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Monthly Report Of Operation Activated Sludge Type Wastewater Treatment Plant 10829 - Indiana

Monthly Report Of Operation Activated Sludge Type Wastewater Treatment Plant Form. This is a Indiana form and can be used in Water Department Of Enviromental Management Statewide .
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Name of Facility Permit Number Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant 1/1/ Substitute for State Form 10829 (R/12-2005) Month Year Plant Design Flow Telephone Number mgd Facility's e-mail address (if available): Certified Operator: Name Class Certificate Number Expiration Date Page 1 of 4 Man-Hours at Plant (Plants less than 1 MGD only) Bypass At Plant Site ("x" If Occurred) Collection System Overflow ("x" If Occurred) Air Temperature (optional) CHEMICALS USED Lbs/Day or Gal./Day Lbs/Day or Gal./Day RAW SEWAGE CBOD5 - lbs (optional) Precipitation - Inches Susp. Solids - mg/l Phosphorus - mg/l Influent Flow Rate (MGD) Susp. Solids - lbs (optional) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Average Maximum Minimum No. of Data I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. (SIGNATURE OF CERTIFIED OPERATOR) (DATE) (SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR AUTHORIZED AGENT) (DATE) American LegalNet, Inc. www.FormsWorkflow.com Ammonia - mg/l Chlorine - Lbs CBOD5 - mg/l Day Of Month Day of Week pH Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant Name of Facility Permit Number For Month Of: Year (SIGNATURE OF CERTIFIED OPERATOR) (DATE) Page 2 of 4 PRIMARY EFFLUENT Susp. Solids - mg/l Substitute for State Form 10829 (R/12-2005) (SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR AUTHORIZED AGENT) SECONDARY RETURN SLUDGE (DATE) AERATION MIXED LIQUOR FINAL EFFLUENT E. Coli - colony/100 ml EFFLUENT Sludge Vol. Index - ml/gm Settleable Solids % in 30 minutes Dissolved Oxygen mg/l Dissolved Oxygen mg/l Residual Chlorine Contact Tank Residual Chlorine Final Susp. Solids - mg/l Susp. Solids - mg/l Susp. Solids - mg/l 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Avg. Max. Min. Data Comments for the Month (major repairs, breakdowns, process upsets and their causes, inplant treatment process bypass, etc.): American LegalNet, Inc. www.FormsWorkflow.com Phosphorus - mg/l Temperature - F CBOD5 - mg/l CBOD5 - mg/l Day Of Month Volume - MG pH Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant Name of Facility Permit Number For Month Of: Year (SIGNATURE OF CERTIFIED OPERATOR) (DATE) Page 3 of 4 Substitute for State Form 10829 (R/12-2005) (SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR AUTHORIZED AGENT) (DATE) Flow Effluent Flow Rate (MGD) BOD FINAL EFFLUENT Total Suspended Solids Susp. Solids - lbs/day Weekly Average Susp. Solids - mg/l Susp. Solids - mg/l Weekly Average Ammonia Ammonia - lbs/day Weekly Average Other Susp. Solids - lbs CBOD5 - lbs/day Weekly Average CBOD5 - mg/l Weekly Average Ammonia - mg/l Weekly Average Effluent Flow Weekly Average Ammonia - mg/l 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Avg Max Min Data Percent Removal Primary Treatment Secondary Treatment Tertiary Treatment Overall Treatment MONTHLY REMOVAL SUMMARY BOD5 S.S. Ammonia Total Monthly Flow: Phosphorus (million gallons) Percent Capacity (actual flow/design) Ammonia - lbs CBOD5 - mg/l Day Of Month CBOD5 - lbs American LegalNet, Inc. www.FormsWorkflow.com Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant Name of Facility Permit Number For Month Of: Year (SIGNATURE OF CERTIFIED OPERATOR) (Date) Waste Act. Sludge Gal. x 1000 Gas Production Cubic Ft. x 1000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Avg. Max. Min. Data Send completed forms by the 28th of the month to: Indiana Department of Environmental Management Office of Water Quality, Mail Code 65-42 100 North Senate Avenue Indianapolis, Indiana 46204-2251 American LegalNet, Inc. www.FormsWorkflow.com Temperature - F Primary Sludge Gal. x 1000 Day Of Month pH Digested Sludge Withdrawn hrs. or Gal. x 1000 Supernatant BOD5 mg/l or NH3-N mg/l Total Solids in Incoming Sludge - % Volatile Solids in Incoming Sludge - % Substitute for State Form 10829 (R/12-2005) Page 4 of 4 SLUDGE TO DIGESTER Anaerobic Only (SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR AUTHORIZED AGENT) (Date) DIGESTER OPERATION Total Solids in Digested Sludge - % Volatile Solids in Digested Sludge - % Supernatant Withdrawn hrs. or Gal. x 1000
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