Mo 780 1560 Form – Fill Out and Use This PDF

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Mo 780 1560 Form PDF Details

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Question	Answer
Form Name	Mo 780 1560 Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	missouri discharge monitoring report, missouri discharge storm latest, missouri discharge storm water, mo dmr form printable

Form Preview Example

MISSOURI DEPARTMENT OF NATURAL RESOURCES

WATER PROTECTION PROGRAM - WATER POLLUTION BRANCH

DISCHARGE MONITORING REPORT FOR STORM WATER AND WASTE WATER DISCHARGES UNDER GENERAL PERMIT

THIS REPORT COVERS THE PERIOD FROM (MONTH/YEAR)

THROUGH (MONTH/YEAR)

PART I:

FACILITY INFORMATION

FACILITY NAME

COUNTY

PERMIT #

MO-

PART II:

MONITORING INFORMATION

SAMPLES COLLECTED BY

PHONE NUMBER

NUMBER OF SAMPLES

LABORATORY (NAME AND ADDRESS)

FIRM

ANALYSIS PERFORMED BY: PLEASE TYPE OR PRINT

PART III: ANALYTICAL RESULTS

OUTFALL #

001

002

003

SAMPLE

ANALYTICAL METHOD

DATE AND TIME OF

DATE

TYPE

SAMPLE COLLECTION

ANALYSIS

DATE

Parameter

Unit

TIME

Rainfall Amount

in.

Flow

MGD

Units

Settleable Solids

mL/L/hr

Oil & Grease

mg/L

Other (list)

NAME OF INDIVIDUAL PREPARING REPORT (PLEASE TYPE OR PRINT)

FIRM

SIGNATURE OF INDIVIDUAL PREPARING REPORT

PHONE NUMBER

REPORT APPROVED BY OWNER

PHONE NUMBER

DATE

MO 780-1560 (7-04)

INSTRUCTIONS

Report should be typed or neatly printed.

PART I:

1. Fill in facility information and permit number.

PART II:

2.Give the name of the individual who actually collected the sample. Indicate whether samples were collected by owner or by personnel of the lab performing the analysis. Indicate the number of samples taken.

PART III:

3.Report results for those parameters listed in Part A of your permit. Write N.A. (Not Applicable) if your permit does not require one of the pre-printed parameters. List under “Other” any additional sampling results required by your permit.

If a storm water sample, indicate the amount of rainfall for the rainfall event in which the sample was taken and write the source of this data (e.g., rain gauge, weather data, etc.) under “Analytical Method” column. If not a storm water discharge, write N.A. in the “Rainfall Amount” column.

4.File a report even if no discharge occurred during the monitoring period. Complete the Facility Information section, write “ND” (no discharge) in the Flow column in Part III, and sign the report. NOTE: If a discharge of storm water occurs at any time during the monitoring period, it must be reported.

5.Record Sample Types as G, C, M or E. G = grab, C = composite, M = measured, and E = estimate. See permit for type of sample required for each parameter.

6.Narrative monitoring requirements for “chemicals stored outside”, “soluble bulk materials stored outside”, etc. are required only if specifically requested by the department in written form. If you have questions about these requirements, contact the Water Protection Program.

7.Add pages if reporting for additional outfalls or sampling dates is needed.

8.Report must be signed by owner and individual preparing the report. Please provide a phone number where each can be reached. Print the name of the individual who prepared the report.

9.Mail to the appropriate DNR regional office as noted in your permit cover letter.

Note: This form is a universal reporting form for General Permits for storm water and waste water discharges with a permit number begin- ning MO-R or MO-G. Industries and individuals who have report forms designed for their specific needs may substitute their forms. A suitable substitute must meet the following specifications:

(a)Form must be 81⁄2” by 11”.

(b)Report must show all of the information indicated on the standard form.

MO 780-1560 (7-04)

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Mo 780 1560 Form – Fill Out and Use This PDF

Mo 780 1560 Form PDF Details

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