Complete the following tables for each sampling pointPlant NameSampleCollectionNumberDate of SampleCollectionSample CollectionTime 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 4NOTE: For influent samples, only the grab 1 row needs to be completed.Plant NameSampleCollectionNumberUntreated CarbonCaptureWastewaterSamplesCollected asGrabs(Yes or No)Mercury and CyanideSamples Collected asGrabs(Yes or No)Carbon Capture WWTEffluent Samples(Except Mercury &Cyanide) Collected as24-Hour Composites(Yes or No)Tyvek Suits used(Yes or No)Dust MasksUsed forMercury(Yes or No)CleanHands/DirtyHands SamplingTechniques Used(Yes or No)Description ofSample CollectionTechnique (if differentthan instructions)Description of AbnormalConditions in Carbon CaptureSystem or Carbon CaptureWastewater Treatment Systemthat May Impact WastewaterCharacteristicsSet 1Set 2Set 3Set 4Complete the following tables based on the plant operating characteristics during each set of samples collectedUnits OperatingDuring SamplingDayUnits Off-lineEntireSampling DaySCRs/SNCRsOperating onUnits FGD OperatingSet 1Set 2Set 3Set 4(Liters/day) (Liters/day) (Liters/day) (Liters/day) (Liters/day)Set 1Set 2Set 3Set 4NOTE: 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, aswell 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 AmountUsed During Each Set of Sampling and UsagePlant NameSampleCollectionNumberDate of SampleCollectionPlant NameSampleCollectionNumberDate of SampleCollectionCarbon 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)

Unit 1 Unit 1 Plant Name Date 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

Effluent Plant Name Date 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.