Form
Approved
OMB
Control
No.
XXX
Approval
Expires
XXX
The
public
reporting
and
recordkeeping
burden
for
this
collection
of
information
is
estimated
to
average
XXX
hours
per
response.
Burden
means
the
total
time,
effort,
or
financial
resources
expended
by
persons
to
generate,
maintain,
retain,
or
disclose
or
provide
information
to
or
for
a
Federal
agency.
This
estimate
includes
the
time
needed
to
review
instructions,
develop,
acquire,
install,
and
utilize
technology
and
systems
for
the
purposes
of
collecting,
validating,
and
verifying
information,
processing
and
maintaining
information,
and
disclosing
and
providing
information;
adjust
the
existing
ways
to
comply
with
any
previously
applicable
instructions
and
requirements;
train
personnel
to
be
able
to
respond
to
a
collection
of
information;
search
data
sources;
complete
and
review
the
collection
of
information;
and
transmit
or
otherwise
disclose
information.
An
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond
to,
a
collection
of
information
unless
it
displays
a
currently
valid
OMB
control
number.
To
comment
on
the
Agency's
need
for
this
information,
the
accuracy
of
the
provided
burden
estimates,
and
any
suggested
methods
for
minimizing
respondent
burden,
including
the
use
of
automated
collection
techniques,
EPA
has
established
a
public
docket
for
this
ICR
under
Docket
ID
No.
OW­
2004­
0035,
which
is
available
for
public
viewing
at
the
Water
Docket
in
the
EPA
Docket
Center
(
EPA/
DC),
EPA
West,
Room
B102,
1301
Constitution
Ave.,
NW,
Washington,
DC
20004.
The
EPA
Docket
Center
Public
Reading
Room
is
open
from
8:
30
a.
m.
to
4:
30
p.
m.,
Monday
through
Friday,
excluding
legal
holidays.
The
telephone
number
for
the
Reading
Room
is
(
202)
566­
1744,
and
the
telephone
number
for
the
Water
Docket
is
(
202)
566­
2426.
An
electronic
version
of
the
public
docket
is
available
through
EPA
Dockets
(
EDOCKET)
at
http://
www.
epa.
gov/
edocket.
Use
EDOCKET
to
submit
or
view
public
comments,
access
the
index
listing
of
the
contents
of
the
public
docket,
and
access
those
documents
in
the
public
docket
that
are
available
electronically.
Once
in
the
system,
select
"
search",
then
key
in
the
docket
ID
number
identified
above.
Also,
you
can
send
comments
to
the
Office
of
Information
and
Regulatory
Affairs,
Office
of
Management
and
Budget,
725
17th
Street,
NW,
Washington,
DC
20503,
Attention:
Desk
Office
for
EPA.
Please
include
the
EPA
Docket
ID
No.
(
OW­
2004­
0035)
and
OMB
control
number
(
XXXX­
XXXX)
in
any
correspondence.
Attach
Address
Label
U.
S.
ENVIRONMENTAL
PROTECTION
AGENCY
DRAFT
DRINKING
WATER
TREATMENT
SHORT
SCREENER
SURVEY
QUESTIONNAIRE
EPA
Form
No.
XXX
Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
i
INTRODUCTION
The
U.
S.
Environmental
Protection
Agency
(
EPA)
is
conducting
a
survey
of
drinking
water
treatment
facilities
as
part
of
its
effort
to
develop
national
effluent
guidelines
regulations
for
the
drinking
water
treatment
point
source
category.
This
survey
requests
information
on
drinking
water
treatment
facilities
operating
during
the
2004
calendar
year.

This
survey
is
conducted
under
the
authority
of
Section
308
of
the
Clean
Water
Act
(
Federal
Water
Pollution
Control
Act,
33
U.
S.
C.
Section
1318).
All
facilities
that
receive
this
survey
must
respond
to
it
within
30
days
of
receiving
it.
Failure
to
respond,
late
filing,
or
failure
to
comply
with
the
instructions
may
result
in
criminal
fines,
civil
penalties,
and
other
sanctions,
as
provided
by
law.

OVERVIEW
OF
THE
SURVEY
EPA
will
use
the
technical
data
collected
in
this
survey
to
determine
rates
of
residual
generation
and
residual
management
and
treatment
and
to
estimate
the
costs
and
benefits
associated
with
any
new
national
effluent
guidelines
regulations
considered
by
EPA.

COMPLETION
OF
THE
SURVEY
All
facilities
must
have
the
corporate
official
or
designee
responsible
for
directing
or
supervising
the
response
to
the
survey
sign
one
of
the
Certification
Statements
on
page
v
to
either
(
1)
verify
and
validate
the
information
provided,
or
(
2)
certify
that
this
facility
did
not
perform
drinking
water
treatment
operations
during
the
2004
calendar
year.

Not
All
Questions
Will
Be
Applicable
to
Every
Facility
EPA
prepared
this
survey
to
be
applicable
to
a
variety
of
facilities;
therefore,
not
all
of
the
questions
will
apply
to
every
facility.
Complete
each
relevant
item
in
the
survey.
If
a
question
is
not
applicable
to
your
facility,
write
"
NA."

Survey
Does
Not
Require
Performance
of
New
or
Non­
Routine
Tests
or
Measurements
You
are
not
required
to
perform
new
or
nonroutine
tests
or
measurements
solely
for
the
purpose
of
responding
to
this
survey.
EPA
intends
that
responses
to
all
questions
be
based
upon
available
data
and
information.
In
the
event
that
exact
data
are
not
available,
please
provide
best
engineering
estimates.

Keep
a
Copy
of
the
Completed
Survey
Please
keep
a
copy
of
the
completed
survey,
including
attachments.
EPA
will
review
the
information
submitted
and
may
request
your
cooperation
in
answering
follow­
up
questions,
if
necessary,
to
complete
analyses.
Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
ii
EPA
DRINKING
WATER
TREATMENT
SURVEY
E­
MAIL
ADDRESSES
AND
WEBSITE
Information:
E­
Mail
Address
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Siddiqui.
Ahmar@
epa.
gov
Website
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
http://
www.
epa.
gov/
waterscience/
guide
SURVEY
ASSISTANCE
WHEN
TO
RETURN
THE
SURVEY
The
response
to
this
survey
is
due
30
days
after
receiving
it.

If
you
wish
to
request
an
extension,
you
must
do
so
in
writing
within
15
days
of
receipt
of
this
survey.
Written
requests
may
be
e­
mailed
to
Mr.
M.
Ahmar
Siddiqui
at
Siddiqui.
Ahmar@
epa.
gov
or
may
be
mailed
to:

Mr.
M.
Ahmar
Siddiqui
U.
S.
Environmental
Protection
Agency
Engineering
and
Analysis
Division
(
4303T)
1200
Pennsylvania
Avenue,
NW
Washington,
DC
20460
Extension
requests
will
be
evaluated
on
a
case­
by­
case
basis.
Submittal
of
an
extension
request
to
EPA
does
not
alter
the
due
date
of
your
survey
unless
and
until
EPA
agrees
to
the
extension
and
establishes
a
new
date.

WHERE
TO
RETURN
THE
SURVEY
After
completing
the
survey
and
certifying
the
information
that
it
contains,
use
the
enclosed
mailing
label
to
mail
the
completed
survey
to:

U.
S.
Environmental
Protection
Agency
Drinking
Water
Treatment
Survey
c/
o
Eastern
Research
Group,
Inc.
14555
Avion
Parkway,
Suite
200
Chantilly,
VA
20151
REQUESTING
AN
ELECTRONIC
VERSION
OF
THE
SURVEY
If
you
would
like
an
electronic
version
of
the
survey,
it
is
available
on
the
EPA
website
at
http://
www.
epa.
gov/
waterscience/
guide.

If
you
choose
to
complete
an
electronic
version
of
this
survey,
you
are
still
responsible
for
submitting
a
properly
formatted
hard
copy
response
which
matches
this
survey's
format
and
pagination.
The
electronic
formatting
of
this
survey
is
complex
and
may
require
more
experienced
clerical
support.
Improperly
formatted
survey
responses
will
be
returned
to
the
respondent.
Therefore,
we
do
not
recommend
that
you
complete
this
survey
electronically.
Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
iii
CONFIDENTIAL
BUSINESS
INFORMATION
If
no
business
confidentiality
claim
accompanies
the
information
when
it
is
received
by
EPA,
EPA
may
make
the
information
available
to
the
public
without
further
notice.

Regulations
governing
the
confidentiality
of
business
information
are
contained
in
the
Code
of
Federal
Regulations
(
CFR)
at
Title
40
Part
2,
Subpart
B.
You
may
assert
a
business
confidentiality
claim
covering
part
or
all
of
the
information
you
submit,
other
than
effluent
data
and
information
or
data
that
is
otherwise
publicly
available,
as
described
in
40
CFR
2.203(
b):

"(
b)
Method
and
time
of
asserting
business
confidentiality
claim.
A
business
which
is
submitting
information
to
EPA
may
assert
a
business
confidentiality
claim
covering
the
information
by
placing
on
(
or
attaching
to)
the
information,
at
the
time
it
is
submitted
to
EPA,
a
cover
sheet,
stamped
or
typed
legend,
or
other
suitable
form
of
notice
complying
language
such
as
`
trade
secret,'
`
proprietary,'
or
`
company
confidential.'
Allegedly
confidential
portions
of
otherwise
nonconfidential
documents
should
be
clearly
identified
by
the
business,
and
may
be
submitted
separately
to
facilitate
identification
and
handling
by
EPA.
If
the
business
desires
confidential
treatment
only
until
a
certain
date
or
until
the
occurrence
of
a
certain
event,
the
notice
should
so
state."

You
may
claim
as
confidential
all
information
included
in
the
response
to
a
question
by
checking
the
Confidential
Business
Information
(
CBI)
box
next
to
the
question
number.
Note
that
you
may
be
required
to
justify
any
claim
of
confidentiality
at
a
later
time.
Note
also
that
facility
effluent
data
are
not
eligible
for
confidential
treatment,
pursuant
to
Section
308(
b)
of
the
Clean
Water
Act,
and
thus
will
be
treated
as
nonconfidential
even
if
the
CBI
box
is
checked.
In
addition,
information
that
is
publicly­
available
should
not
be
claimed
confidential.
Note
also
that
information
claimed
confidential
cannot
be
accessed
or
used
by
the
industry
to
evaluate
data
and
analyses
supporting
the
national
effluent
guidelines
regulations.

Information
covered
by
a
claim
of
confidentiality
will
be
disclosed
by
EPA
only
to
the
extent
of,
and
by
means
of,
the
procedures
set
forth
in
40
CFR
Part
2,
Subpart
B.
In
general,
submitted
information
protected
by
a
business
confidentiality
claim
may
be
disclosed
to
other
employees,
officers,
or
authorized
representatives
of
the
United
States
concerned
with
implementing
the
Clean
Water
Act.

Information
covered
by
a
claim
of
confidentiality
will
be
made
available
to
EPA
contractors
to
enable
the
contractors
to
perform
the
work
required
by
their
contracts
with
EPA.
All
EPA
contracts
provide
that
contractor
employees
use
the
information
only
for
the
purpose
of
performing
the
work
required
by
their
contracts
and
will
not
disclose
any
CBI
to
anyone
other
than
EPA
without
prior
written
approval
from
each
affected
business
or
from
EPA's
legal
office.
Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
iv
GENERAL
INSTRUCTIONS
FOR
SURVEY
Read
all
question­
specific
instructions
and
definitions
of
key
terms.
Carefully
read
the
definitions
of
key
terms
(
found
on
the
following
pages)
and
any
instructions
for
specific
questions.

Enter
Facility
SDWIS
ID
number
on
top
of
each
page.
The
Facility
SDWIS
ID
number
is
provided
on
the
mailing
label.

Mark
responses
for
each
question.
Fill
in
the
appropriate
response(
s)
to
each
question.
Please
use
black
ink
or
type
in
the
spaces
provided.
Answer
the
questions
in
sequence
unless
you
are
directed
to
SKIP.
Do
not
leave
any
entry
blank.
If
the
answer
is
zero,
write
"
0"
or
"
zero".
If
a
question
is
not
applicable
to
your
facility,
write
"
NA."

Include
any
clarifying
attachments.
If
additional
attachments
are
required
to
clarify
a
response,
please
place
the
associated
question
number
and
your
facility
name
and
SDWIS
ID
number
in
the
top
right
corner
of
each
page
of
the
attachments.
The
following
list
contains
examples
of
items
which
may
be
included
as
attachments
to
this
survey:
 
Facility
brochure,
pamphlet,
general
description;
 
Piping
and
residual/
wastewater
treatment
flow
diagrams;
and
 
Hard
copy
summaries
of
analytical
data
collected
from
monitoring
locations.

Provide
best
estimates
when
data
are
not
available.
EPA
intends
that
responses
to
all
questions
be
based
upon
available
data
and
information.
Please
provide
best
estimates
when
exact
data
are
not
available.
You
are
not
required
to
perform
new
or
non­
routine
tests
or
measurements
solely
for
the
purpose
of
responding
to
this
survey.

To
estimate
the
amount
of
residuals
generated
annually
(
Question
10),
please
estimate
to
the
nearest
1,000
gallons
and/
or
100
tons
generated,
exact
volumes
are
not
necessary.
Estimates
may
be
calculated
using
basic
equations
with
average
volumes
and
average
frequencies.
For
example,
the
estimate
of
filter
backwash
generated
annually
may
be
calculated
as
the
average
volume
of
water
used
per
filter
backwash
multiplied
by
the
average
number
of
filter
backwashes
per
week
multiplied
by
52
weeks
per
year.

Indicate
information
that
should
be
treated
as
confidential.
You
may
claim
as
confidential
all
information
included
in
the
response
to
a
question
by
checking
the
Confidential
Business
Information
(
CBI)
box
next
to
the
question
number.
Note
that
you
may
be
required
to
justify
any
claim
of
confidentiality
at
a
later
time.
See
the
CONFIDENTIAL
BUSINESS
INFORMATION
section
on
page
iii.

Questions?
If
you
have
any
questions
regarding
the
completion
of
this
survey,
see
the
SURVEY
ASSISTANCE
section
on
page
ii
for
the
e­
mail
addresses.

BE
SURE
TO
RETAIN
A
COPY
OF
THE
COMPLETED
SURVEY
FOR
YOUR
RECORDS.
Facility
SDWIS
ID:

Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
v
CERTIFICATION
STATEMENT
The
individual
responsible
for
directing
or
supervising
the
preparation
of
the
survey
must
read
and
sign
the
Certification
Statement
listed
below.
The
certifying
official
must
be
a
responsible
corporate
official
or
his/
her
authorized
representative.

Check
(

)
Certification
Statement
#
1
if
this
facility
performed
drinking
water
treatment
operations
during
the
2004
calendar
year
and
the
facility
has
completed
the
survey.

Check
(

)
Certification
Statement
#
2
if
this
facility
did
not
perform
drinking
water
treatment
operations
during
the
2004
calendar
year.

Sign
the
bottom
of
this
Certification
Statement
page
after
checking
the
appropriate
certification
statement.

G
Certification
Statement
#
1
I
certify
under
penalty
of
law
that
the
attached
survey
was
prepared
under
my
direction
or
supervision
in
accordance
with
a
system
designed
to
assure
that
qualified
personnel
properly
gathered
and
evaluated
the
information
submitted.
The
information
submitted
is,
to
the
best
of
my
knowledge
and
belief,
accurate
and
complete.
In
those
cases
where
we
did
not
possess
the
requested
information,
we
provided
best
estimates.
We
have
to
the
best
of
our
ability
indicated
what
we
believe
to
be
company
confidential
business
information
as
defined
under
40
CFR
Part
2,
Subpart
B.
We
understand
that
we
may
be
required
at
a
later
time
to
justify
our
claim
in
detail
with
respect
to
each
item
claimed
confidential.
I
am
aware
that
there
are
significant
penalties
for
submitting
false
information,
including
the
possibility
of
fines
and
imprisonment
as
explained
in
Section
308
of
the
Clean
Water
Act.

G
Certification
Statement
#
2
I
certify
under
penalty
of
law
that
this
facility
did
not
perform
drinking
water
treatment
operations
during
the
2004
calendar
year.
I
am
aware
that
there
are
significant
penalties
for
submitting
false
information,
including
the
possibility
of
fines
and
imprisonment
as
explained
in
Section
308
of
the
Clean
Water
Act.

Signature
of
Certifying
Official
Date
(
)
Printed
Name
of
Certifying
Official
Telephone
Number
Title
of
Certifying
Official
Facility
Name
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
vi
DEFINITIONS
OF
KEY
TERMS
Clean
Water
Act
(
CWA)
­
Federal
legislation
enacted
by
Congress
to
"
restore
and
maintain
the
chemical,
physical,
and
biological
integrity
of
the
Nation's
waters"
(
Federal
Water
Pollution
Control
Act
of
1972,
as
amended,
33
U.
S.
C.
1251
et
seq.).

Contract
Haul
­
Collection
of
wastewater
or
sludge
by
a
private
disposal
service,
scavenger,
or
purveyor,
in
containers
for
subsequent
transportation,
treatment,
and
disposal
off
site.

Discharge
­
The
conveyance
of
wastewater
to:
(
1)
United
States
surface
waters
such
as
rivers,
lakes,
and
oceans,
or
(
2)
a
publicly
owned,
privately
owned,
federally
owned,
combined,
or
other
treatment
works.

Disposal
­
Intentional
placement
of
waste
into
or
on
any
land
where
the
material
will
remain
after
closure.
Waste
placed
into
water
is
defined
as
discharge,
not
disposal.

Drinking
Water
Treatment
Plant
­
Facility
where
water
is
filtered,
disinfected,
and/
or
otherwise
treated
prior
to
its
transmission
into
the
distribution
system
(
or
its
conveyances
to
another
purchasing
water
utility).

Evaporation
­
The
process
by
which
water
or
other
liquid
becomes
a
gas.
Water
from
land
areas,
bodies
of
water,
and
all
other
moist
surfaces
is
absorbed
into
the
atmosphere
as
a
vapor.

Facility
­
Physical
location
corresponding
to
the
site
where
industrial
and
nonindustrial
activities
are
conducted.
The
activities
conducted
include,
but
are
not
limited
to:
drinking
water
supply
and
treatment
operations.

Groundwater
­
Water
in
a
saturated
zone
or
stratum
beneath
the
surface
of
land
or
water.

Landfill
­
A
natural
or
man­
made
formation
in
the
earth
into
which
solid
waste,
sludges,
or
other
process
residuals
are
placed
for
permanent
disposal.

NPDES
Program
­
The
National
Pollutant
Discharge
Elimination
System
(
NPDES)
program
authorized
by
Sections
307,
318,
402,
and
405
of
the
Clean
Water
Act
that
applies
to
facilities
that
discharge
wastewater
directly
to
United
States
surface
waters.

Pollutant
­
Under
the
Clean
Water
Act,
a
dredged
spoil,
solid
waste,
incinerator
residue,
filter
backwash,
sewage
sludge,
munitions,
chemical
waste,
biological
material,
certain
radioactive
material,
heat,
wrecked
or
discarded
equipment,
rock
sand,
cellar
dirt,
and
industrial,
municipal,
and
agricultural
waste
(
40
CFR
122.2).

Process
Water
­
Water
applied
to
the
process,
including
any
combination
of
service
water,
water
recycled
from
the
process,
water
reused
from
other
processes,
and
any
other
water
applied
to
the
process.

Publicly
Owned
Treatment
Works
(
POTW)
­
Any
device
or
system
owned
by
a
state
or
municipality
that
is
used
to
recycle,
reclaim,
or
treat
liquid
municipal
sewage
and/
or
liquid
industrial
wastes.

Purchased
Water
­
Water
obtained
from
a
third­
party
vendor.

Recycle/
Recovery
­
The
process
of
recovering
usable
constituent
fractions
within
a
waste
material
or
removal
of
contaminants
from
a
waste
material
to
allow
it
to
be
reused.

Residuals
­
The
waste
products
generated
during
potable
water
treatment
process,
including
organic
and
inorganic
compounds
in
liquid
and
solid
forms.
Examples
of
residuals
include
sludges
generated
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
vii
from
presedimentation
and
coagulation,
membrane
reject
water,
spent
backwash,
and
ion
exchange
resins.

Surface
Waters
­
Waters
of
the
United
States
including,
but
not
limited
to,
oceans
and
all
interstate
and
intrastate
lakes,
rivers,
streams,
creeks,
mudflats,
sand
flats,
wetlands,
sloughs,
prairie
potholes,
wet
meadows,
playa
lakes,
and
natural
ponds.

Treatment
­
Any
activity
designed
to
change
the
character
or
composition
of
any
waste
so
as
to
prepare
it
for
transportation,
storage,
or
disposal;
render
it
amenable
for
recycling
or
recovery;
or
reduce
it
in
volume.
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
1
TECHNICAL
INFORMATION
Attach
Facility
Address
Label
Here
1.
Is
the
mailing
address
and
SDWIS
ID
on
the
mailing
label
correct?


Yes
(
Skip
to
Question
3)


No
2.
Please
print
the
correct
mailing
address.

Facility
Name
Street
Address
or
Post
Office
Box
­
City
State
Zip
Code
SDWIS
ID
3.
Did
the
drinking
water
treatment
facility
generate
residuals
during
2004?
Residuals
refer
to
the
waste
products
generated
during
potable
water
treatment
processes,
including
organic
and
inorganic
compounds
in
liquid
and
solid
forms.
Examples
of
residuals
include
sludges
generated
from
presedimentation
and
coagulation,
membrane
reject
water,
spent
backwash,
and
ion
exchange
resins.


Yes

No
(
Complete
and
sign
Certification
Statement
#
1
on
page
v
and
return
this
survey
and
the
signed
certification
statement
to
the
survey
return
address
on
page
ii.)
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
2
CBI?

Yes
CBI?

Yes
CBI?

Yes
4.
Provide
the
following
information
for
the
primary
contact
for
the
technical
information
supplied
in
this
questionnaire:

(
)
Primary
Contact
Name
Telephone
Number
(
)
Title
Fax
Number
E­
mail
Address
Convenient
time
to
call:
between
am/
pm
and
am/
pm
Street
Address
or
Post
Office
Box
(
Eastern
Time)

­
City
State
Zip
Code
5.
Indicate
(

)
how
many
people
were
served
by
the
facility
in
2004?
Check
one.


100
or
less

10,001
­
50,000

101
­
500

50,001
­
100,000

501
­
3,300

100,001
­
500,000

3,301
­
10,000

More
than
500,000
6.
Indicate
(

)
what
type
of
source
water
was
treated
at
the
facility
in
2004?
Check
all
that
apply.
Identify
(

)
whether
the
source
water
is
the
primary
water
source
treated
at
the
facility
or
nonprimary
water
source.


Surface
water

Primary

Non­
primary

Ground
water

Primary

Non­
primary

Purchased
water

Primary

Non­
primary

Other
(
Specify):

7.
What
was
the
total
amount
of
finished
water
produced
at
the
facility
in
2004?
Select
one
category.


10
MG
or
less

>
2,000
­
4,000
MG

>
10
­
40
MG

>
4,000
­
10,000
MG

>
40
­
400
MG

>
10,000
­
20,000
MG
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
3

>
400
­
2,000
MG

More
than
20,000
MG
Facility
SDWIS
ID:

Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
4
CBI?


Yes
8.
Identify
processes
used
to
treat
residuals
or
reduce
residual
production
at
the
facility
in
2004.
Check
(

)
all
that
apply.

Residuals
Treatment
Treatment/

P2
Code
Prevention
of
Residuals
Production
Treatment/

P2
Code

No
treatment
5A

Recycling
filter
backwash
5K

Dewatering
5B

Optimizing
surface
water
intake
to
reduce
suspended
solids
intake
5L

Drying
5C

Coagulant
recovery
5M

Thickening
tanks
(
from
flocculation
tanks)
5D

Lime
recovery
5N

Aeration
5E

Optimizing
sludge
collection
5O

Hydrogen
sulfide
removal
5F

Optimizing
filter
bed
media
to
reduce
filter
backwash
volumes
5P

pH
adjustment
5G

Other
(
specify):
5Q

Sedimentation
tanks
and
ponds
5H

Evaporation
ponds
5I

Other
(
specify):
5J
Facility
SDWIS
ID:

Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
5
CBI?


Yes
9.
Identify
the
method
of
disposal
of
residuals
generated
at
the
facility
in
2004.
Identify
the
destination
of
residuals
discharged
to
surface
waters
or
a
POTW.
Check
(

)
all
that
apply.

Residuals
Management
Managemen
t
Code
Zero
Discharge
of
Residuals
Management
Code
Discharge
of
Residuals:
On­
Site
Management:


Discharge
to
surface
waters
6A

On­
site
landfill
disposal
6F
Name
of
receiving
surface
waters:

On­
site
composting
6G

On­
site
spray
irrigation
6H

Discharge
to
Municipal
Separate
Storm
Sewer
(
MS4)
6B

On­
site
evaporation
6I
Name
of
surface
waters
receiving
MS4
discharge:

On­
site
recovery
of
chemicals
6J

Other
(
specify):
6K
Off­
site
Management:


Discharge
to
a
POTW
6C

Off­
site
municipal
non­
hazardous
landfill
disposal
6L
Name
of
receiving
POTW:

Off­
site
hazardous
landfill
disposal
6M

Off­
site
low­
level
radioactive
waste
disposal
6N

Other
(
specify):
6D

Off­
site
disposal
with
POTW
biosolids
6O

Off­
site
underground
injection
6P

Off­
site
composting
6Q

Other
(
specify):
6E

Off­
site
land
application
(
e.
g.,
soil
amendment)
6R

Off­
site
spray
irrigation
6S
Facility
SDWIS
ID:

Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
6
CBI?


Yes

Other
(
specify):
6T
10.
Identify
the
type
of
residuals
generated
at
the
facility
in
2004.
Check
(

)
all
that
apply.
For
each
residuals
waste
stream,
identify
if
you
use
any
treatment
or
pollution
prevention
for
that
waste
stream
and
indicate
the
treatment
or
pollution
prevention
by
using
the
Treatment/
P2
Codes
from
Question
5.
For
each
residuals
waste
stream,
also
identify
the
management
option
and
indicate
the
type
of
management
by
using
the
Management
Codes
from
Question
6.
Estimate
the
amount
of
residuals
generated
annually
to
the
nearest
1,000
gallons
and/
or
100
tons.
The
amount
of
residuals
generated
annually
can
be
estimated
using
average
flows/
volumes
and
average
frequencies.
See
the
instructions
on
page
iv
for
more
information.

Drinking
Water
Treatment
Residuals
Type
Treatment
or
Pollution
Prevention
Used
on
these
Residuals?
Type
of
Treatment
or
Pollution
Prevention
Used
on
these
Residuals
(
Use
Treatment/
P2
Codes
from
Question
5)
Type
of
Management
Used
on
these
Residuals
(
Use
Management
Codes
from
Question
6)
Amount
of
Residuals
Generated
Annually
(
Please
Check
the
Box
for
the
Appropriate
Unit,
i.
e.
`
gallons'

or
`
tons')


Coagulant
sludge

Yes

No

gallons

tons

Filter
backwash
(
including
filter­
to­
waste
rewash)

Yes

No

gallons

tons

Dewatered
solids
filtrate
(
e.
g.
filtrate
from
filter
press)

Yes

No

gallons

tons

Sedimentation
tank/
pond
supernatant
(
lagoon
overflow)

Yes

No

gallons

tons
Facility
SDWIS
ID:

Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
7

Calcium
carbonate
and
magnesium
hydroxide
sludge

Yes

No

gallons

tons

Scraping
waste

Yes

No

gallons

tons

Raking
waste

Yes

No

gallons

tons
Question
10
(
continued)

Drinking
Water
Treatment
Residuals
Type
Treatment
or
Pollution
Prevention
Used
on
these
Residuals?
Type
of
Treatment
or
Pollution
Prevention
Used
on
these
Residuals
(
Use
Treatment/
P2
Codes
from
Question
5)
Type
of
Management
Used
on
these
Residuals
(
Use
Management
Codes
from
Question
6)
Amount
of
Residuals
Generated
Annually
(
Please
Check
the
Box
for
the
Appropriate
Unit,
i.
e.
`
gallons'

or
`
tons')


Membrane
reject
waste
(
e.
g.
brine)

Yes

No

gallons

tons

Rinse
water

Yes

No

gallons

tons

Raw
water
suspended
solids

Yes

No

gallons

tons
Facility
SDWIS
ID:

Draft
Drinking
Water
Treatment
Short
Screener
Survey
Questionnaire
8

Natural
organics

Yes

No

gallons

tons

Spent
granular
activated
carbon
(
GAC)

Yes

No

gallons

tons

Other
(
specify)

Yes

No

gallons

tons
