Industrial Waste discharge self-monitoring report forms

To make self-monitoring reporting easier for all industrial waste dischargers and to ensure accurate data entry, the Industrial Waste Program has designed forms, based on reporting frequency, that are customized to industrial users' permit reporting requirements. If you have questions or believe that you have special reporting needs which are not addressed by the form, please contact your assigned Industrial Waste compliance investigator (see contacts, left).

Downloadable self-monitoring report forms:

• Monthly report form: Microsoft Word File (108KB) or Adobe PDF version (117KB)
• Monthly report form, for food processors only:
  Microsoft Word File (101KB) or Adobe PDF version (54B)
• Quarterly report form: Microsoft Word File (181KB) or Adobe PDF version (122KB)
• Semiannual report form: Microsoft Word File (86KB) or Adobe PDF version (82KB)
• Annual report form: Microsoft Word File (61KB) or Adobe PDF version (83KB)
• Annual report form, for groundwater remediation only: Microsoft Word File (83KB) or Adobe PDF version (84KB)

Note about using the Word file: Word is capable of adding the Flow column to give Total Monthly Flow. For instructions, go to Help and type that you want "perform calculations in a table." After Word adds a column, be sure to reapply the addition formula if you change any number in the column--the total does not automatically change.

Instructions for completing self-monitoring report forms: Microsoft Word File (38KB)

Signature and submittal: Industrial Waste Program forms must be signed and may be submitted to the program by FAX or regular mail. Forms may also be scanned and sent by e-mail to your assigned KCIW compliance investigator. (See contact information, left.)