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Monthly Report Of Operation Activated Sludge Type Wastewater Treatment Plant Form. This is a Indiana form and can be use in Department Of Enviromental Management Statewide.
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Tags: Monthly Report Of Operation Activated Sludge Type Wastewater Treatment Plant, 10829, Indiana Statewide, Department Of Enviromental Management
Name of Facility
Exampleville
IN0000000
Month
Year
Plant Design Flow
January
2009
0.001 mgd
wwtp@city.org
Certified Operator: Name
Class
Mon
Tue
Wed
1
2
3
4
5
Expiration Date
9999
Susp. Solids - lbs
Susp. Solids - mg/l
CBOD5 - lbs
CBOD5 - mg/l
pH
Influent Flow Rate
(if metered) MGD
Lbs/Day or
Gal./Day
Lbs/Day or
Gal./Day
CHEMICALS
USED
Chlorine - Lbs
Bypass At Plant Site
("x" If Occurred)
Collection System Overflow
("x" If Occurred)
0
Precipitation - Inches
Air Temperature (optional)
Man-Hours at Plant
(Plants less than 1 MGD only)
Day of Week
Day Of Month
29
30
31
Total=
Certificate Number
V
RAW SEWAGE
Chris A. Operator
555/555-5555
6/30/2000
Ammonia - mg/l
Facility's e-mail address (if available):
1/1/200
State Form 10829 (R3 / 11-08)
Telephone Number
Phosphorus - mg/l
Monthly Report of Operation
Activated Sludge Type
Wastewater Treatment Plant
Permit Number
Thu
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Fill in December's effluent data on page 3 as necessary for
correct weekly average calculations.
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
21
22
23
24
25
Wed
26
27
28
29
30
31
Mon
Thu
Fri
Sat
Sun
Tue
Wed
Thu
Fri
Sat
Average
Maximum
Minimum
No. of Data
0
0
0
0
0
0
0
0
0
0
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, the information submitted is, to the best of my knowledge and Signature of principal executive officer or authorized agent
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.
0
0
0
0
Date (month, day, year)
Date (month, day, year)
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Signature of Certified Operator
State Form 10829 (R3 / 11-08)
For Month Of:
January
FINAL EFFLUENT
SECONDARY
Phosphorus - mg/l
Dissolved Oxygen mg/l
pH - daily low
(or single sample)
pH - daily high
(if multiple samples)
EFFLUENT
CBOD5 - mg/l
Volume - MG
Temperature - F
RETURN SLUDGE
Dissolved Oxygen mg/l
Sludge Vol. Index - ml/gm
Susp. Solids - mg/l
Settleable Solids % in 30
minutes
Susp. Solids - mg/l
CBOD5 - mg/l
Day Of Month
AERATION
MIXED LIQUOR
Susp. Solids - mg/l
PRIMARY
EFFLUENT
2009
E. Coli - colony/100 ml
IN0000000
Date (month, day, year)
Residual Chlorine Final
Exampleville
Year
Residual Chlorine Contact Tank
Permit Number
Susp. Solids - mg/l
Name of Facility
Date (month, day, year)
Signature of principal executive officer or authorized agent
Monthly Report of Operation
Activated Sludge Type
Wastewater Treatment Plant
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
Comments for the Month (major repairs, breakdowns, process upsets and their causes, inplant treatment process bypass, etc.):
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Monthly Report of Operation
Activated Sludge Type
Wastewater Treatment Plant
Signature of Certified Operator
Signature of principal executive officer or authorized agent
State Form 10829 (R3 / 11-08)
For Month Of:
IN0000000
January
Other
Ammonia - mg/l
Ammonia - mg/l
Weekly Average
Ammonia
Susp. Solids - lbs/day
Weekly Average
Susp. Solids - lbs
Susp. Solids - mg/l
Weekly Average
Susp. Solids - mg/l
CBOD5 - lbs/day
Weekly Average
CBOD5 - lbs
CBOD5 - mg/l
Weekly Average
CBOD5 - mg/l
2009
FINAL EFFLUENT
Total Suspended Solids
BOD
Effluent Flow
Weekly Average
Effluent Flow Rate
(MGD)
Day of Week
Day Of Month
Flow
Date (month, day, year)
Oil & Grease (mg/l)
Exampleville
Year
Ammonia - lbs/day
Weekly Average
Permit Number
Ammonia - lbs
Name of Facility
Date (month, day, year)
29 Mon
30 Tue
31 Wed
1
2
3
4
5
Thu
6
7
8
9
10
Tue
11
12
13
14
15
Sun
16
17
18
19
20
Fri
21
22
23
24
25
Wed
26
27
28
29
30
31
Mon
Fri
Sat
Sun
Mon
Wed
Thu
Fri
Sat
Mon
Tue
Wed
Thu
Sat
Sun
Mon
Tue
Thu
Fri
Sat
Sun
Tue
Wed
Thu
Fri
Sat
Avg
Max
Min
Data
0
0
Percent Removal
Primary Treatment
Secondary Treatment
Tertiary Treatment
Overall Treatment
0
0
0
0
0
0
MONTHLY REMOVAL SUMMARY
BOD5
S.S.
Ammonia
NA
NA
NA
NA
NA
NA
NA
NA
NA
0
0
0
0
0
0
0
0
Total Monthly Flow:
Phosphorus
(million gallons)
0
Percent Capacity
(actual flow/design)
NA
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Signature of Certified Operator
State Form 10829 (R3 / 11-08)
Name of Facility
Permit Number
For Month Of:
Exampleville
IN0000000
January
Date (month, day, year)
2009
DIGESTER OPERATION
Digested Sludge Withdrawn
hrs. or Gal. x 1000
Volatile Solids in Digested
Sludge - %
Volatile Solids in Incoming
Sludge - %
Total Solids in Digested
Sludge - %
Total Solids in Incoming
Sludge - %
Supernatant BOD5 mg/l
or NH3-N mg/l
Supernatant Withdrawn
hrs. or Gal. x 1000
Temperature - F
pH
Gas Production
Cubic Ft. x 1000
Anaerobic Only
Waste Act. Sludge
Gal. x 1000
Primary Sludge
Gal. x 1000
Day Of Month
SLUDGE TO
DIGESTER
Year
Date (month, day, year)
Signature of principal executive officer or authorized agent
Monthly Report of Operation
Activated Sludge Type
Wastewater Treatment Plant
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
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
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Signature of Certified Operator
State Form 10829 (R3 / 11-08)
Name of Facility
Permit Number
IN0000000
Exampleville
For Month Of:
Year
January
Date (month, day, year)
Signature of principal executive officer or authorized agent
Monthly Report of Operation
Activated Sludge Type
Wastewater Treatment Plant
Date (month, day, year)
2009
Day Of Month
Substitute for State Form 30530
29
30
31
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
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