ETA 6-39 Inspection of Waste Treatment Facilities Cost

U.S. Department of Labor Employment and Training Administration Office of Job Corps

ETA FORM 6-39 OMB Control No. 1205-0219 Expiration Date: 05/31/2025

Job Corps Environmental Health Program: Inspection of Wastewater Treatment Facilities

Purpose of this form: The form provides Job Corps with a quarterly record of the performance and health evaluation of Job Corps centers’ wastewater treatment facilities.

Center Name:	Center Director:
Center Address:	Year/Quarter (for example, 2008/1 QTR):

This inspection report is not required of centers utilizing a state-approved municipal supply. Indicate nature of facilities by checking below all that apply:

√		√
1. Septic tank and drainfield	☐	7. Activated sludge	☐
2. Oxidation pond or nonaerated lagoon	☐	8. Coagulation - flocculation	☐
3. Mechanical aerated lagoon	☐	9. Phosphorous removal	☐
4. Evapotranspiration system	☐	10. Filtration	☐
5. Primary Settling	☐	11. Disinfection- chlorine or other	☐
6. Trickling filter	☐	12. Land treatment	☐
		13. Other (Specify)	☐

Item

WT.

Operation

*14. All units operating satisfactorily (discuss specific violations below)

10

15. Operator checks facility daily and has necessary certification

7

16. Equipment in good repair

5

*17. All units enclosed by fence

8

18. Control of weed growth; no sludge deposit or build-up

3

19. Sludge disposed of in approved manner

3

20. No insect breeding, odors, or other nuisance

3

21. Operation logs maintained daily with all chemical usage recorded

5

Effluent

*22. Effluent meets discharge permit standards+

15

23. All effluent parameters measured and recorded as required by discharge permit

7

24. Discharge volume recorded daily

5

25. Effluent disinfected as required

9

Septic Tanks and Drainfields

26. Septic tank cleaned regularly

5

*27. Sewage drainfield operating properly with no liquid breaking through to ground surface

15

SCORE^a (100 less total weight of violations)

___________________________________

28. Provide the following information. If not available or not measured, please indicate. (This item has zero weight.)

Extreme and average effluent BOD recorded during the last 3 months.

Minimum	Average	Maximum
______mg/L	______mg/L	______mg/L
______Date	______Date	______Date

Extreme and average effluent suspended solids recorded during the last 3 months.

Minimum	Average	Maximum
______mg/L	______mg/L	______mg/L
______Date	______Date	______Date

29. Provide the following information. (This item has no weight.)

1. Name of operator in charge:

_________________________________________

2. Laboratory or individual conducting effluent testing:

_________________________________________

3. Permit effluent standards+

BOD –

SS –

Coliform –

Other –

Comments

The items circled above are violations found on this date and must be corrected by next inspection or earlier.

*Critical items requiring immediate corrective action by Center Director

+A score less than 100 requires follow-up correspondence from the Center Director to the National Office of Job Corps and Regional Office with this inspection report detailing necessary corrective action and proposed schedule for completion.

Inspection Date:	Enter information here	Inspected By:	Enter information here
Agency or Company:	Enter information here

I, the Center Director, or designee, have received a copy of this report and understand its contents.
Title
SIGNATURE:		DATE: Click or tap to enter a date.

FORWARD SCANNED FORM AND CORRECTIVE

ACTION WITHIN 7 DAYS OF INSPECTION TO:

U.S. Department of Labor/Office of Job Corps OJC 6-38

E-mail: [email protected] June 2008

INSPECTION OF WASTEWATER TREATMENT FACILITIES

1. Purpose. The purpose of this form is to provide Job Corps with a quarterly record of the performance and health evaluation of Job Corps centers’ wastewater treatment facilities. This report is not required where waste is discharged into municipal type sewers that receive minimum treatment as required by the Environmental Protection Agency.

2. Originator. This form is completed by an appropriate representative of an authorized public health agency or another qualified environmental health specialist, other than center-related personnel, selected by the Center Director.

3. Frequency. Quarterly by December 31, March 31, June 30, and September 30 and any additional time that conditions may warrant.

4. Distribution. This form may or may not be a multi-copy form. The original copy is retained by the center for action purposes. Duplicates of the original should be made and forwarded to (1) the National Office of Job Corps, (2) the Regional Office of Job Corps, (3) agency or contractor operator office, and (4) the contracted inspector, if requested.

5. General Instructions. This form consists of two pages—an inspection form and instructions. Each item of the inspection form should be completed by the authorized person performing the inspection.

6. Detailed Instructions. Self-explanatory.

7. Disposition. Each recipient of this form is to maintain it on file for a period of 3 years, and then destroy.

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