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Temporary Discharge Questionnaire

  1. A. General Information
  2. B. Wastewater Information
  3. Please include date range

  4. Is analytical data available?

    If yes, please provide the latest report to after submitting questionnaire.

  5. The section below must be completed. Please select constituents below that are known or likely to be present in waste.
  6. Acidic (pH<7)
  7. Basic (pH>7)
  8. Contains Heavy Metals (Lead/Copper/Arsenic/Etc)
  9. Contains Inks or Dyes
  10. Organic Compounds (Volatiles/Solvents)
  11. Paints
  12. Pesticides
  13. PCBs
  14. PFAs
  15. Oil and Grease (Fats/Petroleum)
  16. Total Suspended Solids (TSS) Greater Than 290 mg/l
  17. Biochemical Oxygen Demand (BOD) Greater Than 290 mg/l
  18. C. Discharge Process
  19. The discharge flow will be:

    Choose one

  20. (Gallons per minute)

  21. Please submit a map of the project area including discharge location to after submitting questionnaire.

  22. Leave This Blank:

  23. This field is not part of the form submission.