MONTHLY REPORT ON THE WASTE WATER FROM A PETROLEUM REFINERY
Petroleum refinery operated by ___________________________________________
and situated at ___________________________________________________________________
Month of____________________________________________________________________20 _____
Refining capacity declared: ________________________________________________MB*/day
Date of the declaration respecting the refining capacity: ______________________________20 _____
Amount of crude oil refined
— current month ________________________________________________________________MB*
day of production _______________________________________________________________
— preceding month ______________________________________________________________MB*
day of production _______________________________________________________________
— average for 2 months ___________________________________________________MB*/dp**
TABLE OF ACTUAL DEPOSITS
_________________________________________________________________________________
| | | | | |
| | flow measurement | | | |
| | (million | suspended | deposits measured (in kg/day) | |
| | litres/day) | matter in | | |
| |__________________| water supply |_______________________________________| |
|date| | | | | | | | | |
| | liquid | storm | | oil |phenols|sulfide|NH3-N|suspended |pH|
| |effluent| water | | | | | | matter | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 1 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 2 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 3 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 4 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 5 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 6 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 7 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 8 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 9 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 10 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 11 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 12 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 13 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 14 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 15 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 16 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 17 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 18 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 19 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 20 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 21 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 22 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 23 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 24 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 25 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 26 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 27 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 28 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 29 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 30 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | | |
| 31 | | | | | | | | | |
|____|________|_________|______________|______|_______|_______|_____|__________|__|
| | | | | | | | | |
| AVERAGE | | | | | | | | |
|_____________|_________|______________|______|_______|_______|_____|__________|__|
TABLE OF DEPOSITS AUTHORIZED PURSUANT TO THIS REGULATION
_________________________________________________________________________________
| | | | | | | |
| | oil |phenols|sulfide|NH3-N|suspended |pH|
| | | | | | matter | |
|______________________________________|______|_______|_______|_____|__________|__|
| | | | | | | |
| monthly amount | | | | | | |
|______________________________________|______|_______|_______|_____|__________|__|
| | | | | | | |
| average daily amount | | | | | | |
|______________________________________|______|_______|_______|_____|__________|__|
| | | | | | | |
| maximum daily amount | | | | | | |
|______________________________________|______|_______|_______|_____|__________|__|
*MB: thousand barrels
**dp: days of production
I certify that this declaration is true and exact.
_____________________________________
(name of refinery)
signature: _______________________________
title: ___________________________________