EPA/FORMS 3510-1/3510-3
                  lates
                  lental Protection
Office of Water and
Hazardous Waste
Washington, DC 20460
EPA Forms 3510-1 and 3510-3
June 1980
              Solid Waste
              Application for a Hazardous
              Waste Permit

              Consolidated Permits Program
                 This package contains Part A of the application for an EPA
                 hazardous waste permit.

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**•/
a
               UNITED STATES ENVIRONMENTAL PROTECTION AGENCY

          0<                   WASHINGTON, D.C.  20460
       •

                                   JUNE 13, 1980
                                                     THE ADMINISTRATOR
;j            Enclosed are the application forms and  instructions  for
        a Federal permit to treat, store, or dispose of hazardous
-       waste.

             The Resource Conservation and Recovery  Act (RCRA)  requires
Y^      anyone who owns or operates a facility where hazardous  waste
•       is treated, stored, or disposed to have a permit.   RCRA
•J       establishes a procedure for obtaining interim status which
Q       allows existing facilities to continue operating until  a
0       final hazardous waste permit is issued.  In  order to obtain
•—.       interim status, existing facilities must complete a two step
—       process.   The first step is the submittal of a Notification of
'       Hazardous Waste Activity form.  Copies of this form were
0       mailed in mid-June.  You probably already have a form and
        are reminded that it must be submitted by August 18, 1980.
        If you need a form, please contact the EPA Regional Office
        which serves your area.  The second step is  to submit the
        permit application forms included in this package by November
        19, 1980.  If you do not file a notification form and complete
        the permit application on time, you will be  required by law
        to halt your operations until a permit is issued.

             EPA is identifying hazardous waste in several stages.
        The first set of hazardous waste was identified and listed
        in regulations published in the May 19, 1980 Federal Register.
        Applications covering these wastes are due by November  19,
        1980.  In June, EPA will publish an additional set of
        hazardous wastes;  a list of these wastes was included in the
        May 19 Federal Register and in the instruction package  for
        the Notification of Hazardous Waste Activity form.  Applica-
        tions covering these wastes are required in  December.   If
        you treat, store,  or dispose of wastes included in this
        second set of hazardous wastes you are encouraged to include
        those hazardous wastes in the application which is due  by
        November 19, in order to eliminate the need  for filing  two
        separate permit applications.
                                      (1]

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     Copies of the EPA regulations which were published on
May 19 may be obtained by contacting:

     Mr. Ed Cox
     Solid Waste Publications
     26 W. St. Claire Street
     Cincinnati, Ohio  45268
     (513) 684-5362

    There are two parts to a RCRA permit application - Part A
and Part B.  Part A consists of Form 1 and Form 3 of EPA's
Consolidated Permit Application.  These forms are contained
in this package and must be submitted by November 19, 1980.

    Part B of the RCRA permit application contains detailed,
site-specific information.  The Part B information requirements
have not yet been fully developed.  We expect to publish the
full set of Part B information requirements next October or
November.  Part B of the permit application will not have to
be submitted until it is requested by EPA.  You will then
have up to six months to submit that part of the application.
Given the large number of existing treatment, storage, and
disposal facilities, we expect it will take at least several
years before all Part B's will be requested.

     Owners and operators of existing hazardous waste treatment,
storage, and disposal facilities who file both their notification
and Part A of their permit application on time will be sent an
acknowledgement that EPA has received these documents.  The
acknowledgement will include the facility's EPA Identification
Number. This number must be used on shipping manifests for
transporting hazardous waste, on Annual Reports, and on all
other correspondence with EPA.

    Because thousands of persons will be filing permit appli-
cations, it will take four to eight weeks for the Agency to
issue acknowledgements.  If you do not receive an acknow-
ledgement within eight weeks after your application is submit-
ted, you  should contact the appropriate EPA Regional Permit
Contact listed in the enclosed instruction sheets entitled
"How To Apply for a RCRA Permit."

    Several State governments have permit requirements similar
to EPA's.  Even if you have a State hazardous waste permit
you must file a RCRA permit application with EPA if you own
or operate a  facility where hazardous waste is treated, stored,
or disposed.
                              (2)

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    The enclosed instruction sheets show the specific steps
on how to apply for a RCRA permit.  if after reading the
instructions you have any questions regarding the permit
application process, please contact the EPA Regional Permit
Contact in your area for assistance.
Enclosures
                               (3)

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                                                 HOW TO APPLY FOR A RCRA PERMIT
Who Must File a RCRA Permit Application

The Resource Conservation -and Recovery  Act of 1976 (RCRA) re-
quires  each person owning  or operating a facility for the treatment,
storage, or disposal of hazardous waste to have a permit. This includes
individuals, trusts, firms, joint stock companies, corporations (including
government corporations), partnerships, associations,  States,  munici-
palities, commissions, interstate bodies and Federal Agencies.  If you
treat, store, or dispose of  hazardous waste without obtaining a permit,
you may be subject to civil or criminal penalty.
How to Determine if you Handle Hazardous Waste

OFF—SITE  FACILITIES. Owners and operators of off—site treatment,
storage, or disposal facilities are encouraged to  obtain waste informa-
tion from the generators they  serve. If the generators will not supply
this information, you are still responsible for determining if you handle
a hazardous waste  and should follow the procedures below for on—site
facilities.

ON—SITE  FACILITIES. Solid  waste generators who treat, store,  or
dispose of their  own waste on—site should follow the following proce-
dures for determining if their waste is a hazardous waste. This determin-
ation is made as follows:

  A. First, determine  if the solid waste handled is excluded from regul-
  ation  as a hazardous waste. The list  of exclusions can  be  found  in
  the  regulation  titled "Identification and  Listing of Hazardous Waste",
  Sections 261.4 and 261.5 published  in  the "Federal Register," May
  19,  1980.  If the  solid waste handled is excluded, a RCRA hazardous
  waste permit is not needed to treat, store, or dispose of these wastes.

  B. If the solid waste handled is  not  excluded by Sections 261.4  or
  261.5, determine if the waste is listed in Subpart D of "Identification
  and Listing of  Hazardous Waste." Persons  owning or operating facili-
  ties where listed hazardous waste is treated, stored, or  disposed are
  subject to  regulation  and must  file  a  RCRA  permit application.

  C. If the waste handled is not listed in Subpart D of "Identification
  and Listing of Hazardous Waste,"  the waste may still  be  hazardous
  because it possesses certain characteristics or contains certain contam-
  inants. These  characteristics and contaminants are  contained  in
  Subpart C  of  "Identification and Listing  of  Hazardous Waste." A
  determination  that a waste possesses these characteristics or contam-
  inants may be made either  based on:  (1) Your knowledge of the
  hazard characteristic of the waste in light of the materials or the pro-
  cesses used; or (2)  The results of testing the waste according to the
  methods  in Subpart C of "Identification and Listing of Hazardous
  Waste."

Certain persons who handle hazardous waste are  not required to obtain
a RCRA permit. They are:

  Generators who  accumulate their own hazardous waste on—site for
  less than 90 days as provided in 40 CFR 262.34;

  Farmers who dispose of hazardous waste pesticide from their own use
  as provided in 40 CFR 262.51; and

  Owners and operators  of  totally enclosed treatment facilities as de-
  fined in 40 CFR  260.10.
What Information Should be Filed and When

There  are  two parts to the  RCRA  permit  application  — Part A and
Part B. Part A consists of Form 1 and Form 3 of EPA's Consolidated
Permit Application.  Part B requires  detailed site—specific information
such as geologic,  hydrologic, and engineering data.  40 CFR  122.25
specifies the  information that will be  required from  hazardous waste
management facilities in Part B.

RCRA established a procedure for  obtaining "interim  status" which
allows existing  hazardous  waste  management facilities to  continue
their operations until a final hazardous waste permit is issued. In order
to qualify  for interim  status, owners and operators of existing hazard-
ous waste management facilities must complete and sign both Forms 1
and 3  and submit them  to  EPA by  November 19, 1980. In  order for
an existing facility to receive a permit, a complete Part  B must be sub-
mitted within six months after it is requested by EPA.  For new facili-
ties, both  Part A and Part B must  be submitted to EPA at  least 180
days before physical  construction is expected to commence.
Operation During Interim Status

As  provided  in 40  CFR 122.23(b),  Part A of the permit application
defines  the processes to be used for treatment, storage, and  disposal
of  hazardous wastes; the design capacity  of  such processes;  and the
specific hazardous wastes to be handled at  a facility during the interim
status period. Once Part A is submitted to  EPA, changes in the hazard-
ous wastes handled, changes in design of facilities, changes in processes,
and changes  in ownership or operational control  at  a  facility during
the interim status period may only be made in accordance with the
procedures in 40 CFR 122.23(c).  Changes  in  design capacity  and
changes in  processes require prior EPA approval. Changes in the quanti-
ty  of waste  handled at a facility during interim  status can be made
without  submitting a revised Part A provided the quantity does not
exceed the design capacities of the processes specified in Part A of the
permit application.  Failure to furnish all information required to pro-
cess a permit application  is grounds for termination of  interim status.
How Many Applications Should be Filed

You need submit only  one RCRA  permit  application (Part A and
Part B)  per site or location, provided that you describe all of the activi-
ties at that site or location. If you conduct hazardous waste activityf/es^
at more than one site or location, you must submit a separate applica-
tion for each site or location.
Where to File

Permit applications should  be sent  to the EPA Regional office that
serves the  area where your  hazardous waste management facility  is
located. If  you previously received a notification packet from EPA that
contains two preaddressed mailing labels and two envelopes, you should
use one of  the mailing labels and one of the envelopes to send your per-
mit application to EPA. If you do not have a preaddressed mailing la-
bel,  mail your permit application to the EPA Regional  office that
serves the area where your hazardous waste management facility is lo-
cated. The mailing addresses  for the EPA Regional offices are listed on
the following page.
                                                                     (4)

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         REGIONAL MAILING ADDRESSES AND PERMIT CONTACTS UP TO NOVEMBER 19, 1980
EPA
REGION
   III
   IV
   VI
   VII
   VIII
   IX
                 AREA SERVED
                 Connecticut, Maine
                 Massachusetts,
                 Rhode Island,
                 Vermont, New Hampshire

                 New Jersey, New York,
                 Virgin Islands, Puerto Rico
Delaware, District of
Columbia, Maryland,
Pennsylvania, Virginia-,
West Virginia

Alabama, Florida,
Georgia, Kentucky,
Mississippi, North Carolina,
South Carolina, Tennessee

Illinois, Indiana,
Michigan, Minnesota,
Ohio, Wisconsin
                 Arkansas, Louisiana,
                 New Mexico, Oklahoma,
                 Texas
                 Iowa, Kansas,
                 Missouri, Nebraska
                 Colorado, Montana,
                 North Dakota,
                 South Dakota, Utah,
                 Wyoming
                 Arizona, California,
                 Hawaii, Nevada, Guam,
                 American Samoa,
                 Commonwealth of the
                  Northern Marianas

                 Alaska, Idaho, Oregon,
                 Washington
                                PERMIT APPLICATION
                                MAILING ADDRESSES'
EPA Region I
Permits Branch
P.O. Box 8748
Boston, MA 02114

EPA Region II
Information Service Center
26 Federal Plaza
New York, NY 10007

EPA Region III
P.O. Box 1480
Philadelphia, PA 19107
EPA Region IV
RCRA Activities
345 Courtland, N.E.
Atlanta, GA 30308

EPA Region V
RCRA Activities
P.O. Box 7861
Chicago, IL 60680

EPA Region VI
Attn:  6AEP
1201 Elm Street
First International Bldg.
Dallas, TX 75270

EPA Region VII
P.O. Box 15606
Kansas City, MO 64106

EPA Region VIII
8AH-WM (ON)
1860 Lincoln Street
Denver,  CO 80295
                                EPA Region IX
                                Attn: A-3-2
                                215 Fremont Street
                                San Francisco, CA 94105
                                EPA Region X
                                M/S 530-A
                                1200 Sixth Avenue
                                Seattle, WA 98101
                                EPA REGIONAL HAZARDOUS
                                WASTE PERMIT CONTACTS2
                                                                Rich Cavagnero
                                                                (617) 223-0240
                                                                Harry Ruisi
                                                                (212) 264-0503
                                                                                 Shirley Bulkin
                                                                                 (215) 597-8751
                                                                                 Ray Cozart
                                                                                 (404)881-3446
Y. J. Kim
(800) 572-3176 (ID
(800) 621-3192 (IN, Ml, MN,
OH, Wl)

Fred Woods
(214) 767-2765
Dennis Degner
(800) 892-3837 (MO)
(800) 821-3714 (IA, KS, NE)

Jim Rakers
(303) 837-2221
(800) 332-3321 (CO)
(800) 525-3022 (MT, NO, SO,
 UT, WY)

Bill Wilson
(415) 556-1407
                                Betty Wiese
                                (206) 442-1260
                                (800) 542-0841 (WA)
                                (800) 426-0663 (AL, ID, OR)
1 These mailing addresses should be used for all applications filed by November 19, 1980. After November 19, all applications should be
mailed to the addresses listed in Table 1 in the instructions to Form 1 which are enclosed in this packet.

2 These persons should  be contacted if you need assistance in applying for a RCRA  Hazardous Waste Permit up to November 19, 1980.
After November 19, contact the persons listed in Table 1 in the instructions to Form 1 which are enclosed in this packet.
                                                      (5)

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                United States
                Environmental Protection
                Agency
                Office of
                Enforcement
                Washington, DC 20460
EPA Form 3510-1
June 1980
                Permits Division
oEPA
Application  Form  1 -  General
Information

Consolidated  Permits Program
                  This form must be completed by all persons applying for
                  a permit under EPA's Consolidated Permits Program. See
                  the general instructions to Form 1 to determine which
                  other application forms you will need.

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               DESCRIPTION OF CONSOLIDATED
                 PERMIT APPLICATION FORMS
                   FORM 1 PACKAGE
                 TABLE OF CONTENTS
The Consolidated Permit Application Forms are:

  Form 1 - General Information (includedin thispart);

  Form 2 — Discharges to Surface Water (NPDES Permits);

   2A. Publicly Owned Treatment Works (Reserved — not included In
   this package),

   2B. Concentrated Animal Feeding Operations and Aquatic Animal
   Production Facilities (not included in this package),

   2C. Existing Manufacturing, Commercial, Mining,  and Silvicultural
   Operations (not included in this package), and

   2D.  New  Manufacturing,  Commercial, Mining, and Silvicultural
   Operations (Reserved — not included in this package);

  Form  3 —  Hazardous Waste Application Form (RCRA  Permits —
  included in Part 2 of this package);

  Form  4 — Underground  Injection  of  Fluids (UIC Permits —  Re-
  served — not included in this package); and

  Form 5 — Air Emissions in  Attainment Areas  (PSD Permits —  Re-
  served — not included in this package).
Section A. General Instructions

Section B. Instructions for Form 1

Section C. Activities Which Do Not Require Permits

Section D. Glossary

Form 1 (two copies)
                                             SECTION A - GENERAL INSTRUCTIONS
Who Must Apply

With the exceptions described in Section C of these instructions. Fed-
eral laws prohibit you from conducting any of the following activities
without a permit.

NPDES (National Pollutant Discharge Elimination System  Under the
Clean Water Act, 33 U.S.C. 1251). Discharge of pollutants into the
waters of the United States.                           ,

RCRA (Resource Conservation and Recovery Act, 42 U.S.C.  6901).
Treatment, storage, or disposal of hazardous wastes.

UIC (Underground Injection Control Under the  Safe Drinking Water
Act, 42 U.S.C. 3001). Injection of fluids underground by gravity flow
or pumping.

PSD  (Prevention of Significant Deterioration Under the Clean Air
Act, 72 U.S.C. 7401). Emission of an air pollutant by a new or modi-
fied facility in or near an area which has attained the National Ambient
Air Quality Standards for that pollutant.

Each  of the above permit programs is operated in any particular State
by  either the United States Environmental  Protection Agency  (EPA)
or by an approved State agency. You must use this application form to
apply for a permit for those programs administered by EPA. For those
programs administered by approved States,  contact the State environ-
mental agency for the proper forms.

If you have any questions about whether you need a permit under any
of  the above programs, or if you  need information as to whether a
particular program  is administered by EPA or a State agency, or if you
need  to obtain  application  forms, contact your  EPA Regional office
(listed in Table 1).

Upon  your  request, and based upon  information supplied by you,
EPA  will determine whether you are required to obtain a permit for
a particular facility. Be sure to contact EPA if you  have a question,
because Federal laws provide that you may be heavily penalized  if
you do not apply for a permit when a permit is required.

Form 1 of the  EPA consolidated  application forms collects  general
information applying to all programs. You must fill out Form 1 regard-
less of which permit you are applying for. In addition, you must fill
out one of the  supplementary forms (Forms 2—5) for each permit
needed  under each  of  the  above programs.  Item  II of Form 1  will
guide you to the appropriate supplementary forms.

You should note that there are certain exclusions to the permit require-
ments listed above. The exclusions are described in detail in Section C
of these instructions. If your activities are  excluded from permit re-
quirements then you do not need to complete and return any forms.
  NOTE: Certain  activities not  listed above also  are subject to EPA
  administered environmental permit requirements. These include per-
  mits  for ocean  dumping,  dredged or  fill material discharging, and
  certain types of  air emissions. Contact  your EPA Regional office for
  further information.
Table 1. Addresses of EPA Regional Contacts and States Within the
Regional Office Jurisdictions

REGION I

  Permit Contact, Environmental and  Economic Impact Office, U.S.
  Environmental  Protection Agency, John F. Kennedy Building, Bos-
  ton, Massachusetts 02203, (617) 223-4635, FTS 223-4635.
   Connecticut,  Maine, Massachusetts, New Hampshire, Rhode Island,
   and Vermont.

REGION II

  Permit Contact, Permits Administration Branch,  Room 432, U.S.
  Environmental  Protection Agency, 26  Federal Plaza,  New  York,
  New York 10007, (212) 264-9880, FTS 264-9880.
   New Jersey, New York, Virgin Islands, and Puerto Rico.

REGION III

  Permit Contact (3 EN 23), U.S. Environmental Protection Agency,
  6th & Walnut Streets,  Philadelphia,  Pennsylvania 19106,  (215)
  597-8816, FTS 597-8816.
   Delaware,  District of Columbia, Maryland, Pennsylvania, Virginia,
   and West Virginia.

REGION IV

  Permit Contact,  Permits  Section,  U.S.  Environmental Protection
  Agency, 345 Courtland Street, N.E., Atlanta, Georgia 30365, (404)
  881-2017, FTS 257-2017.
   Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
   South Carolina, and Tennessee.

REGION V

  Permit Contact (SEP), U.S.  Environmental  Protection Agency, 230
  South Dearborn Street, Chicage,  Illinois 60604,  (312)  353—2105,
  FTS 353-2105.
   Illinois,  Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
                                                                  1-1

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                                       SECTION A - GENERAL INSTRUCTIONS (continued)
Tibia 1 (continued)

REGION VI

 Permit  Contact (6AEP),  U.S.  Environmental Protection  Agency,
 First International Building, 1201 Elm Street,  Dallas, Texas 75270,
 (214) 767-2765, FTS 729-2765.
   Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.

REGION VII

 Permit  Contact,  Permits  Branch, U.S.  Environmental  Protection
 Agency, 324 East 11th Street,  Kansas City, Missouri 64106, (816)
 758-5955, FTS 758-5955.
   Iowa, Kansas, Missouri, and Nebraska.

REGION VIM

 Permit  Contact (BE—WE). Suite 103, U.S. Environmental Protection
 Agency, 1816 Lincoln Street, Denver, Colorado 80203, (303) 837-
 4901, FTS 837-4901.
   Colorado,  Montana,  North  Dakota, South  Dakota,  Utah,  and
   Wyoming.

REGION IX

 Permit Contact, Permits Branch (E-4), U.S. Environmental Protection
 Agency,  215  Fremont Street, San  Francisco,  California  94105,
 (415) 556-3450, FTS 556-3450.
   Arizona, California, Hawaii, Nevada, Guam, American Samoa, and
   Trust Territories.

REGION X

 Permit  Contact (M/S 621), U.S. Environmental Protection Agency,
 1200 6th Avenue, Seattle, Washington  98101,   (206)  442-7176,
 FTS 399-7176.
   Alaska, Idaho, Oregon, and Washington.
Where to File

The  application  forms should be mailed to the EPA Regional office
whose Region includes the State in which the facility is located (see
Table 1).

If the State in which the facility is located administers a Federal permit
program under which you need a permit, you should contact the appro-
priate State agency for the correct forms. Your EPA Regional office
(Teble II  can tell  you to whom to apply and can provide the appro-
priate address and phone number.
When to File

Because of statutory requirements, the deadlines for filing applications
vary according to the type of facility you operate and the type of per-
mit you need. These deadlines are as follows:1
Table 2. Filing Date* for Permits

   fORMtpermit)  	
WHEN TO FILE
  2A(NPDES)	180 days before your present NPDES per-
                         mit expires.
  2B(NPDES)	180 days before your present NPDES per-
                         mit  expires*, or 180 days prior to start-
                         up if you are a new facility.
  IC(NPDES)	180 days before your present NPDES per-
                         mit expires*.
  2D(NPD£S)	180 days prior to startup.
  ^Hazardous Waste).  . .  .Existing  facility:  Six  months  following
                         publication  of regulations listing  hazard-
                         ous wastes.
                        New facility: 180 days before commencing
                         physical construction.
                                    Table 2 (continued)

                                     4(UIC)	A  reasonable  time prior  to construction
                                                             for new wells; as directed by the Director
                                                             for existing wells.
                                     5(PSD)	Prior  to commencement of construction.

                                     1 Please  note that some of these forms are  not yet available for use
                                     and are listed as  "Reserved" at the beginning of these instructions.
                                     Contact your EPA Regional  office for information on current appli-
                                     cation requirements and forms.

                                     * If your present permit expires on or before November 30, 1980, the
                                     filing date is the  date on which your permit expires. If your permit
                                     expires during the period December 1, 1980— May 31, 1981, the fil-
                                     ing date is 90 days before your permit expires.

                                    Federal regulations provide that you may not begin to construct a
                                    new source in the NPDES program, a new hazardous waste management
                                    facility, a new injection well, or a facility covered by the PSD program
                                    before the  issuance of a  permit under the applicable program. Please
                                    note that if you are required to obtain a permit before beginning con-
                                    struction,  as  described  above, you may  need to submit your permit
                                    epplication well in advance of  an applicable deadline listed  in Table 2.
                                    The U.S. EPA does not require a fee for applying for any permit under
                                    the consolidated permit programs. (However, some States which ad-
                                    minister one or more of these programs require fees for the permits
                                    which they issue.)
                                    Availability of Information to Public

                                    Information contained in these application forms will, upon request,
                                    be made available to the public for inspection and copying. However,
                                    you may request confidential treatment for certain information which
                                    you submit  on  certain supplementary forms. The specific instructions
                                    for each supplementary  form state what information  on the form, if
                                    any, may be claimed as confidential and what procedures govern the
                                    claim. No information on Forms 1 and 2A through 2D may be claimed
                                    as confidential.
                                    Completion of Forms

                                    Unless otherwise specified in  instructions to the forms, each item  in
                                    each form must be answered. To indicate that each item has been con-
                                    sidered, enter "NA," for not  applicable, if a particular item does not
                                    fit  the  circumstances or characteristics  of your  facility or activity.

                                    If you have previously submitted information to EPA or to an approved
                                    State agency which answers a question, you may either  repeat the in-
                                    formation in the space provided or attach a copy of the previous sub-
                                    mission. Some items in the form require narrative explanation. If more
                                    space is necessary to answer a question, attach a separate sheet entitled
                                    "Additional Information."
Financial Assistance for Pollution Control

There are a number of direct loans, loan guarantees, and grants available
to firms and communities for pollution control expenditures. These are
provided by the Small Business Administration, the Economic Devel-
opment Administration,  the Farmers Home Administration, and the
Department  of  Housing and Urban Development.  Each EPA Regional
office (Table 1) has an economic assistance coordinator who can pro-
vide you with additional information.

EPA's construction grants program under Title II of the Clean Water
Act is an  additional source  of assistance to publicly owned treatment
works. Contact your EPA Regional office for details.
                                                                   1-2

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                                       SECTION B - FORM 1 LINE-BY-LINE INSTRUCTIONS
This form must be completed by all applicants.
Completing This Form

Please type or print in  the unshaded areas only. Some items have small
graduation marks in the fill—in spaces. These marks indicate the num-
ber of characters that may be entered into our data system. The marks
are spaced at 1/6" intervals which accommodate elite type (12charac-
ters per inch).  If you  use another type you may ignore the marks. If
you print, place each character between the marks. Abbreviate if neces-
sary to  stay within the number of characters allowed  for each item.
Use one space for breaks  between words,  but not for punctuation
marks unless they are needed to clarify your response.
Item I

Space is provided at the upper right hand corner of Form 1 for inser-
tion of your EPA Identification Number. If you have an existing facil-
ity, enter your Identification  Number. If you don't know your EPA
Identification Number, please contact your EPA Regional office (Table
1), which will provide you with your number. If your facility is new
(not yet constructed), leave this item blank.
Item II

Answer each question to determine which supplementary forms you
need to fill out. Be sure to check  the glossary in Section D of these
instructions for the legal definitions of the bold  faced words.  Check
Section C  of  these  instructions to determine whether your activity
is excluded from permit requirements.

If you answer "no" to every question, then you do not need a permit,
and you do not need to complete and return any  of  these  forms.

If you answer "yes" to any question, then  you must complete and file
the supplementary form  by the deadline listed in Table  2 along with
this form.  (The applicable form number follows each question  and is
enclosed in parentheses.)  You need not submit a supplementary form if
you already have  a permit  under  the appropriate Federal  program,
unless your permit is due to expire and you  wish to renew your permit.

Questions (I) and (J) of Item II refer to major new or modified sources
subject to  Prevention of  Significant Deterioration (PSD) requirements
under the Clean Air Act. For the purpose of the PSD program, major
sources are defined as: (A) Sources listed in Table 3 which have the po-
tential to emit 100 tons or more per year emissions; and  (B) All other
sources with the potential to  emit 250 tons or more per year. See
Section C of these instructions for discussion of exclusions of certain
modified sources.

Table 3. 28 Industrial Categories Listed in Section 169(1) of the Clean
Air Act of 1977

Fossil fuel—fired steam generators of more than 250 million BTU per
 hour heat input;
Coal cleaning plants (with thermal dryers);
Kraft pulp mills;
Portland cement plants;
Primary zinc smelters;
Iron and steel mill plants;
Primary aluminum  ore reduction plants;
Primary copper smelters;
Municipal incinerators capable of charging  more than 250 tons of re-
 fuse per day;
Hydrofluoric acid plants;
Nitric acid plants;
Sulfuric acid plants;
Petroleum refineries;
Lime plants;
Phosphate rock processing plants;
Coke oven batteries;
Sulfur recovery plants;
Carbon black plants (furnaceprocess);
Primary lead smelters;
Fuel conversion plants;
Sintering plants;
Secondary metal production plants;
Chemical process plants;
Fossil fuel  boilers  (or combination  thereof) totaling  more than  250
 million BTU per hour heat input;
 Table 3 (continued)

 Petroleum storage and  transfer units  with a total  storage capacity
  exceeding 300,000 barrels;
 Taconite ore processing plants;
 Glass fiber processing plants; and
 Charcoal production plants.
 Item III

 Enter  the facility's official or legal  name. Do not use a colloquial
 name.
 Item IV

 Give the name, title, and work telephone number of a person who is
 thoroughly familiar with the operation of the facility and with the facts
 reported in this application and who can be contacted by reviewing
 offices if necessary.
Item V

Give the complete mailing address of the office where correspondence
should be sent. This often is not the address used to designate the lo-
cation of the facility or activity.
 Item VI

 Give the address or location of the facility identified in Item III of this
 form. If  the facility lacks a street name or route number, give the most
 accurate alternative  geographic  information  (e.g., section number or
 quarter section number from county records or at intersection of ftts.
 425 and 22).
 Item VII

 List, in descending  order of  significance, the four 4-digit standard
 Industrial  classification  (SIC)  codes which best describe your facility
 in terms of the principal products or services you produce or provide.
 Also, specify each classification in words. These classifications may dif-
 fer from  the  SIC codes describing the operation generating the dis-
 charge, air emissions, or  hazardous wastes.

 SIC  code  numbers are descriptions which  may be found in the  "Stan-
 dard Industrial Classification Manual"  prepared by the Executive Of-
 fice  of the President,  Office of  Management and Budget, which  is
 available  from the  Government  Printing Office,  Washington, D.C.
 Use  the current edition  of the manual. If you have any questions con-
 cerning the appropriate SIC code for your facility, contact your EPA
 Regional office (see Table 1).
Item VI11-A

Give the name,  as it  is legally referred to, of the person, firm, public
organization, or  any other entity which operates the facility described
in this application. This may or may not be the same name as the fa-
cility. The operator of the  facility is  the legal entity which controls
the facility's operation rather than the plant or site manager. Do not
use a colloquial name.
Item VIII-B

Indicate  whether the entity which operates the facility also owns it
by marking the appropriate box.
Item VIII- C

Enter the appropriate letter to indicate the legal status of the operator
of the facility. Indicate "public" for a  facility solely owned by local
government^ such as a city, town, county, parish, etc.
Items VIII-D - H

Enter the telephone number and address of the operator identified in
ItemVIII-A.
                                                                    1-3

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                                 SECTION B - FORM 1 LINE-BY-LINE INSTRUCTIONS (continued)
Item IX

Indicate whether the facility is located on Indian Lands.


lt«mX

Give the number of each presently effective  permit  issued to the fa-
cility for each program or, if you have previously filed an application
but have not yet received a permit, give the number of the application,
if any. Fill in the unshaded area only. If you  have more than  one cur-
rently effective permit for your facility under a particular permit pro-
gram, you  may list additional permit numbers on a  separate  sheet of
paper. List any relevant environmental Federal (e.g., permits under the
Ocean Dumping Act, Section 404 of the Clean  Water Act or the Surface
Mining Control and Reclamation Act), State (e.g.. State permits for
new air emission sources in  nonattainment areas under Part D of the
Clean Air Act or State permits under Section 404 of the Clean Water
Act), or local permiti or application* under "other."


Item XI

Provide a topographic map or maps of  the area extending at least to
one mile beyond the property boundaries  of the facility which clearly
show the following:

  The legal boundaries of the facility;

  The location and serial number of each of your existing and proposed
  intake and discharge structures;

  All hazardous waste  management facilities;

  Each well where you inject fluids underground; and

  All  springs and surface water bodies in the area,  plus all  drinking
  water wells within 1/4 mile of the facility which are identified in the
  public record or otherwise known to you.

If an intake or discharge structure,  hazardous waste disposal site, or
Injection well associated with the facility is located more than  one mile
from the plant, include it on the map, if possible. If not, attach  addi-
tional sheets describing the  location of the structure, disposal site, or
well, and identify the U.S.  Geological Survey (or other) map corres-
ponding to the location.

On each  map, include the map scale, a meridian arrow  showing north,
and  latitude and longitude at the nearest whole second. On all maps of
rivers, show the direction of the current, and  in tidal waters, show the
directions of the ebb and flow tides. Use a  7-1/2 minute series map
published  by the U.S.  Geological  Survey,  which  may be obtained
through  the  U.S.  Geological Survey  Offices  listed  below. If a 7-1/2
minute series map has not been published for your  facility site, then
you may use a 15 minute series map from the U.S. Geological Survey.
If neither a 7-1/2 nor 16 minute series map has been published for your
facility site, use a plat map or other appropriate map, including all the
requested  information; in this  case, briefly describe land uses in the
map area (e.g., residential, commercial).

You may trace your map from a geological survey chart, or other map
meeting the above specifications. If  you do,  your map should bear a
note showing the number or title  of the  map or chart it was traced
from. Include the names of nearby  towns,  water bodies, and other
prominent points. An example of an acceptable location map  is shown
in Figure 1—1 of these instructions. (NOTE: Figure  1—1 Is provided for
purposes of  illustration  only, and does not represent any actual fa-
cility.)
  U.S.G.S. OFFICES
AREA SERVED
  Eastern Mapping Center
  National Cartographic Information
   Center
  U.S.G.S.
  636 National Center
  Reston, Va. 22092
  Phone No. (703) 860-6336
Ala., Conn.,  Del., D.C.,  Fla.
 Ga., Ind., Ky.,  Maine,  Md.
 Mass.,  N.H.,  N.J., N.Y., N.C.
 S.C., Ohio, Pa., Puerto Rico
 R.I., Tenn.,  Vt., Va., W. Va.
 and Virgin Islands.
                                     Item XI (continued)

                                       Mid Continent Mapping Center
                                       National Cartographic Information
                                       Canter
                                       U.S.G.S.
                                       1400 Independance Road
                                       Rolla, Mo. 65401
                                       Phone No. (314) 341-0851

                                       Rocky Mountain Mapping Center
                                       National Cartographic Infomation
                                       Center
                                       U.S.G.S.
                                       Stop 504, Box 25046 Federal Center
                                       Denver, Co. 80225
                                       Phone No. (303) 234-2326

                                       Western Mapping Center
                                       National Cartographic Information
                                       Center
                                       U.S.G.S.
                                       346 Middlefield Road
                                       Menlo Park, Ca. 94025
                                       Phone No. (415) 323-8111
                                     Ark.,  III.,  Iowa,  Kans., La.,
                                      Mich.,  Minn.,   Miss.,   Mo.,
                                      N. Dak., Nebr., Okla., S. Dak.,
                                      and Wis.
                                     Alaska, Colo., Mont., N. Mex.,
                                     Tex., Utah, and Wyo.
                                     Ariz.,  Calif.,  Hawaii,  Idaho,
                                      Nev., Oreg., Wash., American
                                      Samoa,   Guam,  and  Trust
                                      Territories
                                     Item XII

                                     Briefly describe the nature of your business (e.g., products produced
                                     or services provided).
Item XIII

Federal statues provide for severe penalties for submitting false inform-
ation on this application form.

18 U.S.C. Section  1001 provides that "Whoever, in any matter within
the jurisdiction of any department or agency  of the United States
knowingly and willfully falsifies, conceals or covers up  by any trick,
scheme, or device  a  material  fact,  or makes or uses any false writing
or document knowing  same to contain any false, fictitious or fraudu-
lent statement or entry, shall  be fined not more than $10,000 or im-
prisoned not more than five years, or both."

Section 309(c)(2) of the Clean Water Act and Section 113(c)(2) of the
Clean -Air Act each provide that "Any person who knowingly makes
any false  statement, representation, or certification  in any applica-
tion, .  . . 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."

In addition. Section 3008(d)(3) of  the Resource Conservation and Re-
covery Act provides for a fine  up to $25,000 per day or imprisonment
up to one year, or both, for a  first conviction for making a false state-
ment in any application under the  Act, and for double these penalties
upon subsequent convictions.

FEDERAL REGULATIONS REQUIRE THIS APPLICATION TO BE
SIGNED AS FOLLOWS:

  A. For a corporation, by a principal executive officer of  at least the
  level  of vice president. However,  if the only activity in  Item II which
  is marked "yes"  is Question G, the  officer may authorize a person
  having responsibility  for the overall operations of the well or well
  field  to sign the certification. In that case, the authorization must be
  written and submitted to the permitting authority.

  B. For partnership  or sole proprietorship, by a general partner or the
  proprietor, respectively; or

  C. For a municipality, State,  Federal,  or other public  facility, by
  either a principal executive officer or ranking elected official.
                                                                    1-4

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                                  SECTION C - ACTIVITIES WHICH DO NOT REQUIRE PERMITS
I.  National  Pollutant Discharge  Elimination  System Permits Under
the Clean Water Act. You are not'required to obtain an NPDES permit
if your discharge  is in one of the following categories, as provided by
the Clean  Water Act (CWA) and  by the NPDES regulations (40 CFft
Parts  122—125). However, under Section 510 of CWA a discharge ex-
empted from the  federal  NPDES requirements may  still  be regulated
by a State authority; contact your State environmental agency to de-
termine whether you need a State  permit.

 A. DISCHARGES FROM VESSELS. Discharges of seWage from ves-
 sels, effluent  from properly functioning  marine engines, laundry,
 shower, and galley sink wastes,  and any other discharge  incidental to
 the  normal operation of  a vessel  do not require  NPDES permits.
 However, discharges of rubbish, trash, garbage, or other such mater-
 ials discharged overboard require permits, and so do other discharges
 when the vessel  is  operating in  a capacity other than as a means of
 transportation, such as when the vessel is being used as  an energy or
 mining facility, a storage facility, or a seafood processing facility, or
 is secured to the bed of the ocean, contiguous zone, or waters of the
 United States for the purpose  of mineral  or oil exploration or de-
 velopment.

 B. DREDGED OR FILL MATERIAL. Discharges of dredged or fill
 material  into waters of the United States do not need NPDES permits
 if the dredging or filling is authorized by a permit issued by the U.S.
 Army Corps of  Engineers or an EPA  approved State under Section
 404 of CWA.

 C. DISCHARGES  INTO PUBLICLY OWNED TREATMENT WORKS
 (POTWj. The introduction of sewage, industrial wastes,  or other pol-
 lutants into a POTW does  not need  an NPDES permit.  You must
 comply  with  all  applicable pretreatment  standards   promulgated
 under Section 307(b) of CWA, which may  be included in the permit
 issued to the POTW. If you have a plan or an agreement to switch
 to a POTW in the future, this does not relieve you  of the obligation
 to apply for and receive an NPDES permit  until you  have stopped
 discharging pollutants into waters of the United States.

 (NOTE:  Dischargers into privately  owned treatment works do not
 have to apply for or obtain NPDES permits except as otherwise re-
 quired by the EPA Regional Administrator.  The owner or operator
 of the treatment works itself, however, must apply for a permit and
 identify  all users in its application. Users  so identified will receive
 public notice of actions taken on the permit for the treatment works.)

 D.  DISCHARGES FROM AGRICULTURAL AND SILVICULTUR-
 AL ACTIVITIES.  Most  discharges from agricultural and silviculture!
 activities to waters of the United States do not require NPDES per-
 mits. These include runoff from orchards, cultivated crops, pastures,
 range lands, and forest  lands. However, the discharges  listed below
 do require NPDES permits. Definitions of the terms listed below are
 contained in the  Glossary section of these instructions.

   1.  Discharges  from  Concentrated  Animal  Feeding  Operations.
   (See  Glossary  for definitions  of "animal  feeding operations" and
   "concentrated  animal feeding  operations." Only the latter require
   perm its. I

   2.  Discharges  from  Concentrated  Aquatic  Animal  Production
   Facilities. (See  Glossary for size cutoffs.)

   3.  Discharges  associated  with  approved  Aquaculture  Projects.

   4.  Discharges from Silviculture! Point Sources.  (See  Glossary  for
   the definition  of "silvicultural  point source.") Nonpoint  source
   silvicultural activities' are  excluded from  NPDES permit require-
   ments.  However, some of  these  activities, such as stream crossings
   for roads, may involve point  source discharges of dredged or fill
   material which may require a Section 404 permit.  See 33 CFR
   209.120.

 E. DISCHARGES  IN COMPLIANCE WITH  AN  ON-SCENE CO-
 ORDINATOR'S  INSTRUCTIONS.
 II.  Hazardous Waste  Permits Under the Resource Conservation and
 Recovery Act. You may be excluded from the requirement to obtain
 a permit  under  this program  if you fall  into one of the following
 categories:

  Generators who accumulate their  own hazardous waste on—site for
  less than 90 days as provided in 40 CFR 262.34;

  Farmers who dispose of hazardous waste pesticide from their own use
  as provided in 40 CFR  262.51;

  Certain  persons treating, storing, or disposing of small quantities of
  hazardous waste as provided in 40 CFR 261.4 or 261.5; and

  Owners  and operators of totally enclosed treatment facilities as de-
  fined in 40 CFR 260.10.

 Check with your Regional  office  for details. Please note that even if
 you are excluded from  permit requirements, you may be required by
 Federal regulations to handle your  waste in a particular manner.
III. Underground Injection Control Permits Under the Safe Drinking
Water Act. You are not required to obtain a permit under this program
if you:

  Inject into existing wells used to enhance recovery of oil and gas or
  to store hydrocarbons (note, however,  that these underground injec-
  tions are regulated by Federal rules); or

  Inject into or above a stratum which contains, within 1/4 mile of the
  well bore, an underground source of drinking water (unless your in-
  jection is the type identified in  Item II-H, for which you do need a
  permit). However, you must notify EPA of your injection and submit
  certain required information on  forms supplied by the Agency, and
  your operation may be phased out if you are a generator of hazardous
  wastes or  a  hazardous waste management facility which uses wells
  or septic tanks to dispose of hazardous waste.
IV. Prevention  of Significant Deterioration Permits Under the Clean
Air Act. The PSD program applies to newly constructed or modified
facilities (both of which are referred to as  "new sources") which in-
crease air emissions. The Clean Air Act Amendments of 1977 exclude
small new sources of air emissions from the  PSD review program. Any
new source in an  industrial category listed in Table 3 of these instruc-
tions whose potential to emit is less than 100 tons per year is not re-
quired to get a PSD permit. In addition, any new source in an industrial
category not listed in Table 3 whose potential to emit is less than 250
tons per year is exempted from the PSD requirements.

Modified sources  which increase their net  emissions (the difference
between  the total emission increases and total emission decreases at
the source) less than the significant amount set forth in EPA regulations
are also exempt from PSD requirements. Contact your  EPA Regional
office (Table 1) for further information.
                                                                  1-5

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                                                      SECTION D - GLOSSARY
NOTE: This Glossary includes terms used in the instructions and in Forms 1, 2B, 2C, and 3. Additional terms will be included in the
future when other forms are developed to reflect the requirements of other parts of the Consolidated Permits Program. If you have
any questions concerning the meaning of any of these terms, please contact your EPA Regional office (Table 1).
ALIQUOT means a sample of specified volume used to make up a total
composite sample.
ANIMAL FEEDING  OPERATION  means a lot or facility (other than
an aquatic animal production facility) where the following conditions
are met:

  A. Animals (other than aquatic animals) have been, are, or will be
  stabled or confined and fed or maintained for a total of 45 days or
  more in any 12 month period; and

  B. Crops, vegetation, forage growth, or post—harvest residues are not
  sustained in the normal growing season  over any portion of the lot
  or facility.

Two or  more  animal feeding operations under common ownership
are  a single animal feeding operation if they  adjoin  each  other or if
they use a common area or system for the disposal of wastes.
ANIMAL UNIT means a unit of measurement for any animal feeding
operation calculated by adding the following numbers: The number of
slaughter and feeder cattle multiplied by 1.0; Plus the number of ma-
ture dairy cattle multiplied by  1.4; Plus the number of swine weighing
over 25  kilograms (approximately 55pounds) multiplied by 0.4; Plus
the  number of sheep multiplied by  0.1; Plus the number of horses
multiplied by 2.0.
APPLICATION means the EPA standard national forms for applying
for a permit, including any additions, revisions, or modifications to the
forms; or forms approved by EPA for use in approved States, including
any approved modifications or revisions. For  RCRA, "application"
also means "Application, Part B."
APPLICATION,  PART A means that part of the Consolidated Permit
Application  forms which a  RCRA permit applicant must complete to
qualify for interim status under Section 3005(a) of RCRA and for con-
sideration for a  permit. Part A  consists of Form 1 (General Informa-
tion) and Form 3 (Hazardous Waste Application Form).
APPLICATION,  PART B means that part of the application which a
RCRA permit applicant must complete to be issued a permit. (NOTE:
EPA is not developing a specific form for Part B of the permit appli-
cation, but an instruction booklet explaining  what information mutt be
supplied is available from the EPA Regional office.)
APPROVED  PROGRAM or APPROVED STATE means a State  pro-
gram  which has been approved or authorized  by EPA under 40 CFR
Part 123.
AQUACULTURE PROJECT  means a  defined managed water area
which uses discharges of  pollutants into that designated area for the
maintenance  or  production  of harvestable freshwater,  estuarine, or
marine plants or animals.  "Designated area" means the portions of the
waters of the  United States within which the applicant  plans to con-
fine the cultivated species, using a method of plan or operation (includ-
ing, but not limited to, physical confinement) which, on the basis of
reliable scientific evidence, is expected to ensure the specific individual
organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants  and  be harvested within a
defined geographic area.
AQUIFER means a geological formation, group of formations, or part
of a formation that is capable of yielding a significant amount of water
to a well or spring.
AREA OF  REVIEW  means the area surrounding  an  injection well
which is described according to the criteria set forth in 40 CFR Section
146.06.
AREA PERMIT means a UIC permit applicable to all or certain wells
within a geographic area, rather than to a specified well, under 40 CFR
Section 122.37.
ATTAINMENT AREA means, for any air pollutant, an area which has
been designated  under  Section  107 of the Clean  Air Act as having
ambient air quality levels better than any national primary or secondary
ambient air quality standard for that pollutant. Standards have been set
for sulfur oxides, paniculate matter, nitrogen dioxide, carbon monox-
ide,  ozone,  lead, and hydrocarbons. For purposes of  the Glossary,
"attainment  area" also refers to "unclassifiable area," which means,
for any pollutants, an area  designated under Section 107 as unclassi-
fiable with  respect to that pollutant due to insufficient information.
BEST MANAGEMENT PRACTICES (BMP) means schedules of activi-
ties, prohibitions of practices, maintenance procedures, and other man-
agement practices to  prevent or reduce the pollution of waters of the
United States. BMP's  include treatment requirements, operation proce-
dures,  and practices  to control plant site runoff,  spillage or leaks,
sludge or waste disposal, or drainage from raw material storage.
BIOLOGICAL MONITORING TEST  means any test which includes
the use  of aquatic algal, invertebrate, or vertebrate species to measure
acute or chronic toxicity, and any  biological or chemical measure of
bioaccumulation.
BYPASS means the intentional diversion of wastes from any any por-
tion of a treatment facility.
CONCENTRATED ANIMAL FEEDING OPERATION means an animal
feeding operation which meets the criteria set forth in either (A) or (B)
below or which the  Director designates as such on a case—by—case
basis:

 A.  More than the numbers of animals specified in  any of the follow-
 ing categories are confined:

   1. 1,000 slaughter or feeder cattle,

   2. 700 mature dairy cattle (whether milked or dry cows),

   3. 2,500 swine each  weighing over  25 kilograms (approximately
   55 pounds),

   4. 500 horses,

   5, 10,000 sheep or lambs,

   6. 55,000 turkeys,

   7. 100,000 laying  hens or broilers (if the facility has a continuous
   overflow watering),

   8. 30,000 laying hens or broilers  (if the facility has a liquid manure
   handling system),

   9. 5,000 ducks, or

  10. 1,000 animal units; or

 B. More than the following numbers and types of animals are con-
 fined:

   1. 300 slaughter or feeder cattle,

   2. 200 mature dairy cattle (whether milked or dry cows),

   3. 750 swine each weighing over 25  kilograms (approximately 55
   pounds),

   4. 150 horses.
                                                                  1-6

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                                                SECTION D - GLOSSARY (continued)
CONCENTRATED ANIMAL FEEDING OPERATION (continued)

   5. 3,000 sheep or lambs,

   6. 16,500 turkeys,

   7. 30,000 laying  hens or  broilers (if the  facility has continuous
   overflow watering),

   8. 9,000 laying hens or broilers (if the facility has a liquid manure
   handling system),

   9. 1,500 ducks, or

  10. 300 animal units; AND

   Either one of  the following conditions are  met: Pollutants are dis-
   charged into waters of the  United States through a manmade ditch,
   flushing  system  or  other  similar manmade  device  ("manmade"
   means constructed by man and used for the purpose of transporting
   wastes);  or Pollutants are  discharged directly into waters of the
   Unites States which originate outside of and pass  over,  across, or
   through  the facility or otherwise come into direct contact with the
   animals confined in the operation.

   Provided, however, that  no animal feeding operation is  a concen-
   trated animal  feeding operation as defined above if such animal
   feeding operation discharges only in the event of a 25 year, 24 hour
   storm event.
CONCENTRATED  AQUATIC ANIMAL  PRODUCTION  FACILITY
means a hatchery, fish farm, or other facility which contains, grows.or
holds aquatic animals in either of the following categories, or which the
Director designates as such on a case—by—case basis:

  A. Cold water fish species or other cold water aquatic animals includ-
  ing, but not limited to,  the Salmonidae family of fish (e.g., trout and
  salmon) in  ponds, raceways or  other similar structures which  dis-
  charge at least 30 days per year but does not include:

    1. Facilities which produce less than 9,090 harvest weight kilograms
    (approximately  20,000 pounds)  of aquatic animals per year; and

    2. Facilities  which feed  less  than  2,272  kilograms (approximately
    5,000  pounds) of  food during the  calendar month  of maximum
    feeding.

  B. Warm water fish species or  other warm water aquatic  animals
  including,  but not limited to,  the Ameiuridae, Cetrarchidae, and
  Cyprinidae families of  fish (e.g., respectively, catfish, sun fish, and
  minnows) in ponds, raceways, or other similar structures which dis-
  charge at least 30 days per year, but does not include:

    1. Closed ponds which discharge only during periods of excess run-
    off; or

    2. Facilities  which produce  less  than 45,454  harvest weight kilo-
    grams  (approximately  100,000 pounds) of aquatic animals per year.
CONTACT COOLING WATER means water used to reduce tempera-
ture which comes into contact with a raw material, intermediate pro-
duct, waste product other than heat, or finished product.
CONTAINER means any portable device in which a material is stored,
transported, treated, disposed of, or otherwise handled.
CONTIGUOUS ZONE means the entire zone established by the United
States under article 24 of the convention of the Territorial Sea and the
Contiguous Zone.
CWA  means the Clean Water Act  (formerly referred to the  Federal
Water Pollution Control Act) Pub. L. 92-500, as amended by Pub.
L. 95-217 and Pub. L. 95-576, 33 U.S.C. 1251 etseq.
DIKE means any embankment or ridge of either natural or manmade
materials used  to prevent the movement of liquids, sludges, solids, or
other materials.
DIRECT DISCHARGE  means the discharge of a pollutant as defined
below.
DIRECTOR means the EPA Regional  Administrator or the State Di-
rector as the context requires.
DISCHARGE (OF A POLLUTANT) means:

  A. Any  addition of any pollutant or combination of pollutants to
  waters of the United States from any point source; or

  B. Any addition of any pollutant or combination of pollutants to the
  waters of the contiguous zone or the ocean from any point source
  other than a vessel or other floating craft which is being used as a
  means of transportation.

This definition includes discharges into waters  of the United States
from: Surface runoff which is collected  or channelled by man; Dis-
charges through pipes, sewers, or other conveyances owned by a State,
municipality, or other person which do not lead to POTW's; and Dis-
charges  through pipes,  sewers, or other conveyances, leading  into
privately owned treatment works. This term does not include an ad-
dition of pollutants by any indirect discharger.
DISPOSAL tin the RCRA program) means the discharge, deposit, in-
jection, dumping, spilling, leaking, or placing of any hazardous waste
into or on any land or water so that the hazardous waste or any constit-
uent of it may enter the environment or be emitted into  the air or
discharged into any waters, including ground water.
DISPOSAL FACILITY means a facility or part of a facility at which
hazardous waste is intentionally placed into or on land or water, and
at which hazardous waste will remain after closure.
EFFLUENT  LIMITATION  means any  restriction imposed by  the
Director  on quantities, discharge  rates, and  concentrations  of pollu-
tants  which are discharged  from  point  sources into  waters of  the
United States,  the  waters  of the continguous zone,  or the ocean.
EFFLUENT LIMITATION GUIDELINE  means a regulation published
by the Administrator under Section 304(b) of the Clean Water Act to
adopt or revise effluent limitations.
ENVIRONMENTAL  PROTECTION  AGENCY  (EPA)  means  the
United States Environmental Protection Agency.
EPA IDENTIFICATION NUMBER means the number assigned by EPA
to each generator, transporter, and facility.
EXEMPTED AQUIFER means ah aquifer or its portion that meets the
criteria in the definition of USDW, but which has been exempted ac-
cording to the procedures in 40 CFR Section 122.35(b).
EXISTING HWM FACILITY means a Hazardous Waste Management
facility which was in operation, or for which construction had com-
menced, on or before October 21, 1976. Construction had commenced
if (A) the owner or operator had obtained all necessary Federal, State,
and local preconstruction approvals or permits, and either (B1) a con-
tinuous on—site,  physical  construction program had  begun,  or  (B2)
the owner or operator had entered into contractual obligations, which
could not be  cancelled or modified without  substantial loss, for con-
struction of the facility to  be  completed within  a  reasonable time.

  (NOTE: This  definition  reflects the literal  language of the statute.
  However, EPA believes that amendments to RCRA now in conference
  will shortly be enacted and will change the date for determining when
  a facility is an "existing facility" to one no earlier than May of 1980;
  indications are  the  conferees are considering  October 30,  1980.
  Accordingly,  EPA encourages every owner  or operator of a facility
  which was built or under construction as of the promulgation date of
  the RCRA program regulations to file Part A of Its permit application
  so that it can be quickly processed for interim status when the change
  in the law takes effect. When those amendments are enacted, EPA will
  amend this definition.)
                                                                        EXISTING SOURCE  or  EXISTING  DISCHARGER (in the NPDES
                                                                        program) means any source which  is not a new source or a new dis-
                                                                        charger.
                                                                  1-7

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                                               SECTION D - GLOSSARY (continued)
EXISTING INJECTION WELL means an injection well other than a
new injection well.
FACILITY means any HWM facility, UIC underground injection well,
NPDES  point source, PSD stationary source, or any  other facility or
activity  (including land or  appurtenances thereto) that  is subject to
regulation under the RCRA,  UIC, NPDES, or PSD programs.
FLUID means material or substance which flows or moves whether in
a semisolid, liquid, sludge, gas, or any other form or state.
GENERATOR means any person by site, whose act or process produces
hazardous waste identified or listed in 40 CFR Part 261.
GROUNDWATER means water below the land surface in a zone of
saturation.
HAZARDOUS SUBSTANCE means any of the substances designated
under 40  CFR Part  116 pursuant to Section 311 of CWA. (NOTE:
These substances are listed in Table 2c—4 of the instructions to Form
2C.)
HAZARDOUS WASTE means a hazardous waste as defined in 40 CFR
Section 261.3 published May 19, 1980.
HAZARDOUS WASTE  MANAGEMENT FACILITY (HWM facility)
means  all contiguous land, structures,  appurtenances,  and improve-
ments on the land, used for treating, storing, or disposing of hazardous
wastes. A facility may consist of several  treatment, storage, or disposal
operational units (for example, one or more landfills, surface impound-
ments, or combinations of them).
IN OPERATION means a facility which is treating, storing, or disposing
of hazardous waste.
INCINERATOR  (in the RCRA program) means an enclosed device
using controlled flame combustion, the primary purpose of which is to
thermally  break down hazardous waste. Examples of incinerators are
rotary kiln, fluidized bed, and liquid injection incinerators.
INDIRECT DISCHARGER means a nondomestic discharger introduc-
ing pollutants to a publicly owned treatment works.
INJECTION WELL means a well into which fluids are being  injected.
INTERIM AUTHORIZATION  means  approval by  EPA of a State
hazardous waste program which has met the requirements of Section
3006(c) of RCRA and applicable requirements of 40  CFR Part 123,
Subparts A, B, and F.
LANDFILL means a disposal facility or part of a facility where hazard-
ous waste is placed  in or on land and which is not a land treatment
facility, a surface impoundment, or an injection well.
LAND TREATMENT FACILITY  (in the RCRA program) means a
facility or part of a facility at which hazardous waste is applied onto or
incorporated into the soil surface; such facilities are disposal facilities
if the waste will remain after closure.
LISTED  STATE  means a State listed by the Administrator under
Section 1422 of SDWA as needing a State UIC program.
MGD means millions of gallons per day.
MUNICIPALITY means a city, village, town, borough, county, parish,
district, association, or other  public body created by or under State
law and having jurisdiction over disposal of sewage, industrial wastes,
or other wastes, or an Indian tribe or an authorized Indian tribal organ-
ization, or  a  designated and approved management agency  under
Section 208 of CWA.
NATIONAL POLLUTANT  DISCHARGE  ELIMINATION  SYSTEM
(NPDES) means the national program for issuing modifying, revoking
and  reissuing,  terminating,  monitoring,  and enforcing  permits and
imposing and  enforcing pretreatment  requirements, under Sections
307, 318,  402,  and 405 of CWA.  The term includes  an  approved
program.
NEW DISCHARGER means any building, structure, facility, or instal-
lation: (A) From which there is or may be a new or additional discharge
of pollutants at a site at which on October 18, 1972,  it had never dis-
charged  pollutants;  (B) Which  has  never received  a  finally effective
NPDES permit for discharges at that site; and (C) Which is not a "new
source." This definition  includes an  indirect discharger which com-
mences discharging into waters of the United States. It also includes
any existing mobile  point source, such as  an offshore oil drilling rig,
seafood  processing vessel, or aggregate plant that  begins discharging
at a location for which it does not have an existing permit.
                                                                        NEW HWM FACILITY means a Hazardous Waste Management facility
                                                                        which began operation  or  for which  construction commenced after
                                                                        October 21, 1976.
NEW  INJECTION WELL means a well which begins injection after a
UIC program for the State  in which the well is located is approved.
NEW SOURCE (in the NPDES program) means any building, structure,
facility, or  installation from which  there is or may  be a discharge of
pollutants, the construction of which commenced:

  A.  After  promulgation of standards  of performance under Section
  306 of CWA which are applicable to such source; or

  B. After  proposal  of standards of performance in accordance with
  Section 306 of  CWA which are applicable to such source, but only if
  the standards are promulgated in accordance with Section 306 within
  120 days of their proposal.
NON-CONTACT COOLING  WATER means water used to reduce
temperature which does not come into direct contact with  any raw
material, intermediate product,  waste  product  (other than heat), or
finished product.
                                                                        OFF—SITE means any site which is not "on—site."
ON—SITE means on  the same or geographically contiguous property
which may be divided by public or private rightfcl—of—way, provided
the entrance and exit between the properties is at a cross—roads inter-
section, and  access is  by  crossing as opposed to going along, the
rightfe>—of—way. Non—contiguous properties owned by the same per-
son, but connected by a  right—of—way which the person controls and
to which the public does not have access, is also considered on—site
property.
OPEN BURNING means the combustion of any material without the
following characteristics:

 A.  Control of combustion air to maintain adequate temperature for
 efficient combustion;

 B.  Containment of the combustion—reaction  in an enclosed device
 to  provide sufficient residence time and mixing for complete com-
 bustion; and

 C. Control of emission of the gaseous combustion products.

(See also  "incinerator"and "thermal treatment").
                                                                        OPERATOR means  the  person responsible for  the overall operation
                                                                        of a facility.
OUTFALL means a point source.


OWNER means the person who owns a facility or part of a facility.
                                                                  1-8

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                                               SECTION D - GLOSSARY (continued)
PERMIT means an authorization,  license, or equivalent control docu-
ment  issued by EPA or an  approved State to implement the require-
ments of 40 CFR Parts 122,  123, and 124.
PHYSICAL CONSTRUCTION tin  the RCRA program) means excava-
tion, movement  of  earth, erection of forms or structures, or similar
activity to prepare a  HWM facility to accept hazardous waste.
PILE  means any noncontainerized accumulation of solid, nonflowing
hazardous waste that is used for treatment or storage.
POINT SOURCE means any discernible, confined, and discrete convey-
ance,  including but not limited to any pipe, ditch, channel, tunnel,
conduit, well, discrete  fissure, container, rolling stock, concentrated
animal feeding operation, vessel or other floating craft from which pol-
lutants are  or may be discharged.  This term does  not  include return
flows from irrigated agriculture.
POLLUTANT  means dredged spoil, solid waste, incinerator residue,
filter  backwash,  sewage, garbage, sewage sludge, munitions, chemical
waste, biological materials, radioactive materials (except those regulated
under the Atomic Energy Act of 1954, as amended [42 U.S.C. Section
2011  et  seq.J),  heat, wrecked  or  discarded equipment, rocks, sand,
cellar dirt and industrial, municipal, and agriculture waste discharged
into water. It does not mean:

  A. Sewage from vessels; or

  B. Water, gas, or other material which is injected into a well to facili-
  tate production of oil or  gas, or water derived in association with oil
  and gas production and disposed of in a well, if the well used either
  to facilitate  production  or for disposal  purposes  is approved by
  authority of  the State in which the well is located, and if the State
  determines that the injection or disposal will not result in the degrada-
  tion of  ground or surface water resources.

  (NOTE: Radioactive materials covered by the Atomic Energy Act are
  those encompassed in its definition of source, byproduct, or special
  nuclear materials. Examples of materials not covered include radium
  and accelerator produced  isotopes.  See Train v. Colorado Public
  Interest Research Group, Inc., 426 U.S. 1 [1976].)
PREVENTION  OF  SIGNIFICANT DETERIORATION  (PSD) means
the national permitting program under 40 CFR 52.21 to prevent emis-
sions of certain pollutants regulated under the Clean Air Act from signi-
ficantly deteriorating air quality in attainment areas.
PRIMARY INDUSTRY CATEGORY means any industry category list-
ed in the NRDC Settlement Agreement (Natural Resources Defense
Council v. Train, 8 ERC 2120 [D.D.C.  1976], modified 12 ERC 1833
[D.D.C. 1979]).
PRIVATELY OWNED TREATMENT WORKS means any device or
system which  is: (A) Used  to treat wastes from any facility whose
operator  is not the operator of the treatment works; and  (B) Not a
POTW.
PROCESS WASTEWATER means any water which, during manufactur-
ing or  processing, comes  into direct contact with or results from the
production or use of any raw material, intermediate product, finished
product, byproduct, or waste product.
PUBLICLY OWNED TREATMENT WORKS or POTW means any de-
vice or system used  in the treatment (including recycling and reclama-
tion) of municipal sewage or industrial wastes of a liquid nature which
is owned by a State or municipality. This definition includes any sew-
ers, pipes, or other  conveyances only  if they convey wastewater to a
POTW providing treatment.
RENT means use of another's property in return for regular payment.
RCRA means the Solid Waste Disposal Act as amended by the Resource
Conservation  and Recovery Act of 1976 (Pub. L. 94-S80, as amended
by Pub. L. 95-609, 42 U.S.C. Section 6901 etseq.).
ROCK CRUSHING AND GRAVEL WASHING FACILITIES are facil-
ities which process  crushed and broken stone, gravel, and riprap (see
40 CFR Part 436, Subpart B, and the effluent limitations guidelines
for these facilities).
SDWA means the Safe Drinking Water Act (Pub. L 95—523, as amend-
ed by Pub. L. 95-1900, 42 U.S.C. Section 30011} etseq.).
SECONDARY INDUSTRY CATEGORY means any industry category
which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes
from  tiolets and other receptacles intended to receive or  retain body
wastes that are discharged from vessels and regulated under Section 312
of CWA, except that  with respect to commercial vessels on the Great
Lakes this term includes graywater. For the purposes of this definition,
"graywater" means galley, bath, and shower water.
SEWAGE SLUDGE means the solids, residues, and precipitate separat-
ed from or created in sewage  by the unit processes of a POTW. "Sew-
age" as used in this definition means any wastes, including wastes from
humans,  households, commercial establishments, industries, and storm
water  runoff, that are discharged to or otherwise enter  a  publicly
owned treatment works.
 SILVICULTURAL POINT SOURCE means any discernable, confined,
 and discrete conveyance  related  to rock crushing, gravel washing, log
 sorting, or log storage facilities which are operated in connection with
 silvicultural activities  and from  which pollutants are discharged  into
 waters  of  the  United States. This  term does not  include nonpoint
 source silvicultural activities such as nursery operations, site prepara-
 tion, reforestation and subsequent cultural  treatment, thinning,  pre-
 scribed burning, pest and fire control, harvesting operations, surface
 drainage,  or road construction and maintenance from which there  is
 natural runoff.  However,  some of these activities (such as stream cross-
 ing for roads) may  involve point source discharges of  dredged or fill
 material which  may require a CWA Section  404 permit. "Log sorting
 and log storage facilities" are facilities whose discharges result from the
 holding of unprocessed wood, e.g., logs or  roundwood with bark or
 after removal of bark  in self—contained bodies  of water (mill ponds or
 log ponds) or stored on  land where water is applied intentionally on
 the logs (wet decking). (See 40 CFR Part 429, Subpart J, and the efflu-
 ent limitations guidelines for these facilities.)
STATE means any  of the 50 States, the District of Columbia, Guam,
the  Commonwealth of Puerto  Rico,  the  Virgin Islands, American
Samoa, the Trust Territory of the Pacific Islands (except in the case of
RCRA), and the Commonwealth of the  Northern  Mariana Islands
(except in the case of CWA).
STATIONARY SOURCE  (in the PSD program) means any building,
structure, facility, or installation which emits or may emit any air pol-
lutant regulated under the Clean Air Act. "Building, structure, facility,
or  installation" means any  grouping of pollutant—emitting activities
which are located on one or more contiguous or adjacent properties
and which are owned or operated by the same  person (or by persons
under common control).
STORAGE (in the  RCRA program) means the holding of hazardous
waste for a temporary period at the end of which the hazardous waste
is treated, disposed, or stored elsewhere.
STORM WATER RUNOFF means water discharged as a result of rain,
snow, or other precipitation.
SURFACE IMPOUNDMENT or IMPOUNDMENT means a facility or
part of a  facility which is a natural topographic depression, manmade
excavation, or diked  area formed primarily of earthen materials (a/-
though it may be lined with manmade materials), which is designed to
hold an accumulation  of liquid wastes or wastes containing free liquids,
and which is not an injection well. Examples of surface impoundments
are holding, storage,  settling,  and aeration pits, ponds, and  lagoons.


TANK (in the RCRA program) means a stationary device, designed to
contain an accumulation of hazardous waste which is constructed pre-
marily of  non—earthen materials (e.g., wood, concrete, steel, plastic)
which provide structural support.
                                                                  1-9

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                                                SECTION D - GLOSSARY (continued)
THERMAL TREATMENT (in the RCRA program)  means the treat-
ment of hazardous waste in a device which uses elevated temperature as
the primary means to change the chemical, physical, or biological char-
acter or  composition  of  the  hazardous  waste. Examples of thermal
treatment processes are incineration, molten salt, pyrolysis, calcination,
wet air oxidation, and microwave discharge. (See also "incinerator"and
"open burning").
TOTALLY ENCLOSED TREATMENT FACILITY (in the RCRA pro-
gram) means a facility for the treatment of hazardous waste which is di-
rectly connected to an  industrial production process and which is con-
structed and operated in  a manner which prevents the release of any
hazardous waste or any constituent thereof into the environment dur-
ing treatment. An example is a pipe in which waste acid is neutralized.
TOXIC POLLUTANT means any pollutant listed as toxic under Section
307(a)(1)of CWA.
TRANSPORTER  (in the RCRA program)  means a person engaged in
the off—site transportation 6f hazardous waste by air, rail, highway, or
water.
TREATMENT (in the RCRA program) means any method, technique,
or process, including neutralization, designed to change the physical,
chemical, or biological  character  or composition  of any hazardous
waste so as to neutralize such waste, or so as to recover energy or ma-
terial resources from the waste, or so as to render such waste non—haz-
ardous, or less hazardous; safer to transport, store, or dispose of; or
amenable for  recovery,  amenable for storage,  or reduced in  volume.
UNDERGROUND INJECTION means well injection.
UNDERGROUND SOURCE OF DRINKING WATER or USDW means
an aquifer or its portion which is not an exempted aquifer and:

  A. Which supplies drinking water for human consumption; or

  B. In which the ground water contains fewer than 10,000 mg/l  total
  dissolved solids.
UPSET means an exceptional incident in which there is unintentional
and temporary noncompliance with technology—based permit effluent
limitations because of factors beyond  the  reasonable control of the
permittee.  An upset does not include  noncompliance to the extent
caused by  operational error, improperly designed treatment facilities,
inadequate treatment facilities, lack of preventive maintenance, or care-
less or improper operation.
WATERS OF THE UNITED STATES means:

  A. All waters which are currently used, were used in the past, or may
  be susceptible  to use  in interstate or foreign commerce,  including
  all waters which are subject to the ebb and flow of the tide;

  B. All interstate waters, including interstate wetlands;

  C. All other waters such as intrastate lakes,  rivers, streams (including
  intermittent streams), mudflats, sandflats, wetlands, sloughs, prairie
  potholes, wet  meadows, playa lakes, and  natural ponds, the use,
  degradation, or destruction  of which would  or could affect  interstate
  or foreign commerce including any such waters:

    1. Which are or could be used by interstate or foreign travelers for
    recreational or other purposes,

    2. From which fish or shellfish are  or  could be taken and sold in
    interstate or foreign commerce,

    3. Which  are used  or could be used for industrial purposes by in-
    dustries in interstate commerce;

  D. All  impoundments  of waters otherwise  defined as  waters of the
  United States under this definition;

  E. Tributaries  of waters identified in  paragraphs (A)  — (D) above;

  F. The territorial sea; and

  G. Wetlands adjacent to waters  (other than waters that are themselves
  wetlands) identified in paragraphs (A) — (F)  of this definition.

Waste treatment  systems, including treatment ponds or lagoons design-
ed  to meet requirement of CWA  (other than  cooling ponds as defined
in 40  CFR  Section 423.1 Km) which  also meet  the criteria of this
definition)  are not waters of the  United States. This exclusion applies
only to manmade bodies of water which neither were originally created
in waters of the  United States  (such as a disposal area in wetlands) nor
resulted  from the  impoundments of  waters of the United States.
WELL INJECTION  or UNDERGROUND INJECTION means the sub-
surface emplacement of fluids through a bored, drilled, or driven well;
or through a dug well, where the depth of the dug well is greater than
the largest surface dimension.
WETLANDS  means those areas that are inundated or saturated by
surface or groundwater at a frequency and duration sufficient to sup-
port, and that under normal circumstances do support, a prevalence of
vegetation typically adapted for life in saturated soil conditions. Wet-
lands  generally  include  swamps,  marshes,  bogs,  and similar areas.
                                                                  I-IO

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FIGURE 1-1

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 CUM I INULU KHlJM 111!  1-KtiN
 VII. SIC CODES (4-diyic, in order uf firiuri

                               A. FIRST
      I   I   I
 VIII. OPERATOR INFORMATION

      r~ i   i   i  i   i  T^ i   T  i   i
                                           T   T"
 A. NAME
T- i   r   i ~ i   i   i  "i   i   i  i   i   i   i   i   (   i   i  i  n ~ r
        c. STATUS oh OHEH A i OH fi.ritt'r the appropriate letter into the answer lnt\, if "lither", spei-ify.)
   F = FEDERAL      "M - PUBLIC (ultier than federal ur stale)
   S-STATE           <>  1)1 HEM f«im-i/y)
   P - PRIVAHr
U.  Is the iiarnw listed Jn
   Hum VIII A alia thu
   ownor?

    I YES  I  i NO
                                             A
                                                    u. PHONE furt-cl fifdc «t no.)
                                                                          ~ 1
                                                                                                                    iU     21
                                 E. i>1 KEET OH P.O. BOX
   ri   i   ii   ii  i   i   i   i   i   i   i   r  T ~ i ~ ir  r ~r
-r T-rn-r-r-r-T T-
-r ", , , ,
1 1 1 1 L
40
^

ST A I L
, L
41 4.-
H

.ZIP C0[»t
111
_t 1 i t
47 - n i

IX. INDIAN LAFV
Is the facility UM
YES

                               . t  M V OFi TOWN
                     i  i  ~ i   i   i   i  TII
 X. EXISTING ENVIRONMENTAL PERMITS
                                                   D. PSD (AfiJ.'inissionsJrtHti I'niftosed ?i(turce.\l
                                                           ~   —~—I~T~T    "    '~
                  i   i  i   i   i   i   i
                         Irtit'ctitifl of t''litiit.\]
                                                             t. OTHEH  xflff
            . HCRA (llazanhius Waxtt-s)
  Attach  to this application a topographic map of the area extending to at least one mile beyond property boundaries. The map must show
  the outline  of the facility, the location of each  of  its existing and proposed intake and discharge structures, each of its hazardous waste
  treatment, storage,  or disposal facilities, and each well where it injects fluids underground. Include all spiings, rivers and  other surface
  water bodies in the map area. See instructions for precise requirements.
 XII. NATURE OF BUSINESS (p,ovi>f inscription.
 XIII. CERTIFICATION (see instructions)

   I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all
   attachments and that,  based on my  inquiry of those persons immediately responsible for obtaining the information contained in the
   application, 1 believe that the information is true, accurate and complete. I am  aware that there are significant penalties for submitting
   false information, including thv possibility of fine and imprisonment.
  A. M A M I .-^ < I r I I < I K I Till
  COMMENTS FOR OFFICIAL USE ONLY
      T   I   rn   r —i  ii  -[--|"
EPA Form 3H1O-1 (6 HO)

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, -J^^^==J^rs=
                                                     fi"ft5=s?AL
                                                      "   „ ____ i-->,*-.r- f-  --•*- .',..-,-.,.,
                                                           "'
  i.^EPA Lai NUMBED   \i
                                                                                                  rro-
^
=
                                   	       	
       fs t:3jr  facility a proposed £ta:fon=ry ;t3^f=jc which is
       ona of thn  2S ifi-jij:tii3i  rntrgorief;  iitieo  i~  tiis  in
       struction; ft;i-'<  wiiirh  wiil ;j:!tfii'iiaiiy »>ir;it IOC totss
       nsr  yn^r  ot sriy  Jiis  poi]''t£nt rsr^'pt^ci ij;:dr;r the;
       Clean  Air Aiit  End  r!«.y sfffiiit or he  located i;>  nn
                                                                  =  B.  Ucns or wJH this fEciiity  feiiiisr cxisiiiiy or firofinssd)  i     I
                                                                       inciiics? s sit^Bs}jt?-"ts2! rniiiiK!  fssd'ng €5nsiat;en  or  j
                                                                    D, je this E proijosed facility jiither ihi-H tii-ms (icscril,atf
                                                                       in A or 8 above} vvhinh w=!i  result in a ^K^issrfeij  in
                                                                      jwalg-sof t|wU,S.7 (FORM 2DI	
                                                                  |  F, Do  you or vwii! you hiject ot this facility iridusti ia!  or
                                                                       Jmyniftisjg! efflunnr teicw the  tewBii;;osi  strntutu con..
                                                                       teiiiiiig witjiin  onis qdsrter  ndlB of the  yyeii  bora,
                                                                       UM=:=erfirour:d sourees of drinking swatEr? IrORiV: 4}

                                                                  I  > -. Ho  you or vyili you iilject Et this facility fli.'jds fcr EOB
                                                                       Eia! pi'Ocsisni such  ss irsiniiic t>f suifu; hy  tho Fs^sch
                                                                       proasss, ssiirtion  rtiining of minerEis, irj  jitu coji:bi!S"
                                                                       t!Oi? K* fossil nmi. ur rwwveiy cf gHuvhcinniil  eiicrnyi*

                                                                 T _Jl^^ 4i_. .    '.   .    	
                                                                  I  j, is this fecHity s i.roposefl sSBii3i!9«K3 which is
                                                                  j     NOT  one of the  28 industrial c-tgyojiss iisteti iii ths
                                                                  5     :n=tru!:;ionK eins vai?sj;h wiii poteriiinlly es^it 2iiO tons
                                                                  a     par yOn! of any tsir pollutant csgyiated Unricj the  Ciean
                                                                  S     Air Act Eiid friEy  afreet or be  iocat';H in an BtiTjinme-iit
1     3
-------
 CON I INLILL) ( HUM  I tit I HUN I
 VII. SIC CODES (4-iliyic. in nnlin ot firiurnyl
                                 A  i-1 itL. i
                lV.v/;V.i
  VIM. OPERATOR INFORMATION

          I   I   !  I   I   I   I   I   I   I   I   I   !
                        Is tilt: MtlllKi Itbluil jf;
                        Item VIII A ..l»u tht-
                        UWflHI r'
        C. STATUS Oh Ol't K A r t>K (I: Tilt' I tllf /'/ iilff Iciifr ill in if If an.VU'tT .'><> i , // "< ! lllt'l ", .

    F - T-TEDFRAL        M~PHHi 1C (nrlifi ttlitn fi;li-r,ll~i,~r \tutfl
    S - STAFF           (I   Of! II K (
    P  PHFV A I Ir
                                        HiL I  OH HO  LI O K

                                     I   I   1   I   1   I   I   1
IX INDIAN	__^^—
 I-. ihr i,u-|!ny ll.: .Ih-J 1)11 (lull.
        YL:-^       i  i  N( i
                                I . t I I  V O p; I . >w N
                         i   i   i   i      r  i   i   r  i   i  • i ~ i   i   i   i  " i   i
 X. EXISTING ENVIRONMENTAL PERMIT!
               ^ (nisftian;i:\ l<> Nurfiu-t- Wuti-i}
                                                             !   I   1   I   I   I   I   I  ' I   I    I  I
                                                                I   l   I   I   I   I   1   I
             . Kt HA (HlIZUI', fvl t  f^ <_> I I K I ?k 1  ir'll I
  COMMENTS FOR OFFICIAL OSF ONLY
      r  I   r   r~~i   r  ^i   i   r   i   i
  c"
tPA Kurni 3S1H 1 (« BO)

-------
                                               FORM 3 - GENERAL INFORMATION
 This form must be completed by all applicants who check  "yes" to
 Item II—E in Form 1.
 Permit Application Process

 There are two parts to a RCRA permit application — Part A and Part B.
 Part  A consists of this form and  Form  1  of the Consolidated Permit
 Application. Part  B requires detailed site—specific  information such as
 geologic, hydrologic, and  engineering data. 40 CFR  122.25 specifies
 the information that will be required from hazardous waste manage-
 ment facilities in Part B.

 RCRA established a  procedure for obtaining "interim status" which
 allows existing hazardous waste management facilities to continue their
 operations until a final hazardous waste permit is issued.  In order to
 qualify for  interim status,  existing hazardous waste management facil-
 ities  must submit  Part  A  of the permit application to EPA within six
 months  after  the  promulgation of  regulations under Section 3001  of
 RCRA (40  CFR Part 261). In order to receive  a hazardous waste per-
 mit, existing facilities must submit a complete Part  B within six months
 after it  is requested by EPA. New facilities must  submit both  Part A
 and Part B  to EPA at  least 180  days before physical construction is
 expected to commence.
 Operation During Interim Status

 As provided in 40 CFR 122.23(b),  Part A of  the  permit application
 defines the  processes to be used for  treatment,  storage, and disposal of
 hazardous wastes;  the design  capacity of such processes; and the speci-
 fic hazardous wastes to be handled at a facility during the interim status
 period. Once  Part  A is submitted to EPA, changes in the hazardous
 wastes handled, changes in design capacities, changes in processes, and
 changes in ownership or operational  control at  a facility during the in-
 terim status period  may only be made in  accordance with the proce-
 dures in 40  CFR  122.23(c). Changes in  design capacity and changes in
 processes  require prior EPA approval. Changes in the quantity of waste
 handled at  a facility during  interim  status can be made without sub-
 mitting a  revised Part A provided the quantity does not exceed the de-
 sign capacities of the processes specified in Part A of the permit appli-
 cation.  Failure to  furnish all  information required to process a permit
 application  is grounds for termination of interim status.
Confidential Information

All information submitted in  this form will  be  subject to public dis-
closure, to the extent provided by RCRA  and the Freedom of Inform-
ation Act, 5 U.S.C.  Section 552, and  EPA's Business  Confidentiality
Regulations,  40 CFR  Part 2  (see especially  40  CFR 2.305). Persons
filing this form may make claims of confidentiality. Such  claims must
be clearly indicated by marking "confidential" on the specific informa-
tion on the form for which confidential treatment is requested or on
any attachments, and must be accompanied, at the time of filing, by a
written substantiation  of  the  claim, by answering  the  following ques-
tions:
 Confidential Information (continued)

  A. Which portions of the information do you claim  are entitled to
  confidential treatment?

  B. For how long is confidential treatment desired for this informa-
  tion?

  C. What measures have  you taken  to  guard  against undesired  dis-
  closure of the information to others?

  D. To what extent has the information been disclosed to others,  and
  what precautions have been taken in connection with that disclosure?

  E. Has EPA or any other Federal agency made a pertinent confident-
  iality determination? If so, include a copy of such determination or
  reference to it, if available.

  F. Will disclosure of the information be likely  to result in substantial
  harmful effects on your competitive position? If so, what would those
  harmful effects  be  and why should they be viewed as substantial?
  Explain the causal relationship between  disclosure and  the harmful
  effects. ,

 Information  covered  by a  confidentiality claim and the  above sub-
 stantiation will be disclosed by EPA only to the extent and by means
 of the procedures set forth in 40 CFR Part 2.

 If no claim of confidentiality or no substantiation accompanies the in-
 formation when it is submitted, EPA may  make the information avail-
 able to the public without further notice to the submitter.
Definitions

Terms used in these instructions and in this form  are defined in the
Glossary section of the instructions to  Form 1. For additional defini-
tions and procedures to use in applying for a  permit for a hazardous
waste management facility, refer to the  regulations promulgated under
Section 3005 of RCRA and published  in 40 CFR Parts 122 and  124.
                                               FORM 3 LINE-BY-LINE INSTRUCTIONS
Completing This Form

Please type or print in the unshaded areas only. Some items have small
graduation marks or boxes in the fill—in spaces. These marks indicate
the number of characters that may be entered into our data system.
The  marks are spaced at  1/6" intervals which accommodate elite type
(12 characters per inch  — one space between letters). If you  do not
have a typewriter with elite type then please print, placing each  charac-
ter between the marks. Abbreviate if necessary to stay within the num-
ber of characters allowed for each item.  Use  one space for breaks be-
tween words, but not for punctuation marks unless the space is  needed
to clarify your information.
Item I

Existing  hazardous waste  management facilities should  enter  their
EPA Identification Number (if known). New facilities should leave this
item blank.
Item II

A. FIRST APPLICATION. If this is the first application that is being
filed for the  facility place an "X"  in either the Existing Facility  box
or the New Facility box.

  1. EXISTING FACILITY. Existing facilities are:

   a.  Those  facilities which received hazardous waste for  treatment,
   storage, and/or disposal on or before October 21, 1976; or

   b.  Those  facilities for which construction had commenced on or
   before October 21, 1976. Construction had "commenced" only if:

    (1)  The owner or  operator  had obtained all necessary  Federal,
    State, and local preconstruction approvals or permits; and
                                                                    3-1

-------
                                         FORM 3 LINE-BY-LINE INSTRUCTIONS (continued)
 Item II (continued)

     (2-a) A continuous  physical, on—site construction program  had
     begun  (facility design or  other preliminary  non—physical  and
     non-site  specific  preparatory   activities  do  not constitute  an
     on—site construction program}, or

     (2-b) The owner or operator had entered into contractual obliga-
     tions (options to purchase or contracts for feasibility, engineering,
     and  design  studies  do not constitute contractual obligations)
     which  could not be cancelled  or modified  without substantial
     loss. Generally, a loss is deemed  substantial if the amount an own-
     er or operator must pay to  cancel construction agreements or stop
     construction exceeds 10% of the  total project cost.

  (NOTE:  This definition  of  "existing facility" reflects the  literal
  language  of  the statute.  However,  EPA believes  that amendments
  to RCRA now in conference will shortly be enacted and will change
  the date  for  determining  when a facility is an "existing facility" to
  one no earlier than May of 1980;  indications are the conferees are
  considering October 30, 1980.  When those amendments are enacted,
  EPA will amend the definition of "existing facility."

  Accordingly,  EPA encourages  every facility built or under construc-
  tion on the promulgation date of the RCRA  program regulations to
  notify EPA and file Part A of  the permit application so that it can be
  quickly processed for interim status when the change in the law takes
  effect. I

   EXISTING FACILITY DATE. If the Existing Facility box is mark-
   ed, enter  the date hazardous  waste operations began (i.e.,  the date
   the facility began treating, storing, or disposing of hazardous waste)
   or the date construction commenced.

  2. NEW FACILITY. New facilities are all facilities for which construc-
  tion commenced, or will  commence,  after October 21, 1976.

   NEW FACILITY DATE. If the New Facility box is marked, enter
   the date that operation began  or is expected to begin.

B. REVISED APPLICATION. If  this is a subsequent application that is
being filed to amend data filed in a previous application, place an "X"
in the appropriate box to  indicate whether the facility has interim  sta-
tus or a permit.

  1.  FACILITY HAS INTERIM  STATUS. Place an "X" in  this box
  if this is a revised application to make changes  at a facility during the
  interim status period.

  2.  FACILITY HAS A PERMIT. Place an "X" in this  box  if this is
  a revised application to make changes at a facility for which a permit
  has been issued.

  (NOTE: When  submitting a  revised application, applicants must
  resubmit  in  their entirety each item on the  application for which
  changes are requested.  In addition.  Items I and IX [and Item X if ap-
  plicable] must be completed. It is not necessary to resubmit informa-
  tion for other items that will not change).
Item III

The information in Item III describes all the processes that will be used
to treat, store, or dispose of hazardous waste at the facility. The design
capacity of  each  process must be provided as part of the description.
The design capacity of injection wells and landfills at existing facilities
should be measured as the remaining, unused capacity. See the form for
the detailed  instructions to  Item III.
Item IV

The  information  in  Item IV  describes all the hazardous wastes that
will be treated, stored, or disposed at the facility. In addition, the pro-
cesses that will be used to treat, store, or dispose of each waste and the
estimated annual quantity of  each  waste must be provided. See the
form for the detailed instructions to Item IV.
Item V

All existing facilities must include a drawing showing the general lay-
out of the facility. This drawing should be approximately to scale and
fit in the space provided  on the form. This drawing should show the
following:

  The property boundaries of the facility;

  The areas occupied  by all storage, treatment, or disposal operations
  that will be used during interim status;

  The name of each operation. (Example — multiple hearth incinerator,
  drum storage area, etc.)',

  Areas of past storage, treatment, or disposal operations;

  Areas of future storage, treatment, or disposal operations; and

  The approximate dimensions  of the property  boundaries  and all
  storage, treatment, and disposal areas.

See  Figure  3—1 for an example of  a facility drawing. New facilities
do not have to complete this item.
Item VI

All existing facilities must include photographs that clearly delineate
all  existing  structures; all  existing  areas for storing, treating, or dis-
posing of  hazardous  waste; and  all known  sites  of  future storage,
treatment,  or  disposal  operations.  Photographs may be color or  black
and white, ground—level or aerial. Indicate the date the photograph was
taken on the back of each photograph.
Item VII

Enter the latitude  and longitude  of  the facility in degrees, minutes,
and seconds. For larger facilities,  enter the latitude and longitude at
the approximate mid—point of the facility. You may use the map you
provided for Item XI of Form 1 to determine latitude and  longitude.
Latitude and  longitude  information  is also available  from  Regional
Offices  of the U.S. Department  of  Interior, Geological  Survey and
from  State  Agencies, such  as  the Department of Natural Resources.
Item VIII

See the form for the instructions to Item VIII.


Item IX and Item X

All facility owners must sign  Item IX. If the facility will be operated
by someone other than  the owner, then the operator must sign Item X.
Federal regulations require  the certification to  be signed as follows:

  A. For a  corporation, by a  principal executive officer at least  the
  level  of vice president;

  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 facility, by
  either a principal executive officer or ranking elected official.

The  Resource  Conservation  and  Recovery Act provides for severe
penalties for submitting false  information  on  this application form.

Section 3008(d)  of  the Resource Conservation and  Recovery  Act
provides  that "Any person who knowingly makes any  false  statement
or representation in any application,  .  . .  shall, upon conviction be
subject to a fine of not more than $25,000 for each day of violation,
or to imprisonment not to exceed one year, or both."
                                                                     3-2

-------
Continued from page 4.
                                                                         form Hpprovea UIVID ivo.
 V. FACILITY DRAWING (see page 4)
             EXAMPLE
                                            C.OO R
                                                                         omct
                     MO ft.
                                                  r
                                                  I	|
                                                         ISO
                  u.
            I
\
                                  AEROB1C
                                                                DKUM
                                                                100 ft.
                 AKtA
                                           Z75 Ft.
                        r
                                                              \0
                                                               in
                        I	
                                        300 Ft.
                          _  J
UJ
a-
s
                                                                                         O
                                                                 SCALD HHCW  =100FEtT
EPA Form 3510-3 (6-80)
                                             FIGURE 3-1

-------
 (fill—in areas are spaced for elite type, i.e., 12 characters/Inch).
                                                                                        Form Approved OMB No.  158-S80004
 FORM
 RCRA
   3    £EPA
                                    U.S. ENVIRONMENTAL PROTECTION AGENCY
                              HAZARDOUS WASTE PERMIT APPLICATION
                                            Consolidated Permits Program
                                (This information is required under Section 3005 of RCRA.)
                                                                 i, EPA I.D. NUMBER:
 FOR OFFICIAL USE ONLY
II. FIRST OR REVISED APPLICATION
Place an "X" in the appropriate box in A or B below (mark one box only) to indicate whether this is the first application you are submitting for your facility or a
revised application. If this is your first application and you already know your facility's EPA I.D. Number, or if this is a revised application, enter your facility's
EPA I.D. Number in Item f above.
 A. FIRST APPLICATION (place an "X" below and provide the appropriate date)
     I  11, EXISTING FACILITY (See instructions for definition of "existing" facility.
     j.                      Complete Item below.)
                                                                                        g
                         FOR EXISTING FACILITIES, PROVIDE THEE DATE (yr., mo., &day)
                         OPERATION BEGAN OR THE DATE CONSTRUCTION COMMENCED
                         (use the boxet to the left)
                            (place an J'Jt" below and complete Item 1 above)
     Q »• FACILITY HAS INTERIM STATUS  •
.-	n	        ,  -  ,„  i,  	
III. PROCESSES - CODES AND DESIGN CAPACITIES^
                                                                   2.NEW FACILITY (Complete item below.)
                                                                                     FOR NEW FACILITIES,
                                                                                     PROVIDE THE DATE
                                                                                     fyr., ma, & day) OPERA-
                                                                                     TION BEGAN OR IS
                                                                                     EXPECTED TO BEGIN
                                                                                                MO.
                                                                                                      1Z—Z1
                                                                                        f~la. FACILITY HAS A RCRA PERMIT
A. PROCESS CODE - Enter the code from the list of process codes below that best describes each process to be used at the facility. Ten lines are provided for
   entering codes. If more tines are needed, enter the code(s) in the space provided. If a process will be used that is not Included in the list of codes below,|then
   describe the process (Including Its design capacity) in the space provided on the form (Item Ill-Ci.

B. PROCESS DESIGN CAPACITY - For each code entered in column A enter the capacity of the process.
   1. AMOUNT - Enter the amount.
   2. UNIT OF MEASURE — For each amount entered in column BID, enter the code from the list of unit measure codes below that describes the unit of
      measure used. Only the units of measure that are listed below should be used.
          PROCESS
                             PRO-   APPROPRIATE UNITS OF
                             CESS   MEASURE FOR PROCESS
                             CODE      DESIGN CAPACITY
                                                                          PROCESS
                                                                       PRO-   APPROPRI ATE UNITS OF
                                                                       CESS   MEASURE FOR PROCESS
                                                                       CODE     DESIGN CAPACITY
  CONTAINER (barrel, drum, etc,)
  TANK
  WASTE PILE

  SURFACE IMPOUNDMENT

  Disposal:
  INJECTION WELL
  LANDFILL
  LAND APPLICATION
  OCEAN DISPOSAL

  SURFACE IMPOUNDMENT
  UN IT OF MEASURE
  GALLONS.	 . G
  LITERS	L
  CUBIC YARDS . .	Y
  CUBIC METERS	C
  GALLONS PER DAY	U
                             SOI   GALLONS OR LITERS
                             802   GALLONS OR LITERS
                             S03   CUBIC YARDS OR
                                   CUBIC METERS
                             804   GALLONS OR LITERS
                              D7B  GALLONS OR LITERS
                              DBO  ACRE-FEET (the volume that
                                   would caver one acre to a
                                   depth of one foot) OR
                                   HECTARE-METER
                              D81  ACRES OR HECTARES
                              D82  GALLONS PER DAY OR
                                   LITERS PER DAY
                              DBS  GALLONS OR LITERS
                              UN IT OF
                             MEASURE
                               COPE
                                         Treatment:
                                         TANK

                                         SURFACE IMPOUNDMENT

                                         INCINERATOR
                                                  T01

                                                  TOZ
                                                                                               T08
                                                          •steal, chemical,   TO4
                   OTHER (Use for physical, chert
                   thermal or biological treatment
                   processes not occurring in tanks,
                   surface impoundments or inciner-
                   ators.  Describe the processes m
                   the space provided; Item IIl-C.)
                                               GALLONS PER DAY OR
                                               LITERS PER DAY
                                               GALLONS PER DAY OR
                                               LITERS PER DAY
                                               TONS PER HOUR OR
                                               METRIC TONS PER HOUR;
                                               GALLONS PER HOUR OR
                                               LITERS PER HOUR

                                               GALLONS PER DAY OR
                                               LITERS PER DAY
                      UNIT OF MEASURE
                             UNIT OF
                            MEASURE
                              CODE
                                              LITERS PER DAY	 V
                                              TONS PER HOUR	D
                                              METRIC TONS PER HOUR	W
                                              GALLONS PER HOUR .......... E
                                              LITERS PER HOUR ............ H
                                     UNIT OP MEASURE
                                                  UN IT OF
                                                  MEASURE
                                                   COPE
                                                                   ACHE-FEET	 A
                                                                   HECTARE-METER	,	F
                                                                   ACRES	,	B
                                                                   HECTARES	O
EXAMPLE FOR COMPLETING ITEM III (shown in line numbers X-1 andX-2 Mow): A facility has two storage tanks, one tank can hold 200 gallons and the
other can hold 400 gallons. The facility also has an incinerator that can Bbtrn up to 20 gallons per hour.
TTf
                DUP
                                _UL
                                   it
s
JZ
    A. PRO-
     CESS
    CODE
    (from list
    above)
                 B. PROCESS DESIGN CAPACITY
I. AMOUNT
  (specify)
 2, UNIT
OF MEA
 SURE
 (enter
 code)
   FOR
OFFICIAL
   USE
  ONLY
A. PRO
 CESS
 CODE
(from list
 above)
                                                                                 B. PROCESS DESIGN CAPACITY
                                                                                        1. AMOUNT
2. UNIT
OF MEA-
 SURE
 (enter
 code)
   FOR   •
OFFICIAL
   USE '
  ONLY
X-1
                         600
                                                             ft-
                                                                                                                 it.
                                                                                                                      JHL
                                                                                                                              n.
X-2
                          20
                                                                 10
EPA Form 3510-3 (6-80)
                                                        PAGE 1  OF 5
                                                                                                          CONTINUE ON REVERSE

-------
 Continued from the front.
 III. PROCESSES (continued)^
 C. SPACE FOR ADDITIONAL. PROCESS CODES OR FOR DESCRIBING OTHER PROCESSES (code "T04"). FOR EACH PROCESS ENTERED HERE
   INCLUDE DESIGN CAPACITY.
 IV. DESCRIPTION OF HAZARDOUS WASTES	      	
A.  EPA HAZARDOUS WASTE NUMBER - Enter the four-dlgFf number from 40 CFR, Subpart D for each listed hazardous watte you will handle. If you
    handle hazardous wastes which are not listed in 40 CFR, Subpart D, enter the four—digit numberlW from 40 CFR, Subpart C that describes the characteris-
    tics and/or the toxic contaminants of those hazardous wastes.

B.  ESTIMATED ANNUAL QUANTITY - For each listed watte entered in column A estimate the quantity of that waste that will be handled on an annual
    basis. For each characteristic or toxic contaminant entered in column A estimate the total annual quantity of all the non—listed waste W that will be handled
    which possess that characteristic or contaminant.

C.  UNIT OF MEASURE — For each quantity entered in column B enter the unit of measure code. Units of measure which must be used and the appropriate
    codes are:
               ENGLISH UNIT OF MEASURE
                                                           CODE
                                                                             METRIC UNIT OF MEASURE
                                                                                                                         CODE-
               POUNDS.
               TONS. . .
. f
. T
KILOGRAMS	K

METRIC TONS	M
   If facility records use any other unit of measure for quantity, the units of measure must be converted Into one of the required units of measure taking into
   account the appropriate density or specific gravity of the waste.

D. PROCESSES
   1. PROCESS CODES:
      For listed  hazardous waste:  For each lifted hazardous waste entered in column A select the codelW from the list of process codes contained in Item III
      to Indicate how the waste will be stored, treated, and/or disposed of at the facility.
      For non—listed hazardous wattes:  For each characteristic or toxic contaminant entered in column A, select the coded) from the list of process codes
      contained  in Item  III to indicate all the processes that will  be used to store, treat, and/or dispose of all the  non—listed hazardous wastes that possess
      that characteristic or toxic contaminant.
      Note:  Four spaces are provided for entering process codes. If more are needed: (1) Enter the first three as described above; (2) Enter "000"  in the
      extreme right box of Item IV-D(1); and (3) Enter in the space provided on page 4, the line number and the additional codelW.

   2. PROCESS DESCRIPTION:  If a code is not listed for a process that will be used, describe the process in the space provided on the form.

NOTE:  HAZARDOUS WASTES DESCRIBED BY MORE  THAN ONE EPA HAZARDOUS WASTE NUMBER - Hazardous wastes that can be described by
more than one EPA Hazardous Waste Number shall be described on the form as follows:
   1. Select one of the EPA Hazardous Waste Numbers and enter It in column A. On the same line complete columns B,C, and D by estimating the total annual
      quantity of the waste and describing all the processes to be used to treat, store, and/or dispose of the waste.
   2. In column A of the next line enter the other EPA Hazardous Waste Number that can be used to describe the waste.  In column 0(2) on that line enter
      "included  with above" and make no other entries on that line.
   3. Repeat step 2 for each other EPA Hazardous Waste Number that can be used to describe the hazardous waste.

EXAMPLE  FOR COMPLETING ITEM IV (shown In line numbers X-1, X-2, X-3, and X-4 below) - A facility will treat and dispose of an estimated 900 pounds
per year of chrome shavings from leather tanning and finishing operation. In addition, the facility will treat and dispose of three non-listed wastes. Two wastes
are corrosive only and there will be an estimated 200 pounds per year of each waste. The other  waste Is corrosive and ignitable and there will be an estimated
100 pounds per year of that waste. Treatment will be in an incinerator and disposal will be in a landfill.
Id
ZQ
dZ
X-1
X-2
X-3
X-4
A. EPA
HAZARD.
WASTE NO
(enter code)
K
D
D
D
0
0
0
0
5
0
0
0
4
2
1
2
B. ESTIMATED ANNUAL
QUANTITY OF WASTE
900
400
100

C. UNIT
OP MEA-
SURE
(enter
code)




P
P
P





D. PROCESSES
1. PROCESS CODES
Center^
1 1
T 0 3
\ \
T 0 3
\ I
T 0 3
i i
1 T
D 8 0
ri '
D 8 0
\ i
D 8 0
\ i
i i
i i
i i
i i
i i
i i
i i
i i
Z. PROCESS DESCRIPTION
• (if a code Is not entered in D(l»



included with above
EPA Form 3510-3 (6-80)
                                                               PAGE  2 OF 5
                                                                                                                       CONTINUE ON PAGE 3

-------
Continued from page 2.
NOTE: Photocopy this page before completing if you have more than 26 wastes to list
Form Approved OMB No. 158-S80004
EPA I.D. NUMBER (enter from page 1)
IE
W







2
IV. DESCRIPTION
u
So
JfZ
1
2
3
4
5
6
7
8
9
10
1
1
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26


A. EPA
HAZARD.
WASTE NO
(enter code)
ft » 26











































































































OF









19
"V*

14
i-
1
18
\\|
\ \ \

JL
W
1
FOR OFFICIAL USE ONLY \ \ \ \ \ \ \
• 'i' [ 1 1 -jr- \\V\\\\

HAZARDOUS WASTES {continued) '^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^M
B. ESTIMATED ANNUAL
QUANTITY OF WASTE
27 - SB


























27 • - • • * ' • SB
C.UNIT
OF MEA-
SURE
(enter
code)


























M.




















































D. PROCESSES
1. PROCESS CODES
(enter)
27


- 20
1
1






1
1

1 1


1
1
1




1
1
I 1
1 1


1
I
1
1
1
1
1
1
1 1


1
1
17 * 2B
a ' M

I i
i i
i i
I i
1 1
I i
1 i
I i
! 1
1 1
1 1
1 1
1 1

1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1

27 - 20
1 1
1 1

1 1
1 1

1 1
1 1

1 1




1 1

1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
n - 10
2.7 - 20













1 1
1 1

1 1
1 1
1 1
1 1
1 1
1 1

1 1

1 1
27 - 20
2. PROCESS DESCRIPTION
(if a code Is not entered In D(l))


























EPA Form 3510-3 (6-80)
                CONTINUE ON REVERSE
                                                        PAGE  3	OF 5
                                    (enter "A", "B", "C", etc. behind the "3" to identify photocopied pages)

-------
Continued from the front.
IV. DESCRIPTION OF HAZARDOUS WASTES (continued)
 E. USE THIS SPACE TO LIST ADDITIONAL PROCESS CODES FROM ITEM D(1) ON PAGE 3.
      EPA l.D. NO. (enter from page 1)
V. FACILITY DRAWING
 All existing facilities must include in the space provided on page 5 a scale drawing of the facility (see instructions for more detail).
VI. PHOTOGRAPHS
 All existing facilities must include photographs (aerial or ground—level) that clearly delineate all existing structures; existing storage,
 treatment and disposal areas; and sites of future storage, treatment or disposal areas (see instructions for more detail).
VII. FACILITY GEOGRAPHIC LOCATION
                                                                                 LONGITUDE (degrees, minutes, & seconds)
               LATITUDE (degrees, minutes, & seconds)
VIII. FACILITY OWNER
  I  I A.  If the facility owner is also the facility operator as listed in Section VIII on Form 1, "General Information", place an "X" in the box to the left and
        skip to Section IX below.

     B.  If the facility owner is not the facility operator as listed in Section VIII on Form 1, complete the following items:
                                                                                                       2. PHONE NO. (area code & no.)
                                 1.NAME OF FACILITY'S LEGAL OWNER
                3. STREET OR P.O. BOX
                                                                    4. CITY OR TOWN
 IX. OWNER CERTIFICATION
 / certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
 documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the
 submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
 including the possibility of fine and imprisonment.
 A. NAME (print or type)
                                                  B. SIGNATURE
                                                                                                   C. DATE SIGNED
 X. OPERATOR CERTIFICATION,
 / certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
 documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the
 submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
 including the possibility of fine and imprisonment.
 A. NAME (print or type)
                                                  B. SIGNATURE
                                                                                                   C. DATE SIGNED
EPA Form 3510-3 (6-80)
                                                          PAGE 4 OF  5
                                                                                                               CONTINUE ON PAGE 5

-------
Continued from page 4.
                                    Form Approved OMB No. 158-S80004
 V, FACILITY DRAWING (see page 4)
EPA Form 3510-3 (6-80)
PAGE 5 OF 5

-------
  caoc piilii t-M type ill LUC unonaucu ai caa winy
 Ifill-in areas are spaced for elite type, i.e., 12 characters/inch).
                                                                                           Form Approved OMB No.  158-S80004
  FORM
   3
  RCRA
                                     U.S. ENVIRONMENTAL. PROTECTION AGENCY
                               HAZARDOUS WASTE PERMIT APPLICATION
                                             Consolidated Permits Program
                                 (Thit information is required under Section 3005 of RCRA.)
APPLICATION
 APPROVED
               DATE RECEIVED
                       & day I
                                                    COMMENTS
                           JS.
 II. FIRST OR REVISED APPLICATION,
Place an "X" in the appropriate box in A or B below (mark one box only) to indicate whether this is the first application you are submitting for your facility or a
revised application. If this is your first application and you already know your facility's EPA I.D. Number, or if this is a revised application, enter your facility's
EPA (.0. Number in Item I above.
 A. FIRST APPLICATION (place an "£" below and provide the appropriate date)
     I  11. EXISTING FACILITY (See instructions for definition of "existing" facility.
     "^T                       Complete item below.)
                                                                                          g
                          FOR EXISTING FACILITIES, PROVIDE THE DATE Cyr., mo., & day)
                          OPERATION BEGAN OR THE DATE CONSTRUCTION COMMENCED
                          (use the boxes to the left)
                             (place an "X" below and complete Item I above)

        «• FACILITY HAS INTERIM STATUS
                                                                     z.NEW FACILITY (Complete item below.)
                                                                                       FOR NEW FACILITIES,
                                                                                       PROVIDE THE DATE
                                                                                       (yr^mo,, & day) OPERA-
                                                                                       TION BEGAN OR IS
                                                                                       EXPECTED TO BEGIN
                                                                                                     ..,-«.
                                                                                                          ft
                                                                                              . FACILITY HAS A RCRA PERMIT
 HI. PROCESSES - CODES AND DESIGN CAPACITIES
A. PROCESS CODE - Enter the code from the list of process codes below that best describes each process to be used at the facility. Ten lines are provided for
   entering codes. If more lines are needed, enter the code(s) in the space provided. If a process will be used that is not included in the list of codes below(jthen
   describe the process (including its design capacity) in the space provided on the form (Item III-C).

B. PROCESS DESIGN CAPACITY - For each code entered in column A enter the capacity of the process.
   1. AMOUNT - Enter the amount.
   2. UNIT OF MEASURE — For each amount entered in column  B(1), enter the code from the list of unit measure codes below that describes the unit of
      measure used. Only the units of measure that are listed below should be used.
           PROCESS
                              PRO-    APPROPRIATE UNITS OF
                              CESS    MEASURE FOR PROCESS
                              CODE      DESIGN CAPACITY
                                                                            PROCESS
                                                                          PRO-   APPROPRIATE UNITS OF
                                                                          CESS   MEASURE FOR PROCESS
                                                                         CODE      DESIGN CAPACITY
  Storage!
  CONTAINER (barrel, drum, etc.)
  TANK
  WASTE PILE

  SURFACE IMPOUNDMENT
  INJECTION WELL.
  LANDFILL
  LAND APPLICATION
  OCEAN DISPOSAL

  SURFACE IMPOUNDMENT
  UNIT OF MEASURE
  GALLONS	G
  LITERS	 L
  CUBIC YARDS	  . Y
  CUBIC METERS	C
  GALLONS PER DAY	U
                              SOI   GALLONS OR LITERS
                              S02   GALLONS OR LITERS
                              S03   CUBIC YARDS OR
                                    CUBIC METERS
                              804   GALLONS OR LITERS
                              D78   GALLONS OR LITERS
                              D80   ACRE-FEET (the volume that
                                    would cover one acre to a
                                    depth of one foot) OR
                                    HECTARE-METER
                              D8I   ACRES OR HECTARES
                              D82   GALLONS PER DAY OR
                                    LITERS PER DAY
                              D83   GALLONS OR LITERS
                              UN IT OF
                              MEASURE
                                CODE
                                          Treatment!
                                          TANK                          TOl

                                          SURFACE IMPOUNDMENT        T02

                                          INCINERATOR                   TOS
                                          OTHER (Use for physical, chemical,  T04
                                          thermal or biological treatment
                                          processes not occurring in tanks,
                                          surface impoundments or inciner-
                                          ators. Describe the processes in
                                          the space provided; Item III-C.)
                                                         GALLONS PER DAY OR
                                                        • LITERS PER DAY
                                                         GALLONS PER DAY OR
                                                         LITERS PER DAY
                                                         TONE PER HOUR OR
                                                         METRIC TONS PER HOUR)
                                                         GALLONS PER HOUR OR
                                                         LITERS PER HOUR
                                                         GALLONS PER DAY OR
                                                         LITERS PER DAY
                       UNIT OF MEASURE
                              UNIT OF
                             MEASURE
                               CODE
                                               LITERS PER DAY	 V
                                               TONS PER HOUR	D
                                               METRIC TONS PER HOUR	W
                                               GALLONS PER HOUR	E
                                               LITERS PER HOUR	H
                                      UNIT OF MEASURE
                                                    UN IT OF
                                                   MEASURE
                                                     CODE
                                                                     ACRE-FEET	A
                                                                     HECTARE-METER		F
                                                                     ACRES	B
                                                                     HECTARES	Q
 EXAMPLE FOR COMPLETING ITEM III (shown in line numbers X~1 and X-2 below): A facility has two storage tanks, one tank can hold 200 gallons and the
 other can hold 400 gallons. The facility also has an incinerator that can burn up to 20 gallons per hour.
                DUP
                                    u.
                                       15.
  ot
  Id

l!
JZ
   A. PRO-
     CESS
    CODE
   (from list
     above)
                 B, PROCESS DESIGN CAPACITY
t. AMOUNT
  (specify)
2. UNIT
OF MEA-
 SURE
 (enter
 code)
   FOR
OFFICIAL
   USE
  ONLY
                                                                   JZ
A. PRO
 CESS
 CODE
(from list
 above)
                                                                                   B. PROCESS DESIGN CAPACITY
                                                                  1. AMOUNT
 2. UNIT
OF MEA-
 SURE
 (enter
 code)
   FOR .  •;
OFFICIAL
   USE'  .
  ONLY
X-l
            JUL.
                                           JBL
                         600
                         30-

                         G
                                                                                                              -S.
                                                                                                                          3S.
X-2
                          20
                                                                   10
EPA Form 3510-3 (6-80)
                                                           PAGE 1 OF 5
                                                                                                             CONTINUE ON REVERSE

-------
Continued from the front.
III. PROCESSES (continued)^
C. SPACE FOR ADDITIONAL PROCESS CODES OR FOR DESCRIBING OTHER PROCESSES (code "T04"). FOR EACH PROCESS ENTERED HERE
   INCLUDE DESIGN CAPACITY.
IV. DESCRIPTION OF HAZARDOUS WASTES                                                                _
A. EPA HAZARDOUS WASTE NUMBER - Enter the four-digit number from 40 CFR, Subpart D for eacrnisted hazardous waste you will handle. If you
   handle hazardous wastes which are not listed In 40 CFR, Subpart D, enter the four—digit number^ from 40 CFR, Subpart C that describes the characteris-
   tics and/or the toxic contaminants of those hazardous wastes.

B. ESTIMATED ANNUAL QUANTITY - For each listed watte entered in column A estimate the quantity of that waste that will be handled on an annual
   basis. For each characteristic or toxic contaminant entered in column A estimate the total annual quantity of all the non—listed wasted that will be handled
   which possess that characteristic or contaminant.

C. UNIT OF MEASURE — For each quantity entered in column B enter the unit of measure code. Units of measure which must be used and the appropriate
   codes are:
               ENGLISH UNIT OF MEASURE
                                                           CODE
               POUNDS	P
               TONS	T
                                                                             METRIC UNIT OF MEASURE
                                                                                                                        CODE
KILOGRAMS .	K

METRIC TONS	M
   If facility records use any other unit of measure for quantity, the units of measure must be converted Into one of the required units of measure taking into
   account the appropriate density or specific gravity of the waste.

D. PROCESSES
   1.  PROCESS CODES:
      For lilted hazardous waste:  For each listed hazardous waste entered in column A select the codefo/ from the list of process codes contained in Item III
      to indicate how the waste will be stored, treated, and/or disposed of at the facility.
      For non-listed hazardous wastes:  For each characteristic or toxic contaminant entered in column A, select the codeW from the list of process codes
      contained in Item III to indicate all the processes that will be used to store, treat, and/or dispose of all the non—listed hazardous wastes that possess
      that characteristic or toxic contaminant.
      Note:  Four spaces are provided for entering process codes. If more are needed: (1) Enter the first  three as described above; (2) Enter "000" in the
      extreme right box of Item IV-D(1); and (3) Enter in the space provided on page 4, the line number and the additional code(s).

   2.  PROCESS DESCRIPTION:  If a code is not listed for a process that will be used, describe the process in the space provided on the form.

NOTE:  HAZARDOUS WASTES DESCRIBED BY MORE THAN ONE EPA HAZARDOUS WASTE NUMBER - Hazardous wastes that can be described by
more than one EPA Hazardous Waste Number shall be described on the form as follows:
   1.  Select one of the EPA Hazardous Waste Numbers and enter it in column A. On the same line complete columns B,C, and D by estimating the total annual
      quantity of the waste and describing all the processes to be used to treat, store, and/or dispose of the waste.
   2.  In column A of the next line enter the other  EPA Hazardous Waste Number that can be used  to describe the waste.  In column D(2) on that line enter
      "included with above" and make no other entries on that line.
   3.  Repeat step 2 for each other EPA Hazardous Waste Number that can be used to describe the hazardous waste.

EXAMPLE FOR COMPLETING ITEM IV (shown in line numbers X-1, X-2, X-3,andX-4 below) - A facility will treat and dispose of an estimated 900 pounds
per year of chrome shavings from leather tanning and finishing operation. In addition, the facility will  treat and dispose of three non—listed wastes. Two wastes
are corrosive only and there will be an estimated 200 pounds per year of each waste. The other waste is corrosive and ignitable and there will be an estimated
100 pounds per year of that waste. Treatment will be in an  incinerator and disposal will be In a landfill.
u
Ed
JZ
X-1
X-2
X-3
X-4
A. EPA
HAZARD.
WASTE NO
(enter code)
K
D
D
D
0
0
0
0
5
0
0
0
4
2
1
2
B. ESTIMATED ANNUAL
QUANTITY OF WASTE
900
400
100

C.UNIT
OF MEA-
SURE:
(enter
code)




P
P
P





D. PROCESSES
i. PROCESS cooes
(enter)
T 0 3
T 0 3
T 0 3
\ i
D 8 0
D 8 0
D 8 0
i i
i i
i i
i >
i i
i i
i i
i i
i i
2. PROCESS 'DESCRIPTION
(if a code it not entered in D(l))



included with above
EPA Form 3510-3 (6-80)
                                                               PAGE 2 OF 5
                                                                                                                       CONTINUE ON PAGE I

-------
jntinued from page 2.
OTE: Photocopy this page before completing if you have more than 26 wastes to list.
Form Approved OMB No. 1S8-S80004
u
3*
I
•2
3
4
,5
6
t
8
*.
i«
11
-1.2
13
14
IS
i£%
if?-
ffc;
pi
P
;2T
22
&
$
25'
26
. A. EPA
•HAZARD.
WASTE NO
(enter code)
^ M - - 2g









































































































B. ESTIMATED ANNUAL
QUANTITY Of WASTE
•*T ' ' • ' «»



























C. UNIT
OF MEA-
SURE
(enter
code)



























-Si-

























JML1


























0, PROCESSES • ' ' - . , '• '
1. PROCESS COOES
(enter}
W. - M
1 I
1 I
l 1


1 I
t 1
1 1
1 I
1 I
1 1


) 1
1 1
1 1
1 1
1 1
I 1


1 1
1 I
1 1
1 1
1 |
•87 * ftft
W * K9

t 1
1 1
1 1

1 I
1 |
I 1


1 1
1 1
1 1

i 1
1 1
1 1

1 I
I 1
1 1
| I

1 1
1 1
1 1

27 - M
1 1


1 1

1 1
1 1
I 1






I |

I 1
1 1
I |
1 1
1 1
1 1
1 1
1 1
1 1
I 1
87 - »e
27-29
| I












1 t



( |
1 I
1 |


1 1

1 I
1 1
** * »
2. PROCESS DESCRIPTION
df a code is not entered in D{1))


























IPA Form 3510-3 (6-80)
                CONTINUE ON REVERSE
                                                       PAGE 3	OF 5
                                   (enter "A", "B", "C", etc. behind the "3" to identify photocopied pages)

-------
Continued from the front.
      EPA l.D. NO. (enter from page 1)
V. FACILITY DRAWING
IV. DESCRIPTION OF HAZARDOUS WASTES (continued)
 E. USE THIS SPACE TO LIST ADDITIONAL. PROCESS CODES FROM ITEM D(1) ON PAGE
 All existing facilities must include in the space provided on page 5 a scale drawing of the facility (see instructions for more detail).
VI. PHOTOGRAPHS
 All existing facilities must include photographs (aerial or ground—level) that clearly delineate all existing structures; existing storage,
 treatment and disposal areas; and sites of future storage, treatment or disposal areas (see instructions for more detail).
VII. FACILITY GEOGRAPHIC LOCATION
                                                                                 LONGITUDE (degrees, minutes, & seconds)
                LATITUDE (degrees, minutes, & seconds)
 VIII. FACILITY OWNER
  CD A. If the facility owner is also the facility operator as listed in Section VIII on Form 1, "General Information", place an "X" in the box to the left and
        skip to Section IX below,

     B. If the facility owner is not the facility operator as listed in Section VIII on Form 1, complete the following items:
                                                                                                       2. PHONE NO. (area code & no.)
                                 I. NAME OF FACILITY'S LEGAL OWNER
                 3. STREET OH P.O. BOX
                                                                    4. CITY OR TOWN
 IX. OWNER CERTIFICATION
 / certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
 documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the
 submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
 including the possibility of fine and imprisonment.
 A. NAME (print or type)
                                                  B. SIGNATURE
                                                                                                    C. DATE SIGNED
 X. OPERATOR CERTIFICATION.

 / certify under penalty of law that I have personally examined and am familiar with the Information submitted in this and all attached
 documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the
 submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
 including the possibility of fine and imprisonment.
 A. NAME (print or type)
                                                  B. SIGNATURE
                                                                                                    C. DATE SIGNED
EPA Form 3510-3 (6-80)
                                                          PAGE 4 OF  5
                                                                                                               CONTINUE ON PAGE

-------
ontinued from page 4.
/. FACILITY DRAWING (see page
PA Form 3510-3 (6-80)
                                                     PAGE 5 OF 5

-------