Minnesota
Pollution
Control
Agency
 Annual Compliance Report - Form A
For Permittees not in a Trade Association
Minnesota River Basin General Phosphorus Permit - Phase I
General Information
Month Day Year
     
Facilities which are listed as a Permittee in Appendix B of the Minnesota River Basin General Phosphorus Permit - Phase I (Permit) are required to submit an Annual Compliance Report (ACR) unless they have received an exclusion from their 5-Month Mass Phosphorus Limit (as allowed by Chapter 5, item 2 of the Permit). The ACR must be submitted in each year in which the Permittee is subject to a 5-Month Mass Phosphorus Limit. For most Permittees, their 5-Month Mass Phosphorus Limit will become effective in 2008; therefore their first ACR must be submitted by November 30, 2008. Permittees which are "new" (new facilities are listed in Appendix B, part 2 of the Permit) or who will be trading with a new Permittee in 2006 and/or 2007, will be subject to a 5-Month Mass Phosphorus Limit in 2006 and/or 2007; these Permittees shall submit an ACR to the MPCA by November 30, 2006 and November 30, 2007 as applicable. Attach (to this form) a copy of each Legal Contract to Trade that this Permittee entered into for the year covered by this report. Use ACR - Form A (i.e. this form) if your facility is not a member of a Trade Association (as defined in the Permit). If your facility is a member of a Trade Association, it must submit the ACR - Form B instead of this form. The terms used in this form have the same meaning and definitions as used in the Permit. Submit this form to: Water Quality Submittal Center, Minnesota Pollution Control Agency, 520 Lafayette Road North, St. Paul, MN 55155-4194.
General Information
Year Covered by Report (use one form per year):
Permittee Name:
MN River Basin Permit Number:
Annual Phosphorus Trade Registry
Provide the following information regarding the Permittee's purchase or sale of Jordan Trading Units (JTUs). List every trade made for the calendar year of this report. Failure to submit all required information may result in an incorrect compliance determination.
Did this Permittee buy or sell Jordan Trading Units which will adjust its 5-Month Mass Phosphorus Limit for the year covered by this report?
Yes No
If yes, list all such trades in the table below. Add more lines to the table if necessary. Be sure to attach a copy of all trade contracts to this form.
Trade No.1 Trade Date2 Trade Partner Name3 Trade Partner ID4 Trade already reported in PIP?5
1 Yes No
2 Yes No
3 Yes No
1 Fill out a separate row of the table for each trade. Do not include trades which adjust the Permittee's limit in a year not covered by this report.
2 Indicate the date that the Legal Contract to Trade was finalized. This is the date of the last signature to the contract.
3 Indicate the name of the entity with which the Permittee traded. The entity can be either an individual Permittee or a Trade Association.
4 Provide the ID number of each trading partner. If the trading partner is a Permittee, provide their Minnesota River Basin Phosphorus Permit number (i.e. their MNG number). If the trading partner is a Trade Association, provide its MPCA given Trade Association ID number.
5 Indicate whether or not the trade has ALREADY been reported to the MPCA in this Permittee's annual Pre-season Implementation Plan (PIP).
Certification and Signatures
I certify under penalty of law that this document and any attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person, or persons, who manage the system, or those persons directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I specifically certify that this report indicates all Jordan Trading Unit trades made for the calendar year covered by this report. I am aware that I should begin planning on how I will meet my next year's 5-Month Mass Phosphorus Limit (if applicable). I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment.


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Signature of Seller (Principal Executive Officer) 		 

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Date


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Printed name of person signing 		 

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Title