DEQ Form #619-001 Adopted 11/16/04
Oklahoma Department of Environmental Quality
Environmental Complaints and Local Services
TOTAL RETENTION LAGOON MONTHLY OPERATION REPORT
Facility Name: Facility ID:
Mailing Address:
Mailing Address City State Zip
Physical Address:
Physical Address City State Zip
Month: Year:
Flow for the month (in gallons):
Indicate the date of each site visit:
Indicate any analyses done:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Date: Parameter: Results:
Land Application Records:
Site: Method: Crop:
Application Began Application Ended Effluent
Applied
(in gallons)
Area (in
acres)
Cl
residual
Beginning Ending
Date Time Date Time Temp. Rainfall Temp. Rainfall
Maintenance performed:
___________________________________________________________________________________________________________
Report by: _____________________________________________ Title: ____________________________________
Signed: _______________________________________________ Date: ____________________________________
Do not submit this report to DEQ
Retain this report on site for 3 years – subject to DEQ inspection
