ADEQ Form 2C "AZPDES Addendum" - Arizona

What Is ADEQ Form 2C?

This is a legal form that was released by the Arizona Department of Environmental Quality - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2007;
  • The latest edition provided by the Arizona Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of ADEQ Form 2C by clicking the link below or browse more documents and templates provided by the Arizona Department of Environmental Quality.

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Download ADEQ Form 2C "AZPDES Addendum" - Arizona

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FORM 2C C ADDENDUM
AZPDES (NPDES) PERMIT NO. ___________________________
PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY.
V. INTAKE AND EFFLUENT CHARACTERISTICS (continued from page 3 of Form 2C)
OUTFALL
NO.
PART A - You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional details.
2. EFFLUENT
4. INTAKE (optional)
3. UNITS
b. MAXIMUM 30-DAY
a. MAXIMUM DAILY
c. LONG TERM AVERAGE
a. LONG TERM
1. POLLUTANT
d.
b.
VALUE
VALUE
VALUE (if available)
AVERAGE VALUE
NO. OF
NO. OF
(if available)
ANALYSES
ANALYSES
CONCENTRATION
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
(CONC.)
Biochemical Oxygen Demand (BOD)
Chemical Oxygen Demand (COD)
Total Organic Carbon (TOC)
Total Suspended Solids (TSS)
Ammonia (as N)
VALUE
VALUE
VALUE
VALUE
Flow
VALUE
VALUE
VALUE
VALUE
Temperature (winter)
VALUE
VALUE
VALUE
VALUE
Temperature (summer)
MINIMUM
MAXIMUM
MINIMUM
MAXIMUM
STANDARD UNITS
pH
PART B - Mark AX@ in column 2.a for each pollutant you know or have reason to believe is present. Mark AX@ in column 2.b for each pollutant you believe to be absent. If you mark column 2.a for any
pollutant which is limited either directly or indirectly but expressly, in an effluent limitations guideline, you must provide the results of at least one analysis for that pollutant. For other pollutants for which you
mark column 2.a, you must provide quantitative data or an explanation of their presence in your discharge. Complete one table for each outfall. See the instructions for additional details and requirements.
5. INTAKE
2. MARK AX@
3. EFFLUENT
(optional)
1. POLLUTANT AND
4. UNITS
b. MAXIMUM 30-DAY
c. LONG TERM AVG.
CAS NO.
a. MAXIMUM DAILY
a. LONG TERM AVG.
a.
b.
VALUE
VALUE
d.
b.
(if available)
VALUE
VALUE
BELIEVE
BELIEVE
NO. OF
NO. OF
(if available)
(if available)
PRESENT
ABSENT
ANALYSES
ANALYSES
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
Bromide (24959-67-9)
Chlorine, Total Residual
Color
Fecal Coliform
AZPDES Form 2C B Addendum B February 2007
Page 1 of 11
AZPDES (NPDES) NO. ____________________ OUTFALL NO. _________________
FORM 2C C ADDENDUM
AZPDES (NPDES) PERMIT NO. ___________________________
PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY.
V. INTAKE AND EFFLUENT CHARACTERISTICS (continued from page 3 of Form 2C)
OUTFALL
NO.
PART A - You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional details.
2. EFFLUENT
4. INTAKE (optional)
3. UNITS
b. MAXIMUM 30-DAY
a. MAXIMUM DAILY
c. LONG TERM AVERAGE
a. LONG TERM
1. POLLUTANT
d.
b.
VALUE
VALUE
VALUE (if available)
AVERAGE VALUE
NO. OF
NO. OF
(if available)
ANALYSES
ANALYSES
CONCENTRATION
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
(CONC.)
Biochemical Oxygen Demand (BOD)
Chemical Oxygen Demand (COD)
Total Organic Carbon (TOC)
Total Suspended Solids (TSS)
Ammonia (as N)
VALUE
VALUE
VALUE
VALUE
Flow
VALUE
VALUE
VALUE
VALUE
Temperature (winter)
VALUE
VALUE
VALUE
VALUE
Temperature (summer)
MINIMUM
MAXIMUM
MINIMUM
MAXIMUM
STANDARD UNITS
pH
PART B - Mark AX@ in column 2.a for each pollutant you know or have reason to believe is present. Mark AX@ in column 2.b for each pollutant you believe to be absent. If you mark column 2.a for any
pollutant which is limited either directly or indirectly but expressly, in an effluent limitations guideline, you must provide the results of at least one analysis for that pollutant. For other pollutants for which you
mark column 2.a, you must provide quantitative data or an explanation of their presence in your discharge. Complete one table for each outfall. See the instructions for additional details and requirements.
5. INTAKE
2. MARK AX@
3. EFFLUENT
(optional)
1. POLLUTANT AND
4. UNITS
b. MAXIMUM 30-DAY
c. LONG TERM AVG.
CAS NO.
a. MAXIMUM DAILY
a. LONG TERM AVG.
a.
b.
VALUE
VALUE
d.
b.
(if available)
VALUE
VALUE
BELIEVE
BELIEVE
NO. OF
NO. OF
(if available)
(if available)
PRESENT
ABSENT
ANALYSES
ANALYSES
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
Bromide (24959-67-9)
Chlorine, Total Residual
Color
Fecal Coliform
AZPDES Form 2C B Addendum B February 2007
Page 1 of 11
AZPDES (NPDES) NO. ____________________ OUTFALL NO. _________________
5. INTAKE
2. MARK AX@
3. EFFLUENT
(optional)
1. POLLUTANT AND
4. UNITS
b. MAXIMUM 30-DAY
c. LONG TERM AVG.
CAS NO.
a. MAXIMUM DAILY
a. LONG TERM AVG.
a.
b.
d.
b.
VALUE
VALUE
(if available)
VALUE
VALUE
BELIEVE
BELIEVE
NO. OF
NO. OF
(if available)
(if available)
PRESENT
ABSENT
ANALYSES
ANALYSES
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
Fluoride (16984-48-8)
Nitrate-Nitrite (as N)
Nitrogen, Total Organic (as N)
Oil and Grease
Phosphorus (as P), Total
(7723-14-0)
Radioactivity
(1) Alpha, Total
(2) Beta, Total
(3) Radium, Total
(4) Radium 226, Total
Sulfate (as SO4) (14808-79-8)
Sulfide (as S)
Sulfite(as so3) (14265-45-3
)
Surfactants
Aluminum , Total (7429-90-5)
Barium, Total (7440-39 -3)
Boron, Total (7440-42-8)
Cobalt, Total (7440-48-4)
Iron, Total (7439-89-6)
Magnesium, Total (7439-95-4)
Molybdenum,Total (7439-98-7)
Manganese, Total (7439-96-5)
Tin, Total (7440-31-5)
Titanium, Total (7440-32-6)
AZPDES Form 2C B Addendum B February 2007
Page 2 of 11
AZPDES (NPDES) NO. ____________________ OUTFALL NO. _________________
PART C - If you are a primary industry and this outfall contains process wastewater, refer to Table 2C.2 in the instructions to determine which of the GC/MS fractions you must test for. Mark AX@ in column
2.a for all such GC/MS fractions that apply to your industry and for ALL toxic metals, cyanides and total phenols. If you are not required to mark column 2.a (secondary industries, non process wastewater
outfalls and non required GC/MS fractions), mark AX@ in column 2.b for each pollutant you know or believe may be present. Mark AX@ in column 2.c for pollutants you believe are absent. If you mark column
2.a for any pollutant, you must provide results of at least one analysis for that pollutant. If you mark column 2.b for any pollutant, you must provide results of at least one analysis for that pollutant if you
know or have reason to believe it will be discharged in concentrations of 10 ppb or greater. If you mark column 2.b for acrolein, acrylonitrile, 2,4 dinitrophenol or 2-methyl-4,6 dinitrophenol, you must
provide results of at least one analysis for each if you know or have reason to believe that you discharge in concentrations of 100 ppb or greater. Otherwise, for pollutants for which you mark column 2.b,
you must either submit at least one analysis or briefly describe the reasons the pollutant is expected to be discharged. Note that there are 7 pages to Part C; please review each carefully. Complete one
table (7 pages) for each outfall. See instructions for additional details and requirements.
5. INTAKE
2. MARK AX@
3. EFFLUENT
(optional)
1. POLLUTANT
4. UNITS
b. MAXIMUM 30-DAY
c. LONG TERM AVG.
AND CAS NO.
a. MAXIMUM DAILY
a. LONG TERM AVG.
d.
b.
VALUE
VALUE
a.
b.
c.
(if available)
VALUE
VALUE
NO. OF
NO. OF
TESTING
BELIEVE
BELIEVE
(if available)
(if available)
REQUIRED
PRESENT
ABSENT
ANALYSES
ANALYSES
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
1. METALS, CYANIDE AND TOTAL PHENOLS
Antimony, Total
(7440-36-0)
Arsenic, Total
(7440-38-2)
Beryllium, Total
(7440-41-7)
Cadmium, Total
(7440-43-9)
Chromium, Total
(7440-47-3)
Copper, Total
(7440-50-8)
Lead, Total
(7439-92-1)
Mercury, Total
(7439-97-6)
Nickel, Total
(7440-02-0)
Selenium, Total,
(7782-49-2)
Silver, Total
(7440-22-4)
Thallium, Total
(7440-28-0)
Zinc, Total
(7440-66-6)
AZPDES Form 2C B Addendum B February 2007
Page 3 of 11
AZPDES (NPDES) NO. ____________________ OUTFALL NO. _________________
5. INTAKE
2. MARK AX@
3. EFFLUENT
(optional)
1. POLLUTANT
4. UNITS
b. MAXIMUM 30-DAY
c. LONG TERM AVG.
AND CAS NO.
a. MAXIMUM DAILY
a. LONG TERM AVG.
d.
b.
VALUE
VALUE
a.
b.
c.
(if available)
VALUE
VALUE
NO. OF
NO. OF
TESTING
BELIEVE
BELIEVE
(if available)
(if available)
REQUIRED
PRESENT
ABSENT
ANALYSES
ANALYSES
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
Cyanide, Total
(57-12-5)
Phenols, Total
Hardness (CaCO3)
2. DIOXIN
Describe results:
2,3,7,8- Tetra-
chlorodibenzo-P-
Dioxin (1764-01-6)
3. GC/MS FRACTION - VOLATILE COMPOUNDS
Acrolein
(107-02-8)
Acrylonitrile
(107-13-1)
Benzene
(71-43-2)
Bromoform
(75-25-2)
Carbon Tetrachloride
(56-23-5)
Chlorobenzene
(108-90-7)
Chlorodibromo-
methane
(124-48-1)
Chloroethane
(75-00-3)
2-Chloroethylvinyl
Ether (110-75-8)
Chloroform
(67-66-3)
Dichlorobromo-
methane (75-27-4)
1,1-Dichloroethane
(75-34-3)
AZPDES Form 2C B Addendum B February 2007
Page 4 of 11
AZPDES (NPDES) NO. ____________________ OUTFALL NO. _________________
5. INTAKE
2. MARK AX@
3. EFFLUENT
(optional)
1. POLLUTANT
4. UNITS
b. MAXIMUM 30-DAY
c. LONG TERM AVG.
AND CAS NO.
a. MAXIMUM DAILY
a. LONG TERM AVG.
d.
b.
VALUE
VALUE
a.
b.
c.
(if available)
VALUE
VALUE
NO. OF
NO. OF
TESTING
BELIEVE
BELIEVE
(if available)
(if available)
REQUIRED
PRESENT
ABSENT
ANALYSES
ANALYSES
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
CONC.
MASS
1,2 -Dichloroethane
(107-06-2)
1,1- Dichloroethylene
(75-35-4)
1,2-Dichloropropane
(78-87-5)
1,3-Dichloropro-pylene
(542-75-6)
Ethylbenzene
(100-41-4)
Methyl Bromide
(74-83-9)
Methyl Chloride
(74-87-3)
Methylene Chloride
(75-09-2)
1,1,2,2-Tetrachloro-
ethane (79-34-5)
Tetrachloroethylene
(127-18-4)
Toluene
(108-88-3)
1,2 Trans Dichloro-
ethylene (15660-5)
1,1,1 Trichloroethane
(71-55-6)
1,1,2 Trichloroethane
(79-00-5)
Trichloroethylene
(79-01-6)
Vinyl Chloride
(75-01-4)
AZPDES Form 2C B Addendum B February 2007
Page 5 of 11
AZPDES (NPDES) NO. ____________________ OUTFALL NO. _________________
Page of 11