OMB
Control
Number:
2040­
0238
Expiration
Date:
XX/
XX/
XXXX
PRA
Statement:
The
public
reporting
and
recordkeeping
burden
for
this
collection
of
information
is
estimated
to
average
1
hour
per
response.
Send
comments
on
the
Agency's
need
for
this
information,
the
accuracy
of
the
provided
burden
estimates,
and
any
suggested
methods
for
minimizing
respondent
burden,
including
through
the
use
of
automated
collection
techniques
to
the
Director,
Collection
Strategies
Division,
U.
S.
Environmental
Protection
Agency
(
2822T),
1200
Pennsylvania
Ave.,
NW,
Washington,
D.
C.
20460.
Include
the
OMB
control
number
in
any
correspondence.
Do
not
send
the
completed
spreadsheet
to
this
address.

104(
g)(
1)
DATABASE
GUIDANCE
The
following
information
corresponds
to
the
data
input
form
of
the
104(
g)(
1)
Program
database.

(
1a)
COMPLIANCE
ACHIEVED
DATE:
The
assistance
work
at
the
facility
has
resulted
in
the
facility
being
in
compliance
for
at
least
ninety
(
90)
days.
The
date
entered
into
this
field
should
be
the
day
the
facility
continuously
achieved
compliance
for
ninety
(
90)
days.
If
the
compliance
achieved
date
is
entered
so
must
the
compliance
achieved
date.

(
1b)
CONCLUSION
ASSISTANCE
DATE:
Enter
the
date
that
the
assistance
work
has
been
completed
at
the
facility.
This
date
will
be
the
same
as
of
most
likely
after
the
compliance
achieved
date.

(
2)
TYPE
OF
FACILITY:
Choose
the
one
option
that
most
applies
to
the
facility
using
the
drop­
down
box.
Options:
AL,
AS,
CS,
EA,
L,
OD,
PO,
RBC,
SBR,
SP,
TF,
TF/
SC,
WTL,
OTH
AL
­
Aerated
Lagoon
AS
­
Activated
Sludge
CS
­
Contact
Stabilization
EA
­
Extended
Aeration
L
­
Lagoon
OD
­
Oxidation
Ditch
PO
­
Primary
Treatment
Only
SBR
­
Sequencing
Batch
Reactors
RBC
­
Rotating
Biological
Contactors
SP
­
Stabilization
Pond
TF
­
Trickling
Filter
TF/
SC
­
Trickling
Filter/
Solids
Contact
WTL
­
Wetlands
to
Lagoons
OTH
­
Other
{
Type
OTH
in
this
field
and
use
the
comment
field
(
4)
to
explain.}

(
3)
PERFORMANCE
LIMITING
FACTORS
=
PLFs:
Options:
A,
B,
C,
D,
E,
F,
G,
H,
I,
J,
K,
L,
M,
N,
O,
P,
Q,
R,
S,
T,
U,
V,
W,
X,
Y,
Z
Up
to
four
letters
can
be
assigned
to
each
facility
based
on
the
"
performance
limiting
factors"
that
were
found
at
each
facility
that
most
contributed
to
its
non­
compliance
or
its
poor
state
of
O&
M.
These
should
be
listed
from
top
to
bottom
from
the
PLF
that
most
contributed
to
the
PLF
that
least
contributed
to
the
facility's
non­
compliance
or
poor
state
of
O&
M.
Use
your
best
judgement
in
applying
these
factors.

A
­
Poor
understanding
and
application
of
process
control
by
operator
B
­
Staffing
(
too
few
staff
,
low
pay,
turnover,
etc.)
C
­
Support
from
municipality
(
administrative
and
technical)

D
­
Operating
budget
and
user
charge
system
E
­
Operability/
maintainability
considerations
(
process
flexibility,
automation,
standby
units,
alternate
power
source)

F
­
Inflow
and
infiltration
2­

PLFs
continued:

G
­
Lagoon
leakage
H
­
Process
design
errors
(
clarifiers,
aerators,
disinfection,
etc.)

I
­
Over
loaded
J
­
Under
loaded
K
­
Solids
handling
and
sludge
disposal
L
­
Pretreatment,
industrial
dischargers,
and
toxics
M
­
O&
M
manual
(
lack
of
or
deficient)

N
­
QA/
QC
problems
O
­
Spare
parts
inventory
P
­
Chemical
inventory
Q
­
Laboratory
deficiencies
(
process
control
/
NPDES
testing)

R
­
NPDES
reporting
/
record
keeping
S
­
Equipment
/
unit
processes
broken
down/
inoperable
T
­
Hydraulic
related
problems
U
­
Poor
aeration
system
V
­
Sludge
accumulation
W
­
Job
description
(
performing
operator
evaluations
without
a
written
operator
job
description)

X
­
Illegal
dischargers
/
non­
dischargers
Y
­
Algae
problems
in
lagoons
Z
­
Other
(
Type
OTH
in
this
field
and
use
the
comment
field
(
5)
to
explain.)
­
3­

(
4)
REPEAT
ASSISTANCE
FACILITY:
Indicate
with
either
a
yes
or
no,
if
this
facility
has
been
assisted
by
the
program
in
the
past
five
years.
A
drop­
down
box
is
present
for
easier
data
entry
purposes.

(*)
LAST
ASSISTANCE
DATE:
Applies
only
to
Repeat
Assistance
Facilities.
If
applicable
indicate
the
date
of
the
last
conclusion
assistance
date
­
(
1b)
at
this
facility,
otherwise
leave
blank.

(
5)
COMMENTS:
Pertinent
facility
information,
the
type
of
facility
­
(
2)
or
the
need
to
expand
on
the
type
of
facility,
or
PLFs
­
other
(
3).

(
6)
OTHER
BENEFITS:
Energy
savings,
cost
savings,
chemical
addition
savings,
etc.

(
7)
POLLUTANT
(
CBOD/
BOD,
NITROGEN,
&
TSS)
AVG.
­
Start:
The
average
of
the
effluent
monthly
averages
of
the
particular
pollutant
(
CBOD/
BOD,
Nitrogen,
&
TSS)
on
the
facility's
Discharge
Monitoring
Report
for
the
three
months
prior
to
the
start
of
assistance
date.

(
8)
POLLUTANT
(
CBOD/
BOD,
NITROGEN,
&
TSS)
AVG.
­
End:
The
average
of
the
effluent
monthly
averages
of
the
particular
pollutant
(
CBOD/
BOD,
Nitrogen,
&
TSS)
on
the
facility's
Discharge
Monitoring
Report
for
the
three
months
after
the
conclusion
of
assistance
date
(
1b).

(
9)
ANNUAL
AVERAGE
FLOW
{
MGD}:
The
annual
average
of
the
effluent
flow,
in
millions
of
gallons
per
day,
during
the
assistance
period.

The
Pounds
of
CBOD/
BOD
Reduced
,
Pounds
of
Nitrogen
Reduced,
and
Pounds
of
TSS
Reduced
are
fields
that
will
automatically
calculate
information,
data
input
is
unnecessary
and
not
possible.
