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Monthly Report Of Operation Vertical Loop Reactor Wastewater Treatment Plant 53341 - Indiana

Monthly Report Of Operation Vertical Loop Reactor 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 Vertical Loop Reactor Wastewater Treatment Plant State Form 53341 (8-07) Exampleville Month Year IN0000000 Plant Design Flow Telephone Number January 2008 1/1/200Facility's e-mail address (if available): Certified Operator: Name 0.002 mgd wwtp@city.org Class 555/555-1234 Expiration Date Certificate Number Chris A. Operator Man-Hours at Plant (Plants less than 1 MGD only) 0 Bypass At Plant Site ("x" If Occurred) Collection System Overflow ("x" If Occurred) Total= Air Temperature (optional) CHEMICALS USED Lbs or Gal Lbs or Gal V RAW SEWAGE 9999 6/30/2007 Precipitation - Inches Susp. Solids - mg/l Phosphorus - mg/l 0 0 Influent Flow Rate (if metered) MGD Susp. Solids - lbs 29 30 31 Sat Sun Mon Fill in December's effluent data on page 3 as necessary for correct weekly average calculations. 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 No. of Data 0 0 0 0 0 0 0 0 0 0 0 Ammonia - mg/l 0 CBOD5 - mg/l Chlorine - Lbs Day Of Month Day of Week CBOD5 - lbs pH 0 Signature of Certified Operator 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, Signature of principal executive officer or authorized agent 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. Page 1 of 4 Date (month, day, year ) Date (month, day, year ) American LegalNet, Inc. www.FormsWorkflow.com Monthly Report of Operation Vertical Loop Reactor Wastewater Treatment Plant State Form 53341 (8-07) Name of Facility Permit Number For Month Of: Year Signature of Certified Operator Date (month, day, year ) Signature of principal executive officer or authorized agent Date (month, day, year ) Exampleville IN0000000 REACTOR # 1 Sludge Vol. Index - ml/gm January 2008 REACTOR # 3 Sludge Vol. Index - ml/gm Settleable Solids % in 30 minutes REACTOR # 2 Sludge Vol. Index - ml/gm Settleable Solids % in 30 minutes RETURN SLUDGE Dissolved Oxygen mg/l Residual Chlorine Contact Tank Susp. Solids - mg/l FINAL EFFLUENT E. Coli - colony/100 ml Temperature in Reactors Settleable Solids % in 30 minutes 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Comments for the Month (major repairs, breakdowns, process upsets and their causes, inplant treatment process bypass, etc.): Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com pH - daily high (if multiple samples) Dissolved Oxygen mg/l Dissolved Oxygen mg/l Residual Chlorine Final Susp. Solids - mg/l Susp. Solids - mg/l Susp. Solids - mg/l pH - daily low (or single sample) Day Of Month Volume - MG Monthly Report of Operation Vertical Loop Reactor Wastewater Treatment Plant State Form 53341 (8-07) Name of Facility Permit Number For Month Of: Year Signature of Certified Operator Date (month, day, year ) Signature of principal executive officer or authorized agent Date (month, day, year ) Exampleville IN0000000 January 2008 Flow Dissolved Oxygen mg/l Effluent Flow Rate (MGD) Phosphorus - mg/l FINAL EFFLUENT BOD 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 0 0 Susp. Solids - lbs CBOD5 - lbs/day Weekly Average Effluent Flow Weekly Average CBOD5 - mg/l Weekly Average Ammonia - mg/l Weekly Average 0 0 Ammonia - mg/l 29 Sat 30 Sun 31 Mon 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 Avg Max Min Data 0 0 0 0 0 0 0 0 0 0 0 0 Ammonia - lbs CBOD5 - mg/l Day Of Month Day of Week CBOD5 - lbs 0 Percent Removal MONTHLY REMOVAL SUMMARY BOD5 S.S. Ammonia NA NA NA Total Monthly Flow: Phosphorus NA (million gallons) 0 Percent Capacity (actual flow/design) Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com Monthly Report of Operation Vertical Loop Reactor Wastewater Treatment Plant State Form 53341 (8-07) Name of Facility Permit Number For Month Of: Year Signature of Certified Operator Date (month, day, year ) Signature of principal executive officer or authorized agent Date (month, day, year ) Exampleville IN0000000 SLUDGE TO DIGESTER Waste Act. Sludge Gal. x 1000 January 2008 DIGESTER OPERATION 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 - % Anaerobic Only Supernatant Withdrawn hrs. or 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 0 0 0 0 0 0 Temperature - F Day Of Month pH 0 0 0 0 0 0 Volatile Solids in Digested Sludge - % Total Solids in Digested Sludge - % 0 0 0 0 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 Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com
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