompliance with a limitation or other requirement; (4) an exceedance or excursion as
defined in 40 CFR part 64 (CAM); (5) required monitoring that is not performed; and (6) failure to
submit a report. You also must include deviations from permit terms that occur during startup,
shutdown, malfunction, and upset conditions. A deviation is not necessarily a violation; violations will
be determined by EPA (or its delegate Agency).
You may list multiple emission units here if they all had deviations of this permit term and they all
occurred during the same time periods. In addition, you may enter Afacility-wide@ in the emissions unit
column, if appropriate.
You may indicate continuous periods of deviation that span multiple days in a single entry. Use the
24-hour clock (equivalent to military time) for reporting these times (e.g., the day starts and ends at
midnight, 12 a.m., or 00:00 in military time.
Specify the date when the written deviation report was submitted to the permitting authority. Leave the
date field blank if you did not submit a written report during the reporting period.
It is a deviation to submit a required deviation report (whether required by telephone, fax, or in writing
within 24 or 48 hours) after the deadline or to neglect to submit it at. Such deviations must be reported
in Section D.
“Emergencies” (as defined in part 71) are also considered deviations. However if the reporting
requirements of part 71 for emergences are met, they may not necessarily result in noncompliance.
Note that although the terms Aupset,@ Astartup,@ Ashutdown,@ and Amalfunction@ refer to conditions
that are not defined in part 71, the applicable requirements may define these terms, and all deviations
during such conditions are deviations. Also note that the applicable requirement itself may define the
term Adeviation@ or refer to Aexcess emissions;@ and any such occurrences should also be reported
as deviations on this form.
Section D (Deviations Reported Semiannually)
Report those deviations required to be reported for the first time in this 6-month monitoring report.
Note that all deviations not included in section C should be included here. Copy this page as many
times as necessary to report all such deviations.
Cross-reference the permit term for which there is a deviation and describe the requirement.
List the emission units (Unit IDs) where this deviation occurred. You may list multiple units here if they
all had deviations of this permit term and they all occurred during the same time periods. In addition,
for deviations of permit terms that impose requirements to the permitted facility as a whole or to all
units at your facility, you may enter Afacility- wide@ in the emissions unit column.
Identify the time period (beginning and ending) over which the deviation occurred. You may indicate
continuous periods of deviation that span multiple days in a single entry. Use the 24-hour clock
(equivalent to military time) for reporting these times (e.g., the day starts and ends at midnight, or
00:00 in military time.
Briefly explain the probable cause of the deviation from permit terms, if known. Examples of possible
answers to this question include Aoperator error@ or Amechanical failure.@ Be as specific as possible.

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If any corrective actions or preventative measures were taken to avoid similar deviations at the same
emissions units, briefly explain them. Examples of possible answers to this question include Atrained
operator on proper operation of control devices@ or Arepaired defective equipment and will perform
routine maintenance on an accelerated schedule.@ If known, include dates when such actions or
measures were taken or will be taken in the future.
Form CTAC (Certification of Truth, Accuracy, and Completeness by Responsible Official)
You must complete form CTAC and attach it to this monitoring report.

EPA Form 5900-01