ࡱ> DFC{ J&bjbjzz :D8,LxhJ&<<<$@<<2R<<d"<0"H0x4;p448x4 : BIOCIDE/CHEMICAL TREATMENT WORKSHEET-FORM 101 The following calculations are to be performed on any biocidal products ultimately discharged to the surface waters of North Carolina. This worksheet must be completed separately for each biocidal product in use. This worksheet is to be returned with all appropriate data entered into the designated areas with calculations performed as indicated. I. Facility Name NPDES # NC Outfall #____________ County Receiving Stream 7Q10____________(cfs) (All above information supplied by the Division of Water Quality) What is the Average Daily Discharge (A.D.D.) volume of the water handling systems to the receiving water body? A.D.D. = ____________ (in M.G.D.) Please calculate the Instream Waste Concentration (IWC in percent) of this discharge using the data entered above. IWC =  EQ \F((A.D.D.) X 100,(7Q10)(0.646) + (A.D.D)) =  EQ \F(( ) X 100 ,( )(0.646) + ( ) ) =__________% This value (IWC) represents the waste concentration to the receiving stream during low flow conditions. II. What is the name of the whole product chemical treatment proposed for use in the discharge identified in Part I? Please list the active ingredients and percent composition: _________% _________% _________% What feed or dosage rate (D.R.) is used in this application? The units must be converted to maximum grams of whole product used in a 24hr period. D.R.= ________________ grams/24hr period Please note, fluid ounces (a volume) must be converted to grams (a mass). The formula for this conversion is: Grams of product = fluid oz. of product X 1 gal. water X 8.34 lbs. X specific gravity of product X 453.59g. 128 fl. oz. 1 gal. water 1 lb. Estimate total volume of the water handling system between entry of biocidal product and NPDES discharge point. On an attached sheet please provide justification for this estimate (system volume, average cycles per blowdown, holding lagoon size, etc.) Volume= ________________ million gallons What is the pH of the handling system prior to biocide addition? If unknown, enter N/A. _______________ What is the decay rate (D.K.) of the product? If unknown, assume no decay (D.K.=0) and proceed to asterisk. The degradation must be stated at pH level within 1/2 pH standard unit within handling system. Enter the half life (Half Life is the time required for the initial product to degrade to half of its original concentration). Please provide copies of the sources of this data. H.L. = _____________ Days The decay rate is equal to  EQ \F(1,H.L.) X 0.69 = ____________=Decay Rate (D.K.) Calculate degradation factor (D.F.). This is the first order loss coefficient. * D.F. =  EQ \F((A.D.D.),(Volume)) + (D.K.) =  EQ \F(( ),( )) + ( ) = ____________ Calculate Steady State Discharge Concentration: Dischg Conc. =  EQ \F((D.R.),(D.F.)(Volume)(3785)) =  EQ \F(( ),( )( )(3785)) = ____________mg/l Calculate concentration of biocide instream during low flow conditions. (Receiving Stream Concentration)  EQ \F((Dischg. Conc.) x (IWC%),100) =  EQ \F(( ) x ( ),100)  = __________________mg/l Receiving Stream Concentration III. Calculate regulated limitation. List all LC50 and EC50 data available for the whole product according to the following columns. (Note that units should be in mg/l). Please provide copies of the sources of this data. Organism Test Duration LC50/EC50 (mg/l) ___________________________________ ______________________ _________________ ___________________________________ ______________________ _________________ ___________________________________ ______________________ _________________ ___________________________________ ______________________ _________________ ___________________________________ ______________________ _________________ ___________________________________ ______________________ _________________ Choose the lowest LC50/EC50 listed above: Enter the LC50/EC50: _______________ If the half life (H.L.) is less than 4 days, perform the following calculation. Regulated Limitation = 0.05 x LC50 = ________________mg/l If the half life (H.L.) is greater than or equal to 4 days or unknown, perform the following calculation. Regulated Limitation = 0.01 x LC50 = ________________mg/l Choose the appropriate regulated limitation from the calculations immediately above and place in this blank: ____________________mg/liter From Part II enter the receiving stream concentration: ___________________mg/liter IV. Analysis. If the receiving stream concentration is greater than the calculated regulated limitation, then this biocide is unacceptable for use. Person in Responsible Charge  Name (Print) Email Address & Phone Number Signature Date Person Completing This Worksheet (If different from above)  Name (Print) Email Address & Phone Number Signature Date Please submit to: Division of Water Quality Aquatic Toxicology Unit 1621 Mail Service Center Raleigh, NC 27699-1621 Contact info : Cindy Moore (cindy.a.moore@ncmail.net) or John Giorgino (john.giorgino@ncmail.net) Supplemental Metals Analysis If copper, zinc, or chromium are present in the proposed biocidal compound, complete this worksheet. A separate form must be used for each metal and/or metal compound present in the biocide. List the metal, its chemical formula, molecular weight (MW), formula weight (FW), and the concentration of the metal compound in the biocide (MCC). Complete a separate form for every metal present in the biocide. Metal_____ Chemical Formula Molecular Weight of Metal Formula Weight Concentration in Biocide EXAMPLE Copper CuSO45H2O 63.546 g/mole 249.680 g/mole 0.2 % __________ _______________ _____________________ _____________ _________________ Dosage rate of Biocide (DR) (from page 1): DR = ____________grams/day Average Daily Discharge (ADD) (from page 1): ADD = ___________million gallons/day Discharge Concentration (DC) of Biocide: DC =  EQ \F(DR,ADD) =  EQ \F(( grams/day),(__________million gallons/day)) = ____________grams/million gallons Convert DC to micrograms/liter (ppb): DC (g/l) = _______DC (grams/million gal) x  EQ \F(1 x 106 g/g,3.785 x 106 liters/million gal.) = ___________g/l Calculate the fraction of metal in the metal-containing compound (MF): MF =  EQ \F(MW,FW) =  EQ \F(( grams/mole),(____________grams/mole)) = ______________ Calculate the fraction of metal in the biocidal compound (BF): BF = MF x  EQ \F(MCC (%),100) = _____________ x  EQ \F( %,(100)) = ___________ Calculate the concentration of metal in the discharge (M): M = DC x BF = ______________g/l x ______________ = ______________g/l Calculate the instream metal concentration (IMC) at low-flow conditions: IMC = M x  EQ \F(IWC (%),100) = ________g/l x  EQ \F( %,100) = __________g/l Regulated limitation of metal (from below): _______g/l NC General Statutes 15A NCAC 2B.0211 define: Copper- 7 g/l water quality action level* Zinc- 50 g/l water quality action level* Chromium- 50 g/l water quality standard (*Values which exceed action levels must be addressed directly by aquatic toxicity testing.)     Facility Name: ______________________________________ NPDES #: NC__________________ D.W.Q. Form 101 (6/2000)  PAGE 4 A B G H t u v z { ivz '(-.:;wx}~שh;+CJEHOJQJh;+>*CJOJQJh;+5CJOJQJjh;+OJQJUh;+OJQJh;+5OJQJjh;+CJOJQJUh;+CJOJQJB. 0 5 6 3 4  $]^`  ]^` p]^`  ]^` ]` $]`a$4    { >mn ]^` &d  $]^`  ]^`  0]^`0  fGHx StuD' `  d]^`  $0]^`0d]^`  $]  $]^`&./abr4EŸūūūŕʼnŕzk^^h;+6CJEHOJQJh;+56CJEHOJQJhhCJEHOJQJhCJEHOJQJ*jhCJEHOJQJUmHnHuh;+>*CJEHOJQJh;+5CJEHOJQJh;+CJEHOJQJh;+CJEHOJQJjh;+CJOJQJUh;+5CJOJQJh;+CJOJQJ$/7b<=Z[D  $0]^`0  $]^`  $]^`Dae#34a| d]` @ `d]^` d]^` @ d]^` `']^`gd  $]^`6)*=>ABghrs / U  !,!Y!Z!\!]!b!c!j!쾱즜jh;+CJOJQJUh;+CJOJQJh;+5CJOJQJh;+6CJEHOJQJh;+6CJEHOJQJh;+>*CJEHOJQJh;+CJEHOJQJh;+OJQJh;+CJEHOJQJh;+OJQJ86*2ghobb d]` X `h d]` \ h<d]`  h d]`  h d]`  $d]`$  $d]`a$ d]`  / V  !,!!!^""#W###m$$$$1$d$d%d&d'dNOPQ]`a$ Hd]`d]`j!k!{!|!!!!!!!!!!"" """"J"K"^""""""""""""""""""" # ##W#`#a#~########$$ $$$$'$($:$;$@$A$Z$[$m$$$h;+5CJEHOJQJh;+>*CJOJQJh;+OJQJh;+5CJOJQJjh;+CJOJQJUh;+CJOJQJh;+CJEHOJQJF$$$ %%2%E%[%\%]%^%%%%%%%%%%%&&6&7&>&?&@&A&B&C&D&H&I&J&²²۝h hO=6CJOJQJmHnHujh;+6CJOJQJUh;+6CJOJQJh;+h;+CJOJQJh[Sjh[SUh;+5CJEHOJQJh;+CJEHOJQJ"$3%\%%%%%%%%%`[Y[Y[Y[d1$d$d%d&d'dNOPQ]`a$5$  d$d%d&d'dNOPQ]`a$7$ d$d%d&d'dNOPQ]`a$ %%&&B&C&D&E&F&G&H&I&J&1$d$d%d&d'dNOPQ]`a$ !`'` 8 00 P/ =!"#$% Dp^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH j`j Normal(dh5$7$8$9DH$]`CJOJQJ_HmH sH tH r@r  Heading 1/$$  $d@&]`a$5>*CJEHOJQJDA D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List 4 @4 Footer  !4@4 Header  !.).  Page NumberPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] JJD ddj!$J&4 D$%J& !Auz' :  w \ J :ZJ111111111111111111}!8@Z(  \  3 "? \  3 "? B S  ?aJ`8t`r8tdl'x ~ . 6 ow9=6ACDHK6AKabddr6AK[SO=;+B @J@UnknownG* Times New Roman5Symbol3. * Arial;. * Helvetica3* TimesA$BCambria Math" FoJ5oJ5+xx02Q+HX $PB2!xx 2/95 Bio/Metals WkstMelissa RosebrockChristopher J VentaloroOh+'0 4@ ` l x 2/95 Bio/Metals WkstMelissa Rosebrock Normal.dotmChristopher J Ventaloro2Microsoft Office Word@@˿@0@0oJ՜.+,0, hp  NC DENR/DWQ/ATU5 2/95 Bio/Metals Wkst Title2/95 Bio/Metals Wkst  !"$%&'()*+,-./012456789:<=>?@ABERoot Entry F G1Table#4WordDocument:DSummaryInformation(3DocumentSummaryInformation8;CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q