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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) PAGE 3