Noncompliance Report Form

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As listed in your facility permit, if your sampling and analysis indicate a violation, you must:

• Notify the City of Waukesha Pretreatment Coordinator within 24 hours of becoming aware of the exceedance (verbal, email, fax, or hand delivery).
• Followup in writing within five working days of becoming aware of the exceedance. You may use this form to satisfy this requirement. The information listed below is required whether or not you choose to use this form.
• Repeat the sampling and analysis and submit the results within 30 days of becoming aware of the violation. You need only to resample for the parameters that are in violation.

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