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Monthly Report Of Operation Package Type Wastewater Treatment Plants Less Than 0.05 MGD 53344 - Indiana

Monthly Report Of Operation Package Type Wastewater Treatment Plants Less Than 0.05 MGD Form. This is a Indiana form and can be used in Water Department Of Enviromental Management Statewide .
 Fillable pdf Last Modified 1/11/2008
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Monthly Report of Operation Package Type Wastewater Treatment Plants Less Than 0.05 mgd State Form 53344 (8-07) Bypasses/ Overflows Influent Flow Rate If Metered (MGD) Collection System ("x" if occurred) At Plant Site ("x" if occurred) Name of Facility Permit Number Phone Number: Exampleville WWTP Certified Operator: Name Class Certificate Number IN0000000 Expiration Date E-mail Address (if available): Chris A. Operator 1/1/200Month: #: 1 V Name: 9999 Year January 6/30/ 2001 2008 Aeration Tank Treatment Plant design flow: 0.04 mgd General Information Day of the Month Day of the Week Precip. - Inches Raw Wastewater Phosphorus (mg/l) 30 Minute Settling Phosphorus (lbs) Ammonia (mg/l) Ammonia (lbs) Final Effluent Effluent Flow Rate (MGD) Sludge Vol. Index (SVI) - ml/gm CBOD (mg/l) CBOD (mg/l) Temperature CBOD (lbs) CBOD (lbs) Man Hours TSS (mg/l) TSS (mg/l) WAS Gal. TSS (lbs) 1 Tue 2 Wed 3 Thu 4 Fri 5 Sat 6 Sun 7 Mon 8 Tue 9 Wed 10 Thu 11 Fri 12 Sat 13 Sun 14 Mon 15 Tue 16 Wed 17 Thu 18 Fri 19 Sat 20 Sun 21 Mon 22 Tue 23 Wed 24 Thu 25 Fri 26 Sat 27 Sun 28 Mon 29 Tue 30 Wed 31 Thu Average Maximum Minimum Total 0 0 0 Sludge Hauled Off Site (Gal): 0 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 (month, day, year ) Signature of principal executive officer or authorized agent Date (month, day, year ) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com TSS (lbs) MLSS D.O. pH pH Name of Facility: Month/Year: Exampleville WWTP Total Monthly Flow January Percent Capacity (average flow / design) 2008 Percent Removal MONTHLY REMOVAL SUMMARY BOD5 S.S. Ammonia NA NA NA Enter Comments Below: Phosphorus NA 0 mg Final Effluent Phosphorus (mg/l) Residual Chlorine (mg/l) - Contact Residual Chlorine (mg/l) - Final Day of the Month Phosphorus (lbs) Ammonia (mg/l) Ammonia (lbs) E. Coli colony/100 ml 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 D.O. (mg/l) Signature of Certified Operator Send by 28th of the Month to: Date (month, day, year ) Indiana Department of Environmental Management Office of Water Quality, Mail Code 65-42 100 North Senate Avenue Indianapolis, Indiana 46204-2251 Signature of principal executive officer or authorized agent Date (month, day, year ) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com
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