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.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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
-------
FIGURE 1-1
-------
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f f] psnijiiiMX'd jyhul h-"f kfK;Jl provided, i'ff:?- j
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to v^ri^rf: =s> ^S;:T U."-. ^il.i'l L!.Xi! lh:>
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per yffti' of -usy ;;ii .joil^vnni ri;Hii'.,u'f! i
-------
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
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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)
-------
T^eeen nnnT or iyp^ ni:ieix/im:h).
| -,- ,^!
^ "'
, -J^^^==J^rs=
fi"ft5=s?AL
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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
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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*
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3
4
,5
6
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8
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11
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13
14
IS
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pi
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;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
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