LAC 33:IX.1317. Industrial Facility (all non-Treatment Works Treating Domestic Sewage) Annual Fee Rating Worksheet

Invoice No._______________ ANNUAL FEE RATING WORKSHEET PERMIT NO.__________ 1. FACILITY COMPLEXITY DESIGNATION Primary SIC _______________ Other SIC __________ Complexity Designation = __________ I ( 0 points) __________ II (10 points) __________III (20 points) __________ IV (30 points) __________ V (40 points) __________ VI (50 points) COMPLEXITY DESIGNATION POINTS __________ 2. FLOW VOLUME AND TYPE A. Wastewater Type I Is total Daily Average Discharge greater than 400 m? _________Yes, then points = 200 _________No, then Points = 0.5 X Total Daily Average Discharge (mgd) Points = 0.5 X ________ = _______ Total Points = __________ B. Wastewater Type II Points =10 X Total Daily Average Discharge (mgd) Points =10 X ________ = ________ Total Points = __________ C. Wastewater Type III Points = 2 X Total Daily Average Discharge (mgd) Points = 2 X _______ = __________ Total Points = __________ FLOW VOLUME AND TYPE POINTS _____________ 3. POLLUTANTS A. BOD or Daily Average Load = _______  50 lb/day ( 0 points) _______ > 50-500 ( 5 points) _______ > 500-1,000 (10 points) _______ > 1,000-3,000 (20 points) _______ > 3,000-5,000 (30 points) _______ > 5,000 lb/day (calculate) Points = 0.008 X Daily Average Load (lbs.) Points = 0.008 X ________ = ________ COD or Daily Average Load = _______  100 lb/day ( 0 points) _______ > 100-500 ( 5 points) _______ > 500-1,000 (10 points) _______ > 1,000-5,000 (20 points) _______ > 5,000-10,000 (30 points) _______ > 10,000 lb/day (calculate) Points = 0.004 X Daily Average Load (lbs.) Points = 0.004 X ________=________ BOD OR COD DEMAND POINTS __________ (whichever is greater) B. TSS Daily Average Load = _______  100 lb/day ( 0 points) _______ > 100-500 ( 5 points) _______ > 500-1000 (10 points) _______ > 1000-5000 (20 points) _______ > 5000-10000 (30 points) _______ > 10,000 lb/day (calculate) Points = 0.004 X Daily Average Load (lbs.) Points = 0.004 X ________ = ________ TSS POINTS __________ C. TOXICS Total Annual Discharge to Water = ____________ (lbs.) Points = 0.01 X Annual discharge (lbs.) Points = 0.01 X __________ = ________ TOXIC POINTS ________ TOTAL POLLUTANT POINTS _______________ 4. TEMPERATURE (HEAT LOAD) Heat Load = Average Summer flow (mgd) X ΔT X 0.00834 where ΔT = Permit Limit (Max. Temp.) -70° Heat Load = (mgd) X X 0.00834 = ______ Billion BTU Heat Load = _______ 4 billion BTU ( 0 points) _______ > 4-20 billion BTU ( 5 points) _______ > 20-100 billion BTU (10 points) _______ > 100-200 billion BTU (15 points) _______ > 200 billion BTU (20 points) HEAT LOAD POINTS_________________ 5. POTENTIAL PUBLIC HEALTH IMPACTS Is the receiving water to which the wastewater is discharged or a water body to which it is a tributary used as a drinking water supply source within 50 miles downstream? ________No (0 points) ________Yes, then . . . Complexity Designation _____I, II ( 0 points) _____III ( 5 points) _____IV (10 points) _____V (20 points) _____VI (30 points) POTENTIAL PUBLIC HEALTH IMPACT POINTS_______ 6. MAJOR/MINOR FACILITY DESIGNATION Has your facility been designated a major facility by the administrative authority? ________ Yes, then Points = 25 ________ No, then Were effluent limitations assigned to the discharge based on water quality factors in the receiving stream? ________ No, then Points = 0 ________ Yes, then Points = 5 TOTAL MAJOR/MINOR POINTS TOTAL RATING POINTS ASSIGNED