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SECTION I
~
.......- --
~
New York State Department of Environmental Conservation
Division of Water
Report 0..( Noncompliance Event
To: DEC Water Contact
DEe Region:
Report Type: _ 5 Day
Permit Violation
Order Violation _ Anticipated Noncompliance _ Bypass/OveTj1ow
~
-
SECTION 2
SPDES#:NY-0035"to3c:.. Facility: RO'iCl,I e,'()qe sIP
. , i\
Date of noncompliance: ~ / / DS- Location (Outfall, Treatment Unit, or Pump StatiOn):~
()1D/lfkly D~"'::''ie !Io..c erhoilf fkrJ/lt\J~ 1M' rjll'/O lb.;" to 1/:
Has event ceased? (Yes) (No) If so, when?
Start date, time of event:;;).. /' / D5". .i 'J. :00
Was event due to plant upset? (Yes) ~ SPDES limits Violated?~ (No)
~ (PM) End date, time ofevent:g. tJit/OS-. J' :::J-Y (AM)~
/ (AM) (PM) DEC Official contacted:
Date, time oral notification made to DEe? /
Immediate corrective actions:
Preventive (long term) corrective zctionsJAJf1r~'f\9 01\ ':1:.+1:' P"'i')h~ W1
.r:,,",,' _ ~........._ _. __
SECTION 3
Complete this section ifevent was a bvoass:
Bypass amount:
Was prior DEC authorization received for this event? (Yes) (No)
DEC Official contacted:
Date ofDEC approval:
/
Describe event in "Description of noncompliance and cause" area in Section 2. Detail the start and end dates ud times in Section 2 also.
E:::..
SECTION 4
'')t ~ J'/ ,/
t~\ "I ,n /,
.. ' .. . . '. " '.::::'- j'~
FacIlIty Representative: J ( ( pi
Phone #: (:?-..J-...:.S ) 4&0 .7210
Title:OJu) cpQlbh/' Date: \.2 /22, u..;
Fad: (?-f0 )'~1..02 .720'"
I Certify under penalty of law thaI this document and all attachments were
prepared under my direction or supervision in accordnnce with a system designed
to assure thnt 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 knowledge and belief, true, accurate, and complete.
I am aware thatlhere are significant penalties for submitting false information,
inCluding the possibility of fine and imprisonment for knowing violations.
x ItcJlc<t.;/J ~~;-vff/1
p
Signature of Principal Executive
Officer or Authorized Agent