NJ _. T-VWX-014 Page 1 of 2 MONITORING REPORT - TRANSMITTAL SHEET

Transcription

1 T-VWX-014 Page 1 of 2 MONITORING REPORT - TRANSMITTAL SHEET NJPDES NO. NJ _ _ _ _ _ _ _ REPORTING PERIOD MO. YR. MO. YR. _ _ _ _ THRU _ _ _ _ PERMITTEE, Name Address FACILITY Name Address Telephone ( ) FORMS ATTACHED (Indicate Quantity of Each) SLUDGE REPORTS - SANITARY T-VWX-007 T-VWX-008 T-VWX-009 SLUDGE REPORTS - INDUSTRIAL T-VWX-010A T-VWX-010B WASTEWATER REPORTS T-VWX-011 T-VWX-012 T-VWX-013 GROUNDWATER REPORTS VWX-015(A,B) T-VWX-016 T-VWX-017 NJPDES DISCHARGE MONITORING REPORT EPA FORM OPERATING EXCEPTIONS YES NO DYE TESTING TEMPORARY BYPASSING DISINFECTION INTERRUPTION MONITORING MALFUNCTIONS UNITS OUT OF OPERATION OTHER (Detail any "Yes" on page 2 in appropriate space.) NOTE.- The "Hours Attended at Plant" on page 2 must also be completed for each treatment works. AUTHENTICATION - I certify under penalty of law that I have personally examined and am familiar with the Information submitted in this document and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe the submitted information is true, accurate and complete. I am aware that there are significant penalties for submitting false information including the possibility of fine and imprisonment LICENSED OPERATOR Name (Printed) Grade & Registry No. Signature Date PRINCIPAL EXECUTIVE OFFICER or DULY AUTHORIZED REPRESENTATIVE Name (Printed) Title (Printed) Signature Date

2 T-VWX-014 Page 2 of 2 OPERATING EXCEPTIONS DETAILED HOURS ATTENDED AT PLANT Month _ _ Year _ _ Day of Month Licensed Operator Others Day of Month Licensed Operator Others

3 FORM RMS-16 ENGINEERS CERTIFICATION OF ANNUAL INSPECTION OF RESIDUALS-STORAGE TANK Permit Facility Name NJPDES Permit Number Tank I.D. Number The annual inspection of the above referenced residuals storage tank was conducted on (date). The tank and appurtenances have been inspected for: 1. Leakage from the tank, piping, vacuum hose connections, etc. 2. Bursting potential of tank 3. Mixing equipment, aeration equipment, transfer equipment, venting and alarm performance. 4. Odor control. 5. Overflow control and alarm panel performance. 6. Spill control and maintenance. 7. Corrosion, splits and perforations to tank, piping and vacuum hoses for residual transfer The tank and appurtenances have been inspected for all of the above and have been determined to be: Acceptable Unacceptable Conditionally Acceptable (list necessary repairs and other conditions): I certify under penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe the submitted information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment (N.J.A.C. 7:14A-2.4(d)). Name (print): Seal: Signature: Date: NOTE: A Certification Form must be completed for each storage tank

4 INSTRUCTIONS FOR COMPLETION OF FORM RMS-19A "STORAGE INSTALLATION MANIFEST SHEET" Page I of 2 Use these instructions for completing Form RMS-19A, "STORAGE INSTALLATION MANIFEST SHEET". It is required that the permittee keep an accurate record of the amount of each residual which is delivered to and removed from each storage area. Use the STORAGE INSTALLATION MANIFEST SHEET to record and report these actions. Use a separate sheet for each storage area. IDENTIFICATION: Enter the name of the STORAGE INSTALLATION.Each storage area should be on a separate sheet. Enter the type of operation where storage is available. Enter the name and NJPDES number of your operation Enter the quarter which this report summarizes. If more than one STORAGE INSTALLATION MANIFEST SHEET is required to report all deliveries or removals from a given storage installation for a given quarter, then the storage installation name, operation, NJPDES number and Qtr/Year blanks should be entered on each sheet, and shall be clearly labeled as an addendum to the first. MANIFEST INFORMATION A separate line should be used for each delivery or removal of residuals at this storage installation. STARTING BALANCE: Enter the Starting Balance of the amount of residuals in this storage area before any removal/delivery takes place. Column A: Column B: Enter DATE of removal/delivery of sludge to/from this storage installation. - Enter the AMOUNT added from this storage installation. Addition of material is indicated with a "+". Each "load" which is delivered to this storage installation need not be given a separate line; multiple load deliveries from a single sludge source on the same day may be summed for that day and entered as a single entry. Column C: Enter the AMOUNT removed from this storage installation. Removal of material is indicated

5 INSTRUCTIONS FOR COMPLETION OF FORM RMS-19A "STORAGE INSTALLATION.MMIFEST SHEET" Page 2 of 2 with a "-". Each "load" which is delivered to this storage installation need not be given a sbparate line; multiple load removals from a single sludge source on the same day may be summed for that day and entered as a single entry. Column D: Column E: Enter the transfer DESTINATION. This is where the residuals are to be transferred to. Enter the BALANCE of material remaining in the storage installation after the action is completed. This value should equal the STARTING BALANCE plus the addition or minus the removal of residuals reported on any given line.

6 Form RMS-19A: IDENTIFICATION STORAGE INSTALLATION MANIFEST SHEET Page of STORAGE INSTALLATION OPERATION: NJPDES # : QTR/YEAR The permittee shall complete the information required below for each Treatment Works Approved (TWA) residual storage installation associated with your operation. This form shall be kept up to date and submitted with each quarterly report.. (A) DATE OF ACTION: (B) Quantity ADDED (+) (C) QUANTITY REMOVED STARTING BALANCE (D) TRANSFER DESTINATION (E) BALANCE I

7 INSTRUCTIONS FOR COMPLE'TION OF FORM RMS-19B "SLUDGE SOURCE MANIFEST SHEET" Page 1 of 1 Use these instructions for completing Form RMS-19B, "SLUDGE SOURCE MANIFEST SHEET". It is required that the permittee keep an accurate record of the amount of each residual which is collected and transported to the permitted operation. Use the SLUDGE SOURCE MANIFEST SHEET to record and report these actions. Use a separate sheet for each month. * Enter the name of the Processing operation * Enter the Month and Year that this report summarizes. A separate sheet must be completed for each month. * Enter the Name of the Residual Generator. This is where the residuals were collected from. * Enter the NJPDES Permit Number, if the operation is in New Jersey and has been assigned one. * Enter the Quantity Received Each Month. This number represents the AMOUNT of sludge received from the Residual Generator for processing. It may be expressed in dry pounds or gallons. * Total at the bottom of the page the amount of residuals collected from residual generators for processing. Each "load" need not be given a separate line; multiple load collections from a single residuals generator in the same month may be summed for that month and entered as a single entry.

8 Form RMS-19B: SLUDGE SOURCE MANIFEST SHEET Page of Processing Facility: Month/Year The permittee shall complete the information required below for each wastewater treatment plant from which residuals are collected and transported to the permitted operation. This form shall be kept up to date and submitted with the quarterly report for the permitted operation. Name of Residual Generator NJPDES Permit No. (if applicable) Quantity Received Each Month (dry l b or gal) TOTAL