State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management Page 9

Download a blank fillable State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete State Form 35058 - Application For Construction Permit For Public Water System - 327 Iac 8-3-3(A) - Indiana Department Of Environmental Management with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

APPLICATION FOR CONSTRUCTION PERMIT FOR
Attachment E
PUBLIC WATER SYSTEM - 327 IAC 8-3-3(a)
Chemical Addition
State Form 35058 (R5 / 9-98)
Approved by State Board of Accounts 1998
Indiana Department of Environmental Management
Drinking Water Branch
A. What is the common / brand name of the intended chemical?
What is the chemical name of the intended chemical?
B. Does the chemical have the approval of any of the following:
Yes
No
National Sanitation Foundation (NSF)
Yes
No
Underwriters Laboratory (UL)
Yes
No
Food and Drug Administration (FDA)
C. What is the purpose of the chemical addition?
D. Technical data supplied on the chemical (check all that apply)
Material Safety Data Sheet
Manufacturer's Label
Other Studies / Literature
Toxicology Data
Case Histories of Chemical Use
E. Describe or provide technical information on what type of proposed feed equipment
F. Describe or provide technical information on what type of proposed feed controls
G. What is maximum and minimum feed range?
H. How have chemical feed rates been determined? (attach supporting documentation)
I. Is there a means of measuring the quantity of chemical used?
Yes
No
J. Do the plans show the following?
Location of all feeders
Yes
No
All points of chemical application
Yes
No
Piping layout
Yes
No
K. What type of cross connection control is provided?
L. Are there leak detectors provided?
Are there spill containments provided?
Yes
No
Yes
No

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Instructions For Completing The Application For Construction Permitfor Public Water System - 327 Iac 8-3-3 (a) - Indiana Department Of Enviromental Management Instructions For Completing The Application For Construction Permitfor Public Water System - 327 Iac 8-3-3 (a) - Indiana Department Of Enviromental Management Legal
Form 12094 - Public Water Supply Application For Water Treatment Plant And Water Distribution System Operator - Indiana Department Of Environmental Management Drinking Water Branch Form 12094 - Public Water Supply Application For Water Treatment Plant And Water Distribution System Operator - Indiana Department Of Environmental Management Drinking Water Branch Legal
State Form 12094-application For Water Treatment Plant And Water Distribution System Operator Certification-indiana Department Of Environmental Management Drinking Water Branch State Form 12094-application For Water Treatment Plant And Water Distribution System Operator Certification-indiana Department Of Environmental Management Drinking Water Branch Legal
Form 49008 - Notice Of Intent To Construct A Water Main Extension - Indiana Department Of Environmental Management Form 49008 - Notice Of Intent To Construct A Water Main Extension - Indiana Department Of Environmental Management Legal
State Form 43692 - Request For Variance From 326 Iac 4-1 - Indiana Department Of Environmental Management State Form 43692 - Request For Variance From 326 Iac 4-1 - Indiana Department Of Environmental Management Legal
State Form 49401 - Npdes General Permit Notice Of Intent Submittal Application - Indiana Department Of Environmental Management State Form 49401 - Npdes General Permit Notice Of Intent Submittal Application - Indiana Department Of Environmental Management Legal
State Form 50014 - Pollution Complaint Clearinghouse: Pollution Complaint Form - Indiana Department Of Environmental Management State Form 50014 - Pollution Complaint Clearinghouse: Pollution Complaint Form - Indiana Department Of Environmental Management Legal
State Form 44593 - Notification Of Demolition And Renovation Operations - Indiana Department Of Environmental Management State Form 44593 - Notification Of Demolition And Renovation Operations - Indiana Department Of Environmental Management Legal
State Form 49493 - Abandoned Tank Community Assistance Program - Office Of Land Quality Of Indiana Department Of Environmental Management State Form 49493 - Abandoned Tank Community Assistance Program - Office Of Land Quality Of Indiana Department Of Environmental Management Legal
Form 49150 - Notification Of Lead Abatement Activities - Indiana Department Of Environmental Management Form 49150 - Notification Of Lead Abatement Activities - Indiana Department Of Environmental Management Legal

Related Categories

Parent category: Legal
Download
Go
Page of 9