HomeMy WebLinkAboutResolution #3274RESOLIITION N0. 3274
A RESOLIITION APPROVING THE FORM TO BE IISED WHEN MAKING APPLICATION
FOR SPECIAL DISCHARGE
WHEREAS, the Public Works, Water and Sewer Committee has
determined that it is necessary and in the best interest of the
City of Canton to approve the form to be used when making
application for special discharge, hereto attached as Exhibit "A".
WHEREAS, the Canton City Council has made a similar
determination.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF CANTON, Fulton County, Illinois as follows:
1. That the attached Application For Special Discharge,
hereto attached as Exhibit "A" is hereby approved.
2. That this Resolution shall be in full force and effect
immediately upon its passage by the City Council of the City of
Canton, Fulton County, Illinois.
PASSED by the City Council of the City of Canton, Fulton
County, Illinois at a regular meeting this 18~-h day of April,
1995, upon a roll call vote as follows:
AYES: Aldermen Chapm~~n, Bohler, Meade, Sarff, Molleck.
NAYS: None.
ABSENT: Aldermen May, ~?hillips, Coay.
APP VED:
Donald E. Edwards, Mayor
ATTEST: .
Nand Whit , City Clerk.
CITY OF CANTON
APPLICATION FOR SPECIAL DISCHARGE
DISCHARGE TO SANITARY OR COMBINED SEWER ON SITE
NOTE: NO DISCHARGE TO A SEPARATE STORM SEWER OR WATERCOURSE IS ALLOWED
TRANSPORT TO CANTON WESTSIDE TREATMENT PLANT
NOTE: THE CITY CANNOT ACCEPT ANY TRANSPORTED WASTE IDENTIFIED AS HAZARDOUS IN 40 CFR PART 261 IRCRAI
I. RESPONSIBLE PARTIES:
SOURCE:
SITE NAME:
STREET ADDRESS:
CITY:
OWNER:
CONTACT PERSON:
TITLE:
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE:
FAX:
SITE CONTRACTOR:
NAME:
STREET ADDRESS:
CITY:
OWNER:
CONTACT PERSON:
TITLE:
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE:
FAX:
TRANSPORTER:
NAME:
STREET ADDRESS:
CITY:
OWNER:
CONTACT PERSON:
TITLE:
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE:
FAX:
F'AGE 1
APPLICATION FOR APPROVAL FOR SPECIAL DISCHARGE
Ii. MATERIAL TO BE DISCHARGED:
1. FULLY DESCRIBE THE WASTE AND THE NATURE OF THE ACTIVITIES REQUIRING ITS DISPOSAL
A. COPY OF LABORATORY ANALYSES ATTACHED? YES NO
B. COPIES OF MATERIAL SAFETY DATA SHEETS ATTACHED? YES NO
C. IS WASTE FROM A PROCESS SUBJECT TO FEDERAL CATEGORICAL STANDARDS? YES NO
IF YES, IDENTIFY THE STANDARD: 40 CFR PART ,SUBPART
D. IS IEPA PERMIT NECESSARY FOR THIS WASTE? YES NO
IF YES, IS THE IEPA PERMIT ATTACHED? YES NO
IEPA PERMIT NUMBER
2. QUANTITY TO BE DISCHARGED TO CITY:_ GALLONS PER DAY
3. PROPOSED RATE ANDIOR FREQUENCY OF DISCHARGE?
4. IF WASTE IS FROM AN UNDERGROUND STORAGE TANK, STORAGE TANK EXCAVATION,OR IS GROUNDWATER
FROM A SITE REMEDIATION PROJECT:
a. IDENTIFY THE SUBSTANCES WHICH WERE IN THE TANKS:
b. HOW LONG HAS TANK BEEN OUT OF SERVICE?
5. DESCRIBE ANY TREATMENT TO BE PROVIDED PRIOR TO DISCHARGE TO THE CITY:
6. DESCRIBE PROPOSED POINT OF ENTRY TO SEWER (IF NOT TRANSPORTED I:
III. SAMPLING AND MONITORING:
1. A SAMPLE ANALYSES IS REQUIRED FOR THE RAW DISCHARGE WITH THIS APPLICATION. IF THE IEPA PERMIT
ALSO REQUIRED SAMPLING, THE CITY MAY WAIVE THIS SAMPLE.
COMPLETE THE FOLLOWING FOR ANY SAMPLE ANALYSES SUBMITTED:
a. SAMPLED BY (NAMEI:
b. COMPANY:
c. DATE SAMPLED: TIME
d. PRESERVATIVES:
e. TYPE OF SAMPLE? GRAB COMPOSITE HOW COMPOSITED?
2. AFTER INSTALLATION OF ANY TREATMENT SYSTEM, SAMPLING AND MONITORING IS REQUIRED. THE
SCHEDULE OF SAMPLING SHALL BE DETERMINED BY THE WASTEWATER SUPERINTENDENT. THE CITY
RESERVES THE RIGHT TO SAMPLE AND ANALYZE FOR CONTAMINANT STRENGTHS AT ANY TIME A
DISCHARG IS OCCURRING. THE COST OF THIS ANALYSIS SHALL BE BORNE BY THE APPLICANT.
PAGE 2
APPLICATION FOR APPROVAL FOR SPECIAL DISCHARGE
IV. SIGNATURE AND CERTIFICATION:
THIS APPLICATION MUST BE SIGNED BY THE OWNER OF THE SOURCE SITE OR THE ENGINEER DIRECTLY
RESPONSIBLE FOR SITE REMEDIATION ACTIVITIES.
I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS TRUE, COMPLETE, AND ACCURATE. IF GRANTED APPROVAL TO DISCHARGE, I AGREE TO
ABIDE BY THE CITY ORDINANCES, AND ALL APPLICABLE FEDERAL, STATE AND LOCAL REGULATIONS. I
AGREE TO PAY THE COSTS OF ANY PRE-APPROVEL ANALYSES PERFORMED BY THE CITY AND TO PAY ANY
APPLICABLE DISPOSAL CHARGES FOR THE VOLUME OR STRENGTH OF THE WASTES DISCHARGED.
I HEREBY RELIEVE THE CITY OF ALL LIABILITY FOR THE OPERATION AND DISCHARGES OF THE GROUNDWATER
REMEDIATION SYSTEM.
APPLICANT NAME 1 PRINTED 1:
APPLICANT SIGNATURE:
DATE:
V. HAZARDOUS WASTE CERTIFICATION:
IF YOU CHECKED THE BOX ON PAGE 1 "TRANSPORT TO CITY WESTSIDE TREATMENT PLANT", YOU MUST SIGN
THE FOLLOWING CERTIFICATION:
I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE ABOVE MATERIAL IS NOT
CLASSIFIED AS A HAZARDOUS WASTE AS DESCRIBED IN 40 CFR PART 261 IRCRA)
APPLICANT SIGNATURE:
DATE:
VI. TO BE COMPLETED BY CITY PERSONNEL:
APPROVED BY:
DATE:
I IF PERMIT IS DENIED OR SPECIAL CONDITIONS ARE REQUIRED PLEASE EXPLAIN BELOW)
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