2S050
NEIC
PERMIT GUIDANCE FOR WASTE DISPOSAL
BY UNDERGROUND INJECTION
December 1981
&EPA
national enforcement investigations center
denvei (i-ili-r.il tcnicr blclj; 5J. box 25227 dc'nvcr. co 80225
-------
28050
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
OFFICE OF LEGAL AND ENFORCEMENT COUNSEL
PERMIT GUIDANCE FOR WASTE DISPOSAL
BY UNDERGROUND INJECTION
December 1981
NATIONAL ENFORCEMENT INVESTIGATIONS CENTER
Denver, Colorado
-------
CONTENTS
INTRODUCTION 1
AUTHORITY AND IMPLEMENTATION 2
PERMIT PROCEDURES 5
REVIEW PART A OF THE PERMIT APPLICATION 5
COMPILE BACKGROUND INFORMATION 6
DETERMINE WHEN A UIC PERMIT IS NEEDED 6
REQUEST PART B OF THE PERMIT APPLICATION 7
REVIEW PART B OF THE APPLICATION 7
INSPECT THE FACILITY 11
DETERMINE IF A PERMIT SHOULD BE DENIED 11
CONTENTS OF THE PERMIT 11
FACT SHEET 12
FLOW CHART FOR INJECTION WELLS PERMIT DEVELOPMENT 13
SAMPLE EPA PERMIT 18
APPENDICES
A PART A - FORM 1
GENERAL INFORMATION
CONSOLIDATED PERMITS PROGRAM
B PART A - FORM 3
HAZARDOUS WASTE PERMIT APPLICATION
CONSOLIDATED PERMITS PROGRAM
Table
Review Checklist for Part B of the Consolidated Permit
Application, Underground Injection Wells 8
-------
INTRODUCTION
This manual Is designed to assist a permit writer In the step-by-step
development of a permit to control the disposal of wastes by underground
Injection. This manual supplements the various regulations applicable to
this permitting process. A suggested sample EPA permit is included. The
appropriate regulatory authorities are specified for each step of the pro-
cedure to guide the permit writer through the various program requirements.
The procedures discussed in this guidance are generally technical and are
adaptable to both State and Federal permit programs; thus, both State and
Federal permit writers will find them useful.
This manual is directed specifically to aid in processing permit appli-
cations for discharges to injection wells used by generators of hazardous
wastes or hazardous waste management facilities. These wells are classi-
fied as Class I and Class IV wells in 40 CFR 146. For the reasons discussed
below and in other sections, this manual does not address other Class I
wells (other industrial and municipal disposal wells which inject fluids
below the lowermost formation containing, within % mile of the well bore,
an underground source of drinking water), Class IV wells which inject radio-
active wastes, and other injection wells (Classes II, III, and V as defined
in 40 CFR 146). The programs needed to issue permits to these other wells
are not in place at this time. It is anticipated, however, that once pro-
grams for permitting these additional classes of wells are established,
this guidance, with minor modifications, will be useful.
Much of the information in this manual is based on Federal regulations
that are subject to revision or revocation. All such changes through Decem-
ber 1981 are believed to be reflected in the material presented herein.
However, the reader is cautioned to verify the status of any specific regu-
lations before relying on it as being in final form. For example, changes
have already been proposed in the 40 CFR 122 and 146 regulations; if these
changes are finalized, then some of the information in this manual may need
revision.
-------
It Is expected that the manual will be revised as appropriate as policy
and regulation changes or additions occur. Any comments that you might
have to improve the usefulness or accuracy of the manual are most welcome
and should be addressed to:
Mr. Donald Gipe
Environmental Protection Agency
National Enforcement Investigations Center
Building 53, Box 25227
Denver Federal Center
Denver, CO 80225
phone 303-234-4658, FTS 234-4658
-------
AUTHORITY AND IMPLEMENTATION
-------
AUTHORITY AND IMPLEMENTATION
The Safe Drinking Water Act (SDWA, PL 93-523), as amended, charges the
Environmental Protection Agency (EPA) to establish requirements to assure
that underground sources of drinking water are protected from endangerment
when fluids are placed underground by well injection. The Act delegates
primary enforcement authority to the individual states to develop and admin-
ister an underground injection control (UIC) program following the federally
established requirements. In those instances where a State either elects
not to establish and administer a UIC program or the State program does not
satisfy the Federal requirements, the EPA must establish and administer the
program. Generally, enforcement of environmental controls under the UIC
program must await either the development and approval of a State program
or, in the absence of a State program, the development of a Federal program.
The SDWA does not provide for any "interim status" period during which con-
trols could be enforced pending implementation of formal State or Federal
UIC programs. However, underground injection wells may be covered by an
existing State program.
The Resource Conservation and Recovery Act (RCRA, PL 94-580), as
amended, requires that EPA regulate the disposal of hazardous wastes includ-
ing the underground injection of hazardous wastes. The RCRA, unlike the
SDWA, does provide the authority for control during an "interim status"
period pending the development of State regulations or formal Federal programs.
When EPA's statutory authorities provide overlapping jurisdiction over
certain activities, it is within the discretion of the Administrator to
decide which program will be used to regulate the activity. Because UIC
enforcement programs pursuant to the SDWA are not now in place, the decision
has been made to control the underground injection of hazardous waste during
the "interim status" period through the authorities granted EPA under RCRA
(Federal Register Vol. 45, No. 98, May 19, 1980).
-------
It is currently anticipated that once a UIC program is in place, the
RCRA permit for a facility injecting hazardous wastes underground will apply
up to the cutoff valve on the injection well head and a UIC permit will
then apply to the subsurface injection; if the facility already has a RCRA
permit, then the UIC permit will be a "permit by rule".
Federal permits issued for injecting wastes underground use procedures
established under the consolidated permit program (40 CFR 122 and 124*),
which governs permit programs under RCRA, SDWA, and others.
The review, assessment, and inspection of individual injection well
projects is complicated. The wide range of waste types to be injected re-
quires a case-by-case evaluation of the degree of hazard associated with
any given fluid. Hazardous waste injection projects require a high degree
of assurance that the injection operation will function as designed: that
well failure will not occur, that the capacity of the injection zone is
adequate to accept the waste, and that the confining strata have sufficient
integrity to assure long-term containment of the injected fluid after the
injection project is completed. In addition, the proposed injection fluid
must be shown to be physically and chemically compatible with fluids exist-
ing in the injection zone and with the natural earth materials composing
the injection zone.
The "area of review", as defined in 40 CFR 146.06, surrounding a well
injection project should be determined because the critical area of influ-
ence may differ widely, depending on the hydrogeological terrain and pos-
sible interference with or from other subsurface operations in the vicinity.
For example, if subsurface fluid production in a region has altered the
natural fluid pressure regime and groundwater gradients, superposition of
pressure caused by an underground injection operation could create a dynamic
interaction. This interaction would not be expected if only the influence
of the injection operation were considered.
The requirements for State consolidated permit programs operated in
lieu of EPA are in 40 CFR 123.
-------
The review and evaluation of underground waste injection projects re-
quires caution and a high degree of assurance so the project can be managed
successfully. Once an injection activity has begun, it is, to a large ex-
tent, irreversible. If the system fails to operate as designed and an un-
derground source of drinking water becomes contaminated, reclaiming the
affected aquifer may be impractical. At best, contaminated aquifer recla-
mation efforts are exceedingly expensive and require years to decades to
accomplish.
For these reasons, the proposed injection fluid must be thoroughly
characterized, the injection well design and operating procedures clearly
defined, and the hydraulic and hydrogeological characteristics of the injec-
tion and confining layers well understood.
To effectively review and evaluate permit applications for underground
injection projects, a broad range of subjects including chemistry, well de-
sign and construction, well development and testing, well and formation
hydraulics, and hydrogeology is useful. The project reviewer must know
when and from whom to seek assistance when that person does not have all of
the knowledge and experience to ensure a complete and thorough evaluation
of a complex underground injection project.
-------
PERMIT PROCEDURES
-------
PERMIT PROCEDURES
There are a number of general procedural and technical steps that must
be followed to develop a permit for the underground injection of wastes.
These steps are briefly discussed in the following paragraphs and enumerated
in the flow charts beginning on page 13. As noted earlier, these steps are
primarily for the injection of hazardous wastes; however, they are also
generally applicable to the issuance of any permit for waste injection.
Where appropriate, the flow chart refers to processing permit applications
for other than injection of hazardous wastes; note, however, that these
steps are not applicable until such time as a State or EPA UIC permit pro-
gram is approved pursuant to the SOWA and is in effect.
REVIEW PART A OF THE PERMIT APPLICATION
All generators, owners, or operators of facilities which treat, store,
or dispose of hazardous wastes must submit Part A of the consolidated permit
forms (Forms I and 3, attached as Appendices 1 and 2). The first step in
the permitting process is to examine Part A: (1) to determine if the appli-
cant is injecting a hazardous waste underground, and (2) if injecting, to
verify the completeness of the application. If the facility is not inject-
ing hazardous wastes but otherwise treats, stores, or disposes of hazardous
wastes, then a RCRA permit may be appropriate but the processing of that
permit would be in accordance with other guidance.*
Supplemental information requested from the applicant may be necessary
to determine if the injection fluid contains a hazardous contaminant as
listed in 40 CFR 261. The applicant must be notified when the application
is complete.
* See "A-Step-by-Step Approach to Development of NPDES and RCRA Permits",
EPA-330/1-81-004, July 1981.
-------
COMPILE BACKGROUND INFORMATION
A variety of data and reference materials are available to assist the
permit writer in reviewing Part A of the permit application and preparing
permit conditions. These include RCRA interim status or uncontrolled site
inspection reports, annual reports, information in other program files, and
technical guidance or reference manuals. This information is also useful
in determining supplemental data needs prior to requesting Part B (see be-
low). In the case of EPA permits, State files may contain additional data,
especially if the State has its own hazardous waste permit program or under-
ground injection program.
DETERMINE WHEN A UIC PERMIT IS NEEDED: (Note: This section will not be
applicable until a State or EPA UIC program, pursuant to the SDWA, is
implemented.)
All owners and/or operators of existing injection wells must apply for
a UIC permit no later than 4 years after approval of a State UIC program or
implementation of an EPA-administered program (40 CFR 122.38(b)(l)). If
the injected hazardous waste is accompanied by a manifest or contains a
hazardous contaminant as listed in 40 CFR 261, Appendix VIII, a UIC permit
must be applied for within 6 months after approval of an applicable State
program.
UIC permit applications are required for new Class I wells, wells sus-
pected of contaminating an underground supply of drinking water (USDW),
wells operating in violation of existing regulations, and wells needing
permits issued by other State or Federal agencies (40 CFR 146.09).
Other existing Class I wells may be authorized by rule under RCRA for
the interim period (40 CFR 122.37).
-------
REQUEST PART B OF THE PERMIT APPLICATION
The second phase of the application process is the submission of Part B
by the applicant. Unless voluntarily submitted, Part B must be requested
by the permitting authority, and the applicant must be given at least 6
months to submit requested data.
There is no Part B application form. The data required differ, depend-
ing on the type of facility. Required data for each type of facility are
defined in 40 CFR 122.25. More specific information requirements are listed
in 40 CFR 146, Subpart B. Prior to requesting Part B, the permit writer
should determine the specific data required for the facility. These re-
quirements should be reviewed for adequacy as additional data may be needed
for some complex facilities or unusual cases. Supplemental data is easier
to request at this stage than after an inadequate application has been
received.
Conversely, some required data may not be needed for simpler facili-
ties. Waiver of certain data requirements may be possible upon request by
the applicant.
REVIEW PART B OF THE APPLICATION
When Part B is received, it must be reviewed for technical and admini-
strative completeness within 30 days for new facilities and 60 days for
existing facilities. The applicant is then notified that Part B is com-
plete or that supplemental information is required.
The adequacy of Part B data is a key to efficient preparation of a
comprehensive permit. Thorough review of Part B at this stage is thus very
important. A lengthy checklist to assist the permit writer in determining
completeness of this review is presented in Table 1.
-------
REVIEW CHECKLIST FOR PART B
-------
Table 1
REVIEW CHECKLIST FOR PART B
OF THE CONSOLIDATED PERMIT APPLICATION
Underground Injection Wells
I. Justification for injection well (Administrator's Decision Statement No. 5)
A. Pertinent manufacturing processes and products (Application Parts A and B)
B. Current method(s) of disposal for wastes to be injected (industry review)
C. Alternative methods considered
0. Treatability study results
E. Anticipated life of the injection project
II. Well location
A. Maps of facility (such as 1:5,000 scale) and area (such as 1:24,000 scale)
showing well location (may be combined with B below)
B. Area of review
1. Zone of endangering influence (calculation acceptable)
2. Fixed radius (adequate consideration given to factors described in
§ 146.04(b))
3. Population in area of review
4. Maps showing ownership of land surface, water, and mineral rights
5. Tabulation of owners shown on maps prepared for item 4 above
6. Map showing features listed under § 145.14(a}(2)
7. Tabulation of all wells in area of review that penetrate the pro-
posed injection zone, their construction, and present use/condition
8. Proposed corrective actions for defective wells and related infor-
mation listed in § 146.07
9. Owners of defective wells agree to corrective actions
III. Hydrogeology
A. Geology
1. Generalized maps and cross sections illustrating the regional geo-
logic setting (within a suggested radius around the well of 10
miles or more), control borings, or wells must be indicated on draw-
ings [§ 146.14(a)(6)]
2. Maps and cross sections delineating geologic structure of the local
area (area of review), control borings, or wells must be indicated
on drawings [§ 146.14(a)(5)]
3. Isopach maps depicting major lithologic or hydrologic units of
significance to the injection well
4. A history of sedimentary deposition or tectonic events in the area
5. Map showing location of any Holocene faults within 3,000 ft of the
well or within the area of review (whichever is larger)
[§ 122.25(a)(ll)]
6. Narrative on probable effects of above factors on project
B. Groundwater
1. Maps and cross sections indicating all underground sources of
drinking water as indicated in § 146.14(a)(4). Water quality in each
hydrologic unit differentiated on the basis of total dissolved
solids concentration (eg., less than 3,000 rag/4, between 3,000 and
10,000 mg/i, and greater than 10,000 mg/£)
2. Narrative describing interconnection of significant hydrologic units
3. Piezometric surface maps for injection zone and overlying hydrologic
units
4. Supporting data for piezometric surface maps
5. Copies of drill stem tests, extrapolations, and other relevant data
6. Present and potential uses of water above the injection zone in the
area of review
7. Exempted aquifers (§ 146.04)
C. Characteristics of the disposal zone
1. Effective thickness and area! extent (isopach map)
2. Lithology and mineralogy of injection and confining intervals
3. Effective porosity (how determined)
4. Permeability (vertical and horizontal) (how determined)
5. Extent of natural fracturing
6. Fracturing and fracture propagation gradients
7. Location, extent, and effects of known or suspected faulting
-------
10
Table 1 (Continued)
8. Extent and effect of natural solution channels
9. Fluid saturation
10. Formation fluid chemistry
11. Formation temperature (how determined)
12. Formation fluid pressure (original and modifications resulting from
previous fluid withdrawals)
13. Osmotic characteristics of rock and fluids both compressive and
contiguous to the reservoir
14. Diffusion and dispersion characteristics of the waste and formation
fluid including effect of gravity separation
IV. Waste source(s) and characteristics
A. Tabulation of all existing or proposed waste sources
1. Waste type
2. Generator identification numbers
3. Percentage of each waste stream to injection facility
4. Estimated monthly or yearly volume of each waste stream
5. Total annual volume of waste stream
6. Anticipated life of the project
B. Waste pretreatment facilities
1. Existing facilities
2. Proposed facilities
3. Flow diagram with waste streams identified
4. Plans for emergency storage or treatment in case of well failure
5. Pond or lagoons proposed or in use
6. Filter types and locations
7. Disposal of sludges or solids
C. Waste Characteristics
1. Chemical
2. Physical (including temperature)
3. Biological
4. Stability characteristics with respect to time, temperature, pres-
sure, or other influences
5. Corrosion characteristics of the injection fluid •
6. Compatibility of injected waste with physical, chemical, and biological
characteristics of the reservoir
V. Well design
A. Proposed Well Construction
1. Total depth to the injection zone
2. Injection interval
3. Surface casing: size, type, weight, setting depth, guide/float
equipment, centralizers, scratchers, grade, wall thickness, dia-.
meter, length joint space, construction materials
4. Surface casing cement data and service company recommendations
5. Intermediate string and cementing data
6. Injection or long string: size, type, weight, setting depth,
guide/float equipment, DV tool, centralizers. scratchers, etc.
7. Injection string cement data and service company recommendations,
cement compatability data, type and grade
8. Packer: type and setting depth or fluid seal
9. Description of annulus monitoring system, including type fluid,
fluid characteristics and proposed pressure
10. Type completion
a. Open hole
b. Perforated long string: where and how many
c. Screen and blank liner: size, setting depth, type
d. Underream and/or gravel pack
e. Other
11. Diagrammatic sketch of well
12. Diagrammatic sketch of well and head and complete description
13. Injection pump design and location
14. Type of drilling rig used for boring hole
-------
11
Table 1 (Continued)
B. Proposed Well Operation
1. Data on initial testing for mechanical integrity
2. Estimated average and maximum injection rates and pressures;
external, internal, and axial loading
3. Expected injection schedule
4. Expected change in pressure and rate, and direction of fluid dis-
placement by injected wastes relative to time in area of review
5. Monitoring measures to assure continued mechanical integrity of
well and injection zone
6. Provision for monitoring Injection pressure and volume
7. Plan for determining chemical and physical characteristics of
waste stream on a routine schedule (waste analysis plan)
VI. Reservoir Stimulation and Testing
A. Description of proposed injectivity tests
B. Well stimulation: acidizing, etc.
C. Description of logging program
D. Description of coring program and laboratory testing
VII. Plugging and Abandoning the Injection Well
A. Financial responsibility for closure established
B. Plug placement according to approved procedure [§ 146.10(b),
and § 264.434]
C. Plug and seal designed for appropriate level in well to prevent
escape of injected fluids from the zone of injection
D. Complete specifications of seal, design drawings, and description of
emplacement procedure
E. Method for bringing well into state of static equilibrium between fluid
in well and that in the injection zone before sealing [§ 146.10(c)]
-------
12
The Part B data should be compared to the background information and
discrepancies and deficiencies noted. In some cases, the background data
may adequately supply missing Part B information. A supplemental request
or a facility inspection may be necessary in some cases to verify data or
compile supplemental information.
INSPECT THE FACILITY
There are several factors that would indicate the need to inspect the
facility prior to permit development. These are:
A history of environmental problems
A history of noncompliance with interim status standards
Available information is inadequate to prepare a permit
Large amounts of acutely hazardous or toxic wastes are handled
Major land disposal or surface impoundment facilities are present
A previous inspection indicates the need for a followup inspection
A followup inspection may be needed if the previous inspection did not in-
clude observations or documentation of critical activities or data.
DETERMINE IF A PERMIT SHOULD BE DENIED
When the background and application data and/or inspection observations
for existing facilities indicate that the injection well operation cannot
assure protection from migration of injected fluids or other formation
fluids into underground sources of drinking water, the permit must be denied.
Similarly, if the proposed design and construction details for new wells
do not ensure protection of underground sources of drinking water, the permit
must be denied.
CONTENTS OF THE PERMIT
1. Name of the permittee
2. Nature of the business
3. Description and location of the activity
4. Name of the injection formation and the subsurface interval
-------
13
5. Description of the injection fluid (range of properties,
physical, chemical, and biological) including quality assurance
6. Construction requirements
7. Logging and testing requirements
8. Operating parameters including injection rates, pressures,
daily volumes, annual volumes, and annular pressure
9. Monitoring requirements, including quality assurance
10. Completion report (newly drilled wells only)
11. Well work-over instructions
12. Reporting instructions
13. Recordkeeping
14. Plugging and abandonment requirements
15. General conditions
16. Special conditions
17. Effective and termination dates
FACT SHEET
A fact sheet must accompany every draft permit notice of intent to
deny a permit, or notice of intent to terminate a permit in accordance with
the directions in 40 CFR 124.8. The fact sheet presents the principal facts
and significant factual, legal, methods, and policy questions considered in
preparing the draft permit or in making the determination to deny or term-
inate a permit.
-------
FLOW CHART FOR INJECTION UIELLS PERMIT DEVELOPMENT
Start
Review Part A of consolidated
permit application
Request supplemental
information
i
Part A information completeTy
No
Notify Applicant
No
Is this an exempted aquifer? \ es t*/stop. Permit not required )
122.35 (b), 146.04 / V J
Yes
r*-
this a Class I well? \ ^ »( Stop. Does- not apply )
Do you know whether injection fluid contains hazardous contaminants?
See Part 261 for identification and listing of hazardous'wastes.
Do you know whether or hot well is suspected of contaminating USDW?
nDo you know whether or not well is in violation of existing regulations?
Do you know whether or not other State or Federal permits are required?
No
-^Request supplemental
I information
to next page
-------
Continued from previous
page
No
No
No
Is this a new\
well? )—'
1
Yes
;is the well suspected
of contaminating
groundwater?
Yes
Is the well in viola-
tion of existing
regulations?
1
rls a permit required
, by other state or
Federal Agency?
No
Yes
Must file Part B information
within 6 mos. after approval of
an applicable stata program.
Facility must comply with 122.45
Yes
j
Is this hazardous waste
accompanied by a manifest
or delivery document?*
122.45(b)
Does the injection fluid
contain a hazardous contami-
nant listed in Part 261
Appendix VIII?
Request Part B detailed
information as required
by Parts:
and 267.
122, 146, 264,
Review Part B
information
Request
supplemental
information
Yes
Is all the information needed
for the technical analysis
available?
Notify applicant
to the next page
rls a site visit
necessary?
v
Permit by rule
as specified in 122
.37 |
File application for DIG
permit no later than 4 years
after approval of UIC program
( Stop )
Yes
Notify applicant
and make inspection
It is assumed in this flow chart that if a manifest or
delivery document does not accompany the waste, then,
one is not needed. If a manifest is needed but not
nrovided, then a violation of RCRA requirements may
have occurred and legal counsel is necessary.
-------
(^Continued from previous page
No
'is the well located in any of the political jurisdictions
listed in Part 264 Appendix VI?
Yes
an 21
Yes /Is the'well located more tfian"2Uo ft from"a Holocene faufti
V Can compliance with 122.25(a) (11) be demonstrated?
Yes
No /Is facility
\in 100 yr f
i
located \
lood plain?/
\
\
KDoes facility design and operatinq X^0
plan show compliance with 264.18(b)y
Compliance
schedule to
modifv desirm
fl
No/ Is the IDS of the injection
\aquifer less than 10,000 ppm?
Yes
No
Request
modification
[Return to appropriate
ystep in sequence
/ Is the zone of endangered
-( influence presently defined?
\ 146.06
Do the design and construction details
adequately guard against migration of the
injection formation? 122.34
Wes
Deny permit
Go to next page J
-------
17
C Continued from previous page j
J
Yes
/Does the information listed in \No
-(-146.14a affirm the mechanical
\integrity of the well 122.42(a)?y
r
Yes
operating conditions meet
^requirements of 146.13(a)
eet \No ^
? /
\
Yes / Does monitorinq system meet
\requirements of 146.13(b)?
—\
^es /Does quarterly report to Director \.No_
\ meet requirements of 146.13(c)? /
1
Set up compliance schedule
to achieve compliance within
3 yrs of effective date
Set up compliance schedule
to be completed within
1 yr of effective date
/Return to appropriate ^
ystep in sequence J
Yes /Are monitoring and response procedures yM^,
^adequate for accidents? 264.433 f
/
\
Does the closure plan meet require- \No
ments of 264.434? /
1
Yes /Are financial arrangements adequate
kfor the effective closure of the well?
Request necessary
changes to plans
i
(Return to appropriate )
.step in sequence _J
Draft UIC Permit
and prepare Fact
Sheet
( Stop
-------
18
Continued from previous page)
New injection well
Yes /Do available logging and testing program
data affirm the mechanical integrity of
\the well? 146.14(b) and 146.08
Do planned operating conditions meet
requirements of 146.13(a)?
Yes
Are monitoring and response procedures
adequate for accidents? 264.433
1
Yes
Does the closure plan meet requirements
of 264.434?
JL
Are financial arrangements adequate for
the effective closure of the well?
Draft UIC Permit and
prepare Fact Sheet
Stop ")
No
No
Yes / Does planned monitoring system meet \ No
requirements of 146.13(b)? /
No
No
No
Request necessary
changes to well con-
struction and/or plans
Return to appropriate"^
step in sequence J
-------
SAMPLE EPA PERMIT
-------
19
Following is a sample permit for an underground inspection well. Note
that discussions in parentheses are intended as explanation and should not
be included in the actual permit. Also shown in parentheses is the appli-
cable regulatory requirement. If a State permit, all references to the
Regional Administrator should be changed to Director or other appropriate
title for the head of the State permitting agency. Explanatory information
is provided parenthetically in italics.
Permit No.
Application No.
EPA Identification No.
I. NAME OF PERMITTEE
A. Name
B. Address
II. NATURE OF BUSINESS
A. (Brief description of permittee's business)
B. SIC code:
III. DESCRIPTION AND LOCATION OF INJECTION ACTIVITY
(Description of activity (type waste, etc.)
(Legal description of location)
Injection will be into the (name of formation(s)) in the approximate
subsurface interval between ft and ft.
The permittee is authorized to conduct injection activity in accordance
with the provisions of the Resource Conservation and Recovery Act, as
amended, (the Safe Drinking Water Act, following implementation of a
State or EPA VIC program), and with the limitations, requirements, and
other conditions set forth in this permit.
This permit shall become effective on and shall ex-
pire at midnight unless amended or terminated by the Regional Administrator.
Signatures
-------
20
PART I: SPECIAL CONDITIONS
1. CONSTRUCTION REQUIREMENTS
The permittee is required to set and cement surface casing to a
minimum subsurface depth of ft to properly pro-
tect all underground supplies of drinking water.
Cementing shall be by the method and sufficient
grout shall be used to fill the annular space between the hole
and surface casing to the surface of the ground.
The intermediate casing shall be set and cemented from ft
to ft.
The long string casing shall be set and cemented from ft
to ft.
Except as specifically required in the terms of this permit, the
drilling and completion of the well shall be done in accordance
with the plans and specifications contained in the permit appli-
cation. Any proposed significant changes to the plans and speci-
fications must be submitted to the Regional Administrator and
receive written approval.
2. LOGGING AND TESTING REQUIREMENTS
A. The following logs shall be run during the drilling and
completion of the well. A descriptive report interpreting
the results of the logs shall be prepared by a qualified
log analyst and submitted to the Regional Administrator.
-------
21
1. For Surface Casing Hole before the casing Is Installed:
[List the type of Jogs to be run (electric, caliper,
etc.)]
a. _
b. _
c. _
d. _
e. _
After the casing Is Installed:
[List the types of logs to be run (cement Jbond, noise,
etc.)]
f. _
g. _
h.
j-
2. For Intermediate and Long String Casing Holes before
casing is installed:
[List the types of logs to be run (electric, tempera-
ture, caliper, etc.)]
a.
b.
c.
d.
e.
and after the casing is installed:
[List the types of logs to be run (cement bond, noise,
etc.)]
f.
g-
h.
i.
j-
-------
22
B. Prior to completing the well, the bottom home pressure, bot-
tom temperature, and static fluid level shall be determined
and a representative sample of formation fluids obtained and
analyzed.
C. After completion of the well, tests shall be performed to
determine the following reservoir characteristics: [List the
tests to be conducted in the injection zone (permeability,
hydraulic pressure responses, etc.)]
1.
2.
3.
4.
D. The permittee shall run compatibility tests of the injected
waste with injection zone fluids, and core samples of the
injection zone and the confining zone.
E. Before any injection can commence, the. permittee shall per-
form the following to insure that the well has mechanical
integrity.
1. A (full hole temperature or noise log) shall
be run to show that there will be no significant fluid
movement into USDWs.
2. The surface casing shall be tested to psi for
minutes and the long string casing shall be
tested to psi for minutes.
3. OPERATING PARAMETERS
The maximum rate of injection shall not exceed gallons
per minute. The volume of liquid(s) injected shall not exceed
gallons per month. (This information may be obtained
from evaluation of hydraulic testing and formation pressure
response.)
-------
23
The operating injection pressure at the well head shall not exceed
psig. (This pressure is selected to give assurance that
the down-hole pressure will not be great enough to fracture the
confining strata.)
The tubing-long string casing annulus shall be filled with a fluid
containing corrosion inhibitors, and a differential pressure of
at least psig shall be maintained on the annulus to de-
tect well malfunctions. (The annulus pressure is always greater
than the injection pressure to assure containment of the injection
fluid. Sudden changes in annulus pressure and/or annulus fluid
inventory indicates a probable casing or tubing failure or a leak-
ing packer.)
4. MONITORING (40 CFR 122.11)
A. Pressure gages shall be installed and maintained in proper
operating conditions at all times on the injection tubing
and on the tubing-long string casing annulus at the well
head.
B. Continuous recording devices shall be installed and main-
tained in proper operating conditions at all times to record
injection tubing pressures, injection flow rates, injection
volumes and tubing-long string casing annulus pressure.
C. The mechanical integrity of the well shall be tested every
(at least once every 5 years - more often, if deemed neces-
sary) year by performing the following: (Caliper log pres-
sure test on casing and tubing)
1.
2.
-------
24
D. Injected fluids shall be analyzed (frequency) for the follow-
ing parameters:
(List contaminants limited by this permit and screen for
changes from original waste stream.)
1.
2.
3.
E. The monitoring wells identified in the permit application
shall be sampled on a (frequency) basis and the samples
analyzed for the following-parameters:
(List contaminants limited by this permit and other char-
acteristic constituents which would indicate migration
of other formation fluids such as pressure, etc.)
1.
2.
3.
4. ;
5. COMPLETION REPORT (Newly drilled wells only)
The permittee shall submit a notice of completion of construction
to the Regional Administrator before commencing injection.
As part of the notice, the Permittee shall submit the following
information:
1. All available logging and testing data as required in Part I,
Section 2.
2. The demonstration of mechanical integrity required in Part I,
Section 2-E.
3. Any modification to the permitted operating parameters
described in Part I, Section 3.
-------
25
The Regional Administrator will inform the permittee within
13 days of the date of the notice of his intent to inspect or
review the injection well. If the Regional Administrator waives
his right or does not inform the permittee of his intent within
13 days, the permittee may commence injection.
6. WELL WORKOVERS
The permittee shall give notice to the Regional Administrator as
soon as possible of any planned workover of the well.
The notification shall be in writing and shall include plans
for the workover.
A complete report of the workover shall be prepared including
the reason for the workover and details of the work performed.
7. REPORTING [40 CFR 122.7(1)4]
A. The permittee shall file (frequency - suggest quarterly) re-
ports within days after the last day of , ,
, and of each year on:
1. Monthly average, maximum and minimum values for injection
pressure, flow rate, volume, and annular pressure.
2. Results of analyses of the injected fluids.
3. Results of the monitoring analyses.
The results of periodic tests of mechanical integrity and
reports of well workover shall be reported with the first
(frequency - e.g., quarterly) report following their
completion.
B. The permittee shall notify the Regional Administrator at least
180 days before conversion or abandonment of the well.
-------
26
8. PLUGGING AND ABANDONMENT [40 CFR 122.41(e)]
The permittee shall notify the Regional Administrator in writing
180 days prior to commencing plugging operations. The well shall
be plugged in the manner described in the permit application.
Grout plugs shall be set at the following intervals:
from ft to ft
from ft to ft
from ft to ft
If the permittee wishes to modify the location of the plugs or
the plugging method, he shall furnish the Regional Administrator
the following information:
1. The location of the plugs.
2. The type of grades and quantity of grout to be used.
3. The method of placement of the plugs.
4. The method for insuring static equilibrium in the well prior
to the placement of the plugs.
PART II: GENERAL CONDITIONS
1. DUTY TO COMPLY [40 CFR 122.7(a), 122.41(a)]
The permittee shall comply with all conditions of this permit.
The filing of a request by the permittee for a permit modification,
revocation and reissuance, or termination, or a notification of
planned changes or anticipated noncompliance, does not stay any
condition of this permit. Any permit noncompliance constitutes a
violation of the Act and is grounds for enforcement action includ-
ing permit termination, revocation and reissuance, modification,
or denial of a permit renewal application. In addition, criminal
or civil actions may be brought in appropriate instances.
-------
27
A. The permittee need not comply with the conditions of this
permit to the extent and for the duration such noncompliance
is authorized in an emergency permit.
B. It is not a defense in an enforcement action for a permittee
to assert that it would have been necessary to halt or reduce
the permitted activity in order to maintain compliance with
the conditions of this permit.
2. IMMINENT HAZARD ACTION [40 CFR 264.4]
Notwithstanding any other provisions of this permit, enforcement
actions may be brought pursuant to § 7003 of RCRA.
3. DUTY TO REAPPLY [40 CFR 122.7(b)]
If the permittee wishes to continue the activity regulated by this
permit after the expiration date of this permit, the permittee
must apply for and obtain a new permit in a timely manner.
4. DUTY TO MITIGATE [40 CFR 122.7(d)]
The permittee shall take all reasonable steps to minimize or
correct any adverse impact on the environment resulting from
noncompliance with this permit even to the extent of re-
ducing or halting the permitted activity.
(PENALTIES FOR VIOLATIONS OF PERMIT CONDITIONS
The Safe Drinking Water Act (SDWA) provides that any person
who violates a permit condition implementing Sections 1421,
1423, and 1424 of the SDWA is subject to a civil penalty not
to exceed $5,000 for each day the violation occurs. Any
person who willfully violates permit conditions implementing
Sections 1421, 1423, and 1424 of the SDWA is subject to a
fine not to exceed $10,000 for each day the violation occurs.
(to ?:r?cted in a permit issued pursuant to the
-------
28
5. PROPERTY RIGHTS [40 CFR 122.7(g)]
Issuance of this permit does not convey any property rights of
any sort or any exclusive privilege. Issuance of this permit
does not authorize any injury to persons or property or invasion
of other private rights or any infringement of State or local law
or regulations.
6. MODIFICATIONS OR REVOCATION AND REISSUANCE OF PERMITS [40 CFR
122.7(d)]
This permit may be modified, revoked and reissued, or terminated
for causes specified in 40 CFR 122.15. The filing of a request
by the permittee for a permit modification, revocation and reis-
suance, or termination, or a notification of planned changes or
anticipated noncompliance, does not stay any permit condition.
7. PROPER OPERATION AND MAINTENANCE [40 CFR 122.7(e)]
The permittee shall at all times properly operate and maintain
all facilities and systems of treatment and control (and related
appurtenances) which are installed-or used by the permittee to
achieve compliance with the conditions of this permit. Proper
operation and maintenance includes effective performance, adequate
funding, adequate operator staffing and training, and adequate
laboratory and process controls, including appropriate quality
assurance procedures. This provision requires the operation of
back-up or auxiliary facilities or similar systems only when nec-
essary to achieve compliance with the conditions of the permit.
8. DUTY TO HALT OR REDUCE ACTIVITY [40 CFR 122.7(c)]
The permittee shall modify operations as necessary to maintain
compliance with this permit when changes (equipment failures,
power outages, etc.) occur. The permittee shall not use, as a
-------
29
defense in an enforcement action, the fact that it would have
been necessary to halt or reduce the permitted activity in order
to comply with permit conditions.
9. DUTY TO PROVIDE INFORMATION [40 CFR 122.7(h)]
The permittee shall furnish to the Regional Administrator within
a reasonable time, any information which the Regional Administrator
may request to determine whether cause exists for modifying, re-
voking and reissuing, or terminating this permit, or to determine
compliance with this permit. The permittee shall also furnish to
the Regional Administrator, upon request, copies of records required
to be kept by this permit.
10. INSPECTION AND ENTRY [40 CFR 122.7(c)]
The permittee shall allow the Regional Administrator, or an author-
ized representative, upon the presentation of credentials and
other documents as may be required by law, to:
a. Enter upon the permittee's premises where the regulated facil-
ity or activity is located or conducted, or where records
must be kept under the conditions of this permit;
b. Have access to and copy, at reasonable times, any records
that must be kept under the conditions of this permit;
c. Inspect at reasonable times any facilities, equipment
(including monitoring and control equipment), practices,
or operations regulated or required under this permit; and
d. Sample or monitor at reasonable times, for the purposes
of assuring permit compliance or as otherwise authorized
by the appropriate Act, any substances or parameters at
any location.
-------
30
11. MONITORING AND RECORDS [40 CFR 122.70')]
Samples and measurements taken for the purpose of monitoring
shall be representative of the monitored activity. Monitoring
must meet the requirements of 40 CFR 146.13(b).
The permittee shall retain records of all monitoring informa-
tion, including all calibration and maintenance records and
all original strip chart recordings for continuous monitoring
instrumentation, copies of all reports required by this per-
mit, and records of all data used to complete the application
for this permit, for a period of at least 3 years from the
date of the sample measurement, report, or application.
This period may be extended by request of the Regional
Administrator at any time.
Records of monitoring information shall include:
a. The date, exact place, and time of sampling or
measurements;
b. The individual(s) who performed the sampling or
measurements;
c. The date(s) analyses were performed;
d. The individual(s) who performed the analyses;
e. The analytical techniques or methods used; and
f. The results of such analyses.
Also, the permittee shall retain all records concerning the
nature and composition of injected fluids until 3 years after
completion of any plugging and abandonment procedures. The
Regional Administrator may require the owner or operator to
deliver the records to the Regional Administrator at the con-
clusion of the retention period.
-------
31
12. SIGNATORY REQUIREMENT [40 CFR 122.7(fc)]
All applications, reports, or information submitted to the
Regional Administrator shall be signed and certified.
a. Applications - All permit applications shall be signed
as follows:
(1) For a corporation: by a principal executive offi-
cer of at least the level of vice-president,
(2) For a partnership or sole proprietorship: by a
general partner or the proprietor, respectively; or
(3) For a municipality, State, Federal, or other public
agency: by e'ither a principal executive officer or
ranking elected official.
b. Reports - All reports required by the permit and other
information requested by the Regional Administrator shall
be signed by a person described above or by a duly authorized
representative of that person. A person is a duly authorized
representative only if:
(1) The authorization is made in writing by a person
described above.
(2) The authorization specifies either an individual or
a position having responsibility for the overall
operation of the regulated facility or activity,
such as the position of plant manager, operator of
a well or a well field, superintendent, or posi-
tion of equivalent responsibility. (A duly auth-
orized representative may thus be either a named
individual or any individual occupying a named
position), and
(3) The written authorization is submitted to the
Regional Administrator.
-------
32
c. Changes to authorization - If an authorization under para-
graph b of this section is no longer accurate because a
different individual or position has responsibility for the
overall operation of the facility, a new authorization satis-
fying the requirements of paragraph b of this section must
be submitted to the Regional Administrator prior to or to-
gether with any reports, information, or applications to be
signed by an authorized representative.
d. Certification - Any person signing a document under paragraph
a or b of this section shall make the following certification:
"I certify under penalty of law that I have personally examined
and am familiar with the information submitted in this document
and all attachments and that, based on my inquiry of those indivi-
duals immediately responsible for obtaining the information, I
believe that the 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."
13. REPORTING REQUIREMENTS [40 CFR 122.7(1)1,2; 40 CFR 122.41(c)]
a. Planned Changes - The permittee shall give notice to the
Regional Administrator as soon as possible of any planned
physical alterations or additions to the permitted facility.
Except for the new wells authorized by an area permit under
40 CFR 122.39(c), a new injection well may not commence
injection until construction is complete, and:
(1) The permittee has submitted notice of completion of con-
struction to the Regional Administrator; and
-------
33
(2) The Regional Administrator has inspected or otherwise
reviewed the new injection well and finds it is in com-
pliance with the conditions of the permit or the per-
mittee has not received notice from the Regional Admini-
strator of his or her intent to inspect or otherwise
review the new injection well within 13 days of the
date of the notice in paragraph (1) of this section,
in which case prior inspection or review is waived and
the permittee may commence injection. The Regional
Administrator shall include in his notice a reasonable
time period in which he shall inspect the well.
b. Anticipated Noncompliance - The permittee shall give advance
notice to the Regional Administrator of any planned changes
in the permitted facility or activity which may result in
noncompliance with permit requirements.
c. Monitoring Reports [40 CFR 122.7(1)4] - Unless more frequent
reporting is specified herein, monitoring results shall be
reported at the intervals specified in 40 CFR 146.13(c)
and meet minimum monitoring requirements of 40 CFR 146.13(b).
d. Compliance Schedules [40 CFR 122.7(1)5; 40 CFR 122.41(d)] -
Reports of compliance or noncompliance with, or any progress
reports on, interim and final requirements contained in any
compliance schedule of this permit shall be submitted no
later than 14 days following each schedule date. Any reports
of noncompliance shall include the cause of noncompliance,
any remedial actions taken, and the probability of future
noncompliance. The following must be reported within 24 hours.
(1) Any monitoring or other information which indicates
that any contaminant may cause an endangerment to a
USDW.
(2) Any noncompliance with a permit condition or malfunction
of the injection system which may cause fluid migration
into or between USDWs.
-------
34
e. Twenty-four Hour Reporting [40 CFR 122.7(2)6] - The permittee
shall report any noncompliance which may endanger health or
the environment. Any information shall be provided orally
within 24 hours from the time the permittee becomes aware of
the circumstances. A written submission shall also be prov-
ided within 5 days of the time the permittee becomes aware
of the circumstances. The written submission shall contain
a description of the noncompliance and its cause; the period
of noncompliance, including exact dates and times; and, if
the noncompliance has not been corrected, the anticipated
time it is expected to continue; and steps taken or planned
to reduce, eliminate, and prevent reoccurrence of the non-
compliance. If information is not available for the 5-day
report, the written report may only be a confirmation of the
oral report. In such a case, the Regional Administrator must
require a followup report, within 30 days, containing all the
information listed above. If all information is still not
available, the Regional Administrator must require that the
operator submit it as soon as it becomes available. The
authority to require such additional reports is contained in
40 CFR 122.7(h) and 40 CFR 122.7(1)(8).
f. Other Noncompliance [40 CFR 122.7(1)7] - The permittee shall
report all instances of noncompliance not reported under other
paragraphs of this section at the time monitoring reports are
submitted. The reports shall contain the information listed
in paragraph e of this section.
g. Other Information [40 CFR 122.7(1)8'] - When the permittee
becomes aware that it failed to submit any relevant facts in
a permit application, or submitted incorrect information in
a permit application or in any report to the Regional Admini-
strator, it shall promptly submit such facts or information.
-------
35
14. Termination of Permit (40 CFR 122.16)
a. The Regional Administrator may terminate a permit during its
term or deny a permit renewal application for the following
causes:
(1) Noncompliance by the permittee with any condition of
the permit;
(2) The permittee's failure in the application or during
the permit issuance process to disclose fully all rele-
vant facts, or the permittee's misrepresentation of any
relevant facts at any time; or
(3) A determination that the permitted activity endangers
human health or the environment and can only be regula-
ted to acceptable levels by permit modification or
termination.
b. This permit will terminate upon final action by the Regional
Administrator and Director (of the State Pollution Control
Agency) to issue or deny a permit under an approved under-
ground injection control program pursuant to PL 93-523, as
amended.
15. Minor Modifications of Permit
Upon the consent of the permittee, the Regional Administrator may
modify a permit to make corrections or allowances for changes in
the permitted activity as listed in 40 CFR 122.17.
16. Transfer of Permit
Transfers - This permit is not transferable to any person except
after notice to the Regional Administrator. The Regional Admini-
strator may require modification or revocation and reissuance of
the permit to change the name of the permittee and incorporate
such other requirements as may be necessary.
-------
36
17. Mid-Course Evaluation Requirements
The permittee must submit the following minimum information at
6-month intervals during the first 2 years of operation.
a. Data required under 40 CFR 122.4 and 122.38(c);
b. A tabulation of data on all wells within the area of review
which penetrate into the proposed injection zone. Such data
shall include a description of each well's type, construc-
tion, date drilled, location (including the distance and di-
rection from the injection well), depth, record of plugging
and/or completion, and any additional information the
Regional Administrator may require;
c. The depth to the top and bottom of any USDW;
d. The distance to the nearest down-gradient water supply well;
e. A description of the geology and hydrology of the area;
f. The construction characteristics of the well;
g. The corrective action proposed, if needed, as well as that
performed;
h. The type and results of all mechanical integrity tests re-
ported to the Regional Administrator; and
i. (1) Any monitoring or other information which indicates that
any contaminant may cause an endangerment to a USDW, or
(2) Any noncompliance with a permit condition or malfunction
of the injection system which may cause fluid migration
into or between USDWs.
18. Conversion, Closure, and Abandonment
The permittee shall notify the Regional Administrator at such
time as the permit requires before conversion or abandonment of
the well or in the case of area permits before closure of the
project.
-------
37
19. Additional Requirements for Hazardous Waste Management Facilities
All hazardous waste management facilities must comply with the
applicable regulation of 40 CFR Part 264. These regulations
include: General Facility Standards (Subpart B); Preparedness
and Prevention (Subpart C); Contingency Plan and Emergency Proce-
dures (Subpart B); and Manifest System, Recordkeeping, and Report-
ing (Subpart E).
-------
APPENDIX A
PART A - FORM 1
GENERAL INFORMATION
CONSOLIDATED PERMITS PROGRAM
-------
United States
Environmental Protection
Agency
Office of
Enforcement
Washington. DC 20460
EPA Form 3510-1
June 1980
Permits Division
$EPA
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.
-------
DESCRIPTION OF CONSOLIDATED
PERMIT APPLICATION FORMS
FORM 1 PACKAGE
TABLE OF CONTENTS
The Consolidated Permit Application Formi are:
Form 1 - General Information (included in thit parti:
Form 2 - Diichargei to Surface Water (NPDES Permit*):
2A. Publicly Owned Treatment Works {Reserved — not included in
thit package!.
2B. Concentrated Animal Feeding Operations and Aquatic Animal
Production Facilities Inot included in thit package).
2C. Existing Manufacturing, Commercial. Mining, and Silviculture)
Operations (not included in thit package), and
2O. New Manufacturing, Commercial, Mining, and Silviculture!
Operations (Reserved - not included in this package);
Form 3 - Hazardous Waste Application Form IRCRA Permits —
not Included in this package);
Form 4 - Underground Injection of Fluids (UIC Permits — He-
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 O. 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. 30011. Injection of fluids underground by gravity flow
or pumping.
PSD (Prevention of Significant Deterioration Under the Clean Air
Act. 72 U.S.C. 74011. 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 (SPA)
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 whan a permit ii 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 I5EPI, U.S. Environmental Protection Agency, 230
South Dearborn Street, Chicago. Illinois 60604, (312) 353-2105,
FTS 353-2105.
Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
1-1
-------
SECTION A -GENERAL INSTRUCTIONS (continued)
Table 1 (continued)
REGION VI
Permit Contact I6AEP). U.S. Environmental Protection Agency,
Flrtt International Building, 1201 Elm Street. Dallas. Texai 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 VIII
Permit Contact (BE-WEI. 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 IE-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 S21). 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 (fee
Table II.
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
(Table 1) 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:'
Table 2. Filing Dates for Permits
FORM(permit)
WHEN TO FILE
1MNPDES) 180 days before your present NPDES per-
mit expires.
•ZT.f.'"}£S) 180 days before your present NPDES per-
mit expires', or 180 days prior to start-
up if you are a new facility.
KINROSS) 180 days before your present NPDES per-
mit expires*.
•2OINPDES) 180 days prior to startup.
ZlHaiardout Waste). . . .Existing facility: Six months following
publication of regulations listing hazard-
ous wastes.
New facility: 180 days before commencing
physical construction.
Tabto 2 (continued)
A(UIC) A reasonable time prior to construction
for new wells; as directed by the Director
for existing wells.
B(fSOI 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 progrem
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
application well in advance of an applicable deadline listed in Table 2.
Fees
The U.S. EPA does not require a fee for applying for any permit under
the consolidated permit programs. (However, tome Statei which ad-
minister one or more of these progrem* 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 I) has en economic assistance coordinator who can pro-
vide you with additional information.
EPA's construction grants program under Title II of the Clean Water
Act is an additional source of assistance to publicly owned treatment
works. Contact your EPA Regional office for details.
1-2
-------
SECTION B - FORM 1 LINE-BY-LINE INSTRUCTIONS
This form mint be completed by all applicants.
Completing Thb 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 merles
are spaced at 1/6" intervals which accommodate elite type (12 charac-
ter* 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
It. 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 it
enclosed in parentheses.) You need not submit e 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 (furnace process):
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 Rts.
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 (tee Table 1).
Item VIII-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
Item VIII-A.
1-3
-------
SECTION B - FORM 1 LINE-BY-LINE INSTRUCTIONS (continued)
Nam IX
Indicate whether the facility is located on Indian Lands.
ItamX
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 fart D of the
Clean Air Act or State permits under Section 404 of the dean Water
Act), or local permits or applications under "other."
Hem XI
Provide a topographic map or maps of the area extending at least to
one mile beyond the property boundaries of Ihe 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 otherl 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 15 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 oi 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.
536 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
Center
U.S.G.S.
1400 Independence Road
Rolla. Mo. 65401
Phone No. (314) 341-0851
Rocky Mountain Mapping Center
National Cartographic Infomaiion
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.
345 Middlefield Road
Menlo Park. Ca. 94025
Phone No. (415) 323-8111
Ark.. III.. Iowa. Kens.. 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, end for double these penalties
upon subsequent convictions.
FEDERAL REGULATIONS REQUIRE THIS APPLICATION TO BE
SIGNED AS FOLLOWS:
A. For a corporation, by a principal executive officer of at least the
level of vice president. However, if the only activity in Item II which
is marked "yes" is Question G, the officer may authorize a person
having responsibility for the overall operations of the well or well
field to sign the certification. In that case, the authorization must be
written and submitted to the permitting authority.
B. For partnership or sole proprietorship, by a general partner or the
proprietor, respectively; or
C. For a municipality. State, Federal, or other public facility, by
either a principal executive officer or ranking elected official.
1-4
-------
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 it in one of the following categories, as provided by
the Clean Water Act ICWA) and by the NPDES regulations (40 CFR
Partt 122—1251. 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 environmentel 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, end 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 Uniied 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
(POTW). 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: Discharger* into privately owned treatment works do not
have to apply for or obtain NPDES permit! except at 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
permits.)
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
silviculture! 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.S1;
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 stretum which contains, within 1/4 mile of the
well bore, en underground source of drinking water (unleu 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 eir emissions. The Clean Air Act Amendments of 1977 exclude
small new sources of air emissions from the PSO 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 Regionel
office (Table 1) for further information.
1-5
-------
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 (ample 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 animaltl 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 55 pounds) 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(e) of RCRA and for con-
sideration for a permit. Part A consists of Form 1 (General Informa-
tion) and Form 3 (Hazardous Want Application Form).
APPLICATION, PART B means thet part of the application which a
RCRA permit applicant must complete to be issued a permit. (NOTE:
EPA it not developing a specific form for fan B of the permit appli-
cation, but an instruction booklet explaining what information mutt be
supplied it 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, estuarme, or
marine plants or animals. "Designated area" means the portions of the
weters 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 meens 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 lit 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 end types of enimals 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
-------
SECTION D - GLOSSARY (continued)
CONCENTRATED ANIMAL FEEDING OPERATION (continued)
6. 3,000 sheep or lambs,
6. 16,500 turkeys.
7. 30,000 laying hens or broilers (H the facility hai continu tut
overflow watering).
8. 9,000 laying hens or broilers (if the facility ha* 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"
meant contracted 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 ol 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 at teg.
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 e pollutant as defined
below.
DIRECTOR means th:- 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 (in 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 an 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 lots, for con-
struction of the facility to be completed within a reasonable time.
(NOTE: This definition reflects the literal language of the statute.
However. SPA 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 an 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
to 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 fin the NPDES
program) means any source which is not a new source or a new dis-
charger.
1-7
-------
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 appurtenance* 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 weter 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 tuottance* are lifted in Table 2c—4 of the inttructiont to Form
2CI
HAZARDOUS WASTE means a hazardous wane 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 landfill*, turfaee impound-
ment*, or combination} 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 nondomeitic 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,
SubpartsA. 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; IB) 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 propose! 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 rightM—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
rightM-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 alto "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
-------
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 (in 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 ttiote regulated
under the Atomic Energy Act of 1954, as amended [42 U.S. C. Section
2011 et tag.]), 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 meterial 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 material* covered by the Atomic Energy Act are
those encompassed in it* 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
thfe 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. 19761. modified 12 ERC 1833
[D.D.C. 1979J).
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 end reclama-
tion) of municipal sewage or industrial wastes of a liquid nature which
is owned by a State or municipality. This definition includes eny 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. 04-580. as amended
by Pub. L. 95-609.42 U.S.C Section 6901 etseq.l.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES are facil-
ities which process crushed and broken stone, gravel, and riprap (see
40 CFR Pan 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 300lfl 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
silviculture! activities and from which pollutants are discharged into
waters of the United States. This term does not include nonpoint
source silviculture! 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
end 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 (al-
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.
1-8
-------
SECTION O - GLOSSARY (continued)
THERMAL TREATMENT (in the RCRA program) meant the treat-
ment of hazardous waste in a device which uses elevated temperature at
the primary meant to change the chemical, physical, or biological char-
acter or composition of the hazardous wane. Examples of thermal
treatment processes are incineration, molten salt, pyrolysis. calcination.
wet air oxidation, and microwave discharge. (See alto "incinerator"and
"open burning").
TOTALLY ENCLOSED TREATMENT FACILITY tin the RCRA pro-
gram) means a facility for the treatment of hazardous wane 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 wane 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—lite transportation of 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 to'tal
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 ttreamt). 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 at waters of the
United States under this definition;
E. Tributaries of waters identified in paragraphs (A) — (D) above;
F. The territorial tea; and
G. Wetlandt adjacent to waters (other man water* that are themselvet
wetlandt) identified in paragraphs (A) — (F) of this definition.
Wane treatment systems, including treatment ponds or lagoons design-
ed to meet requirement of CWA (other than cooling pondt at defined
In 40 CFR Section 423.111m) which alto meet the criteria of thit
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 Statei Itueh a* a d/tpotal ana in wetlandt) nor
resulted from the impoundments of waters of the United States.
WELL INJECTION or UNDERGROUND INJECTION means the sub-
turf ace 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 largen 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.
1-10
-------
c
c
X
m
400 47' 30"
A M «V
'CENTRAL PROCESSING CCT
GRID AND 19'0 MAGNETIC NORTH
DECLINATION AT CENTER OF SHEET
Scale 1:24,000
1000 0 Feet
USGS Map Central City. Ohio
Location Map
Central Processing Co.
Central City, Ohio
750 37- 30
-------
Please print or type in the unshaded areas only
ffill—in areas are spaced for elite type, i.e.. 12 characters/inch).
FORM
GENERAL
&EPA
U.S. ENVIRONMENTAL PROTECTION AGENCY
GENERAL INFORMATION
Consolidated Permit* Program
(Riod the "General Inttructloni" before starting.)
Form Approved OMB No. 158-R0175
t-ABE
L. ITEM
TEMS
Sill. FACILITY NAME N
>AC\,>Y \ \ ^
'• MAILING ADDRESS,
5EPL>
1NT1
If a preprinted label hat been provided, affix
it in the designated space. Review the Inform-
ation carefully; if any of It I* incorrect, cross
through it and enter, the correct data In the
appropriate fill—in area below. Also, if any of
the preprinted data is absent (the area to the
left of the label space Kit* the Information
that should appear), please provide it in the
proper fill-in areaM below. If the label Is
complete and correct, you need not complete
Items j. III. V. and VI (except VI-B which
mutt OB completed regardless). Complete ell
items if no label has been provided. Refer to
the instructions for detailed item descrip-
tions and for the legal authorizations under
which this data ii collected.
II. POLLUTANT CHARACTERISTICS
INSTRUCTIONS: Complete A through J to determine whether you need to submit any permit application forms to the EPA. If you answer "yes" to any
questions, you must submit this form and the supplemental form listed in the parenthesis following the question. Mark "X" in the box in the third column
if the supplemental form is attached. If you answer "no" to each question, you need not submit any of these forms. You may answer "no" if your activity
is excluded from permit requirements; see Section C of the instructions. See also. Section D of the instructions for definitions of bold-faced terms.
SPECIFIC QUCSTIONS
SPECIFIC QUESTIONS
A. Is this facility a publicly owned treatment world
which results in a discharge to waters of the U.S.?
(FORM 2A)
B. Does or will this facility (either existing or proposed)
include a concentrated animal feeding operation or
aquatic animal production facility which results in a
discharge to waters of the U.S.7 (FORM 2B)
C. Is this a facility which currently results in discharges
to waters of the U.S. other than those described in
A or B above? (FORM 2CI
D. Is this a proposed facility (other than those described
in A or B above) which will result in a dischbrge to
watan of the U.S.? (FORM 2D>
E. Does or will this facility treat, store, or dispose of
hazardous wastes? (FORM 3)
F. Do you or will you inject at this facility industrial or
municipal effluent below the lowermost stratum con-
taining, within one quarter mile of the well bore,
underground sources of drinking water? (FORM 4)
G. Do you or will you inject at this facility any produced
water or other fluids which are brought to the surface
in connection with conventional oil or natural gas pro-
duction, inject fluids used for enhanced recovery of
oil or natural gas. or inject fluids for storage of liquid
hydrocarbons? (FORM 4)
H. Do you or will you inject at this facility fluids for spe-
cial processes such as mining of sulfur by the Frasch
process, solution mining of minerals. In situ combus-
tion of fossil fuel, or recovery of geothermal energy?
(FORM 41
\. Is this facility a proposed stationary source which is
one of the 28 industrial categories listed in the in-
structions and which will potentially emit 100 tons
per year of any air pollutant regulated under the
Clean Air Act end may affect or be located in an
attainment area? (FORM 51
J. Is this facility a proposed stationary source which is
NOT one of the 28 industrial categories listed in the
instructions and which will potentially emit 250 tons
per year of any air pollutant regulated under the Clean
Air Act and may affect or be located in an attainment
area? (FORM 5)
A. NAME a TITLE (loit. first, & title)
V. FACILITY MAILING ADDRESS
A. STREET. ROUTE NO. OR OTHER SPECIFIC IDENTIFIER
I I T
I I I I
B. COUNTY NAME
C. CITY OR TOWN
O.STATE
E. ZIP CODE
nojunj
' M
EPA Fom 3510-1 (6-80)
CONTINUE ON REVERSE
-------
CONTINUED FROM THE FRONT
VII. SIC CODES (4-digit, in order of priority)
VIM. OPERATOR INFORMATION
B. It th» mm* lined In
Item VIII-A alto th«
owntr?
LJ YES LJ NO
c. STATUS OF OPERATOR (Enter the appropriate letter Into the answer box; if "Other", specify.)
D. PHONE (area coat A no.)
f- FEDERAL
S- STATE
P • PRIVATE
M - PUBLIC (other than federal or state)
O • OTHER (ipectfy)
B. STREET OR P.O. BOX
P. CITY OR TOWN
It the facility located on Indian landi?
O YES O NO
sa
X. EXISTING ENVIRONMENTAL PERMITS
D. PSO (Air Emlaiont from Proposed Sources)
A. NPDES (Discharges to Surface water)
E. OTHER (specifyJ
B. uic (Underground Infection of Fluids)
c. RCRA (Hazardous Wastes)
E. OTHER (specify)
Attach to this application a topographic map of the area extending to at least one mile beyond property bounderies. 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 springs, rivers and other surface
water bodies in the map area. See instructions for precise requirements.
XII. NATURE OF BUSINESS (provide a brief description}
XIII. CERTIFICATION Isee 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, I believe that the 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 a OFFICIAL TITLE (type or print!
COMMENTS FOR OFFICIAL USE
EPA Form 3510-1 (6-80) REVERSE
-------
Please print or type in the unshaded areas only
ffill-in anas are spaced for elite type, i.e.. 12 character!finch).
FORM
GENERAL
&EPA
U.S. ENVIRONMENTAL PROTECTION AGENCY
GENERAL INFORMATION
Consolidated Permits Program
(Read Me "General Instruction*" before ttorting.)
Form Approved OMB No. 158-R017S
I. EPA I.D. NUMBER
h*{
III. FACILITY NAME N
»• MAILING ADDRESS^
II. POLLUTANT CHARACTERISTICS
If a preprinted label hat been provided, affix
it in the designated space. Review the inform-
ation carefully; If any of it Is incorrect, cross
through it and enter the correct data in the
appropriate fill—in area below. Also, if any of
the preprinted data is absent (the area to the
left of Hie label tpace lilts the information
that should appear), please provide it In the
proper fill-in areaW below. If the label is
complete-and correct, you need not complete
Items I, III, V, and VI (except VI-B which
mutt be completed regardless). Complete all
Items if no label has been provided. Refer to
the instructions for detailed hern descrip-
tions and for the legal authorizations under
which this data is collected.
INSTRUCTIONS: Complete A through J to determine whether you need to submit any permit application forms to the EPA. If you answer "yes" to any
questions, you must submit this form and the supplemental form listed in the parenthesis following the question. Mark "X" in the box in the third column
if the supplemental form is attached. If you answer "no" to each question, you need not submit any of these forms. You may answer "no" if your activity
is excluded from permit requirements; see Section C of the instructions. See also, Section D of the Instructions for definitions of bold-faced terms.
SPECIFIC QUESTIONS
UIAPK 'at*
SPECIFIC QUESTIONS
XARK -X-
NO ATTACHED
A. Is this facility a publicly owned treatment .works
'which results in a discharge to waters of the U.S.?
(FORM 2A)
B. Does or will this facility (either existing or proposed)
Include a concentrated animal feeding operation or
aquatic animal production facility which results in a
discharge to waters of the U.S.? (FORM 2B)
C. Is this a facility which currently results in discharges
to waters of the U.S. other than those described in
A or B above? (FORM 2C)
D. Is this a proposed facility (other than those described
In A or B above) which will result in a discharge to
• waters of the U.S.? (FORM 20)
E. Does or will this facility treat, store, or dispose of
hazardous wastes? (FORM 3)
F. Do you or will you inject at this facility industrial or
municipal effluent below the lowermost stratum con-
taining, within one quarter mile of the well bore.
underground sources of drinking water? (FORM 4)
C. Do you or will you inject at this raciiity any produced
water or other fluids which are brought to the surface
in connection with conventional oil or natural gas pro-
duction, inject fluids used for enhanced recovery of
oil or natural gas, or inject fluids for storage of liquid
hydrocarbons? IFORM 4)
H. Do you or will you inject at this facility fluids for spe-
cial processes such as.mining of sulfur by the Frasch
process, solution mining of minerals, in situ combus-
tion of fossil fuel, or recovery of geothermal energy?
(FORM 4)
Is this facility a proposed stationary sourest which is
one of the 28 industrial categories listed in the in-
structions and which will potentially emit 100 tons
per year of any eir pollutant regulated under the
Clean Air Act and may affect or be located in an
attainment area? (FORM 5)
Is this facility a proposed stationary source which is
NOT one of the 28 industrial categories listed in the
Instructions and which will potentially emit 250 tons
per year of any air pollutant regulated under the Clean
Air Act and may affect or be located in an attainment
i? (FORM 5)
A. NAME 81 TITLE (lott. flnt, & title)
V. FACILITY MAILING ADDRESS
A. STREET. ROUTE NO. OR OTHER SPECIFIC IDENTIFIER
B. COUNTY NAME
C. CITY OR TOWN
D.STATE
E. ZIP CODE
F. COUNTY CODE
U
if
hngum,
it.
EPA Form 3510-1 (6-80)
CONTINUE ON REVERSE
-------
CONTINUED FROM THE FRONT
Vli. SIC CODES (4-digit. In order of priority)^
B. SECOND
(specify)
iri
"Tl*
(specify)
D. FOURTH
a.
(specify)
JO.
VIII. OPERATOR INFORMATION
A. NAME
I I
I I I 1 I
S. If the name lined In
Item Vll I-A elio the
owner?
O YES D'NO
66
P = FEDERAL
S- STATE
P • PRIVATE
M - PUBLIC (other than federal ornate)
O - OTHER (ipeclfy) .
E. STREET OR P.O. BOX
P. CITY OR TOWN
It the facility located on Indian lands?
CD YES CD NO
»Z
X. EXISTING ENVIRONMENTAL PERMITS
C. STATUS OP OPERATOR (Enter the appropriate letter Into the answer box; if "Other", specify.)
O. PHONE (area code A no.)
A. NPDES (Discharges to Surface Water)
D. PSD (Air Emissions from Proposed Sources)
B. uic (Underground Injection of Fluids)
e. OTHER (specify)
U
IB I* I5f If
(specify)
c. RCRA (Hazardous Wastes)
E. OTHER-(specify)
9TRI
(specify)
Attach to this application a topographic map of the area extending to at least one mile beyond property bounderies. 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 springs, rivers and other surface
water bodies in the' map area. See instructions for precise requirements.
XII. NATURE OF BUSINESS (provide a brief descriptionT
XIII. CERTIFICATION (tee instructionsr
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 thdsa persons immediately responsible for obtaining the information contained in the
application. I believe that the information is true, accurate and complete. I am aware that then are significant penalties for submitting
false information, including the possibility of fine and imprisonment.
A. NAME » OFFICIAL TITLE (type or print)
B. SIGNATURE
1C. DATE SIGNED
COMMENTS FOR OFFICIAL USE ONLY
EPA Form 3510-1 (6-80)
REVERSE
ft U.S. GOVERNMENT PRINTING OFFICE 1980-323429 6355
-------
APPENDIX B
PART A - FORM 3
HAZARDOUS WASTE PERMIT APPLICATION
CONSOLIDATED PERMITS PROGRAM
-------
lliil-in aitus art.1 */>jCftl
Farm ApprovaJ OMB No. I58-S8WU4
U.S. ENVIRONMENTAL PROTECTION AGENCY
HAZARDOUS WASTE PERMIT APPLICATION
Consolidated Permits Program
(This information u required under Section 300.". of RCRA.)
I. EPA I.D. NUMBER
hUK UtMLIAL USt ONLY
APPLICATION DATE RECEIVED
APPROVED fvr mn Aria
II. FIRST OK 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 1.0. Number in Item I above.
A. Fl
(
c^
8]
RST APPLICATION (place an "X" below and provide the appropriate date)
~\ 1 . EXISTING FACILITY (See instruction* for definition of "existing" facility. [~1 2. NEW FACILITY (C
7T Complete item below.) it
VR.
MO.
DAY
1
FOR EXISTING FACILITIES. PROVIDE THE DATE fyr., mo.. Ol Oayl
OPERATION BEGAN OR THE DATE CONSTRUCTION COMMENCED
(use the boxes to the left)
VN.
1
MO.
1
DAY
1
omplete item below.)
FOR NEW FACILITIES,
PROVIDE THE DATE
(yr.. mo., & day) OPERA-
TION BEGAN OR IS
EXPECTED TO BEGIN
B. REVISED APPLICATION (place an "X" below and complete Item 1 above) \
Ql. FACILITY HAS INTERIM STATUS
It _ -__---„_ |-_-Ll»
111. 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 codefsl 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 in design capacity I in the space provided on the form 11 tern III-C).
B. PROCESS DESIGN CAPACITY — For each code entered in column A enter the capacity of the process.
t. AMOUNT - Enter the amount.
2. UNIT OF MEASURE — For each amount entered in column 8(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
COPE DESIGN CAPACITY
PROCESS
PRO- APPROPRIATE UNITS OF
CESS MEASURE FOR PROCESS
COPE DESIGN CAPACITY
CONTAINER (barrel, drum, etc.) SOI
TANK . S02
WASTE PILE SOS
SURFACE IMPOUNDMENT
Disposal;
INJECTION WELL
LANDFILL
LAND APPLICATION
OCEAN DISPOSAL
SURFACE IMPOUNDMENT
504
D79
D80
081
DB2
GALLONS OR LITERS
GALLONS OR LITERS
CUBIC YARDS OR
CUBIC METERS
GALLONS OR LITERS
GALLONS OR LITERS
ACRE-FEET (the volume that
would cover one acre to a
depth of one foot) OR
HECTARE-METER
ACRES OR HECTARES
GALLONS PER DAY OR
LITERS PER DAY
GALLONS OR LITERS
Treatment?
TANK
SURFACE IMPOUNDMENT
INCINERATOR
OTHER (Use for physical, chemical.
thermal or biological treatment
proceuei not occurring in tanks,
surface impoundments or inciner-
ators. Describe the processes in
the space provided; Item III-C.)
TOI GALLONS PER DAY OR
LITERS PER DAY
TOZ GALLONS PER DAY OR
LITERS PER OAY
T03 TONS PER HOUR OR
METRIC TONS PER HOUR:
GALLONS PER HOUR OR
LITERS PER HOUR
T04 GALLONS PER DAY OR
LITERS PER DAY
UNIT OF
MEASURE
UNIT OF MEASURE CODE
GALLOF
LITERS
CUBIC Y
CUBIC IV
GALLOF
EXAMPLE
Dther can 1
K
^'
1 •
OL
U
m
•Js
:3
JZ
VI
;-:
i
£.
3
-4
IS G
L.
ET
IS f
FC
old
•
ERS C
ER DAY U
IR COMPLETING ITEM III (shown In line
400 gallons. The facility also has an inciru
r/A
DUP
11 14
A. PRO-
CESS
CODE:
(from list
i* - i •
5
T
0
0
T
3
IV • II
B. PROCESS DESIGN
c
1
IS
UNIT OF UNIT OF
MEASURE MEASURE
UNIT OF MEASURE CODE UNIT OF MEASURE CODE
LITERS PER DAY
TONS PER HOUR
METRIC TONS PE
GALLONS PER HC
LITERS PER HOU
numbers X-J and X
jrator that can burn
V ACRE-FEET i
. B MeCT ARC-MET PR 1
R H
>UF
1^
OUR
i
H
*
P
1
a
2 below): A facility has two storage tanks, one tank can hold 200 gallons and the
jp to 20 gallons per hour.
\\X\\\\\\\\\\\\\\\\\\\Y
CAPACITY
1. AMOUNT
(specify)
19
27
600
20
it
21
2. UNIT
Or MEA-
SURE
(enter
code)
1L.
G
E
FOR
OFFICIAL
USE
ONLY
|b • 12
11 ' Jl
LINE
NUMBER
5
6
7
8
9
10
A. PRO-
CESS
CODE
(from list
above)
!• - II
16 • II
B. PROCESS DESIGN CAPACITY
1. AMOUNT
19 - 2»
19 - 17
Z. UNIT
OF MEA-
SURE
(vn tur
code)
It
It
FOR
OFFICIAL
USE
ONLY
2* - It
19 • 12
:I'A Form 3510-3 (6-80)
PAGE 1 OF 5
CONTINUE ON REVERSE
-------
•mica i ruin ihe iroiu.
'ROCESSES (continued) _
ACE FOR ADDITIONAL. PROCESS CODES OR FOR DESCRIBING OTHER PROCESSES (COlle "T04"). FOR EACH PROCESS ENTERED HERE
iJCLUDE DESIGN CAPACITY.
DESCRIPTION OF HAZAKI
. PA HAZARDOUS WASTE NUMBER — Enter the four-digit number from 40 CFR, Subpart D for each listed hazardous waste you will handle. It you
.ndlc hazardous wastes which are not listed in 40 CFR, Subpart D. enter the four—digit numberrfW from 40 CFR. Subpart C that describes the characteris-
:s and/or the toxic contaminants of those hazardous wastes.
5TIMATED ANNUAL QUANTITY - For each listed waste entered in column A estimate the quantity of that waste that will be handled on an annual
..isis. 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
-Inch possess that characteristic or contaminant.
NIT 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
ides are:
ENGLISH UNIT OF MEASURE
CODE
METRIC UNIT OF MEASURE
COPE
POUNDS.
TONS. . .
. P
. T
KILOGRAMS K
METRIC TONS M
<• 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
ccount the appropriate density or specific gravity of the waste.
3OCESSES
. PROCESS COOES:
For listed hazardous waste: For each listed hazardous waste entered in column A select the code(s) from the list of process codes contained in Item III
to indicate how the waste will be store.l, 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 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 codeltl.
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.
lE: HAZARDOUS WASTES DESCRIBED BY MORE THAN ONE EPA HAZARDOUS WASTE NUMBER - Hazardous wastes that can be described by
.- than one EPA Hazardous Waste Number shall be described on the form as follows:
. Select one of the EPA Hazardous Wosfe 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.
. 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.
; Repeat step 2 for each other EPA Hazardous Waste Number that can be used to describe the hazardous waste.
MPLE 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
•ejr of chrome shavings from leather tanning and finishing operation. In addition, the facility will treat and dispose of three non-listed wastes. Two wastes
.orrosive only and there will be an estimated 200 pounds per year of each waste. The other waste is corrosive and ignitableand there will be an estimated
Bounds par year of that waste. Treatment will be in an incinerator and disposal will be in a landfill.
A. EPA
HAZARD.
WASTENO
(enter cudvl
K
D
/)
D
0
0
0
0
5
0
0
0
4
2
I
2
B. ESTIMATED ANNUAL
QUANTITY OF WASTE
900
400
100
C.UNIT
OF MEA-
SURE
(enter
code)
P
P
/'
D. PROCESSES
1. PROCESS CODES
(enter)
T 0 3
T 0 3
T 0 3
\ i
080
i i
D 8 0
D 8 0
] i
i i
i i
i i
2. PROCESS DESCRIPTION
(if a code u not entered in D(l»
included with above
Form 3510-3 (6-80)
PAGE 2 OF 5
CONTINUE ON PAGE 3
-------
Dntinued from page 2.
OTE: Photocopy this page before completing if you have more than 26 wastes to list.
Form Approved OMB No. 1S8-S80004
FOR OFFICIAL USE ONLY
EPA I.D. NUMBER (enter from page II
IV. DESCRIPTION OF HAZARDOUS WASTES (continued,
Ul
Ed
JZ
I
2
3
4
5
6
7
8
9
10
II
12
13
14
15
16
17
18
19
20
21
n
23
24
25
26
A. EPA
HAZARD.
WASTE NO
(anlcr cadet
11 - 2t
It
!'
B. ESTIMATED ANNUAL
QUANTITY OF WASTE
11 - 19
" • 14
C. UNIT
OF MEA-
SURE
(en t?r
codr)
Ji.
D. PROCESSES
1. PROCESS COOES
(enter)
21 • >•
1 |
1 1
I 1
1 1
| 1
1 1
I 1
I 1
| 1
1 I
I 1
1 I
I 1
1 1
1 1
| 1
17 - 29
I 1
I 1
1 1
| I
| i
| 1
•
1 1
1 1
I 1
1 I
1 1
1 1
| 1
I t
a? - »
I i
i i
i i
i i
i i
i i
i i
1 I
l i
IT - »
| 1
I 1
1 I
1 1
1 1
1 1
1 1
I 1
1 1
1 1
1 I
1 1
2. PROCESS DESCRIPTION
(if a code la not entered in D(l))
•
CA Form 3510-3 IG-UO)
CONTINUE ON REVERSE
PAGE 3 OF 5
• /I ". "U". "I111, vu fi.-fiinj the "3" la ul,-iilify phti
-------
,V. DESCRIPTION OF HAZARDOUS WASTES (continued)
E. USE THIS SPACE TO LIST ADDITIONAL PROCESS CODES FROM ITEM D(l) ON PAGE 3.
EPA I.O. NO. (enter from pane It
/. 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!.
'/I. 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
LATITUDE (di-yrect, minulct, & seconds)
LONGITUDE Illcgreet, minutrt, & seconds)
. 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. (urea code & no.)
I. NAME OF FACILITY'S LEGAL OWNER
3. STREET OR P.O. BOX
4.-CITV OR TOWN
X. OWNER CERTIFICATION
/ certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached
•locuments. and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the
ubmitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information.
ncluding the possibility of fine and imprisonment.
A. NAME (print or type)
B. SIGNATURE
C. DATE SIGNED
X. OPERATOR CERTIFICATION
certify under penalty of low that I have personally examined and am familiar with the information submitted in this and all attached
locuments. and that based on my inquiry of those individuals immediately responsible for obtaining the information. I believe that the
Mbmitted 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.
l or Zf
B SIGNATURE
C. DATE SIGNED
?A Form 3510-3 (6-80)
PAGE 4 OF 5
CONTINUE ON PAGE b
-------
Continued from paiiu 4.
Form Approved OMB No. 158-580004
V. FACILITY DRAWING (see page 4)
EPA Form 3510-3 (6-80)
PAGE 5 OF 5
------- |