Please print or type in the unshaded areas only
EPA ID Number (copy from ftam (of Form 1)
Form Approved. OMB No. 2040-0086
Approval expires 5-31-92
Form
2F
NPDES
xvEPA
United States Environmental Protection Agency
Washington, DC 20460
Application for Permit to Discharge Storm Water
Discharges Associated with Industrial Activity
Paperwork Reduction Act Notice
Public reporting burden for this application is estimated to average 28.6 hours per application, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate, any other aspect of this collection of information, or suggestions for improving this form, including
suggestions which may increase or reduce this burden to: Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401
M St., SW, Washington, DC 20460, or Director, Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC
20503.
I. Outfall Location
For each outfall, list the latitude and longitude of its location to the nearest 15 seconds and the name of the receiving water.
A. Outfall Number
Hist)
B. Latitude
C. Longitude
D. Receiving Water
(name)
II. Improvements
A. Are you now required by any Federal, State, or local authority to meet any implementation schedule for the construction, upgrading or
operation of wastewater treatment equipment or practices or any other environmental programs which may affect the discharges described
in this application? This includes, but is not limited to, permit conditions, administrative or enforcement orders, enforcement compliance
schedule letters, stipulations, court orders, and grant or loan conditions.
1. Identification of Conditions,
Agreements, Etc.
2. Affected Outfalls
number
source of discharge
3. Brief Description of Project
4. Rnal
Compliance Date
a. req.
b. proj.
B. You may attach additional sheets describing any additional water pollution (or other environmental projects which may affect your
discharges) you now have under way or which you plan. Indicate whether each program is now under way or planned, and indicate your
actual or planned schedules for construction.
Attach a site map showing topography (or indicating the outline of drainage areas served by the outfall (s) covered in the application if a
topographic map is unavailable) depicting the facility including: each of its intake and discharge structures; the drainage area of each storm
water outfall; paved areas and buildings within the drainage area of each storm water outfall, each known past or present areas used for outdoor
storage or disposal of significant materials, each existing structural control measure to reduce pollutants in storm water runoff, materials loading
and access areas, areas where pesticides, herbicides, soil conditioners and fertilizers are applied; each of its hazardous waste treatment,
storage or disposal units (including each area not required to have a RCRA permit which is used for accumulating hazardous waste under 40
CFR 262.34); each well where fluids from the facility are injected underground; springs, and other surface water bodies which receive storm
water discharges from the facility.
EPA Form 3510-2F (Rev. 1-92)
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Continued from the Front
IV. Narrative Description of Pollutant Sc
For each outfall, provide an estimate of the area (include units) of impervious surfaces (including paved areas and building roofs) drained to
the outfall, and an estimate of the total surface area drained by the outfall.
Outfall
Number
Area of Impervious Surface
(provide units}
Total Area Drained
(orovide unite)
Outfall
Number
Area of Impervious Surface
(provide units}
Total Area Drained
(provide units)
Provide a narrative description of significant materials that are currently or in the past three years have been treated, stored or disposed in a
manner to allow exposure to storm water; method of treatment, storage, or disposal; past and present materials management practices
employed to minimize contact by these materials with storm water runoff; materials loading and access areas; and the location, manner,
and frequency in which pesticides, herbicides, soil conditioners, and fertilizers are applied.
C. For each outfall, provide the location and a description of existing structural and nonstructural control measures to reduce pollutants in
storm water runoff; and a description of the treatment the storm water receives, including the schedule and type of maintenance for control
and treatment measures and the ultimate disposal of any solid or fluid wastes other than bv discharge.
Outfall
Number
Treatment
List Codes from
Table 2F-1
V. Nonstormwater Discharges
A. I certify under penalty of law that the outfall (s) covered by this application have been tested or evaluated for the presence of nonstormwater
discharges, and that all nonstormwater discharges from these outfall (s) are identified in either an accompanying Form 2C or Form 2E
application for the outfall.
Name and Official Title (type or print)
Signature
Date Signed
B. Provide a description of the method used, the date of any testing, and the onsite drainage points that were directly observed during a test.
VI. Significant Leaks or Spills
Provide existing information regarding the history of significant leaks or spills of toxic or hazardous pollutants at the facility in the last three
years, including the approximate date and location of the spill or leak, and the type and amount of material released.
EPA Form 3510-2F (Rev. 1-92)
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lEPA ID Number (copy from Item I of Form 1)
Continued from Page 2
VII. Discharge information
A,B,C, & D: See instructions before proceeding. Complete one set of tables for each outfall. Annotate the outfall number in the space provided.
Tables VII-A, VII-B, and VII-C are included on separate sheets numbered VII-1 and VII-2.
E: Potential discharges not covered by analysis - is any toxic pollutant listed in table 2F-2, 2F-3 or 2F-4, a substance or a componant of a substance
which you currently use or manufacture as an intermediate or final product or byproduct?
| | Yes (list all such pollutants below) | | No (go to Section DQ ,_
VIII. Biological Toxicity Tes
Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made on any of your discharges or
on a receiving water in relation to your discharge within the last 3 years?
| | Yes (list all such pollutants below)
| | No (go to Section IX)
IX. Contract Analysis Information
Were any of the analysis reported in item VII performed by a contract laboratory or consulting firm?
I | Yes (list the name, address, and telephone number of, and pollutants
analyzed bv. each such laboratory or firm below)
No (go to Section X)
A. Name
B. Address
C. Area Code & Phone No.
D. Pollutants Analyzed
/ 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 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 for submitting false information,
including the possibility of fine and Imprisonment for knowing violations.
A. Name & Official Title (type or print)
B. Area Code and Phone No.
C. Signature
D. Date Signed
EPA Form 3510-2F (Rev. 1-92)
Page 3 of 3
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EPA ID Number (copy from Kern / of Form 1)
Form Approved. OMB No. 2040-0086
Approval expires 5-31-92
VII. Discharge Information (Continued from oaae 3 of Form 2F)
Part A - You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See
instructions for additional details.
Pollutant
and
CAS Number
(if available;
Oil and Grease
Biological Oxygen
Demand (BODS)
Chemical Oxygen
Demand (COD)
Total Suspended
Solids (TSS)
Total
Nitrogen
Total
Phosphorus
pH
Maximum Values
(include units)
Grab Sample
Taken During
First 20
Minutes
Minimum
Row-weighted
Composite
N/A
Maximum
Average Values
(include units)
Grab Sample
Taken During
First 20
Minutes
Minimum
Row-weighted
Composite
Maximum
Number
of
Storm
Events
Sampled
Sources of Pollutants
Part B - List each pollutant that is limited in an effluent guideline which the facility is subject to or any pollutant listed in the facility's NPDES
permit for its process wastewater (if the facility is operating under an existing NPDES permit). Complete one table for each outfall. See
the instructions for additional details and reaui ements.
Pollutant
and
CAS Number
(if available)
Maximum Values
(include units)
Grab Sample
Taken During
First 20
Minutes
Row-weighted
Composite
'
Average Values
(include units)
Grab Sample
Taken During
First 20
Minutes
Row-weighted
Composite
Number
of
Storm
Events
Sampled
Sources of Pollutants
••
EPA Form 3510-2F (Rev. 1-92)
Page VII-1
Continue on Reverse
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Continued from the Front
Part C - List each pollutant shown in Tables 2F-2, 2F-3, and 2F-4 that you know or have reason to believe is present. See the instructions for
additional details and requirements. Complete one table for each outfall.
Pollutant
and
CAS Number
(H available)
Maximum Values
(include units)
Grab Sample
Taken During
First 20
Minutes
Row-weighted
Composite
Average Values
[include units)
Grab Sample
Taken During
First 20
Minutes
Row-weighted
Composite
Number
of
Storm
Events
Sampled
Sources of Pollutants
Part D - Provide data for the storm eventfs) which resulted in the maximum values for the flow weighted composite sample.
1. 2. 3.
Date of Duration Total rainfall
Storm of Storm Event during storm event
Event (in minutes) fin inches)
4.
Number of hours between
beginning of storm meas-
ured and end of previous
measurable rain event
7. Provide a description of the method of flow measurement or estimate.
5. 6.
Maximum flow rate during Total flow from
rain event ,„;.. _,,__«
(gaHons/minuteor rain event
specify units (gallons or specify units)
EPAForm3510-2F (Rev. 1-92)
PageVII-2
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Instructions - Form 2F
Application for Permit to Discharge Storm Water
Associated with Industrial Activity
Who Must File Form 2F
Form 2F must be completed by operators of facilities which discharge storm water associated with industrial
activity or by operators of storm water discharges that EPA is evaluating for designation as a significant
contributor of pollutants to waters of the United States, or as contributing to a violation of a water quality
standard.
Operators of discharges which are composed entirely of storm water must complete Form 2F (EPA Form
3510-2F) in conjunction with Form 1 (EPA Form 3510-1).
Operators of discharges of storm water which are combined with process wastewater (process wastewater
is water that comes into direct contact with or results from the production or use of any raw material, interme-
diate product, finished product, byproduct, waste product, or wastewater) must complete and submit Form
2F, Form 1, and Form 2C (EPA Form 3510-2C).
Operators of discharges of storm water which are combined with nonprocess wastewater (nonprocess
wastewater includes noncontact cooling water and sanitary wastes which are not regulated by effluent guide-
lines or a new source performance standard, except discharges by educational, medical, or commercial
chemical laboratories) must complete Form 1, Form 2F, and Form 2E (EPA Form 3510-2E).
Operators of new sources or new discharges of storm water associated with industrial activity which will be
combined with other nonstormwater new sources or new discharges must submit Form 1, Form 2F, and
Form 2D (EPA Form 3510-2D).
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 2F 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 administer the NPDES
permits program, the State environmental agency should be contacted for proper permit application forms
and instructions.
Information on whether 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.
Completeness
Your application will not be considered complete unless you answer every question on this form and on Form
1. If an item does not apply to you, enter "NA" (for not applicable) to show that you considered the question.
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(j) of the Clean Water Act requires that all permit
applications will be available to the public. This information will be made available to the public upon request.
Any information you submit to EPA which goes beyond that required by this form, Form 1, or Form 2C you
may claim as confidential, but claims for information which are effluent data will 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 to yoU. Claims of confidentiality will be handled in accordance with
EPA's business confidentiality regulations at 40 CFR Part 2.
Definitions
All significant terms used in these instructions and in the form are defined in the glossary found in the General
Instructions which accompany Form 1.
EPA ID Number
Fill in your EPA Identification Number at the top of each odd-numbered page of Form 2F. You may copy this
number directly from item I of Form 1.
EPA Form 3510-2F (Rev. 1-92) 1-1
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Item J
You may use the map you provided for item XI of Form 1 to determine the latitude and longitude of each of
your outfalls and the name of the receiving water.
Item 11-A
If you check "yes" to this question, complete all parts of the chart, or attach a copy of any previous submission
you have made to EPA containing the same information.
Item II-B
You are not required to submit a description of future pollution control projects if you do not wish to or if none
is planned.
Item III
Attach a site map showing topography (or indicating the outline of drainage areas served by the outfall(s)
covered in the application if a topographic map is unavailable) depicting the facility including:
each of its drainage and discharge structures;
the drainage area of each storm water outfall;
paved areas and building within the drainage area of each storm water outfall, each known past or
present areas used for outdoor storage or disposal of significant materials, each existing structural con-
trol measure to reduce pollutants in storm water runoff, materials loading and access areas, areas where
pesticides, herbicides, soil conditioners and fertilizers are applied;
each of its hazardous waste treatment, storage or disposal facilities (including each area not required to
have a RCRA permit which is used for accumulating hazardous waste for less than 90 days under 40 CFR
262.34);
each well where fluids from the facility are injected underground; and
springs, and other surface water bodies which receive storm water discharges from the facility;
Item IV-A
For each outfall, provide an estimate of the area drained by the outfall which is covered by impervious
surfaces. For the purpose of this application, impervious surfaces are surfaces where storm water runs off at
rates that are significantly higher than background rates (e.g., predevelopment levels) and include paved
areas, building roofs, parking lots, and roadways. Include an estimate of the total area (including all impervi-
ous and pervious areas) drained by each outfall. The site map required under item III can be used to estimate
the total area drained by each outfall.
Item IV-B
Provide a narrative description of significant materials that are currently or in the past three years have been
treated, stored, or disposed in a manner to allow exposure to storm water; method of treatment, storage or
disposal of these materials; past and present materials management practices employed, in the last three
years, to minimize contact by these materials with storm water runoff; materials loading and access areas;
and the location, manner, and frequency in which pesticides, herbicides, soil conditioners, and fertilizers are
applied. Significant materials should be identified by chemical name, form (e.g., powder, liquid, etc.), and
type of container or treatment unit. Indicate any materials treated, stored, or disposed of together. "Signifi-
cant materials" includes, but is not limited to: raw materials; fuels; materials such as solvents, detergents, and
plastic pellets; finished materials such as metallic products; raw materials used in food processing or produc-
tion; hazardous substances designated under Section 101(14) of CERCLA; any chemical the facility is re-
quired to report pursuant to Section 313 of Title III of SARA; fertilizers; pesticides; and waste products such
as ashes, slag and sludge that have the potential to be released with storm water discharges.
Item IV-C
For each outfall, structural controls include structures which enclose material handling or storage areas,
covering materials, berms, dikes, or diversion ditches around manufacturing, production, storage or treat-
ment units, retention ponds, etc. Nonstructural controls include practices such as spill prevention plans,
employee training, visual inspections, preventive maintenance, and housekeeping measures that are used to
prevent or minimize the potential for releases of pollutants.
EPA Form 3510-2F (Rev. 1-92) I - 2
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ItemV
Provide a certification that all outfalls that should contain storm water discharges associated with industrial
activity have been tested or evaluated for the presence of non-storm water discharges which are not covered
by an NPDES permit. Tests for such non-storm water discharges may include smoke tests, fluorometric dye
tests, analysis of accurate schematics'as well as other appropriate tests. Part B must include a description
of the method used, the date of any testing, and the onsite drainage points that were directly observed during
a test. All,non-storm water discharges must be identified in a Form 2C or Form 2E which must accompany
this application (see beginning of instructions under section titled "Who Must File Form 2F" for a description
of when Form 2C and Form 2E must be submitted).
Item VI
Provide a description of existing information regarding the history of significant leaks or spills of toxic or
hazardous pollutants at the facility in the last three years.
Item VII-A, B, and C
These items require you to collect and report data on the pollutants discharged for each of your outfalls. Each
part of this item addresses a different set of pollutants and must be completed in accordance with the specific
instructions for that part. The following general instructions apply to the entire item.
General Instructions
Part A requires you to report at least one analysis for each pollutant listed. Parts B and C require you to report
analytical data in two ways. For some pollutants addressed in Parts B and C, if you know or have reason to
know that the pollutant is present in your discharge, you may be required to list the pollutant and test (sample
and analyze) and report the levels of the pollutants in your discharge. For all other pollutants addressed in
Parts B and C, you must list the pollutant if you know or have reason to know that the pollutant is present in
the discharge, and either report quantitative data for the pollutant or briefly describe the reasons the pollutant
is expected to be discharged. (See specific instructions on the form and below for Parts A through C.) Base
your determination that a pollutant is present in or absent from your discharge on your knowledge of your
raw materials, material management practices, maintenance chemicals, history of spills and releases, inter-
mediate and final products and byproducts, and any previous analyses known to you of your effluent or
similar effluent.
A. Sampling: The collection of the samples for the reported analyses should be supervised by a person
experienced in performing sampling of industrial wastewater or storm water discharges. You may con-
tact EPA or your State permitting authority for detailed guidance on sampling techniques and for answers
to specific questions. Any specific requirements contained in the applicable analytical methods should
be followed for sample containers, sample preservation, holding times, the collection of duplicate sam-
ples, etc. The time when you sample should be representative, to the extent feasible, of your treatment
system operating properly with no system upsets. Samples should be collected from the center of the
flow channel, where turbulence is at a maximum, at a site specified in your present permit, or at any site
adequate for the collection of a representative sample.
For pH, temperature, cyanide, total phenols, residual chlorine, oil and grease, and fecal coliform, grab
samples taken during the first 30 minutes (or as soon thereafter as practicable) of the discharge must be
used (you are not required to analyze a flow-weighted composite for these parameters). For all other
pollutants both a grab sample collected during the first 30 minutes (or as soon thereafter as practicable)
of the discharge and a flow-weighted composite sample must be analyzed. However, a minimum of one
grab sample may be taken for effluents from holding ponds or other impoundments with a retention
period of greater than 24 hours.
All samples shall be collected from the discharge resulting from a storm event that is greater than 0.1
inches and at least 72 hours from the previously measurable (greater than 0.1 inch rainfall) storm event.
Where feasible, the variance in the duration of the event and the total rainfall of the event should not
exceed 50 percent from the average or median rainfall event in that area.
A grab sample shall be taken during the first thirty minutes of the discharge (or as soon thereafter as
practicable), and a flow-weighted composite shall be taken for the entire event or for the first three hours
of the event.
Grab and composite samples are defined as follows:
EPA Form 3510-2F (Rev. 1-92) I - 3
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Grab sample: An individual sample of at least 100 milliliters collected during the first thirty minutes
(or as soon thereafter as practicable) of the discharge. This sample is to be analyzed separately from
the composite sample.
Flow-Weighted Composite sample: A flow-weighted composite sample may be taken with a con-
tinuous sampler that proportions the amount of sample collected with the flow rate or as a combina-
tion of a minimum of three sample aliquots taken in each hour of discharge for the entire event or for
the first three hours of the event, with each aliquot being at least 100 milliliters and collected with a
minimum period of fifteen minutes between aliquot collections. The composite must be flow propor-
tional; either the time interval between each aliquot or the volume of each aliquot must be propor-
tional to either the stream flow at the time of sampling or the total stream flow since the collection of
the previous aliquot. Aliquots may be collected manually or automatically. Where GC/MS Volatile
Organic Analysis (VOA) is required, aliquots must be combined in the laboratory immediately before
analysis. Only one analysis for the composite sample is required.
Data from samples taken in the past may be used, provided that:
All data requirements are met;
Sampling was done no more than three years before submission; and
All data are representative of the present discharge.
Among the factors which would cause the data to be unrepresentative are significant changes in produc-
tion level, changes in raw materials, processes, or final products, and changes in storm water treatment.
When the Agency promulgates new analytical methods in 40 CFR Part 136, EPA will provide information
as to when you should use the new methods to generate data on your discharges. Of course, the
Director may request additional information, including current quantitative data, if they determine it to be
necessary to assess your discharges. The Director may allow or establish appropriate site-specific sam-
pling procedures or requirements, including sampling locations, the season in which the sampling takes
place, the minimum duration between the previous measurable storm event and the storm event sam-
pled, the minimum or maximum level of precipitation required for an appropriate storm event, the form
of precipitation sampled (snow melt or rainfall), protocols for collecting samples under 40 CFR Part 136,
and additional time for submitting data on a case-by-case basis.
B. Reporting: All levels must be reported as concentration and mass (note: grab samples are reported
in terms of concentration). You may report some or all of the required data by attaching separate
sheets of paper instead of filling out pages VII-1 and VII-2 if the separate sheets contain all the required
information in a format which is constant with pages VII-1 and VII-2 in spacing and identification of
pollutants and columns. Use the followiing abbreviations in the columns headed "Units."
Concentration Mass
ppm parts per million Ibs pounds
mg/1 milligrams per liter ton tons (English tons)
ppb parts per billion mg milligrams
ug/1 micrograms per liter g grams
kg kilograms T tonnes (metric tons)
All reporting of values for metals must be in terms of "total recoverable metal," unless:
(1) An applicable, promulgated effluent limitation or standard specifies the limitation for the metal in
dissolved, valent, or total form; or
(2) All approved analytical methods for the metal inherently measure only its dissolved form (e.g.,
hexavalent chromium); or
(3) The permitting authority has determined that in establishing case-by-case limitations it is neces-
sary to express the limitations on the metal in dissolved, valent, or total form to carry out the provi-
sions of the CWA. If you measure only one grab sample and one flow-weighted composite sample
for a given outfall, complete only the "Maximum Values" columns and insert "1" into the "Number of
Storm Events Sampled" column. The permitting authority may require you to conduct additional
analyses to further characterize your discharges.
EPA Form 3510-2F (Rev. 1-92) i _ *
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If you measure more than one value for a grab sample or a flow-weighted composite sample for a given
outfall and those values are representative of your discharge, you must report them. You must describe
your method of testing and data analysis. You also must determine the average of all values within the
last year and report the concentration and mass under the "Average Values" columns, and the total
number of storm events sampled under the "Number of Storm Events Sampled" columns.
C. Analysis: You must use test methods promulgated in 40 CFR Part 136; however, if none has been
promulgated for a particular pollutant, you may use any suitable method for measuring the level of the
pollutant in your discharge provided that you submit a description of the method or a reference to a
published method. Your description should include the sample holding time, preservation techniques,
and the quality control measures which you used. If you have two or more substantially identical outfalls,
you may request permission from your permitting authority to sample and analyze only one outfall and
submit the results of the analysis for other substantially identical outfalls. If your request is granted by the
permitting authority, on a separate sheet attached to the application form, identify which outfall you did
test, and describe why the outfalls which you did not test are substantially identical to th,e outfall which
you did test.
Part VII-A
Part VII-A must be completed by all applicants for all outfalls who must complete Form 2F.
Analyze a grab sample collected during the first thirty minutes (or as soon thereafter as practicable) of the
discharge and flow-weighted composite samples for all pollutants in this Part, and report the results except
use only grab samples for pH and oil and grease. See discussion in General Instructions to Item VII for
definitions of grab sample coHected during the first thirty minutes of discharge and flow-weighted composite
sample. The "Average Values" column is not compulsory but should be filled out if data are available.
Part VII-B
List all pollutants that are limited in an effluent guideline which the facility is subject to (see 40 CFR Subchap-
ter N to determine which pollutants are limited in effluent guidelines) or any pollutant listed in the facility's
NPDES permit for its process wastewater (if the facility is operating under an existing NPDES permit). Com-
plete one table for each outfall. See discussion in General instructions to item VII for definitions of grab
sample collected during the first thirty minutes (or as soon thereafter as practicable) of discharge and flow-
weighted composite sample. The "Average Values" column is not compulsory but should be filled out if data
are available.
Analyze a grab sample collected during the first thirty minutes of the discharge and flow-weighted composite
samples for all pollutants in this Part, and report the results, except as provided in the General Instructions.
Part VII-C
Part VII-C must be completed by all applicants for all outfalls which discharge storm water associated with
industrial activity, or that EPA is evaluating for designation as a significant contributor of pollutants to waters
of the United States, or as contributing to a violation of a water quality standard. Use both a grab sample and
a composite sample for all pollutants you analyze for in this part except use grab samples for residual chlorine
and fecal coliform. The "Average Values" column is not compulsory but should be filled out if data are
available. Part C requires you to address the pollutants in Table 2F-2, 2F-3, and 2F-4 for each outfall. Pollu-
tants in each of these Tables are addressed differently.
Table 2F-2: For each outfall, list all pollutants in Table 2F-2 that you know or have reason to believe are
discharged (except pollutants previously listed in Part VII-B). If a pollutant is limited in an effluent guideline
limitation which the facility is subject to, the pollutant must be analyzed and reported in Part VII-B. If a
pollutant in Table 2F-2 is indirectly limited by an effluent guideline limitation through an indicator (e.g., use
of TSS as an indicator to control the discharge of iron and aluminum), you must analyze for it and report
the data in Part VII-B. For other pollutants listed in Table 2F-2 (those not limited directly or indirectly by an
effluent limitation guideline), that you know or have reason to believe are discharged, you must either report
quantitative data or briefly describe the reasons the pollutant is expected to be discharged.
Table 2F-3: For each outfall, list all pollutants in Table 2F-3 that you know or have reason to believe are
discharged. For every pollutant in Table 2F-3 expected to be discharged in concentrations of 10 ppb or
greater, you must submit quantitative data. For acrolein, acrylonitrile, 2,4 dinitrophenol, and 2-methyl-4,6
dinitrophenol, you must submit quantitative data if any of these four pollutants is expected to be discharged
EPA Form 3510-2F (Rev. 1-92) I - 5
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in concentrations of 100 ppb or greater. For every pollutant expected to be discharged in concentrations less
than 10 ppb (or 100 ppb for the four pollutants listed above), then you must either submit quantitative data
or briefly describe the reasons the pollutant is expected to be discharged.
Small Business Exemption - If you are a "small business," you are exempt from the reporting requirements
for the organic toxic pollutants listed in Table 2F-3. There are two ways in which you can qualify as a "small
business". If your facility is a coal mine, and if your probable total annual production is less than 100,000 tons
per year, you may submit past production data or estimated future production (such as a schedule of esti-
mated total production under 30 CFR 795.14(c)) instead of conducting analyses for the organic toxic pollu-
tants. If your facility is not a coal mine, and if your gross total annual sales for the most recent three years
average less than $100,000 per year (in second quarter 1980 dollars), you may submit sales data for those
years instead of conducting analyses for the organic toxic pollutants. The production or sales data must be
for the facility which is the source of the discharge. The data should not be limited to production or sales for
the process or processes which contribute to the discharge, unless those are the only processes at your
facility. For sales data, in situations involving intracorporate transfer of goods and services, the transfer price
per unit should approximate market prices for those goods and services as closely as possible. Sales figures
for years after 1980 should be indexed to the second quarter of 1980 by using the gross national product
price deflator (second quarter of 1980=100). This index is available in National Income and Product Ac-
counts of the United States (Department of Commerce, Bureau of Economic Analysis).
Table 2F-4: For each outfall, list any pollutant in Table 2F-4 that you know or believe to be present in the
discharge and explain why you believe it to be present. No analysis is required, but if you have analytical
data, you must report them. Note: Under 40 CFR 117,l2(a)(2), certain discharges of hazardous substances
(listed at 40 CFR 177.21 or 40 CFR 302.4) may be exempted from the requirements of section 311 of CWA,
which establishes reporting requirements, civil penalties, and liability for cleanup costs for spills of oil and
hazardous substances. A discharge of a particular substance may be exempted if the origin, source, and
amount of the discharged substances are identified in the NPDES permit application or in the permit, if the
permit contains a requirement for treatment of the discharge, and if the treatment is in place. To apply for an
exclusion of the discharge of any hazardous substance from the requirements of section 311, attach addi-
tional sheets of paper to your form, setting forth the following information:
1. The substance and the amount of each substance which may be discharged.
2. The origin and source of the discharge of the substance.
3. The treatment which is to be provided for the discharge by:
a. An onsite treatment system separate from any treatment system treating your normal dis-
charge;
b. A treatment system designed to treat your normal discharge and which is additionally capable
of treating the amount of the substance identified under paragraph 1 above; or
c. Any combination of the above.
See 40 CFR 117.l2(a)(2) and (c), published on August 29, 1979, in 44 FR 50766, or contact your Regional
Office (Table 1 on Form 1, Instructions), for further information on exclusions from section 311.
Part VII-D
If sampling is conducted during more than one storm event, you only need to report the information re-
quested in Part VII-D for the storm event(s) which resulted in any maximum pollutant concentration reported
inPartVII-A, VII-B, orVII-C.
Provide flow measurements or estimates of the flow rate, and the total amount of discharge for the storm
event(s) sampled, the method of flow measurement, or estimation. Provide the data and duration of the storm
event(s) sampled, rainfall measurements, or estimates of the storm event which generated the sampled runoff
and the duration between the storm event sampled and the end of the previous measurable (greater than 0.1
inch rainfall) storm event.
Part VII-E
List any toxic pollutant listed in Tables 2F-2, 2F-3, or 2F-4 which you currently use or manufacture as an
intermediate or final product or byproduct. In addition, if you know or have reason to believe that 2,3,7,8-te-
trachlorodibenzo-p-dioxin (TCDD) is discharged or if you use or manufacture 2,4,5-trichlorophenoxy acetic
EPA Form 3510-2F (Rev. 1 -92) 1 - 6
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acid (2,4,5,-T); 2-(2,4,5-trichlorophenoxy) propanoicacid (Silvex, 2,4,5,-TP); 2-(2,4,5-trichlorophenoxy) ethyl,
2,2-dichloropropionate (Erbon); O,O-dimethyl O-(2,4,5-trichlorphenyl) phosphorothioate (Ronnel); 2,4,5-
trichiorophenol (TCP); or hexachlorophene (HCP); then list TCDD. The Director may waive or modify the
requirement if you demonstrate that it would be unduly burdensome to identify each toxic pollutant and the
Director has adequate information to issue your permit. You may not claim this information as confidential;
however, you do not have to distinguish between use or production of the pollutants or list the amounts.
Item VIM
Self explanatory. The permitting authority may ask you to provide additional details after your application is
received.
ItemX
The Clean Water Act provides for severe penalties for submitting false information on this application form.
Section 309(c)(4) of the Clean Water Act provides that "Any person who knowingly makes any false material
statement, representation, or certification in any application,... shall upon conviction, be punished by a fine
of not more than $10,000 or by imprisonment for not more than 2 years, or by both. If a conviction of such
person is for a violation committed after a first conviction of such person under this paragraph, punishment
shall be by a fine of not more than $20,000 per day of violation, or by imprisonment of not more than 4 years,
or by both." 40 CFR Part 122.22 requires the certification to be signed as follows:
(A) For a corporation: by a responsible corporate official. For purposes of this section, a responsible
corporate official means (i) a president, secretary, treasurer, or vice-president of the corporation in
charge of a principal business function, or any other person who performs similar policy- or decision-
making 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 as-
signed or delegated to the manager in accordance with corporate procedures.
Note: EPA does not require specific assignments or delegation of authority to responsible corporate
officers identified in 122.22(a)(1)(i). The Agency will presume that these responsible corporate officers
have the requisite authority to sign permit applications unless the corporation has notified the Director to
the contrary. Corporate procedures governing authority to sign permit applications may provide for
assignment or delegation to applicable corporate position under 122.22(a)(1)(ii) rather than to specific
individuals.
(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).
EPA Form 3510-2F (Rev. 1-92) | . 7
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Table 2F-1
Codes for Treatment Units
Physical Treatment Processes
1-A
1-B
1-C
1-D
1-E
1-F
1-G
1-H
1-1
1-J
1-K
1-L
2-A
2-8
2-C
2-D
2-E
2-F
3-A
3-P
3-C
3-D
4-A
4-B
5-A
5-B
5-C
5-D
5-E
5-F
5-G
5-H
5-I
5-J
5-K
5-L
Ammonia Stripping
Dialysis
Diatomaceous Earth Filtration
Distillation
Electrodialysis
Evaporation
Rocculation
Rotation
Foam Fractionation
Freezing
Gas-Phase Separation
Grinding (Comminutors)
Carbon Adsorption
Chemical Oxidation
Chemical Precipitation
Coagulation
Dechiorination
Disinfection (Chlorine)
Activated Sludge
Aerated Lagoons
Anaerobic Treatment
Nitrification-Denitrification
1-M Grit Removal
1-N Microstraining
1-O Mixing
1-P Moving Bed Rlters
1-Q Multimedia Rltration
1-R Rapid Sand Rltration
1-S Reverse Osmosis (Hyperfiltration)
1-T Screening
1-U Sedimentation (Setting)
1-V Slow Sand Rltration
1-W Solvent Extraction
1-X Sorption
Chemical Treatment Processes
2-G Disinfection (Ozone)
2-H Disinfection (Other)
2-I Electrochemical Treatment
2-J Ion Exchange
2-K Neutralization
2-L Reduction
Biological Treatment Processes
3-E Pre-Aeration
3-F Spray Irrigation/Land Application
3-G Stabilization Ponds
3-H Trickling Rltration
Other Processes
4-C
4-D
Discharge to Surface Water
Ocean Discharge Through Outfall
Sludge Treatment and Disposal
Aerobic Digestion 5-M
Anaerobic Digestion 5-N
Belt Filtration 5-0
Centrifugation 5-P
Chemical Conditioning 5-Q
Chlorine Treatment 5-R
Composting 5-S
Drying Beds 5-T
Elutriation 5-U
Flotation Thickening 5-V
Freezing 5-W
Gravity Thickening
Reuse/Recycle of Treated Effluent
Underground Injection
Processes
Heat Drying
Heat Treatment
Incineration
Land Application
Landfill
Pressure Rltration
Pyrolysis
Sludge Lagoons
Vacuum Rltration
Vibration
Wet Oxidation
EPA Form 3510-2F (Rev. 1-92)
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Table 2F-2
Conventional and Nonconventional Pollutants
Bromide
Chlorine, Total Residual
Color
Fecal Coliform
Fluoride
Nitrate-Nitrite
Nitrogen, Total Organic
Oil and Grease
Phosphorus, Total
Radioactivity
Sulfate
Sulfite
Surfactants
Aluminum, Total
Barium, Total
Boron, Total
Cobalt, Total
Iron, Total
Magnesium, Total
Molybdenum, Total
Manganese, Total
Tin, Total
Titanium, Total
EPA Form 3510-2F (Rev. 1-92)
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Antimony, Total
Arsenic, Total
Beryllium, Total
Cadmium, Total
Chromium, Total
Acrolein
Acrylonitrile
Benzene
Bromoform
Carbon Tetrachloride
Chlorobenzene
Ctilorodibromomethane
Chloroethane
2-Chloroethylvinyl Ether
Chloroform
2-Chlorophenol
2,4-Dichlorophenol
2,4-Dimethylphenol
4,6-Dinitro-O-Cresol
Acenaphthene
Acenaphthylene
Anthracene
Benzidine
Benzo(a)a*;hracene
Benzo(a)pyr.ene
3,4-Benzofluoranthene
Benzo(ghi)perylene
Benzo(k)fluoranthene
Bis(2-chloroethoxy)methane
Bis(2-chloroethyl)ether
Bis(2-chloroisopropyl)ether
Bis(2-ethy!yhexyl)phthalate
4-Bromophenyl Phenyl Ether
Butylbenzyl Phthalate
Aldrin
Alpha-BHC
Beta-BHC
Gamma-BHC
Delta-BHC
Chlordane
4,4'-DDT
4,4'-DDE
4,4'-DDD
Table 2F-3
Toxic Pollutants
Toxic Pollutants and Total Phenol
Copper, Total
Lead, Total
Mercury, Total
Nickel, Total
Selenium, Total
GC/MS Fraction Volatites Compounds
Dichlorobromomethane
1,1-Dichloroethane
1,2-Dichloroethane
1,1 -Dichloroethylene
1,2-Dichloropropane
1,3-Dichloropropylene
Ethylbenzene
Methyl Bromide
Methyl Chloride
Methylene Chloride
Acid Compounds
2,4-Dinitrophenol
2-Nitrophenol
4-Nitrophenol
p-Chloro-M-Cresol
Base/Neutral
2-Chloronaphthalene
4-Chlorophenyl Phenyl Ether
Chrysene
Dibenzo(a,h)anthracene
1,2-Dichlorobenzene
1,3-Dichlorobenzene
1,4-Dichlorobenzene
3,3'-Dichlorobenzidine
Diethyl Phthalate
Dimethyl Phthalate
Di-N-Butyl Phthalate
2,4-Dinitrotoluene
2,6-Dinitrotoluene
Di-N-Octylphthalate
1,2-Diphenylhydrazine (as Azoben-
zene)
Pesticides
Dieldrin
Alpha-Endosulfan
Beta-Endosulfan
Endosulfan Sulfate
Endrin
Endrin Aldehyde
Heptachlor
Heptachlor Epoxide
PCB-1242
Silver, Total
Thallium, Total
Zinc, Total
Cyanide, Total
Phenols, Total
1,1,2,2,-Tetrachloroethane
Tetrachloroethylene
Toluene
1,2-Trans-Dichloroethylene
1,1,1 -Trichloroethane
1,1,2-Trichloroethane
Trichioroethylene
Vinyl Chloride
Pentachlorophenol
Phenol
2,4,6-Trichlorophenol
2-methyl-4,6 dinitrophenol
Ruroranthene
Ruorene
Hexachlorobenzene
Hexachlorobutadiene
Hexachloroethane
lndeno(1,2,3-cd)pyrene
Isophorone
Napthalene
Nitrobenzene
N-Nitrosodimethylamine
N-Nitrosodi-N-Propylamine
N-Nitrosodiphenylamine
Phenanthrene
Pyrene
1,2,4-Trichlorobenzene
PCB-1254
PCB-1221
PCB-1232
PCB-1248
PCB-1260
PCB-1016
Toxaphene
EPA Form 3510-2F (Rev. 1-92)'
1-10
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Table 2F-4
Hazardous Substances
Asbestos
Acetaldehyde
Allyl alcohol
Allyl chloride
Amyl acetate
Aniline
Benzonitrile
Benzyl chloride
Butyl acetate
Butylamine
Carbaryl
Carbofuran
Carbon disulfide
Chlorpyrifos
Coumaphos
Cresol
Crotonaldehyde
Cyclohexane
2,4-D (2,4-Dichlorophenoxyacetic
acid)
Diazinon
Dicamba
Dichlobenil
Dichlone
2,2-Dichloropropionic acid
Dichlorvos
Diethyl amine
Dimethyl amine
Toxic Pollutant
Hazardous Substances
Dinitrobenzene
Diquat
Disulfoton
Diuron
Epichlorohydrin
Ethion
Ethylene diamine
Ethylene dibromide
Formaldehyde
Furfural
Guthion
Isoprene
Isopropanolamine
Kelthane
Kepone
Malathion
Mercaptodimethur
Methoxychlor
Methyl mercaptan
Methyl methacrylate
Methyl parathion
Mevinphos
Mexacarbate
Monoethyl amine
Monomethyl amine
Naled
Napthenic acid
Nitrotoluene
Parathion
Phenolsulfonate
Phosgene
Propargite
Propylene oxide
Pyrethrins
Quinoline
Resorcinol
Stronthium
Strychnine
Styrene
2,4,5-T (2,4,5-Trichlorophenoxyacetic
acid)
IDE (Tetrachlorodiphenyl ethane)
2,4,5-TP [2-(2,4,5-Trichlorophenoxy)
propanoic acid]
Trichlorofan
Triethylamine
Trimethylamine
Uranium
Vanadium
Vinyl acetate
Xylene
Xylenol
Zirconium
U. S. Government Printing Office: 1992 - 617-003 (47058)
EPA Form 3510-2F (Rev. 1-92)
I - 11
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