Wildwood
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PERMITTEE NAME/ADDRES~ (In~/Ude Facility Na~e;lbbation'i,rD;fferent)
NAME:", ' WAPPINGE~ (T) " !' I .'1' I ":! !:
ADDRESS: 20 MIDDLE~USH RD ' I. i;, i i
WAPPI~GEfS FALLS'jN'( 12590 I.! iii' Ii
FACILITY: 'WILDWOOD SD (L & A" I I', I 1!1
LOCATION: , ~~~p~~g~~~SF~~~:~Y 12590~ 1 ',I I"'"
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NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE MONITORING REPORT (DMR)
NY0037117
PERMIT NUMBER
001-A
DISCHARGE NUMBER
i:
MONITORING PERIOD
MM/DDIYYYY MM/DDNYYY
FROM
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10/01/2011
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Li
12590
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system, or those persons directly responsibleforgathermg the infonnllboo, tbe informatton sUb A J~1J.T/./T *;-OAAA. " .
tothebestofm knowled eandbehef,lrue,acalrae,andcom lete.lam aware lhatthereare_s nificmt ,'v.""""" . ·
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TELEPHONE
DATE
11/17/2011
845 463-7310
NUMBER
MMlDDNYYY
AREA Code I
COMMENTS AND EXPLANA,TION OF ANY VIOLATIONS (Reference all ~ttachments here)
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TOWN OF WAPPINGER
TOWN CLERK
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PERMITTEE NAME/ADDRES..S.. (InClUde... Facility Nameltjocatio. .nlifDifferen..t.~
NAME: , WAPPI~G~k (T~;' I' I. Ii:; Ii I,
ADDRESS: 20 MIDDLI~JUSH RD i' III 'I !
, WAPPINGERS FALLS, 'NY 12590'1 !
FACILITY: I WILDwood SD' (L 8. Aj: I I I
LOCATION' NEW HACKENSACK RD
'I " WAPPINGERS FALLS'/Nl'I 12590 I
ATTN' DAWN !;' I t I 'j i
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, ~certu:.vunderpenaJty of IllWthal: tbis documml and all attachments were prepared ulldermy direction or
NAMEITITLE PRINCIP~LE:.XECUTIVE ?FFICER1' sup~i,sion in accordi'llcewith a system desisnedlo as:surelhal <pIalified personnel properly 8atherand
evaluate the information sUbmitted. Based on my inquiry ufthe person or persons who manage the
Mi C h a e 1 P.(- T.: r." enip e r system, or those per~ns dittctly responsible for githering the infonnation. the infonnation sub":J ift~d is,
Chie fOe r a to r' I :re~i,lk}:ls~6m~tin~~~ a:1;:~fo~~ci~d:~~~~bWi~~~lf: :fu~~~~~~;ros:t~~=~
TYPED OR PRINTED i I ri"';O"~!!i i ::! ,
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
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Percent Removal ,'i"
NATlpNAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE MONITORING REPORT (DMR)
Form Approved
OMB No. 2040-0004
NY0037117
PERMIT NUMBER
DMR Mailing ZIP CODE:
MINOR
(SUBR 03)
WWTP OUTFALL
External Outfall
001-A
DISCHARGE NUMBER
12590
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MONITORING PERIOD
MM/DD/yyYY I I MM/DDIYYYY
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---
MMlDOIYYYY
DATE
11/17/2011
NUMBER
10117/2011 Page 2
"',1' 1 I j i
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PERMITTEE NAME/ADDRESS (Include Facility Narrlellbcationif.Different)
~AME: I WAPPI~GE~ (T) ! I .,11'; ii l" ·
ADDRESS: 20 MIDDLEBUSH RD I I, :
WAPPINGE"rS FALLS, ,NY 12590 I i
FACILITY: WILDWOOD SD (L & A) I
LOCATION: NEW HACKENSACK RD
, WAPPINGERS FALLS, NY
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COMMENTS AND EXPLANATION OF ANY VIOLATiONs (Reference all attachments here)
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EPA Form,' 3320-! (R~V'01/06,) pr, ~Jllous ,editions 'may be US~d.: Ii I ,i I
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NAME/TITLE PRINCIPAL, ~XECUTIVE ?FFICER:
Michael Po: 1'remper !
Chief 0 eratdr "I
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NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE MONITORING REPORT (DMR)
rU111l ......fJtJIVyCU
OMS No, 2040-0004
NY0037117
PERMIT NUMBER
DMR Mailing ZIP CODE:
MINOR
(SU BR 03)
WWTP OUTFALL
External Outfall
001.A
DISCHARGE NUMBER
12590
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MONITORING PERIOD
MM/DD/YYVY MM/DDNVYY
10/01/2011 10/31/2011
No Discharge 0
FROM
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system, <lr thoo~ persons directly responsible for gtthering the information, the information sub~ilt~d is.
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EX OF ANALYSIS TYPE
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VALUE
UNITS
UNITS
VALUE
VALUE
VALUE
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TELEPHONE
DATE
11/17/2011
MMlDDffYYY
NUMBER
10/17/2011
Page 3
SECTION I
~
....
~
New York State Department of Environmental Conservation
Division of Water
Report o.t Noncompliance Event
To: DEC Water Contact
DEC Region:
Report Type: _ 5 Day _ Permit Violation r/';rder Violation _ Anticipated Noncompliance _ Bypass/Overj1ow
SECTION 2
SPDES #: NY. DO 31/17 Facility: vi, I Jweo J
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Description of
~ llow
Ou--!-- ~/I
~f4:.t11 T LEvE. L
Has event ceased? (Yes) (No) If so, when? Was event due to plant upset? (Yes) @ SPDES limits violated? @ (No)
Startdate,timeofevent:/D / / ;// . IA-:DO (AM) (PM) End date, time of event: 10/31/ If . If :6Cj (AM)(PM)
. Date; time oral notification made to DEC?
/
(AM) (PM) DEC Official contacted:
lD/\/ r t r Pr<o bleJXI
Immediate corrective actions:
Vl/O Rku"lf
Preventive (long term) corrective actions:
SECTION 3
Comolete this section if event was a bypass:
Bypass amount:
Was prior DEe 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 and times in Section 2 also.
SECTION 4
FadlitY R'P"'''taflV''M.. ~ T91\\ pi TIt!" ~~rD.t" )1, J
Phone#:~ Fax#: ~ -~
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I Certify under penalty of law 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 information
submitted. Based on my inquiry of the p.erson 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 that there are significant penalties for submitting false information,
, including the possibility affine and imprisonment for knowing violations.
x