Wastewater Systems Effluent Regulations (SOR/2012-139)

[Name and address of owner or operator]

in respect of [name and address of wastewater system]

is (are) authorized, as of [date] , for [number of hours] , until [date], to deposit effluent [level of treatment] and a volume of [volume in m³] m³ from [identify one or more discharge points] into [name, if any, of the water or place where deposit(s) occur and, in the case of water, the name, if any, of the body of water that includes the water ].

IMPORTANT: Please refer to sections 45.1 and 45.2 of the Wastewater Systems Effluent Regulations for the conditions and compliance obligations for this authorization. Please also note that this authorization may be revoked under subsection 47(3) of the Wastewater Systems Effluent Regulations.