Total Site Acreage Available for Land Application

LAND APPLICATION SUMMARY LOG (only one site per form) REPORTING PERIOD: Jan 1 to June 30 July 1 to Dec 31

STP LICENSE NAME: LICENSE #: Waste Type Total Volume To update volume value, highlight value and press F9 Disposal Site Name: S 0 PT/VT 0 Total site acreage available for land application: G 0

C 0 Acreage used during the reporting period: AAR= GrW 0 O 0 Mail completed forms to: DEQ, WUTMB, Septic Tank Pumper Program, PO Box 200901, Helena, MT 59620-0901

VOLUME APPLIED by WASTE TYPE VAPR LAND APPLIED BY: S – Septic, PT/VT – Portable Toilet/Vault AREA OF METHOD TIME (list pumper name) G – Grease Trap, C – Carwash, GrW – Gray Water, TIME T – Tilled, pH, TILLED O – Other (specify) APPLICATION / Date APPLIED F = ft2 or L – Limed, or if limed AND PT/ I - Injected S G C GrW O A = acreage LITTER VT REMOVED