Page 4 of 4
Effect on Receiving Stream
| Effect on Receiving Stream | Effect on Receiving Stream | Effect on Receiving Stream | Effect on Receiving Stream | Effect on Receiving Stream | Effect on Receiving Stream | Effect on Receiving Stream |
|---|---|---|---|---|---|---|
| Name of Receiving Stream | ||||||
| Shanty Hollow Creek | ||||||
| Date | ||||||
| Station | ||||||
| Parameter | ||||||
| Result | ||||||
TRUCKED WASTE RECEIVED THIS MONTH
==> picture [178 x 56] intentionally omitted <==
----- Start of picture text -----
1- Septage, holding tank waste and portable toilet waste Total Max day 2- All other wastes Total Max day ----- End of picture text -----
==> picture [65 x 12] intentionally omitted <==
----- Start of picture text -----
Volume (Gal.) 2- All other wastes ----- End of picture text -----
-
3- Number of Part 364 haulers currently approved to transport wastes to this POTW
-
a.Septage,etc
-
b. All others
|||m plant: #REF!|m plant: #REF!| |---|---|---|---| ||||| |||ontent|| |||Superior Sanitation|| |||s:|| ||||| ||||| ||||| ||||| ||||| ||||| ||||| |||ted|| |POSITION NAME|NUMBER FULL TIME|NUMBER PART TIME|TOTAL HOURS| |Operator|||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| ||||| |||||
I hereby affirm under penalty of perjury that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law
Leslie A Coon Jr.
Signature of Chief Operator or Designated Facility Representative
Date