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SECTION 1
..
...... .-.
~
New York State Department of Environmental Conservation
Division of Water
Report of Noncompliance Event
To: DEe Water Contact
R,p,"TYp" _ 5 Day Lu Via/at.m
DEe Region:
Order Violation _ Anticipated Noncompliance _ Bypass/Overflow
--~...-_... .'.P';' ~
--
SECTION 2
SPDES #: NY-DO~' ea.O j Facility: 'F/ee+&.Uaxf (hDd\6r OS D WW,p
Date of noncompliance:;l I 105 Location (Outfal~ Treatment Unit, or Pump Station): aJ4 ~'c..11
D~cription ofnoqcomplia.nce(s) and eause(s):5li5pPfl,-1ld ~h1S perCi"r"\'t f(;^"oi!c:,{ hB/W pUM..J. /eve:. /qJ
~3 P,'/rCt't1 t ,
Has event ceased? (Yes) (No) Ifso, when? Was event dueto plant upset? (Yes)e SPDES limits ViO!a.ted?~ (No)
Start date, time of event:~ 1 I 185: J;).: DOG (PM) End dllJte, time of event: 1+ 1;)ffIOf: /I :S1 (AM)@
Date, time oral notification made to DEe? I I (AM) (PM) DEe Official contacted:
Immediate corrective lIJctions:
Preventive (long term) corrective l?lctions:
..:w-~
~'.== .=~"-=''"''''.-'"..' _.co, _,.. .,......_ ~_,_-"..__.-....;~_",."",_.___
-"""'"
..----
--
SECTION 3
Complete this section if event was a bypass:
Bypass amount:
Was prior DEC authorization received for this event? (Yes) (No)
DEC Official contacted:
Date ofDEC approval:
J
Describe event in "Description of noncompliance and cause" area in Section Z. Detail the s+..art and end dates and times in Section 2 also.
~
r..-
SECTION 4
'I J~l ,r
FacilitY Representative: I iL. I, (C{ll,OQ (
Phone#: (f),sAl::J 1.73 iO
TitleCltiC+tDQ{CU Datei3 12-3'1 i)';
I /
Fax #: ( if:::; r~ .700<,
I Certify under penalty of law thaI 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 person or persons who manage the system,
or those persons directly responsible for gathering the information, the information
submitted is, to the best of my h:nowledge and belief, true, accurate, and complete.
r am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
11" "
1/ ,I .' j' ."\ ()
X . / Lv~Q r [ti'lA41)
I
Signature of Principal Executive
Officer or Authorized Agent