Free 53343.xls - Indiana

Instructions for Monthly Report of Operation - Lagoon Type Wastewater Treatment Plant (State Form 53343)
Please direct questions or comments to Don Daily at 317/234-2579 or 800/451-6027 extension 4-2579, or by email to [email protected] . Note "MRO" tab at bottom of page. After entering the general information (name, permit #, etc.), save a copy (blank). The phone number and e-mail address should be the ones IDEM staff should contact with questions regarding your data. Once you've begun entering data for a month, save that file version under a new name so that you still have the blank version for future months. Entering the year and the number of the month allows the program to insert the names of the month and days. "Freeze Panes" has been used to keep row and column labels visible as you scroll. This feature can be turned off by selecting "Unfreeze Panes" under the Window menu selection. Do not use the space bar to remove data. This inserts a space character which may cause problems. Instead, use the delete key. Be sure the column headings match the data (eg change CBOD to TBOD if testing for TBOD). E. Coli - The formula in the "average" box actually calculates the geometric mean. The program converts "TNTC" to 63,200 and converts "0" to "1" when calculating the monthly geometric mean. As with any important computer file, you should save a backup copy to a floppy disk or other location on a regular basis. Cells containing formulas are "locked" to prevent accidental modification. Should you find it necessary to remove the cell protection, the password is: mro

Monthly Report of Operation Lagoon Type Wastewater Treatment Plant
State Form 53343 (8-07)
Bypasses/ Overflows Influent Flow Rate (MGD) Collection System ("x" if occurred) At Plant Site ("x" if occurred) Chemical Used (lbs)

Send by 28th of the month to: Indiana Department of Environmental Management Office of Water Quality 100 North Senate Avenue Mail Code 65-42 Indianapolis, IN 46204-2251

Name of Facility

Permit Number

Certified Operator:

Class

Certificate Number

Expiration Date

Month:

Year:

E-mail address:

General Information
Day of the Month Day of the Week Precip. - Inches Chemical Used (lbs)

Raw Wastewater
Effluent Flow Rate (MGD) Phosphorus (mg/l) Ammonia (mg/l)

Final Effluent
Residual Chlorine (mg/l) (Cont. Tank) Phosphorus (mg/l) Residual Chlorine (mg/l) (Final) Ammonia (mg/l)

Controlled Discharge
Upstream Gage Reading (in.) Last Cell Water Level (ft.) Upstream Flow (MGD)

1st Cell Water Level (ft.)

E. Coli colony/100 ml

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Avgerage Maximum Minimum Totals
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

Signature of Certified Operator Signature of principal executive officer or authorized agent

Date (month, day, year) Date (month, day, year)

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Dilution Ratio (Discharge / Upstream)

CBOD (mg/l)

CBOD (mg/l)

D.O. (mg/l)

TSS (mg/l)

TSS (mg/l)

pH

pH

Monthly Report of Operation Lagoon Type Wastewater Treatment Plant
State Form 53343 (8-07)

Name of Facility

Permit Number

For Month Of:

Year

Influent Loading
Day of the Month Phosphorus (lbs)

Effluent Loading
Phosphorus (lbs)

Enter Comments Below:

Ammonia (lbs)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Avg Max Min I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

Ammonia (lbs)

CBOD (lbs)

CBOD (lbs)

TSS (lbs)

TSS (lbs)

Removal Rates: Overall BOD removal: Overall TSS removal:

Monthly Totals: Influent flow (mg): Effluent flow (mg):

Signature of Certified Operator Signature of principal executive officer or authorized agent

Date (month, day, year ) Date (month, day, year )

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