DEQ Form 583-D "Facility Update Form" - Oklahoma

What Is DEQ Form 583-D?

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

Form Details:

  • Released on February 1, 2003;
  • The latest edition provided by the Oklahoma 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 printable version of DEQ Form 583-D by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Environmental Quality.

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Download DEQ Form 583-D "Facility Update Form" - Oklahoma

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ROUTING
Int. Date
Inventory Update ___ ___
Oklahoma Department of Environmental Quality
QZ Check
___ ___
Water Quality Division
File Action
___ ___
FACILITY UPDATE FORM
File 583-D
___ ___
PWS ________ WPC _______ IND _________ County Name _______________________ Phone _________________
New _________ Update ______ Please Specify ______________________ Change of Type __________ Inactive _______
Owner/Industry/Municipality
Facility (Site Information)
Name _______________________________________
Name ___________________________________________
Address _____________________________________
Address _________________________________________
City ________________________________________
City ____________________________________________
State __________________ Zip __________________
State ____________________ Zip ____________________
Population Served _____________________________
Number of Services ________________________________
Finding Location ______________________________________________________________________________________
PUBLIC WATER SUPPLY
PWSID No. _______________________ Surface _______ Ground ___________ Purchase _______________________
Under Construction _______ Completion Date _______________ Seasonal System _______ Dates _________________
Community ________ Non-community ___________ NTNC _________ Minor (a) __________ Minor (b) _____________
Source _________________________________________________ Seller ID _____________________________________
(name of stream, lake aquifer, or seller system)
Is there a discharge?
Yes ________ No _______ If yes, give NPDES No. _____________________________________
INTAKE OR WELL
1.
Legal Location ______ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Well Depth _______________________ Well Name or Number __________________________________________
Latitude _____________________________ Longitude _______________________________________________
2.
Legal Location ______ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Well Depth _______________________ Well Name or Number _________________________________________
Latitude _____________________________ Longitude _______________________________________________
3.
Legal Location ______ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Well Depth _______________________ Well Name or Number _________________________________________
Latitude _____________________________ Longitude _______________________________________________
No. of Wells _______________ (submit supplemental sheet for more wells)
Certified Operator ____________________________________________________________________________________
Responsible Official ___________________________________________________________________________________
DEQ Form 583-D (Rev. 2/03)
ROUTING
Int. Date
Inventory Update ___ ___
Oklahoma Department of Environmental Quality
QZ Check
___ ___
Water Quality Division
File Action
___ ___
FACILITY UPDATE FORM
File 583-D
___ ___
PWS ________ WPC _______ IND _________ County Name _______________________ Phone _________________
New _________ Update ______ Please Specify ______________________ Change of Type __________ Inactive _______
Owner/Industry/Municipality
Facility (Site Information)
Name _______________________________________
Name ___________________________________________
Address _____________________________________
Address _________________________________________
City ________________________________________
City ____________________________________________
State __________________ Zip __________________
State ____________________ Zip ____________________
Population Served _____________________________
Number of Services ________________________________
Finding Location ______________________________________________________________________________________
PUBLIC WATER SUPPLY
PWSID No. _______________________ Surface _______ Ground ___________ Purchase _______________________
Under Construction _______ Completion Date _______________ Seasonal System _______ Dates _________________
Community ________ Non-community ___________ NTNC _________ Minor (a) __________ Minor (b) _____________
Source _________________________________________________ Seller ID _____________________________________
(name of stream, lake aquifer, or seller system)
Is there a discharge?
Yes ________ No _______ If yes, give NPDES No. _____________________________________
INTAKE OR WELL
1.
Legal Location ______ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Well Depth _______________________ Well Name or Number __________________________________________
Latitude _____________________________ Longitude _______________________________________________
2.
Legal Location ______ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Well Depth _______________________ Well Name or Number _________________________________________
Latitude _____________________________ Longitude _______________________________________________
3.
Legal Location ______ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Well Depth _______________________ Well Name or Number _________________________________________
Latitude _____________________________ Longitude _______________________________________________
No. of Wells _______________ (submit supplemental sheet for more wells)
Certified Operator ____________________________________________________________________________________
Responsible Official ___________________________________________________________________________________
DEQ Form 583-D (Rev. 2/03)
MUNICIPAL WASTEWATER
S or T No. _________________________ Type of Treatment _________________________________________________
Proposed ____________
Under Construction __________________________
Name of Receiving Stream ______________________________________________________________________________
Is there a discharge?
Yes ________ No _______ If yes, give NPDES No. _____________________________________
DISCHARGE OR FACILITY LOCATION
Legal Location ____________ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Latitude ___________________________________ Longitude _______________________________________________
Certified Operator ____________________________________________________________________________________
Responsible Official ___________________________________________________________________________________
INDUSTRIAL WASTEWATER
Industrial ID No. ___________________ Type of Facility ___________________________________________________
Existing ______ Proposed _________ Under Construction ________ Closure ___________
State Permit No. ___________________________________ SIC Code __________________________________________
Is there a discharge?
Yes ________ No _______ If yes, give NPDES No. _____________________________________
FACILITY LOCATION
Legal Location ____________ /4 ________/4 _________ /4 Sec. _______ T _______ N/S
R ______ E/W
IM
CM
Latitude ___________________________________ Longitude _______________________________________________
Certified Operator ____________________________________________________________________________________
Responsible Official ___________________________________________________________________________________
COMMENTS
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Update form completed by ___________________________________________________________________ Date _______
Name
Title
Mail form to:
Department of Environmental Quality
Water Quality Division
P.O. Box 1677, 707 North Robinson
Oklahoma City, Oklahoma 73101-1677
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