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Project Name

Company Name
Address

Project Number
REV DATE BY APVD REV DATE

Sheet
BY

1
APVD

EFFLUENT SUMMARY
Form XXXXX-YY-ZZ

Owner's Name Plant Location Case Description PROCESS EMISSIONS Vapor Emissions Measurement (estimate) method Continuous / Intermittent

Units

English

Metric

Pollutant Nitrogen Oxides

Process Source (Stream No. if avail.)

kg/day

kg/yr

Regulatory Status

Total Sulfur Oxides

Total Particulate matter

Total Volatile organic compounds

Total HAPs (list by name)

Stream Name

Process Source (Stream No. if avail.)

Water flow kg/day

Aqueous Waste Streams Contaminant

Contaminent flow kg/day

Contaminent flow metric ton/yr Concentration (wt%)

Stream Name

Process Source (Stream No. if avail.)

Organic Waste Streams Measurement (estimate) method Component

kg/day

kg/yr

Stream Name

Process Source (Stream No. if avail.)

Solid Waste Streams Measurement (estimate) method Component

kg/day

kg/yr

UTILITY AND OFFSITES EMISSIONS Vapor Emissions Measurement (estimate) method Continuous / Intermittent

Pollutant Nitrogen Oxides

Process Source (Stream No. if avail.)

kg/day

kg/yr

Regulatory Status

Total Sulfur Oxides

Total Particulate matter

Total Volatile organic compounds

Total

Stream Name Boiler blowdown Cooling water blowdown

Process Source (Stream No. if avail.)

Water flow kg/day

Aqueous Waste Streams Contaminant TDS Corrosion inhibitor TDS Fouling inhibitor Chloride

Contaminent flow kg/day

Contaminent flow metric ton/yr Concentration (wt%)

Stream Name

Process Source (Stream No. if avail.)

Solid Waste Streams Measurement (estimate) method Component

kg/day

kg/yr