Form TTB F 5000.29 TTB F 5000.29 Environmental Information

OMB No. 1513-0023 (08/31/2011)

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

ENVIRONMENTAL INFORMATION
INSTRUCTIONS
1. COMPLETION. Answer all items in sufficient detail or as not applicable to your activity. The information on all items should relate to the activity in which
the Bureau has an interest. If additional space is required for any item, please attach a separate sheet identified by the ite m number of this form. Your
answers are evaluated by the Bureau to determine whether the activity will have a significant effect on the environment. If TTB F 5000.30, Supplemental
Information on Water Quality Considerations - Under 33 U.S.C. 1341(a), is also being submitted for your activity, you may make reference to any relevant
information given on TTB F 5000.30 for items 6 and 7 of this form.
2. FILING. Submit an original and one copy of this form to the Director, National Revenue Center, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215.
3. DISPOSITION. After final action taken on the related application or other document, the copy of this form will be returned to the applican t.
1. Name and Principal Business Address of Applicant

2. Description of Activity in which Alcohol and Tobacco Tax and
Trade Bureau has an interest

3. Number of
Employees

4. Location Where Activity is to be Conducted (Be specific, Number, Street, City, State, ZIP Code; describe locations of buildings and outside equipment and
their situation relative to surrounding environment including other structures, land use, lakes, streams, roads, railroad facilities, etc. Maps, photos, or
drawings may be provided.)

5. Heat and Power:
A. Describe types of heat and power to be used and their sources. If they are to be produced in connection with the proposed ac tivity, estimate type and
quantity of fuel to be used for each purpose. (Example: 40 tons/yr. anthracite coal for heat, 20 million cu.-ft./yr. natural for power generating.)

B. Describe any air pollution control equipment proposed for use in connection with fuel burning equipment, boilers, or smokesta cks.

6. Solid Waste:
A. Describe amount and composition of all solid waste to be generated.

B. Discuss proposed methods of disposal (Incineration, open burning, landfill, government or commercial garbage collection, etc.)
Specify whether on-site or off-site.

C. Describe any air pollution control equipment proposed for use in connection with any incinerators.

TTB F 5000.29 (10/2008)

7. Liquid Waste (Complete this item irrespective of any certification obtained as to compliance with any environmental quality standards of an y Federal, State,
or local agency having UHVSRQVLELOLW\ for environmental protection including any certification under the Federal Water Pollution Control Act.)
A. Describe amount and content of any liquid waste to be generated.

B. Describe proposed method of disposal ( sewer, flaming, recycling, etc). Describe any proposed means to monitor quality and characteristics, and any
proposed equipment or facilities for treatment or control of liquid wastes.

8. Noise (Describe operational noise sources other than those normally associated with office operations, building maintenance, or uti lities.)

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THE INFORMATION SHOWN ON THIS FORM AND, TO THE BEST OF MY
KNOWLEDGE AND BELIEF, IT IS TRUE, CORRECT, AND COMPLETE. I AGREE THAT COPIES OF THIS FORM MAY BE FURNISHED TO CONCERNED FEDERAL, STATE, AND LOCAL AGENCIES HAVING RESPONSIBILITIES FOR ENVIRONMENTAL PROTECTION AND THAT THE INFORMATION HEREON MAY BE USED IN THE PREPARATION OF AN ENVIRONMENTAL STATEMENT PURSUANT TO THE REQUIREMENTS OF THE
NATIONAL ENVIRONMENTAL POLICY ACT, 42 U.S.C. 4332.
9. Date

11. By (Signature and Title)

10. Applicant

Alcohol and Tobacco Tax and Trade Bureau Determination of Effect. After consideration of all available environmental information relevant to the proposed
activity, it is determined that:
The conduct of the activity described in item 2, pursuant to issuance or approval of the
will

(Specify whether application, bond, formula, permit, license, etc.)

will not significantly affect the environment.

Signature of Director, National Revenue Center

Date

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by TTB to determine if any environmental impact
statement or environmental permit is necessary for the proposed operation. The information is required to obtain a benefit.
The estimated average burden associated with this collection of information is 30 minutes per respondent or recordkeeper, depen ding on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management
Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it display s a current, valid OMB control
number.
TTB F 5000.29 (10/2008)