Non-Standard Discharge Form

Use this form when a discharge is classified as "Non-Standard" according to Sections 2.1 and 2.2 of the Sewer Use Protocol which can be found here.  Please also review the Non-Standard Discharge flowchart here.  A response will be provided within five (5) business days.  Should you have any questions, please contact Terri Bechta at (413)-577-3632 or twolejko@ehs.umass.edu.

 

REQUESTER INFORMATION

DISCHARGE INFORMATION

Gallons

Non standard discharges shall occur during normal business hours - 8:00 AM to 5:00 PM

The pH must be between 5.0 and 10.0

Degrees F

In no case shall heat in such quantities that the temperature at the Amherst POTW exceeds 104 degrees F be discharged.

POLLUTANT INFORMATION

Please attach the analytical document below.

You may skip the document attachment below.

Please fill out the remainder of this form below.

You may skip the remainder of this form below.

An MSDS must be provided for each chemical.  Please attach the file or provide a web link to the MSDS for each chemical here.

(e.g. Percent, Gallons, Rate, etc..)

If more than one chemical is involved, please expand and enter information for the additional chemical(s) below.

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