FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

This presentation will assist you in the completion of the Form 1014HD. The notice of surface discharge of hydrostatic test water.

Date of Last Revision: 2001

Rule Requirement: 10-7-17

Explanation of Form: Companies wishing to discharge water as required by OAC 165:10-7-17, used to test a pipeline, tank, etc. must submit a Form 1014HD to the appropriate Conservation Division District Office and the Pollution Abatement Department for prior approval. [Reference 165:10-7-17]

Question concerning this Form: For more information contact Pollution Abatement at (405) 522-2763

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

OCC LOG-IN NUMBER: DO NOT WRITE IN THIS SPACE

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

NAME OF OPERATOR

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

OTC/OCC OPERATOR NUMBER

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

MAILING ADDRESS, PHONE NUMBER, CITY, STATE, ZIP CODE AND FAX NUMBER OF THE OPERATOR

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

TYPE OF FACILITY

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

LOCATION OF WHERE DISCHARGE WILL OCCUR: PROVIDE THE QUARTER SECTION CALLS, SECTION, TOWNSHIP AND RANGE PLUS THE COUNTY

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

METHOD OF RELEASE

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

WHICH DISTRICT OFFICE OF THE OCC WAS SENT A COPY OF THIS REPORT

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

MAXIMUM VOLUME TO BE DISCHARGE AT ANY ONE TIME (IN BARRELLS)

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

NUMBER OF ACRES IN PROPOSED DISCHARGE AREA

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

SOURCE OF WATER TO BE USED FOR THE TEST

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

DOES THE OIL AND GREASE CONTENT EXCEED 15 MG/L

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

DOES THE WATER CONTAIN A SHEEN OR DISCOLORATION

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

DOES THE TOTAL SUSPENDED SOLIDS EXCEED 45 MG/L

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

THE PH IS NOT LESS THAN 6.5 OR GREATER THAN 9.0 S.U.

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

THE DISCHARGE IS FREE FROM FOREIGN MATERIAL

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

THE DISCHARGE IS DESIGNED TO PREVENT EROSION

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

IF THE DISCHARGE WATER IS TO BE LAND APPLIED, A COPY OF THIS NOTICE WAS SENT AND APPROVAL WAS OBTAINED FROM THE SURFACE OWNER

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

SIGNATURE BLOCK OF THE OPERATOR

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

NOTICE SIGNATURE BLOCK

FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

INSTRUCTIONS FOR COMPLETING THIS FORM