Form 2c - Application For Permit To Discharge Wastewater - Existing Manufacturing, Commrecial, Mining And Silviculture Operarions - Idaho Department Of Environmental Quality Page 15

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PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY. You may report some or all of this information
.ID. NUMBER (copy from Item 1 of Form 1)
on separate sheets (use the same format) instead of completing these pages.
SEE INSTRUCTIONS.
OUTFALL NO.
V. INTAKE AND EFFLUENT CHARACTERISTICS (continued from page 3 of Form 2-C)
PART A –You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional details.
3. UNITS
4. INTAKE
2. EFFLUENT
(specify if blank)
(optional)
b. MAXIMUM 30 DAY VALUE
c. LONG TERM AVRG. VALUE
a. LONG TERM
a. MAXIMUM DAILY VALUE
(if available)
(if available)
AVERAGE VALUE
d. NO. OF
a. CONCEN-
b. NO. OF
(1)
(1)
(1)
1. POLLUTANT
ANALYSES
TRATION
b. MASS
ANALYSES
CONCENTRATION
(2) MASS
CONCENTRATION
(2) MASS
(1) CONCENTRATION
(2) MASS
CONCENTRATION
(2) MASS
a. Biochemical Oxygen
Demand (BOD)
b. Chemical Oxygen
Demand (COD)
c. Total Organic Carbon
(TOC)
d. Total Suspended
Solids (TSS)
e. Ammonia (as N)
VALUE
VALUE
VALUE
VALUE
f. Flow
VALUE
VALUE
VALUE
VALUE
g. Temperature
°C
(winter)
VALUE
VALUE
VALUE
VALUE
h. Temperature
°C
(summer)
MINIMUM
MAXIMUM
MINIMUM
MAXIMUM
i. pH
STANDARD UNITS
PART B – Mark “X” in column 2-a for each pollutant you know or have reason to believe is present. Mark “X” in column 2-b for each pollutant you believe to be absent. If you mark column 2a for any pollutant which is limited either
directly, or indirectly but expressly, in an effluent limitations guideline, you must provide the results of at least one analysis for that pollutant. For other pollutants for which you mark column 2a, you must provide
quantitative data or an explanation of their presence in your discharge. Complete one table for each outfall. See the instructions for additional details and requirements.
2. MARK “X”
3. EFFLUENT
4. UNITS
5. INTAKE (optional)
1. POLLUTANT
b. MAXIMUM 30 DAY VALUE
c. LONG TERM AVRG. VALUE
a. LONG TERM AVERAGE
AND
a. MAXIMUM DAILY VALUE
(if available)
(if available)
VALUE
a.
b.
CAS NO.
d. NO. OF
a. CONCEN-
b. NO. OF
BELIEVED
BELIEVED
(1)
(1)
(1)
(1)
(if available)
ANALYSES
TRATION
b. MASS
ANALYSES
PRESENT
ABSENT
CONCENTRATION
(2) MASS
CONCENTRATION
(2) MASS
CONCENTRATION
(2) MASS
CONCENTRATION
(2) MASS
a. Bromide
(24959-67-9)
b. Chlorine, Total
Residual
c. Color
d. Fecal Coliform
e. Fluoride
(16984-48-8)
f. Nitrate-Nitrite
(as N)
CONTINUE ON REVERSE
PAGE V-1

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