INSTRUCTIONS TO FILL OUT WASTEWATER DISCHARGE PERMIT APPLICATION

All questions must be answered. DO NOT LEAVE BLANKS. If you answer "no" to question E.1., you may skip to Section I. Otherwise, if a question is not applicable, indicate so on the form. Instructions to some questions on the permit application are given below.

SECTION A - INSTRUCTIONS (GENERAL INFORMATION)

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

a. Operator Name: 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 facility.

b. Indicate whether the entity which operates the facility also owns it by marking the appropriate box.

(i) If the response is "No", clearly indicate the operator's name and address and submit a copy of the contract and/or other documents indicating the operator's scope of responsibility for the facility.

2. Provide the physical location of the facility that is applying for a discharge permit.

3. Provide the mailing address where correspondence from the control Authority may be sent.

4. Provide all the names of the authorized signatories for this facility for the purposes of signing all reports. The designated signatory is defined as:

(a) By a responsible corporate official, if the Industrial User submitting the reports is a corporation. For the purpose of this paragraph, a responsible corporate official means:

(i) a president, secretary, treasurer, or vice president of the corporation in charge of a principal business function, or any other Person who performs similar policy or decision making functions for the corporation, or

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(ii) the manager of one or more manufacturing, production, or operation facilities employing 250 persons or having gross annual sales or expenditures exceeding $25 million (in second quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.

(b) a general partner or proprietor if the Industrial User submitting the reports is a partnership or sole proprietorship respectively.

(c) The principal executive officer or director having responsibility for the overall operation of the discharging facility in the Industrial User submitting the reports is a Federal, State, or local governmental entity, or their agents.

(d) a duly authorized representative of the individual designated in paragraph (a) or (b) or (c) of this section if:

(i) The authorization is made in writing by the individual described in paragraph (a), (b) or (c);

(ii) The authorization specifies either an individual or a position having responsibility for the overall operation of the facility from which the Industrial discharge originates, such as the position of plant manager, or a position of equivalent responsibility, or having overall responsibility for environmental matters for the company; and

(iii) The written authorization is submitted to the Control Authority.

(e) If an authorization under paragraph (d) is no longer accurate because a different individual or position has responsibility for the overall operation of the facility, or overall responsibility for environmental matters for the company, a new authorization satisfying the requirements of paragraph (d) must be submitted to the Control Authority prior to or together with any reports to be signed by an authorized representative.

5. Provide the name of a person who is thoroughly familiar with the facts reported on this form and who can be contacted by the Control Authority (e.g., the plant manager).

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SECTION B - INSTRUCTIONS (BUSINESS OPERATIONS)

1. Check of all operations that occur or will occur at your facility. If you have any questions regarding how to categorize your business activity, contact the control Authority for technical guidance.

3. For all processes found on the premises, indicate the Standard Industrial Classification Code Number, as found in the most recent Edition of Standard Industrial Classification Manual prepared by the Executive Office of the President, Office of Management and Budget. This document is available from the Government Printing Office in Washington D.C.. DO NOT USE PREVIOUS EDITIONS OF THE MANUAL. Copies of the manual are also available at most public libraries.

4. List the types of products, giving the common or brand name and the proper or scientific name. Enter from your records the average and maximum amounts produced daily for each operation for the previous calendar year, and the estimated total daily production for this calendar year. Be sure to specify the daily units of production. Attach additional pages as necessary.

SECTION C - INSTRUCTIONS (WATER SUPPLY)

4. Provide daily average water usage within the facility. Contact cooling water is cooling water that during the process comes into contact with process materials, thereby becoming contaminated. Non-contact cooling water does not come into contact with process materials. Sanitary water include only water used in rostrums. Plant and equipment washdown includes floor washdown. If sanitary flow is not metered, provide an estimate based on 15 gallons per day (gpd) for each employee.

SECTION E - INSTRUCTIONS (WASTEWATER DISCHARGE INFORMATION)

1. If you answer "no" to this question, skip to Section I, otherwise complete the remainder of the application.

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4. A schematic flow diagram is required to be completed and is recommended to be certified for accuracy by a State registered professional engineer. Assign a sequential reference number to each process starting with No. 1. An example of a drawing is shown below in Figure 1. To determine your average daily volume and maximum daily volume of wastewater flow, you may have to read water meters, sewer meters, or make estimates of volumes that are not directly measurable.

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5. Non-categorical users should report average daily and maximum daily wastewater flows from each process, operation, or activity present at the facility. Categorical users should skip to question 6.

6. Categorical users should report average daily and maximum daily wastewater flows from every regulated, unregulated, and dilution process. A regulated wastestream is define as wastewater from an industrial process that is regulated for a particular pollutant by a categorical pretreatment standard. Unregulated wastestreams are wastestreams from an industrial process that are not regulated by a categorical pretreatment standard and are not defined as a dilution wastestream. Dilution wastestreams include sanitary wastewater, boiler blowdown, non-contact cooling water or blowdown, stormwater streams, demineralizer backwash streams and process wastestreams from certain industrial subcategories exempted by EPA from categorical pretreatment standards. [For further details, see 40 CFR 403.6 (e).]

7. Total Toxic Organics (TTO) means the sum of the masses or concentrations of specific toxic organic compounds found in the industrial user's process discharge. The individual organic compounds that make up the TTO value and the minimum reportable quantities differ according to the particular industrial category. [see applicable categorical pretreatment standards, 40 CFR Parts 405-471].

SECTION H - INSTRUCTIONS (FACILITY OPERATIONAL CHARACTERISTICS)

2. Indicate whether the business activity is continuous throughout the year or if it is seasonal. If the activity is seasonal, circle the months of the year during which the discharge occurs. Make any comments you feel are required to describe the variation in operation of your business activity.

4. Indicate any shut downs in operation which may occur during the year and indicate the reasons for shutdown.

5. Provide a listing of all primary raw materials used (or planned) in the facility's operations. Indicate amount of raw material used in daily units.

6. Provide a listing of all chemicals used (or planned) in the facility's operations. Indicate the amount used or planned in daily units. Avoid the use of trade names of chemicals. If trade names are used, also provide chemical compounds. Provide copies of all available manufacturer's safety data sheets for all chemical identified.

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7. A building layout or plant site plan of the premises is required to be completed and is recommended to be certified for accuracy by a State registered professional engineer. Approved building plans may be substituted. An arrow showing North as well as the map scale must be shown. The location of each existing and proposed sampling location and facility sewer line must be clearly identified as well as all sanitary and wastewater drainage plumbing. Number each unit process discharging wastewater to the public sewer. Use the same numbering system shown in Figure 1, the schematic flow diagram. An example of the drawing required is shown below.

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SECTION I - INSTRUCTIONS (SPILL PREVENTION)

5. Describe how the spill occurred, what was spilled, when the spill happened, where it occurred, how much was spilled, and whether or not the spill reached the sewer. Also explain what measures have been taken to prevent a reoccurrence or what measure have been taken to limit damage if another spill occurs.

SECTION J - INSTRUCTIONS (NON-DISCHARGED WASTES)

1. For wastes not discharged to the Control Authority's sewer, indicate types of waste generated, amount generated, the way in which the waste is disposed (e.g. incinerated, hauled, etc.), and the location of disposal.

2. Onsite disposal system could be a septic system, lagoon, holding pond, (evaporative-type), etc.

5. Type of permits could be: air, hazardous waste, underground injection, solid waste, NPDES (for discharges to surface water), etc.

SECTION K - INSTRUCTIONS (AUTHORIZED SIGNATURES)

See instructions for question 4 in Section A, for a definition of an authorized representative.