Atch 1- 6a. Discharge Monitoring Report (SAMPLE).pdf
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- Wastewater Plant Operator
- Solicitation number
- W9124J-23-R-WWPO
About this file
This Discharge Monitoring Report template is for a wastewater treatment facility operated by the US Army Reserve in Nevada. It requires monitoring and reporting of flow volume and concentrations of various water quality parameters including BOD, TSS, nitrogen, pH, and petroleum hydrocarbons on a regular basis. Reporting is to the state environmental regulator to demonstrate compliance with the facility's NPDES permit. The related federal contract opportunity seeks a contractor to provide wastewater plant operator services at this facility. The contractor will be responsible for monitoring, testing, and reporting to ensure effective facility operation in accordance with the permit. All contractor employees working on the contract must hold a current Class III or higher wastewater operator certification from Nevada.
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Text version
PERMITTEE NAME/ADDRESS (Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved
Facility Name/Location if different) DISCHARGE MONITORING REPORT (DMR) OMB No. 2000-0015
NAME HQ, 63D Regional Support Command, US Army Reserve
ADDRESS P.O. Box 63 NEV2010504 NA
Moffett Field, CA 94035 PERMIT NUMBER DISCHARGE NUMBER
FACILITY US Army Reserve Center WWTF Leach Field MONITORING PERIOD
LOCATION Roark Ave. and Hinson St. Sloan, NV 89054 YEAR MO DAY YEAR MO DAY
FROM 14 10 01 TO 14 12 31
PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION
NO. FREQUENCY SAMPLE TYPE
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
EX. OF ANALYSIS
Flow Sample
Measurement 1980 6600 GPD Cont. Cont.
Permit
Requirement 7500 M & R Cont. Cont.
Effluent BOD5
Sample
Measurement 1 2 mg/l 1/30 Discrete Permit
Requirement 30 45 1/30 Discrete
Effluent TSS Sample
Measurement ND ND mg/l 1/30 Discrete Permit
Requirement 30 45 1/30 Discrete
Total Nitrogen Sample
Measurement 3.3 4.5 mg/l 1/30 Discrete as N Permit
Requirement 10 10 1/30 Discrete pH Sample
Measurement 7.3 7.5 7.6 pH 1/30 Discrete Permit
Requirement 6 6 – 9 9 1/30 Discrete
Total Petroleum Sample
Measurement ND ND mg/l 1/90 Discrete
Hydrocarbons Permit
Requirement n/a 1 1 1/90 Discrete Sample
Measurement
Permit
Requirement
NAME/TITLE PRINCIPAL EXECUTIVE OFFICER
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND AM
FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND 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. SEE 18 U.S.C.
§ 1001 AND 33 U.S.C. § 1319. (Penalties under these statutes may include fines up to $10,000 and/or maximum imprisonment of between 6 months and 5 years.)
TELEPHONE DATE
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. SEE 18 U.S.C. 1001 AND 33
U.S.C. 1319. (Penalties under these statutes may include fines up to $10,000 and/or maximum imprisonment of between 6 months and 5 years.)
TYPED OR PRINTED
SIGNATURE OF PRINCIPAL EXECUTIVE
OFFICER OR AUTHORIZED AGENT
AREA
CODE
NUMBER YEAR MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
PERMITTEE NAME/ADDRESS (Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved thomas.e.wiley Rectangle
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