Exhibit 06 - DMR - WCJC.pdf
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- Operation and Maintenance of Water and Wastewater Systems Umpqua National Forest (Various Locations)
- Solicitation number
- AG-04T0-S-17-0017
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Exhibit 06
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Discharge Monitoring Report - Oregon Department of Environmental Quality Facility Name Phone Number Month/Year I certify, under penalty of law, that this document and all attachments were prepared under
DEQ Permit No. DEQ File No./Facility ID EPA Reference No. my direction or supervision in accordance with a system designed to assure that qualified
Plant Type County Population Served personnel properly gather and evaluate the information submitted. Based on my inquiry of X the person or persons who manage the system, or those persons directly responsible for Authorized Signature Date
Operator Certification gathering the information, the information submitted is, to the best of my knowledge and belief, Collection Sys. Class Principal Operator Name (print) Certification No. & Grade true, accurate, and complete. I am aware that there are significant penalties for submitting
Treatment Sys. Class Principal Operator Name (print) Certification No. & Grade false information, including the possibility of fines and imprisonment for knowing violations. Name (Print)
INFLUENT EFFLUENT (identify outfall number -- e.g. 001, 002, 003):
•F BOD TSS •F BOD CBOD TSS NUTRIENTS DISINFECTION COLIFORM RECEIVING STREAM
•C Grab Comp. Grab Comp. •C Grab Comp. Grab Comp. Grab Comp. Grab Composite CHLORINE UV MPN MPN MPN •F
MF MF MF •C
S.U. MGD mg/L lbs. mg/L mg/L lbs. S.U. MGD mg/L mg/L % lbs. mg/L % lbs. mg/L % lbs. mg/L lbs. mg/L % N.T.U CFU/100 ml CFS S.U.
1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9
10 10 11 11 12 12 13 13 14 14 15 15 16 16 17 17 18 18 19 19 20 20 21 21 22 22 23 23 24 24 25 25 26 26 27 27 28 28 29 29 30 30 31 31
TOTAL TOTAL
DAILY MINIMUM DAILY MINIMUM
DAILY MAXIMUM DAILY MAXIMUM
WKLY. AVG. MAX. WEEKLY AVERAGE MAX.
MONTHLY AVG. MONTHLY AVERAGE
DAILY LIMITS DAILY LIMITS
WEEKLY LIMITS WEEKLY LIMITS
MONTHLY LIMITS MONTHLY LIMITS
mkbernard Typewritten Text Wolf Creek CCC mkbernard Typewritten Text 100064 mkbernard Typewritten Text Activated Sludge mkbernard Typewritten Text 541-496-3507 x8609 mkbernard Typewritten Text 90964 mkbernard Typewritten Text Douglas mkbernard Typewritten Text
OR-002321-3
mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Text Box Temp Avg Daily Max mkbernard Text Box Excess Therm Loading mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Text Box
X______________________________________________ Authorized Treatment Signature Date Print Name
X______________________________________________ Authorized Collections Signature Date Print Name
Discharge Monitoring Report - Oregon Department of Environmental Quality (Page Two) Facility Name Month/Year Explanation of exceeding permits limits: Description & cause, steps taken or plans to reduce, eliminate, & prevent DEQ Permit No. DEQ File No./Facility ID recurrence of noncompliance (attach additional pages if needed):
MAIL ORIGINAL TO: Notes:
Oregon Department Of Environmental Quality * Indicate test type for TSS, BOD, CBOD, nutrients, & coliform Western Region - Medford Office * If a sewer system overflow occurs at more than one location, attach an additional report 221 Stewart Avenue, Suite 201 * If groundwater monitoring is required, data reporting should be in accordance with permit conditions Medford, OR 97501 * For additional information, refer to the Oregon DEQ guidance document for completing DMRs
AERATION LAGOON OR SOLIDS AEROBIC ANAEROBIC SEWER SYS. SEWER SYS. RECLAIMED
BASIN POLISHING POND DIGESTER DIGESTER OVERFLOWS BYPASS WATER
PRIMARY CELL SECONDARY CELL Outfall ______ Outfall ______
Days S.U. S.U. mg/L Ft. Ft. mg/L S.U. Ft. mg/L S.U. Gal. % lbs./Gal. Gal. % S.U. Ratio S.U. Gal. Hrs. Gal. Hrs. In./acre In. Hrs./day
1 1 During this reporting period did 2 2 all monitoring data & sampling 3 3 frequencies meet permit 4 4 requirements & limits (If “no”, 5 5 explain)? Yes / No 6 6 7 7 During this reporting period were 8 8 there unanticipated bypasses 9 9 or upsets which exceeded any
10 10 effluent limits (if “yes”, explain)? Yes / No 11 11 12 12 During this reporting period was 13 13 there any sewer system 14 14 overflow (if “yes”, explain)? Yes / No 15 15 16 16 17 17 Energy Tracking (optional)
18 18 ENERGY USED COST COMMENTS
19 19 POWER KWH
20 20 FUEL GAS
21 21 OIL
22 22 23 23 24 24
25 25 26 26 27 27 Additional Notes (reference attachments here):
28 28 29 29 30 30 31 31
TOTAL TOTAL
DAILY MINIMUM DAILY MINIMUM
DAILY MAXIMUM DAILY MAXIMUM
WKLY. AVG. MAX. WKLY. AVG. MAX.
MONTHLY AVG. MONTHLY AVG.
DAILY LIMITS DAILY LIMITS
WEEKLY LIMITS WEEKLY LIMITS
MONTHLY LIMITS MONTHLY LIMITS
mkbernard Typewritten Text Wolf Creek CCC mkbernard Typewritten Text 100064 mkbernard Typewritten Text 90964 mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Text Box
OUTFALL #002
mkbernard Text Box
ACT%
mkbernard Text Box
SSV/30
mkbernard Text Box Min Wasted mkbernard Text Box
BOD
mkbernard Text Box
TSS
mkbernard Text Box Flow Drain Field mkbernard Typewritten Text
GPD
mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Typewritten Text mkbernard Text Box
OUTFALL #002
Nutrients mkbernard Text Box
MLSS
mkbernard Text Box GPD Flow to Digester mkbernard Text Box Total Phosphorus mkbernard Text Box
TKN
mkbernard Text Box Ammonia as N mkbernard Text Box Nitrate as N mkbernard Line mkbernard Line mkbernard Line mkbernard Line mkbernard Line mkbernard Line mkbernard Line mkbernard Line mkbernard Line
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