Pretreatment Annual Report Template For Publicly Owned Treatment Works Page 5
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8H. Identify all waste haulers that discharge to the POTW and include the following information:
N/A
Type and
Method for
Waste Hauler
Source of Waste
Permitted?
Verifying Loads
Point of Discharge to WWTP
Yes
No
Yes
No
Yes
No
Yes
No
I. Provide the following information regarding SIU compliance schedules (CS) that are currently in effect:
N/A
SIU Name
Date Issued
Completion Date
Reason for CS
J. Significant Non-Compliance
1. List all industrial users which were in significant noncompliance (SNC).
N/A
Published in
Action taken by IU
IU Name
Local Newspaper
Reason for SNC
to achieve compliance
Yes
No
Yes
No
2. Attach a copy of the publication tear sheet.
N/A
K. Did the Control Authority make any of the following changes to the Pretreatment Program? Describe the changes.
1. Administrative structure
Yes
No
2. Local Discharge Limitations
Yes
No
3. Monitoring Parameters/Frequencies in Industrial User Permits
Yes
No
4. Legal Authority or Enforcement Policy
Yes
No
5. Funding mechanism, resource requirements or staffing levels
Yes
No
L. Describe the current sludge disposal method(s) and any proposed or planned changes.
M. Estimate the annual budget for the Pretreatment Program.
N. List all multi-jurisdictional agreements and identify SIUs within each jurisdiction.
N/A
O. Please attach a copy of the signed and dated adoption of the most recent local limits into the local sewer use
ordinance (or comparable document).
P. General Comments:
DEP / DOW
Revised October 2014
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