United States
Environmental Protection
Agency
Office of Water
Enforcement and Permits
Washington, DC 20460
EPA Form 3510-2E
Revised August 1990
Permits Division
<&EPA Application Form 2E
Facilities Which Do Not
Discharge Process
Waste water
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Paperwork Reduction Act Notice
The public reporting and recordkeeping burden for this collection of information
is estimated to average 14 hours per response. This estimate includes the time
needed to review instructions; develop, acquire, install, and utilize technology
and systems for the purposes of collecting, validating, and verifying information,
processing and maintaining information, and disclosing and providing
information; adjust the existing ways to comply with any previously applicable
instructions and requirements; train personnel to respond to a collection of
information; search existing data sources; complete and review the collection of
information; and transmit or otherwise disclose the information. An Agency may
not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send
comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing the burden, to Chief, OPPE
Regulatory Information Division, U.S. Environmental Protection Agency (2136),
401 M St., S.W., Washington, DC 20460; and to the Office of Information and
Regulatory Affairs, Office of Management and Budget, 725 17th St., N.W.,
Washington, DC 20503, Attention: Desk Officer for EPA. Include the OMB
control number in any correspondence. Do not send the completed application
form to these addresses.
EPA Form 3510-2E (8-90) $$ Printed on Recycled Paper
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Form 2E Instructions
Who Must File Form 2E
EPA Form 3510-2E must be completed in conjunction
with EPA Form 3510-1 (Form 1). This short form may be
used only by operators of facilities which discharge only
nonprocess wastewater (process wastewater is water
that comes into direct contact with or results from the
production or use of any raw material, intermediate
product, finished product, byproduct, waste product, or
wastewater) which is not regulated by effluent limita-
tions guidelines or new source performance standards.
The form is intended primarily for use by dischargers
(new or existing) of sanitary wastes and noncontact
cooling water. It may not be used for discharges of
stormwater runoff or by educational, medical, or com-
mercial chemical laboratories or by publicly owned
treatment works (POTW's).
Where to File Applications
The application forms should be sent to the EPA
Regional Office which covers the State in which the
facility is located. Form 2E (the short form) must be used
only when applying for permits in States where the
NPDES permits program is administered by EPA. For
facilities located in States which are approved to admin-
ister the NPDES permits program, the State environ-
mental agency should be contacted for proper permit
application forms and instructions. Information on whe-
ther a particular program is administered by EPA or by a
State agency can be obtained from your EPA Regional
Office. Form 1, Table 1 of the "General Instructions"
lists the addresses of EPA Regional Offices and the
States within the jurisdiction of each Office.
Public Availability of Submitted Information
You may not claim as confidential any information
required by this form or Form 1, whether the information
is reported on the forms or in an attachment. Section
402(1) of the CWA requires that all permit applications
shall be available to the public. This information will
therefore be made available to the public upon request.
You may claim as confidential any information you sub-
mit to EPA which goes beyond that required by this form
or Form 1. However, confidentiality claims for effluent
data 'must be denied. If you do not assert a claim of
confidentiality at the time of submitting the information,
EPA may make the information public without further
notice. Claims of confidentiality will be handled in
accordance with EPA's business confidentiality regula-
tions in 40 CFR Part 2.
Completeness
Your application will not be considered complete unless
you answer every question on this form and Form 1
EPA Form 3510-2E (8-90)
(except as instructed below). If an item does not apply to
you, enter "NA" (for "not applicable") to show that you
considered the question.
Followup Requirements for New Dischargers and
New Sources
Please note that no later than 2 years after commence-
ment of discharge from the proposed facility, you must
complete and submit Item IV of this form (NPDES Form
2E). At that time you must test and report actual rather
than estimated data for the pollutants or parameters in
Item IV, unless waived by the permitting authority.
Definitions
Significant terms used in these instructions and in the
form are defined in the Glossary found in the General
Instructions accompanying Form 1.
Item!
Under Part A, list an outfall number. Under Part B, list
the latitude and longitude to the nearest 15 seconds for
this outfall. Under Part C, list the name of the outfall's
receiving water. When there is more than one outfall,
you must submit a separate Form 2E (Items I, III, and IV
only) for each outfall.
Item II (New Dischargers Only)
This item requires your best estimate of the date on
which your facility will begin to discharge.
Item III
In Part A, indicate the general type(s) of wastes to be
discharged by placing an "x" in the appropriate box(es).
If "other nonprocess wastewater" is marked, it should
be identified. If cooling water additives are to be used,
they must be listed by name under Part B.
In addition, the composition of the cooling water addi-
tives should be listed if this information is available. The
composition of cooling water additives may be found on
product labels or from manufacturer's data sheets.
Item IV Reporting
All pollutant levels must be reported as concentration
and as total mass (except for discharge flow, pH, and
temperature). Total mass is the total weight of pollutants
discharged over a day. Use the following abbreviations
for units:
Concentration
parts per million
milligrams per liter
parts per billion
Mass
Ibs
ton
mg
ppm
mg/1
ppb
Ug/1 micrograms per liter g
kg kilograms T
A. Existing Sources
You are required to provide at least one analysis for each
pollutant or parameter listed by filling in the requested infor-
pounds
tons (English tons)
milligrams
grams
Tonnes (metric tons)
1-1
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mation under the applicable column. Data reported
must be representative of the facility's current operation
(average daily value over the previous 365 days should
be reported). Most facilities routinely monitor these pol-
lutants or parameters as part of existing permit require-
ments.
The pollutants or parameters listed are: average flow,
biochemical oxygen demand (BOD), total suspended sol-
ids (TSS), fecal coliform (if believed present or if sanitary
waste is discharged), pH, total residual chlorine (if chlo-
rine is used), temperature (winter and summer), oil and
grease, chemical oxygen demand (COD), total organic
carbon (TOC) (COD and TOC are only required if noncon-
tact cooling water is discharged), and ammonia (as N).
The analysis of these pollutants or parameters must be
done in accordance with procedures promulgated in 40
CFR Part 136. Grab samples must be used for pH,
temperature, residual chlorine, oil and grease, and fecal
coliform. For all other pollutants, 24-hour composite
samples must be used. Any further questions on sam-
pling or analysis should be directed to your EPA or State
permitting authority. The authority may request that you
do additional testing, if appropriate, on a case-by-case
basis under Section 308 of the Clean Water Act (CWA).
If you expect a pollutant to be present solely as a result of
its presence in your intake water, state this information
on Item VII of the form.
B. New Dischargers
You are required to provide an estimated maximum daily
and average daily value for each pollutant or parameter
(exceptions noted on the form). Please note that fol-
lowup testing and reporting are required no later than 2
years after the facility starts to discharge. Sampling and
analysis are not required at this time. If, how-
ever, data from such analyses are available, then such
data should be reported. The source of the estimates is
also required. Base your determination of whether a
pollutant will be present in your discharge on your
knowledge of the proposed facility's use of maintenance
chemicals, and any analyses of your effluent or of any
similar effluent. You may also provide the estimates
based on available inhouse or contractor's engineering
reports or any other studies performed on the proposed
facility. If you expect a pollutant or parameter to be
present solely as a result of its presence in your intake
water, state this information on Item VII of the form.
In providing the estimates, use the codes in the follow-
ing table to indicate the source of such information.
Engineering study Code
Actual data from pilot plants 1
Estimates from other engineering studies .2
Data from other similar plants 3
Best professional estimates 4
Others specify on the form
C. Testing Waivers
To request a waiver from reporting any of these pollu-
tants or parameters, the applicant (whether a new or
existing discharger) must submit to the permitting
authority a written request specifying which pollutants
or parameters should be waived and the reasons for
requesting a waiver. This request should be submitted
to the permitting authority before or with the permit
application. The permitting authority may waive the
requirements for information about any pollutant or
parameter if he determines that less stringent reporting
requirements are adequate to support issuance of the
permit. No extensive documentation of the request will
normally be needed, but the applicant should contact
the permitting authority if he or she wishes to receive
instructions on what his or her particular request should
contain.
Item V
Describe the average frequency of flow and duration of
any intermittent or seasonal discharge (except for storm-
water runoff, leaks, or spills). The frequency of flow
means the number of days or months per year there is
intermittent discharge. Duration means the number of
days or hours per discharge. For new dischargers, base
your answers on your best estimate.
Item VI
Describe briefly any treatment system(s) used (or to be
used for new dischargers), indicating whether the
treatment system is physical, chemical, biological, sludge
and disposal, or other. Also give the particular type(s) of
process(es) used (or to be used). For example, if a physi-
cal treatment system is used (or will be used), specify the
processes applied, such as grit removal, ammonia strip-
ping, dialysis, etc.
Item VII
This item is intended for you to provide any additional
information (such as sampling results) that you feel
should be considered by the reviewer in establishing
permit limitations. Any response here is optional. If you
wish to demonstrate your eligibility for a "net" effluent
limitation, i.e., an effluent limitation adjusted to provide
credit for the pollutant(s) present in your intake water,
please add a short statement of why you believe you are
eligible (see §122.45(g)). You will then be contacted by
the permitting authority for further instructions.
Item VIII
The Clean Water Act provides severe penalties for sub-
mitting false information on this application form. Sec-
tion 309(cH2)of the Clean Water Act provides that "Any
person who knowingly makes any false statement.
EPA Form 3510-2E (8-90)
I-2
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representation, or certification in any application, . . .
shall upon conviction, be punished by a fine of no more
than $10,000 or by imprisonment for not more than six
months or both."
40 CFR Part 122.22 requires the certification to be
signed as follows:
a. For a corporation: by a responsible corporate officer.
A responsible corporate officer means (i) a presi-
dent, secretary, treasurer, or vice-president of the
corporation in charge of of a principal business func-
tion, or any other person who performs similar pol-
icy or decisionmaking functions for the corporation,
or (ii) the manager of one or more manufacturing,
production, or operating facilities employing more
than 250 persons or having gross annual sales or
expenditures exceeding $25,000,000 (in second
quarter 1980 dollars), if authority to sign documents
has been assigned or delegated to the manager in
accordance with corporate procedures.
b. For a partnership or sole proprietorship: by a general
partner or the proprietor, respectively; or
c. For a municipality, State, Federal, or other public
agency: by either a principal executive officer or
ranking elected official. For purposes of this section,
a principal executive officer of a Federal agency
includes (i) the chief executive officer of the agency,
or (ii) a senior executive officer having responsibility
for the overall operations of a principal geographic
unit of the agency (e.g.. Regional'Administrators of
EPA).
1-3
EPA Form 3510-2E (8-90)
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3lease type or print in the unshaded areas only
EPA ID Number (copy from Item 1 of Form 1)
Form Approved. OMB No. 2040-0086.
Approval expires 8-31 -98.
Facilities Which Do Not Discharge Process Wastewater
.Receiving Waters
For this outfall, list the latitude and longitude, and name of the receiving water(s).
Outfall
Number (list)
Latitude
Deg Min Sec
Longitude
Min Sec
Receiving Water (name)
II. Discharge Date (If a new discharger, the date you expect to begin discharging)
III. Type of Waste
A. Check the box(es) indicating the general type{s) of wastes discharged. Non r(jB8sg
I I Noncontact Cooling Water LJ
Sanitary Wastes
Feteria Wastes
Wastewater (Identify]
3. If any cooling water additives are used, list them here. Briefly describe their composition if this information is available.
IV. Effluent Characteristics
A.: Existing Sources Provide measurements for the parameters listed in the left-hand column below, unless waived by the permitting
au\hor\ty (see instructions).
8. New Dischargers Provide estimates for the parameters listed i.n the left-hand column below, unless waived by the permitting
authority. Instead of the number of measurements taken, provide the source of estimated values (see instructions).
Pollutant or
Parameter,;-.,:;
Biochemical Oxygen
Demand (BOD) ,
(D
Maximum
.DailyValue,,
(include units)
' Mass
Concentration
(2)
Average Daily
Value (last year)
(include units)
Mass
Concentration
(3)
(or)
W
Number of
Measurements
Taken
(last year)
Source of
Estimate
(if new
discharger]
Total Suspended Solids (TSS)
Fecal Coliform (ifbelieved ,
present or if sanitary waste fs
discharged) .
Total Residual Chlorine///
chlorine is used) ,; >-'
Oil and Grease
'Chemical oxygen demand
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V, Except for leaks or spills, will the discharge described In this form be intermittent or seasonal?
If yes, briefly describe the frequency of flow and duration. ' . '
VI. Treatment
) usetf&iohe used)
VII. Other Information rOpf/o^aO
, , Use the space below to expand upon any of the above questions or to bring to the attention of the reviewer any c
should be considered in establishing permit limitations. Attach additional sheets, if necessary. :
won
VIII. Certification
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on myfnqittlgft&fthe
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted
is to the bestofmykno wiedge and belief, true, accurate, and complete, lama ware that there are significantpenalties tor submitting false
information, including the possibility of fine and imprisonment for knowing violations. ^ - , ,, 5 «1 '
A. Name & Official Title
B. Phone" No. (area code
&no.)
C. Signature
D. Date Signed
EPA Form 3510-2E (8-90)
Page 2 of 2
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Please type or print in the unshaded areas only
EPA ID Number (copy from Item 1 of Form 1)
Form Approved. OMB No. 2040-0086.
,Approval expires 8-31 -98.
:'"--f*ornv
2E
Facilities Which Do Not Discharge Process Wastewater
I. Receiving Waters
for this outfall, list the latitude and longitude, and name of the receiving water(s).
Outfall
Number (list)
Latitude
Deg Min Sec
Longitude
Deg Min Sec
Receiving Water (name)
II. Discharge Date {If a new discharger, the date you expect to begin discharging)
Ill/Type of Waste
A. Check the box(es) indicating the general type(s) of wastes discharged.
r""i * -11*"*!''; ' ,'&'',* r^n
II Sanitary Wastes II Restaurant or Cafeteria Wastes II Noncontact Cooling Water
D Other Nonprocess
Wastewater (Identify)
3. If any cooling water additives are used, list them here. Briefly describe their composition if this information is available.
IV. Effluent Characteristics
; A. Existing Sources Provide measurements for the parameters listed in the left-hand column below, unless waived by the permitting
authority (see instructions). '.'-
B. New Dischargers Provide estimates for the parameters listed in the left-hand column below, unless waived by the permitting
authority. Instead of the number of measurements taken, provide the source of estimated values (see instructions}.
Pollutant or
Parameter ^~
Maximum
Daily Value
Concentration
(2)
Average Daily
Value (last year)
(include units)
Mass
Concentration
m
lor)
(41
Number of
Measurements
Taken
(last year)
Source of
Estimate
(if new
discharger)
Biochemical Oxygen
Demand (BOD)
Total Suspended Solids (TSS)
Fecal CoMorm (if believed
present or if sanitary waste is
discharged)
Total Residual Chlorine (if
chlorine is used),; f *
Oil and Grease
"Chemical oxygen demand
(COO)
Total organic carbon (TOO
Ammonia (as N)
Discharge Flow
Value
nti (give range)
Value
Temperature (Winter)
Temperature (Summer)
"If noncontact cooling water is discharged
EPA Form 3510-2E (8-90)
Page 1 of 2
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V. Except for leaks or spills, will the discharge described in this form be intermittent or seasonal?
If yes, briefly describe the frequency of flow and duration.
VI. Treatment System (Describe briefly any treatment systemfsj used or to be used)
VII. Other Information rOpf/ona//
Use the space below to expand upon any of the i
should be considered in establish!
»questions or to bring to the attention of the reviewer any 01
Li" V Attach additional sheets, if necessary.",; ,:;'',.';,;,: £r' *
VIII. Certification
I certify under penalty of law that this document and all attachments were prepared under my direct ion or supervision in accordance with
a system designed to assure that qualified personnel properly gather and evaluate 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 submitted
is to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties forsubmitting.false
information, including the possibility of fine and imprisonment for knowing violations. * », ' f
A. Name & Official Title
B. Phone" No. (area code
& no.}
C. Signature
D. Date Signed
EPA Form 3510-2E (8-90)
Page 2 of 2
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