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Orange County Sanitation District GovOnline Public – Reference Guide
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GGOOVVOONNLLIINNEE PPUUBBLLIICC PPOORRTTAALL
–– RREEFFEERREENNCCEE GGUUIIDDEE
Orange County Sanitation District
(OCSD)
Version: 1.1
March 4, 2015
1368 How Lane
North Brunswick, New Jersey 08902 www.enfotech.com
Restriction on Use and Disclosure of Document Information
This document includes data that should not be disclosed outside the business entity for which it was intended, indicated as the recipient on this title page. The entire document is copyrighted by enfoTech and is protected under the US copyright law and international treaties. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without express written permission from enfoTech & Consulting Inc.
Copyright © 2001 – 2013 by enfoTech & Consulting Inc. All Rights Reserved.
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Tables of Contents
1 PUBLIC SITE ACCOUNT MANAGEMENT .......................................................................................... 3
1.1 ACCOUNT CREATION PROCESS ................................................................................................................. 3
1.1.1 Managing Consultants .................................................................................................................. 8
1.2 PUBLIC SITE – CREATE SUBMITTALS AND MANAGEMENT ................................................................................ 10
1.2.1 Home Page (aka the “My Dashboard”) ........................................................................................ 10
1.2.2 Submittal Overview .................................................................................................................... 11
1.2.3 SMR Submission by Authorized Signatories .................................................................................. 12
1.2.4 Meter Reading Submission by Authorized Signatories ................................................................... 20
1.2.5 Information Request Submission by Authorized Signatories .......................................................... 23
1.2.6 Data Entry by Non-Authorized Signatories ................................................................................... 25
1.2.7 Submittal Status Tracking ........................................................................................................... 26
1.2.8 Request for Revision .................................................................................................................. 27
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1 Public Site Account Management
1.1 Account Creation Process
The Public site will be made available to the public and will allow interested parties to create an account and create submittals towards SMR, Meter Readings, or Information Request to OCSD. The subsequent sections will highlight the Public site login page, new user creation process, editing user profile information, create SMR reports or upload Requested Information attachments, and checking the status of submittals.
Public Account user creation is made available to anyone who has access to the GovOnline Public Site URL as there will be a “Create a new account” link on the login page. Follow these steps to obtain a public user account.
Step 1: Click the “Create a New Account” link in the login page.
Step 2: Enter in your personal identification information (Business, Name, Username, Title, etc.) along with your contact information (address, e-mail, phone number).
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Step 3: Make sure to review your information to ensure accuracy of your input. Then, click Next.
Step 4: Select an Account Group and corresponding Account Type from the list displayed on screen. User must select only one group record – via radio buttons – that most closely matches their account type. Based on account group selection, user must define his/her account type. For Responsible Officers or Designated Signatories, user must select “Authorized to Sign” account group, whereas for Consultants, Facility Operators, Lab Technician, and Others must select “Not Authorized to Sign” account group option.
Step 5: If “Authorized to Sign” account group is selected, user must associate facility (facilities) that you would like to submit for by clicking “Associate New” button.
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Step 6: Enter the facility name and click “Search”. System will return search results matching user-defined search criteria. Select desired facility (facilities) via checkbox to left of Facility ID and Name, and then application types that you would like to be able to submit for the facility. Once appropriate selection(s) has(have) been made, click “OK”. The facility and submittal type is associated to user account and is displayed under “Associated Facility List”. User can delete associated facility (facilities) and submittal type by click the Red Cross. Click “Next” to proceed.
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Step 7: Enter answers to your Security Questions and click Next.
Step 8: Enter CAPTCHA code to verify that a machine is not generating spam accounts. Click Create Account.
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Once public users complete account creation process, system sends an automated email to the user’s email with his/her “temporary” password.
Step 9a: Login to GovOnline using username/password credentials provided in the email.
Step 9b: When logging in for the first time, system will prompt user to change temporary password to a permanent password that is at least 10 characters long and contains at least one of the following: one uppercase letter, one lowercase letter, and one number.
If desired and/or needed, users can change their account information at any time in future by logging in with their account name/password. Their personal information, such as Name and Address, along with Password details can be update via My Account module.
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1.1.1 Managing Consultants
The GovOnline system allows Responsible Officers and Designated Signatories to manage authorized consultants’ account associated to his/her account, and assign consultants to act as preparers of report submittals.
Consultant can be assigned to one of following three (3) roles: a. Viewer: can view submittals, but cannot prepare or certify/submit them. b. Preparer: can prepare submittals on behalf of authorized signatory, but cannot certify and submit them. c. Certifier: can make submittals on behalf of authorized signatory.
To associate or manage consultants, Facility Admin goes to Manage Users Not Authorized to Sign at the left panel of My Account Module. A list of users or consultants associated with current user account will appear under the User Information section.
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Click on the to the Consultant’s User Information page. Responsible Officer / Designated Signatory can switch between consultants via drop-down on upper right corner of the window.
Under the Authorized Submittal Types section, Admin can view, edit and delete the authorized facilities and submittal types assigned to the consultant.
By clicking button, an Application Search window will prompt user to add and authorize new permissions to the consultant.
If
If Responsible Officer / Designated Signatory wants to grant submission access (i.e. “Certifier” permission), he/she must submit “Delegate Agent Subscriber Agreement” with his/her own and consultant’s signatures. User can print subscriber agreement via “Delegate Agent Subscriber Agreement”.
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1.2 Public Site – Create Submittals and Management
Once system has sent users their “temporary” passwords, users can login to the Public site, change the password to a preferred one that meets password requirements, and begin report submission process. The report submission process, and all corresponding details (that are relevant to public users only), are highlighted in following sections.
1.2.1 Home Page (aka the “My Dashboard”)
When Public User logs into GovOnline via Public portal, system will navigate user to a dashboard with several out-of-box web parts. These web parts are static and cannot be changed or adjusted in position by any user. For details on what each web part entails, refer to the table below.
Web Part Web Part Description
Start A New Submittal Begin a new Non-Permit Report submittal based on Water Department Submittal Type List (e.g. SMR, Meter Readings, etc.).
Upcoming Submittal Obligations
Display submittal requirements along with their statuses, whether submitted, pending, or overdue on submission. Click “View All Pending Submittals” or “View All Historical Submittals” to view corresponding items.
Permits/Licenses Display all Permits/Licenses related to the facilities that the user is associated with.
Message Center Provide a quick link to access submittals that have new email notification, have payment due, have been recently amended/revised, have Permits/Licenses notifications, or have scheduled inspections.
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1.2.2 Submittal Overview
Once logged into the Public site, Public users can select and create Non-Permit Reports for OCSD review from a list of submittal types listed by clicking “Submit Non-Permit Report” under “Start a New Submittal” web part or within the Submittal module.
During the submission process, the GovOnline system guides user to successfully complete the submittal by breaking the entire procedure into a 4-step process highlighted below.
1) Data Entry: used to capture all desired data information as part of a submittal; the forms can be configured to contain special logic and validation checks to ensure data accuracy.
2) Attachments: upload supporting documents required for the submittal. User may choose to mail required documents, if so desired and applicable. In such cases where all documents are not uploaded as part of the report submission, system marks submittals with “Partial Submittal” status after submittal has been completed to signify pending receipt of specific documents. On the contrary, if all documents have been uploaded during submission process, GovOnline marks submittal as “Complete Submittal” after successful submission.
3) Validation: validates entire submittal package to ensure it meets minimum requirements mandated by OCSD.
4) Submission: used to certify report data to be submitted in the form. Upon successfully completion of a submittal, GovOnline sends an automated message to applicant for receipt confirmation.
5) Review: page displayed after successful submission of a report; the page serves as submission receipt for applicant to maintain for records purposes and/or mail any attachments.
6)
To create a submittal, follow these steps:
Step 1: Log into GovOnline as a public user.
Step 2: Go to the Submittal tab on the top. Make sure the left panel displays Start a New Submittal.
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Step 3: Select the report in which you wish to create for and click the Start icon. In the following screen shot, we will use the Self-Monitoring Report for demonstration purposes.
1.2.3 SMR Submission
1.2.3.1 SMR Submission Daily Data Form
Step 1: Overview of the SMR Daily Data Form
On the top of the page is the facility information section for user to view. The Daily Data form tab consists of a grid view with substances that are required to be sampled by facility pre-populated in the table. Grid view displays following data elements for each constituent result that can be submitted: Sampling Date, Grab Time, Analytical Result, Measure Unit, Detection Limit, Analysis Method, Sample Collection Method, Bottle Container and Laboratory Name.
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Step 2a: User can click on “Edit Record” icon to left of each substance to manually enter result for each consituent; results can be entered in Sampling Result Detail pop-up window.
User must fill in all the required data marked with a red asterisk and should provide additional information, such as Detection Limit and Analysis Method, for compliance purposes.
Step 2b: Click the “Copy Record” icon to left of each constituent; this allows user to create a new constituent result record using an existing consituent result set entered for the current form.
Step 2c: Click the “Delete Record” icon to left of each constituent to delete that result record., if it was added erroneously.
Step 2d: If there are compound substances marked with , user must enter data for constituents that make up the compound parameter first.
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1) To enter result for a compound parameter, click the “Edit” icon to left of the compound parameter. This will bring up a pop-up window similar to that of any other consituent. For a compound parameter, however, user cannot enter result directly and must click on “Populate and Calculate” button. This will result in auto-populate of compound parameter result based on results of constituents that make the compound parameter.
2) Click the button. In doing so, system Compound Substance List section will extend and display consittuents and corresponding results that make up the compound parameter. User may still provide additional set of information for the compound parameter (e.g. Detection Limit and
Analysis Method), and click on button to save compound parameter result.
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Step 3: Batch Add Sampling Records
1) To add a new substance record which is not pre listed in the table, click the icon in the form. An Add New Sampling Result pop-up window will be displayed. Fill in the required fields and click Add to add selected constituents to the current form record. User can search for constituents he/she would like to add in Section 3 – “Substance” of pop-up window.
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2) If user-selected constituent is a compound parameter, then system also adds all constituents that make up the compound parameter to data submission list as well.
Step 4: User must fill-in all required fields for all constituents as needed. To proceed to next page, click Next at bottom left of the page. At this point, system will run following two (2) checks:
1) Constituents that are missing results, and
2) Potential non-compliance in a pop-up window, such as Detection Limit exceeds EPA-approved value.
Click Next again to proceed to General Comment page.
Step 5: If no flow discharge is observed during SMR monitoring period, user can select the No Discharge checkbox option in Facility Information section. In this manner, a message is displayed to the user, and user is able to skip constituent and flow reading data entry, any can proceed to General Comment Page.
Step 6: User enters any comments and Explanation related to the previously entered Constituent and Flow data.
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Step 7: Upload required and optional attachments for the submittal requirement as necessary. User can select any of the following methods for attachment submission:
1) Online: upload attachment in GovOnline for submission 2) Mail: mail attachment to OCSD at address specified on-screen 3) Other: attachment was otherwise submitted to OCSD, or cannot be submitted for reason specified. 4) N/A: attachment does not need to be submitted; option sometimes available for “Optional” attachments
only. Click on Next button when information about attachments has been provided.
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Step 8: In Validation page, system checks whether all required information has been provided in the submission and that at least one (1) constituent result exist for all constituents required to be sampled by facility.
If all information is provided, user will see green checkmark icons next to “Online Self-Monitoring Report” and “Attachment” options. If, however, validation check fails, system will ask user to go back to corresponding page (SMR or Attachment) and update data as necessary.
Click on Next button to proceed with submission if all validation checks pass.
Step 9: Finally, check the certification statement, answer the security question, and enter PIN established when first logging into GovOnline as Responsible Officer or Designated Signatory. Then, click Submit. If user is a Consultant and not an Authorized Signatory, then Notify owner ready for review and submittal button is displayed instead that can be used to notify Responsible Officer / Designated Signatory for the facility via email.
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1.2.3.2 SMR Submission Meter Reading Form
Step 1: Overview of the SMR Flow Reading Form
The Flow Reading form is the second tab next to Daily Data Form used to submit meter readings at the sample point. Table contains Start Date, End Date, Reading Type, Start Reading, End Reading, Reading Unit, Flow Meter and Comment fields.
Step 2: Click the “Add Flow Reading” icon in leftmost column of the table to add a new meter reading record. A Flow Reading Information pop-up window will allow user to submit meter readings. User is required to provide details on each field provided in the pop-up, except for Comments. When providing a Totalizer Reading (digital or mechanical reading), user is required to provide Start and Stop Reading Value. On the contrary, when providing a Calculated average reading value for a day or month, user is only required to provide Reading Value. When all information is added in the pop-up, click on Save button to add meter reading record, which will then be displayed in meter reading grid view in the Flow Data tab.
Step 3: User can click “Edit” or “Delete” icon to modify content of or delete an existing meter reading record.
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Step 4: Click on Next button to proceed with providing attachments for the SMR form.
1.2.4 Meter Reading Submission
Purpose of this form is to allow facility users to submit meter reading information to OCSD apart from those required in a Self-Monitoring Report. The process to submit such meter readings is similar to that highlighted for “Flow Data” tab in the Self-Monitoring Report. For reference purposes, the information corresponding to meter reading submission is also detailed below.
Step 1: Overview of Meter Reading Report
On the top of the page is the facility information section for user to view. User must submit flow readings to the form to proceed. The Meter Reading Form 1 consists of a grid view with no data prefilled. The table contains Start Date, End Date, Flow Stream Type, Reading Type, Start Reading, End Reading, Reading Unit, Flow Meter and Comment in the column to be filled in.
Step 2: Click the “Add Flow Reading” icon in leftmost column of the table to add a new meter reading record. A Flow Reading Information pop-up window will allow user to submit meter readings. User is required to provide details on each field provided in the pop-up, except for Comments. When providing a Totalizer Reading (digital or mechanical reading), user is required to provide Start and Stop Reading Value. On the contrary, when providing a Calculated average reading value for a day or month, user is only required to provide Reading Value. When all information is added in the pop-up, click on Save button to add meter reading record, which will then be displayed in meter reading grid view in the Flow Data tab.
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Step 3: User can click “Edit” or “Delete” icon to modify content of or delete an existing meter reading record.
Step 4: Click on Next button to proceed to General Comments/Form 2 Page of Meter Readings form.
Step 5: User can enter any comments and Explanation related to meter readings submitted in this section.
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Step 6: Upload required and optional attachments for the submittal requirement as necessary. User can select any of the following methods for attachment submission:
1) Online: upload attachment in GovOnline for submission 2) Mail: mail attachment to OCSD at address specified on-screen 3) Other: attachment was otherwise submitted to OCSD, or cannot be submitted for reason specified. 4) N/A: attachment does not need to be submitted; option sometimes available for “Optional” attachments
only.
Click on Next button when information about attachments has been provided.
Step 7: In Validation page, system checks whether all required information has been provided in the submission and that at least one (1) constituent result exist for all constituents required to be sampled by facility.
If all information is provided, user will see green checkmark icons next to “Online Self-Monitoring Report” and “Attachment” options. If, however, validation check fails, system will ask user to go back to corresponding page (SMR or Attachment) and update data as necessary.
Click on Next button to proceed with submission if all validation checks pass.
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Step 8: Finally, check the certification statement, answer the security question, and enter PIN established when first logging into GovOnline as Responsible Officer or Designated Signatory. Then, click Submit.
If user is a Consultant and not an Authorized Signatory, then Notify owner ready for review and submittal button is displayed instead that can be used to notify Responsible Officer / Designated Signatory for the facility via email.
1.2.5 Information Request Form Submission
Purpose of this form is to allow facility users to submit additional reporting requirements as mandated by OCSD in a permit document. Types of reporting requirements that can be submitted via GovOnline are:
1) Best Management Practice(s)
2) Effluent Calibration Log
3) Permit Conditions
4) Watermeter Bills
Note that following steps highlight reporting requirement submission for Watermeter Bills, but the process of submission is the same for each of the four (4) requirement types listed above.
Step 1: Overview of Information Request Submission
On top of the page is the facility information section for user to view. User may provide comments for reporting requirement if desired, and click Next to proceed with submittal.
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Step 2: Step 6: Upload required and optional attachments for the submittal requirement as necessary. User can select any of the following methods for attachment submission:
1) Online: upload attachment in GovOnline for submission 2) Mail: mail attachment to OCSD at address specified on-screen 3) Other: attachment was otherwise submitted to OCSD, or cannot be submitted for reason specified. 4) N/A: attachment does not need to be submitted; option sometimes available for “Optional” attachments
only.
Click on Next button when information about attachments has been provided.
Step 3: In Validation page, system checks whether all required information has been provided in the submission and that at least one (1) constituent result exist for all constituents required to be sampled by facility.
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If all information is provided, user will see green checkmark icons next to “Online Self-Monitoring Report” and “Attachment” options. If, however, validation check fails, system will ask user to go back to corresponding page (SMR or Attachment) and update data as necessary.
Click on Next button to proceed with submission if all validation checks pass.
Step 4: Finally, check the certification statement, answer the security question, and enter PIN established when first logging into GovOnline as Responsible Officer or Designated Signatory. Then, click Submit. If user is a Consultant and not an Authorized Signatory, then Notify owner ready for review and submittal button is displayed instead that can be used to notify Responsible Officer / Designated Signatory for the facility via email.
1.2.6 Data Entry by Non-Authorized Signatories
The GovOnline system allows Authorized Consultants to act as preparers of report submittals. This scenario is identified in one of following two manners:
1) Consultants may not be authorized to certify and submit applications. In such cases, in certification page, a consultant can send an email to authorized signatory indicating submittal ready for submission.
2) Consultant can be assigned one of following three (3) responsibilities: a. Viewer: can view submittals, but cannot prepare or certify/submit them. b. Preparer: can prepare submittals on behalf of authorized signatory, but cannot certify and
submit them.
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c. Certifier: can make submittals on behalf of authorized signatory.
In such cases where it is an authorized consultant that prepares a submittal – rather than the Responsible Officer or Designated Signatory, GovOnline maintains the submission process consistent for all steps above.
1.2.7 Submittal Status Tracking
For all submittals completed, an applicant can keep track of submittal status in one of the following two (2) manners:
1) Automatic Email Notifications: system sends email notifications automatically to public users when a submittal is completed or status is updated.
2) Review submittals in Public Portal: user can review all submittals in “Manage Submitted Cases” page in Submittal module and displayed under the Submittal List.
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When user selects to view more details on a particular submittal record by clicking on icon, the GovOnline displays all submittal-related information in various sets of tabs as follows:
a) Submittal: user can view information related to submittals and status; GovOnline displays: Submission ID, Report Name, Submitted Date, Submitted By (Name, Address, Phone and Email), Most Recent Review Status, Submittal Status History with Comments and Most Recent Submittals.
b) Attachments: displays any attachments that have been uploaded to GovOnline during submission process; if attachments were uploaded during submission process, applicant can upload additional set of attachments in this page.
c) Correspondence: allows applicant to initiate correspondence with agency users, but visible to third-party users as well.
d) Email History: displays a list of emails that have been manually sent by agency users, and are not system-automated emails.
1.2.8 Request for Revision
After successfully submitting a reporting requirement (SMR, Meter Reading, or Information Request), user may request to revise a submitted report or attachments to resolve data-entry issues and/or provide updated data/documentation. To do so, user must go to Submittal module, select Manage Submitted Cases on the left-
panel, and click the icon of desired submittal to navigate to Basic Information page of the submittal.
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To request for revision, user may enter Reason for Revision and click Request for Revision in “Application Revision” section of the Basic Information page. Upon request for revision of a submittal, user will need to wait for OCSD to confirm revision request before new revision submittal can be initiated by the user.
Once OCSD approves a revision request, applicant can access revised submittal record via Submittal module, Edit Pending Submittals sub-module page, and select the submittal record for same reporting period as one that is requested to be revised. Please note that process to submit a revised submittal record does not change from original submittal with following exception: all data submitted previously (constituent results, meter readings, and/or attachments) is(are) pre-populated in the form for user to modify as necessary.
Attachment #1
OCSD Online Reporting System
Electronic Signature Agreement (ESA) for
User Authorized to Sign Documents
OCSD Environmental Compliance Source
Control Form 6101ESAA
*OCSDSCASC_FORM_INFM-6101ESAA* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 1 E S A A
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 1 E S A A
Electronic Signature Agreement (ESA) for Users Authorized to Sign Documents Reference Identifier Type Version Date ASC_FORM_INFM-6101ESAA Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 1 of 6
This Electronic Signature Agreement (ESA) is required to be completed and submitted to OCSD as a user with
Responsible Official (RO) privileges or Authorized Representative (AR) / Designated Signatory (DS) privileges,
which allows the user to electronically submit permitting and monitoring data to OCSD.
6101.1 Your Responsible Official (RO) or Authorized Representative (AR) / Designated
Signatory (DS) User Information
User Name: _____________________________
Legal Full Name: __________________________________________________________
Job Title: __________________________________________________________
Mailing Address: __________________________________________________________
City, State, Zip: __________________________________________________________
Email Address: __________________________________________________________
Phone Number: _____________________________
6101.2 Facility Information
Responsible Officer (RO) or Authorized Representative (AR) / Designated Signatory (DS) privileges* are
requested for the following facilities:
Permit No. Facility Name Facility Location Address
* Note: Requesting privileges initiates the process of acquiring authorization in the OCSD Online Reporting System. In
order to be certified as a Responsible Officer (RO) for a facility or authorized as a Designated Signatory (DS), a
separate Responsible Officer (RO) Certification Form and/or Designated Signatory (DS) Authorization Form
must be submitted to Orange County Sanitation District (OCSD).
Submittal Reason:
NEW: This is the first ESA submitted for this user account for the above facilities.
CHANGE: This is an updated ESA submitted because the user’s responsibility at the facility has changed.
*OCSDSCASC_FORM_INFM-6101ESAA* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 1 E S A A
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 1 E S A A
Electronic Signature Agreement (ESA) for Users Authorized to Sign Documents Reference Identifier Type Version Date ASC_FORM_INFM-6101ESAA Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 2 of 6
Specify the change in responsibility: _________________________________________
Note: Any RO or AR/DS requesting to discontinue electronic submissions must complete the OCSD Online Reporting
System Account Deactivation Request Form.
REACTIVATION: This is a re-activation of a user account associated to the above facilities.
Notes to OCSD (optional):
6101.3 Terms and Conditions
1. DEFINITIONS: A Responsible Official (RO) is defined by 40 CFR §403.12(l)(1) and refers to an individual
who has accepted responsibility for the overall operation of a facility and/or overall responsibility for
compliance with all regulatory requirements for the facility from which the wastewater discharge originates.
An Authorized Representative (AR), also referred to as a Designated Signatory (DS), is defined by 40 CFR
§403.12(l)(3) and refers to an individual who has accepted responsibility for the overall operation of a facility
and/or overall responsibility for compliance with all regulatory requirements for the facility from which the
wastewater discharge originates, on behalf of the Responsible Officer (RO).
2. PURPOSE: This agreement creates legally binding obligations for the parties using the specified data
transmission protocols and the OCSD Online Reporting System. The user, as a RO or AR/DS, agrees to (i)
maintain confidentiality and protect the electronic signature from unauthorized use or compromise, and
follow all procedures specified by OCSD for this purpose; and (ii) be as legally bound, obligated, and
responsible by use of the RO’s, AR’s, or DS’s electronic signature as by hand-written signature.
3. VALIDITY AND ENFORCEABILITY: By this Agreement the parties agree to follow OCSD procedures to
create binding regulatory reporting documents using electronic transmission and receipt of such records,
consistent with the provisions of 40 C.F.R. Part 3 (CROSS-MEDIA ELECTRONIC REPORTING
Requirements, CROMERR). Acceptance and execution of this agreement by OCSD is shown by the issuance
of a personal identification number (PIN) to the Certifier. Consistent with 40 C.F.R. Part 3, electronic
signatures under this agreement have the same force and effect as a written signature. Written signatures will
remain on file with OCSD.
*OCSDSCASC_FORM_INFM-6101ESAA* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 1 E S A A
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 1 E S A A
Electronic Signature Agreement (ESA) for Users Authorized to Sign Documents Reference Identifier Type Version Date ASC_FORM_INFM-6101ESAA Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 3 of 6
4. RECEIPT: A submission is received when it is accessible by OCSD, can be fully processed and complies
with OCSD’ electronic transfer protocol which OCSD may modify from time to time. A submission does not
satisfy any reporting requirement until it is received. For permit renewal and compliance reporting, the RO or
AR/DS agrees that upon activation of the RO or AR/DS account for requested facilities, the OCSD Online
Reporting System will be expecting to receive electronic transmission of reports at the interval specified in
the permit. If OCSD does not receive the submissions from the RO and/or AR/DS at the expected time, the
database will flag the required submissions as not received. If the RO or AR/DS chooses to discontinue using
the OCSD Online Reporting System and return to using paper forms, the RO or AR/DS must complete, sign,
and submit an OCSD Account Deactivation Form. If OCSD does not receive this form, it is likely that the
system will continue to produce “not received” flags (indicating reporting violations).
5. VERIFICATION: Upon receipt of a submission, OCSD will process the submission to make it accessible.
The RO, or AR/DS if applicable, is responsible for the content of each submission, and for reviewing the
accuracy of the processed document, both in accordance with the associated certification statement, as made
available by the OCSD Online Reporting System.
6. SIGNATURE: The RO and AR/DS agree that their personal identification number (PIN) will serve as their
electronic signature following acceptance of this Agreement. The RO and AR/DS agree that any such
electronic signature affixed to or associated with any transmitted submission verifies (1) that the RO, or
AR/DS if applicable, has the requisite authority to originate the transaction; and (2) the accuracy of the
content at the time of transmittal. The RO and AR/DS also agree that each submission the RO, or AR/DS if
applicable, submits using their PIN constitutes their agreement with the certification statement in each
transmission per 40 CFR §403.6(a)(2).
7. SECURITY: The parties must take reasonable actions to implement and maintain security procedures
necessary to ensure the protection of transmissions against the risk of unauthorized access, alteration, loss or
destruction including, but not limited to: protecting the secrecy of passwords and electronic signatures and
only transmitting files in an acceptable protocol.
8. USE OF PIN: Each RO and AR/DS must be a person identified by the facility as someone who meets EPA’s
criteria of being an authorized representative. If a PIN is compromised or there is evidence of potential
compromise, OCSD will suspend the PIN and affected account. In addition, OCSD will inactivate or revoke a
PIN where the RO or AR/DS is no longer an authorized signatory. Each RO and AR/DS agree that OCSD
may act immediately and unilaterally in any decision to suspend, inactivate, revoke, or otherwise disallow use
of a PIN by any RO, or AR/DS if applicable, where OCSD staff believes that such action is necessary to
ensure the authenticity, integrity or general security of transmissions or records, or where there are any actual
or apparent violations of this agreement. Each RO and AR/DS also agree to immediately report to OCSD any
compromise or potential compromise of a PIN.
*OCSDSCASC_FORM_INFM-6101ESAA* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 1 E S A A
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 1 E S A A
Electronic Signature Agreement (ESA) for Users Authorized to Sign Documents Reference Identifier Type Version Date ASC_FORM_INFM-6101ESAA Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 4 of 6
9. INABILITY TO TRANSMIT OR FILE REPORTS ELECTRONICALLY: No party is liable for any failure
to perform its obligations in connection with any Electronic Transaction or any Electronic Document, where
the failure results from any act or cause beyond the party’s control that prevents the party from electronically
transmitting or receiving any document submissions. The RO, or AR/DS if applicable, is nonetheless required
to submit records or information required by law by other means within the time period required by law,
unless a written extension has been granted by OCSD.
10. CONTINUATION OF OPERATIONS: In the event that electronic submission of data is not possible via the
OCSD Online Reporting System, it is the responsibility of the RO, or AR/DS if applicable, to submit paper
copies in accordance with the requirements of the Permit, or written extension granted by OCSD. Failure to
submit data by the date required by the Permit or extension is a violation and will be enforced according to
OCSD’ Enforcement Response Plan.
11. SEVERABILITY: Any provision of this Agreement which is determined to be invalid or unenforceable will
be ineffective to the extent of that determination without invalidating the remaining provisions of this
Agreement or affecting the validity or enforceability of the remaining provisions.
12. TERMINATION AND RENEWAL: This Agreement may be terminated by either party. Upon termination of
this Agreement, the ability to submit electronic information through the OCSD Online Reporting System will
also terminate. This Agreement becomes effective upon notification of approval by the OCSD to the RO or
AR/DS (which may be an automated message from the OCSD Online Reporting System or by separate
notification). OCSD will normally provide notification of the effective date, but if no date is provided, the
effective date is the next reporting cycle following the notification. This Agreement will continue until
modified by mutual consent or unless terminated with 60 days written notice by any party. This Agreement
will be periodically reviewed and amended or revised by both parties as needed or when required. OCSD
reserves the right to approve or disapprove this subscriber agreement. This Agreement will be terminated if
the facility’s Permit is also terminated.
13. GOVERNING LAW: This Agreement is governed by and interpreted in accordance with 40 CFR §3, 40 CFR
§122, 40 CFR §403 et seq., and other applicable California State Law provisions.
14. AGREEMENT: I and the facilities listed in Section 6101.2 agree:
To protect my account and password from compromise, not allow anyone else to use my account, and not
share my password with any other person;
To change my password if I believe it becomes known to any other person;
To promptly report to OCSD any evidence of the loss, theft, or other compromise of my account or password
within one business day;
*OCSDSCASC_FORM_INFM-6101ESAA* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 1 E S A A
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 1 E S A A
Electronic Signature Agreement (ESA) for Users Authorized to Sign Documents Reference Identifier Type Version Date ASC_FORM_INFM-6101ESAA Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 5 of 6
To notify OCSD in writing, if I terminate my employment, am reassigned or if any other change in my status
causes me to cease to be an authorized signatory of any of the requested facilities listed in this Agreement.
Notification should occur as soon as the change occurs.
To review, in a timely manner, the email and onscreen acknowledgements and copies of data submissions
transmitted through my account to the OCSD Online Reporting System;
To report discrepancy between the submissions and what the OCSD Online Reporting System received;
To acknowledge that OCSD is not responsible for managing access for users who are not authorized to sign
(i.e. viewers and/or preparers); that responsibility belongs to the Responsible Officer (RO), Authorized
Representative (AR), and/or Designated Signatory (DS) associated to the facility.
That in no event will OCSD be liable to me or the facilities I represent for any special, consequential, indirect
or similar damages, including any lost profits or lost data arising out of the use or inability to use the software
or of any data supplied therewith even if OCSD or anyone else has been advised of the possibility of such
damages, or for any claim by any other party. OCSD disclaims all warranties, expressed or implied, including
but not limited to warranties of merchantability and fitness for a particular purpose, with respect to the
software and the accompanying written materials;
That these Terms and Conditions, and agreement thereof, are subject to changes by OCSD, and that these
Terms and Conditions are in effect regardless of any addition or removal of facilities associated to my user
account
To not intentionally disclose my knowledge-based questions and answers.
I understand that I and the facilities I represent are as legally bound, obligated, and responsible by the electronic
signature created as by a handwritten signature.
*OCSDSCASC_FORM_INFM-6101ESAA* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 1 E S A A
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 1 E S A A
Electronic Signature Agreement (ESA) for Users Authorized to Sign Documents Reference Identifier Type Version Date ASC_FORM_INFM-6101ESAA Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 6 of 6
6101.4 Signature
For Responsible Officers (RO):
For the above-listed facilities, I, __________________________________, as the Certified Responsible
Officer (RO), have the authority to enter into this Agreement under the applicable standards.
For Authorized Representatives (AR) / Designated Signatories (DS):
For the above-listed facilities, I, __________________________________, as the Authorized
Designated Signatory (DS) / Authorized Representative (AR), am authorized by the Responsible Officer
(RO), whose name is _________________________, and who has the signatory authority under 40 CFR
§403.12(l), to enter into this Agreement.
By submitting this Agreement to OCSD, I have read, understand, and accept the terms and conditions of
this Agreement. I certify under penalty of law that I have personally examined and am familiar with the
information submitted in this Agreement and all attachments contained in the Agreement, I believe that
the information is true, accurate and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment.
_________________________ _________________________ ____________________
Signature Printed Name Date
Print this form, save a copy for your records, and mail to:
OCSD Online Reporting System Coordinator
10844 Ellis Avenue
Fountain Valley, CA 92708
Once this form is reviewed and approved, OCSD will activate the user’s access in the OCSD Online
Reporting System.
Attachment #2
OCSD Online Reporting System
Electronic Signature Agreement (ESA) for
User Not Authorized to Sign Documents
OCSD Environmental Compliance Source
Control Form 6102ESAN
*OCSDSCASC_FORM_INFM-6102ESAN* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 2 E S A N
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 2 E S A N
Electronic Signature Agreement (ESA) for Users Not Authorized to Sign Documents
Reference Identifier Type Version Date ASC_FORM_INFM-6102ESAN Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 1 of 6
Although OCSD Online Reporting System access will be granted by a facility Responsible Office (RO),
Authorized Representative (AR), or Designated Signatory (DS), this Electronic Signature Agreement (ESA) is
required to be completed and submitted to OCSD as a User of OCSD’s Online Reporting System.
6102.1 Your User Information
User Name: _____________________________
Legal Full Name: __________________________________________________________
Job Title: __________________________________________________________
Mailing Address: __________________________________________________________
City, State, Zip: __________________________________________________________
Email Address: __________________________________________________________
Phone Number: _____________________________
6102.2 Facility Information
Access to records for a specific facility must be granted by that facility’s Responsible Officer (RO) or Authorized
Representative (AR) / Designated Signatory (DS), and may not be granted by OCSD. However, to expedite the
process of associating your account to a facility, please indicate your expected facility associations below:
Permit No. Facility Name Facility Location Address
* Note: Listing facilities above will not associate your account to these facilities. Facility associations must be
confirmed within the Online Reporting System via action by a certified Responsible Officer (RO) and/or a
Designated Signatory (DS) / Authorized Representative (AR).
Submittal Reason:
NEW: This is the first ESA submitted for this user account for the above facilities.
CHANGE: This is an updated ESA submitted because the user’s information has changed.
Specify the change in information: _________________________________________
*OCSDSCASC_FORM_INFM-6102ESAN* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 2 E S A N
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 2 E S A N
Electronic Signature Agreement (ESA) for Users Not Authorized to Sign Documents
Reference Identifier Type Version Date ASC_FORM_INFM-6102ESAN Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 2 of 6
Note: Any User requesting to discontinue electronic submissions must complete the OCSD Online Reporting System
Account Deactivation Request Form.
REACTIVATION: This is a re-activation of a user account.
Notes to OCSD (optional):
6102.3 Terms and Conditions
1. DEFINITIONS: A User is defined as an individual who has registered an account in the OCSD Online
Reporting System, and may have been granted access to view and/or prepare facility submission information.
A Responsible Official (RO) is defined by 40 CFR §403.12(l)(1) and refers to an individual who has accepted
responsibility for the overall operation of a facility and/or overall responsibility for compliance with all
regulatory requirements for the facility from which the wastewater discharge originates. An Authorized
Representative (AR), also referred to as a Designated Signatory (DS), is defined by 40 CFR §403.12(l)(3) and
refers to an individual who has accepted responsibility for the overall operation of a facility and/or overall
responsibility for compliance with all regulatory requirements for the facility from which the wastewater
discharge originates, on behalf of the Responsible Officer (RO).
2. PURPOSE: This agreement creates legally binding obligations for the parties using the specified data
transmission protocols and the OCSD Online Reporting System. The User agrees to (i) maintain
confidentiality and protect the electronic access from unauthorized use or compromise, and follow all
procedures specified by OCSD for this purpose; and (ii) be as legally bound, obligated, and responsible by
use of the electronic access.
3. VALIDITY AND ENFORCEABILITY: By this Agreement the parties agree to follow OCSD procedures to
create binding regulatory reporting documents using electronic transmission and receipt of such records,
consistent with the provisions of 40 C.F.R. Part 3 (CROSS-MEDIA ELECTRONIC REPORTING
Requirements, CROMERR). Acceptance and execution of this agreement by OCSD is shown by the issuance
of a personal identification number (PIN) to the Certifier. Consistent with 40 C.F.R. Part 3, electronic
*OCSDSCASC_FORM_INFM-6102ESAN* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 2 E S A N
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 2 E S A N
Electronic Signature Agreement (ESA) for Users Not Authorized to Sign Documents
Reference Identifier Type Version Date ASC_FORM_INFM-6102ESAN Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 3 of 6
signatures under this agreement have the same force and effect as a written signature. Written signatures will
remain on file with OCSD.
4. RECEIPT: A submission is received when it is accessible by OCSD, can be fully processed and complies
with OCSD’ electronic transfer protocol which OCSD may modify from time to time. A submission does not
satisfy any reporting requirement until it is received. For permit renewal and compliance reporting, the RO or
AR/DS agrees that upon activation of the RO or AR/DS account for requested facilities, the OCSD Online
Reporting System will be expecting to receive electronic transmission of reports at the interval specified in
the permit. If OCSD does not receive the submissions from the RO and/or AR/DS at the expected time, the
database will flag the required submissions as not received. If the RO or AR/DS chooses to discontinue using
the OCSD Online Reporting System and return to using paper forms, the RO or AR/DS must complete, sign,
and submit an OCSD Account Deactivation Form. If OCSD does not receive this form, it is likely that the
system will continue to produce “not received” flags (indicating reporting violations).
5. VERIFICATION: Upon receipt of a submission, OCSD will process the submission to make it accessible.
The RO, or AR/DS if applicable, is responsible for the content of each submission, and for reviewing the
accuracy of the processed document, both in accordance with the associated certification statement, as made
available by the OCSD Online Reporting System.
6. SIGNATURE: The RO and AR/DS agree that their personal identification number (PIN) will serve as their
electronic signature following acceptance of this Agreement. The RO and AR/DS agree that any such
electronic signature affixed to or associated with any transmitted submission verifies (1) that the RO, or
AR/DS if applicable, has the requisite authority to originate the transaction; and (2) the accuracy of the
content at the time of transmittal. The RO and AR/DS also agree that each submission the RO, or AR/DS if
applicable, submits using their PIN constitutes their agreement with the certification statement in each
transmission per 40 CFR §403.6(a)(2).
7. SECURITY: The parties must take reasonable actions to implement and maintain security procedures
necessary to ensure the protection of transmissions against the risk of unauthorized access, alteration, loss or
destruction including, but not limited to: protecting the secrecy of passwords and electronic signatures and
only transmitting files in an acceptable protocol.
8. USE OF PIN: Each RO and AR/DS must be a person identified by the facility as someone who meets EPA’s
criteria of being an authorized representative. If a PIN is compromised or there is evidence of potential
compromise, OCSD will suspend the PIN and affected account. In addition, OCSD will inactivate or revoke a
PIN where the RO or AR/DS is no longer an authorized signatory. Each User agrees that OCSD may act
immediately and unilaterally in any decision to suspend, inactivate, revoke, or otherwise disallow use of a
PIN by any User, where OCSD staff believes that such action is necessary to ensure the authenticity, integrity
*OCSDSCASC_FORM_INFM-6102ESAN* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 2 E S A N
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 2 E S A N
Electronic Signature Agreement (ESA) for Users Not Authorized to Sign Documents
Reference Identifier Type Version Date ASC_FORM_INFM-6102ESAN Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 4 of 6
or general security of transmissions or records, or where there are any actual or apparent violations of this
agreement. Each User also agrees to immediately report to OCSD any compromise or potential compromise
of a PIN.
9. INABILITY TO TRANSMIT OR FILE REPORTS ELECTRONICALLY: No party is liable for any failure
to perform its obligations in connection with any Electronic Transaction or any Electronic Document, where
the failure results from any act or cause beyond the party’s control that prevents the party from electronically
transmitting or receiving any document submissions. The RO, or AR/DS if applicable, is nonetheless required
to submit records or information required by law by other means within the time period required by law,
unless a written extension has been granted by OCSD.
10. CONTINUATION OF OPERATIONS: In the event that electronic submission of data is not possible via the
OCSD Online Reporting System, it is the responsibility of the RO, or AR/DS if applicable, to submit paper
copies in accordance with the requirements of the Permit, or written extension granted by OCSD. Failure to
submit data by the date required by the Permit or extension is a violation and will be enforced according to
OCSD’ Enforcement Response Plan.
11. SEVERABILITY: Any provision of this Agreement which is determined to be invalid or unenforceable will
be ineffective to the extent of that determination without invalidating the remaining provisions of this
Agreement or affecting the validity or enforceability of the remaining provisions.
12. TERMINATION AND RENEWAL: This Agreement may be terminated by either party. Upon termination of
this Agreement, the ability to submit electronic information through the OCSD Online Reporting System will
also terminate. This Agreement becomes effective upon its submission to OCSD. This Agreement will
continue until modified by mutual consent or unless terminated with 60 days written notice by any party. This
Agreement will be periodically reviewed and amended or revised by both parties as needed or when required.
OCSD reserves the right to approve or disapprove this subscriber agreement. This Agreement may be
terminated if the User’s associated facility’s Permit is also terminated.
13. GOVERNING LAW: This Agreement is governed by and interpreted in accordance with 40 CFR §3, 40 CFR
§122, 40 CFR §403 et seq., and other applicable California State Law provisions.
14. AGREEMENT: I agree:
To protect my account and password from compromise, not allow anyone else to use my account, and not
share my password with any other person;
To change my password if I believe it becomes known to any other person;
*OCSDSCASC_FORM_INFM-6102ESAN* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 2 E S A N
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 2 E S A N
Electronic Signature Agreement (ESA) for Users Not Authorized to Sign Documents
Reference Identifier Type Version Date ASC_FORM_INFM-6102ESAN Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 5 of 6
To promptly report to OCSD any evidence of the loss, theft, or other compromise of my account or password
within one business day;
To notify OCSD in writing, if I terminate my employment, am reassigned or if any other change in my status
causes me to cease to be an authorized signatory of any of the requested facilities listed in this Agreement.
Notification should occur as soon as the change occurs.
To review, in a timely manner, the email and onscreen acknowledgements and copies of data submissions
transmitted through my account to the OCSD Online Reporting System;
To report discrepancy between the submissions and what the OCSD Online Reporting System received;
That in no event will OCSD be liable to me or the facilities I represent for any special, consequential, indirect
or similar damages, including any lost profits or lost data arising out of the use or inability to use the software
or of any data supplied therewith even if OCSD or anyone else has been advised of the possibility of such
damages, or for any claim by any other party. OCSD disclaims all warranties, expressed or implied, including
but not limited to warranties of merchantability and fitness for a particular purpose, with respect to the
software and the accompanying written materials;
That these Terms and Conditions, and agreement thereof, are subject to changes by OCSD, and that these
Terms and Conditions are in effect regardless of any addition or removal of facilities associated to my user
account
To not intentionally disclose my knowledge-based questions and answers.
I understand that I and the facilities I represent are as legally bound, obligated, and responsible by the electronic
signature created as by a handwritten signature.
*OCSDSCASC_FORM_INFM-6102ESAN* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 2 E S A N
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 2 E S A N
Electronic Signature Agreement (ESA) for Users Not Authorized to Sign Documents
Reference Identifier Type Version Date ASC_FORM_INFM-6102ESAN Online Reporting System Legally Binding Signature Agreement 06/27/2016
OCSD Online Reporting System: Electronic Signature Agreement (ESA) Page 6 of 6
6102.4 Signature
By submitting this Agreement to OCSD, I have read, understand, and accept the terms and conditions of
this Agreement. I certify under penalty of law that I have personally examined and am familiar with the
information submitted in this Agreement and all attachments contained in the Agreement, I believe that
the information is true, accurate and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment.
_________________________ _________________________ ____________________
Signature Printed Name Date
Print this form, save a copy for your records, and mail to:
OCSD Online Reporting System Coordinator
10844 Ellis Avenue
Fountain Valley, CA 92708
Attachment #3
Responsible Officer Certification Form
Certification of Responsible Officer I, the undersigned, do hereby certify that I meet the definition of a Responsible Officer, as outlined below:
A responsible officer is defined as found in 40 CFR 403.12 (I)(1)(i): 1. For a corporation: a. A president, secretary, treasurer, or vice-president of the corporation in charge of the principal
business functions, or any other person who performs similar policy- or decision-making functions for the corporation, or
b. The manager of one or more manufacturing, production, or operation facilities employing more than 250 persons or having gross annual sales or expenditures exceeding $25 million (in second-quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.
2. For partnership or sole proprietorship, a general partner or proprietor, respectively. 3. For a public agency; a general manager, department manager, or supervisor of a public agency who performs policy of decision making functions for the public agency.
I accept the responsibility for the overall operation of the facility and/or overall responsibility for compliance with all regulatory requirements for the facility from which the wastewater discharge originates.
Name of Responsible Officer
(Please Print or Type)
Signature
Title Date
Company Name Permit No.
NOTE: All correspondence regarding permit, enforcement, and self-monitoring issues (e.g., Self-Monitoring Forms and Reminder Letters, Notices of Violations, Permit Application, etc.) shall be sent to the Responsible Officer or to the Designated Signatory if properly authorized. If there is a change in the Responsible Officer or Designated Signatory in the future, the
Districts must be notified in writing and the appropriate form must be submitted.
This is mandatory Complete and return this form
Attachment #4
Designated Signatory Authorization Form
Option to Designate Signatory This is to authorize the individual whose name and title appear below, ___________________________________________________________________________________ Designated Signatory’s Name (Please Print or Type) Title
to be the designated individual responsible for wastewater discharges who can be served with notices, and who is the Designated Signatory on my behalf for purposes of signing all reports. This individual has the responsibility for the overall operation of the facility and/or overall responsibility for compliance with all regulatory requirements for this facility from which the wastewater discharge originates. I understand that if, in the future, this information is no longer correct, the District will be notified in writing to terminate designation of the above-named individual and to establish a new signatory. Name of Responsible Officer ________________________________________________________ (Please Print or Type)
Signature _____________________________________________________________________ Title _____________________________________________ Date _________________ Company Name ___________________________________________ Permit No. ____________
I accept the responsibility for the overall operation of the facility and/or overall responsibility for compliance with all regulatory requirements for this facility from which the wastewater discharge originates. I understand that it is my responsibility to keep the Responsible Officer informed at all times regarding all permit and enforcement issues. Name of Designated Signatory _________________________________________________________ (Please Print or Type)
Signature _________________________________ Date ___________________________ Title __________________________________ E-mail __________________________
All correspondence regarding all permit and enforcement issues shall be sent to the Designated Signatory. It is the Designated Signatory’s responsibility to keep the Responsible Officer informed at all times regarding all permit and enforcement issues. The Responsible Officer remains legally responsible for all wastewater discharge to the sewer from this facility and for ensuring that he is duly informed by the Designated Signatory.
A designated signatory is defined as found in 40CFR 403.12 (I)(3)(ii): 1. An individual or a position having responsibility for the overall operation of the facility from which the industrial
discharge originates, such as the position of plant manager, operator of a well, or well field superintendent, or a position of equivalent responsibility, or having overall responsibility for environmental matters for the company, and;
2. Written authorization is submitted to the Source Control Permit Supervisor at the Orange County Sanitation Districts, and;
3. Written authorization must be submitted by a responsible corporate officer such as a President, Secretary, Treasurer,
or Vice President of the corporation in charge of a principle business function or any other person who performs decision-making function for the corporation.
THIS IS OPTIONAL.
Submit this form only if the Responsible Officer wants to designate a Signatory.
Attachment #5
OCSD Online Reporting System
Account Deactivation Form
OCSD Environmental Compliance Source
Control Form 6105ACDA
*OCSDSCASC_FORM_INFM-6105ACDA* O C S D S o u r c e C o n t r o l : A S C _ F O R M _ I N F M - 6 1 0 5 A C D A
ORANGE COUNTY SANITATION DISTRICT Environmental Compliance Source Control Online Report in g Sys t em
Form
6 1 0 5 A C D A
Account Deactivation Form Reference Identifier Type Version Date ASC_FORM_INFM-6105ACDA Online Reporting System Account Management 03/15/2016
OCSD Online Reporting System:
Account Deactivation Form
Page 1 of 1
Please complete this Account Deactivation Form, which allow the user to request discontinuation of data
submittal thorough the Online Reporting System.
6105.1 Information for User to be Deactivated
User Name: _____________________________
Legal Full Name: __________________________________________________________
Job Title: __________________________________________________________
Mailing Address: __________________________________________________________
City, State, Zip: __________________________________________________________
Email Address: __________________________________________________________
Phone Number: _____________________________
6105.2 Facility Information
Account Deactivation is requested for the following facilities:
Permit No. Facility Name Facility Location Address
6105.3 Signature
Please deactivate the user account identified above from the OCSD Industrial Online System, which is
associated to the above-listed facilities. I understand that I am obligated to continue to use the OCSD
Online Reporting System to conclude any business (reporting, correcting or submitting data) during the
time this user account is active. I further understand that this request in no way changes the submission
requirements of this facility. This request only provides notice that the user will no longer use the OCSD
Online Reporting System.
_________________________ _________________________ ____________________
Signature Printed Name Date
Print this form, save a copy for your records, and mail to:
OCSD Online Reporting System Coordinator
10844 Ellis Avenue, Fountain Valley, CA 92708