Water Quality and Animal Feeding Operations in Arizona: A Producer's Notebook

Worksheet #12: Reporting Discharges (Excel version, 9KB)
(see part IV. B. 1. c. viii. of Arizona General NPDES permit)
Give EPA verbal notification of a discharge within 24 hours at (415) 744-1905. A written notification is required within 5 days of discharge to the address at the bottom of Worksheet 12, page 2. This worksheet is designed to be used for a single discharge event and satisfies the requirements for Discharge Notification and Monitoring, Parts V.A. and V.B. of the permit.

Cause of Discharge:

___________________________________________________________________

___________________________________________________________________

Description of Discharge:

___________________________________________________________________

___________________________________________________________________

Date and Time of Discharge (start and end):

Start Date and Time: ___________________________________________________

End Date and Time: ____________________________________________________

In what water body did discharged manure water go and how did it get there from the containment structure?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

An estimate of the flow and volume discharge:

___________________________________________________________________

If the discharge was caused by a precipitation event, specify amount and type of event: (information from http://www.nws.noaa.gov/, http://ag.arizona.edu/azmet/ or an on-site weather gauge)

___________________________________________________________________

Name of person recording the discharge:

___________________________________________________________________

Steps being taken to reduce, eliminate, and prevent recurrence:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

This worksheet was developed by the Arizona Department of Agriculture, Agricultural Consultation and Training Program, in collaboration with Natural Resources Conservation Service, University of Arizona, & AZ Conservation Districts, for use in record keeping requirements for the Arizona NPDES General Permit.

Worksheet #12: Reporting Discharges
(page 2)
Discharge Monitoring (Parts V.B., V.C. and V.D.)

Time and Date of Discharge: _____________________________________________

Time and Date of Sampling: _____________________________________________

Reason for Sampling Delay, if any:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Sample taken by: _____________________________________________________

Request a copy of the Chain of Custody sheet from the laboratory and attach to this report.

Send written notification of discharge to:

EPA, Region 9
Attn. AZG800000, WTR-7
75 Hawthorne St.
San Francisco, CA 94105

This worksheet was developed by the Arizona Department of Agriculture, Agricultural Consultation and Training Program, in collaboration with Natural Resources Conservation Service, University of Arizona, & AZ Conservation Districts, for use in record keeping requirements for the Arizona NPDES General Permit.

Page updated 7/02.

Arizona
Dept. of
Agriculture