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O:>NI IoSIDIOM.HV'I 'IV.LN~WNOHIAN~
- --...",..,.~ --
SECTION I
~
......
~
New ~ State Department of Environmental C~ervation
Division of Water
Reoort of Noncompliance Event
-... -
To: DEC Water Contact
DEe Region:
Report Type: _ 5 Day ~rmit Violation
Order Violation _ Anticipated Noncompliance _ Bypass/Overflow
SECTION 2
SPDES #: NY-OO~("3'.7 Facility: ('r\,ld ~+ (> j( Si) ulW'rP f..~'!c,' R..d].
Date of noncompliance: " / / 0'1 Location (Outfall, Treatment Unit, or Pump Station)~ .f" II
i"\ ' 1\
Description ofnoncompllance(s) and cause(s): (nOf\t h \'1 o.vefGll.c;'2 TI.,1A.i q~v't (A;rm'l J-ille' riUof'.\.-o t'ti: rote, I~ 511cw
f\1-tt+ c.nd 4:+:r. ,..
Has event ceased? (Yes) (No) If so, when? Was event due to plant upset? (Yes) ~ SPDES limits Violated~(No)
Startdate,tlmeofevent:iJ /01 /04. f).,.:oO @)(PM) End date, time of event: II /.30/0'1. II $"9 (A~
Date, time oral notification made to DEe? / / (AM) (PM) DEe Official contacted:
Immediate corrective actions:
lP . L' '- ,..IJ ~ a ^ .... ~ L ~
revellltive (long term) corrective actions: ~ I L. n -I ~ ~ ..=!::::!::!!::::
p rob Ie t'JI\ .
-.-.....-....
-
-
SECTION 3
Comolete this section if event was. a bvoass:
Bypass amount:
Was prior DEC authorization received for this event? (Yes) (No)
DEC OfficiaJ contacted:
Date ofDEC approval:
/
/
Describe event in "Description of noncompliance and cause" area in Section 2. Detail the start and end dates and times in Section Z also.
-
SECTION 4
FacilitY Representative:
Title:
Date:
/
Phone #: (
)
Fax #: (
1 CertIfy under penalty oflaw 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 infonnation
submitted. Based on my inquiry of the person or persons who manage the system,
or those persons directly responsible for gathering the infonnation, the information
submitted is, to the best of my knowledge and belief. true, accurate, and comple~.
1 am aware that there are significant penalties for submitting false infonnation,
including the possibility of fine and imprisonment for knowing violations.
x