NOTICE OF REGULAR MEETING ALTUS MUNICIPAL AUTHORITY
Transcript of NOTICE OF REGULAR MEETING ALTUS MUNICIPAL AUTHORITY
NOTICE OF REGULAR MEETING ALTUS MUNICIPAL AUTHORITY
DATE TIME PLACE
MARCH 2, 2021 6:00 PM COUNCIL CHAMBERS 509 S. MAIN STREET
AGENDA
1. Call to Order
2. Roll Call
3. Comments from the Audience
4. Consent Agenda
All matters under the “Consent” are considered by the Trust Authority to be routine and will
be enacted by one motion. Any Trustee may, however, remove an item from consent by
request.
a. Minutes Approval
1. Altus Municipal Authority - Regular Meeting - Feb 2, 2021 6:00 PM
b. Acknowledge Receipt of Claims List
c. Authorize the AMA Board Chairman/Mayor to Sign the Application for a Permit to
Construct from the Oklahoma Department of Environmental Quality for DWSRF Water
Looping Project
5. Consider any item(s) removed from the Consent Agenda if necessary
6. Consideration, Discussion, and Possible Action to (1) Approve Purchase of a John Deere
310SL Backhoe Under Sourcewell National Purchasing Contract #032119-JDC for the Line
Maintenance and Construction Department in an Amount Not to Exceed $107,000 (2)
Declare Surplus a 2008 Caterpillar 416E Backhoe and Authorize Trust Manager to Dispose
of by Sealed Bids
7. Consideration, Discussion, and Possible Action to Hire D&K Fencing of Cache, OK to
Install a New Chain Link Fence and Motor-Operated Cantilever Gate at the Polishing
Lagoons for a Fee of $14,612.35
8. Consideration, Discussion, and Possible Action to Authorize the Mayor to Sign Application
Forms as Needed to Apply for a Permit to Treat and Dispose of Commercial Car Wash
Sludge
ALTUS MUNICIPAL AUTHORITY AGENDA - MARCH 2, 2021 PAGE 2
9. Trust Manager's Reports and Comments
10. Trustees' Comments
11. Chairman's Comments
12. Adjourn
The City of Altus encourages participation from all of its citizens. If participation at any public
meeting is not possible due to a disability, notification to the Mayor’s office at least 48 hours
prior to the scheduled meeting is encouraged to make the necessary accommodations. The City
may waive the 48 hour rule if signing is not the necessary accommodation. Call 481-2202 to
make the necessary arrangements. We will accommodate you anytime and in every way
possible. Just call and let us know your needs.
To be completed by person filing notice:
NAME: Debbie Davis
TITLE: City Clerk
ADDRESS: 509 S. Main
Altus, OK 73521
PHONE: (580) 481-2244
Filed in the office of the City Clerk/Treasurer at ________ a.m./p.m. on ___________________.
Signed:______________________
Clerk/Deputy Clerk
ALTUS MUNICIPAL AUTHORITY
MEETING MINUTES
FEBRUARY 2, 2021
1. Call to Order
The Altus Municipal Authority met in a regular meeting, Tuesday, February 2, 2021 at 6:50
P.M. in the Council Chambers of City Hall. Notice of the meeting was duly filed and posted
in the office of the City Clerk January 29, 2021 at 3:43 P.M.
2. Roll Call Attendee Name Present Absent Late Arrived
Perry Shelton
Dwayne E. Martin
Doyle Jencks
Jon Kidwell
Jack Smiley
John Womack
Robert Garrison
Roberta Brady-Lee
Patricia Blackman
3. Consent Agenda
All matters under the “Consent” are considered by the Trust Authority to be routine and will
be enacted by one motion. Any Trustee may, however, remove an item from consent by
request.
RESULT: APPROVED [UNANIMOUS]
MOTION: John Womack, Trustee
SECOND: Doyle Jencks, Trustee
AYES: Shelton, Martin, Jencks, Kidwell, Smiley, Womack, Garrison, Brady-Lee, Blackman
a. Minutes Approval
1. Altus Municipal Authority - Regular Meeting - Jan 5, 2021 6:00 PM
b. Acknowledge Receipt of Claims List
4. Consider any item(s) removed from the Consent Agenda if necessary
5. Consideration, Discussion and Possible Action to Approve a Contract with Cowan Group
Engineering, LLC of Oklahoma City, OK for Closed Circuit TV Inspection of Sewer Mains
for a Not-To-Exceed Fee of $100,000.00 and Authorize the Mayor to Sign the Contract
City Engineer Johnny Barron presented the item. Trust Manager Gary Jones and Trustee
Kidwell commented.
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ALTUS MUNICIPAL AUTHORITY MINUTES - FEBRUARY 2, 2021 PAGE 2
RESULT: APPROVED [8 TO 1]
MOTION: Doyle Jencks, Trustee
SECOND: Robert Garrison, Trustee
AYES: Shelton, Jencks, Kidwell, Smiley, Womack, Garrison, Brady-Lee, Blackman
NAYS: Dwayne E. Martin
6. Consideration, Discussion, and Possible Action to Authorize the Mayor to Sign an
Application to Modify a Solid Waste Disposal Facility Permit for the Expansion of the Altus
Municipal Landfill
City Engineer Johnny Barron presented the item. Chairman Smiley, Trustee Kidwell, and
City Engineer Johnny Barron commented.
RESULT: APPROVED [UNANIMOUS]
MOTION: Jon Kidwell, Trustee
SECOND: John Womack, Trustee
AYES: Shelton, Martin, Jencks, Kidwell, Smiley, Womack, Garrison, Brady-Lee, Blackman
7. Consideration, Discussion, and Possible Action to Accept the Work Performed by R.B.
Electric, LLC to Install a New 450 KW Generator and Switch Gear at Altus Water Treatment
Plant (Bid No. 20065), Approve Change Order No. 1 in the Amount of $38,000.00 and
Authorize the Mayor to Sign the Letter of Acceptance
City Engineer Johnny Barron presented the item.
RESULT: APPROVED [UNANIMOUS]
MOTION: John Womack, Trustee
SECOND: Roberta Brady-Lee, Trustee
AYES: Shelton, Martin, Jencks, Kidwell, Smiley, Womack, Garrison, Brady-Lee, Blackman
8. TRUST MANAGER'S REPORTS AND COMMENTS
None
9. TRUSTEES' COMMENTS
None
10. CHAIRMAN'S COMMENTS
None
11. ADJOURN
7:01 P.M.
_______________________________ _______________________________
Debbie Davis, Secretary Jack Smiley, Chairman
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Date: March 2, 2021
AGENDA ITEM COMMENTARY
ITEM TITLE: Acknowledge Receipt of Claims List
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Fund Summary
Payment AmountFund
53 - ENTERPRISE FUND (53) 1,370,851.68
54 - WATER TREATMENT PLANT IMP 14,760.00
1,385,611.68Grand Total:
AMA - Claims ListAltus, OK By Fund
Payable Dates 2/1/2021 - 2/19/2021
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Fund: 53 - ENTERPRISE FUND (53)
Department: 16 - PW - W/S MAINTENANCE
Vendor: 044654 - ALTUS POWER
587.14WATER/SEWER # 16Utilities202102018890ALTUS POWER 22086
Vendor 044654 - ALTUS POWER Total: 587.14
Vendor: 03124 - CINTAS CORP
337.92LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 337.92
Vendor: 044184 - FLEET SERVICES
938.37FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 938.37
Vendor: 043860 - GARCIA CONCRETE
4,027.95CONCRETEContract Services137GARCIA CONCRETE 22128
2,263.70CONCRETEContract Services138GARCIA CONCRETE 22223
Vendor 043860 - GARCIA CONCRETE Total: 6,291.65
Vendor: 041498 - M & B CONTRACTING, LP
1,150.00EXCAVATOR AND OPERATORContract ServicesEO1127M & B CONTRACTING, LP 22182
1,150.00EXCAVATOR AND OPERATORContract ServicesE01127M & B CONTRACTING, LP 22227
Vendor 041498 - M & B CONTRACTING, LP Total: 2,300.00
Vendor: 16070 - PIONEER SUPPLY
207.001"X3/4" BRSS BUSHINGLine MaintINV8932, INV9739PIONEER SUPPLY 221271,185.806"X30" REPAIR CLAMPLine MaintINV8932, INV9739PIONEER SUPPLY 221272,035.682" BRSS 90 DEG ELLLine MaintINV8932, INV9739PIONEER SUPPLY 22127
582.001" CTS COMP NUT&GLine MaintINV8932, INV9739PIONEER SUPPLY 22127
817.006"X12" REPAIR CLAMPLine MaintINV8932, INV9739PIONEER SUPPLY 22127
303.001" MIPT ADAPTERLine MaintINV8932, INV9739PIONEER SUPPLY 22127
384.003/4" MIPT ADAPTERLine MaintINV8932, INV9739PIONEER SUPPLY 22127
482.00CTS COMP NUT&GASKETLine MaintINV8932, INV9739PIONEER SUPPLY 22127
489.001" CTS COMP N&GLine MaintINV8932, INV9739PIONEER SUPPLY 22127
507.503/4"X2.4" METER BRSSLine MaintINV8932, INV9739PIONEER SUPPLY 22127
575.00CTS CORP NUT&GASKETSLine MaintINV8932, INV9739PIONEER SUPPLY 22127
40.004" PVC X PVC CANTEXLine MaintINV9738PIONEER SUPPLY 22127
290.006"X4" SEWER SADDLELine MaintINV9738PIONEER SUPPLY 22127
804.003/4" CPPR TUBING, FTLine MaintINV9738PIONEER SUPPLY 22127
893.206" SDR SEWER PIPE FTLine MaintINV9738PIONEER SUPPLY 22127
420.00UNI CANTEX STRAPSLine MaintINV9738PIONEER SUPPLY 22127
40.004" CLAY X PVC CANTEXLine MaintINV9738PIONEER SUPPLY 22127
Vendor 16070 - PIONEER SUPPLY Total: 10,055.18
Vendor: 044039 - WESTERN PRAIRIE SERVICES
1,000.00ROAD BOREContract Services202102028892WESTERN PRAIRIE SERVICES 22138
Vendor 044039 - WESTERN PRAIRIE SERVICES Total: 1,000.00
Department 16 - PW - W/S MAINTENANCE Total: 21,510.26
AMA - Claims List Payable Dates: 2/1/2021 - 2/19/20214.b.a
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 18 - PW - AAFB CONTRACT
Vendor: 03124 - CINTAS CORP
140.00LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 140.00
Vendor: 044184 - FLEET SERVICES
412.68FUEL CREDIT CARD CHARGESDiesel Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 412.68
Department 18 - PW - AAFB CONTRACT Total: 552.68
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 19 - PW - SANITATION
Vendor: 044654 - ALTUS POWER
364.91SANITATION # 19Utilities202102018890ALTUS POWER 22086
Vendor 044654 - ALTUS POWER Total: 364.91
Vendor: 03124 - CINTAS CORP
648.21LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 648.21
Vendor: 044184 - FLEET SERVICES
363.67FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
4,490.07FUEL CREDIT CARD CHARGESDiesel Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 4,853.74
Vendor: 046145 - JOHN EARLS CONSTRUCTION
1,509.003RD QTR BTPU FY 20-21Contract Services71JOHN EARLS CONSTRUCTION 22120
2,477.003RD QTR BTPU FY 20-21Contract Services72JOHN EARLS CONSTRUCTION 22180
Vendor 046145 - JOHN EARLS CONSTRUCTION Total: 3,986.00
Vendor: 041498 - M & B CONTRACTING, LP
450.00BTPU ROLL OFFSContract ServicesC01800M & B CONTRACTING, LP 22182
150.00BTPU ROLL OFFSContract ServicesC01838M & B CONTRACTING, LP 22182
250.00BTPU ROLL OFFSContract ServicesC01842M & B CONTRACTING, LP 22182
Vendor 041498 - M & B CONTRACTING, LP Total: 850.00
Department 19 - PW - SANITATION Total: 10,702.86
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 21 - PW - WATER TREATMENT
Vendor: 044654 - ALTUS POWER
26,423.37STEED PUMP STATIONUtilities202102018890ALTUS POWER 22086
Vendor 044654 - ALTUS POWER Total: 26,423.37
Vendor: 03124 - CINTAS CORP
411.03LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 411.03
Vendor: 044184 - FLEET SERVICES
168.80FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 168.80
Vendor: 046671 - MUNICIPALH2O
4,200.00Annual fee-Risk Management P…Contract Services10451MUNICIPALH2O 22230
Vendor 046671 - MUNICIPALH2O Total: 4,200.00
Vendor: 16130 - PUBLIC SERVICE COMPANY OF OKLAHOMA
6,410.99MT. PARK UTILITESUtilitiesINV0000009PUBLIC SERVICE COMPANY OF … 22188
Vendor 16130 - PUBLIC SERVICE COMPANY OF OKLAHOMA Total: 6,410.99
Department 21 - PW - WATER TREATMENT Total: 37,614.19
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 22 - PW - ELECTRIC
Vendor: 046327 - ALCORTA'S CARWASH
8.00VEHICLE CAR WASHMaint/EquipmentINV0000180ALCORTA'S CARWASH 22213
Vendor 046327 - ALCORTA'S CARWASH Total: 8.00
Vendor: 044654 - ALTUS POWER
1,012.37ELECT SUBSTATION # 22Utilities202102018890ALTUS POWER 22086
Vendor 044654 - ALTUS POWER Total: 1,012.37
Vendor: 01495 - ARKANSAS ELECTRIC COOP, INC
5,274.0075 KVA POLE MOUNTTransformers03986168ARKANSAS ELECTRIC COOP, INC 22169
Vendor 01495 - ARKANSAS ELECTRIC COOP, INC Total: 5,274.00
Vendor: 044603 - CHRIS FINLEY MOBILE SERVICE, INC
2,827.00TRUCKS ANNUAL TESTINGContract Services2038CHRIS FINLEY MOBILE SERVICE, … 22108
Vendor 044603 - CHRIS FINLEY MOBILE SERVICE, INC Total: 2,827.00
Vendor: 03124 - CINTAS CORP
1,250.34LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 1,250.34
Vendor: 04110 - DITCH WITCH OF OKLAHOMA, DBA
52,905.00EXCAVATORHeavy EquipmentE02466DITCH WITCH OF OKLAHOMA, … 22175
Vendor 04110 - DITCH WITCH OF OKLAHOMA, DBA Total: 52,905.00
Vendor: 044184 - FLEET SERVICES
1,290.44FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
685.82FUEL CREDIT CARD CHARGESDiesel Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 1,976.26
Vendor: 13372 - LAMAR ENTERPRISES, INC.
8,279.003 PH TRANSFORMERTransformers12871LAMAR ENTERPRISES, INC. 22124
Vendor 13372 - LAMAR ENTERPRISES, INC. Total: 8,279.00
Vendor: 041498 - M & B CONTRACTING, LP
125.00ROLL OFF DUMPBuildings & GroundsCO1839M & B CONTRACTING, LP 22182
Vendor 041498 - M & B CONTRACTING, LP Total: 125.00
Vendor: 15064 - OKLA MUNICIPAL POWER AUTH
1,050,744.40JANUARY 2021 POWER BILLElectric Power PurchasesINV0000175OKLA MUNICIPAL POWER AUTH DFT0000102
Vendor 15064 - OKLA MUNICIPAL POWER AUTH Total: 1,050,744.40
Vendor: 041825 - SPARKLIGHT
59.50INTERNET/CABLECommunicationsINV0000010SPARKLIGHT 22191
Vendor 041825 - SPARKLIGHT Total: 59.50
Vendor: 20037 - TECHLINE, LTD.
940.00EQUIPMENTTools,Equip&Safety Gear1724426-00TECHLINE, LTD. 22192
Vendor 20037 - TECHLINE, LTD. Total: 940.00
Vendor: 044571 - TEXAS ELECTRIC COOP
2,308.96POLELINE SUPPLIESPoleline Supplies202102038914TEXAS ELECTRIC COOP 22137
4,725.00WIRECable Conductors202102038914TEXAS ELECTRIC COOP 22137
989.04BULBSLight Fixtures & Lamps202102038914TEXAS ELECTRIC COOP 22137
633.44POLE LINE HARDWAREPoleline SuppliesINV01053885TEXAS ELECTRIC COOP 22137
18.46POLE LINE HARDWAREPoleline SuppliesINV01057948TEXAS ELECTRIC COOP 22137
1,211.52PRIMARY BELLSPoleline SuppliesINV01067083TEXAS ELECTRIC COOP 22137
7,543.00FBGS TANG X-ARMSPoleline SuppliesINV01067085TEXAS ELECTRIC COOP 22137
Vendor 044571 - TEXAS ELECTRIC COOP Total: 17,429.42
Department 22 - PW - ELECTRIC Total: 1,142,830.29
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 25 - PW - ENTERPRISE SERVICES
Vendor: 041301 - BANK OF OKLAHOMA
56,497.13SERIES 2015 PAYMENTSeries 2015 Note Payment202102038903BANK OF OKLAHOMA 22105
Vendor 041301 - BANK OF OKLAHOMA Total: 56,497.13
Vendor: 047293 - DAN L WIGINGTON
4,500.00LAND APPRAISALSTrust ContingencyINV0000008DAN L WIGINGTON 22174
Vendor 047293 - DAN L WIGINGTON Total: 4,500.00
Department 25 - PW - ENTERPRISE SERVICES Total: 60,997.13
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 26 - PW - WASTEWATER
Vendor: 01008 - ACCURATE ENVIRONMENTAL, LLC
220.00MONTHLY TESTINGLab TestingDA06172ACCURATE ENVIRONMENTAL, L… 22099
195.00MONTHLY TESTINGLab TestingDA13130ACCURATE ENVIRONMENTAL, L… 22099
120.00MONTHLY TESTINGLab TestingDA20146ACCURATE ENVIRONMENTAL, L… 22099
120.00MONTHLY TESTINGLab TestingDA27047ACCURATE ENVIRONMENTAL, L… 22099
Vendor 01008 - ACCURATE ENVIRONMENTAL, LLC Total: 655.00
Vendor: 046327 - ALCORTA'S CARWASH
16.00VEHICLE CAR WASHMaint/Equipment & VehiclesINV0000180ALCORTA'S CARWASH 22213
24.00VEHICLE CAR WASHMaint/Equipment & VehiclesINV0000180ALCORTA'S CARWASH 22213
Vendor 046327 - ALCORTA'S CARWASH Total: 40.00
Vendor: 044654 - ALTUS POWER
15,075.03WWTP # 26Utilities202102018890ALTUS POWER 22086
Vendor 044654 - ALTUS POWER Total: 15,075.03
Vendor: 08030 - ALTUS READY MIX, INC.
784.00CONCRETEMaint/Equipment & Vehicles5960ALTUS READY MIX, INC. 22165
Vendor 08030 - ALTUS READY MIX, INC. Total: 784.00
Vendor: 03124 - CINTAS CORP
285.16LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 285.16
Vendor: 046261 - COVE ENVIROMENTAL, LLC
7,993.00Lab Testing FeesLab Testing27-1-21COVE ENVIROMENTAL, LLC 22109
Vendor 046261 - COVE ENVIROMENTAL, LLC Total: 7,993.00
Vendor: 044184 - FLEET SERVICES
1,979.21FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
607.89FUEL CREDIT CARD CHARGESDiesel Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 2,587.10
Vendor: 08087 - HAYNES EQUIPMENT CO., LLC
1,204.08Service Call to look at valve act…Maint/Equipment & Vehicles8124391-INHAYNES EQUIPMENT CO., LLC 22224
1,283.50Service Call to look at Bar ScreenMaint/Equipment & Vehicles8124392-INHAYNES EQUIPMENT CO., LLC 22225
Vendor 08087 - HAYNES EQUIPMENT CO., LLC Total: 2,487.58
Vendor: 041064 - OKLA TURNPIKE AUTHORITY
74.75PIKEPASSTraining & Travel Expenses20210194070OKLA TURNPIKE AUTHORITY 22114
Vendor 041064 - OKLA TURNPIKE AUTHORITY Total: 74.75
Vendor: 046437 - PRAIRIE HILL CONSTRUCTION AND SERVICES LLC
1,600.00TRACKHOE EXCAVATION AND V…Contract Services282615PRAIRIE HILL CONSTRUCTION A… 22232
Vendor 046437 - PRAIRIE HILL CONSTRUCTION AND SERVICES LLC Total: 1,600.00
Vendor: 043166 - REYES ELECTRIC, LLC
3,150.00ELECTRICAL WORKContract Services201017-01REYES ELECTRIC, LLC 22190
200.00CHAIN HOIST REPAIRMaint/Equipment & Vehicles201017-02REYES ELECTRIC, LLC 22190
Vendor 043166 - REYES ELECTRIC, LLC Total: 3,350.00
Vendor: 047454 - TWISTED S CONTAINERS
4,618.00STORAGE CONTAINERMaint/Equipment & Vehicles2422TWISTED S CONTAINERS 22194
Vendor 047454 - TWISTED S CONTAINERS Total: 4,618.00
Vendor: 25000 - WESTERN EQUIPMENT, LLC
8,625.00BOX BLADEEquipment3129605WESTERN EQUIPMENT, LLC 22197
Vendor 25000 - WESTERN EQUIPMENT, LLC Total: 8,625.00
Department 26 - PW - WASTEWATER Total: 48,174.62
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AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 28 - PW - UTILITY SERVICES
Vendor: 046327 - ALCORTA'S CARWASH
4.00VEHICLE CAR WASHMaint/Equipment & VehiclesINV0000180ALCORTA'S CARWASH 22213
Vendor 046327 - ALCORTA'S CARWASH Total: 4.00
Vendor: 03124 - CINTAS CORP
302.68LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 302.68
Vendor: 041590 - EXPRESS SERVICES, INC
249.25COLLECTIONS/UTILITIESContract Services24978071EXPRESS SERVICES, INC 22220
Vendor 041590 - EXPRESS SERVICES, INC Total: 249.25
Vendor: 044184 - FLEET SERVICES
325.84FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 325.84
Vendor: 046797 - TECHNICAL PROGRAMMING SERVICES, INC.
3,114.30Prep of Altus Power BillsContract Services108283TECHNICAL PROGRAMMING SE… 22135
1,697.11Prep of Altus Power BillsContract Services108328TECHNICAL PROGRAMMING SE… 22135
1,532.70PREP OF ALTUS POWER BILLSContract Services108433TECHNICAL PROGRAMMING SE… 22236
Vendor 046797 - TECHNICAL PROGRAMMING SERVICES, INC. Total: 6,344.11
Vendor: 23180 - WILMES SUPERSTORE, INC.
271.77Starter wire EyelitMaint/Equipment & Vehicles148472WILMES SUPERSTORE, INC. 22139
Vendor 23180 - WILMES SUPERSTORE, INC. Total: 271.77
Department 28 - PW - UTILITY SERVICES Total: 7,497.65
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AMA - Claims List Payable Dates: 2/1/2021 - 2/19/2021
2/25/2021 2:37:36 PM Page 9 of 13
AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 35 - ENGINEERING DEPT
Vendor: 047390 - ASBESTOS HANDLERS, INC
5,500.00Sampling at PoolContract Services7795-21-0202ASBESTOS HANDLERS, INC 22171
Vendor 047390 - ASBESTOS HANDLERS, INC Total: 5,500.00
Vendor: 044184 - FLEET SERVICES
96.31FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 96.31
Vendor: 06150 - FOX, DRESCHLER & BRICKLEY, INC.
6,060.00Survey for Pool ProjectContract Services8516FOX, DRESCHLER & BRICKLEY, I… 22113
Vendor 06150 - FOX, DRESCHLER & BRICKLEY, INC. Total: 6,060.00
Vendor: 046041 - MESHEK & ASSOCIATES, LLC
1,472.66Annual GIS HostingContract Services8003MESHEK & ASSOCIATES, LLC 22183
Vendor 046041 - MESHEK & ASSOCIATES, LLC Total: 1,472.66
Department 35 - ENGINEERING DEPT Total: 13,128.97
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AMA - Claims List Payable Dates: 2/1/2021 - 2/19/2021
2/25/2021 2:37:36 PM Page 10 of 13
AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Department: 36 - PW - LANDFILL
Vendor: 044341 - ASAP ENERGY INC.
4,020.00DIESELDiesel Fuel4250414ASAP ENERGY INC. 22101
4,504.50CLEAR DIESELDiesel Fuel4270902ASAP ENERGY INC. 22215
Vendor 044341 - ASAP ENERGY INC. Total: 8,524.50
Vendor: 03124 - CINTAS CORP
255.12LAUNDRY SERVICELaundryINV0000174CINTAS CORP 22218
Vendor 03124 - CINTAS CORP Total: 255.12
Vendor: 045333 - DUKE MUNICIPAL AUTHORITY
53.90DUKE WATER USEUtilities202102038912DUKE MUNICIPAL AUTHORITY 22111
Vendor 045333 - DUKE MUNICIPAL AUTHORITY Total: 53.90
Vendor: 044184 - FLEET SERVICES
61.00FUEL CREDIT CARD CHARGESGasoline Fuel69743559FLEET SERVICES 0
Vendor 044184 - FLEET SERVICES Total: 61.00
Vendor: 12134 - MANGUM OIL & GAS COMPANY, INC.
416.58PROPANEPropane-Landfill140167MANGUM OIL & GAS COMPANY… 22123
Vendor 12134 - MANGUM OIL & GAS COMPANY, INC. Total: 416.58
Vendor: 04052 - WARREN POWER & MACHINERY, INC
18,531.93DOZER REPAIRMaint/DozerWOOO8OO77359WARREN POWER & MACHINERY… 22196
Vendor 04052 - WARREN POWER & MACHINERY, INC Total: 18,531.93
Department 36 - PW - LANDFILL Total: 27,843.03
Fund 53 - ENTERPRISE FUND (53) Total: 1,370,851.68
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AMA - Claims List Payable Dates: 2/1/2021 - 2/19/2021
2/25/2021 2:37:36 PM Page 11 of 13
AmountDescription (Item)Account NamePayable NumberVendor Name Payment Number
Fund: 54 - WATER TREATMENT PLANT IMP
Department: 40 - CAPITAL DEVELOPMENT
Vendor: 041793 - R.B. ELECTRIC
14,760.00RETAINAGE FROM BID 20066-G…Settlement & Projects5585R.B. ELECTRIC 22189
Vendor 041793 - R.B. ELECTRIC Total: 14,760.00
Department 40 - CAPITAL DEVELOPMENT Total: 14,760.00
Fund 54 - WATER TREATMENT PLANT IMP Total: 14,760.00
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% Complete: 57.69%JAN 2021 FY21 FY TD
DEPT NAME ACTUAL BUDGET ACTUALPW- W/S MAINT 67,713.15 573,095.00 425,403.89 74.23%PW- SANITATION 40,718.65 559,476.00 366,435.05 65.50%PW- AAFB RECYCLING 13,252.02 140,796.00 90,107.17 64.00%PW- WATER TRMT 50,667.79 591,952.00 377,831.84 63.83%PW- ELECTRIC 109,753.51 1,361,510.00 788,239.17 57.89%PW- WASTEWATER 31,982.09 445,504.00 285,615.83 64.11%PW- UTILITY SVC 42,059.02 543,653.00 308,548.04 56.75%PW- ENGINEERING 10,684.16 134,587.00 80,687.98 59.95%PW- LANDFILL 29,787.13 255,150.00 176,421.76 69.14%TOTAL PAYROLL: 396,617.52 4,605,723.00 2,899,290.73 62.95%
ENTERPRISE FUNDPAYROLL: BUDGET TO ACTUALMONTH END: JANUARY 2021
**This report includes all wages, taxes, and benefits.**
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DEPARTMENT AMOUNTELECTRIC Total 3,875.79 ENGINEERING Total 41.50 SANITATION Total 9,775.27 UTILITIES Total 109.02 WASTE WTR Total 4,807.09 WATER TRMT Total 3,905.26 WTR/SWR MNTC Total 2,627.33 Grand Total 25,141.26
ALTUS MUNICIPAL AUTHORITYPurchase Cards - 12/29/2020 - 1/27/2021
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DEPARTMENT VENDOR DESCRIPTION AMOUNTELECTRIC LOCKE SUPPLY WE ALTUS PUMP STATION LIGHTING 40.58 ELECTRIC LOCKE SUPPLY WE ALTUS PUMP STATION LIGHTING 54.64 ELECTRIC LOCKE SUPPLY WE ALTUS UPGRADE WASH HOUSE ELECTR 243.07 ELECTRIC LOCKE SUPPLY WE ALTUS EMERGENCY LIGHT RETROFIT 143.13 ELECTRIC LOCKE SUPPLY WE ALTUS RO PLC FUSE 5.95 ELECTRIC LOCKE SUPPLY WE ALTUS REPLACE MOTOR EXHAUST FAN 11.47 ELECTRIC FOX BUILDING SUPPLY AL DEWALT ORGANIZER 29.13 ELECTRIC NAPA OF ALTUS GREASE 72.20 ELECTRIC FOX BUILDING SUPPLY AL SOCKET SET 18.99 ELECTRIC AMSCO STEEL LLC 4 1/2 INCH PIPE 276.00 ELECTRIC HABOR FREIGHT TOOLS304 AUGER EXTENTION 24.99 ELECTRIC FOX BUILDING SUPPLY AL CEMENT MIX 14.20 ELECTRIC FOX BUILDING SUPPLY AL CEMENT MIX 3.55 ELECTRIC FOX BUILDING SUPPLY AL 7.48 ELECTRIC CONSOLIDATED BEARING O HAMMER DRILL 419.26 ELECTRIC AMAZON.COM*ZZ40M6YE3 FR COAT DJ GONZALES 259.99 ELECTRIC ATWOOD 11 ALTUS GREASE FIITINGS AND COUPL 40.76 ELECTRIC TEXAS ELECTRIC COOPERA WORK GLOVES 333.36 ELECTRIC SQ *ARKANSAS ELECTRIC SM WOOD BRACES 172.00 ELECTRIC WARREN HEIM CORPORATIO BUCKET COVERS 306.35 ELECTRIC MOONLIGHT MAINTENANCE TRASH BAGS, SPRAY, BLEACH 69.58 ELECTRIC HI-LINE 7813 VINYL TOOL BOARD W/ HOOKS 275.01 ELECTRIC MANGUM OIL & GAS FILL PROPANE TANKS 59.04 ELECTRIC JACKSON HIRSH INC 9 X 12-10 LAMINATING SHEE 75.74 ELECTRIC CEMBRE INC 18 V LI-ION BATTERIES 455.00 ELECTRIC IN *PRIVETT SALES DESKTOP CALENDERS 50.00 ELECTRIC HI-LINE 7813 TOOL BOARD 414.32 ELECTRIC Total 3,875.79 ENGINEERING SOUTHWEST TECHNOLOGY C PRINTING FEES 12.00 ENGINEERING USPS PO 3902420401 POSTAGE 13.90 ENGINEERING USPS PO 3902420401 CERTIFIED MAIL TO SELVIDG 15.60 ENGINEERING Total 41.50 SANITATION WARREN CAT-PARTS STORE HYD HOSE 68.09 SANITATION PHILLIPS 66 - HUTCHS 1 USER ERROR SEE ATTACHED 10.84 SANITATION ATWOOD 11 ALTUS TRASH BAGS 84.49 SANITATION NAPA OF ALTUS DOZER FILTERS 55.45 SANITATION UNITED SUPERMARKET 3 DRINKING WATER 20.69 SANITATION SOLID WASTE ASSOCIA SWANA MEMBERSHIP 223.00 SANITATION WARREN CAT-PARTS STORE FILTER 56.51 SANITATION WARREN CAT-PARTS STORE SERVICE FILTERS 330.15 SANITATION NAPA OF ALTUS BATTERIES FIRE TRUCK 249.14 SANITATION ATWOOD 11 ALTUS SHOP LIGHTS 76.76 SANITATION FOX BUILDING SUPPLY AL RAKES FOR LITTER 28.98 SANITATION WARREN CAT COMPACTOR SAMPLE 29.00 SANITATION FOX BUILDING SUPPLY AL CLEVIS HOOKS 21.16 SANITATION SOUTHWESTERN EQUIPMENT HYD FILLER CAPS 122.22 SANITATION WAL-MART #0479 STENCILS, ETC. 16.15 SANITATION NAPA OF ALTUS HYD HOSE 212 165.35 SANITATION O'REILLY AUTO PARTS 32 SPRAY PAINT 36.82 SANITATION WASTE SYSTEMS SIDELOADER PARTS 107.66 SANITATION FOX BUILDING SUPPLY AL BLACK PAINT 22.35 SANITATION FOX BUILDING SUPPLY AL PIPE & NUTS 6.34
ALTUS MUNICIPAL AUTHORITYPurchase Cards - 12/29/2020 - 1/27/2021
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DEPARTMENT VENDOR DESCRIPTION AMOUNT
ALTUS MUNICIPAL AUTHORITYPurchase Cards - 12/29/2020 - 1/27/2021
SANITATION WAL-MART #0479 TORCH HEAD & PROPANE 19.02 SANITATION HABOR FREIGHT TOOLS304 PAINTER'S TAPE 5.19 SANITATION HABOR FREIGHT TOOLS304 TRANSFER PUMP 7.99 SANITATION WESTERN EQUIPMENT ALTU ELEC CONNECTORS 203 3.40 SANITATION NAPA OF ALTUS SOLDER BEADS 4.68 SANITATION HABOR FREIGHT TOOLS304 PAINTER'S TAPE 5.19 SANITATION HABOR FREIGHT TOOLS304 RACHET STRAP 218 11.99 SANITATION NAPA OF ALTUS BTTRY, TRMNLS, WIRE 218 145.97 SANITATION FOX BUILDING SUPPLY AL HYDRATED LIME 12.35 SANITATION FOX BUILDING SUPPLY AL LOCK NUTS; CLAMPS--218 4.73 SANITATION J-SYSTEMS GLOVES #9688L 5 DZ 123.00 SANITATION ATWOOD 11 ALTUS BOLTS & WASHERS--218 8.38 SANITATION O'REILLY AUTO PARTS 32 TOGGLE SWITCHES 218 9.98 SANITATION WM SUPERCENTER #479 ELEC CONNECTORS 15.94 SANITATION AMSCO STEEL LLC METAL FOR RACK--218 155.00 SANITATION O'REILLY AUTO PARTS 32 HOSE & CONNECTOR--218 26.01 SANITATION FOX BUILDING SUPPLY AL HOSE CLAMPS 7.12 SANITATION O'REILLY AUTO PARTS 32 30 AMP FUSES 3.99 SANITATION NAPA OF ALTUS FITTINGS/HOSES 218 153.77 SANITATION WM SUPERCENTER #479 WATER 77.60 SANITATION O'REILLY AUTO PARTS 32 EMERY CLOTH 4.22 SANITATION WEBER'S DIESEL SERVICE GASKET & SEAL KITS 205 426.79 SANITATION ALTUS PRINTING CO POLYCART LABELS 396.00 SANITATION AMZN MKTP US*XP0F20OF3 GREASE GUN BRACKET 15.50 SANITATION HABOR FREIGHT TOOLS304 PAINT SHAKER 103.99 SANITATION ATWOOD 11 ALTUS DEF 209.70 SANITATION FOX BUILDING SUPPLY AL SPLIT - NUTS, BOLTS, WASH (79.96%) 38.06 SANITATION FOX BUILDING SUPPLY AL SPLIT - FILTERS (20.04%) 9.54 SANITATION DOLLAR TREE CLEANER, SOAP 9.00 SANITATION O'REILLY AUTO PARTS 32 COPPER LUGS 218 10.98 SANITATION WEBER'S DIESEL SERVICE 206 WIRING REPAIR 137.00 SANITATION ROLL OFFS OF AMERICA ROLLOFF SHIPPING 367.00 SANITATION NAPA OF ALTUS SIDELOADER PARTS 1,385.51 SANITATION FOX BUILDING SUPPLY AL AIR COMPRESSOR FOR BASE 463.99 SANITATION NAPA OF ALTUS ONE TON PARTS 30.52 SANITATION WALGREENS #9670 SCALE OFFICE HEATER 34.99 SANITATION NAPA OF ALTUS ONE TON PARTS 21.31 SANITATION SOLID WASTE ASSOCIA SWANA TRAINING 843.00 SANITATION SOLID WASTE ASSOCIA SWANA MEMBERSHIP 223.00 SANITATION SOLID WASTE ASSOCIA SWANA MEMBERSHIP PER JONN 843.00 SANITATION NAPA OF ALTUS SIDELOADER PARTS 136.72 SANITATION NAPA OF ALTUS AAFB BASE EQUIPMENT 1,388.00 SANITATION TILLCO SUPPLY CO SIDELOADER PARTS 145.00 SANITATION Total 9,775.27 UTILITIES WAL-MART #0479 WATER FOR OFFICE 25.04 UTILITIES IN *PRIVETT SALES OFFICE SUPPLY 83.98 UTILITIES Total 109.02 WASTE WTR AMSCO STEEL LLC WIRE FOR CONCRETE 100.00 WASTE WTR AMAZON.COM*TP6IC83Z3 INTERIOR DOOR HANDLE 601 57.39 WASTE WTR NAPA OF ALTUS JUMP STARTER 12/24VOLT 399.00 WASTE WTR NAPA OF ALTUS BATTERY UNIT 601 93.56 WASTE WTR PIONEER SUPPLY LLC GATE VALVE PVC GASKET NUT 1,069.20
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DEPARTMENT VENDOR DESCRIPTION AMOUNT
ALTUS MUNICIPAL AUTHORITYPurchase Cards - 12/29/2020 - 1/27/2021
WASTE WTR FOX BUILDING SUPPLY AL GLOVES 27.96 WASTE WTR LOCKE SUPPLY ALTUS COUPLINGS 37.86 WASTE WTR KIRBYS WRECKER & SERVI FLAT REPAIR 20.00 WASTE WTR THE HOME DEPOT #3914 HOSE CLAMP DRAIN PIPE ELB 160.07 WASTE WTR LOCKE SUPPLY ALTUS COUPLING/CLAMP 39.77 WASTE WTR THE HOME DEPOT #3914 DRAIN PIPE FITTINGS 30.98 WASTE WTR 1@PVC-FLEX-AND-FITTING PVC FITTINGS 78.13 WASTE WTR PVC FITTINGS ONLINE 4" PVC FLANGE 161.19 WASTE WTR 1@PVC-FLEX-AND-FITTING HOSE FITTINGS 25.25 WASTE WTR AMAZON.COM*XS9IO2RJ3 HIP BOOTS 81.12 WASTE WTR AMAZON.COM*ZZ3NS92H3 FITTINGS 73.26 WASTE WTR FOX BUILDING SUPPLY AL STEEL WOOL 4.49 WASTE WTR TEEX RETAIL BENNY CLASS TEXAS CANCELL 440.00 WASTE WTR HABOR FREIGHT TOOLS304 GLOVES SCREWDRIVER HEX 130.92 WASTE WTR USA BLUE BOOK SLUDGE JUDGE TOP AND MIDD 193.67 WASTE WTR OFFICESUPPLY.COM PAPER LABELING TAPE HANDL 162.16 WASTE WTR FOX BUILDING SUPPLY AL PLYWOOD FRAMING 34.36 WASTE WTR FOX BUILDING SUPPLY AL TAPE SCREWS U/KNIFE BROOM 60.12 WASTE WTR AMZN MKTP US*WP0G71RQ3 HEATER/EAST PLANT SHOP 948.27 WASTE WTR USA BLUE BOOK SLUDGE JUDGE VALVE 142.39 WASTE WTR FOX BUILDING SUPPLY AL SCREWS 9.47 WASTE WTR NAPA OF ALTUS FUEL FILTER 8.10 WASTE WTR FOX BUILDING SUPPLY AL HANDLE COUPLING SQUEEGEE 31.26 WASTE WTR FOX BUILDING SUPPLY AL PLYWOOD/FRAMING 61.04 WASTE WTR FOX BUILDING SUPPLY AL BLADE 19.99 WASTE WTR NAPA OF ALTUS FUEL CAP 12.45 WASTE WTR FOX BUILDING SUPPLY AL PLUG TEST SPONGES BRACKET 33.62 WASTE WTR FOX BUILDING SUPPLY AL ROPE 19.99 WASTE WTR WAL-MART #0479 SPLENDA COFFEE 40.05 WASTE WTR Total 4,807.09 WATER TRMT HACH COMPANY LAB SUPPLIES 63.85 WATER TRMT HACH COMPANY LAB SUPPLIES 14.59 WATER TRMT WM SUPERCENTER #479 OFFICE SUPPLIES 77.09 WATER TRMT ROSE STATE COLLEGE WOR TRAINING/SCHOOL 428.00 WATER TRMT ROSE STATE COLLEGE WOR TRAINING/SCHOOL 223.00 WATER TRMT ROSE STATE COLLEGE WOR TRAINING/SCHOOL 428.00 WATER TRMT HACH COMPANY LAB SUPPLIES 266.00 WATER TRMT LOCKE SUPPLY - ALTUS PVC SUPPLIES 6.50 WATER TRMT LOCKE SUPPLY - ALTUS PVC SUPPLIES 1.86 WATER TRMT HACH COMPANY LAB SUPPLIES 606.61 WATER TRMT USA BLUE BOOK LAB SUPPLIES 35.71 WATER TRMT FOX BUILDING SUPPLY AL PVC ADPT,CEMENT PVC 21.31 WATER TRMT LOCKE SUPPLY WE ALTUS HIGH OUTPUT LIGHTING 98.80 WATER TRMT ATWOOD 11 ALTUS CORD REEL,CORD REEL W/OUT 62.97 WATER TRMT ATWOOD 11 ALTUS HOSE CLAMPS,HOSE. 48.19 WATER TRMT WM SUPERCENTER #479 HAND SANI,BLCH WIPES,DISI 104.27 WATER TRMT JANUS SUPPLY CO. BROWN PAPER TOWELS 31.80 WATER TRMT WM SUPERCENTER #479 SURGE STRIPS. 28.78 WATER TRMT ATWOOD 11 ALTUS SAW BLADE SET 27.99 WATER TRMT LOCKE SUPPLY ALTUS BALL VALVE COUPLING 34.48 WATER TRMT GRAINGER REFUND CALENDERS. NVR GOT (34.13) WATER TRMT LOCKE SUPPLY - ALTUS COUPLING SCH 80 7.97
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DEPARTMENT VENDOR DESCRIPTION AMOUNT
ALTUS MUNICIPAL AUTHORITYPurchase Cards - 12/29/2020 - 1/27/2021
WATER TRMT LOCKE SUPPLY ALTUS COUPLINGS SCH 80 16.85 WATER TRMT USA BLUE BOOK ROTARY PUMP 96.14 WATER TRMT USA BLUE BOOK CHEMICAL PUMP. 104.48 WATER TRMT ATWOOD 11 ALTUS BARREL PUMP 32.99 WATER TRMT TRACTOR SUPPLY # 1289 STALL MATTS 152.60 WATER TRMT GATEHOUSE LIMIT SWITCHES 27.85 WATER TRMT GATEHOUSE LIMIT SWITCHES 63.18 WATER TRMT GATEHOUSE REFUNDED GOT WRONG SWITCH (27.85) WATER TRMT WAL-MART #0479 DESK CALENDERS 9.94 WATER TRMT ATWOOD 11 ALTUS BATTERY ADAPTER,U BOLT. 157.98 WATER TRMT FOX BUILDING SUPPLY AL CABLETIES PIPE. 13.96 WATER TRMT SQ *SCOTT BROWN PROPANE 70.00 WATER TRMT LOCKE SUPPLY ALTUS PRESSURE TEE SLIP CAP 8.38 WATER TRMT TRACTOR SUPPLY # 1289 STALL MATT 406.93 WATER TRMT LOCKE SUPPLY ALTUS 2 PVC 45 ELL 3.66 WATER TRMT CONSOLIDATED BEARING O CHAIN BREAKER, LINK. 32.53 WATER TRMT FOX BUILDING SUPPLY AL PVC PIPING 25.34 WATER TRMT ADVANTAGE OFFICE PRODU PRINTER PAPER. 37.99 WATER TRMT FOX BUILDING SUPPLY AL MORE PVC PIPING 34.60 WATER TRMT FOX BUILDING SUPPLY AL CLAMP HOSE ADPTR FLAIR 54.07 WATER TRMT Total 3,905.26 WTR/SWR MNTC PIONEER SUPPLY LLC GATE VALVE AND PIPE LUBE 477.05 WTR/SWR MNTC WM SUPERCENTER #479 OFFICE SUPPLIES 55.43 WTR/SWR MNTC AUTOZONE #0524 RATCHET 34.99 WTR/SWR MNTC ATWOOD 11 ALTUS STRAINER, HOSE CLAMPS 17.46 WTR/SWR MNTC KENNYS SIGN GRAPHX LLC ON CALL PLAQUES 10.00 WTR/SWR MNTC LOCKE SUPPLY WE ALTUS SPLICE KIT 5.00 WTR/SWR MNTC ATWOOD 11 ALTUS CHAIN BINDER CABLES HANDL 146.71 WTR/SWR MNTC FOX BUILDING SUPPLY AL RASP, KEYS 61.89 WTR/SWR MNTC LOCKE SUPPLY - ALTUS 6" PVC COUPLING 78.45 WTR/SWR MNTC NAPA OF ALTUS BATTERY 28.39 WTR/SWR MNTC ATWOOD 11 ALTUS GLOVES, MASKS 52.95 WTR/SWR MNTC WESTERN EQUIPMENT ALTU SOCKET, HOSE, PLUG 132.82 WTR/SWR MNTC LOCKE SUPPLY ALTUS PIPE 146.52 WTR/SWR MNTC ATWOOD 11 ALTUS JB WELD, DETERGENT 15.97 WTR/SWR MNTC EREPLACEMENTPARTS.COM CHOKE CONTROL 26.14 WTR/SWR MNTC SUPPLYHOUSE.COM PONY PUMP 108.77 WTR/SWR MNTC AUTOZONE #0524 REFUND FOR DEFECTIVE RATC (34.99) WTR/SWR MNTC FOX BUILDING SUPPLY AL CHISELS, OIL, WIRE 31.14 WTR/SWR MNTC SQ *OKIE INDUSTRIAL SU TURBO NOZZLE 344.89 WTR/SWR MNTC PHILLIPS 66 - HUTCHS 1 FILL UP GAS CAN 10.73 WTR/SWR MNTC USA BLUE BOOK PIPE DESCALERS 752.53 WTR/SWR MNTC AUTOZONE #0524 RATCHETS 69.98 WTR/SWR MNTC ATWOOD 11 ALTUS LIGHTS, BRAKE CLEANER, PA 54.51 WTR/SWR MNTC Total 2,627.33 Grand Total 25,141.26
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Date: March 2, 2021
AGENDA ITEM COMMENTARY
ITEM TITLE: Authorize the AMA Board Chairman/Mayor to Sign the Application for a
Permit to Construct from the Oklahoma Department of Environmental Quality for DWSRF
Water Looping Project
BACKGROUND: On January 21, 2014, the City Council voted to “begin the process of
implementing Treatment Alternative No. 1 as recommended by Freese & Nichols, which
requires construction of a 12” water line…”
On August 5, 2014, the AMA Board and City Council voted to approve an Agreement for
Engineering Services with SBC Consulting Engineers of Altus, OK for professional design and
construction oversight services for this project to include the 12-inch water main as well as
various water line looping projects.
The project was partially funded by a State Financial Assistance Program Grant for Emergency
Drought Relief for an amount of $575,000 (Grant No. FAP-13-0002-EDR). 60% of grant funds
were applied to construction costs and 40% of the grant were applied to design costs.
The remainder of project costs were funded by a loan through the Drinking Water State
Revolving Fund (DWSRF). This loan, known as DWSRF Loan No. ORF-15-0005-DW has
already coverer $1,084,624.07 of construction costs and $167,000 of engineering costs for the
12-inch water main.
This loan also had an additional $1,204,307.07 available for water line looping projects. SBC
Consulting has completed the design and bid documents and we are ready to apply for a Permit
to Construct from ODEQ. Dead-end lines will be looped together in five separate areas.
Staff respectfully requests that the AMA Board of Trustees authorize the Chairman to sign the
application for the Permit to Construct.
FUNDING: None
EXHIBITS: ODEQ Application for Permit to Construct
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Oklahoma Department of Environmental QualityWater Quality Division | (405) 702-8100707 N. Robinson , OKC, OK 73102-6010
P.O. Box 1677, OKC, OK 73101-1677
ppli a on for Permit to Constru t Water Pollu on Control or Publi Water upply a ili es an or upply Potable Water
Check type(s) of Construc on Propose
Water Wells Waterlines Water Treatment Sanitary Sewer Wastewater Treatment Water Reuse
A. Supply Potable Water: Date: ______________ , 20 ___ ONLY
_____________________________________
______________________________________
______________________________________
________________________________________
_____________________________________
B. Supply Reclaime Water: Date: ______________ , 20 ___ONLY
_______________________________________
________________________________________
______________________________________
________________________________________
_________________________________________
______________________________________
C. Construc on acili es: Date: ______________ , 20 ___
__________________________________________________________________________________________________
______________________________________________________________________________________________
_______________________________ _____________________________________________________________
________________________ ___________________________ _________________________
________________________________________________________________________________________
_____________________________________________________________________________________________________
____/4 _____ /4 _____ /4 _______ ______ ____ _______ ____ ________________________
____/4 _____ /4 _____ /4 _______ ______ ____ _______ ____ ________________________
D. Fee: ________ _______________ / _________________
E. n makin this applica on, the applicant cer es an states the followin : Yes No
4
____________________________________________________________________________________
PRIVATE APPLICANT WITHIN MUNICIPALITY
RECEIVE, TRANSPORT, OR TREAT
____________________________________________________________________________________
X
City of Altus, Oklahoma / Altus Municipal AuthorityFebruary 19 21
1011501580-481-3515 [email protected]
[email protected] 580-512-1597 NAPotable Water Lines
City of Altus, Oklahoma
2 N 20 WIM JacksonSee At tachment I
NA
FAP-13-0002-EDR
NA
NA
X
XX
X
XX
X
X
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F. Fun in Source(s)
_______________________
Applicant Signature or Private Applicant Within MunicipalityNote:
______________
___________________________________________ ___________________________________________
___________________________________________ ___________________________________________
___________________________________________ ___________________________________________
___________________________________________ ___________________________________________
___________________________________________ ___________________________________________
___________________________________________ ___________________________________________ / / / /
___________________________________________ ___________________________________________ / / / /
Receive, Transport, or TreatNote:
________________________________________ ____________________
_____________________________________________________ ____________________________________________________
_____________________________________________________ ____________________________________________________
_____________________________________________________
_____________________________________________________ / /
_____________________________________________________ / /
NOTARY SEAL
NOTARY SEAL
NOTARY SEAL
XXX
X
NA
City of Altus, Oklahoma / Altus Municipal Authority
Jack Smiley
509 South Main Street
Mayor / Chairman
Altus, Oklahoma 73521
--------------------------------------------- ________
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AGENDA ITEM COMMENTARY
ITEM TITLE: Consideration, Discussion, and Possible Action to (1) Approve Purchase of a
John Deere 310SL Backhoe Under Sourcewell National Purchasing Contract #032119-JDC for
the Line Maintenance and Construction Department in an Amount Not to Exceed $107,000 (2)
Declare Surplus a 2008 Caterpillar 416E Backhoe and Authorize Trust Manager to Dispose of by
Sealed Bids
BACKGROUND:
FUNDING: Series 2015 Loan Proceeds
EXHIBITS: (1) Quote from CLBoyd (2) Sourcewell Contract Information
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Salesperson : X ______________ Accepted By : X ______________
Confidential
Quote SummaryPrepared For:CITY OF ALTUS509 S MAIN STALTUS, OK 73521Business: 580-477-1950
Prepared By:STEVE LITTLE
The Clarence L. Boyd Company4220 West Reno
Oklahoma City, OK 73107Phone: 405-942-8000Mobile: 580-585-7427
Pricing provided through the Sourcewell National Purchasing Contract. JD Contract ID#032119-JDC City of Altus member ID#62660
Quote Id: 23723122
Expiration Date: 31 March 2021
Equipment Summary Suggested List Selling Price Qty Extended
JOHN DEERE 310SL BACKHOE LOADER
$ 187,686.80 $ 106,510.00 X 1 = $ 106,510.00
Extended WarrantyExtended Warranty, 310SL, Comprehensive, 2500 Total Hours or 48 Total Months, $200 Deductible
Sub Total $ 106,510.00
Equipment Total $ 106,510.00
Trade In Summary Qty Each Extended
2008 CATERPILLAR 416E - CAT0416EPSHA03466
1 $ 24,000.00 $ 24,000.00
PayOff $ 0.00Total Trade Allowance $ 24,000.00
Trade In Total $ 24,000.00Quote SummaryEquipment Total $ 106,510.00Trade In $ (24,000.00)SubTotal $ 82,510.00
Est. Service Agreement Tax $ 0.00
Total $ 82,510.00Balance Due $ 82,510.00
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Quote Id: 23723122 Customer: CITY OF ALTUS
Confidential
JOHN DEERE 310SL BACKHOE LOADERHours:Stock Number:
Suggested List$ 184,592.00Selling Price$ 103,415.20
Code Description Qty Unit Extended0A71T 310SL BACKHOE LOADER 1 $ 124,205.00 $ 124,205.00
Standard Options - Per Unit170C JDLink Ultimate 5 Year Subscription 1 $ 0.00 $ 0.001065 John Deere PowerTech™ EWL 4.5L
(276 Cu. In.) Engine Meets Final Tier 4 and Stage IV Emissions
1 $ 10,028.00 $ 10,028.00
2035 Cab 1 $ 13,243.00 $ 13,243.002401 English Decals with English Operator
and Safety Manuals1 $ 0.00 $ 0.00
3025 2 Wheel Drive Autoshift Transmission 1 $ -8,406.00 $ -8,406.004446 Galaxy 19.5L - 24 in. 12 PR Rear &
12.5/80-18 12PR Front1 $ 66.00 $ 66.00
5285 Pilot Controls, Two Lever, with Pattern Selection
1 $ 2,594.00 $ 2,594.00
5401 Less Coupler - Thumb Ready 1 $ 0.00 $ 0.005656 24" (610 mm) Wide, Heavy-Duty, 7.5
Cu. Ft. (0.21 Cu. M.) Capacity Bucket1 $ 1,370.00 $ 1,370.00
6020 Extendible Dipperstick 1 $ 8,365.00 $ 8,365.006230 Auxiliary Hydraulic with One & Two
Way Flow (Hammer & Thumb/Swinger)1 $ 4,582.00 $ 4,582.00
7080 Three-Function Loader Hydraulics, Single Lever
1 $ 3,268.00 $ 3,268.00
7685 Wide Multipurpose Bucket 1 $ 7,593.00 $ 7,593.008475 1000 Lb. (454 kg) Front Counterweight 1 $ 1,374.00 $ 1,374.008685 Dual Maintenance Free Batteries With
Disconnect and Jump Post1 $ 544.00 $ 544.00
9060 Front View Mirror 1 $ 82.00 $ 82.009115 Auto Ride Control 1 $ 2,335.00 $ 2,335.009230 37 Inch Hydraulic Backhoe Thumb - 4
Tine1 $ 5,697.00 $ 5,697.00
9917 Radio, Bosch Basic Package 1 $ 873.00 $ 873.009919 Sun Visor 1 $ 95.00 $ 95.009965 Seat, Cloth Air-Suspension 1 $ 503.00 $ 503.00
Standard Options Total $ 54,206.00Dealer Attachments
AT448428 Hand Held Hydraulics 1 $ 464.00 $ 464.00AT448429 Auxilary Hydraulic Selective Flow
Control Kit1 $ 1,259.00 $ 1,259.00
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Quote Id: 23723122 Customer: CITY OF ALTUS
Confidential
AT437340 BKH Pin-on Bucket 18 In. (457 mm) Heavy-Duty 5.1 Cu. Ft. (0.14 Cu. M.)
1 $ 1,358.00 $ 1,358.00
Dealer Attachments Total $ 3,081.00Value Added Services
Extended Warranty 1 $ 3,094.80 $ 3,094.80Value Added Services Total $ 3,094.80
Other ChargesFreight 1 $ 2,300.00 $ 2,300.00Setup 1 $ 800.00 $ 800.00Other Charges Total $ 3,100.00
Suggested Price $ 187,686.80Customer Discounts
Customer Discounts Total $ -81,176.80 $ -81,176.80Total Selling Price $ 106,510.00
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Extended Warranty Proposal PowerGard™ Protection PlanConstructionDate : February 24, 2021Machine/Use Information Plan Description Price
Manufacturer JOHN DEERE Plan Type: Extended Warranty Deductible: $ 200
Equipment Type Construction Coverage: Comprehensive Quoted Price $ 3,094.80
Model 310SL Total Months: 48
Country US Total Hours: 2500 Date Quoted February 23, 2021
MFWD/Tracks N
Scraper Use Extended Warranty is available only through authorized John Deere Dealers for John Deere Products,and may be purchased at any time before the product's Standard Warranty,or Extended Warranty expires.
Customer Name - Please Print
Customer Signature
Extended Warranty Proposal Prepared for: I have been offered this extended warranty and
I ACCEPT the Extended Warranty✔
I DECLINE the Extended Warranty
If declined, I fully understand that any equipment listed above is not covered for customer expenses due to component failures beyond the original basic warranty period provided by John Deere.
This is not a contract. For specific Extended Warranty coverage terms and conditions, please refer to the actual Extended Warranty contract for more information and the terms, conditions and limitations of the agreement.
Note :
What Extended Warranty is :The Extended Warranty Program is for the reimbursement on parts and labor for covered components that fail due to faulty material or original workmanship that occur beyond the John Deere Basic Warranty coverage period. The agreement is between Deere & Company and the owners of select John Deere Construction and Forestry equipment, who purchase the Extended Warranty Plans for the desired coverage as indicated in this proposal.
What Extended Warranty is not :Extended Warranty is not insurance. It also does not cover routine maintainance or high wear items,or insurance-related risks/perils such as collision, overturn, vandalism, wind, fire, hail, etc. It does not cover loss of income during or after an equipment failure. See the actual product-specific Extended Warranty agreement for a complete listing of covered components, and limitations and conditions under the program.
Features/Benefits:Extended Warranty includes the following features and benefits under the program :Pays for parts and labor costs incurred on failed covered components (less any applicable deductibles),Does not require pre-approval before repairs are made by the authorized John Deere dealership,Payments are reimbursed directly to the dealership with no prepayment required by the contract holder.
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Date: March 2, 2021
AGENDA ITEM COMMENTARY
ITEM TITLE: Consideration, Discussion, and Possible Action to Hire D&K Fencing of
Cache, OK to Install a New Chain Link Fence and Motor-Operated Cantilever Gate at the
Polishing Lagoons for a Fee of $14,612.35
BACKGROUND: As part of an ongoing effort to increase security at our sewer plants, we have
been installing new gates. In 2018, a new gate was installed at the SW plant by BestBuilt
Fencing of Lawton, OK. In, 2020, a new gate was installed at the SE plant by D&K Fencing of
Cache, OK.
Both of these gates are motor-operated cantilever gates that can be triggered with remote devices
or by entering a code on the key pad.
Staff would like to install a new gate for the polishing lagoons west of the SW plant. This
property is not currently fenced and there is no gate on the entrance road.
Price quotes were requested for a new 20-foot wide gate with 50 feet of chain link fence on
either side. The following fencing contractors were asked for a price quote.
• D&K Fencing
• BestBuilt Fencing
• Collins Fencing
• Big Bob’s Fencing
Two quotes were received as follows:
Contractor Address Price Quote
BestBuilt Fencing P.O. Box 2172
Lawton, OK
$11,038.60
D&K Fencing 316 Wildflower Cir
Cache, OK
$14,612.35
When BestBuilt Fencing installed the gate at the SW Plant, there were quality problems. They
did not pull the fence fabric tight and they did not install bracing on the gate which was sagging.
They were not initially responsive to fixing the sag in the gate but they put in square tube steel
for bracing instead of round steel and it looks tacky. Finally, the gate still sagged and dragged on
the ground a bit and we asked for that to be adjusted and they didn’t come back. Our operators
purchased and installed an additional roller to fix the sag. Staff does not want to hire them again.
D&K Fencing installed the same fence and gate at the SE plant and did a much better job. Even
though their price is higher, staff recommends hiring D&K Fencing using Capital Improvement
funds.
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FUNDING: 21-5-26-5400.100 Capital Improvement
EXHIBITS: Price Quote from D&K Fencing
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AGENDA ITEM COMMENTARY
ITEM TITLE: Consideration, Discussion, and Possible Action to Authorize the Mayor to Sign
Application Forms as Needed to Apply for a Permit to Treat and Dispose of Commercial Car
Wash Sludge
BACKGROUND: The Great American Car Wash has been dumping sludge from grit chambers
at the Altus SW WWTP. This sludge has a slot of mud and treatment plant operators wanted to
discontinue allowing the sludge in the sewer lagoon.
It was decided to construct a drying bed on City property close to the landfill where the sludge
could be dumped and allowed to dry by evaporation. Then the solids, could be removed and
placed in the landfill.
Staff feels this approach is least costly and less burdensome on City operations.
ODEQ, however, requires this to be permitted and has order that we complete and submit an
OPDES Application to Discharge and/or Treat or Dispose of Industrial Wastewater or Sludge.
The application has two separate forms as follows:
Form 1 - General Information
Form 2S1 – Surface Impoundments and Underground Tank Systems
Both forms need to be signed by “the principal executive officer of the entity or the ranking
elected official.”
FUNDING: N/A
EXHIBITS: Application Form 1 and Form 2S1
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Return to:
Oklahoma Department of
Environmental Quality
Water Quality Division 707 N. Robinson
P.O. Box 1677
Oklahoma City, OK 73101-1677
Revised August 2019
Industrial Permits Section
Oklahoma DEQ Application for Permit to Discharge and/or Treat or Dispose of Industrial Wastewater or Sludge
Form 1 - General Information
PLEASE DETACH THESE INSTRUCTIONS AND RETURN ONLY THE
COMPLETED APPLICATION FORMS THEMSELVES.
This form must be completed by all persons applying for a permit under DEQ’s
Industrial OPDES Permit Program. Form 2C, 2D, 2SI, and/or 2L must also be
filled out (see Item B of the Form 1 Line-by-Line Instructions to determine
which specific forms you will need).
See Form 1, Attachment 1 for instructions for the submittal of applications
and the public notice requirements.
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DESCRIPTION OF INDUSTRIAL FORM 1 PACKAGE
PERMIT APPLICATION FORMS TABLE OF CONTENTS
The Industrial Permit Application Forms are:
Form 1 - General Information (included in this package);
Form 2 - Industrial Pollutant Discharge and/or Wastewater Treatment:
2C. Discharge: Existing Manufacturing, Commercial and Mining
Operations (not included in this package),
2D. Discharge: New Manufacturing, Commercial and Mining
Operations (not included in this package), and
2SI. Surface Impoundments (Pits, Ponds, Lagoons, etc.), Subsurface Tank Systems, Land Application of Sludge or Wastewater, and/or
Other Treatment/Disposal Methods (not included in this package).
2L. Land Application of Sludge or Wastewater (not included in this
package)
606-008. Categorical or Significant Industrial User in a Non-
Pretreatment Municipality to Discharge Industrial Waste to the Publicly Owned Treatment Works (POTW)
Section A. General Instructions
Section B. Instructions for Form 1
Section C. Activities Which Do Not Require Regular Discharge Permits
Section D. Glossary
Form 1
SECTION A - GENERAL INSTRUCTIONS
Who Must Apply
These application forms must be filled out by anyone applying for a new
industrial discharge permit, industrial wastewater treatment permit and/or
permit for land application of industrial sludge or wastewater, or for a
renewal or major modification of an existing such permit from the Oklahoma
Department of Environmental Quality (DEQ), with the exception of facilities
listed in Section C of these instructions.
A discharge permit must be obtained prior to commencing any discharge of a
pollutant into waters of the State, from any facility, source or activity subject to
the jurisdiction of DEQ (as outlined below). When a facility or activity is owned by one person but operated by another person, it is the operator’s duty to obtain a
permit.
The Oklahoma Pollutant Discharge Elimination System Act, 27A O.S. §2-6-201
et seq. (the OPDES Act) provides that it shall be unlawful to discharge any
pollutant to waters of the State or elsewhere without first obtaining a permit from the Executive Director of DEQ. DEQ has jurisdiction over point source and
nonpoint discharges to waters of the State including:
A. All point source discharges of pollutants and stormwater to waters of
the State which originate from municipal, industrial, commercial,
mining, transportation and utilities, construction, trade, real estate and finance, services, public administration, manufacturing and all other
sources, facilities and activities, except as provided in 27A O.S. §1-3-
101, subsections D and E; B. All nonpoint source discharges and pollution of waters of the State,
except as provided in 27A O.S. §1-3-101, subsections D, E, and F;
C. Surface water and groundwater quality and protection and water quality certifications;
E. Discharges of pollutants and stormwater, surface impoundment and
land application of wastes and sludge from: 1. Commercial manufacturers of fertilizers, grain and feed
products, and chemicals, and over manufacturing of food and
kindred products, tobacco, paper, lumber, wood, textile mill and
other agricultural products;
2. Dairy waste and wastewater associated with milk production
facilities, but not including discharges to waters of the United States from concentrated animal feeding operations at such
facilities;
3. Slaughterhouses, but not including feedlots at such facilities; 4. Animal aquaculture and fish hatcheries;
F. Stormwater discharges required by EPA NPDES regulations to obtain
a permit for facilities which store grain, feed, seed, fertilizer, and agricultural chemicals;
G. Deleterious substances from Corporation Commission regulated
facilities and activities which enter point source discharges of pollutants or stormwater from a facility or activity regulated by DEQ;
H. Point source discharges of pollutants to waters of the United States
during site remediation of underground storage tanks;
I. Point source discharges of pollutants to waters of the United States
during site remediation of aboveground storage tanks used in
connection with the retail sale of flammable liquids into fuel tanks; J. Discharge or release of deleterious substances or solid or hazardous
waste or other pollutants from rolling stock and rail facilities;
K. Point and nonpoint source discharges of pollutants and stormwater to waters of the State from:
1. Refineries, petrochemical manufacturing plants and natural gas
liquid extraction plants; 2. Manufacturing of oil and gas related equipment and products;
3. Bulk terminals, aboveground and underground storage tanks not
subject to the jurisdiction of the Corporation Commission; 4. Other facilities, activities and sources not subject to the
jurisdiction of the Corporation Commission or Department of
Agriculture as specified in 27A O.S. §1-3-101, subsections D and E;
L. Environmental regulation of any entity or activity, and the prevention,
control and abatement of any pollution, not subject to the specific statutory authority of another state environmental agency.
In addition, it shall be unlawful for any person to carry on any of the following activities with regard to industrial wastewater or sludge without first securing a
permit from DEQ:
A. The construction, installation, operation, and closure of any industrial
surface impoundment or treatment system, or the use of any existing
unpermitted surface impoundment or treatment system that is within the jurisdiction of DEQ and which is proposed to be used for the
containment or treatment of industrial wastewater or sludge;
B. The construction, installation, or operation of any industrial or commercial facility subject to the permitting authority of DEQ, the
operation of which would cause an increase in the discharge of waste
into the waters of the State or would otherwise alter the physical, chemical, or biological properties of any waters of the State in any
manner not already lawfully authorized; or
C. The construction or use of any new outfall for the discharge of any
industrial waste or pollutant into the waters of the State.
If you have any questions about whether you need a permit or if you need information as to whether a particular permit program is administered by DEQ or
another agency, or if you need to obtain application forms, contact DEQ at the
address and phone number listed below under Where to File.
Upon your request, and based upon information supplied by you, DEQ will
determine whether you are required to obtain a permit for a particular facility. Be sure to contact DEQ if you have a question, because state and federal laws provide
that you may be heavily penalized if you do not apply for a permit when a permit
is required.
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What Forms to Fill Out
Form 1 of the Industrial Permit Application Forms collects general information applying to all facilities. You must fill out Form 1. In addition, you must fill
out one or more of the supplementary forms (Forms 2C, 2D, 2SI, 2L, and
606-008), as appropriate to the activities at your facility. Item B of Form 1 will guide you to the appropriate supplementary forms.
You should note that there are certain exclusions to the permit requirements listed above. The exclusions are described in detail in Section C of the instructions. If
your activities are excluded from permit requirements then you do not need to
complete Form 1 or any of the Forms 2. Depending on the nature of your activity, however, you may have to complete some other application form.
In addition to issuing regular individual permits, DEQ also issues several types of general permits. These general permits are located at
http://www.deq.state.ok.us/wqdnew/genpermits.html. If you have questions
about whether these types of permits are applicable to your activity or if you need to obtain application forms, contact DEQ.
Where to File
Completed applications must be filed with DEQ’s central office at the following
address:
Water Quality Division
Oklahoma Department of Environmental Quality 707 N. Robinson
P.O. Box 1677
Oklahoma City, OK 73101-1677 (405) 702-8100
See Form 1, Attachment 1 for guidance with the number of applications submitted and placement of application for public review.
When to File
An application for a new or modified permit should be submitted at least 180 days
before the date on which the discharge or other activity requiring a permit (e.g., construction of a surface impoundment, installation of a treatment system, etc.) is
to commence.
An application for renewal of an existing permit shall be submitted at least 180
days before the existing permit expires.
Different submittal dates may be required under the terms of applicable general
permits.
The filing of an application itself shall not be construed as authority to carry on
such activity. Activities being carried on without a permit are unlawful and shall be subject to applicable enforcement provisions and penalties contained in the
Environmental Quality Code. Unauthorized activities must cease until a proper
permit or other written authorization is obtained from DEQ. State and federal regulations provide that you may not begin construction of any industrial surface
impoundment or treatment system; any industrial or commercial facility, the
operation of which would cause an increase in the discharge of waste into the waters of the State; or any new outfall for the discharge of industrial waste or
pollutants into the waters of the State; without first securing a permit under the
applicable program. Please note that if you are required to obtain a permit before beginning construction, as described above, you may need to submit your permit
application well in advance of the applicable deadlines listed above.
Fees
Application fees are non-refundable and are due when an application is filed with DEQ. Annual fees shall be paid upon receipt of an invoice from DEQ. Payments
for annual fees received by DEQ shall be applied for each fiscal year (July 1st –
June 30th). Failure to pay an annual fee may result in suspension or termination of the permit. Fees are described in OAC 252:606 and OAC 252:616.
Availability of Information to Public
Information contained in these application forms will, upon request, be made
available to the public for inspection and copying. This includes any information submitted on the forms themselves and any attachments used to supply
information required by the forms. You may, however, request confidential
treatment for certain supplemental information you may be asked to provide
during the drafting of the permit. Such requests shall be handled in accordance
with the Oklahoma Open Records Act.
Completion of Forms
Unless otherwise specified in instructions to the forms, each item in each form must be answered. To indicate that each item has been considered, enter “NA,”
for not applicable, if a particular item does not fit the circumstances or
characteristics of your facility or activity.
If you have previously submitted information to DEQ, to another state agency or
to EPA which answers a question, you may either repeat the information in the space provided or attach a copy of the previous submission. Some items in the
form require narrative explanation. If more space is needed to answer a question,
attach a separate sheet entitled “Additional Information.”
Public Notice Requirement
Upon filing a Tier II or Tier III application for a permit (including an application
for a permit renewal), you must publish notice of the filing in a newspaper local
to the area of the facility site. Proof of publication should be filed with the Department within twenty (20) days after the application is filed or the application
may be deemed incomplete. Instructions for filing the public notice are given in
Form 1, Attachment 1.
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SECTION B - FORM 1 LINE-BY-LINE INSTRUCTIONS
This form must be completed by all applicants.
Completing This Form
Please type or print in the unshaded areas only. Abbreviate if necessary to stay
within the space allowed for each item. Use one space for breaks between words,
but not for punctuation marks unless they are needed to clarify your response.
Item A
Indicate the permit action requested by marking the appropriate box.
Item B
Answer each question to determine which supplementary forms you need to fill
out. Be sure to check the glossary in Section D of these instructions for the legal definitions of the bold faced words. Check Section C of these instructions to
determine whether your activity is excluded from permit requirements.
If you answer “no” to every question, then you do not need a regular individual
industrial permit, and you do not need to complete and return any of these forms.
However, you may still require one of the other types of permits administered by
DEQ (as outlined under Who Must Apply in Section A). If you have questions
about whether you need one of these permits or if you need to obtain application
forms, contact DEQ.
If you answer “yes” to any question for which a form number is listed, then you
must complete and file the supplementary form. (The applicable form number follows each question and is enclosed in parentheses.)
Item C
Enter the facility’s official or legal name. Do not use a colloquial name.
Item D
Give the name, title, work telephone number, and email address of a person who is thoroughly familiar with the operation of the facility and with the facts reported
in this application and who can be contacted by reviewing offices if necessary.
Item E
Give the complete mailing address of the office where correspondence should be sent. This often is not the address used to designate the location of the facility or
activity.
Item F
Give the address or location of the facility identified in Item C of this form. If the facility lacks a street name or route number, give the most accurate alternative
geographic information. Also give the legal description of the facility’s location to the nearest 10 acres (¼, ¼, ¼, Section, Range, Township). If you do not know
the legal description of location, it should be available from county records of
property deeds, or can be determined from a topographic map. Alternately, if you are filing for permit renewal, you can find the legal description of location in your
previous permit.
Item G-1
Give the full legal name of the person, firm, public organization, or any other
entity which operates the facility described in this application. This may or may
not be the same name as the facility. The operator of the facility is the legal entity
which controls the facility’s operation rather than the plant or site manager. Do not use a colloquial name.
Item G-2
Indicate whether the entity which operates the facility also owns it by marking the
appropriate box.
Item G-3
Enter the appropriate letter to indicate the legal status of the operator of the facility.
Indicate “public” for a facility solely owned by local government(s) such as a city,
town, county, parish, etc.
Items G-4 through G-9
Enter the telephone number, email address, and mailing address, of the operator
identified in Item G-1.
Item H
Indicate whether the facility is located on Indian Lands.
Item I
If the permit applicant does not own all land subject to the permit application, then
fill out DEQ Form 100-810 that is available on the DEQ web page.
Item J
Give the number of each presently effective permit issued to the facility for each
program or, if you have previously filed an application but have not yet received
a permit, give the number of the application, if any. If you have more than one currently effective permit for your facility under a particular permit program, you
may list additional permit numbers on a separate sheet of paper. List any relevant
environmental federal (e.g., permits under Section 404 of the Clean Water Act or
the Surface Mining Control and Reclamation Act), state (e.g., state permits for
new air emission sources in nonattainment areas under Part D of the Clean Air
Act or state permits under Section 404 of the Clean Water Act), or local permits or applications under “other.”
Item K
Provide a plat or topographic map or maps of the area extending at least to one
mile beyond the property boundaries of the facility which clearly show the following:
(1) The legal boundaries of the facility;(2) The location and ID number of each of your existing and proposed
intake and discharge structures;
(3) All hazardous waste management facilities (including surface impoundments and land application sites);
(4) Each monitoring well or well where you inject fluids underground;
and (5) All springs and surface water bodies in the area, plus all drinking water
wells within 1/4 mile of the facility which are identified in the public
record or otherwise known to you.
If an intake or discharge structure, hazardous waste disposal site, or injection well
associated with the facility is located more than one mile from the plant, include it on the map, if possible. If not, attach additional sheets describing the location
of the structure, disposal site, or well, and identify the U.S. Geological Survey (or
other) map corresponding to the location.
On each map, include the map scale, a meridian arrow showing north, and latitude and longitude at the nearest whole second. On all maps of rivers, show the
direction of the current. Use a 7-1/2 minute series map published by the U.S.
Geological Survey, which may be available at a local engineering supply company or can be obtained from the Oklahoma Geological Survey at the address listed
below. If a 7-1/2 minute series map has not been published for your facility site,
then you may use a 15 minute series map published by the U.S. Geological Survey. If neither a 7-1/2 nor 15 minute series map has been published for your
facility site, use a plat map or other appropriate map, including all the requested
information; in this case, briefly describe land uses in the map area (e.g.,
residential, commercial).
You may trace your map from a geological survey chart, or other map meeting the above specifications. If you do, your map should bear a note showing the number
or title of the map or chart it was traced from. Include the names of nearby towns,
water bodies, and other prominent points.
The Oklahoma Geological Survey’s address is:
Oklahoma Geological Survey
100 E. Boyd
Norman, OK 73019 (405) 325-3035
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Item L
List, in descending order of significance, up to four 4-digit standard industrial
classification (SIC) codes and up to four 6-digit North American Industry
Classification System (NAICS) codes which best describe your facility in terms of the principal products or services you produce or provide. Also, specify each
classification in words. These classifications may differ from the codes describing
the operation generating the wastes.
SIC code numbers are descriptions which may be found in the “Standard
Industrial Classification Manual” prepared by the Executive Office of the President, Office of Management and Budget. This document is available online
from the Occupational Safety and Health Administration (OSHA) website at
http://www.osha.gov/pls/imis/sic_manual.html.
NAICS code numbers and descriptions can be found in the “North American
Industrial Classification System Manual” prepared by the Executive Office of the President, Office of Management and Budget. This document is available online
from the National Technical Information Service (NTIS) website at
http://www.census.gov/eos/www/naics/.
If you have any questions concerning the appropriate code(s) for your facility,
contact DEQ.
Item M
Briefly describe the nature of your business (e.g., products produced or services
provided). List all manufacturing or production processes, and industrial
operations. Processes and operations may be described in general terms (for example, “strip mine,” “distillation tower,” “vehicle wash,” or “transfill of tank
trucks”). Do not include office operations.
Also list intermediate and final products produced (if any), and daily quantity
produced. Give the date the facility began operations, the approximate number of
employees at the facility, and the routine hours of operation, including number of shifts.
Item N
Indicate whether your facility uses cooling water, and if so, specify the source of
the cooling water. If the facility uses a cooling water intake structure, you may be
required to submit the additional information described in 40 CFR 122.21(r) with
your permit application. If you have any questions concerning whether or not this
additional information is required, contact DEQ.
Item O
Indicate whether you plan to request and/or renew a variance.
Item P
Enter the appropriate letter(s) to identify all sources of water supply and provide the appropriate description of each source (as indicated in parentheses). List each
source on a separate line. For each source, list the average daily flows received.
If you have more than one source of a given type, indicate this by entering the letter, followed by two digits (e.g., if you obtained your water from three different
wells, the sources would be indicated as G01, G02, and G03).
Item Q
State statutes provide for severe penalties for submitting false information on this
application form.
27A O.S. §2-6-206(G)(4) provides that, “Any person who knowingly makes any
false material statement, representation, or certification in any application, record,
report, plan, or other document filed or required to be maintained under the Oklahoma Pollutant Discharge Elimination System Act... shall upon conviction
be punished by a fine of not more than Ten Thousand Dollars ($10,000.00), or by
imprisonment for not more than two (2) years, or by both.”
All applications must be signed by the applicant. Signatures must be original
signatures; photostatic copies of signatures will not be accepted. Permit applications must be signed as follows:
(A) If the applicant is a private corporation, the application must be signed by:
(i) A president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function, or any other person who performs similar policy- or decision-making
functions for the corporation; or
(ii) The manager of one or more manufacturing, production, or operating facilities employing more than 250 persons or having
gross annual sales or expenditures exceeding $25 million (in
second-quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in accordance with
corporate procedures.
(B) If the applicant is a partnership, sole proprietorship or individual person, the application must be signed, respectively, by a general
partner, the proprietor or the individual.
(C) If the applicant is a municipality, political subdivision, the state or federal government or other public agency or entity, the application
must be signed by the principal executive officer of the entity or the
ranking elected official.
Any person signing an application form must make the following certification:
I certify under penalty of law that this document and all attachments were
prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
I further certify that the facility to be permitted possesses or shall acquire a right to the use of the property or properties on which discharging facilities,
activities or discharge sources are located and the property on which the
proposed discharge point or points are located, including the access route thereto, and that the facility to be permitted shall maintain such right of use
and access for the duration of the permit term.
SECTION C - ACTIVITIES WHICH DO NOT REQUIRE REGULAR POLLUTANT DISCHARGE PERMITS
You are not required to obtain a regular individual industrial discharge permit
from DEQ if your discharge is in one of the following categories. However, you may be required to secure another type of permit from DEQ or to secure a permit
from another agency.
A. DISCHARGES INTO PUBLICLY OWNED TREATMENT WORKS
(POTW). The introduction of sewage, industrial wastes, or other pollutants
into a POTW does not require a regular industrial discharge permit from DEQ. You must comply with all applicable pretreatment standards
promulgated under Section 307(b) of CWA, which may be included in the
permit issued to the POTW. If you have a plan or an agreement to switch to a POTW in the future, this does not relieve you of the obligation to apply for
and receive an industrial discharge permit until you have stopped discharging
pollutants into waters of the State.
B. DISCHARGES FROM AGRICULTURAL AND SILVICULTURAL
ACTIVITIES. Most discharges from agricultural and silvicultural activities
to waters of the State do not require discharge permits from DEQ. These
include point and nonpoint discharges from agricultural crop production, agricultural services, livestock production, silviculture, feed yards, livestock
markets, forestry, and nurseries, etc. Such activities may, however, be
subject to EPA permitting requirements. The facilities or activities listed below do require discharge permits from DEQ:
1. Commercial manufacturers of fertilizers, grain and feed products and chemicals, food and kindred products, tobacco, paper, lumber, wood,
textile mill and other agricultural products.
2. Dairy waste and wastewater associated with milk production facilities, but not including concentrated feeding operations at such facilities.
3. Slaughterhouses, but not including feedlots at such facilities.
4. Animal aquaculture and fish hatcheries. Discharge from an aquatic animal production facility using only pond culture requires a general
discharge permit from DEQ. Discharge from all other animal
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aquaculture and fish hatcheries requires a regular industrial discharge
permit.
5. Facilities which store grain, feed, seed, fertilizer, and agricultural chemicals that are required by federal NPDES regulations to obtain a
permit for stormwater discharges. Such facilities only fall under DEQ
jurisdiction with respect to such stormwater discharges.
C. DISCHARGES FROM PUBLICLY OWNED TREATMENT WORKS
(POTW). Most POTWs do not require regular industrial discharge permits. However, POTWs which treat only industrial wastes do require regular
industrial discharge permits.
D. OPERATIONS COVERED BY GENERAL DISCHARGE PERMITS.
General discharge permits have been established for certain categories of
operations for which the same general conditions exist. Each type of general permit has its own application form. Please contact the Water Quality
Division directly or visit the Division’s web site at
http://www.deq.state.ok.us/wqdnew/forms.html for the appropriate form.The categories of general permits are:
1. Petroleum Storage and Transfer (PST) Facilities. PST facilities which
are not within the boundaries of refineries, petrochemical
manufacturing plants or natural gas liquid extraction plants are under
the jurisdiction of the Corporation Commission. Thus, PST General
Permits are no longer issued by the DEQ.
2. Groundwater Remediation Projects Associated With Leaking Underground Storage Tanks Containing Hydrocarbons (UST
projects). All other groundwater remediation projects require regular
industrial discharge permits. Request Application Form 606-G83. 3. Hydrostatic Test Projects. Some hydrostatic test projects fall under the
jurisdiction of the Corporation Commission, and thus must be
permitted through EPA rather than DEQ. DEQ has direct jurisdiction over and has a general permit for hydrostatic test projects at the
following facilities and activities: refineries, petrochemical
manufacturing plants, natural gas liquid extraction plants, manufacturing of oil and gas related equipment and products, bulk
terminals, aboveground and underground tanks not subject to
Corporation Commission jurisdiction, and other facilities and activities not subject to Corporation Commission jurisdiction.
Request Application Form G27.
5. Surface Coal Strip Mines. Request Application Form 606-G04.
6. Vehicle Wash Facilities. Request Application Form 606-G75.
7. Concrete Batch Plants. Request Application Form 606-G11.
8. Mobile Concrete Batch Plants. Request Application Form 616-G11MT.
9. Total Retention Class III Industrial Surface Impoundments. Request
Application Form 616-GC3T. 10. Rock, Sand, and Gravel Quarries. Request Application Form 606-
OKG95.
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SECTION D - GLOSSARY
NOTE: This Glossary includes terms used in the instructions and in Forms 1, 2C, 2D, 2SI, 2L, and 606-008. If you have any questions concerning the
meaning of any of these terms, please contact DEQ.
ANIMAL FEEDING OPERATION means a lot or facility (other than an aquatic animal production facility) where the following conditions are met:
A. Animals (other than aquatic animals ) have been, are, or will be stabled or confined and fed or maintained for a total of 45 days or more in any
12 month period; and
B. Crops, vegetation, forage growth, or post-harvest residues are not sustained in the normal growing season over any portion of the lot or
facility.
Two or more animal feeding operations under common ownership are a single animal feeding operation if they adjoin each other or if they use a common area
or system for the disposal of wastes.
Note: In Oklahoma, animal feeding operations are regulated by the Department
of Agriculture, rather than the DEQ. Thus, such facilities do not require permits
from DEQ.
ANIMAL UNIT means a unit of measurement for any animal feeding operation
calculated by adding the following numbers: The number of slaughter and feeder
cattle multiplied by 1.0; Plus the number of mature dairy cattle multiplied by 1.4;
Plus the number of swine weighing over 25 kilograms (approximately 55 pounds) multiplied by 0.4; Plus the number of sheep multiplied by 0.1; Plus the number of
horses multiplied by 2.0.
APPLICATION means the DEQ standard forms for applying for a permit,
including any additions, revisions, or modifications to the forms.
AQUATIC ANIMAL PRODUCTION FACILITY means a hatchery, fish farm,
or other facility which contains, grows or holds aquatic animals in either of the
following categories:
A. Cold water fish species or other cold water aquatic animals including,
but not limited to, the Salmonidae family of fish (e.g., trout and salmon) in ponds, raceways, or other similar structures which
discharge at least 30 days per year; or
B. Warm water fish species or other warm water aquatic animals including, but not limited to the Ameiuridae, Cetrarchidae, and
Cyprinidae families of fish (e.g., respectively, catfish, sunfish, and
minnows) in ponds, raceways, or other similar structures which discharge at least 30 days per year.
AQUIFER means a formation that contains sufficient saturated, permeable material to yield significant quantities of water to wells and springs. This implies
an ability to store and transmit water; unconsolidated sands and gravels are typical
examples.
BEST MANAGEMENT PRACTICES (BMP) means schedules of activities,
prohibitions of practices, maintenance procedures, and other management practices to prevent or reduce the pollution of waters of the State or United States.
BMPs also include treatment requirements, operating procedures, and practices to
control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage.
BIOLOGICAL MONITORING TEST means any test which includes the use of aquatic algal, invertebrate, or vertebrate species to measure acute or chronic
toxicity, and any biological or chemical measure of bioaccumulations.
BOARD means the Environmental Quality Board.
BYPASS means the intentional or unintentional diversion of waste streams from any portion of a treatment, disposal, or collection facility.
CATEGORICAL USER means an industrial discharger that employs or will be employing processes in any of the industrial categories or business activities listed
below (regardless of whether they generate wastewater, waste sludge, or
hazardous wastes). A facility with processes inclusive in these business areas may be covered by Environmental Protection Agency's (EPA) categorical pretreatment
standards.
Aluminum Forming
Asbestos Manufacturing
Battery Manufacturing
Can Making
Canning & preserved Fruits and Vegetables
Canning & preserved Seafood
Carbon Black
Cement Manufacturing
Centralized Waste Treatment
Coal Mining
Coil Coating
Copper Forming
Dairy Products Processing
Electric and Electronic Components
Electroplating
Explosive Manufacturing
Feedlots Specify type
Fertilizer Manufacturing
Ferroalloy Manufacturing
Foundries (Metal Molding and Casting)
Glass Manufacturing
Grain Mills
Gum & Wood Chemicals Manufacturing
Hospital
Ink Formulating
Landfills
Leather Tanning and Finishing
Meat Products
Metal Finishing
Metal Powders
Mineral Mining & Processing
Nonferrous Metals Forming
Nonferrous Metals Manufacturing
Oil & Gas Extraction
Ore Mining and Dressing
Organic Chemicals Manufacturing
Organic Plastics & Synthetic Fibers Mfg.
Paint and Ink Formulating
Paper & Board Mills
Paving and Roofing Manufacturing
Pesticides Manufacturing
Petroleum Refining
Pulp, Paper, and Paperboard Manufacturing
Rubber Manufacturing
Soap and Detergent Manufacturing
Steam Electric Power Generation
Sugar Processing
Textile Mills
Timber Products
Transportation Equipment Cleaning
Inorganic Chemicals
Iron and Steel Manufacturing
CELL means a part of a surface impoundment system that shares a wall or berm
with another impoundment area.
CLEAN WATER ACT means the federal Water Pollution Control Act, 33 U.S.C., Section 1251 et seq., as amended.
COMPLETE APPLICATION means an application which contains all information required by any appropriate form, applicable rules, requested by DEQ
staff, filed with the appropriate DEQ service and that all appropriate fees have
been paid to and received by the DEQ.
COMPLIANCE SCHEDULE means a schedule of time for initiation and
completion of remedial measures set forth in a Department Permit or Order and includes an enforceable sequence of interim requirements (e.g., actions,
operations, or milestone events) leading to compliance with the limitations and
conditions of a pollutant discharge permit.
CONCENTRATED ANIMAL FEEDING OPERATION means an animal
feeding operation which meets the criteria set forth in either (A) or (B) below or which the Director designates as such on a case-by-case basis:
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A. More than the numbers of animals specified in any of the following
categories are confined:
1. 1,000 slaughter or feeder cattle, 2. 700 mature dairy cattle (whether milked or dry cows),
3. 2,500 swine each weighing over 25 kilograms (approximately 55
pounds), 4. 500 horses,
5. 10,000 sheep or lambs,
6. 55,000 turkeys, 7. 100,000 laying hens or broilers (if the facility has a continuous
overflow watering),
8. 30,000 laying hens or broilers (if the facility has a liquid manure handling system),
9. 5,000 ducks, or
10. 1,000 animal units; or B. More than the following numbers and types of animals are confined:
1. 300 slaughter or feeder cattle,
2. 200 mature dairy cattle (whether milked or dry cows),3. 750 swine each weighing over 25 kilograms (approximately 55
pounds),
4. 150 horses,5. 3,000 sheep or lambs,
6. 16,500 turkeys,
7. 30,000 laying hens or broilers (if the facility has continuous
overflow watering),
8. 9,000 laying hens or broilers (if the facility has a liquid manure
handling system),9. 1,500 ducks, or
10. 300 animal units; AND
Either one of the following conditions are met: Pollutants are
discharged into waters of the State through a man-made ditch flushing
system or other similar manmade device (“man-made” means constructed by man and used for the purpose of transporting wastes);
or Pollutants are discharged directly into waters of the State which
originate outside of and pass over, across or through the facility or otherwise come into direct contact with the animals confined in the
operation.
Provided, however, that no animal feeding operation is a concentrated
animal feeding operation as defined above if such animal feeding
operation discharges only in the event of a 25 year, 24 hour storm
event.
Note: In Oklahoma, concentrated animal feeding operations are regulated by the Department of Agriculture, rather than the DEQ. Thus, such facilities do not
require permits from DEQ.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY means an
aquatic animal production facility which meets the criteria in either (A) or (B) below or which the Director designates as such on a case-by-case basis:
A. Facilities which: 1. Produce more than 9,090 harvest weight kilograms
(approximately 20,000 pounds) of cold water fish species or
other cold water aquatic animals per year; and 2. Feed more than 2,272 kilograms (approximately 5,000 pounds)
of food during the calendar month of maximum feeding.
B. Facilities which produce more than 45,454 harvest weight kilograms(approximately 100,000 pounds) of warm water fish species or other
warm water aquatic animals per year; provided, however, that the
aquatic animals are not held in closed ponds which discharge only during periods of excess runoff.
CONTACT COOLING WATER means water used to reduce temperature which comes into contact with a raw material, intermediate product, waste product other
than heat, or finished product.
CONTAINER means any portable device in which a material is stored,
transported, treated, disposed of, or otherwise handled.
CONTINUOUS DISCHARGE means a discharge which occurs without
interruption throughout the operating hours of the facility, except for infrequent
shutdowns for maintenance, process changes, or other similar activities.
COUNCIL means the Water Quality Management Advisory Council.
CWA means the Clean Water Act.
DEPARTMENT means the Oklahoma Department of Environmental Quality.
DEQ means the Oklahoma Department of Environmental Quality.
DIKE means any embankment or ridge of either natural or manmade materials
used to prevent the movement of liquids, sludges, solids, or other materials.
DIRECT DISCHARGE means the discharge of a pollutant to waters of the State.
DIRECTOR or EXECUTIVE DIRECTOR means the Executive Director of the
Oklahoma Department of Environmental Quality.
DISCHARGE when used without qualification means the discharge of a pollutant.
DISCHARGE OF A POLLUTANT means:
1. Any addition of any pollutant or combination of pollutants to waters of
the United States or to waters of the State from any point source.
2. Includes additions of pollutants into the waters of the State, including waters of the United States from:
a. surface runoff which is collected or channeled by man;
b. discharges through pipes, sewers, or other conveyances owned by a federal agency or division of the federal government, state,
municipality, or other person which do not lead to a treatment
works; and
c. discharges through pipes, sewers, or other conveyances, leading
into privately owned treatment works.
4. Does not include an addition of pollutants by an indirect discharger. 5. Means any release by leaking, pumping, pouring, emitting, emptying,
dumping, escaping, seeping, or leaching of wastes into any waters of
the State or into a location where they may enter waters of the State.
This definition includes additions of pollutants into waters of the United States
from: surface runoff which is collected or channeled by man; discharges through pipes, sewers, or other conveyances owned by a state, municipality, or other
person which do not lead to a treatment works; and discharges through pipes,
sewers, or other conveyances, leading into privately owned treatment works. This term does not include an addition of pollutants by an indirect discharger.
Discharge shall also mean any release by leaking, pumping, pouring, emitting,
emptying, dumping, escaping, seeping, or leaching of pollutants into any waters of the State, into a location where they may enter waters of the State or elsewhere.
DISCHARGE POINT means the point at which pollutants or wastewater or
stormwater enters waters of the State or becomes waters of the State.
DISPOSAL (in the RCRA program) means the discharge, deposit, injection, dumping, spilling, leaking, or placing of any hazardous waste into or on any land
or water so that the hazardous waste or any constituent of it may enter the
environment or be emitted into the air or discharged into any waters, including ground water.
DISPOSAL FACILITY (in the RCRA program) means a facility or part of a
facility at which hazardous waste is intentionally placed into or on land or water,
and at which hazardous waste will remain after closure.
DISPOSAL SYSTEM means a system for disposing of wastewater, including
treatment systems.
DOMESTIC WASTEWATER means and includes but is not limited to
wastewater from drinking fountains, showers, toilets, lavatories, and kitchens.
DRAFT PERMIT means a document prepared under 40 CFR §124.6 or applicable
Department rules indicating the Director’s tentative decision to issue or deny, modify, revoke and reissue, terminate, or reissue a permit. A notice of intent to
terminate a permit and a notice of intent to deny a permit, as discussed in 40 CFR
§124.5 and applicable Department rules, are types of draft permits. A denial of arequest for modification, revocation and reissuance, or termination, as discussed
in 40 CFR §124.5 and corresponding Department rules, is not a draft permit. A
proposed permit is not a draft permit.
EFFLUENT LIMITATION means any restriction imposed by the Executive
Director on quantities, discharge rates, and concentrations of pollutants which are discharged from point sources into waters of the United States, the waters of the
contiguous zone, waters of the State, or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the
EPA under Section 304(b) of the Clean Water Act to adopt or revise effluent limitations.
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EXISTING SOURCE or EXISTING DISCHARGER (in the NPDES program)
means any source which is not a new source or a new discharger.
FACILITY or ACTIVITY means any OPDES point source or any other facility
or activity (including land or appurtenances thereto) that is subject to regulation under the OPDES program.
FLEXIBLE MEMBRANE LINER means a manufactured liner material composed of plastics, resins or other flexible materials, which is designed and
manufactured to be used to control the seepage or release of waste through the
liner material.
FLOW-THROUGH SURFACE IMPOUNDMENT means an impoundment
designed and constructed with an outfall structure which allows the controlled discharge of wastes or wastewater out of the impoundment.
FLUID means material or substance which flows or moves whether in a semisolid, liquid, sludge, gas, or any other form or state.
FREEBOARD means the distance between the water surface in an impoundment and the top of the lowest part of the surrounding berm.
GENERAL PERMIT means an NPDES permit issued under 40 CFR §122.28
authorizing a category of discharges under the CWA within a geographical area,
or a general permit issued by the Department through rulemaking procedures as
allowed under the Oklahoma Administrative Procedures Act and other applicable state law.
GPD means gallons per day.
GROUNDWATER means waters of the state under the surface of the earth
regardless of the geologic structure in which it is standing or moving outside the cut bank of any definite stream.
HAZARDOUS SUBSTANCE means any of the substances designated under 40 CFR Part 116 pursuant to Section 311 of CWA. (NOTE: These substances are
listed in Table 2c-4 of the instructions to Form 2C.)
HAZARDOUS WASTE has the meaning set forth in the Environmental Quality
Code and rules promulgated by the Board pursuant thereto.
HAZARDOUS WASTE MANAGEMENT FACILITY (HWM facility) means
all contiguous land, structures, appurtenances, and improvements on the land,
used for treating, storing, or disposing of hazardous wastes. A facility may consist of several treatment, storage, or disposal operational units (for example, one or
more landfills, surface impoundments, or combinations of them).
IMPOUNDMENT means Surface Impoundment.
INDIRECT DISCHARGER means a non-domestic discharger introducing
pollutants to a publicly owned treatment works.
INDUSTRIAL WASTEWATER TREATMENT PERMIT shall mean permits
issued by the Department after July 1, 1993, under Section 2-6-501 of Title 27A
of the Oklahoma Statutes, and waste disposal permits issued on or before June 30, 1993, by the Oklahoma Water Resources Board for land application of industrial
waste or surface impoundments or disposal systems for industrial waste or
wastewater.
INDUSTRY means any person, manufacturer, trade, or business who discharges
or retains wastes.
INJECTION WELL means a well into which fluids are being injected.
LAGOON means a surface impoundment.
LAND APPLICATION means the controlled discharge of waste or wastewater or sludge which is not a hazardous waste onto the land surface, as may be allowed
under provisions of Title 27A O.S. §2-1-101 et seq. and OAC 252:616.
LINER means a barrier which is designed, constructed and installed in a surface impoundment and which has appropriate chemical and physical properties to
ensure that such structures do not fail to control the seepage or release of waste
and wastewater from the impoundment.
MGD means millions of gallons per day.
MONITORING WELL means all borings, wells, piezometers, or other means of
retrieving a soil, waste, wastewater, or vapor sample from the subsurface.
MUNICIPALITY means a city, village, town borough, county, parish, district,
association, or other public body created by or under state law and having
jurisdiction over disposal of sewage, industrial wastes, or other wastes, or an Indian tribe or an authorized Indian tribal organization, or a designated and
approved management agency under Section 208 of CWA.
OKLAHOMA POLLUTANT DISCHARGE ELIMINATION SYSTEM
(OPDES) means the EPA approved state program for issuing modifying, revoking
and reissuing, terminating, monitoring, and enforcing permits and imposing and enforcing pretreatment requirements, under Sections 307, 318, 402 and 405 of
CWA. The term includes an approved program.
NEW DISCHARGER (in the OPDES program) means any building, structure,
facility, or installation: (A) From which there is or may be a new or additional
discharge of pollutants at a site at which on October 18, 1972, it had never discharged pollutants; (B) Which has never received a finally effective NPDES or
OPDES permit for discharges at that site; and (C) Which is not a “new source.”
This definition includes an indirect discharger which commences discharging into waters of the United States. It also includes any existing mobile point source, such
as an offshore oil drilling rig, seafood processing vessel, or aggregate plant that
begins discharging at a location for which it does not have an existing permit.
NEW SOURCE (in the OPDES program) means any building, structure, facility
or installation from which there is or may be a discharge of pollutants, the construction of which commenced:
A. After promulgation of standards of performance under Section 306 of CWA which are applicable to such source; or
B. After proposal of standards of performance in accordance with Section
306 of CWA which are applicable to such source, but only if the standards are promulgated in accordance with Section 306 within 120
days of their proposal.
NON-CONTACT COOLING WATER means water used to reduce temperature
which does not come into direct contact with any raw material, intermediate
product, waste product (other than heat), or finished product.
NON-PRETREATMENT MUNICIPALITY means a municipality that does
not contain a pre-treatment facility for industrial waste.
NONPOINT SOURCE means the contamination of the environment with a
pollutant for which a specific path of origin may not be well defined.
NOTICE BY PUBLICATION means, unless otherwise specifically provided,
publication in a daily or weekly newspaper of general circulation in the area(s) affected by proposed or actual activities regulated by the Department.
OAC means the Oklahoma Administrative Code.
OFF-SITE means any site which is not “on-site.” OKLAHOMA’S WATER QUALITY STANDARDS means the rules
promulgated by the Oklahoma Water Resources Board which designate the
beneficial uses for which the various waters of the State shall be maintained and protected, classify waters of the State, prescribe the water quality standards
required to sustain designated uses, and set forth implementation requirements, as
specified in OAC 785:45.
ON-SITE means on the same or geographically contiguous property which may
be divided by public or private right(s)-of-way provided the entrance and exit between the properties is at a cross-roads intersection, and access is by crossing
as opposed to going along, the right(s)-of-way. Non-contiguous properties owned
by the same person, but connected by a right-of-way which the person controls and to which the public does not have access, is also considered on-site property.
OPDES Act means the Oklahoma Pollutant Discharge Elimination System Act, 27A Oklahoma Statutes §2-6-201 et seq.
O.S. means Oklahoma Statutes.
OUTFALL means the point where monitoring can occur or takes place for the
purpose of evaluating compliance with discharge permits issued.
OWNER or OPERATOR means the owner or operator of any facility or activity
subject to regulation under the NPDES or OPDES or other state water permit
program, and shall include but is not limited to the person holding legal or equitable title to property, and the person responsible for the maintenance and
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operation of a treatment or disposal system or site and for keeping records and
providing reports to the Department.
PERMIT means an authorization, license, or equivalent control document issued
by EPA to implement the requirements of 40 CFR Parts 122, 123, 124, and the
license issued by the Executive Director of the Department of Environmental Quality or the authorization issued by the Executive Director of the Department
under a general permit promulgated by the Environmental Quality Board to
implement the requirements of these rules, state law, federal regulations and the Clean Water Act. Permit includes an NPDES general permit, state-issued
individual permits, and authorizations under general permits, as authorized under
the ODPES Act and the Environmental Quality Code. Permit does not include any permit which has not yet been the subject of final agency action, such as a
draft permit or a proposed permit. In the State of Oklahoma, the term permit shall
be equivalent to the term license as defined under the Oklahoma Administrative Procedures Act.
PERSON means any individual, association, partnership, firm, company, public trust, corporation, joint-stock company, trust, estate, municipality, state or federal
agency, other governmental entity, any other legal entity or an agent, employee,
representative, assignee or successor thereof.
PILE means any non-containerized accumulation of solid, non-flowing hazardous
waste that is used for treatment or storage.
POINT SOURCE means any discernible, confined, and discrete conveyance,
including but not limited to any pipe, ditch, channel, tunnel, conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill
leachate system, vessel or other floating craft from which pollutants are or may be
discharged. This term does not include return flows from irrigated agriculture or agricultural stormwater runoff.
POLLUTANT includes but is not limited to dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions, chemical
wastes, biological materials, radioactive materials, heat, wrecked or discarded
equipment, rock, sand, cellar dirt and industrial, municipal, and agribusiness waste discharged into water.
POLLUTION means the presence in the environment of any substance, contaminant or pollutant, or any other alteration of the physical, chemical or
biological properties of the environment or the release of any liquid, gaseous, or
solid substance into the environment which is or will likely create a nuisance or
render the environment harmful or detrimental or injurious to public health, safety
or welfare, or to domestic, commercial, industrial, agricultural, recreational, or
other legitimate beneficial uses, or to livestock, wild animals, birds, biological communities, fish or other aquatic life, or to property. For purpose of this
definition, environment shall include but is not limited to waters of the state and
release shall include but is not limited to discharge of a pollutant. Pollution shall include such acts or conduct as will or are likely to cause a violation of
Oklahoma’s Water Quality Standards. POTW means publicly owned treatment works.
PREVENTION OF SIGNIFICANT DETERIORATION (PSD) means the national permitting program under 40 CFR 52.21 to prevent emissions of certain
pollutants regulated under the Clean Air Act from significantly deteriorating air
quality in attainment areas.
PRIVATELY OWNED TREATMENT WORKS means any device or system
which is (A) Used to treat wastes from any facility whose operator is not the operator of the treatment works; and (B) Not a POTW.
PROCESS WASTEWATER means any water which, during manufacturing or processing, comes into direct contact with or results from the production or use of
any raw material, intermediate product, finished product, byproduct, or waste
product.
PROPOSED PERMIT means an OPDES permit prepared after the close of the
public comment period (and, when applicable, any public hearing and administrative appeals) before final issuance by the State. A proposed permit is
not a draft permit.
PUBLICLY OWNED TREATMENT WORKS or POTW means any device or
system used in the treatment (including recycling and reclamation) of municipal
sewage or industrial wastes of a liquid nature which is owned by a state or municipality. This definition includes any sewers, pipes, or other conveyances
only if they convey wastewater to a POTW providing treatment.
RCRA means the Solid Waste Disposal Act as amended by the Resource
Conservation and Recovery Act of 1976 (Pub. L. 94-580, as amended by Pub. L.
95-609, 42 U.S.C. Section 6901 et seq.)
RECEIVING WATER means that portion of any waters of the state into which
wastes are discharged.
SDWA means the Safe Drinking Water Act (Pub. L. 95-523, as amended by Pub.
L. 95-1900, 42 U.S.C. Section 300[f] et seq.).
SEWAGE SLUDGE means the solids, residues, and precipitate separated from or
created in sewage by the unit processes of a POTW. “Sewage” as used in this definition means any wastes, including wastes from humans, households,
commercial establishments, industries, and stormwater runoff that are discharged
to or otherwise enter a publicly owned treatment works.
SIC CODE means Standard Industrial Classification code of the Executive Office
of the President of the U.S., Office of Management and Budget.
SIGNIFICANT INDUSTRIAL USER means
A. All industrial uses subject to categorical pretreatment standards,
also known as CATEGORIAL USER
B. Any other industrial user that:
1. discharges 25,000 gallons per day or more of process
wastewater to the POTW (excluding sanitary, non-contact
cooling water, and boiler blow down wastewater) and/or2. contributes process wastewater to the POTW which makes
up 5% or more of the average dry weather hydraulic capacity of
the wastewater treatment plant and/or 3. contributes process wastewater to the POTW which makes
up 5% or more of the organic capacity of the wastewater
treatment plant and/or 4. is designated as such by the POTW on the basis that the
industrial user has a reasonable potential for adversely
affecting the wastewater treatment plant’s operation andsewer system or for violating any pretreatment requirement
and/or
5. discharges pollutants exhibiting significant pass through or interference in the POTW.
SILVICULTURAL POINT SOURCE means any discernible, confined, and
discrete conveyance related to rock crushing, gravel washing, log sorting, or log
storage facilities which are operated in connection with silvicultural activities and
from which pollutants are discharged into waters of the State. This term does not include nonpoint source silvicultural activities such as nursery operations, site
preparation, reforestation and subsequent cultural treatment, thinning, prescribed
burning, pest and fire control, harvesting operations, surface drainage, or road construction and maintenance from which there is natural runoff. However, some
of these activities (such as stream crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA Section 404
permit. “Log sorting and log storage facilities” are facilities whose discharges
result from the holding of unprocessed wood, e.g., logs or roundwood with bark or after removal of bark in self-contained bodies of water (mill ponds or log ponds)
or stored on land where water is applied intentionally on the logs (wet decking).
(See 40 CFR Part 429, Subpart J, and the effluent limitations guidelines for these facilities.)
SLUDGE has the meaning assigned to that term in OAC 252:525.
SOLID WASTE has the meaning assigned to that term in OAC 252:500.
STATE means the State of Oklahoma or any of the other 49 states as the context
requires.
STORAGE (in the RCRA program) means the holding of hazardous waste for a
temporary period at the end of which the hazardous waste is treated, disposed, or
stored elsewhere.
STORMWATER POINT SOURCE means a conveyance or system of
conveyances (including pipes, conduits, ditches, and channels) primarily used for collecting and conveying stormwater runoff.
STORMWATER RUNOFF means water discharged as a result of rain, snow, or other precipitation.
SURFACE IMPOUNDMENT means an excavated soil or lined basin either below or above ground level which is designed, maintained and/or operated to
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store, recycle, treat and/or dispose of industrial wastewater or stormwater, and
shall include but is not limited to natural and man-made topographic depressions,
excavations, basins, diked areas, lagoons, pits, and ponds.
SYSTEM means pipelines or conduits, pumping stations, and force mains, and all
other constructions, devices, appurtenances, and facilities used for collecting or conducting wastewater to a point of storage, treatment, or ultimate disposal.
TANK SYSTEM means any subsurface disposal system which involves the storage and/or treatment of wastewater.
TOTAL RETENTION SURFACE IMPOUNDMENT means an impoundment designed and constructed without an outfall structure.
TOXIC POLLUTANT means any pollutant listed as toxic under Section 307(a)(1) of CWA.
TOXIC WASTE means substances regulated by the Department to protect beneficial uses, human health, or the environment.
TREATMENT means any method, technique, or process used to remove pollutants from wastewater or sludge to the extent that the wastewater or sludge
may be reused, discharged into waters of the State or otherwise disposed and
includes, but is not limited to, the utilization of mechanized works, surface
impoundments and lagoons, aeration, evaporation, digesters, or other devices or
methods.
TREATMENT WORKS means any plant, disposal field, lagoon, dam, pumping
station, incinerator or any other facility used for the purpose of treating or
stabilizing wastes or wastewater.
UNDERGROUND INJECTION means well injection.
UNDERGROUND SOURCE OF DRINKING WATER or USDW means an
aquifer or its portion which is not an exempted aquifer and:
A. Which supplies drinking water for human consumption; or
B. In which the ground water contains fewer than 10,000 mg/l total
dissolved solids.
UNDERGROUND STORAGE SYSTEM means a partially or totally submerged
wastewater or waste containment system or treatment system.
UPSET means an exceptional incident in which there is unintentional and
temporary noncompliance with technology-based permit effluent limitations because of factors beyond the reasonable control of the permittee. An upset does
not include noncompliance to the extent caused by operational error, improperly
designed treatment facilities, inadequate treatment facilities, lack of preventive maintenance, or careless or improper operation.
WASTE means any liquid, gaseous or solid or semi-solid substance, or thermal
component, whether domestic, municipal, commercial, agricultural or industrial
in origin, which may pollute or contaminate, or tend to pollute or contaminate, any air, land or waters of the State and which is within the jurisdiction of the
Department.
WASTE CONTAINMENT SYSTEMS means storage tanks, containers, and
other storage reservoirs, transfer lines, pumps, fittings, overfill prevention devices,
and any associated anticorrosion measures and/or leak prevention/detection systems.
WASTEWATER includes any substance, including sewage, that contains any
discharge from the bodies of human beings or animals, or contaminating chemicals or other waste or pollutants from domestic, municipal, commercial,
agricultural, industrial or manufacturing activities or facilities and which is within
the jurisdiction of the Department.
WASTEWATER PERMIT means a permit issued by the Department which limits
the types and quantities of pollutants or wastes an industry may store, transport,
or dispose of and consists of four categories:
1. Construction and operation of total retention systems;
2. Tanks other than those used solely for domestic waste; 3. Construction and operation of other wastewater treatment systems;
4. Underground or aboveground wastewater or waste containment,
treatment or storage systems, including but not limited to tanks, pipes, and fittings.
WASTEWATER TREATMENT SYSTEM means treatment works and all related pipelines or conduits, pumping stations and force mains, and all other
appurtenances and devices used for collecting, treating, conducting, or
discharging wastewater.
WASTEWATER TREATMENT SYSTEM means treatment works and all
related pipelines or conduits, pumping stations and force mains, and all other appurtenances and devices used for collecting, treating, conducting, or
discharging wastewater.
WATERS OF THE STATE means all streams, lakes, ponds, marshes,
watercourses, waterways, wells, springs, irrigation systems, drainage systems,
storm sewers, and all other bodies or accumulations of water, surface and
underground, natural or artificial, public or private, which are contained within,
flow through, or border upon this state or any portion thereof, and shall include
under all circumstances the waters of the United States which are contained within the boundaries of, flow through or border upon this State or any portion thereof.
WATERS OF THE UNITED STATES means:
A. All waters which are currently used, were used in the past, or may be
susceptible to use in interstate or foreign commerce, including all waters which are subject to the ebb and flow of the tide;
B. All interstate waters, including interstate wetlands;
C. All other waters such as intrastate lakes, river, streams (including intermittent streams), mudflats, sandflats, wetlands, sloughs, prairie
potholes, wet meadows, playa lakes, and natural ponds, the use,
degradation, or destruction of which would or could affect interstate or foreign commerce including any such waters:
1. Which are or could be used by interstate or foreign travelers for
recreational or other purposes,
2. From which fish or shellfish are or could be taken and sold in
interstate or foreign commerce,
3. Which are used or could be used for industrial purposes by industries in interstate commerce;
D. All impoundments of waters otherwise defined as waters of the United
States under this definition; E. Tributaries of waters identified in paragraphs (A) - (D) above;
F. The territorial sea; and G. Wetlands adjacent to waters (other than waters that are themselves
wetlands) identified in paragraphs (A) - (F) of this definition.
Waste treatment systems, including treatment ponds or lagoons designed to
meet requirement of CWA (other than cooling ponds as defined in 40 CFR
Section 423.11(m) which also meet the criteria of this definition) are not waters of the United States. This exclusion applies only to manmade bodies
of water which neither were originally created in waters of the United States
(such as a disposal area in wetlands) nor resulted from the impoundments of waters of the United States.
WELL INJECTION means the subsurface emplacement of fluids through a bored, drilled, or driven well; or through a dug well, where the depth of the dug well is
greater than the largest surface dimension.
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Form 1, Attachment 1
Public Notice and Application Requirements
A public notice is not required for a Tier I permit application. The Oklahoma Uniform Environmental Permitting Act, 27A O.S. §2-
14-301 requires that upon filing a Tier II or Tier III application with the Department, the applicant shall publish notice of the filing as legal notice in one newspaper local to the proposed new site or existing facility. For Tier III applications, the publication shall also include notice of a thirty-day opportunity to request, or give the date, time and place for, a process meeting on the permitting process.
One (1) copy of Tier I applications must be filed with DEQ. One (1) copy of Tier II and Tier III applications must be filed with DEQ and one copy must be placed for public review in the county in which the facility is located. A copy of the application must remain on
file at the location of the public review site until issuance of the related permit.
Use the following table as guidance for determining the public notice and application requirements for the facility. Select the category
appropriate to the facility and follow the public notice and application requirements. If a public notice is necessary, instructions for
completing the public notice are given in the following pages.
Question Yes
No
Tier I,
II, or
III
Public Notice
Requirements Applications
Is the facility applying for a renewal
of an expiring permit for an
industrial, non-discharging
impoundment or tank system?
Tier I None
One (1) copy of the
application must be filed
with the DEQ.
Is the facility applying for a renewal
of an expiring permit with minor or
no change for land application of
sludge and/or wastewater?
Is the facility applying for a new or
renewal of an expiring permit for a
Categorical or Significant Industrial
User in a Non-Pretreatment
Municipality to discharge industrial
waste to the POTW?
Is the facility applying for a new
discharge permit or renewal of an
expiring discharge permit for a
minor facility?
Tier II
The applicant must publish notice of the
filing as legal notice in one newspaper local
to the proposed new site or existing facility.
One (1) copy of the
application must be filed
with the DEQ and one
copy must be placed for
public review in the county
in which the facility is
located.
Is the facility applying for a renewal
of an expiring discharge permit for a
major facility?
Is the facility applying for a new
permit for an industrial, non-
discharging impoundment or tank
system?
Is the facility applying for a new
permit or major modification of an
existing permit for land application
of sludge and/or wastewater?
Is the facility applying for a new
discharge permit for a major
facility?
Tier III
The applicant must publish notice of the
filing as legal notice in one newspaper local
to the proposed new site or existing facility.
The publication must also include notice of
a thirty-day opportunity to request (or give
the date, time, and place for) a process
meeting on the permitting process.
One (1) copy of the
application must be filed
with the DEQ and one
copy must be placed for
public review in the county
in which the facility is
located.
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Instruction for Completing the Public Notice
for Tier II and Tier III Applications
The Notice Must Contain the Following Information:
(1) Name and address of the applicant;
(2) Name, address, and legal description (i.e., ¼, ¼, ¼, Section, Township, Range, County) of the site,
facility and/or activity;
(3) Purpose of notice;
(4) Type of permit or permit action being sought;
(5) Description of activities to be regulated;
(6) Locations where the application may be reviewed;
(7) Names, addresses, and telephone numbers of contact persons for the DEQ and for the applicant;
(8) Description of public participation opportunities and time period for comment and requests;
(9) Any other information required by DEQ rules; and
(10)Any information the applicant deems relevant.
Templates for the public notice which fulfills the above requirements appears on the following sheets, and
should be used as a guideline in preparing your own notice. Choose the notice appropriate to the facility and
application. Instructions appear in brackets {} and should not be included in the notice to be published. Square
brackets [ ] indicate spaces where information should be inserted.
If you have any other questions concerning public notice requirements or preparation of the public notice,
please contact the Industrial Permits Section at (405) 702-8100.
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{Instructions in brackets should not be included in the Notice to be published.}
{If your application is a Tier II application and uses only Forms 1, 2SI, and/or 2L, use paragraphs one, two, and
three, and seven, eight, and nine below.}
{If your application is a Tier II application and uses Forms 1, 2C, or 2D, and/or 2SI, and/or 2L, use paragraphs
four through nine below.}
OKLAHOMA DEPARTMENT OF ENVIRONMENTAL QUALITY
TIER II NOTICE OF FILING
A Tier II application for a [new/renewal of an] OPDES permit to operate an industrial wastewater treatment
system has been filed with the Department of Environmental Quality (DEQ) by [Company Name], [Street,
Route, or Other Specific Identifier], [City, State].
The applicant requests a permit to treat industrial wastewater by [Impoundment(s), Tank(s), and/or Land
Application] at their [Name of facility/plant/quarry/mine/etc., if different than Company Name] facility, located
in the [Legal Location], Oklahoma, or at [Street Address/General Location].
The wastewater to be treated will consist of [Wastewater Description(s)]. The permit, if issued, would
establish guidelines for the operation of the industrial wastewater treatment system.
A Tier II application for a [new/renewal of an] OPDES permit to discharge industrial wastewater has been
filed with the Department of Environmental Quality (DEQ) by [Company Name], [Street, Route, or Other
Specific Identifier], [City, State].
The applicant requests a permit to discharge wastewater from their [Name of facility/plant/quarry/mine/etc.,
if different than Company Name] facility, located in the [Legal Location], Oklahoma, or at [Street
Address/General Location].
The discharge, which will consist of [Wastewater Description(s)], will be to [Receiving Stream(s)], in the
[Legal Location(s) of Discharge Point(s)], Oklahoma. The permit, if issued, would establish effluent
limitations on the discharge.
The application may be reviewed at [Address where the application has been made available for review].
After reviewing the application the DEQ will prepare either a draft permit or draft denial. At that time, notice
of the prepared draft will be made by the Department and the public will be given the opportunity to review
it, submit written comments, or request a public meeting within thirty days.
For additional information, contact the applicant’s representative, [Facility Contact] at [Facility Contact’s
Phone Number] or [Facility Contact’s Address], or the Industrial Permitting Unit of the Water Quality
Division of the Department’s central office, located at 707 N. Robinson, P.O. Box 1677, Oklahoma City,
OK 73101-1677, (405) 702-8100.
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{If your application is a Tier III application, use the Notice below.}
OKLAHOMA DEPARTMENT OF ENVIRONMENTAL QUALITY
TIER III NOTICE OF FILING
A Tier III application for a new OPDES permit to discharge industrial wastewater has been filed with the
Department of Environmental Quality (DEQ) by [Company Name], [Street, Route, or Other Specific Identifier],
[City, State].
The applicant requests a permit to discharge wastewater from their [Name of facility/plant/quarry/mine/etc.,
if different than Company Name] facility, located in the [Legal Location], Oklahoma, or at [Street
Address/General Location].
The proposed discharge, which will consist of [Wastewater Description(s)], will be to [Receiving Stream(s)],
in the [Legal Location(s) of Discharge Point(s)], Oklahoma. The permit, if issued, would establish effluent
limitations on the proposed discharge.
The application may be reviewed at [Address where the application has been made available for review].
Any person may now request a process meeting on the permitting process through which this application will
go. The request must be in writing and must be made within 30 days after the date of this publication. Address
the request to the DEQ contact listed below. If the DEQ finds that a sufficient degree of public interest in the
application exists, it will hold the requested meeting after advance notice of the meeting’s time, date, and place
has been given.
Regardless of whether a process meeting is held, the DEQ will prepare either a draft permit or draft denial.
At that time, notice of the prepared draft will be made by the Department and the public will be given the
opportunity to review it, submit written comments, or request a public meeting within thirty days.
For additional information, contact the applicant’s representative, [Facility Contact] at [Facility Contact’s
Phone Number] or [Facility Contact’s Address], or the Industrial Permits Section of the Water Quality
Division of the Department’s central office, located at 707 N. Robinson, P.O. Box 1677, Oklahoma City,
OK 73101-1677, (405) 702-8100.
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Form 1 (Rev. 8/2019) Page 1 of 3
FORM
1 GENERAL
OKLAHOMA
DEQ
OPDES APPLICATION TO DISCHARGE AND/OR TREAT OR DISPOSE OF
INDUSTRIAL WASTEWATER OR SLUDGE
GENERAL INFORMATIONA. TYPE OF PERMIT REQUESTED
NEW RENEWAL MODIFICATION CONVERSION FROM
GENERAL PERMIT
B. REGULATED ACTIVITIESINSTRUCTIONS: ALL applicants MUST fill out FORM 1. Complete items 1 through 5 below to determine which additional forms you need to
submit. If you answer “yes” to any questions, you must submit the supplemental form listed after the question in parentheses. If you answer “no” to
every question, you do not need to submit an application. You may answer “no” if your activity is covered by a general permit or is otherwise excluded
from individual permit requirements (see Section C of the instructions). See Section D of the instructions for definitions of bold-faced terms.
SPECIFIC QUESTIONS YES NO
1. Is this an existing facility which currently results in a discharge of industrial wastewater to waters of the State and is not
eligible for an authorization under a general permit? (FORM 2C)
2. Does this facility use or propose to use surface impoundments (pits, ponds or lagoons) and/or tank systems to treat or
dispose of industrial wastewater and/or land apply industrial sludge or wastewater? (FORM 2SI)
3. Is this a proposed facility which will result in a discharge of industrial wastewater to waters of the State? (FORM 2D)
4. Does this facility perform or propose to perform land application of industrial sludge or wastewater (including beneficial
use for soil conditioning, crop or vegetative fertilization, erosion control or dust suppression)? (FORM 2L)
5. Is this a new or existing categorical user or significant industrial user in a non-pretreatment municipality that will or
does discharge industrial wastewater to a public owned treatment works? (FORM 606-008)
C. NAME OF FACILITY
D. FACILITY CONTACT
1. NAME & TITLE
2. PHONE (area code & number) 3. EMAIL ADDRESS
E. FACILITY MAILING ADDRESS
1. STREET OR P.O. BOX
2. CITY OR TOWN 3. STATE 4. ZIP CODE
F. FACILITY LOCATION
1. STREET, ROUTE NO., OR OTHER SPECIFIC IDENTIFIER 2. COUNTY
3. CITY OR TOWN 4. STATE 5. ZIP CODE
6. LEGAL DESCRIPTION (¼, ¼, ¼, Section, Township, Range)
G. OPERATOR INFORMATION
1. NAME 2. Is the operator also the owner?
YES NO
3. STATUS OF OPERATOR (select the appropriate box below; if “Other,” specify)
Federal State Private Public (other than federal or state) Other (specify):
4. OPERATOR PHONE (if different from facility contact) 5. EMAIL ADDRESS (if different from facility contact)
6. STREET OR P.O. BOX
7. CITY OR TOWN 8. STATE 9. ZIP CODE H. Is the facility located on Indian land?
YES NO
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I. DEQ LANDOWNER NOTIFICATION AFFIDAVIT
1. Does applicant own all land subject to the application: YES NO
If yes, proceed to Section J. If no, proceed to Part 2 of this section.
2. Application(s) for which the applicant does not own all the land subject to the application must notify the owner(s) of leases and/or
pipeline right-of-ways that a permit application has been submitted to the DEQ. The basis for this requirement is 27A of the Oklahoma
Statutes, § 2-14-103(9), as described in OAC 252:004-7-13(b). DEQ Form 100-810 shall be used for this purpose and is available on the
DEQ web page.
J. EXISTING ENVIRONMENTAL PERMITS
1. NPDES 2. UIC 3. RCRA 4. PSD
5. OTHER (permit number) (description) 6. OTHER (permit number) (description)
K. MAP
Attach a topographic map (or other map if a topographic map is unavailable) extending one mile beyond the property boundaries. The
map must show the outline of the facility, the location of each of its intake and discharge structures; each of its hazardous waste
treatment, storage, or disposal facilities; each well where fluids are injected underground; and those wells, springs, other surface water
bodies, and drinking water wells listed in public records or otherwise known to the applicant.
L. SIC and NAICS CODES (in order of priority)
SIC CODE NUMBER DESCRIPTION
NAICS CODE NUMBER DESCRIPTION
M. NATURE OF BUSINESS
1. PRODUCTS AND SERVICES
2. PLANT OPERATIONS
a. PROCESS/OPERATION b. PRODUCT c. DAILY QUANTITY (units)
3. Date the facility began operations: 4. Number of employees at this location:
5. Plant normally operates: hours per day, days per week, in shifts.
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Form 1 (Rev. 8/2019) Page 3 of 3
N. COOLING WATER INTAKE STRUCTURES
1. Does the facility use cooling water? YES NO
2. If so, specify the source of the cooling water:
Facilities that use or propose to use a cooling water intake structure as defined in 40 CFR 125 Subparts I and J may be required to
submit additional information as described in 40 CFR 122.21(r). Please consult with DEQ to determine if this additional information
is required.
O. VARIANCE REQUESTS
Do you intend to request and/or renew one or more of the variances authorized at 40 CFR 122.21(m)? Check all that apply.
If you do intend to request one or more variances, please consult with DEQ to determine what additional information you may need to
submit with your application.
Fundamentally different factors (CWA Section 301(n))
Non-conventional pollutants (CWA Section 301(c) and (g))
Water quality-related effluent limitations (CWA Section 302(b)(2))
Thermal discharges (CWA Section 316(a))
No variance requested
P. SOURCES OF WATER SUPPLY AND AMOUNT USED
Identify all sources of facility water by entering the appropriate letter(s) in the boxes below and then providing the appropriate
description(s), as indicated in parentheses. List each source on a separate line. If you have more than one source of a given type,
indicate this by entering the letter, followed by two digits (e.g., if your water comes from three wells, the sources would be indicated
as G01, G02, and G03). For each source, estimate of the average daily use. Continue on additional sheets if needed.
G = GROUNDWATER WELL
S = SURFACE WATER
P = PUBLIC WATER SUPPLY
W = WASTEWATER TREATMENT PLANT
O = OTHER
(legal description of well location)
(name of stream, river, lake, etc., and legal description of intake)
(name of entity from which water is obtained)
(name of entity from which water is obtained)
(source of supply, and legal description if applicable)
1. SOURCE 2. DESCRIPTION3. AVG. DAILY USE
(specify units)
Q. CERTIFICATION (see instructions)
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted
is, to the best of my knowledge and true belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fine and imprisonment for knowing violations.
1. NAME & OFFICIAL TITLE (type or print) 2. SIGNATURE 3. DATE SIGNED
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Return to: Oklahoma Department of
Environmental Quality
Water Quality Division 707 N. Robinson
P.O. Box 1677
Oklahoma City, OK 73101-1677
Revised July 2019
Industrial Permits Section
Oklahoma DEQ Application for Permit to Discharge and/or Treat or Dispose of
Industrial Wastewater or Sludge
Form 616-2SI
Surface Impoundments and
Underground Tank Systems
This form must be completed by all persons applying for a permit to treat or
dispose of industrial wastewater in surface impoundments (pits, ponds, or
lagoons) and/or underground tanks. This form must be completed in addition
to Form 1 and any other applicable forms.
See Form 1, Attachment 1 for instructions for the submittal of applications and
the public notice requirements.
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Form 616-2SI Instructions (Rev 7/2019) Page 1 of 3
INSTRUCTIONS - FORM 2SI OPDES APPLICATION TO TREAT AND/OR DISPOSE OF INDUSTRIAL WASTEWATER OR SLUDGE
SURFACE IMPOUNDMENTS & UNDERGROUND TANK SYSTEMS
This form must be completed by all applicants who check “yes” to Item B-2
in Form 1.
Your application will not be considered complete unless you answer every
question on this form and on any other required forms. If an item does not apply to you, enter “NA” (for not applicable) to show that you considered the question.
Public Availability of Submitted Information
You may not claim as confidential any information required by this form or by
any other required forms, whether the information is reported on the forms or in an attachment. This information will be made available to the public upon request.
Any information you submit to the Oklahoma Department of Environmental Quality (DEQ) which goes beyond that required by this or any other forms you
may claim as confidential, but claims for information which is effluent data will
be denied. If you do not assert a claim of confidentiality at the time of submitting the information, DEQ may make the information public without further notice to
you. Claims of confidentiality will be handled in accordance with the Oklahoma
Public Records Act.
Definitions All significant terms used in these instructions and in Form 2SI are defined in the
glossary found in the General Instructions to Form 1.
Item A
Enter the facility’s official or legal name. Do not use a colloquial name.
Item B Give the name, title, work telephone number, and email address of a person who
is thoroughly familiar with the operation of the facility and with the facts reported
in this application and who can be contacted by reviewing offices if necessary.
Item C
All surface impoundments and/or tanks on your map should be identified by
number (see Item F below for how to determine impoundment numbers).
Your map should meet the specifications outlined under Item J in the General
Instructions to Form 1. Topographic maps may be obtained from the Oklahoma
Geological Survey at the address also listed under that item.
You may use the same map to fulfill the requirements for Item J in Form 1, Item
C in Form 2SI, provided it clearly shows all information required for each item.
Item D
List all chemical compounds and raw materials in containers of 55 gallons or
more, used in plant operations. Describe the purpose for which each chemical is used. Uses may be described in general terms (for example, “cooling tower
pretreatment,” “process feed stock,” “wastewater treatment,” or “stored pending
sale”). Chemicals may be identified by trade name, but in such case a Safety Data Sheet (SDS) for the product should be attached to the application.
Also describe the storage location, indicating whether it is indoors or outdoors, above or below ground. Storage locations may be keyed to locations on the
facility map included for Item J of Form 1, provided all such locations are clearly
labeled on the map. List the number and type of containers (for example, cylinders, bottles, sacks, barrels, or bulk tanks) used to store each chemical; if the
number varies over time, give a daily average. Also list the average and maximum
daily quantity of each chemical stored on site. For bulk storage tanks, maximum capacity may be reported in place of maximum quantity.
Item E
Impoundment numbers should consist of the letter F (for flow-through) or T (for
total retention) followed by two digits. Number separately for flow-through and total retention impoundments. For example, if you have four (4) flow-through
impoundments and two (2) total retention impoundments, they would be
numbered F01, F02, F03, F04, and T01, T02.
Tank numbers should consist of the letter S (for tank system without lateral lines) or Z (for tanks with lateral lines) followed by two digits.
Use the same numbers throughout Form 2SI to identify the impoundments and/or tanks. If you have an existing permit, use the same numbering scheme in the
application as that used in your current permit, where applicable.
List the impoundment numbers of any impoundments that lie within the 100-year
floodplain. If you are not sure whether an impoundment lies within the 100-year
floodplain, you can determine this by reviewing the Flood Insurance Rate Map (FIRM) for your community or county. FIRMs are prepared by the Federal
Emergency Management Agency (FEMA) as part of the National Flood Insurance
Program (NFIP). If your community or county is a member of NFIP, copies of FIRMs should be on file in the offices of your community or county government,
and are also available online at https://msc.fema.gov/portal/home, or at
https://www.owrb.ok.gov/maps/index.php (see Floodplain Zoning & Community Participation map).
Item F-1
The line drawing should show generally the route taken by water in your facility
from intake to discharge or final disposal. Show all operations contributing wastewater, including process and production areas, sanitary flows, cooling water,
and stormwater runoff. You may group similar operations into a single unit,
labeled to correspond to the more detailed listing in Item G-2. The water balance should show average flows. Show all significant losses of water to products,
atmosphere, and discharge. Use actual measurements whenever available;
otherwise use your best estimate.
You may use the same drawing to fulfill the requirements of Item D-1 in Form 2C
or Item D-1 in Form 2D and Item G-1 in Form 2SI, provided the drawing shows both outfalls and surface impoundments.
Item F-2
List all sources of wastewater to each impoundment and/or tank. Operations may
be described in general terms (for example, “dye-making reactor” or “distillation
tower”). You may estimate the flow contributed by each source if no data are
available. For stormwater runoff you may estimate the average flow, but you must
indicate the rainfall event upon which the estimate is based and the method of estimation.
Report the highest and lowest daily values for flow rate in the “Maximum” and “Minimum” columns (columns c-(2) and c-(3)). Report the average of all daily
values measured during days when discharge occurred within the last year in the “Average” column (column c-(1)).
Item F-3
List all wastes and/or pollutants which are or will otherwise be contained in each
surface impoundment and/or tank (e.g., lubricants, additives, bactericides, detergents, softeners) and their sources. Be as specific as possible in identifying
pollutants. Operations may be described in general terms (for example, “dye-
making reactor” or “distillation tower”). Include all waste types which have the potential to be contained in the impoundments due to spills, bypasses, or unit
failures (e.g., raw materials, oils and greases, solvents or product). Also indicate
(with a “Y” or an “N”) whether you possess analytical data on the wastes contained in each impoundment.
Item F-4
List the volume of sludge generated annually in each impoundment and/or tank.
Use actual measurements if available; otherwise use your best estimate. Indicate whether the sludge will be periodically removed or will accumulate in the
impoundment as a site of final disposal. If sludge is to be removed, give the
frequency of removal (e.g., every six months, annually, every two years, etc.) Determine this frequency using historical data if available; otherwise use your best
estimate. Indicate (with a “Y” or an “N”) whether you possess analytical data on
the sludge generated in each impoundment.
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Form 616-2SI Instructions (Rev 7/2019) Page 2 of 2
Item F-5
List the treatment purpose of each impoundment and/or tank (e.g., settling,
aeration, evaporation, or final disposal). If an impoundment is made up of several
cells (as defined in OAC 252:616-1-2) having different treatment purposes, list
each cell on a separate line.
List any chemicals or equipment used for each treatment method. Also list the
treatment operation parameters (inlet concentration, goal concentration, and detention time) for each impoundment. Use averages of actual measurements
whenever possible; otherwise use design values or your best estimate of average
values.
Item G-1
The plans and specifications should show all inlets to and outlets from each
impoundment, as well as each impoundment’s physical dimensions. The plans
should be clearly labeled with the appropriate impoundment number(s). If the impoundment is made up of several cells, all cells should be clearly shown and
labeled according to flow sequence.
Item G-2
You may use the plans and specifications from Item H-1 to determine each
impoundment’s holding capacity and dimensions. If an impoundment is made up
of several cells, list the overall capacity and dimensions of the impoundment on the first line, followed by the capacity and dimensions of each cell (according to
flow sequence) on a separate line.
Item G-3
List the type of liner material to be installed or currently in use for each
impoundment. Use the classifications in OAC 252:616-7-3 thru 7-7 (e.g., native
soil, compacted clay, flexible membrane, etc.) Within each classification, describe the material of construction as completely as possible (for example,
flexible membrane - HDPE, or alternative - fiberglass tank in excavated-soil pit).
Also list the liner thickness in inches. Hydraulic conductivity (permeability) in column d should be expressed in cm/sec for all liner types as proposed or as built,
except that inches/hour may be used for native soil liners, if desired.
List the type(s) of soil (series name(s) and USDA texture(s)) underlying each impoundment. This information can be found in the appropriate Soil Survey for
the county in which the facility is located. Soil Surveys are published by the
United States Department of Agriculture Soil Conservation Service, and are
available online at
https://websoilsurvey.sc.egov.usda.gov/App/WebSoilSurvey.aspx.
Item G-4
In addition to describing the rationale used to select the liner system, indicate whether you possess any engineering reports or analytical data to support your
rationale.
Item H
The plans and specifications should show the location and length of lateral lines
as well as the distance from each tank and lateral line to potable water wells, water
lines, buildings, property lines, streams, lakes, embankments, and cuts. The plans should be clearly labeled with the appropriate impoundment number(s). Note that
you do not need to list subsurface tanks that are used solely for sanitary wastewater
treatment/disposal.
For each tank, list the tank volume and construction material (e.g. concrete,
steel, plastic, fiberglass). If lateral lines are used for disposal, list the length of
lateral lines and the percolation rate of the soil. Briefly describe the rationale used to select the proposed or currently used lateral line system. If wastewater
is disposed of other than by lateral lines (e.g. impoundment, discharge, recycle),
list the other destination.
Item I
List the method and volume of sanitary wastewater disposal used by the facility.
Item J
Briefly describe any other methods of waste disposal used by your facility which have not been previously covered. Examples include disposal wells, tanks,
aboveground and underground storage tanks, and waste hauling. Include
information on the nature and volume of wastes disposed of by each method, and the legal description of the final disposal site. If the wastes are removed from the
facility, provide the name, address, and phone number of the company hauling the waste, and (if appropriate), the name, address, and phone number of the final
disposal site.
Item K
For each surface impoundment and/or tank, list the depth to groundwater, the
hydrologic gradient or direction of groundwater flow, and the legal description of
each well used to determine groundwater information. The hydrologic gradient or groundwater flow direction should be determined using a minimum of three
wells spaced in a triangular pattern. Hydraulic connections to surface water bodies
may also be used to estimate groundwater flow direction. Attach copies of any well logs or hydrologic atlas pages used to determine this information, if available.
You may list multiple impoundments and/or land application sites on the same
line, provided the same well was used to determine the groundwater information for all impoundments and/or sites. If you cannot determine the direction of
groundwater flow, enter “Unknown” in column C to show that you considered the
question.
Well logs may be obtained from OWRB by utilizing the online tool at http://www.owrb.ok.gov/wd/search/search.php. You should consider well logs
for all Sections (or quarter-sections) lying full or in part within a ½-mile radius of
the surface impoundment(s) and/or outside boundary of the land application site(s).
Item L
For each surface impoundment and/or tank, list the total depth and depth of completion of each monitoring well or water well within ½ mile of the
impoundment and/or tank. Also list the elevation of each well as surveyed, the
depth to static water level, the date the static water level was measured, and the legal description of each monitoring well. Do not include monitoring wells that
are used only to monitor USTs. If there are no water wells within one-half (½)
mile of any impoundments and/or land application sites, enter “N/A” in column A.
Item M
State statutes provide for penalties for submitting false information on this application form.
27A O.S. §2-6-206(G)(4) provides that, “Any person who knowingly makes any
false material statement, representation, or certification in any application, record,
report, plan, or other document filed or required to be maintained under the
Oklahoma Pollutant Discharge Elimination System Act... shall upon conviction
be punished by a fine of not more than Ten Thousand Dollars ($10,000.00), or by imprisonment for not more than two (2) years, or by both.”
All applications must be certified as provided on the forms furnished by the
Department, and must be signed by the applicant. Signatures must be original
signatures; photostatic copies of signatures will not be accepted. Permit applications must be signed as follows:
A. If the applicant is a private corporation, the application must be signed
by:
1. a president, secretary, treasurer, or vice-president of the corporation
in charge of a principal business function, or any other person who
performs similar policy- or decision-making functions for the corporation, or
2. the manager of one or more manufacturing, production, or operating
facilities employing more than 250 persons or having gross annual sales or expenditures exceeding $25 million (in second-quarter 1980
dollars), if authority to sign documents has been assigned or delegated
to the manager in accordance with corporate procedures.
B. If the applicant is a partnership, sole proprietorship or individual
person, the application must be signed, respectively, by a general
partner, the proprietor or the individual.
C. If the applicant is a municipality, political subdivision, the State or
Federal government or other public agency or entity, the application
must be signed by the principal executive officer of the entity or the ranking elected official.
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Form 616-2SI (Rev 7/2019) Page 1 of 6
FORM
2SI OPDES
OKLAHOMA
DEQ OPDES APPLICATION TO TREAT AND/OR DISPOSE OF INDUSTRIAL WASTEWATER OR SLUDGE
SURFACE IMPOUNDMENTS & UNDERGROUND TANK SYSTEMS
A. NAME OF FACILITY
B. FACILITY CONTACT
1. Name & Title 2. Phone (area code & number) 3. Email Address
C. MAP
On the map used for Item K of Form 1, add the locations of any of the following items which are or will be present:
surface impoundments, tank systems, storage facilities, containment devices, monitoring wells, and any water wells
within one-half (½) mile of any surface impoundment or tank system.
D. INVENTORY OF CHEMICALS AND RAW MATERIALS
List all chemical compounds and raw materials in containers of 55 gallons or more, used in plant operations and stored
outside a building (e.g., solvents, cleaning compounds, water treatment chemicals). Describe the storage location and the
purpose for which each chemical is used. Continue on additional sheets if needed.
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Form 616-2SI (Rev 7/2019) Page 2 of 6
E. LOCATION
For each industrial surface impoundment and/or tank system, provide the ID number, legal description, and indicate if the
impoundment or tank is located in the 100 year flood plain. If the impoundment(s) or tank(s) have previously been
permitted, use the ID number(s) contained in the previous permit. If the impoundment(s) or tanks(s) have not previously
been permitted, ID numbers should be assigned using the appropriate letter followed by two digits (e.g., if you have three
flow-through impoundments, their ID numbers would be F01, F02, and F03). Each type of impoundment and/or tank
system should be numbered separately (e.g., if you have one flow-through and one total retention impoundment, their ID
numbers would be F01 and T01, rather than F01 and T02). Use the same numbers throughout this form. Continue on
additional sheets if needed.
F = Flow-Through Surface Impoundment
T = Total Retention Surface Impoundment
S = Underground Tank System Without Lateral Lines
Z = Underground Tank System With Lateral Lines
1. ID
No. 2. Legal Description (¼, ¼, ¼, Section, Township, Range) 3. Flood Plain (yes or no)
F. FLOWS, SOURCES OF WASTE, AND TREATMENT
1. Attach a line drawing showing the flow of wastes or wastewaters through the facility unit processes. Indicate sources of
intake water, chemicals, raw materials, and other sources of wastes. Label all unit processes or operations that
contribute wastes or wastewater, including production areas, waste treatment units, and sources of blowdown or
backwash. Indicate disposal pathways of the wastes and wastewaters, including evaporation, recycle, discharge, solid
waste storage, tanks, impoundments, land application, landfill, or other pathways. Provide a water balance (measured
or estimated) on the line drawing that shows average flows between sources, unit processes, and disposal pathways. If
you filled out Form 2C, you may use the same line drawing, provided it shows all required information.
2. For each impoundment and/or tank system, provide a description of: (1) All operations and other sources of pollution
which contribute waste to the impoundment or tank, including but not limited to process wastes, sanitary wastes,
cooling water, and stormwater; and (2) The average, maximum, and minimum flows contributed by each operation or
other source of pollution. Continue on additional sheets if needed.
a. ID
No. b. Operation(s)/Source(s)
c. Daily Flow (specify units)
(1) Average (2) Maximum (3) Minimum
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Form 616-2SI (Rev 7/2019) Page 3 of 6
3. List all wastes which are or will be contained in the surface impoundment(s) and/or tank system(s) (e.g., lubricants,
additives, bactericides, detergents, softeners) and their sources. Include all wastes which have the potential to be
contained in the impoundment(s) or tank(s) due to spills, bypasses, or unit failures (e.g., raw materials, oils and
greases, solvents, or product). Also indicate whether you possess any chemical analysis of the wastes. Continue on
additional sheets if needed.
a. ID
No. b. Waste/Pollutant c. Source d. Data?
4. For each impoundment and/or tank, list the actual or engineering estimate of the volume of sludge generated annually.
Indicate whether the sludge will be periodically removed from the impoundment or tank (give frequency of removal) or
will accumulate in the impoundment or tank as a site of final disposal. Also indicate whether you possess analytical
data on the sludge generated in each impoundment. Continue on separate sheets if necessary.
a. ID
No. b. Frequency Of Removal/Final Disposal Site c. Sludge Analytical Data d. Volume
5. Describe the treatment purpose of each cell, impoundment, or tank (e.g., settling, aeration, evaporation, or final
disposal). List any chemicals and equipment used for each treatment method. Also list the treatment operation
parameters (inlet concentration, goal concentration, and detention time) for each impoundment or tank. Continue on
additional sheets if necessary.
a. ID
No.
b. Treatment
(1) Description
(2) Chemicals/
Equipment
(3) Inlet
Conc.
(units)
(4) Goal
Conc.
(units)
(5) Detention
Time (units)
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Form 616-2SI (Rev 7/2019) Page 4 of 6
G. IMPOUNDMENT INFORMATION
1. For each impoundment, attach plans sufficient to define the following design parameters: (1) Length and width at top
and bottom; (2) Total depth; (3) Designed minimum and maximum freeboard; (4) Interior and exterior side-slopes
(ratio of horizontal to vertical distances); and (5) Inlet and outlet structures.
2. For each impoundment, list the holding capacity in gallons (assuming a minimum freeboard) and the dimensions in
feet. The following abbreviations are used in the table to indicate the various impoundment dimensions.
BW = Bottom Width
BL= Bottom Length
TW= Top Width
TL = Top Length
D = Depth
F = Minimum Freeboard
MF = Maximum Freeboard
IS = Interior Side-Slope Ratio (Horiz:Vert)
ES = Exterior Side-Slope Ratio (Horiz:Vert)
a. ID No. b. Holding Capacity
(gallons)
c. Dimensions (feet)
(1)
BW
(2)
BL
(3)
TW (4) TL (5) D (6) F
(7)
MF
(8) IS
(ratio)
(9) ES
(ratio)
3. In the table below, list the type of liner material (e.g., native soil, compacted clay, flexible membrane, composite,
soil/bentonite, concrete, or alternative) to be installed or currently in use. Definitive information and justification is
required for alternative liner systems. List the thickness (in inches, feet, or miles, as appropriate) and permeability rate
(in inches/hour) or hydraulic conductivity (in centimeters/second), as appropriate, of each liner as proposed or as built.
Also list the type of soil (series name and USDA texture) underlying the impoundment. Continue on additional sheets
if necessary.
a. ID No. b. Liner Type c. Thickness
(inches)
d. Hydraulic Conductivity
(Permeability)
(cm/sec or in/hr, as
appropriate)
e. Soil Type
(1) Series
Name
(2) USDA
Texture
4. Briefly describe the rationale used to select the proposed or currently used liner systems. Include the date of
construction, along with a discussion of the physical and chemical properties of liner materials which are indicative of
the waste/liner compatibility and the liner’s effectiveness as a physical barrier between the waste and groundwater.
References can be made to similar facilities, related research, or trade organization guidelines. Continue on additional
sheets if necessary.
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Form 616-2SI (Rev 7/2019) Page 5 of 6
H. TANK INFORMATION
1. Attach plans that show the locations of lateral lines, water wells, water lines, buildings, property lines, streams, lakes,
embankments, and cuts within 150 feet of tanks.
2. In the table below, list the tank volume (in gallons) and construction material (e.g. concrete, steel, plastic, fiberglass).
If lateral lines are used for disposal, list the length of lateral lines and the percolation rate of the soil. If wastewater is
disposed of other than by lateral lines (e.g. impoundment, discharge, recycle), list the other destination. Continue on
additional sheets if necessary.
a. ID No. b. Tank Volume
(gallons) c. Construction
Material
d. Lateral Lines e. Other
Destination (1) Length
(feet) (2) Percolation Rate
(minutes/inch fall)
3. Briefly describe the rationale used to select the proposed or currently used lateral line system (if applicable).
I. SANITARY WASTEWATER DISPOSAL
In the table below, list the estimated volume of sanitary wastewater and the method of sanitary wastewater disposal.
1. Volume Of Sanitary Wastewater 2. Method Of Sanitary Wastewater Disposal
J. OTHER DISPOSAL METHODS
Briefly describe any other methods of waste disposal used by your facility which have not been previously covered.
Examples include disposal wells, tanks (with or without leach fields), aboveground or underground storage tanks, and
waste hauling. Include information on the nature and volume of wastes disposed of by each of these other methods.
Continue on additional sheets if necessary.
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Form 616-2SI (Rev 7/2019) Page 6 of 6
K. GROUNDWATER INFORMATION
For each surface impoundment and/or land application site, list the depth to groundwater, the direction of groundwater
flow, and the legal description of each well used to determine groundwater information. Continue on additional sheets if
necessary.
1. ID No. 2. Depth to Water
(feet) 3. Direction of Flow 4. Legal Description of Well
L. WELL INFORMATION
1. For each monitoring well or water well within ½ mile of any impoundment and/or tank system, list in the table below
the total depth, depth of completion, elevation, static water level, and legal description of well. Continue on additional
sheets if necessary.
2. For each well, attach the well log or drillers log, if available. If no water wells are found within ½ mile, attach a copy
of the OWRB letter indicating no wells were found in their records search.
a. ID No. b. Total
Depth
c. Depth of
Completion d. Elevation
e. Static
Water Level
f. Legal Description
of Well
M. CERTIFICATION (see instructions)
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted.
Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering
the information, the information submitted is, to the best of my knowledge and true belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.
1. Name & Official Title (type or print) 2. Signature 3. Date Signed
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