Complete the following tables for each sampling point

Plant Name

Sample 

Collection 

Number

Date of Sample 

Collection

Sample Collection 

Time Temperature (°C)

pH

(S.U.)

Set 1 - Grab 1Set 1 - Grab 2Set 1 - Grab 3Set 1 - Grab 4Set 2 - Grab 1Set 2 - Grab 2Set 2 - Grab 3Set 2 - Grab 4Set 3 - Grab 1Set 3 - Grab 2Set 3 - Grab 3Set 3 - Grab 4Set 4 - Grab 1Set 4 - Grab 2Set 4 - Grab 3Set 4 - Grab 4

NOTE: For influent samples, only the grab 1 row needs to be completed.

Plant Name

Sample 

Collection 

Number

Untreated Carbon 

Capture 

Wastewater 

Samples 

Collected as 

Grabs

(Yes or No)

Mercury and Cyanide 

Samples Collected as 

Grabs

(Yes or No)

Carbon Capture WWT 

Effluent Samples 

(Except Mercury & 

Cyanide) Collected as 

24-Hour Composites

(Yes or No)

Tyvek Suits used

(Yes or No)

Dust Masks 

Used for 

Mercury 

(Yes or No)

Clean 

Hands/Dirty 

Hands Sampling 

Techniques Used

(Yes or No)

Description of 

Sample Collectio

Technique (if differ

than instructions

Set 1Set 2Set 3Set 4
Complete the following tables based on the plant operating characteristics during each set of samples collected

Units Operating 

During Sampling 

Day

Units Off-line 

Entire 

Sampling Day

SCRs/SNCRs 

Operating on 

Units FGD Operating

Set 1Set 2Set 3Set 4

(Liters/day) (Liters/day) (Liters/day) (Liters/day) (Liters/day)

Set 1Set 2Set 3Set 4

NOTE: If the plant does not treat the carbon capture wastewater on site, the plant must provide the name of the company/facility that treats the wastewater, a

well as a description of the treatment system. (See the "Off Site Treatment" tab in this Excel file).

Insert the Names of the Chemicals Used in Treatment in the Cells Below and Provide the Amou

Used During Each Set of Sampling and Usage

Plant Name

Sample 

Collection 

Number

Date of Sample 

Collection

Plant Name

Sample 

Collection 

Number

Date of Sample 

Collection

Carbon Capture Wastewater Treatment Chemical Usage During Sample Collection (if on site)

Plant Operation During Sample Collection
Flue Gas Flow Through Carbon Capture 

System (scf/min)

MW-Equivalent Power Generation 

Treated by the Carbon Capture System 

(MW-hr)

Plant Name Date Unit 1 Unit 1

Provide the daily flue gas flowrate (and MW equivalent) for the carbon capture system starting two weeks prior to the first set

of samples through the last set of samples
Untreated Carbon 

Capture Wastewater 

Dilution Water Flow 

Rate (if added prior 

to Effluent)

Carbon Capture 

Wastewater Treatment 

Plant Name Date Effluent

Provide the average flow rate of the untreated carbon capture wastewater and the associated wastewater 

treatment system (if applicable) for each stream included in the table starting two weeks prior to the first 

set of samples through the last set of samples. 

Carbon Capture Wastewater Generation and Treatment System 

Flow Rates
Carbon Capture Wastewater Treatment System (if located off site)

Does the plant ship the carbon capture wastewater off site for treatment or disposal?

If the plant answered yes to the question above, please answer the following questions:

Provide the name of the company and facility where the carbon capture wastewater is transferred.

Company

Facility

Address line 1

Address line 2

City

State

Zip

Provide a description of the wastewater treatment or disposal system used for the carbon capture wastewater.