Discharge Serial Number. 2. Discharge Type (check all types that could be discharged at a single discharge location): Noncontact Cooling Water Water Treatment Wastewater Hydrostatic Pressure Testing of Natural Gas/Petroleum Tanks and/or Pipelines Wastewater Fire Suppression System Testing Wastewater Geothermal Heat Pump Water, Residential Building Geothermal Heat Pump Water, Residential Institution or Nonresidential Building 3. Is discharge to: a surface water body the ground 4. Latitude of the discharge point: 5. Longitude of the discharge point: 6. Date Discharge Began or Will Begin: 7. Is discharge: continuous intermittent 8. Total maximum daily flow: gallons per day 9. Average daily flow: gallons per day 10. Maximum hourly flow rate: gallons per hour 11. Maximum instantaneous flow rate: gallons per minute
