1. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER

2. This presentation will assist you in the completion of the Form 1014HD. The notice of surface discharge of hydrostatic test water. Date of Last Revision: 2001 Rule Requirement: 10-7-17 Explanation of Form: Companies wishing to discharge water as required by OAC 165:10-7-17, used to test a pipeline, tank, etc. must submit a Form 1014HD to the appropriate Conservation Division District Office and the Pollution Abatement Department for prior approval. [Reference 165:10-7-17] Question concerning this Form: For more information contact Pollution Abatement at (405) 522-2763

3. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER OCC LOG-IN NUMBER: DO NOT WRITE IN THIS SPACE

4. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER NAME OF OPERATOR

5. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER OTC/OCC OPERATOR NUMBER

6. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER MAILING ADDRESS, PHONE NUMBER, CITY, STATE, ZIP CODE AND FAX NUMBER OF THE OPERATOR

7. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER TYPE OF FACILITY

8. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER LOCATION OF WHERE DISCHARGE WILL OCCUR: PROVIDE THE QUARTER SECTION CALLS, SECTION, TOWNSHIP AND RANGE PLUS THE COUNTY

9. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER METHOD OF RELEASE

10. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER WHICH DISTRICT OFFICE OF THE OCC WAS SENT A COPY OF THIS REPORT

11. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER MAXIMUM VOLUME TO BE DISCHARGE AT ANY ONE TIME (IN BARRELLS)

12. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER NUMBER OF ACRES IN PROPOSED DISCHARGE AREA

13. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER SOURCE OF WATER TO BE USED FOR THE TEST

14. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER DOES THE OIL AND GREASE CONTENT EXCEED 15 MG/L

15. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER DOES THE WATER CONTAIN A SHEEN OR DISCOLORATION

16. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER DOES THE TOTAL SUSPENDED SOLIDS EXCEED 45 MG/L

17. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER THE PH IS NOT LESS THAN 6.5 OR GREATER THAN 9.0 S.U.

18. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER THE DISCHARGE IS FREE FROM FOREIGN MATERIAL

19. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER THE DISCHARGE IS DESIGNED TO PREVENT EROSION

20. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER IF THE DISCHARGE WATER IS TO BE LAND APPLIED, A COPY OF THIS NOTICE WAS SENT AND APPROVAL WAS OBTAINED FROM THE SURFACE OWNER

21. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER SIGNATURE BLOCK OF THE OPERATOR

22. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER NOTICE SIGNATURE BLOCK

23. FORM 1014HD – NOTICE OF SURFACE DISCHARGE OF HYDROSTATIC TEST WATER INSTRUCTIONS FOR COMPLETING THIS FORM