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SECTION J
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New York State Department of Environmental Conservation
Division of Water
Report of NOltCOlltpliance Event
To: DEC Water Contact
D'EC Region:
/
Report Type: .....;... 5 Day " Permit Violation
Order Violation _ Anticipated Noncompliance _ Bypass/Overflow
-
"""'OIl
SECTION 2
"l -.'
SPDES#: NY': OOjt{/,..7y7 Facility:-r~r\Lj,1t I ~', .::;Q7-F!.,
Date of nOD compliance: I I Location (Outfall, Treatment Unit, or Pump StatiOn):..QJLt.~ II
Descript\,Q,n ofpoDcomplil1,Dce(s) and cause(s): ~10(J+n)f cd)erC?9<' ~ /ot-d Qh-"Jve OeNn/ + fevel dUe.f..o
{VI ,'Il~Q, 11 CJ. .tl d ::r-. -h:. / I
Has event ceased? (Yes) (No) If so, when? Was event due to plant upset? (Yes) e SPDES limits violated?~ (No)
Start date, time ofeve~t::J / j IID.'~ :00 @(PM) End date, time of event: .2. ;:}'flf () . 1l:()9 (AM)~
Date, time oral notification made to DEC? I (AM) (PM) DEC Official contacted:
[mrnediate corrective actions:
'reventive (long term) cor~ective actions:lL2o...t.k;-~ 'O~\ ~ +::r::. prdlb[ e h1
,-
SECTION 3
Complete this section if event 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" a.rea in Section 2. Detail the start and end dates and times in Section 2 also.
~CTJON 4
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FacilitY Representative: . I Ix), '-I-W
Phone #: (g J-t~)"J~)3 _72 I C>
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Title. u...L' lre) (6 o( Date: ~ II b / I U
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Fax #: (O'(..j )J+L;1~'. (...!J '-.~
~rtify under penalty ofJaw that this document and all attachments were
Jared under my direction or supervision in accordnnce with a system designed
ssure thnt qualified personnel properly gnther and evaluate the information
mined. Based on my inquiry of lhe person or persons who manage the system,
lose persons directly responsible for gathering the iilfonnation, the infonnation
nitted is. to the bes) of my knowledge and belief. true, accurate. and complete.
I aware that there are significant penalties for submitting false infonnation.
Jding the possibility offine and imprisonment for knowing violations.
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Signature of Principal Executive
Officer or Authorized Agent
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