Monthly Report Of Operation Activated Sludge Type Wastewater Treatment Plant {10829}

Name of Facility Permit Number MONTHLY REPORT OF OPERATION ACTIVATED SLUDGE TYPE WASTEWATER TREATMENT PLANT State Form 10829 (R4 / 3-14) Month Year Plant Design Flow Telephone Number mgd 3/1/ CHEMICALS USED Lbs/Day or Gal./Day Lbs/Day or Gal./Day E-mail address: Certified Operator: Name Class Certificate Number Expiration Date Man-Hours at Plant (Plants less than 1 MGD only) Precipitation - Inches Bypass At Plant Site ("x" If Occurred) Collection System Overflow ("x" If Occurred) Total= RAW SEWAGE Air Temperature (optional) Susp. Solids - mg/l Phosphorus - mg/l Influent Flow Rate (if metered) MGD Susp. Solids - lbs 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 Prepared by or under the direction 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 Signature of principal executive officer or authorized agent information, the information submitted is, to the best of my knowledge and (or attested by NetDMR subscriber agreement) 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 5 American LegalNet, Inc. www.FormsWorkFlow.com Date (month, day, year) Date (month, day, year) Ammonia - mg/l Chlorine - Lbs CBOD5 - mg/l Day Of Month Day of Week CBOD5 - lbs pH MONTHLY REPORT OF OPERATION ACTIVATED SLUDGE TYPE WASTEWATER TREATMENT PLANT State Form 10829 (R4 / 3-14) Name of Facility Permit Number For Month Of: Year PRIMARY EFFLUENT Settleable Solids % in 30 minutes AERATION MIXED LIQUOR RETURN SLUDGE SECONDARY EFFLUENT FINAL EFFLUENT E. Coli - colony/100 ml Sludge Vol. Index - ml/gm pH - daily high (if multiple samples) 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 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.): Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Phosphorus - mg/l pH - daily low (or single sample) Temperature - F CBOD5 - mg/l CBOD5 - mg/l Day Of Month Volume - MG MONTHLY REPORT OF OPERATION ACTIVATED SLUDGE TYPE WASTEWATER TREATMENT PLANT State Form 10829 (R4 / 3-14) Name of Facility Permit Number For Month Of: Year Flow 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 Oil & Grease (mg/l) Effluent Flow Rate (MGD) Susp. Solids - lbs CBOD5 - lbs/day Weekly Average Effluent Flow Weekly Average CBOD5 - mg/l Weekly Average Ammonia - mg/l 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) Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Ammonia - lbs CBOD5 - mg/l Day Of Month Day of Week CBOD5 - lbs MONTHLY REPORT OF OPERATION ACTIVATED SLUDGE TYPE WASTEWATER TREATMENT PLANT State Form 10829 (R4 / 3-14) Name of Facility Permit Number For Month Of: Year 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 Page 4 of 5 Temperature - F Primary Sludge Gal. x 1000 Day Of Month pH American LegalNet, Inc. www.FormsWorkFlow.com Digested Sludge Withdrawn hrs. or Gal. x 1000 SLUDGE TO DIGESTER DIGESTER OPERATION Anaerobic Only Total Solids in Incoming Sludge - % Supernatant BOD5 mg/l or NH3-N mg/l Volatile Solids in Incoming Sludge - % Total Solids in Digested Sludge - % Volatile Solids in Digested Sludge - % Supernatant Withdrawn hrs. or Gal. x 1000 MONTHLY REPORT OF OPERATION ACTIVATED SLUDGE TYPE WASTEWATER TREATMENT PLANT State Form 10829 (R4 / 3-14) Name of Facility Permit Number For Month Of: Year Substitute for State Form 30530 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 Day Of Month 1 2 3 4 5 Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com