|92-15-7 (7/91)-27¢ NEWYORKSTATEDEPARTMENTOFENVIROMENTAL CONSERVATION

DIVISION OFWATER

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14 Old Route 199 Red Hook, NY 12571 845-244-0129 C3ND ENVIRONMENTAL 2A =a Enter any other comments, observations, operating problems, equipment failure, etc lowData Type Type MWICM2 Effluent REMARKS |tuforf | eee a a | jsat}os} | t00% | | jsunfoafIMonfos}ftuefos} || aa | (eeeesgee(eea ar Wed}or} | t0.0% | too PO a | t00% | too Fi foo} |es 2t00% | 100% SSes bsatfiof | t00% ftom PO Mon 2}a|ee) t00% ftom LS | i a a wea] 1a{ | | 100m | 100m | ——4dY SSCS... trufis|Fifties] | t00% | LL, SACCOCOCSCOCO..CCCCCCTCTTTTTTTTTTTTTCCSY| Ea Ed ee| 00% | (SSa(|ge! Monf—_— a (ey (eee yee ofes| LSee| Fwea| 21 | | oe100m | i100% || [———SSSSOCOCTCCY] CCC rot | | 10% | 100% | 1 | p23 t00% ftom PO |sat} 2a] | | Isunf25f| SS| IMonf26f | ee |tuefa7{ of a Wed} 28{ | LS ee ne ee the faea a eeSSeee ee : 2 ee |e Seee)es 30 day flaw-weighted avg.(1) Monthly 30 day Geometric Maan (1) 1 1 1 a (1) Refer to current edition of "Notice to SPDES Permitees Regarding Use of the National Pollutant Discharge Elimination System (NPDES) Discharge Monitoring Report Form” for procedures to calculate loadings, flowweighted average, geometric mean, maximum minimum, percent ramoval, etc. ----- End of picture text -----

Note: Refer to current SPDES permit for spacific monitoring requirements, Sample type for chlorine residual and fecal coliformsis grab.

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Effect on Receiving Stream Name and amount of chemicals used in treatment process Sludge Removal from Plant: a. Chlorine Ibs. b. Solid Content % ey b. Sodium Hypochlorite gal. C. Volatile Solids Content % a es c. soda Ash ibs. d. Disposal Site Superior Sanitation — rya)RS (SNor Ibs. ee ——eses ee ee Ibs. (S| ee (ee) Amount of electrical power consumed Other Solid Waters: (a (es a. Commercial kilowatt hours a. Screening cubic feet eS ee eee b. Stand-by kilowatt hours Cb . AshesGrit tonscubic feet po} Amount of tuet consumer d. | (ees Gee a. Natural Gas cubic feet e. es) (ees 6b O) gallons 6) ..22.._____|_ (ees | eens | (ees c. Gasoline gallons g. Disposal Site Private hauler eees ee ee | tons |e Se ee ! ceeee e.f. DigesterPropane Gas cubicgallons feet Digester Gas Wasted cubic feet po Labor expended: a po Supervisor PC po Chief Operator po pert po Mechanic rerers ee es ees SS ees esOpQO esesfp(OQ Fp OO en(es(QO Yd nn 0 eefyOO GO(oO OS a | aes eee | hereby affirm under penality of perjury that information proided on this form is true to the best of my knowledge and belief. False statements made Ey, | eee, eee herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. | | ee a S |e (eee Signatdre of Chief Operator/or Designated Facility Representative ee | ees (eee - |es ieee esee ae ----- End of picture text -----