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pdfContains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-1
Revised
Water Permits Division
Application Form 1
General Information
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NPDES Permitting Program
Note: All applicants to the National Pollutant Discharge Elimination System (NPDES) permits
program, with the exception of publicly owned treatment works and other treatment works treating
domestic sewage, must complete Form 1. Additionally, all applicants must complete one or more of the
following forms: 2B, 2C, 2D, 2E, or 2F. To determine the specific forms you must complete, consult the
“General Instructions” for this form.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Paperwork Reduction Act Notice
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The U.S. Environmental Protection Agency estimates the average burden to collect information
and complete Form 1 to be 3 hours for new applicants and 1 hour for applicants renewing
existing permits. This estimate includes time to review instructions, search existing data sources,
gather and maintain the needed data, and complete and review the collection of information.
New respondents must also prepare a topographic map. Send comments about the burden
estimate or any other aspect of this collection of information to the Chief, Information Policy
Branch (PM-223), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW,
Washington, DC 20460, and to the Office of Information and Regulatory Affairs, Office of
Management and Budget, 725 17th Street, NW, Washington, DC 20503, marked “Attention:
Desk Officer for EPA.”
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
DESCRIPTION OF NPDES PERMIT APPLICATION FORMS
CONTENTS OF FORM 1 PACKAGE
The application forms for individual National Pollutant Discharge
Elimination System (NPDES) permits include the following:
Form 1—General Information (included in this package).
Form 1—General Instructions
Form 1—Line-by-Line Instructions
Form 1—Activities That Do Not Require Permits
Form 1—Glossary
Form 1—Application
Form 2—Forms Based on Facility or Activity Type (not included
in this package):
2C.
2D.
2E.
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2F.
2S.
New and Existing Publicly Owned Treatment Works
Concentrated Animal Feeding Operations and
Concentrated Aquatic Animal Production Facilities
Existing Manufacturing, Commercial, Mining, and
Silvicultural Operations
New Manufacturing, Commercial, Mining, and Silvicultural
Operations That Have Not Yet Commenced Discharge of
Process Wastewater
Manufacturing, Commercial, Mining, and Silvicultural
Facilities Which Discharge Only Nonprocess Wastewater
Stormwater Discharges Associated with Industrial Activity
New and Existing Treatment Works Treating Domestic
Sewage
FORM 1—GENERAL INSTRUCTIONS
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2A.
2B.
Who Must Apply for an NPDES Permit?
Upon your request, and based on information supplied by you,
EPA or the authorized NPDES state will determine whether you
are required to obtain a permit for a particular facility or activity.
Be sure to contact EPA or your state if you have a question.
With the exceptions described in “Form 1—Activities That Do Not
Require Permits,” the federal Clean Water Act (33 U.S.C. 1251 et
seq.) prohibits any person from discharging pollutants into waters
of the United States without first having been issued a permit
under the NPDES program.
Form 1 collects general information only. You must also complete
a more detailed application based on your proposed discharge
activity, as follows:
Who Must Complete Form 1?
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All applicants, other than publicly owned treatment works
(POTWs) and treatment works treating domestic sewage
(TWTDS), must submit Form 1. If you operate one of the
following facilities, you must submit Form 1: concentrated animal
feeding operations and aquatic animal production facilities;
manufacturing, commercial, mining, and silvicultural operations;
or other industrial facilities.
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At the state level, either the U.S. Environmental Protection
Agency (EPA) or an approved state agency administers the
NPDES permit program. If you are located in a jurisdiction in
which an EPA regional office administers the NPDES permit
program, you should use Form 1 and all other applicable forms
described in these instructions. If you are located in a jurisdiction
where a state administers the NPDES permit program, contact
the state to determine the forms you should complete. States
often develop their own application forms rather than use the
federal forms. See http://www.epa.gov/npdes/npdes-stateprogram-information for a list of states that have approved
NPDES permit programs and those that do not.
Exhibit 1–1 (see end of this section) provides contact information
for each of EPA’s 10 regional offices. Since the exhibit’s content is
subject to change, consult EPA’s website for the latest information:
http://www.epa.gov/aboutepa#regional.
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If your facility is a concentrated animal feeding operation
or a concentrated aquatic animal production facility, you
must also complete Form 2B.
If your facility is an existing manufacturing, commercial,
mining, or silvicultural facility that currently discharges
process wastewater, you must also complete Form 2C.
If your facility is a new manufacturing, commercial, mining,
or silvicultural facility that has yet to commence discharge of
process wastewater, you must also complete Form 2D.
If your facility is a new or existing facility (including
manufacturing, commercial, mining, and silvicultural
facilities) that discharges only nonprocess wastewater,
you must also complete Form 2E.
If your facility is a new or existing facility whose discharge
is composed entirely of stormwater associated with industrial
activity—excluding discharges from construction activity
under 122.26(b)(14)(x) or (b)(15)—you must also complete
Form 2F. If the discharge is composed of stormwater and
non-stormwater, you must complete Form 2F and you must
also complete Forms 2C, 2D, and/or 2E, as appropriate. See
Form 2F’s instructions for further details.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 1—GENERAL INSTRUCTIONS CONTINUED
Where to File Your Completed Form
Completion of Forms
If you are in a jurisdiction with an approved state NPDES
permit program, file according to the instructions on the state
forms.
If you are in a jurisdiction where EPA is the NPDES
permitting authority (i.e., the state is not an NPDESauthorized state), mail the completed application forms to the
EPA regional office that covers the state in which your facility
is located (see Exhibit 1–1).
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
Because of statutory and regulatory requirements, the deadlines
for filing applications vary according to your facility or activity type
and the type of permit you need. The various permit application
deadlines are listed in Exhibit 1–2 at the end of this section.
Fees
Do not leave any response areas blank unless the form directs
you to skip them. If the form directs you to respond to an item that
does not apply to your facility or activity, enter “NA” for “not
applicable” to show that you considered the item and determined
a response was not necessary for your facility.
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EPA does not require applicants to pay a fee for applying for
NPDES permits. However, states that administer the NPDES
permit program may charge fees. Consult with state officials for
further information.
Provide your EPA Identification Number from the Federal Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 1 and any attachments. If your facility is new
(i.e., not yet constructed), write or type “New Facility” in the space
provided for the EPA Identification Number and NPDES number.
If you do not know your EPA Identification Number, contact your
NPDES permitting authority. See Exhibit 1–1 for contact
information.
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When to File Your Completed Form
The NPDES permitting authority could consider your application
incomplete if you do not provide an answer (or indicate "NA" for
"not applicable") for all questions on Form 1 and the applicable
Form 2.
Public Availability of Submitted Information
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request.
You may not claim any information on Form 1 (or related
attachments) as confidential.
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You may make a claim of confidentiality for any information that
you submit to EPA that goes beyond the information required by
Form 1. If you do not assert a claim of confidentiality at the time
you submit your information to the NPDES permitting authority,
EPA may make the information available to the public without
further notice to you. EPA will handle claims of confidentiality in
accordance with the Agency’s business confidentiality regulations
at Part 2 of Title 4 of the Code of Federal Regulations (CFR).
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received
and completed according to the authority’s satisfaction. The
NPDES permitting authority will judge the completeness of any
application independently of the status of any other permit
application or permit for the same facility or activity.
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Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 1—GENERAL INSTRUCTIONS CONTINUED
Exhibit 1–1. Addresses of EPA Regional Contacts and Covered States
REGION 6
U.S. Environmental Protection Agency, Region 6
1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733
Phone: (214) 665-2200; toll free: (800) 887-6063
Fax: (214) 665-7113
Website: http://www.epa.gov/aboutepa/epa-region-6-south-central
Covered states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
REGION 2
U.S. Environmental Protection Agency, Region 2
290 Broadway, New York, NY 10007-1866
Phone: (212) 637-3000; toll free: (877) 251-4575
Fax: (212) 637-3526
Website: http://www.epa.gov/aboutepa/epa-region-2
Covered states: New Jersey, New York, Virgin Islands, and Puerto Rico
REGION 7
U.S. Environmental Protection Agency, Region 7
11201 Renner Boulevard, Lenexa, KS 66219
Phone: (913) 551-7003; toll free: (800) 223-0425
Website: http://www.epa.gov/aboutepa/epa-region-7-midwest
Covered states: Iowa, Kansas, Missouri, and Nebraska
REGION 3
U.S. Environmental Protection Agency, Region 3
1650 Arch Street, Philadelphia, PA 19103-2029
Phone: (215) 814-5000; toll free: (800) 438-2474
Fax: (215) 814-5103
Website: http://www.epa.gov/aboutepa/epa-region-3-mid-atlantic
Covered states: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia,
and West Virginia
REGION 8
U.S. Environmental Protection Agency, Region 8
1595 Wynkoop Street, Denver, CO 80202-1129
Phone: (303) 312-6312; toll free: (800) 227-8917
Fax: (303) 312-6339
Website: http://www.epa.gov/aboutepa/epa-region-8-mountains-and-plains
Covered states: Colorado, Montana, North Dakota, South Dakota, Utah, and
Wyoming
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REGION 1
U.S. Environmental Protection Agency, Region 1
5 Post Office Square, Suite 100, Boston, MA 02109-3912
Phone: (617) 918-1111; toll free: (888) 372-7341
Fax: (617) 918-0101
Website: http://www.epa.gov/aboutepa/epa-region-1-new-england
Covered states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont
REGION 9
U.S. Environmental Protection Agency, Region 9
75 Hawthorne Street, San Francisco, CA 94105
Phone: (415) 947-8000; toll free: (866) EPA-WEST
Fax: (415) 947-3553
Website: http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest
Covered states: Arizona, California, Hawaii, Nevada, Guam, American Samoa,
and Trust Territories
REGION 5
U.S. Environmental Protection Agency, Region 5
77 West Jackson Boulevard, Chicago, IL 60604-3507
Phone: (312) 353-2000; toll free: (800) 621-8431
Fax: (312) 353-4135
Website: http://www.epa.gov/aboutepa/epa-region-5
Covered states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
REGION 10
U.S. Environmental Protection Agency, Region 10
1200 Sixth Avenue, Suite 900, Seattle, WA 98101
Phone: (206) 553-1200; toll free: (800) 424-4372
Fax: (206) 553-2955
Website: http://www.epa.gov/aboutepa/epa-region-10-pacific-northwest
Covered states: Alaska, Idaho, Oregon, and Washington
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REGION 4
U.S. Environmental Protection Agency, Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, SW, Atlanta, GA 30303-8960
Phone: (404) 562-9900; toll free: (800) 241-1754
Fax: (404) 562-8174
Website: http://www.epa.gov/aboutepa/about-epa-region-4-southeast
Covered states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, and Tennessee
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Exhibit 1–2. Filing Dates for NPDES Permit Applications
Permit Application
2A
2B
2C
2D
2E
2F
2S
When to File
180 days before your present NPDES permit expires or, if you are a
new discharger, 180 days before the date on which the discharge is
to commence unless the NPDES permitting authority has granted
permission for a later date.
180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
180 days before your present NPDES permit expires.
180 days prior to startup.
180 days before your present NPDES permit expires, or 180 days
prior to startup if you are a new facility.
Construction: 90 days prior to date construction is to commence.
Nonconstruction: 180 days before your present NPDES permit
expires or 180 days prior to startup if you are a new facility.
180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
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FORM 1—LINE-BY-LINE INSTRUCTIONS
If you answer “Yes” to a question in Item 1.1, then you do not
need to complete Form 1, but you must comply with the
application requirements specified.
Item 1.2. Respond to the questions in Items 1.2.1 to 1.2.5. If you
answer “Yes” to any question, you must complete Form 1 and the
Form 2 application specified. See Exhibit 1–2 for filing deadlines.
If you answer “No” to every question in Items 1.1 and 1.2, then
you do not need an NPDES permit, and you do not need to
complete and return any of the NPDES application forms.
Section 2. Name, Mailing Address, and Location
Item 2.1. Enter the facility’s official or legal name. Do not use a
colloquial name.
You can find NAICS code numbers and descriptions in the North
American Industrial Classification System Manual prepared by the
Executive Office of the President, Office of Management and
Budget. This document is available from the National Technical
Information Service (NTIS) in Alexandria, Virginia. It is also
available online at http://www.census.gov/eos/www/naics/.
Use the latest edition of the manuals. If you have any questions
about the appropriate SIC or NAICS codes for your facility,
contact your NPDES permitting authority.
Section 4. Operator Information
Item 4.1. Give the legal name of the person, firm, public
organization, or other entity that operates the facility described in
this application. This may or may not be the same as the facility’s
name. The operator of the facility is the legal entity that controls
the facility’s operation rather than the plant or site manager. Do
not use a colloquial name.
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Item 2.2. Provide your EPA Identification Number from the
Federal Registry System if you have an existing facility. If you do
not know your EPA Identification Number, contact your NPDES
permitting authority. If your facility is new (i.e., not yet
constructed), write or type “New Facility.”
You can find SIC code numbers and descriptions in the
1987 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, Washington, D.C. An online version of the manual is also
available courtesy of the Occupational Safety and Health
Administration at http://www.osha.gov/pls/imis/sic_manual.html.
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Section 1. Activities Requiring an NPDES Permit
Item 1.1. Review the questions in Item 1.1 to determine if you are
required to submit Form 1. Be sure to check the Form 1—
Glossary for the legal definitions of any key terms.
Item 2.3. Give the name (first and last), title, work telephone
number, and email address of the person who is thoroughly
familiar with the operation of the facility and with the facts
reported in this application. The NPDES permitting authority will
contact the person listed if they have questions on the material
submitted.
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Item 2.4. Give the complete mailing address of the office to which
the NPDES permitting authority should send correspondence.
This often is not the address used to designate the location of the
facility or activity.
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Item 2.5. Give the address or location of the facility identified
under Item 2.1. 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 Routes 425 and 22"). Also provide the county
name, county code (if known), city or town, state, and zip code.
For concentrated aquatic animal production facilities, provide the
address or location of the production area (i.e., the location where
the animals are contained, grown, or held).
Section 3. SIC and NAICS Codes
Items 3.1 and 3.2. List, in descending order of significance, up to
four 4-digit standard industrial classification (SIC) codes and
North American Industrial Classification System (NAICS) codes
that best describe your facility in terms of the principal products or
services it produces or provides. If the SIC or NAICS codes do
not adequately describe your facility’s products or services, you
have the option to provide additional descriptive information.
Item 4.2. Indicate whether the entity listed in response to Item 4.1
also owns the facility by marking the appropriate box.
Item 4.3. Indicate the ownership status of the operator of the
facility by marking the appropriate box. If the facility is a federal
facility (i.e., owned by the U.S. government), check the box for
“Public—federal.” If the facility is owned by a state government,
check the box for “Public—state.” If the facility is owned by a
county government, municipal (e.g., city or town) government,
tribal government, school district, water district, or other local
government entity, check the box for “Other public” and specify
the type of government entity. If the facility is owned by a
corporation or other private entity, check the box for “Private.” If
the facility has mixed ownership (e.g., public/private) or is not
owned by an entity of the types previously listed, check the box
for “Other” and specify the type of entity.
Items 4.4 to 4.6. Enter the telephone number, address, and email
address of the operator identified in Item 4.1.
Section 5. Indian Land
Item 5.1. Indicate whether the facility is located on Indian Land.
Section 6. Existing Environmental Permits
Item 6.1. Check the appropriate boxes and provide the permit
numbers for all relevant federal, state, and local environmental
permits or construction approvals received or applied for under
any of the programs listed below. If you have more than one
currently effective permit under a particular permit program for
your facility, list the additional permit numbers on the application
form or on a separate sheet of paper.
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FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
Hazardous waste management program under the Resource
Conservation and Recovery Act (RCRA).
Underground Injection Control (UIC) program under the Safe
Drinking Water Act (SDWA).
NPDES program under the Clean Water Act (CWA).
Prevention of Significant Deterioration (PSD) program under
the Clean Air Act (CAA).
Nonattainment program under the CAA.
National Emission Standards for Hazardous Pollutants
(NESHAPs) preconstruction approval under the CAA.
Ocean dumping permits under the Marine Protection
Research and Sanctuaries Act (MPRSA).
Dredge or fill permits under Section 404 of the CWA.
Other federal, state, or local environmental permits.
If the facility is a concentrated animal feeding operation, you are
not required to provide the topographic map required by this
section of Form 1. Instead, you are required to provide a
topographic map as specified in Section 4 of Form 2B.
Item 7.1. Note that you have completed your topographic map
and attached it to the application.
Section 8. Nature of Business
Briefly describe the nature of your business (e.g., products
produced or services provided). See Examples 1 and 2.
Example 1
Facilities Subject to 40 CFR 426, Subparts F and G
Industry A is an auto tempered and auto laminated glass
manufacturing facility subject to effluent limitation guidelines
(ELGs) for the “Automotive Glass Tempering” and “Automotive
Glass Laminating” subcategories of the “Glass Manufacturing”
point source category at 40 CFR 426, subparts F and G. At the
facility, glass is cut and then passed through a series of
processes that grind and polish the edges, bend the glass, and
then temper the glass to produce side and back windows for
automobiles. Tempering involves heating the glass near the
melting point, then rapidly cooling it to increase its mechanical
and thermal endurance. The facility also produces automobile
windshields and undertakes processes that laminate a plastic
sheet between two layers of glass and that prepare the glass for
lamination (e.g., cutting, bending, and washing).
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Section 7. Map
Unless the facility is a concentrated animal feeding operation,
provide a topographic map(s) of the area extending at least one
mile beyond the property boundaries of the facility that clearly
shows the following:
(e.g., residential, commercial). An example of an acceptable
location map is shown as Exhibit 1–3 at the end of these
instructions. Note: Exhibit 1–3 is provided for illustration only; it
does not show an actual facility.
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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, storage, and disposal
facilities.
Each well where you inject fluids underground.
All wells, springs, surface water bodies, and drinking water
wells that are in the public record or otherwise known to you
and that are located in the map area.
Example 2
Facility Not Subject to ELGs
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If the facility has associated water intakes, discharge structures,
hazardous waste disposal sites, or injection wells and these items
are located more than one mile from the facility, include them on
the map if possible. If you cannot, attach additional sheets
describing the location of the structures, disposal site(s), or well(s)
and identify the U.S. Geological Survey (USGS) or other map
corresponding to the location(s).
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Industry B undertakes batch-type resin manufacturing operations.
It has aboveground storage tanks for raw materials and finished
goods, resin loading operations, and warehouses for 55-gallon
drums of finished product. Industry B manufactures alkyd,
saturated and unsaturated polyester resins in batches using
reactor vessels and mix tanks. Most of the feedstock liquids are
pumped from storage tanks to the kettles and mixers via a closed
piping system. Additional feedstocks are added manually as
solids from bags and sacks via manways, which are located on
top of the kettles. The resin is then chemically reacted in the
kettles. After the reaction step finishes, the resin is transferred
from the kettles to the mix tanks, where solvents are added to
thin it. The primary byproduct of the reaction is water vapor
containing condensed soluble organics. The byproduct flows to
an isolation tank where the vapors are directed to an onsite
thermal oxidizer. The finished resin is then pumped through one
of three types of filtration systems into finished goods storage
tanks, 55-gallon drums, 350-gallon intermediate bulk container
totes, or directly into tanker trucks. A typical batch takes about 30
hours to complete.
On each map, include the map scale, a meridian arrow showing
north, and latitude and longitude to the nearest second. Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., USGS).
On all maps of rivers, show the direction of the current. In tidal
waters, show the directions of ebb and flow tides.
You may develop your map by going to USGS’s National Map
website at http://nationalmap.gov/. (For a map from this site, use
the traditional 7.5-minute quadrangle format. If none is available,
use a USGS 15-minute series map.) You may also use a plat or
other appropriate map. Briefly describe land uses in the map area
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FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
Item 9.2. Identify the source of the cooling water. For example,
indicate whether the cooling water is from a surface water,
groundwater well, public water system, or treated effluent that
would otherwise be discharged to a water of the U.S.
If the facility uses a cooling water intake structure as described in
40 CFR 125, Subparts I and J, the facility may have additional
application requirements under 40 CFR 122.21(r). Note that the
information required by 40 CFR 122.21(r) is not requested as part
of Form 1. Contact your NPDES permitting authority to determine
the specifics of what you should provide and when.
Section 10. Variance Requests
An applicant (other than a POTW) may request a variance from
otherwise applicable effluent limitations under certain conditions
described at 40 CFR 122.21(m).
A.
For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer
means: (1) 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 decisionmaking functions for the corporation, or (2) the manager of
one or more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
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Item 10.1. If known at the time of application, check all of the
authorized variances that you plan to request or renew. Note that
you are not being asked to submit any other information at this
time. Contact your NPDES permitting authority to determine the
specifics of what you should provide and when. The ability to
request a variance is not limited to the time of application, and an
applicant may request a variance consistent with statutory and
regulatory requirements.
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
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Section 9. Cooling Water Intake Structures
Item 9.1. Indicate whether the facility uses cooling water. If yes,
continue to Item 9.2. If no, skip to Item 10.1.
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Section 11. Checklist and Certification
Item 11.1. Review the checklist provided. In Column 1, mark the
sections of Form 1 that you have completed and are submitting
with your application. In Column 2, indicate for each section
whether you are submitting attachments.
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Item 11.2. The Clean Water Act provides for severe penalties for
submitting false information on this application form. CWA Section
309(c)(2) provides that, “Any person who knowingly makes any
false statement, representation, or certification in any application,
…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.”
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Exhibit 1–3. Example Topographic Map
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FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge
is in one of the following categories, as provided by the CWA and
NPDES regulations at 40 CFR 122 to 125. (However, under CWA
Section 510, a discharge exempted from the federal NPDES
requirements may still be regulated by a state NPDES permitting
authority.)
Any discharge of sewage from vessels and any effluent from
properly functioning marine engines, laundry, shower, and
galley sink wastes, or any other discharge incidental to the
normal operation of: (1) A vessel of the Armed Forces within
the meaning of section 312 of the CWA; and (2) A
recreational vessel within the meaning of section 502(25) of
the CWA. None of these exclusions apply to rubbish, trash,
garbage, or other such materials discharged overboard; nor
to other discharges when the vessel is operating in a
capacity other than as a means of transportation such as
when used as an energy or mining facility, a storage facility
or a seafood processing facility, or when secured to a
storage facility or a seafood processing facility, or when
secured to the bed of the ocean, contiguous zone or waters
of the United States for the purpose of mineral or oil
exploration or development.
Discharges of dredged or fill material into waters of the
United States that are regulated under CWA Section 404.
The introduction of sewage, industrial wastes, or other
pollutants into publicly owned treatment works by indirect
dischargers. Plans or agreements to switch to this method of
disposal in the future do not relieve dischargers of the
obligation to have and comply with permits until all
discharges of pollutants to waters of the United States are
eliminated. (See also 40 CFR 122.47(b).) This exclusion
does not apply to the introduction of pollutants to privately
owned treatment works or to other discharges through pipes,
sewers, or other conveyances owned by a state, municipality,
or other party not leading to treatment works.
Any discharge in compliance with the instructions of an OnScene Coordinator pursuant to 40 CFR 300 (The National Oil
and Hazardous Substances Pollution Contingency Plan) or
33 CFR 153.10(e) (Pollution by Oil and Hazardous
Substances).
Any introduction of pollutants from non point-source
agricultural and silvicultural activities, including stormwater
runoff from orchards, cultivated crops, pastures, range lands,
and forest lands, but not discharges from concentrated
animal feeding operations as defined in 40 CFR 122.23,
discharges from concentrated aquatic animal production
facilities as defined in 40 CFR 122.23, discharges from
concentrated aquatic animal production facilities as defined
in 40 CFR 122.24, discharges to aquaculture projects as
defined in 40 CFR 122.25, and discharges from silvicultural
point sources as defined in 40 CFR 122.27. Note: Per 40
CFR 122.26(b)(14)(ii), facilities classified within SIC 24,
Industry Group 241, that are rock crushing, gravel washing,
log sorting, or log storage facilities operated in connection
with silvicultural activities defined in 40 CFR 122.27(b)(2)–(3)
and Industry Groups 242 through 249; 26 (except 265 and
267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441,
and 373 (not included are all other types of silviculture
facilities) are considered stormwater discharges associated
with industrial activity, and are required to obtain an NPDES
permit.
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Return flows from irrigated agriculture.
Discharges into a privately owned treatment works, except as
the NPDES permitting authority may otherwise require under
40 CFR 122.44(m).
Discharges from a water transfer. “Water transfer” means an
activity that conveys or connects waters of the United States
without subjecting the transferred water to intervening
industrial, municipal, or commercial use. This exclusion does
not apply to pollutants introduced by the water transfer
activity itself to the water being transferred.
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FORM 1—GLOSSARY
Note: This glossary includes terms used in the various NPDES application forms, including Form 1. The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (other than an aquatic animal production facility) where the
following conditions are met;
Animals (other than aquatic animals) have been, are, or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period; and
Crops, vegetation, forage growth, or post-harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
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.
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APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
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AQUACULTURE PROJECT (defined at § 122.25) means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater, estuarine, or marine plants or animals. DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species, using a method or plan or operation (including, but not limited to, physical confinement) which, on the basis of reliable
scientific evidence, is expected to ensure that 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.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
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BEST MANAGEMENT PRACTICES (BMPs) means schedules of activities, prohibitions of practices, maintenance procedures, and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements, operation
procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage.
BIOSOLIDS (see sewage sludge).
BYPASS (defined at § 122.41(m)) means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW (CSO) means a discharge from a combined sewer system (CSS) at a point prior to the Publicly Owned
Treatment Works (POTW) Treatment Plant (defined at § 403.3(r)).
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COMBINED SEWER SYSTEM (CSS) means a wastewater collection system owned by a State or municipality (as defined by section
502(4) of the CWA) which conveys sanitary wastewaters (domestic, commercial and industrial wastewaters) and storm water through a
single-pipe system to a Publicly Owned Treatment Works (POTW) Treatment Plant (as defined at § 403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of (A) or (B) below, or that is designated as a CAFO in accordance with 40 CFR 122.23(c). Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation, if they adjoin each other or if they use a common area or system for the disposal of wastes.
A.
LARGE CONCENTRATED ANIMAL FEEDING OPERATION (LARGE CAFO) means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1.
2.
3.
4.
5.
700 mature dairy cows, whether milked or dry;
1,000 veal calves;
1,000 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and cow/calf
pairs;
2,500 swine each weighing 55 pounds or more;
10,000 swine each weighing less than 55 pounds;
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FORM 1—GLOSSARY CONTINUED
6.
7.
8.
9.
10.
11.
12.
13.
B.
500 horses;
10,000 sheep or lambs;
55,000 turkeys;
30,000 laying hens or broilers, if the AFO uses a liquid manure handling system;
125,000 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
82,000 laying hens, if the AFO uses other than a liquid manure handling system;
30,000 ducks (if the AFO uses other than a liquid manure handling system); or
5,000 ducks (if the AFO uses a liquid manure handling system).
MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION (MEDIUM CAFO) means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO. An AFO is defined as a
Medium CAFO if:
The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows, whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or lambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers, if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens, if the AFO uses other than a liquid manure handling system;
l. 10,000 to 29,999 ducks (if the AFO uses other than a liquid manure handling system); ore
m. 1,500 to 4,999 ducks (if the AFO uses a liquid manure handling system); and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch, flushing system, or other similar manmade device; or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over, across, or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY (defined at § 122.24) 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:
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1.
A.
Cold water fish species or other cold water aquatic animals including, but not limited to, the Salmonidae family of fish (e.g., trout and
salmon) in ponds, raceways, or other similar structures which discharge 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, Cetrarchiclae, and
Cyprinidae families of fish (e.g., respectively, catfish, sunfish, and minnows) in ponds, raceways, or other similar structures which
discharge at least 30 days per year, but does not include;
1.
Closed ponds which discharge only during periods of excess runoff; or
2.
Facilities which produce less than 45,454 harvest weight kilograms (approximately 100,000 pounds) of aquatic animals per year.
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FORM 1—GLOSSARY CONTINUED
CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972) Public Law 92–500, as amended by Public Law 95–217, Public Law 95–576, Public Law 96–483 and Public Law
97–117, 33 U.S.C. 1251 et seq.
CWA AND REGULATIONS means the Clean Water Act (CWA) and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
DAILY DISCHARGE means the “discharge of a pollutant” measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass, the “daily discharge” is
calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of
measurement, the “daily discharge” is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the “discharge of a pollutant.”
DISCHARGE (OF A POLLUTANT) means:
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DIRECTOR means the Regional Administrator or the State Director, as the context requires, or an authorized representative. When there
is no “approved State program,” and there is an EPA administered program, “Director” means the Regional Administrator. When there is
an approved State program, “Director” normally means the State Director. In some circumstances, however, EPA retains the authority to
take certain actions even when there is an approved State program. (For example, when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval, see § 123.1.) In such cases, the term
“Director” means the Regional Administrator and not the State Director.
Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or
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.
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This definition includes discharges into waters of the United States from: surface runoff which is collected or channelled by man;
discharges through pipes, sewers, or other conveyances owned by a State, municipality, or other person which do not lead to a treatment
works; and discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not
include an addition of pollutants by any “indirect discharger”.
DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions, revisions, or
modifications for the reporting of self-monitoring results by permittees. DMRs must be used by “approved States” as well as by EPA. EPA
will supply DMRs to any approved State upon request. The EPA national forms may be modified to substitute the state agency name,
address, logo, and other similar information, as appropriate, in place of EPA's.
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DRAFT PERMIT means a document prepared under § 124.6 indicating the Director's tentative decision to issue or deny, modify, revoke
and reissue, terminate, or reissue a “permit.” A notice of intent to terminate a permit, and a notice of intent to deny a permit, as discussed
in § 124.5, are types of “draft permits.” A denial of a request for modification, revocation and reissuance, or termination, as discussed in
§ 124.5, is not a “draft permit.” A “proposed permit” is not a “draft permit.”
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EFFLUENT LIMITATION means any restriction imposed by the Director on quantities, discharge rates, and concentrations of “pollutants”
which are “discharged” from “point sources” into “waters of the United States,” the waters of the “contiguous zone,” or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b) of the CWA to adopt or
revise “effluent limitations.”
ENVIRONMENTAL PROTECTION AGENCY (EPA) means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES “point source” or any other facility or activity (including land or appurtenances thereto) that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES “permit” issued under § 122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of the CWA.
INDIAN COUNTRY (or INDAN LANDS) means:
All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the
issuance of any patent, and, including rights-of-way running through the reservation;
All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof, and whether within or without the limits of a state; and
All Indian allotments, the Indian titles to which have not been extinguished, including rights-of-way running through the same.
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INDIAN TRIBE means any Indian Tribe, band, group, or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing “pollutants” to a “publicly owned treatment works.”
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(4)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census (Appendix F of 40 CFR 122); or
(ii) Located in the counties listed in appendix H of 40 CFR 122, except municipal separate storm sewers that are located in the
incorporated places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraphs (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs (i) or (ii). In making this determination
the Director may consider the following factors:
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(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(E) Other relevant factors; or
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(D) The nature of the receiving waters; and
(iv) The Director may, upon petition, designate as a large municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii).
LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whose discharges result from the holding of
unprocessed wood, for example, logs or roundwood with bark or after removal of bark held 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 429, subpart I, including the
effluent limitations guidelines.)
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MAJOR FACILITY means any NPDES “facility or activity” classified as such by the Regional Administrator, or, in the case of “approved
State programs,” the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable “daily discharge.”
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(7)) means all municipal separate storm sewers that
are either:
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(i) Located in an incorporated place with a population of 100,000 or more but less than 250,000, as determined by the 1990 Decennial
Census by the Bureau of the Census (appendix G of 40 CFR 122); or
(ii) Located in the counties listed in appendix I of 40 CFR 122, except municipal separate storm sewers that are located in the incorporated
places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraph (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; or
(E) Other relevant factors; or
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(iv) The Director may, upon petition, designate as a medium municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii) of this section.
MUNICIPALITY means a city, 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 organization,
or a designated and approved management agency under section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER (defined at § 122.26(b)(8)) means a conveyance or system of conveyances (including roads
with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains):
Owned or operated by a State, city, town, borough, county, parish, district, association, or other public body (created by or pursuant to
State law) having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, including special districts under
State law such as a sewer district, flood control district or drainage district, or similar entity, or an Indian tribe or an authorized Indian
tribal organization, or a designated and approved management agency under section 208 of the CWA that discharges to waters of the
United States.
Designed or used for collecting or conveying stormwater.
Which is not a combined sewer; and
Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE (see sewage sludge)
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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,
402, 318, and 405 of the CWA. The term includes an “approved program.”
NEW DISCHARGER means any building, structure, facility, or installation:
From which there is or may be a “discharge of pollutants;”
That did not commence the “discharge of pollutants” at a particular “site” prior to August 13, 1979;
Which is not a “new source;” and
Which has never received a finally effective NPDES permit for discharges at that “site.”
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This definition includes an “indirect discharger” which commences discharging into “waters of the United States” after August 13, 1979. It
also means any existing mobile point source (other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig) such as a seafood processing rig, seafood processing vessel, or aggregate plant, that begins discharging at a
“site” for which it does not have a permit; and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979, at a “site” under EPA’s permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern, the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1) through (10).
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An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a “new discharger” only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building, structure, facility, or installation from which there is or may be a “discharge of pollutants,” the
construction of which commenced:
After promulgation of standards of performance under section 306 of the CWA which are applicable to such source, or
After proposal of standards of performance in accordance with section 306 of the 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.
OWNER OR OPERATOR means the owner or operator of any “facility or activity” subject to regulation under the NPDES program.
PERMIT means an authorization, license, or equivalent control document issued by EPA or an “approved State” to implement the
requirements of this part and parts 123 and 124. “Permit” includes an NPDES “general permit” (§ 122.28). Permit does not include any
permit which has not yet been the subject of final agency action, such as a “draft permit” or a “proposed permit.”
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides, and the application of chemical pesticides that leave a residue, from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application, this does not include
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agricultural storm water discharges and return flows from irrigated agriculture, which are excluded by law (33 U.S.C. 1342(l); 33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether a NPDES permit is needed for discharges to waters of the United States
from pesticide application, means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
POINT SOURCE means any discernible, confined, and discrete conveyance, including but not limited to, any pipe, ditch, channel, tunnel,
conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill leachate collection system, vessel or
other floating craft from which pollutants are or may be discharged. This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff. (See § 122.3).
POLLUTANT means dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions,
chemical wastes, biological materials, radioactive materials (except those regulated under the Atomic Energy Act of 1954, as amended (42
U.S.C. 2011 et seq.)), heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal, and agricultural waste
discharged into water. It does not mean:
Sewage from vessels; or
Water, gas, or other material which is injected into a well to facilitate 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
degradation of ground or surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source, byproduct, or special nuclear materials. Examples of materials not covered include radium
and accelerator-produced isotopes. See Train v. Colorado Public Interest Research Group, Inc., 426 U.S. 1 (1976).
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PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement (Natural Resources Defense
Council et al. v. Train, 8 E.R.C. 2120 (D.D.C. 1976), modified 12 E.R.C. 1833 (D.D.C. 1979)); also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is (1) used to treat wastes from any facility whose
operator is not the operator of the treatment works and (2) not a “POTW.”
PROCESS WASTEWATER means any water which, during manufacturing 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.
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PROPOSED PERMIT means a state NPDES “permit” prepared after the close of the public comment period (and, when applicable, any
public hearing and administrative appeals) which is sent to EPA for review before final issuance by the State. A “proposed permit” is not a
“draft permit.”
PUBLICLY OWNED TREATMENT WORKS or POTW (defined at § 403.3) means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality (as defined by CWA Section 502(4)). This definition includes any devices or systems used in the
storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition also includes
sewers, pipes, and other conveyances only if they convey wastewater to a POTW. The term also means the municipality as defined in
CWA Section 502(4), which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
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REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES (defined at § 122.27) means facilities which process crushed and broken
stone, gravel, and riprap (See 40 CFR 436, subpart B, including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a “permit”, including an enforceable sequence of
interim requirements (for example, actions, operations, or milestone events) leading to compliance with the CWA and regulations.
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 toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under section 312 of the 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 any solid, semi-solid, or liquid residue removed during the treatment of municipal waste water or domestic
sewage. Sewage sludge includes, but is not limited to, solids removed during primary, secondary, or advanced waste water treatment,
scum, septage, portable toilet pumpings, type III marine sanitation device pumpings (33 CFR 159), and sewage sludge products. Sewage
sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge.
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SlLVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock
crushing, gravel washing, log sorting, or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States. This term does not include non-point source silvicultural activities such as
nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed 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 crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit (see 33 CFR 209.120 and part 233).
SITE means the land or water area where any “facility or activity” is physically located or conducted, including adjacent land used in
connection with the facility or activity.
SLUDGE-ONLY FACILITY means any “treatment works treating domestic sewage” whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to section 405(d) of the CWA and is required to obtain a permit under § 122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d) of the CWA
which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
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STATE means any of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Virgin Islands, American
Samoa, the Commonwealth of the Northern Mariana Islands, the Trust Territory of the Pacific Islands, or an Indian Tribe as defined in
these regulations which meets the requirements of § 123.31 of this chapter.
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STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an “approved program,” or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies, “State Director”
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER (or STORM WATER) (defined at § 122.26(b)(13)) means stormwater runoff, snow melt runoff, and surface runoff and
drainage.
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STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY (defined at § 122.26(b)(14)) means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing, processing or raw materials
storage areas at an industrial plant. The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, stormwater discharges
from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products,
waste material, or by-products used or created by the facility; material handling sites; refuse sites; sites used for the application or disposal
of process waste waters (as defined at 40 CFR 401); sites used for the storage and maintenance of material handling equipment; sites
used for residual treatment, storage, or disposal; shipping and receiving areas; manufacturing buildings; storage areas (including tank
farms) for raw materials, and intermediate and final products; and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include storage, loading
and unloading, transportation, or conveyance of any raw material, intermediate product, final product, by-product or waste product. The
term excludes areas located on plant lands separate from the plant's industrial activities, such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities (including industrial facilities that are federally, State, or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below) include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v). The
following categories of facilities are considered to be engaging in “industrial activity” for purposes of 40 CFR 122.26(b)(14):
1.
2.
3.
Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effluent standards
under 40 CFR Subchapter N (except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing, gravel washing, log sorting, or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)–(3) and Industry Groups 242
through 249; 26 (except 265 and 267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441, 373; (not included are all other types of
silvicultural facilities);
Facilities classified as Standard Industrial Classifications 10 through 14 (mineral industry) including active or inactive mining
operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of
non–coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17, 1990) and oil and gas exploration, production, processing, or treatment operations, or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with, any overburden, raw material, intermediate
products, finished products, byproducts or waste products located on the site of such operations; (inactive mining operations are
mining sites that are not being actively mined, but which have an identifiable owner/operator; inactive mining sites do not include sites
1-15
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 1—GLOSSARY CONTINUED
4.
where mining claims are being maintained prior to disturbances associated with the extraction, beneficiation, or processing of mined
materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a permit under
subtitle C of RCRA;
Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is received from any
of the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and automobile
junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
7. Steam electric power generating facilities, including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40, 41, 42 (except 4221–25), 43, 44, 45, and 5171 which have
vehicle maintenance shops, equipment cleaning operations, or airport deicing operations. Only those portions of the facility that are
either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication),
equipment cleaning operations, airport deicing operations, or which are otherwise identified under paragraphs 1–7 or 9–11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the
storage treatment, recycling, and reclamation of municipal or domestic sewage, including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility, with a design flow of 1.0 mgd or more, or required to have an approved
pretreatment program under 40 CFR 403. Not included are farm lands, domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility, or areas that are in compliance
with section 405 of the CWA;
10. Construction activity including clearing, grading and excavation, except operations that result in the disturbance of less than five acres
of total land area. Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20, 21, 22, 23, 2434, 25, 265, 267, 27, 283, 285, 30, 31 (except 311), 323, 34
(except 3441), 35, 36, 37 (except 373), 38, 39, and 4221–25.
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5.
TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1) or, in the case of “sludge use or disposal practices,” any
pollutant identified in regulations implementing section 405(d) of the CWA.
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TREATMENT WORKS TREATING DOMESTIC SEWAGE (TWTDS) means a POTW or any other sewage sludge or waste water
treatment devices or systems, regardless of ownership (including federal facilities), used in the storage, treatment, recycling, and
reclamation of municipal or domestic sewage, including land dedicated for the disposal of sewage sludge. This definition does not include
septic tanks or similar devices. For purposes of this definition, “domestic sewage” includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a “treatment works treating domestic sewage,” where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling, use or disposal
practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET (defined at § 122.41(n)) 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 careless or improper operation.
VARIANCE means any mechanism or provision under section 301 or 316 of the CWA or under 40 CFR 125, or in the applicable “effluent
limitations guidelines” which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA. This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
sections 301(c), 301(g), 301(h), 301(i), or 316(a) of the CWA.
WATERS OF THE UNITED STATES as defined at § 122.2.
WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test.
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Contains Nonbinding Recommendations
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EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved
OMB No.
Form Expires
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
Form
1
NPDES
GENERAL INFORMATION
Name, Mailing Address, and Location
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Activities Requiring an NPDES Permit
SECTION 1. ACTIVITIES REQUIRING AN NPDES PERMIT (40 CFR 122.21(f) and (f)(1))
1.1
Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned
Is the facility a new or existing treatment works
1.1.1
1.1.2
treatment works?
treating domestic sewage?
If yes, STOP. Do NOT complete
No
If yes, STOP. Do NOT
No
Form 1. Complete Form 2A.
complete Form 1. Complete
Form 2S.
1.2
Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding
1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal
commercial, mining, or silvicultural facility that is
production facility?
currently discharging process wastewater?
Yes
Complete
Form
1
No
Yes Complete Form No
and Form 2B.
1 and Form 2C.
1.2.3 Is the facility a new manufacturing, commercial,
1.2.4 Is the facility a new or existing manufacturing,
mining, or silvicultural facility that has not yet
commercial, mining, or silvicultural facility that
commenced to discharge?
discharges only nonprocess wastewater?
Yes Complete Form 1 No
Yes Complete Form No
and Form 2D.
1 and Form 2E.
1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of stormwater
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
Yes Complete Form 1
No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
(b)(15).
SECTION 2. NAME, MAILING ADDRESS, AND LOCATION (40 CFR 122.21(f)(2))
2.1
Facility Name
2.2
EPA Identification Number
2.3
Facility Contact
Name (first and last)
Title
Phone number
State
ZIP code
Email address
2.4
Facility Mailing Address
Street or P.O. box
City or town
EPA Form 3510-1 (revised )
Page 1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Name, Mailing Address,
and Location Continued
EPA Identification Number
2.5
NPDES Permit Number
Facility Name
Form Approved
OMB No.
Form Expires
Facility Location
Street, route number, or other specific identifier
County name
County code (if known)
City or town
State
ZIP code
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3.2
NAICS Code(s)
Description (optional)
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SIC and NAICS Codes
SECTION 3. SIC AND NAICS CODES (40 CFR 122.21(f)(3))
3.1
SIC Code(s)
Description (optional)
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4.2
Is the name you listed in Item 4.1 also the owner?
Yes No
4.3
Operator Status
Public—federal
Private
Operator Information
Continued
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Operator Information
SECTION 4. OPERATOR INFORMATION (40 CFR 122.21(f)(4))
4.1
Name of Operator
4.4
Phone Number of Operator
4.5
Operator Address
Street or P.O. Box
Public—state
Other public (specify)_______________
Other (specify) _______________
City or town
State
ZIP code
Email address of operator
Indian
Land
SECTION 5. INDIAN LAND (40 CFR 122.21(f)(5))
5.1
Is the facility located on Indian Land?
Yes No
EPA Form 3510-1 (revised )
Page 2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved
OMB No.
Form Expires
Existing Environmental
Permits
SECTION 6. EXISTING ENVIRONMENTAL PERMITS (40 CFR 122.21(f)(6))
Existing Environmental Permits (check all that apply and print or type the corresponding permit number for each)
6.1
NPDES (discharges to surface RCRA (hazardous wastes)
water)
_______________________
Nonattainment program (CAA)
NESHAPs (CAA)
Ocean dumping (MPRSA)
Dredge or fill (CWA Section 404)
Other (specify)
___________________________
________________________
SECTION 7. MAP (40 CFR 122.21(f)(7))
Map
fluids)
________________________
____________________________
PSD (air emissions)
________________________
7.1
UIC (underground injection of
_______________________
____________________________
_________________________
Have you attached a topographic map containing all required information to this application? (See instructions for
specific requirements.)
Nature of Business
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SECTION 8. NATURE OF BUSINESS (40 CFR 122.21(f)(8))
8.1
Describe the nature of your business.
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Yes No CAFO—Not Applicable (See requirements in Form 2B.)
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Yes No SKIP to Item 10.1.
9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
NPDES permitting authority to determine what specific information needs to be submitted and when.)
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Cooling Water
Intake Structures
SECTION 9. COOLING WATER INTAKE STRUCTURES (40 CFR 122.21(f)(9))
9.1
Does your facility use cooling water?
Variance Requests
SECTION 10. VARIANCE REQUESTS (40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
Fundamentally different factors (CWA
Water quality related effluent limitations (CWA Section
302(b)(2))
Section 301(n))
Non-conventional pollutants (CWA
Thermal discharges (CWA Section 316(a))
Section 301(c) and (g))
Not applicable
EPA Form 3510-1 (revised )
Page 3
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved
OMB No.
Form Expires
SECTION 11. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
Section 1: Activities Requiring an NPDES Permit
w/ attachments
Section 2: Name, Mailing Address, and Location
w/ attachments
Section 3: SIC Codes
w/ attachments
Section 4: Operator Information
w/ attachments
Section 5: Indian Land
w/ attachments
Section 6: Existing Environmental Permits
w/ attachments
Section 7: Map
w/ topographic
map
Section 8: Nature of Business
w/ attachments
Section 9: Cooling Water Intake Structures
w/ attachments
Section 10: Variance Requests
w/ attachments
Section 11: Checklist and Certification Statement
w/ attachments
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w/ additional attachments
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11.2
In Column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to provide attachments.
Column 1
Column 2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
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Checklist and Certification Statement
11.1
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Name (print or type first and last name)
Signature
Official title
Date signed
EPA Form 3510-1 (revised )
Page 4
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-2A
Revised
Water Permits Division
Application Form 2A
New and Existing Publicly
Owned Treatment Works
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NPDES Permitting Program
Note: Complete this form if your facility is a new or existing publicly owned treatment works.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Paperwork Reduction Act Notice
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The U.S. Environmental Protection Agency estimates the average burden to collect information and
complete Form 2A to average between 5 and 25 hours, depending on the number of sections the
applicant must complete. The estimate includes time for reviewing instructions, searching existing data
sources, gathering and maintaining the needed data, and completing and reviewing the collection of
information. Send comments about the burden estimate or any other aspect of this collection of
information to the Chief, Information Policy Branch (PM-223), U.S. Environmental Protection Agency,
1200 Pennsylvania Avenue, NW, Washington, DC 20460, and to the Office of Information and
Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503,
marked “Attention: Desk Officer for EPA.”
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2A—GENERAL INSTRUCTIONS
Form 2A. If you do not assert a claim of confidentiality at the time
you submit your information to the NPDES permitting authority,
EPA may make the information available to the public without
further notice to you. EPA will handle claims of confidentiality in
accordance with the Agency’s business confidentiality regulations
at Part 2 of Title 4 of the Code of Federal Regulations (CFR).
Who Must Complete Form 2A?
All new and existing publicly owned treatment works (POTWs) and
other dischargers designated by the National Pollutant Discharge
Elimination System (NPDES) permitting authority must complete
Form 2A. Note that you may wish to consult the “General
Instructions” of NPDES Application Form 1 to determine if your
treatment works is required to submit any additional NPDES
application forms.
Completion of Forms
Form 2A is divided into six major sections. It also contains five
effluent monitoring tables (Tables A through E) and an industrial
discharge information table (Table F), all located at the end of the
form. Note that not all applicants are required to complete each
section of the form or all of the tables. The questions on the form
will direct you to the items and tables you must complete.
At the state level, either the U.S. Environmental Protection Agency
(EPA) or an approved state agency administers the NPDES permit
program. If you are located in a jurisdiction in which an EPA
regional office administers the NPDES permit program, you should
use Form 2A and all other applicable forms described in these
instructions. If you are located in a jurisdiction where a state
administers the NPDES permit program, contact the state to
determine the forms you should complete. States often develop
their own application forms rather than use the federal forms. See
http://www.epa.gov/npdes/npdes-state-program-information for a
list of states that have approved NPDES permit programs and
those that do not.
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Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
Provide your EPA Identification Number from the Federal Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 2A and any attachments. If your facility is new
(i.e., not yet constructed), write or type “New Facility” in the space
provided for the EPA Identification Number and NPDES permit
number. If you do not know your EPA Identification Number,
contact your NPDES permitting authority. See Exhibit 2A–1 for
contact information. Additionally, for Tables A through E, provide
the applicable outfall number at the top of each page.
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Exhibit 2A–1 (see end of this section) provides contact information
for each of EPA’s 10 regional offices. Since the exhibit’s content is
subject to change, consult EPA’s website for the latest information:
http://www.epa.gov/aboutepa#regional.
Where to File Your Completed Form
If you are in a jurisdiction where EPA is the NPDES permitting
authority (i.e., the state is not an NPDES-authorized state),
mail the completed application forms to the EPA regional office
that covers the state in which your facility is located (see
Exhibit 2A–1).
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If you are in a jurisdiction with an approved state NPDES
permit program, file according to the instructions on the state
forms.
When to File Your Completed Form
If you have previously submitted information that answers a specific
question to EPA or an approved state NPDES agency, you may
either repeat the information in the space provided or attach a copy
of the previous submission.
Note for New Dischargers
Provide all information available to you at the time you
complete Form 2A. If you do not have information to respond
to an item because your facility has yet to discharge, write or
type “data are not available” next to the item on the form. Note
that you are required to submit actual data no later than
24 months after your facility commences to discharge.
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Form 2A must be submitted at least 180 days before your present
NPDES permit expires or, if you are a new discharger, at least
180 days before the date on which the discharge is to commence,
unless the NPDES permitting authority has granted permission for a
later date.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter “NA” for “not applicable” to
show that you considered the item and determined a response was
not necessary for your facility.
Fees
EPA does not require applicants to pay a fee for applying for
NPDES permits. However, states that administer the NPDES permit
program may charge fees. Consult with state officials for further
information.
Public Availability of Submitted Information
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request. You
may not claim any information on Form 2A (or related attachments)
as confidential.
You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority’s satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
Definitions
The legal definitions of all key terms used in the various NPDES
application forms are included in the “Glossary” at the end of these
instructions.
2A-1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2A—GENERAL INSTRUCTIONS CONTINUED
Exhibit 2A–1. Addresses of EPA Regional Contacts and Covered States
REGION 6
U.S. Environmental Protection Agency, Region 6
1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733
Phone: (214) 665-2200; toll free: (800) 887-6063
Fax: (214) 665-7113
Website: http://www.epa.gov/aboutepa/epa-region-6-south-central
Covered states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
REGION 2
U.S. Environmental Protection Agency, Region 2
290 Broadway, New York, NY 10007-1866
Phone: (212) 637-3000; toll free: (877) 251-4575
Fax: (212) 637-3526
Website: http://www.epa.gov/aboutepa/epa-region-2
Covered states: New Jersey, New York, Virgin Islands, and Puerto Rico
REGION 7
U.S. Environmental Protection Agency, Region 7
11201 Renner Boulevard, Lenexa, KS 66219
Phone: (913) 551-7003; toll free: (800) 223-0425
Website: http://www.epa.gov/aboutepa/epa-region-7-midwest
Covered states: Iowa, Kansas, Missouri, and Nebraska
REGION 3
U.S. Environmental Protection Agency, Region 3
1650 Arch Street, Philadelphia, PA 19103-2029
Phone: (215) 814-5000; toll free: (800) 438-2474
Fax: (215) 814-5103
Website: http://www.epa.gov/aboutepa/epa-region-3-mid-atlantic
Covered states: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia,
and West Virginia
REGION 8
U.S. Environmental Protection Agency, Region 8
1595 Wynkoop Street, Denver, CO 80202-1129
Phone: (303) 312-6312; toll free: (800) 227-8917
Fax: (303) 312-6339
Website: http://www.epa.gov/aboutepa/epa-region-8-mountains-and-plains
Covered states: Colorado, Montana, North Dakota, South Dakota, Utah, and
Wyoming
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REGION 1
U.S. Environmental Protection Agency, Region 1
5 Post Office Square, Suite 100, Boston, MA 02109-3912
Phone: (617) 918-1111; toll free: (888) 372-7341
Fax: (617) 918-0101
Website: http://www.epa.gov/aboutepa/epa-region-1-new-england
Covered states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont
REGION 9
U.S. Environmental Protection Agency, Region 9
75 Hawthorne Street, San Francisco, CA 94105
Phone: (415) 947-8000; toll free: (866) EPA-WEST
Fax: (415) 947-3553
Website: http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest
Covered states: Arizona, California, Hawaii, Nevada, Guam, American Samoa,
and Trust Territories
REGION 5
U.S. Environmental Protection Agency, Region 5
77 West Jackson Boulevard, Chicago, IL 60604-3507
Phone: (312) 353-2000; toll free: (800) 621-8431
Fax: (312) 353-4135
Website: http://www.epa.gov/aboutepa/epa-region-5
Covered states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
REGION 10
U.S. Environmental Protection Agency, Region 10
1200 Sixth Avenue, Suite 900, Seattle, WA 98101
Phone: (206) 553-1200; toll free: (800) 424-4372
Fax: (206) 553-2955
Website: http://www.epa.gov/aboutepa/epa-region-10-pacific-northwest
Covered states: Alaska, Idaho, Oregon, and Washington
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REGION 4
U.S. Environmental Protection Agency, Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, SW, Atlanta, GA 30303-8960
Phone: (404) 562-9900; toll free: (800) 241-1754
Fax: (404) 562-8174
Website: http://www.epa.gov/aboutepa/about-epa-region-4-southeast
Covered states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, and Tennessee
2A-2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2A—LINE-BY-LINE INSTRUCTIONS
Section 1. Basic Application Information for All Applicants
Facility Information
Item 1.1. Enter the facility’s official or legal name. Do not use a
colloquial name. Provide the mailing address of the facility. Next,
give the name (first and last), title, work telephone number, and
email address of the person who is thoroughly familiar with the
operation of the facility and with the facts reported in this
application.
Discharge Points by Type
Item 1.11. Provide the facility’s total number of effluent discharge
points to waters of the United States by type (e.g., treated effluent,
untreated effluent, combined sewer overflows, bypasses, and
constructed emergency overflows).
Outfalls and Other Discharge or Disposal Methods
Outfalls Other Than to Waters of the United States
Item 1.12. Indicate whether the POTW discharges wastewater to
basins, ponds, or other surface impoundments that do not have
outlets for discharge to waters of the United States. If yes, continue
to Item 1.13. If no, skip to Item 1.14.
Include a complete location address for the facility if different from
the mailing address. 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 Routes 425 and 22”).
Item 1.13. Specify the location of each surface impoundment, the
average daily volume discharged to each surface impoundment in
gallons per day (gpd), and whether the discharge is continuous or
intermittent.
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Item 1.2. Indicate whether the application is for a facility that has
not yet commenced discharge. If yes, be advised that you are
required to submit actual data no later than 24 months after your
facility commences to discharge.
Item 1.14. Indicate if the facility applies wastewater to land. If yes,
continue to Item 1.15. If no, skip to Item 1.16.
Applicant Information
Item 1.3. Indicate if the applicant is different from the entity listed
under Item 1.1. If so, specify the applicant name and address.
Provide the name (first and last) of a contact, including his/her title,
telephone number, and email address.
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Item 1.15. Provide the location of each land application site; the
size of each land application site (in acres); the average daily
volume applied to each land application site (in gpd), and whether
the land application is continuous or intermittent.
Item 1.4. Indicate if the applicant is the facility’s owner, operator, or
both.
Item 1.5. Specify whether the NPDES permitting authority should
send correspondence to the facility or the applicant.
Item 1.16. Note whether the facility’s effluent is transported to
another facility for treatment prior to discharge. If yes, continue to
Item 1.17. If no, skip to Item 1.21.
Item 1.17. Describe the means by which the effluent is transported,
such as by tank truck or pipe.
Existing Environmental Permits
Item 1.6. Indicate all environmental permits or construction
approvals received or applied for (including dates) under the noted
programs. Print or type the corresponding permit number for each.
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Item 1.18. Specify whether the facility’s effluent is transported by a
party other than the applicant. If yes, continue to Item 1.19. If no,
skip to Item 1.20.
Item 1.19. Provide the name, mailing address, contact person,
phone number, and email address of the entity that transports the
discharge.
Collection System and Population Served
Item 1.7. Specify the municipalities served by the treatment works,
including unincorporated connector districts. For each municipality,
indicate the population served, the percentage of each collection
system type if known (e.g., separate sanitary or combined storm
and sanitary), and collection system ownership status. Finally,
indicate the total percentage of sewer line each type comprises.
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Item 1.20. Provide the name, mailing address, contact person,
phone number, email address, and NPDES permit number (if any)
of the receiving facility. Also specify the average daily flow rate from
the facility into the receiving facility in mgd.
Item 1.21. Indicate if wastewater is disposed of in a manner other
than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the United States, such as
underground percolation and underground injections. If yes,
continue to Item 1.22. If no, skip to Item 1.23.
Do not report privately owned collection systems discharging
industrial waste to the treatment works in Item 1.7. Those facilities
must be reported on Table F.
Indian Country
Item 1.8. Indicate if the POTW is located in Indian Country.
Item 1.9. Note whether the treatment works discharges to a
receiving stream that flows through Indian Country.
Design and Actual Flow Rates
Item 1.10. Provide the facility’s design flow rate in million gallons
per day (mgd). Next, specify the facility’s actual annual average
daily flow rate and maximum daily flow rate for each of the previous
three years (in mgd).
Item 1.22. Provide a description of the disposal method, including
the location and size of each disposal site; the annual average daily
discharge volume (in gpd), and whether disposal through this
method is continuous or intermittent.
Variance Requests
Item 1.23. If known at the time of application, check all of the
authorized variances that you plan to request or renew. Note that
you are not being asked to submit any other information at this
time. Contact your NPDES permitting authority to determine the
2A-3
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FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED
website at http://nationalmap.gov/. (For a map from this site, use
the traditional 7.5-minute quadrangle format. If none is available,
use a USGS 15-minute series map.) You may also use a plat or
other appropriate map. Briefly describe land uses in the map area
(e.g., residential, commercial). An example of an acceptable
location map is shown as Exhibit 2A–2 at the end of these
instructions. Note: Exhibit 2A–2 is provided for illustration only; it
does not show an actual facility. Note that you have completed your
topographic map and attached it to the application.
specifics of what you should provide and when. The ability to
request a variance is not limited to the time of application, and an
applicant may request a variance consistent with statutory and
regulatory requirements.
Contractor Information
Item 1.24. Indicate if any of the operational or maintenance
activities associated with wastewater treatment and effluent quality
of the POTW are the responsibility of a contractor. If yes, continue
to Item 1.25. If no, skip to Section 2.
Flow Diagram
Item 2.4. Provide a process flow diagram or schematic showing the
processes of the treatment plant, including all bypass piping and all
backup power sources or redundancy in the system. This includes
a water balance showing all treatment units, including disinfection
(e.g., chlorination and dechlorination), and showing daily average
flow rates at influent and discharge points, and approximate daily
flow rates between treatment units. Also provide a narrative
description of the diagram/schematic. Answer “Yes” to Item 2.4
once you have completed and attached your diagram to the
application.
Item 1.25. Provide a listing of all contractors (by company name).
For each, specify the mailing address, a contact name, telephone
number, and email address. Also summarize the operational and
maintenance responsibilities of each contractor.
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Section 2. Additional Information
Outfalls to Waters of the United States
Design Flow
Item 2.1. Indicate whether the treatment works has a design flow
greater than or equal to 0.1 mgd. If yes, continue to Item 2.2. If no,
skip to Section 3.
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Scheduled Improvements and Schedules of Implementation
Item 2.5. Indicate whether any improvements to the facility are
scheduled. If yes, list and briefly describe each scheduled
improvement and continue to Item 2.6. If no, skip to Section 3.
Inflow and Infiltration
Item 2.2. Specify the POTW’s current average daily volume of
inflow and infiltration (in gpd) and steps the facility is taking to
minimize inflow and infiltration.
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Topographic Map
Item 2.3. Prepare a topographic map (or other map if a topographic
map is unavailable) extending at least one mile beyond property
boundaries of the treatment plant, including all unit processes and
showing the following: (1) treatment plant area and unit processes;
(2) major pipes or other structures through which wastewater enters
the treatment plant and the pipes or other structures through which
treated wastewater is discharged from the treatment plant (include
outfalls from bypass piping, if applicable); (3) each well where fluids
from the treatment plant are injected underground; (4) wells,
springs, and other surface water bodies listed in public records or
otherwise known to the applicant within ¼ mile of the treatment
works’ property boundaries; (5) sewage sludge management
facilities (including onsite treatment, storage, and disposal sites);
and (6) location at which waste classified as hazardous under the
Resource Conservation and Recovery Act (RCRA) enters the
treatment plant by truck, rail, or dedicated pipe.
On each map, include the map scale, a meridian arrow showing
north, and latitude and longitude to the nearest second. Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS).
On all maps of rivers, show the direction of the current. In tidal
waters, show the directions of ebb and flow tides.
You may develop your map by going to USGS’s National Map
Item 2.6. For each scheduled improvement, indicate the outfall
number of each outfall affected and the scheduled or actual dates
of completion for the following: (1) commencement of construction,
(2) completion of construction, (3) commencement of discharge,
and (4) attainment of operational level.
Item 2.7. Note whether the appropriate permits/clearances
concerning other federal/state requirements have been obtained
and briefly explain your response.
Section 3. Information on Effluent Discharges
Description of Outfalls
Item 3.1. Provide a description of each of the POTW’s wastewater
discharge outfalls. The application form provides reporting space
for three outfalls. If your facility has more than this number, attach
additional sheets as necessary.
For each outfall, provide the outfall number. Indicate the state,
county, and city or town where each outfall is located. Note the
distance from shore in feet and the depth below the surface in feet.
Specify the average daily flow rate through the outfall in mgd. Also
specify the latitude and longitude of each outfall to the nearest
second. Latitude and longitude coordinates may be obtained in a
variety of ways, including use of hand held devices (e.g., a GPS
enabled smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., USGS). The location of each outfall (i.e.,
where the coordinates are collected) shall be the point where the
discharge is released into a water of the United States. For further
guidance, refer to http://www.epa.gov/geospatial/latitudelongitudedata-standard.
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FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED
Seasonal or Periodic Discharge Data
Item 3.2. Indicate whether any of the outfalls described under
Item 3.1 have seasonal or periodic discharges. If yes, continue to
Item 3.3. If no, skip to Item 3.4.
completing Items 3.10 to 3.26 and Tables A through E.
Item 3.5. Briefly describe the diffuser type at each applicable
outfall.
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Treatment Description
Item 3.12. For each applicable outfall, note the number of acute
and chronic WET tests conducted since the last permit reissuance
of the facility’s discharges or of the receiving water near the
discharge points.
Item 3.13. Note whether the POTW has a design flow greater than
or equal to 0.1 mgd. If yes, continue to Item 3.14. If no, skip to Item
3.16.
Item 3.14 and Table B. Answer whether the treatment works uses
chlorine for disinfection, uses it elsewhere in the treatment process,
or otherwise has reasonable potential to discharge chlorine in its
effluent. If yes, complete Table B including chlorine. If no, complete
Table B, omitting chlorine.
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Waters of the United States
Item 3.6. Note whether the POTW discharges or plans to discharge
wastewater to waters of the United States from one or more
discharge points. If yes, continue to Item 3.7. If no, skip to
Section 6.
Receiving Water Description
Item 3.7. Provide receiving water and related information in the
table provided on the form (if known): (1) name of receiving water,
(2) name of watershed/river/stream system and U.S. Soil
Conservation Service 14-digit watershed code, (3) name of state
management/river basin and U.S. Geological Survey (USGS) 8-digit
hydrologic unit code, (4) acute and chronic critical low flow in cubic
feet per second (cfs) and total hardness of receiving stream at
critical low flow, in milligrams per liter (mg/L) of calcium carbonate,
if applicable.
Item 3.11. Answer whether the POTW has conducted any whole
effluent toxicity (WET) tests during the 4.5 years prior to the date of
the application on any of the facility’s discharges or on any
receiving water near the discharge points. If yes, continue to Item
3.12. If no, skip to Item 3.13.
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Item 3.3. Specify the following for each applicable outfall:
(1) number of times per year discharge occurs, (2) average duration
of each discharge, (3) average flow of each discharge in mgd, and
(4) months in which discharge occurs.
Diffuser Type
Item 3.4. Note whether any of the outfalls listed under Item 3.1 are
equipped with a diffuser. If yes, continue to Item 3.5. If no, skip to
Item 3.6.
Item 3.10 and Table A. All applicants that discharge wastewater to
waters of the United States must provide effluent data for Table A
parameters. Respond “Yes” to Item 3.10 when you have completed
Table A and attached it to your application.
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Item 3.8. Specify the highest level of treatment provided for
discharges from each outfall (e.g., primary, equivalent to
secondary, secondary, or advanced). Also indicate the following
design removals (in percent) for the following parameters for each
outfall: (1) biochemical oxygen demand (BOD5 or CBOD5), (2) total
suspended solids (TSS), (3) phosphorus (if applicable), (4) nitrogen
(if applicable), and (5) any other removals that an advanced
treatment system is designed to achieve.
Item 3.9. Provide a description of the type(s) of disinfection used for
wastewater discharged through each outfall. Indicate the seasons
the disinfection type is used. Note whether the POTW dechlorinates
if disinfection is accomplished through chlorination. Otherwise,
check “Not Applicable.”
Effluent Testing Data and Tables A through E
Items 3.10 to 3.26. These items require you to collect and report
data for the parameters and pollutants listed in Tables A through E,
located at the end of Form 2A. The instructions for completing the
tables are table-specific, as are the criteria for determining who
should complete them.
Important note: Read the “General Instructions for Reporting,
Sampling, and Analysis” later in these instructions before
Item 3.15. Answer “Yes” when you have completed monitoring for
all applicable Table B parameters and attached the results to your
application.
Item 3.16 and Screen for Tables C through E. Indicate whether
one or more of the conditions apply to your POTW. If yes, continue
to Item 3.17. If no, skip to Section 4.
Item 3.17 and Table C. Answer “Yes” to indicate you have
completed monitoring for all applicable Table C pollutants and
attached the results to your application package.
Item 3.18 and Table D. Answer “Yes” to indicate you have
completed monitoring for applicable Table D pollutants required by
your NPDES permitting authority and attached the results to your
application package, or “No” if the NPDES permitting authority has
not required additional sampling for the pollutants in Table D.
Item 3.19 and Additional Screen for Table E. Answer whether the
POTW conducted either (1) a minimum of four quarterly WET tests
for one year preceding this permit application or (2) at least four
annual WET tests in the past 4.5 years. If yes, continue to Item
3.20. If no, complete tests and Table E and then skip to Item 3.26.
Item 3.20 and Additional Screen for Table E. Report whether you
have previously submitted the results of the WET tests indicated in
Item 3.19 to your NPDES permitting authority. If yes, continue to
Item 3.21. If no, provide the results in Table E and skip to Item 3.26.
Item 3.21. Report the dates the testing data were submitted to your
NPDES permitting authority and provide a summary of the results.
Item 3.22. Regardless of how you may have provided the results of
previously conducted WET analyses to your NPDES permitting
authority, indicate if any of the tests resulted in toxicity. If yes,
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FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED
continue to Item 3.23. If no, skip to Item 3.26.
pretreatment program, which is defined at 40 CFR 403.3 as a
program administered by a POTW that meets the criteria
Item 3.23. Describe the cause(s) of toxicity.
established in 40 CFR 403.8 and 403.9 and that has been
Item 3.24. Indicate if the POTW has conducted a toxicity reduction
approved by the NPDES permitting authority.
evaluation. If yes, continue to Item 3.25. If no, skip to Item 3.26.
Item 4.4. Answer whether you have submitted either of the
Item 3.25. Provide details of any toxicity reduction evaluations
following to the NPDES permitting authority that contains
performed.
information substantially identical to that required in Table F: (1) a
pretreatment program annual report submitted within one year of
Item 3.26. Answer “Yes” when you have completed Table E for all
the application or (2) a pretreatment program. If yes, continue to
applicable outfalls and attached the results to the application
Item 4.5. If no, skip to Item 4.6.
package, or answer “No” if the item is not applicable because you
previously submitted WET data to your NPDES permitting authority. Item 4.5. Identify the title and date of the pretreatment program
annual report or pretreatment program referenced in Item 4.4 and
Section 4. Industrial Discharges, Table F, and Hazardous
skip to Item 4.7.
Wastes
Item 4.1. Indicate if the POTW receives discharges from significant Item 4.6 and Table F. Complete Table F by providing the following
industrial users (SIUs) or non-significant categorical industrial users information for each SIU that discharges to the POTW: (1) name
and mailing address; (2) description of all industrial processes that
(NSCIUs), including SIUs and NSCIUs that truck or haul waste. If
affect or contribute to each SIU’s discharge; (3) a list of the principal
yes, continue to Item 4.2. If no, skip to Item 4.7.
products and raw materials that affect or contribute to the SIU’s
1. SIUs are defined as:
discharge; (4) average daily volume of wastewater discharged by
each SIU, indicating the amount attributable to process flow and
a. All industrial users subject to categorical pretreatment
non-process flow; (5) whether the SIU is subject to local limits;
standards under 40 CFR 403.6 and 40 CFR Chapter I,
(6) whether the SIU is subject to categorical standards and the
Subchapter N (CIUs); and
categories/subcategories under which the SIU is subject; and
b. Any other industrial user per 40 CFR 403.3 that:
(7) whether any problems (e.g., upsets, pass-through interference)
i. Discharges an average of 25,000 gpd or more of
have occurred at the POTW that can be attributed to the SIU in the
process wastewater to the treatment works (with
past 4.5 years. Answer “Yes” to Item 4.6 when you have completed
certain exclusions); or
and attached Table F to the application package.
ii. Contributes a process wastestream that makes up
Note: SIUs include users that truck or haul industrial waste to the
5 percent or more of the average dry weather
POTW. Information for these users must be provided in Table F.
hydraulic or organic capacity of the treatment plant;
or
Item 4.7. Indicate if the POTW receives or has been notified that it
will receive by truck, rail, or dedicated pipe any wastes that are
iii. Is designated as an SIU by the control authority.
regulated as RCRA hazardous wastes pursuant to 40 CFR 261. If
2. The control authority may determine that an Industrial User
yes, continue to Item 4.8. If no, skip to Item 4.9.
subject to categorical Pretreatment Standards under 40 CFR
Item 4.8. For each hazardous waste received, provide the
403.6 and 40 CFR Chapter I, Subchapter N is a NSCIU rather
hazardous waste number, the method by which the waste is
than a SIU on a finding that the Industrial User never
received (e.g., by truck, dedicated pipe, rail, etc.), and the amount
discharges more than 100 gpd of total categorical wastewater
of waste received annually (specify units).
(excluding sanitary, non-contact cooling and boiler blowdown
wastewater, unless specifically included in the Pretreatment
Item 4.9. Answer whether the POTW receives, or has been notified
Standard) and the following conditions are met:
that it will receive, wastewaters that originate from remedial
a. The Industrial User, prior to the control authority's finding, activities, including those undertaken pursuant to Comprehensive
Environmental Response, Compensation, and Liability Act
has consistently complied with all applicable categorical
(CERCLA) and Sections 3004(u) or 3008(h) of RCRA. If yes,
Pretreatment Standards and Requirements;
continue to Item 4.10. If no, skip to Section 5.
b. The Industrial User annually submits the certification
statement required in 40 CFR 403.12(q) together with any Item 4.10. Answer whether the POTW receives (or expects to
receive) less than 15 kilograms per month of non-acute hazardous
additional information necessary to support the
wastes as specified at 40 CFR 261.30(d) and 261.33(e). If yes, skip
certification statement; and
to Section 5. If no, continue to Item 4.11.
c. The Industrial User never discharges any untreated
Item 4.11. In an attachment to the application, provide an
concentrated wastewater.
identification and description of the site(s) or facility(ies) at which
Item 4.2. Indicate the number of SIUs and NSCIUs that discharge
the wastewater originates; the identities of the wastewater’s
to the POTW.
hazardous constituents, as listed in Appendix VII of 40 CFR 261, if
known; and the extent of treatment, if any, the wastewater receives
Item 4.3. Answer whether the POTW has an approved
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Contains Nonbinding Recommendations
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General Instructions for Reporting, Sampling, and Analysis
General Items
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number, NPDES permit
number, facility name, and applicable outfall number at the top of
each page of the tables and any associated attachments.
You may report some or all of the required data by attaching
separate sheets of paper instead of completing Tables A through
E for each of your outfalls, so long as the sheets contain all of the
required information and are similar in format to Tables A through
E. For example, you may be able to print a report in a compatible
format from the data system used in your analysis of metals
completed under Table C.
The method ML is above the water quality criterion, but the
amount of the pollutant or pollutant parameter in the facility’s
discharge is high enough that the method detects and
quantifies the level of the pollutant or pollutant parameter in
the discharge.
The method has the lowest ML of the analytical methods
approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or O, for the measured pollutant or
pollutant parameter.
Consistent with 40 CFR 136, you may provide matrix- or samplespecific MLs rather than the published levels. Further, where you
can demonstrate that, despite a good faith effort to use a method
that would otherwise meet the definition of “sufficiently sensitive,”
the analytical results are not consistent with the quality assurance
(QA)/quality control (QC) specifications for that method, then the
NPDES permitting authority may determine that the method is not
performing adequately and the NPDES permitting authority should
select a different method from the remaining EPA-approved
methods that is sufficiently sensitive consistent with 40 CFR
122.21(e)(3)(i). Where no other EPA-approved methods exist, you
must select a method consistent with 40 CFR 122.21(e)(3)(ii).
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Note for new dischargers. Provide all information available to
you at the time you complete Form 2A. If you do not have
information to respond to an item because your facility has yet to
discharge, write or type “data are not available” next to the item
on the form. Note that you are required to submit actual data no
later than 24 months after your facility commences discharge.
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Important note: Read these instructions before completing
Tables A through E and Section 3 of Form 2A.
Reporting of Effluent Data
Where effluent data are requested, do not provide information on
CSOs. The latter information is requested instead under Section 5
of Form 2A.
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Provide data for each outfall through which effluent is discharged.
When an applicant has two or more outfalls with substantially
identical effluents, the NPDES permitting authority may allow the
applicant to test only one outfall and report that quantitative data
as applying to the substantially identical outfall. If the permitting
authority grants your request, attach a separate sheet to the
application form identifying the outfall tested and describing why
the other outfall(s) are substantially identical.
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At a minimum, effluent testing data must be based on at least
three samples taken within 4.5 years prior to the date of the
permit application. Samples must be representative of the
seasonal variation in the discharge from each outfall. Existing
data may be used, if available, in lieu of sampling done solely for
the purpose of this application.
All existing data for pollutants specified in Tables A through D that
is collected within 4.5 years of the application must be included in
the pollutant data summary that you submit. If, however, you
sampled for a specific pollutant on a monthly or more frequent
basis, it is only necessary, for such pollutant, to summarize all
data collected within 1 year of the application.
Except as specified below, all required quantitative data shall be
collected in accordance with sufficiently sensitive analytical
methods approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or O. A method is “sufficiently sensitive”
when:
When there is no analytical method that has been approved under
40 CFR 136; required under 40 CFR chapter I, subchapter N or O,
and is not otherwise required by the NPDES permitting authority,
you may use any suitable method but shall provide a description
of the method. When selecting a suitable method, other factors
such as a method’s precision, accuracy, or resolution, may be
considered when assessing the performance of the method.
Effluent monitoring data must comply with the QA/QC
requirements of 40 CFR 136 (and other appropriate QA/QC
requirements for standard methods for analytes not addressed by
40 CFR 136).
Clearly specify the units of measure on Tables A through E for
each parameter/pollutant analyzed. Values should be reported as
concentration or mass, except for flow, temperature, pH, color,
and fecal coliform organisms, unless otherwise requested or
required by the NPDES permitting authority. Flow, temperature,
pH, color, and fecal coliform organisms must be reported as mgd,
degrees Celsius (°C), standard units, color units, and most
probable number per 100 milliliters (MPN/100 mL), respectively.
Use the following abbreviations in the columns requiring “units” in
Tables A through D.
Concentration
Mass
ppm = parts per million
lbs = pounds
mg/L = milligrams per liter
ton = tons (English tons)
ppb = parts per billion
mg = milligrams
µg/L = micrograms per liter
g = grams
kg = kilograms
T = tonnes (metric tons)
MPN = most probable number
per 100 milliliters
The method minimum level (ML) is at or below the level of
the applicable water quality criterion for the measured
pollutant or pollutant parameter.
2A-7
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General Instructions for Reporting, Sampling, and Analysis Continued
Grab samples must be used for pH, temperature, cyanide, total
phenols, residual chlorine, oil and grease, fecal coliform (including
E. coli), and volatile organic compounds. For all other pollutants,
24-hour composite samples must be used. For a composite
sample, only one analysis of the composite of aliquots is required.
times, and the collection of duplicate samples—must be followed.
The time when you sample should be representative of your normal
operation, to the extent feasible, with your treatment system
operating properly with no system upsets. Collect samples from the
center of the flow channel, where turbulence is at a maximum, at a
site specified in your present NPDES permit, or at any site
adequate for the collection of a representative sample.
The effluent monitoring data provided must include at least the
following for each parameter: (1) the maximum daily discharge
based upon actual sample values, (2) average daily discharge for
all samples, expressed as concentration or mass, and the number
of samples used to obtain this value, (3) the analytical method
used, and (4) the threshold level (i.e., method detection limit,
minimum level, or other designated method endpoints) for the
analytical method used.
Further Requirements for Table E, Whole Effluent Toxicity
Testing
Sampling
Applicants must conduct tests with multiple species (no less than
two species; e.g., fish, invertebrate, plant) and test for acute or
chronic toxicity, depending on the range of receiving water dilution.
See 40 CFR 122.21(j)(5)(v) for further details.
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The collection of samples for the reported analyses should be
supervised by a person experienced in performing sampling of
domestic wastewater. You may contact your NPDES permitting
authority for detailed guidance on sampling techniques and for
answers to specific questions. See Exhibit 2A–1 for contact
information. Any specific requirements in the analytical methods—
for example, for sample containers, sample preservation, holding
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Metals must be reported as “total recoverable metal,” unless all
approved analytical methods for the metal inherently measure only
its dissolved form (e.g., hexavalent chromium) or otherwise directed
by the NPDES permitting authority.
Each applicant required to perform WET testing must provide
results of a minimum of four quarterly tests for a year, from the year
preceding the permit application, or the results from four tests
performed at least annually in the 4.5-year period prior to the
application, provided the results show no appreciable toxicity using
a safety factor determined by the NPDES permitting authority.
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WET testing must be conducted using methods approved under
40 CFR 136. West coast facilities in Washington, Oregon,
California, Alaska, Hawaii, and the Pacific Territories are exempted
from 40 CFR 136 chronic methods and must use alternative
guidance as directed by the NPDES permitting authority.
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watershed (14-digit) code, if known; (3) name of the state
management/river basin and the USGS 8-digit hydrologic
cataloging unit code, if known; and (4) a description of any known
water quality impacts on the receiving water caused by the CSO
(e.g., permanent or intermittent beach closings, permanent or
intermittent shellfish bed closings, fish kills, fish advisories, other
recreational loss, or exceedance of any applicable state water
quality standard).
Section 6. Checklist and Certification Statement
Item 6.1. Review the checklist provided. In Column 1, mark the
sections of Form 2A that you have completed and are submitting
with your application. In Column 2, indicate for each section
whether you are submitting attachments.
Item 6.2. The Clean Water Act provides for severe penalties for
submitting false information on this application form. CWA Section
309(c)(2) provides that “Any person who knowingly makes any false
statement, representation, or certification in any application, …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.”
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A. For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer means:
(1) 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 (2) the manager of one or
more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
END
Submit your completed Form 2A and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
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or will receive before entering the POTW. Answer “Yes” to Item
4.11 when you have completed and attached the information to the
application package.
Section 5. Combined Sewer Overflows
CSO Map and Diagram
Item 5.1. Indicate if the treatment works has a combined sewer
system. If yes, continue to Item 5.2. If no, skip to Section 6.
Item 5.2. Attach a CSO system map to the application. The map
should indicate: (1) all CSO discharge points, (2) sensitive use
areas potentially affected by CSOs (e.g., beaches, drinking water
supplies, shellfish beds, sensitive aquatic ecosystems, and
outstanding national resource waters), and (3) waters supporting
threatened and endangered species potentially affected by CSOs.
Answer “Yes” to Item 5.2 when you have completed the map and
attached it to the application package.
Item 5.3. Prepare a diagram of the CSO collection system. The
diagram should show the following: (1) the location of major sewer
trunk lines, both combined and separate sanitary; (2) the locations
of points where separate sanitary sewers feed into the combined
sewer system; (3) in-line and off-line storage structures; (4) the
locations of flow-regulating devices; and (5) the locations of pump
stations. Answer “Yes” to Item 5.3 when you have completed the
diagram and attached it to the application package.
CSO Outfall Description
Item 5.4. Provide the following information for each CSO outfall:
(1) outfall number; (2) state, county, city or town and ZIP code in
which the outfall is located; (3) latitude and longitude of the outfall,
to the nearest second, (4) distance of the outfall from shore and
depth of the outfall below water surface. Latitude and longitude
coordinates may be obtained in a variety of ways, including use of
hand held devices (e.g., a GPS enabled smartphone), internet
mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., USGS). The location of each CSO
outfall (i.e., where the coordinates are collected) shall be the point
where the discharge is released into a water of the United States.
CSO Monitoring
Item 5.5. Indicate whether the POTW has monitored any of the
following items in the past year for each of its CSO outfalls:
(1) rainfall, (2) CSO flow volume, (3) CSO pollutant concentrations;
(4) receiving water quality, (5) CSO frequency, and (6) number of
storm events.
CSO Events in Past Year
Item 5.6. For each CSO outfall, record (1) the number of CSO
events in the past year, (2) the average duration in hours per event,
(3) the average volume per CSO event in million gallons, and
(4) the minimum rainfall that caused a CSO event in inches of
rainfall in the past year. Note whether your responses for sub-items
(2) through (4) above are based on actual or estimated data.
CSO Receiving Waters
Item 5.7. For each CSO outfall, record the following receiving water
information: (1) name of receiving water; (2) name of
watershed/stream system and the U.S. Soil Conservation Service
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Exhibit 2A–2. Example Topographic Map
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FORM 2A—GLOSSARY
Note: This glossary includes terms used in the various NPDES application forms, including Form 2A. The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (other than an aquatic animal production facility) where the
following conditions are met;
Animals (other than aquatic animals) have been, are, or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period; and
Crops, vegetation, forage growth, or post-harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
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.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
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AQUACULTURE PROJECT (defined at § 122.25) means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater, estuarine, or marine plants or animals. DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species, using a method or plan or operation (including, but not limited to, physical confinement) which, on the basis of reliable
scientific evidence, is expected to ensure that 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.
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AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES (BMPs) means schedules of activities, prohibitions of practices, maintenance procedures, and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements, operation
procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage.
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BIOSOLIDS (see sewage sludge).
BYPASS (defined at § 122.41(m)) means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW (CSO) means a discharge from a combined sewer system (CSS) at a point prior to the Publicly Owned
Treatment Works (POTW) Treatment Plant (defined at § 403.3(r)).
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COMBINED SEWER SYSTEM (CSS) means a wastewater collection system owned by a State or municipality (as defined by section
502(4) of the CWA) which conveys sanitary wastewaters (domestic, commercial and industrial wastewaters) and storm water through a
single-pipe system to a Publicly Owned Treatment Works (POTW) Treatment Plant (as defined at § 403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of (A) or (B) below, or that is designated as a CAFO in accordance with 40 CFR 122.23(c). Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation, if they adjoin each other or if they use a common area or system for the disposal of wastes.
A.
LARGE CONCENTRATED ANIMAL FEEDING OPERATION (LARGE CAFO) means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows, whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
6. 500 horses;
7. 10,000 sheep or lambs;
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8.
9.
10.
11.
12.
13.
B.
55,000 turkeys;
30,000 laying hens or broilers, if the AFO uses a liquid manure handling system;
125,000 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
82,000 laying hens, if the AFO uses other than a liquid manure handling system;
30,000 ducks (if the AFO uses other than a liquid manure handling system); or
5,000 ducks (if the AFO uses a liquid manure handling system).
MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION (MEDIUM CAFO) means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO. An AFO is defined as a
Medium CAFO if:
The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows, whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or lambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers, if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens, if the AFO uses other than a liquid manure handling system;
l. 10,000 to 29,999 ducks (if the AFO uses other than a liquid manure handling system); ore
m. 1,500 to 4,999 ducks (if the AFO uses a liquid manure handling system); and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch, flushing system, or other similar manmade device; or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over, across, or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY (defined at § 122.24) 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:
Cold water fish species or other cold water aquatic animals including, but not limited to, the Salmonidae family of fish (e.g., trout and
salmon) in ponds, raceways, or other similar structures which discharge at least 30 days per year but does not include:
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1.
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, Cetrarchiclae, and
Cyprinidae families of fish (e.g., respectively, catfish, sunfish, and minnows) in ponds, raceways, or other similar structures which
discharge at least 30 days per year, but does not include;
1.
Closed ponds which discharge only during periods of excess runoff; or
2.
Facilities which produce less than 45,454 harvest weight kilograms (approximately 100,000 pounds) of aquatic animals per year.
CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972) Public Law 92–500, as amended by Public Law 95–217, Public Law 95–576, Public Law 96–483 and Public Law
97–117, 33 U.S.C. 1251 et seq.
CWA AND REGULATIONS means the Clean Water Act (CWA) and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
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DAILY DISCHARGE means the “discharge of a pollutant” measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass, the “daily discharge” is
calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of
measurement, the “daily discharge” is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the “discharge of a pollutant.”
DIRECTOR means the Regional Administrator or the State Director, as the context requires, or an authorized representative. When there
is no “approved State program,” and there is an EPA administered program, “Director” means the Regional Administrator. When there is
an approved State program, “Director” normally means the State Director. In some circumstances, however, EPA retains the authority to
take certain actions even when there is an approved State program. (For example, when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval, see § 123.1.) In such cases, the term
“Director” means the Regional Administrator and not the State Director.
DISCHARGE (OF A POLLUTANT) means:
Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or
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.
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This definition includes discharges into waters of the United States from: surface runoff which is collected or channelled by man;
discharges through pipes, sewers, or other conveyances owned by a State, municipality, or other person which do not lead to a treatment
works; and discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not
include an addition of pollutants by any “indirect discharger”.
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DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions, revisions, or
modifications for the reporting of self-monitoring results by permittees. DMRs must be used by “approved States” as well as by EPA. EPA
will supply DMRs to any approved State upon request. The EPA national forms may be modified to substitute the state agency name,
address, logo, and other similar information, as appropriate, in place of EPA's.
DRAFT PERMIT means a document prepared under § 124.6 indicating the Director's tentative decision to issue or deny, modify, revoke
and reissue, terminate, or reissue a “permit.” A notice of intent to terminate a permit, and a notice of intent to deny a permit, as discussed
in § 124.5, are types of “draft permits.” A denial of a request for modification, revocation and reissuance, or termination, as discussed in
§ 124.5, is not a “draft permit.” A “proposed permit” is not a “draft permit.”
EFFLUENT LIMITATION means any restriction imposed by the Director on quantities, discharge rates, and concentrations of “pollutants”
which are “discharged” from “point sources” into “waters of the United States,” the waters of the “contiguous zone,” or the ocean.
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EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b) of the CWA to adopt or
revise “effluent limitations.”
ENVIRONMENTAL PROTECTION AGENCY (EPA) means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES “point source” or any other facility or activity (including land or appurtenances thereto) that is
subject to regulation under the NPDES program.
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GENERAL PERMIT means an NPDES “permit” issued under § 122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of the CWA.
INDIAN COUNTRY (or INDAN LANDS) means:
All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the
issuance of any patent, and, including rights-of-way running through the reservation;
All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof, and whether within or without the limits of a state; and
All Indian allotments, the Indian titles to which have not been extinguished, including rights-of-way running through the same.
INDIAN TRIBE means any Indian Tribe, band, group, or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing “pollutants” to a “publicly owned treatment works.”
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LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(4)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census (Appendix F of 40 CFR 122); or
(ii) Located in the counties listed in appendix H of 40 CFR 122, except municipal separate storm sewers that are located in the
incorporated places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraphs (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(D) The nature of the receiving waters; and
(E) Other relevant factors; or
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(C) The quantity and nature of pollutants discharged to waters of the United States;
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(iv) The Director may, upon petition, designate as a large municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii).
LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whose discharges result from the holding of
unprocessed wood, for example, logs or roundwood with bark or after removal of bark held 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 429, subpart I, including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES “facility or activity” classified as such by the Regional Administrator, or, in the case of “approved
State programs,” the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable “daily discharge.”
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MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(7)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 100,000 or more but less than 250,000, as determined by the 1990 Decennial
Census by the Bureau of the Census (appendix G of 40 CFR 122); or
(ii) Located in the counties listed in appendix I of 40 CFR 122, except municipal separate storm sewers that are located in the incorporated
places, townships or towns within such counties; or
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(iii) Owned or operated by a municipality other than those described in paragraph (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; or
(E) Other relevant factors; or
(iv) The Director may, upon petition, designate as a medium municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii) of this section.
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MUNICIPALITY means a city, 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 organization,
or a designated and approved management agency under section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER (defined at § 122.26(b)(8)) means a conveyance or system of conveyances (including roads
with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains):
Owned or operated by a State, city, town, borough, county, parish, district, association, or other public body (created by or pursuant to
State law) having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, including special districts under
State law such as a sewer district, flood control district or drainage district, or similar entity, or an Indian tribe or an authorized Indian
tribal organization, or a designated and approved management agency under section 208 of the CWA that discharges to waters of the
United States.
Designed or used for collecting or conveying stormwater.
Which is not a combined sewer; and
Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE (see sewage sludge)
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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,
402, 318, and 405 of the CWA. The term includes an “approved program.”
NEW DISCHARGER means any building, structure, facility, or installation:
From which there is or may be a “discharge of pollutants;”
That did not commence the “discharge of pollutants” at a particular “site” prior to August 13, 1979;
Which is not a “new source;” and
Which has never received a finally effective NPDES permit for discharges at that “site.”
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This definition includes an “indirect discharger” which commences discharging into “waters of the United States” after August 13, 1979. It
also means any existing mobile point source (other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig) such as a seafood processing rig, seafood processing vessel, or aggregate plant, that begins discharging at a
“site” for which it does not have a permit; and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979, at a “site” under EPA’s permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern, the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1) through (10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a “new discharger” only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building, structure, facility, or installation from which there is or may be a “discharge of pollutants,” the
construction of which commenced:
After promulgation of standards of performance under section 306 of the CWA which are applicable to such source, or
After proposal of standards of performance in accordance with section 306 of the 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.
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OWNER OR OPERATOR means the owner or operator of any “facility or activity” subject to regulation under the NPDES program.
PERMIT means an authorization, license, or equivalent control document issued by EPA or an “approved State” to implement the
requirements of this part and parts 123 and 124. “Permit” includes an NPDES “general permit” (§ 122.28). Permit does not include any
permit which has not yet been the subject of final agency action, such as a “draft permit” or a “proposed permit.”
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides, and the application of chemical pesticides that leave a residue, from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application, this does not include
agricultural storm water discharges and return flows from irrigated agriculture, which are excluded by law (33 U.S.C. 1342(l); 33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether a NPDES permit is needed for discharges to waters of the United States
from pesticide application, means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
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POINT SOURCE means any discernible, confined, and discrete conveyance, including but not limited to, any pipe, ditch, channel, tunnel,
conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill leachate collection system, vessel or
other floating craft from which pollutants are or may be discharged. This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff. (See § 122.3).
POLLUTANT means dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions,
chemical wastes, biological materials, radioactive materials (except those regulated under the Atomic Energy Act of 1954, as amended (42
U.S.C. 2011 et seq.)), heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal, and agricultural waste
discharged into water. It does not mean:
Sewage from vessels; or
Water, gas, or other material which is injected into a well to facilitate 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
degradation of ground or surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source, byproduct, or special nuclear materials. Examples of materials not covered include radium
and accelerator-produced isotopes. See Train v. Colorado Public Interest Research Group, Inc., 426 U.S. 1 (1976).
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PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement (Natural Resources Defense
Council et al. v. Train, 8 E.R.C. 2120 (D.D.C. 1976), modified 12 E.R.C. 1833 (D.D.C. 1979)); also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is (1) used to treat wastes from any facility whose
operator is not the operator of the treatment works and (2) not a “POTW.”
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PROCESS WASTEWATER means any water which, during manufacturing 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.
PROPOSED PERMIT means a state NPDES “permit” prepared after the close of the public comment period (and, when applicable, any
public hearing and administrative appeals) which is sent to EPA for review before final issuance by the State. A “proposed permit” is not a
“draft permit.”
PUBLICLY OWNED TREATMENT WORKS or POTW (defined at § 403.3) means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality (as defined by CWA Section 502(4)). This definition includes any devices or systems used in the
storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition also includes
sewers, pipes, and other conveyances only if they convey wastewater to a POTW. The term also means the municipality as defined in
CWA Section 502(4), which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
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REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES (defined at § 122.27) means facilities which process crushed and broken
stone, gravel, and riprap (See 40 CFR 436, subpart B, including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a “permit”, including an enforceable sequence of
interim requirements (for example, actions, operations, or milestone events) leading to compliance with the CWA and regulations.
D
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 toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under section 312 of the 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 any solid, semi-solid, or liquid residue removed during the treatment of municipal waste water or domestic
sewage. Sewage sludge includes, but is not limited to, solids removed during primary, secondary, or advanced waste water treatment,
scum, septage, portable toilet pumpings, type III marine sanitation device pumpings (33 CFR 159), and sewage sludge products. Sewage
sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge.
SlLVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock
crushing, gravel washing, log sorting, or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States. This term does not include non-point source silvicultural activities such as
nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed 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 crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit (see 33 CFR 209.120 and part 233).
2A-16
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2A—GLOSSARY CONTINUED
SITE means the land or water area where any “facility or activity” is physically located or conducted, including adjacent land used in
connection with the facility or activity.
SLUDGE-ONLY FACILITY means any “treatment works treating domestic sewage” whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to section 405(d) of the CWA and is required to obtain a permit under § 122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d) of the CWA
which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Virgin Islands, American
Samoa, the Commonwealth of the Northern Mariana Islands, the Trust Territory of the Pacific Islands, or an Indian Tribe as defined in
these regulations which meets the requirements of § 123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an “approved program,” or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies, “State Director”
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
T
STORMWATER (or STORM WATER) (defined at § 122.26(b)(13)) means stormwater runoff, snow melt runoff, and surface runoff and
drainage.
1.
Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effluent standards
under 40 CFR Subchapter N (except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing, gravel washing, log sorting, or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)–(3) and Industry Groups 242
through 249; 26 (except 265 and 267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441, 373; (not included are all other types of
silvicultural facilities);
Facilities classified as Standard Industrial Classifications 10 through 14 (mineral industry) including active or inactive mining
operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of
non–coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17, 1990) and oil and gas exploration, production, processing, or treatment operations, or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with, any overburden, raw material, intermediate
products, finished products, byproducts or waste products located on the site of such operations; (inactive mining operations are
mining sites that are not being actively mined, but which have an identifiable owner/operator; inactive mining sites do not include sites
where mining claims are being maintained prior to disturbances associated with the extraction, beneficiation, or processing of mined
materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a permit under
subtitle C of RCRA;
D
2.
R
AF
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY (defined at § 122.26(b)(14)) means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing, processing or raw materials
storage areas at an industrial plant. The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, stormwater discharges
from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products,
waste material, or by-products used or created by the facility; material handling sites; refuse sites; sites used for the application or disposal
of process waste waters (as defined at 40 CFR 401); sites used for the storage and maintenance of material handling equipment; sites
used for residual treatment, storage, or disposal; shipping and receiving areas; manufacturing buildings; storage areas (including tank
farms) for raw materials, and intermediate and final products; and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include storage, loading
and unloading, transportation, or conveyance of any raw material, intermediate product, final product, by-product or waste product. The
term excludes areas located on plant lands separate from the plant's industrial activities, such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities (including industrial facilities that are federally, State, or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below) include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v). The
following categories of facilities are considered to be engaging in “industrial activity” for purposes of 40 CFR 122.26(b)(14):
3.
4.
5.
6.
Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is received from any
of the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA;
Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and automobile
junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
2A-17
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2A—GLOSSARY CONTINUED
Steam electric power generating facilities, including coal handling sites;
Transportation facilities classified as Standard Industrial Classifications 40, 41, 42 (except 4221–25), 43, 44, 45, and 5171 which have
vehicle maintenance shops, equipment cleaning operations, or airport deicing operations. Only those portions of the facility that are
either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication),
equipment cleaning operations, airport deicing operations, or which are otherwise identified under paragraphs 1–7 or 9–11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the
storage treatment, recycling, and reclamation of municipal or domestic sewage, including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility, with a design flow of 1.0 mgd or more, or required to have an approved
pretreatment program under 40 CFR 403. Not included are farm lands, domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility, or areas that are in compliance
with section 405 of the CWA;
10. Construction activity including clearing, grading and excavation, except operations that result in the disturbance of less than five acres
of total land area. Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20, 21, 22, 23, 2434, 25, 265, 267, 27, 283, 285, 30, 31 (except 311), 323, 34
(except 3441), 35, 36, 37 (except 373), 38, 39, and 4221–25.
T
7.
8.
TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1) or, in the case of “sludge use or disposal practices,” any
pollutant identified in regulations implementing section 405(d) of the CWA.
AF
TREATMENT WORKS TREATING DOMESTIC SEWAGE (TWTDS) means a POTW or any other sewage sludge or waste water
treatment devices or systems, regardless of ownership (including federal facilities), used in the storage, treatment, recycling, and
reclamation of municipal or domestic sewage, including land dedicated for the disposal of sewage sludge. This definition does not include
septic tanks or similar devices. For purposes of this definition, “domestic sewage” includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a “treatment works treating domestic sewage,” where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling, use or disposal
practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
R
UPSET (defined at § 122.41(n)) 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 careless or improper operation.
VARIANCE means any mechanism or provision under section 301 or 316 of the CWA or under 40 CFR 125, or in the applicable “effluent
limitations guidelines” which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA. This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
sections 301(c), 301(g), 301(h), 301(i), or 316(a) of the CWA.
WATERS OF THE UNITED STATES as defined at § 122.2.
D
WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test.
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D
R
AF
T
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Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
Form
2A
NPDES
NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and (9))
1.1
Facility name
Mailing address (street or P.O. box)
Facility Information
City or town
Contact name (first and last)
Title
State
ZIP code
Phone number
Email address
Same as mailing address
T
Location address (street, route number, or other specific identifier)
City or town
State
Is this application for a facility that has yet to commence discharge?
Yes See instructions on data submission
No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
Yes
AF
1.2
ZIP code
No SKIP to Item 1.4.
Applicant address (street or P.O. box)
City or town
R
Applicant Information
Applicant name
Contact name (first and last)
1.4
Owner
Phone number
Email address
Operator
Both
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
and applicant
Facility
Applicant
Facility
(they are one and the same)
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.)
D
Existing Environmental Permits
1.6
ZIP code
Is the applicant the facility’s owner, operator, or both? (Check only one response.)
1.5
Title
State
NPDES (discharges to surface
water)
_________________________
PSD (air emissions)
_________________________
Ocean dumping (MPRSA)
_________________________
EPA Form 3510-2A (Revised )
Existing Environmental Permits
RCRA (hazardous waste)
_________________________
Nonattainment program (CAA)
UIC (underground injection
control)
_______________________
NESHAPs (CAA)
_______________________
Other (specify)
_________________________
Dredge or fill (CWA Section
404)
_________________________
_______________________
Page 1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Provide the collection system information requested below for the treatment works.
Municipality
Population
Collection System Type
Served
Served
(indicate percentage)
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer
Unknown
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer
Unknown
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer
Unknown
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer
Unknown
Total
Population
Served
Ownership Status
1.9
No
Yes
No
Provide design and actual flow rates in the designated spaces.
Annual Average Flow Rates (Actual)
Last Year
Two Years Ago
mgd
Maximum Daily Flow Rates (Actual)
Last Year
Two Years Ago
mgd
This Year
mgd
This Year
mgd
mgd
Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Discharge Points by Type
D
Discharge Points
by Type
mgd
1.11
Design Flow Rate
mgd
R
Design and Actual
Flow Rates
%
Does the facility discharge to a receiving water that flows through Indian Country?
1.10
Yes
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
%
AF
Indian Country
1.8
Combined Storm and
Sanitary Sewer
Separate Sanitary Sewer System
Total percentage of each type of
sewer line (in miles)
Is the treatment works located in Indian Country?
Own
Own
Own
Own
Own
Own
Own
Own
Own
Own
Own
Own
T
Collection System and Population Served
1.7
Form Approved
OMB No.
Form Expires
Treated Effluent
EPA Form 3510-2A (Revised )
Untreated Effluent
Combined Sewer
Overflows
Bypasses
Constructed
Emergency
Overflows
Page 2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
Form Approved
OMB No.
Form Expires
AF
T
Outfalls Other Than to Waters of the United States
1.12 Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets for
discharge to waters of the United States?
Yes
No SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
Continuous
gpd
Intermittent
Continuous
gpd
Intermittent
Continuous
gpd
Intermittent
1.14 Is wastewater applied to land?
Yes
No SKIP to Item 1.16.
1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Continuous or
Average Daily Volume
Location
Size
Intermittent
Applied
(check one)
Continuous
acres
gpd
Intermittent
Continuous
acres
gpd
Intermittent
Continuous
acres
gpd
Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
No SKIP to Item 1.21.
Yes
1.17 Describe the means by which the effluent is transported (e.g., tank truck, pipe).
R
Outfalls and Other Discharge or Disposal Methods
EPA Identification Number
Is the effluent transported by a party other than the applicant?
Yes
No SKIP to Item 1.20.
1.19
Provide information on the transporter below.
D
1.18
Entity name
Transporter Data
Mailing address (street or P.O. box)
City or town
State
Contact name (first and last)
Title
Phone number
Email address
EPA Form 3510-2A (Revised )
ZIP code
Page 3
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving Facility Data
Facility name
Mailing address (street or P.O. box)
City or town
State
Contact name (first and last)
Title
Phone number
Email address
NPDES number of receiving facility (if any)
1.21
Average daily flow rate
No SKIP to Item 1.23.
T
Yes
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
Disposal
Annual Average
Location of
Size of
Method
Daily Discharge
Disposal Site
Disposal Site
Description
Volume
Variance
Requests
Continuous or Intermittent
(check one)
Continuous
Intermittent
Continuous
acres
gpd
Intermittent
Continuous
acres
gpd
Intermittent
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
into marine waters (CWA
quality related effluent limitation (CWA Section
Discharges
Water
Section 301(h))
302(b)(2))
acres
1.23
mgd
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
1.22
None
ZIP code
AF
Outfalls and Other Discharge or Disposal Methods Continued
1.20
Form Approved
OMB No.
Form Expires
Not applicable
R
gpd
1.24
Contractor Information
D
1.25
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
Yes
No SKIP to Section 2.
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
Contractor name
(company name)
Mailing address
(street or P.O. box)
City, state, and ZIP
code
Contact name (first and
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A (Revised )
Page 4
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
2.2
No SKIP to Section 3.
Provide the treatment works’ current average daily volume of inflow
and infiltration.
Average Daily Volume of Inflow and Infiltration
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
2.4
Yes
T
2.3
No
Have you attached a process flow diagram or schematic to this application that contains all the required information?
(See instructions for specific requirements.)
2.5
Yes
No
Are improvements to the facility scheduled?
Yes
No SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1.
2.
R
3.
4.
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected
Scheduled
Begin
End
Begin
Outfalls
Improvement
Construction
Construction
Discharge
(list outfall
(from above)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
number)
D
Scheduled Improvements and Schedules of Implementation
Yes
AF
Flow
Topographic
Inflow and Infiltration Design Flow
Diagram
Map
SECTION 2. ADDITIONAL INFORMATION (40 CFR 122.21(j)(1) and (2))
Outfalls to Waters of the United States
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
Attainment of
Operational
Level
(MM/DD/YYYY)
1.
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
Yes
No
None required or applicable
Explanation:
EPA Form 3510-2A (Revised )
Page 5
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
SECTION 3. INFORMATION ON EFFLUENT DISCHARGES (40 CFR 122.21(j)(3) to (5))
3.1
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number ______
Outfall Number _____
Outfall Number ______
Description of Outfalls
State
County
City or town
Distance from shore
ft.
ft.
ft.
Depth below surface
ft.
ft.
ft.
mgd
mgd
mgd
Average daily flow rate
T
Latitude
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
3.3
Outfall Number _____
Number of times per year
discharge occurs
Average duration of each
discharge (specify units)
Average flow of each
mgd
discharge
Months in which discharge
occurs
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
3.5
No SKIP to Item 3.4.
If so, provide the following information for each applicable outfall.
Outfall Number _____
3.4
Yes
Outfall Number _____
mgd
mgd
No SKIP to Item 3.6.
Briefly describe the diffuser type at each applicable outfall.
Outfall Number _____
Outfall Number _____
Outfall Number _____
Waters of
the U.S.
D
Diffuser Type
Yes
AF
3.2
R
Seasonal or Periodic Discharge Data
Longitude
3.6
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?
Yes
EPA Form 3510-2A (Revised )
No SKIP to Section 6.
Page 6
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
3.7
Form Approved
OMB No.
Form Expires
Provide the receiving water and related information (if known) for each outfall.
Outfall Number _____
Outfall Number _____
Outfall Number _____
Receiving water name
T
Receiving Water Description
Name of watershed, river,
or stream system
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
management/river basin
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
Critical low flow (chronic)
cfs
cfs
cfs
cfs
mg/L of
Total hardness at critical
mg/L of
CaCO3
CaCO3
low flow
Provide the following information describing the treatment provided for discharges from each outfall.
Highest Level of
Treatment (check all that
apply per outfall)
mg/L of
CaCO3
Outfall Number _____
Outfall Number _____
Outfall Number _____
Primary
Equivalent to
secondary
Secondary
Advanced
Other (specify)
__________________
Primary
Equivalent to
secondary
Secondary
Advanced
Other (specify)
___________________
Primary
Equivalent to
secondary
Secondary
Advanced
Other (specify)
_________________
R
Design Removal Rates by
Outfall
BOD5 or CBOD5
%
%
%
TSS
%
%
%
D
Treatment Description
cfs
AF
3.8
cfs
Phosphorus
Nitrogen
Other (specify)
______________________
EPA Form 3510-2A (Revised )
Not applicable
Not applicable
%
Not applicable
Not applicable
%
Not applicable
%
Not applicable
Not applicable
%
Not applicable
%
%
%
Not applicable
%
%
Page 7
Contains Nonbinding Recommendations
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NPDES Permit Number
Facility Name
EPA Identification Number
Treatment Description Continued
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
Outfall Number _____
Outfall Number _____
Outfall Number _____
Disinfection type
Seasons used
Dechlorination used?
3.12
Not applicable
Yes
Not applicable
Yes
Not applicable
Yes
No
No
No
Have you completed monitoring for all Table A parameters and attached the results to the application package?
Yes
No
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility’s
discharges or on any receiving water near the discharge points?
Yes
No SKIP to Item 3.13.
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility’s
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number _____
Outfall Number ______
Outfall Number _____
Acute
Chronic
Acute
Chronic
Acute
Chronic
Number of tests of discharge
water
Number of tests of receiving
water
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
Yes
No SKIP to Item 3.16.
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
Yes Complete Table B, including chlorine.
No Complete Table B, omitting chlorine.
R
3.13
T
3.11
AF
3.10
3.14
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
Yes
No
D
Effluent Testing Data
Form Approved
OMB No.
Form Expires
3.16
3.17
3.18
Does one or more of the following conditions apply?
The facility has a design flow greater than or equal to 1 mgd.
The POTW has an approved pretreatment program or is required to develop such a program.
The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls (Table E).
Tables C, D, and E as
Yes Complete
No SKIP to Section 4.
applicable.
Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
Yes
No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
additional sampling required by NPDES
Yes
No
permitting authority.
EPA Form 3510-2A (Revised )
Page 8
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
3.19
3.20
3.21
Form Approved
OMB No.
Form Expires
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
tests and Table E and SKIP to
Yes
No Complete
Item 3.26.
Have you previously submitted the results of the above tests to your NPDES permitting authority?
Provide results in Table E and SKIP to
Yes
No Item
3.26.
Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
3.23
3.24
3.25
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
toxicity?
Yes
No SKIP to Item 3.26.
Describe the cause(s) of the toxicity:
T
3.22
AF
Effluent Testing Data Continued
(MM/DD/YYYY)
Has the treatment works conducted a toxicity reduction evaluation?
Yes
Provide details of any toxicity reduction evaluations conducted.
D
R
Have you completed Table E for all applicable outfalls and attached the results to the application package?
applicable because previously submitted
Yes
Not
information to the NPDES permitting authority.
SECTION 4. INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES (40 CFR 122.21(j)(6) and (7))
4.1
Does the POTW receive discharges from SIUs or NSCIUs?
Yes
No SKIP to Item 4.7.
4.2
Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs
Number of NSCIUs
Industrial Discharges and Hazardous Wastes
3.26
No SKIP to Item 3.26.
4.3
Does the POTW have an approved pretreatment program?
4.4
Yes
No
Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the
application or (2) a pretreatment program?
Yes
No SKIP to Item 4.6.
4.5
Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.
4.6
Have you completed and attached Table F to this application package?
Yes
EPA Form 3510-2A (Revised )
No
Page 9
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
4.8
Yes
If yes, provide the following information:
Truck
Dedicated pipe
Rail
Truck
Dedicated pipe
Rail
Other (specify)
________________
________________
Truck
Dedicated pipe
Other (specify)
________________
________________
Yes
No SKIP to Section 5.
Does the POTW receive (or expect to receive) less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?
Yes SKIP to Section 5.
No
Have you reported the following information in an attachment to this application: identification and description of the
site(s) or facility(ies) at which the wastewater originates; the identities of the wastewater’s hazardous constituents; and
the extent of treatment, if any, the wastewater receives or will receive before entering the POTW?
R
4.11
Units
Rail
Other (specify)
________________
________________
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA?
4.10
Annual
Amount of
Waste
Received
Waste Transport Method
(check all that apply)
AF
Industrial Discharges and Hazardous Wastes Continued
Hazardous Waste
Number
4.9
No SKIP to Item 4.9.
T
4.7
Form Approved
OMB No.
Form Expires
Yes
No
No SKIP to Section 6.
Yes
D
CSO Map and Diagram
SECTION 5. COMBINED SEWER OVERFLOWS (40 CFR 122.21(j)(8))
Does the treatment works have a combined sewer system?
5.1
5.2
Have you attached a CSO system map to this application? (See instructions for map requirements.)
5.3
Yes
No
Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)
Yes
EPA Form 3510-2A (Revised )
No
Page 10
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
5.4
For each CSO outfall, provide the following information. (Attach additional sheets as necessary.)
CSO Outfall Number ____
CSO Outfall Number _____
CSO Outfall Number _____
Distance from shore
ft.
ft.
ft.
Depth below surface
ft.
ft.
ft.
CSO Outfall Description
City or town
State and ZIP code
County
Latitude
Longitude
T
CSO Outfall Number ____
CSO Outfall Number _____
CSO Outfall Number _____
Rainfall
Yes No
Yes No
Yes No
CSO flow volume
Yes No
Yes No
Yes No
CSO pollutant
concentrations
Yes No
Yes No
Yes No
Receiving water quality
Yes No
Yes No
Yes No
CSO frequency
Yes No
Yes No
Yes No
Number of storm events
Yes No
Yes No
Yes No
CSO Outfall Number ____
CSO Outfall Number ____
CSO Outfall Number ____
events
events
events
hours
hours
hours
Provide the following information for each of your CSO outfalls.
R
5.6
Did the POTW monitor any of the following items in the past year for its CSO outfalls?
AF
CSO Monitoring
5.5
Number of CSO events in
the past year
Average duration per
event
D
CSO Events in Past Year
Form Approved
OMB No.
Form Expires
Average volume per event
Minimum rainfall causing
a CSO event in last year
EPA Form 3510-2A (Revised )
Actual or Estimated
million gallons
Actual or Estimated
inches of rainfall
Actual or Estimated
Actual or Estimated
million gallons
Actual or Estimated
inches of rainfall
Actual or Estimated
Actual or Estimated
million gallons
Actual or Estimated
inches of rainfall
Actual or Estimated
Page 11
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
5.7
Form Approved
OMB No.
Form Expires
Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number ____
CSO Outfall Number ____
CSO Outfall Number ____
Receiving water name
AF
w/ Table A
w/ Table B
R
Section 3: Information on
Effluent Discharges
Section 4: Industrial
Discharges and Hazardous
Wastes
Section 5: Combined Sewer
Overflows
D
Checklist and Certification Statement
T
CSO Receiving Waters
Name of watershed/
stream system
U.S. Soil Conservation
Unknown
Unknown
Unknown
Service 14-digit
watershed code
(if known)
Name of state
management/river basin
U.S. Geological Survey
Unknown
Unknown
Unknown
8-Digit Hydrologic Unit
Code (if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
examples)
SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
6.1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1
Column 2
Section 1: Basic Application
Information for All Applicants w/ variance request(s)
w/ additional attachments
w/ topographic map
w/ process flow diagram
2: Additional
Section
Information
w/ additional attachments
Section 6: Checklist and
Certification Statement
Certification Statement
6.2
w/ Table C
w/ SIU and NSCIU attachments
w/ Table D
w/ additional attachments
w/ Table E
w/ additional attachments
w/ Table F
w/ additional attachments
w/ CSO map
w/ CSO system diagram
w/ attachments
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Signature
EPA Form 3510-2A (Revised )
Date signed
Page 12
EPA Identification Number
NPDES Permit Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge
Pollutant
Value
Units
Outfall Number
Average Daily Discharge
Value
Units
Number of
Samples
Form Approved
OMB No.
Form Expires
Analytical
Method1
ML or MDL
(include units)
Biochemical oxygen demand
BOD5 or CBOD5
ML
MDL
Fecal coliform
ML
MDL
T
(report one)
Design flow rate
pH (minimum)
AF
pH (maximum)
Temperature (winter)
Temperature (summer)
Total suspended solids (TSS)
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
D
R
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised )
Page 13
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
EPA Identification Number
NPDES Permit Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Value
Units
Value
Units
Number of
Samples
Form Approved
OMB No.
Form Expires
Analytical
Method1
ML or MDL
(include units)
ML
MDL
Chlorine
(total residual, TRC)2
ML
MDL
Dissolved oxygen
ML
MDL
T
Ammonia (as N)
Nitrate/nitrite
AF
Kjeldahl nitrogen
Oil and grease
Phosphorus
Total dissolved solids
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
D
R
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised )
Page 15
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
.
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Permit Number
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge
Pollutant
Value
Units
Average Daily Discharge
Value
Units
Number of
Samples
Analytical
Method1
ML or MDL
(include units)
Metals, Cyanide, and Total Phenols
T
Hardness (as CaCO3)
Antimony, total recoverable
Arsenic, total recoverable
Beryllium, total recoverable
AF
Cadmium, total recoverable
Chromium, total recoverable
Copper, total recoverable
Lead, total recoverable
Mercury, total recoverable
Nickel, total recoverable
Silver, total recoverable
Thallium, total recoverable
Zinc, total recoverable
Cyanide
D
Total phenolic compounds
R
Selenium, total recoverable
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
Volatile Organic Compounds
Acrolein
Acrylonitrile
Benzene
Bromoform
EPA Form 3510-2A (Revised )
ML
MDL
ML
MDL
ML
MDL
ML
MDL
Page 17
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Permit Number
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge
Pollutant
Value
Units
Average Daily Discharge
Value
Units
Number of
Samples
Carbon tetrachloride
Chlorobenzene
T
Chlorodibromomethane
Chloroethane
2-chloroethylvinyl ether
AF
Chloroform
Dichlorobromomethane
1,1-dichloroethane
1,2-dichloroethane
trans-1,2-dichloroethylene
1,1-dichloroethylene
1,3-dichloropropylene
Ethylbenzene
Methyl bromide
Methyl chloride
D
Methylene chloride
R
1,2-dichloropropane
1,1,2,2-tetrachloroethane
Tetrachloroethylene
Toluene
1,1,1-trichloroethane
1,1,2-trichloroethane
EPA Form 3510-2A (Revised )
Analytical
Method1
ML or MDL
(include units)
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
Page 18
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Permit Number
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge
Pollutant
Value
Units
Average Daily Discharge
Value
Units
Number of
Samples
T
Vinyl chloride
Acid-Extractable Compounds
p-chloro-m-cresol
AF
2-chlorophenol
2,4-dichlorophenol
2,4-dimethylphenol
4,6-dinitro-o-cresol
2,4-dinitrophenol
2-nitrophenol
4-nitrophenol
Base-Neutral Compounds
D
Acenaphthene
R
Pentachlorophenol
2,4,6-trichlorophenol
Acenaphthylene
Anthracene
Benzidine
ML or MDL
(include units)
ML
MDL
ML
MDL
Trichloroethylene
Phenol
Analytical
Method1
Benzo(a)anthracene
Benzo(a)pyrene
3,4-benzofluoranthene
EPA Form 3510-2A (Revised )
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
Page 19
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Permit Number
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge
Pollutant
Value
Units
Average Daily Discharge
Value
Units
Number of
Samples
Benzo(ghi)perylene
Benzo(k)fluoranthene
T
Bis (2-chloroethoxy) methane
Bis (2-chloroethyl) ether
Bis (2-chloroisopropyl) ether
AF
Bis (2-ethylhexyl) phthalate
4-bromophenyl phenyl ether
Butyl benzyl phthalate
2-chloronaphthalene
4-chlorophenyl phenyl ether
Chrysene
di-n-octyl phthalate
Dibenzo(a,h)anthracene
1,2-dichlorobenzene
1,3-dichlorobenzene
D
1,4-dichlorobenzene
R
di-n-butyl phthalate
3,3-dichlorobenzidine
Diethyl phthalate
Dimethyl phthalate
2,4-dinitrotoluene
2,6-dinitrotoluene
EPA Form 3510-2A (Revised )
Analytical
Method1
ML or MDL
(include units)
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
Page 20
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Permit Number
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge
Pollutant
Value
Units
Average Daily Discharge
Value
Units
Number of
Samples
Analytical
Method1
ML or MDL
(include units)
1,2-diphenylhydrazine
Fluoranthene
T
Fluorene
Hexachlorobenzene
Hexachlorobutadiene
AF
Hexachlorocyclo-pentadiene
Hexachloroethane
Indeno(1,2,3-cd)pyrene
Isophorone
Naphthalene
Nitrobenzene
N-nitrosodimethylamine
N-nitrosodiphenylamine
Phenanthrene
Pyrene
D
1,2,4-trichlorobenzene
R
N-nitrosodi-n-propylamine
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
1
EPA Form 3510-2A (Revised )
Page 21
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
EPA Identification Number
NPDES Permit Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
TABLE D. ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge
Average Daily Discharge
Pollutant
(list)
Value
Units
Value
Units
Number of
Samples
Form Approved
OMB No.
Form Expires
Analytical
Method1
ML or MDL
(include units)
No additional sampling is required by NPDES permitting authority.
D
R
AF
T
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
ML
MDL
1 Sampling
shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised )
Page 23
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
EPA Identification Number
NPDES Permit Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Information
Test Number _____
Grab
24-hour composite
Grab
24-hour composite
Grab
24-hour composite
Before Disinfection
After Disinfection
After Dechlorination
Before Disinfection
After Disinfection
After Dechlorination
Before disinfection
After disinfection
After dechlorination
Acute
Chronic
Both
Acute
Chronic
Both
R
Sample Location
Check one:
AF
Test species
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxicity Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s)
Sample Type
Check one:
Test Number _____
T
Test Number _____
D
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (Check one response.)
EPA Form 3510-2A (Revised )
Acute
Chronic
Both
Page 25
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Permit Number
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number _____
Source of Dilution Water
Indicate the source of dilution water. (Check
one response.)
If laboratory water, specify type.
If receiving water, specify source.
Type of Dilution Water
Indicate the type of dilution water. If salt
water, specify “natural” or type of artificial
sea salts or brine used.
Acute Test Results
Percent survival in 100% effluent
LC50
95% confidence interval
Control percent survival
EPA Form 3510-2A (Revised )
Static
Static-renewal
Flow-through
Static
Static-renewal
Flow-through
Laboratory water
Receiving water
Laboratory water
Receiving water
Fresh water
Salt water (specify)
Fresh water
Salt water (specify)
pH
Salinity
Temperature
D
Parameters Tested
Check the parameters tested.
Laboratory water
Receiving water
R
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Static
Static-renewal
Flow-through
T
response.)
Test Number _____
AF
Test Type
Indicate the type of test performed. (Check one
Test Number _____
Ammonia
Dissolved oxygen
pH
Salinity
Temperature
Fresh water
Salt water (specify)
Ammonia
pH
Dissolved oxygen Salinity
Temperature
Ammonia
Dissolved oxygen
%
%
%
%
%
%
%
%
%
Page 26
EPA Identification Number
NPDES Permit Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number _____
Test Number _____
Test Number _____
Chronic Test Results
NOEC
IC25
Control percent survival
Other (describe)
Quality Control/Quality Assurance
Is reference toxicant data available?
Yes
Yes
No
No
Yes
Yes
No
No
%
%
%
Yes
Yes
No
No
D
R
Was reference toxicant test within
acceptable bounds?
What date was reference toxicant test run
(MM/DD/YYYY)?
Other (describe)
%
%
%
AF
%
%
%
T
Acute Test Results Continued
Other (describe)
EPA Form 3510-2A (Revised )
Page 27
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE F. INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU ____
SIU ____
SIU ____
Name of SIU
Mailing address (street or P.O. box)
T
City, state, and ZIP code
List the principal products and raw materials that
affect or contribute to the SIU’s discharge.
Indicate the average daily volume of wastewater
discharged by the SIU.
R
How much of the average daily volume is
attributable to process flow?
AF
Description of all industrial processes that affect
or contribute to the discharge.
How much of the average daily volume is
attributable to non-process flow?
Yes
D
Is the SIU subject to local limits?
Is the SIU subject to categorical standards?
EPA Form 3510-2A (Revised )
Yes
gpd
gpd
gpd
gpd
gpd
gpd
gpd
gpd
gpd
No
Yes
No
Yes
No
No
Yes
No
Yes
No
Page 29
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE F. INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU ____
SIU ____
SIU ____
No
Yes
No
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Yes
Yes
No
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Has the POTW experienced problems (e.g.,
upsets, pass-through interferences) in the past 4.5
years that are attributable to the SIU?
If yes, describe.
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Under what categories and subcategories is the
SIU subject?
EPA Form 3510-2A (Revised )
Page 30
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-2B
Revised
Water Permits Division
Application Form 2B
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Concentrated Animal Feeding
Operations and Concentrated
Aquatic Animal Production
Facilities
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NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is a new or existing concentrated animal feeding
operation or concentrated aquatic animal production facility.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Paperwork Reduction Act Notice
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The U.S. Environmental Protection Agency (EPA) estimates the average burden for concentrated animal
feeding operation respondents to collect information and complete Form 2B to be 9.5 hours (9 hours to
complete and submit the application and 0.5 hours to complete and submit a nutrient management plan).
EPA estimates the average burden for concentrated aquatic animal production respondents to collect
information and complete Form 2B to be 6 hours. These estimates include time for reviewing
instructions, searching existing data sources, gathering and maintaining the needed data, and completing
and reviewing the collection of information. Send comments about the burden estimates or any other
aspect of this collection of information to the Chief, Information Policy Branch (PM-223), U.S.
Environmental Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460, and to the
Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW,
Washington, DC 20503, marked “Attention: Desk Officer for EPA.”
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2B—INSTRUCTIONS
General Instructions
Who Must Complete Form 2B?
You must complete Form 2B if you answered “Yes” to Item 1.2.1 on
Form 1—that is, if you are a concentrated animal feeding operation
(CAFO) or a concentrated aquatic animal production (CAAP)
facility.
Where to File Your Completed Form
Submit your completed application package (Forms 1 and 2B) to
your National Pollutant Discharge Elimination System (NPDES)
permitting authority. Consult Exhibit 1–1 of Form 1’s “General
Instructions” to identify your NPDES permitting authority.
Public Availability of Submitted Information
The U.S. Environmental Protection Agency (EPA) will make
information from NPDES permit application forms available to the
public for inspection and copying upon request. You may not claim
any information on Form 2B (or related attachments) as
confidential.
Definitions
The legal definitions of all key terms used in these instructions and
Form 2B are in the “Glossary” at the end of the “General
Instructions” in Form 1.
Line-by-Line Instructions
Section 1. General Information
Item 1.1. Mark whether your facility/business type is a CAFO or a
CAAP.
For a CAFO, you must complete Sections 1 through 6 and
Section 8.
For a CAAP, you must complete Sections 1, 7, and 8.
Section 2. CAFO Owner/Operator Contact Information
Item 2.1. Provide the name, title, telephone number, and email
address of the owner/operator of the facility/business.
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You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by Form
2B. Note that NPDES authorities will deny claims for treating any
effluent data as confidential. If you do not assert a claim of
confidentiality at the time you submit your information to the
NPDES permitting authority, EPA may make the information
available to the public without further notice to you. EPA will handle
claims of confidentiality in accordance with the Agency’s business
confidentiality regulations at Part 2 of Title 40 of the Code of
Federal Regulations (CFR).
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Item 1.2. Indicate whether your facility is an existing or proposed
facility. Mark “Proposed Facility” if your facility is presently not in
operation or is expanding to meet the definition of a CAFO in
accordance with the regulations at 40 CFR 122.23.
Item 2.2. Provide the complete mailing address of the
owner/operator of the facility/business.
Section 3. CAFO Location and Contact Information
Item 3.1. Provide the legal name and location (complete mailing
address) of the facility. Also indicate whom the NPDES permitting
authority should contact about the application, including a
telephone number and email address.
Item 3.2. Provide the latitude and longitude of the entrance to the
production area (i.e., the part of the operation that includes the
animal confinement area, the manure storage area, the raw
materials storage area, and the waste containment areas). Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS). For
further guidance, refer to
http://www.epa.gov/geospatial/latitudelongitude-data-standard.
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Completion of Forms
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
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Provide your EPA Identification Number from the Federal Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 2B and any attachments. If your facility is new
(i.e., not yet constructed), write or type “New Facility” in the space
provided for the EPA Identification Number and NPDES permit
number. If you do not know your EPA Identification Number,
contact your NPDES permitting authority. See Exhibit 1–1 of the
“General Instructions” of Form 1 for contact information.
Item 3.3. If the facility uses a contract grower, provide the name
and complete mailing address of the integrator.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter “NA” for “not applicable” to
show that you considered the item and determined a response was
not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority’s satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
Section 4. CAFO Topographic Map
Item 4.1. Provide a topographic map of the geographic area in
which the facility is located, showing the specific location of the
production area(s). You are not required to provide the topographic
map required by Section 7 of Form 1.
On each map, include the map scale, a meridian arrow showing
north, and latitude and longitude to the nearest second. Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
2B-1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2B—INSTRUCTIONS CONTINUED
geographic information systems (e.g., ArcView), or paper maps
Item 6.3. Indicate if a nutrient management plan is being
from trusted sources (e.g., USGS).
implemented at the CAFO. If not land applying, describe the
alternative uses of the manure, litter, and wastewater (e.g.,
On all maps of rivers, show the direction of the current. In tidal
composting, pelletizing, energy generation).
waters, show the directions of ebb and flow tides.
Item 5.1. Provide the maximum number of each type of animal in
open confinement or housed under roof (either partially or totally)
that are held at your facility for a total of 45 days or more in any 12month period. Provide the total number of animals confined at the
facility.
Note: A permit application is not complete until a nutrient
management plan is submitted to the NPDES permitting authority.
Section 7. CAAP Facility Characteristics
Item 7.1. Indicate if the CAAP facility is located on land. If the
facility is located in water (e.g., a net pen or submerged cage
system), check “No” and skip to Item 7.3. If yes, continue to Item
7.2.
Item 7.2. Provide the maximum daily and maximum average
monthly discharge at the CAAP facility by outfall number. Outfall
numbers should correspond with the outfall numbers provided on
the map submitted in Section 7 of Form 1. Values given for flow
should be representative of your normal operation. The maximum
daily flow is the maximum measured flow occurring over a calendar
day. The maximum average monthly flow is the average of
measured daily flow over the calendar month of highest flow.
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Item 5.2. Identify the applicable types of containment and storage
for manure, litter, and process wastewater at the facility and
indicate the capacity of storage in days and gallons or tons.
Item 6.4. Indicate the date of the last review or revision of the
nutrient management plan.
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You may develop your map by going to the United States USGS’s
National Map website at http://nationalmap.gov/. (For a map from
this site, use the traditional 7.5-minute quadrangle format. If none is
available, use a USGS 15-minute series map.) You may also use a
plat or other appropriate map. Briefly describe land uses in the map
area (e.g., residential, commercial.). Note that you have completed
your topographic map and attached it to the application.
Section 5. CAFO Characteristics
Supply all information in Section 5 if you checked “Existing facility”
in response to Item 1.2.
Item 7.3. Indicate the number of ponds, raceways, net pens,
submerged cages, or similar structures at your facility that result in
discharges to waters of the United States. Describe each type and
provide the name of the associated receiving water and intake
water source.
Item 5.3. Indicate the total number of acres that are drained and
collected in the containment and storage structure(s).
Item 5.4. Specify the tons of manure or litter and the gallons of
process wastewater generated at the facility on an annual basis.
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Item 5.5. Indicate whether the manure, litter, and/or process
wastewater is land applied. If yes, continue to Item 5.6. If no, skip to
Item 5.8.
Item 5.6. Indicate the number of acres of land under the control of
the applicant that are available for land application of the manure,
litter, or process wastewater.
For each species, provide the total harvestable weight in pounds
(lbs.) for a typical calendar year. Also indicate the maximum weight
present at any one time at your facility.
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Item 5.7. Check any of the identified best management practices
that are being implemented at the facility to control runoff and
protect water quality.
Item 5.8. Indicate if the manure, litter, and/or process wastewater is
transferred to any other persons. If yes, continue to Item 5.9. If no,
skip to Item 5.10.
Item 5.9. Specify the tons of manure or litter or the gallons of
process wastewater transferred annually to other people.
Item 5.10. Describe any alternative uses of manure, litter, or
process wastewater, if any (e.g., composting, pelletizing, energy
generation).
Section 6. CAFO Nutrient Management Plans
Item 6.1. Indicate if you have submitted a nutrient management
plan that satisfies the requirements at 40 CFR 122.42(e) and, if
applicable, the requirements at 40 CFR 412.4(c).
Item 7.4. List the species of fish or aquatic animals held and fed at
your facility. Distinguish between cold-water and warm-water
species. The names of fish species should be proper, common, or
scientific names as given in Special Publication 34 of the American
Fisheries Society, Common and Scientific Names of Fishes from
the United States, Canada, and Mexico.
Item 7.5. Indicate the maximum monthly pounds of food given at
your facility. Also indicate the month given. The amounts should be
representative of your normal operations.
Section 8. Checklist and Certification Statement
Item 8.1. Review the checklist provided. In Column 1, mark the
sections of Form 2B that you have completed and are submitting
with your application. For each section in Column 2, indicate
whether you are submitting attachments.
Item 8.2. The Clean Water Act provides for severe penalties for
submitting false information on this application form. CWA Section
309(c)(2) provides that, “Any person who knowingly makes any
false statement, representation, or certification in any application,
…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.”
Item 6.2. If you have not yet submitted a nutrient management
plan, explain why not.
2B-2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2B—INSTRUCTIONS CONTINUED
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
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For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer means:
(1) 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 (2) the manager of one or
more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
END
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A.
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Submit your completed Form 1, Form 2B, and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
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Contains Nonbinding Recommendations
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Contains Nonbinding Recommendations
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EPA Identification Number
NPDES Permit Number
Form Approved
OMB No.
Form Expires
Facility Name
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
Form
2B
NPDES
General
Information
CONCENTRATED ANIMAL FEEDING OPERATIONS and
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITIES
SECTION 1. GENERAL INFORMATION (40 CFR 122.21(I)(1))
1.1
Indicate the facility/business type. (Check only one response.)
CAFO Complete Sections 1 through 6 and Section 8.
1.2
CAAP Complete Sections 1, 7, and 8.
Indicate the operational status of the facility. (Check one.)
Existing facility
Proposed facility
2.2
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Phone number
Email address
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CAFO Owner/Operator
Contact Information
SECTION 2. CAFO OWNER/OPERATOR CONTACT INFORMATION (40 CFR 122.21(f)(2) and (4) and 122.21(i)(1)(i))
Owner/Operator Contact
2.1
Name (first and last)
Title
Owner/Operator Mailing Address
Street or P.O. box
City or town
State
Zip code
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Address (street, route number, or other specific identifier)
City or town
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CAFO Location and Contact Information
SECTION 3. CAFO LOCATION AND CONTACT INFORMATION (40 CFR 122.21(i)(1)(ii and iii))
3.1
CAFO Location and Contact
Name
Facility contact name
3.2
County
State
Zip code
Phone number
Email address
Latitude/Longitude of Entrance to Production Area (see instructions)
Latitude
EPA Form 3510-2B (revised )
Longitude
Page 1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
CAFO Location and Contact
Information Continued
EPA Identification Number
3.3
Facility Name
Form Approved
OMB No.
Form Expires
Integrator Name and Address
Name
Street address
City or town
State
Zip code
Yes SKIP to Section 5.
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CAFO
Topographic
Map
SECTION 4. CAFO TOPOGRAPHIC MAP (40 CFR 122.21(i)(1)(iv))
Have you attached a topographic map containing all required information to this application? (See instructions for
4.1
specific requirements.)
No
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SECTION 5. CAFO CHARACTERISTICS (40 CFR 122.21(i)(1)(v-ix))
5.1
Provide information on the type and number of animals in the table below.
Number in Open
Confinement
Number
Housed
Under Roof
Mature dairy
cows
5.2
Dairy heifers
Veal calves
Cattle (not dairy
or veal calves)
Swine
(55 lbs. or more)
Swine
(under 55 lbs.)
Horses
Turkeys
Number in Open
Confinement
Number
Housed
Under Roof
Sheep or
lambs
Chickens
(broilers)
Chickens
(layers)
Ducks
Other
(specify)
Other
(specify)
Other
(specify)
Total Animals
Indicate the type of containment and storage, total number of days, and total capacity for manure, litter, and
process wastewater storage in the table below.
Type of Containment
and Storage
5.3
Animal Type
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CAFO Characteristics
Animal Type
Total Number of
Days
Total
Capacity
(specify gallons
or tons)
Type of
Containment and
Storage
Anaerobic lagoon
Belowground
storage tanks
Evaporation
Roofed
storage shed
Aboveground
storage tanks
Concrete pad
Storage pond
Impervious
soil pad
Underfloor pit
Other
(specify)
Total Number of
Days
Total
Capacity
(specify gallons
or tons)
Indicate the total number of acres drained and collected in the containment and storage structure(s) reported under
Item 5.2.
____________ acres
EPA Form 3510-2B (revised )
Page 2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
EPA Identification Number
Facility Name
Form Approved
OMB No.
Form Expires
Manure, Litter, and/or Process Wastewater Production and Use
5.4
How many tons of manure or litter and gallons of process wastewater are generated annually at the CAFO?
Manure
tons
Litter
tons
Process wastewater
Is manure, litter, and/or process wastewater generated at the CAFO land applied?
5.7
Setbacks
Grass filter
Conservation tillage
Constructed wetlands
Terrace
Other (specify)
Is manure, litter, and/or process wastewater transferred to any other persons?
Yes
No SKIP to Item 5.10.
How many tons of manure or litter and gallons of process wastewater, produced by the CAFO, are transferred
annually to other people?
Manure
tons
Litter
tons
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5.9
No SKIP to Item 5.8.
How many acres of land under the control of the applicant are available for applying the CAFO’s manure, litter,
or process wastewater?
______________ acres
Check all land application best management practices that are being implemented.
Buffers
Infiltration field
5.8
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CAFO Characteristics Continued
5.6
Yes
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5.5
gallons
Process wastewater
Describe alternative use(s) of manure, litter, or process wastewater, if any.
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5.10
gallons
CAFO Nutrient Management Plans
SECTION 6. CAFO NUTRIENT MANAGEMENT PLANS (40 CFR 122.21(i)(1)(x))
6.1
Has the applicant attached a nutrient management plan that satisfies the requirements at 40 CFR 122.42(e)
and, if applicable, the requirements at 40 CFR 412.4(c)? Note: A permit application is not complete until a
nutrient management plan is submitted to the NPDES permitting authority.
Yes SKIP to Item 6.3.
No
6.2
Explain why a nutrient management plan is not attached to the application.
6.3
Is a nutrient management plan being implemented at the CAFO?
Yes
No
6.4
What was the date of the last review
or revision of the nutrient
management plan?
EPA Form 3510-2B (revised )
Date _________________________________
Page 3
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
EPA Identification Number
Facility Name
SECTION 7. CAAP FACILITY CHARACTERISTICS (40 CFR 122.21(i)(2))
7.1
Is the CAAP facility located on land?
Yes
Provide the maximum daily and maximum average monthly discharge at CAAP by outfall.
Discharge
Outfall
Number
7.3
No SKIP to Item 7.3.
Maximum Daily Discharge
Maximum Average Monthly Discharge
gpd
gpd
gpd
gpd
gpd
gpd
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7.2
Form Approved
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Indicate the type and number of discharge structures at the CAAP. Provide a brief description of each structure.
Also note the name of the receiving water and the source of the intake water for each structure.
Number of Each
Receiving Water
Name
Description
Source of Intake
Water
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Structure
Type
Raceways
Net pens
Not applicable
Submerged
cages
Similar
structures
Not applicable
(specify)
_____________
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CAAP Facility Characteristics
Ponds
7.4
List the cold-water and/or warm-water aquatic species raised/produced in the table below. For each species
listed, indicate the total yearly and maximum harvestable weight (in pounds).
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Species
Cold Water Species
Harvestable Weight
Total Yearly
Maximum
7.5
Species
Warm Water Species
Harvestable Weight
Total Yearly
Maximum
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
lbs.
Indicate the calendar month of maximum feeding and the total mass of food fed (in pounds) during that month.
Month of Maximum Feeding
Total Mass of Food Fed
lbs.
EPA Form 3510-2B (revised )
Page 4
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
EPA Identification Number
Facility Name
Form Approved
OMB No.
Form Expires
Section 1: General Information
w/ attachments
Section 2: CAFO Owner/Operator Contact Information
w/ attachments
Section 3: CAFO Location and Contact Information
w/ attachments
Section 4: CAFO Topographic Map
Section 5: CAFO Characteristics
Section 6: CAFO Nutrient Management Plans
Section 7: CAAP Facility Characteristics
Section 8: Checklist and Certification Statement
w/ attachments
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w/ topographic map
w/ additional attachments
w/ attachments
w/ nutrient management plan
w/ attachments
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8.2
w/ attachments
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
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Checklist and Certification Statement
SECTION 8. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
8.1
In Column 1, below, mark the sections of Form 2B that you have completed and are submitting with your
application. For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting
authority. Note that not all applicants are required to provide attachments.
Column 1
Column 2
Date signed
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Signature
EPA Form 3510-2B (revised )
Page 5
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-2C
Revised
Water Permits Division
Application Form 2C
Existing Manufacturing,
Commercial, Mining, and
Silvicultural Operations
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NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is an existing manufacturing, commercial, mining,
or silvicultural facility that currently discharges process wastewater.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Paperwork Reduction Act Notice
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The U.S. Environmental Protection Agency estimates the average burden to collect information and
complete Form 2C to be 33 hours. This estimate includes time for reviewing instructions, searching
existing data sources, gathering and maintaining the needed data, and completing and reviewing the
collection of information. Send comments about the burden estimate or any other aspect of this
collection of information to the Chief, Information Policy Branch (PM-223), U.S. Environmental
Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460, and to the Office of
Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW,
Washington, DC 20503, marked “Attention: Desk Officer for EPA.”
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2C—INSTRUCTIONS
Who Must Complete Form 2C?
You must complete Form 2C if you answered “Yes” to Item 1.2.2 on
Form 1—that is, if you are an existing manufacturing, commercial,
mining, or silvicultural facility that currently discharges process
wastewater.
Where to File Your Completed Form
Submit your completed application package (Forms 1 and 2C) to
your National Pollutant Discharge Elimination System (NPDES)
permitting authority. Consult Exhibit 1–1 of Form 1’s “General
Instructions” to identify your NPDES permitting authority.
Public Availability of Submitted Information
The U.S. Environmental Protection Agency (EPA) will make
information from NPDES permit application forms available to the
public for inspection and copying upon request. You may not claim
any information on Form 2C (or related attachments) as
confidential.
Completion of Forms
Line-by-Line Instructions
Section 1. Outfall Location
Item 1.1. Identify each of the facility’s outfall structures by number.
For each outfall, specify the latitude and longitude to the nearest
15 seconds and name of the receiving water. The application form
provides reporting space for three outfalls. If your facility has more
than this number, attach additional sheets as necessary. The
location of each outfall (i.e., where the coordinates are collected)
shall be the point where the discharge is released into a water of
the United States. Latitude and longitude coordinates may be
obtained in a variety of ways, including use of hand held devices
(e.g., a GPS enabled smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS).For
further guidance, refer to
http://www.epa.gov/geospatial/latitudelongitude-data-standard.
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You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by Form
2C. Note that NPDES authorities will deny claims for treating any
effluent data as confidential. If you do not assert a claim of
confidentiality at the time you submit your information to the
NPDES permitting authority, EPA may make the information
available to the public without further notice to you. EPA will handle
claims of confidentiality in accordance with the Agency’s business
confidentiality regulations at Part 2 of Title 40 of the Code of
Federal Regulations (CFR).
Definitions
The legal definitions of all key terms used in these instructions and
Form 2C are in the “Glossary” at the end of the “General
Instructions” in Form 1.
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General Instructions
Section 2. Line Drawing
Item 2.1. Attach a line drawing showing water flow through your
facility, from intake to discharge. Indicate the sources of intake
water (e.g., city, well, stream, other); operations contributing
wastewater to the effluent including process and production areas,
sanitary flows, cooling water, and stormwater runoff; and treatment
units labeled to correspond to the more detailed descriptions under
Section 3. You may group similar operations into a single unit.
Construct a water balance on the line drawing by showing average
flows (specify units) between intakes, operations, treatment units,
and outfalls. Show all significant losses of water to products, the
atmosphere, and discharge. You should use actual measurements
wherever available; otherwise use your best estimate. If you cannot
determine a water balance for your activities (such as mining
activities), provide a pictorial description of the nature and amount
of any sources of water and any collection and treatment measures.
An example of an acceptable line drawing is provided in Exhibit
2C–1 at the end of these instructions.
R
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
D
Provide your EPA Identification Number from the Federal Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 2C and any attachments. If you do not know
your EPA Identification Number, contact your NPDES permitting
authority. See Exhibit 1–1 of Form 1’s “General Instructions” for
contact information. Additionally, for Tables A through E, provide
the applicable outfall number at the top of each page.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter “NA” for “not applicable” to
show that you considered the item and determined a response was
not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority’s satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
Section 3. Average Flows and Treatment
Item 3.1. For each outfall identified under Item 1.1, provide the
following information: (1) all processes, operations, or production
areas that contribute wastewater to the effluent for the outfall,
including process wastewater, sanitary wastewater, cooling water,
and stormwater runoff; (2) average flow of wastewater contributed
by each operation in million gallons per day (mgd); (3) a description
of the treatment unit (including size of each treatment unit, flow rate
through each treatment unit, retention time, etc.); (4) the applicable
treatment code(s) from Exhibit 2C–2 (see end of instructions); and
(5) the ultimate disposal of any solid or fluid wastes that are not
discharged to the receiving water. You may describe processes,
operations, or production areas in general terms (e.g., “dye-making
reactor” or “distillation tower”). You may estimate the average flow
of point sources composed of stormwater; however, you must
2C-1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
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AF
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FORM 2C—INSTRUCTIONS CONTINUED
indicate the basis of the rainfall event and the method of estimation. Item 5.3. Indicate if the limitations in the applicable ELGs are
Add additional sheets as necessary.
expressed in terms of production or other measure of operation. For
Item 3.2. Answer whether you are applying for an NPDES permit to operational parameter, it is expressed in terms of production (e.g.,
“pounds of biological oxygen demand per cubic foot of logs from
operate a privately owned treatment works. If yes, continue to Item
which bark is removed,” or “pounds of total suspended solids per
3.3. If no, skip to Section 4.
megawatt hour of electrical energy consumed by smelting
Item 3.3. Attach a list to your application that includes the identity of furnace”). An example of an ELG not expressed in terms of a
each user of the treatment works, then answer “Yes” to Item 3.3.
measure of operation is one that limits the concentration of
pollutants. If yes, continue to Item 5.4. If no, skip to Section 6.
Section 4. Intermittent Flows
Item 5.4. Indicate the operations, products, or materials produced
Item 4.1. Answer “Yes” or “No” to indicate whether any of the
at the facility for each outfall. For each operation, product, or
discharges you described in Sections 1 and 3 of Form 2C are
material produced, denote the quantity produced per day using the
intermittent or seasonal, except for stormwater runoff, spillage, or
measurement units specified in the applicable ELG. The NPDES
leaks. An intermittent discharge is one that is not continuous. A
permitting authority will use the production information to apply
continuous discharge is one that occurs without interruption during
ELGs to your facility. You may not claim that the production
the operating hours of the facility, except for infrequent shutdowns
information you submit is confidential. You do not need to indicate
for maintenance, process changes, or other similar activities. A
how you calculated the reported information. The production figures
discharge is seasonal if it occurs only during certain parts of the
provided must be based on a reasonable measure of actual daily
year. If yes, continue to Item 4.2. If no, skip to Section 5.
production, not on design capacity or on predictions of future
Item 4.2. By relevant outfall number, identify each operation that
operations. To obtain alternate limits under 40 CFR 122.45(b)(2)(ii),
has intermittent or seasonal discharges. Indicate the average
you must define your maximum production capability and
frequency (days per week and months per year), the long-term
demonstrate to the NPDES permitting authority that your actual
average and maximum daily flow rates in mgd, and the duration of
production is substantially below maximum production capability
the intermittent or seasonal discharges. Base your answers on
and that there is a reasonable potential for an increase above
actual data if available. Otherwise, provide your best estimate.
actual production during the duration of the permit.
Report the average of all daily values measured during days when
Section 6. Improvements
the discharge occurred for “Long-Term Average,” and report the
highest daily value for “Maximum Daily.”
Item 6.1. Indicate if you are required by any federal, state, or local
authority to meet an implementation schedule for constructing,
Section 5. Production
upgrading, or operating wastewater treatment equipment or
Item 5.1. Indicate whether any effluent limitation guidelines (ELGs)
practices or any other environmental programs that could affect the
promulgated under Section 304 of the Clean Water Act (CWA)
discharges described in your application. The requirements include,
apply to your facility. If yes, continue to Item 5.2. If no, skip to
but are not limited to, permit conditions, administrative enforcement
Section 6. All ELGs promulgated by EPA appear in the Federal
orders, enforcement compliance schedule letters, stipulations, court
Register and are published annually in 40 CFR Subchapter N. An
orders, and grant or loan conditions. If yes, continue to Item 6.2. If
ELG applies if you have any operations contributing process
no, skip to Item 6.3.
wastewater in any subcategory covered by a Best Practicable
Item 6.2. Briefly identify and describe each applicable project (e.g.,
Control Technology Currently Available (BPT), Best Conventional
consent decree, enforcement order, or permit condition). For each
Pollutant Control Technology (BCT), or Best Available Technology
condition, specify the affected outfall number(s), the source(s) of
Economically Achievable (BAT) guideline. If you are unsure
the discharge, the projected final compliance date, and the
whether you are covered by a promulgated ELG, consult your
required final compliance date.
NPDES permitting authority (see Exhibit 1–1 of the “General
Instructions” of Form 1). You must check “Yes” if an applicable ELG Item 6.3. OPTIONAL ITEM. If desired, attach descriptions of any
has been promulgated, even if the ELG is being contested in court. additional water pollution control programs (or other environmental
If you believe that a promulgated ELG has been remanded for
projects that could affect your discharges) that are now underway
reconsideration by a court and does not apply to your operations,
or planned. Indicate in your attachments whether each program is
you may answer “No” to Item 5.1 and skip to Section 6.
actually underway or is planned, and indicate your actual or
Applicable ELGs
Item 5.2. Complete Item 5.2 by indicating the applicable ELG
category, ELG subcategory, and corresponding regulatory citation.
See the example below.
5.2
ELG Category
Pulp, Paper,
and
Paperboard
Point Source
Category
ELG
Subcategory
Secondary Fiber
Non-Deink
Subcategory
Regulatory
Citation
40 CFR 430,
Subpart J
planned schedule for construction.
Section 7. Effluent and Intake Characteristics
Items 7.1 to 7.17. These items require you to collect and report
data for the parameters and pollutants listed in Tables A through E,
located at the end of Form 2C. The instructions for completing the
tables are table-specific in addition to the criteria for determining
who should complete them. In general, the following conditions
apply:
2C-2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2C—INSTRUCTIONS CONTINUED
Pollutants/Parameters
Conventional and nonconventional pollutants
B
Toxic metals, cyanide, total
phenols, and organic toxic
pollutants
Certain conventional and
non-conventional pollutants
C
D
E
Certain hazardous
substances and asbestos
2,3,7,8-tetrachlorodibenzop-dioxin (2,3,7,8-TCDD)
Item 7.5. Because you indicated in Item 7.4 that the facility’s
processes contribute wastewater that falls into one or more of the
primary industry categories, check “Testing Required” for all toxic
metals, cyanide, and total phenols in Section 1 of Table B. Answer
“Yes” to Item 7.5 once you have completed this task.
Who Completes?
All applicants from all outfalls unless a
waiver is obtained from the NPDES
permitting authority.
Applicants in the primary industry
categories listed in Exhibit 2C-3 at the
end of these instructions.
Applicants subject to ELGs that limit
pollutants directly or indirectly and
applicants who believe pollutants may
be present in their facility’s discharge.
Applicants who believe pollutants may
be present in their facility’s discharge.
Applicants that use or manufacture the
pollutant or believe the pollutant may
be present in the facility’s discharge.
Item 7.6. Because you indicated in Item 7.4 that the facility’s
processes contribute wastewater that falls into one or more of the
primary industry categories, list the primary industry categories
applicable to your facility. Next, review Exhibit 2C-3 to determine
whether testing is required and for which GC/MS fraction(s): volatile
compounds, acid compounds, base/neutral compounds, and
pesticides. Check the applicable boxes for each GC/MS fraction
requiring testing.
Important note: Read the “General Instructions for Reporting,
Sampling, and Analysis” on pages 2C-5 and 2C-6 before
completing Section 7 and Tables A through E.
Item 7.8 and Sections 1 through 5 of Table B. For all other cases
(secondary industries, nonprocess wastewater outfalls, and
nonrequired GC/MS fractions) and remaining pollutants, check
“Believed Present” or “Believed Absent” in Sections 1 through 5 of
Table B to indicate whether you have reason to believe that any of
the pollutants listed are discharged from your outfalls. Answer “Yes”
to Item 7.8 after you have completed this step.
AF
Item 7.1 and Table A. All applicants must report at least one
analysis for each conventional and non-conventional pollutant listed
in Table A for each outfall (one table per outfall). This includes
outfalls discharging only noncontact cooling water or stormwater
runoff. However, at your request, the NPDES permitting authority
may waive the requirement to test for one or more of the listed
pollutants for specific outfalls, upon a determination that available
information is adequate to support issuance of your NPDES permit
with less stringent reporting requirements. You may also request a
waiver from your NPDES permitting authority for one or more of the
Table A pollutants for your industry category or subcategory.
Indicate whether you are requesting a waiver in response to Item
7.1. If yes, continue to Item 7.2. If no, skip to Item 7.3.
Item 7.7. For each of the required GC/MS fractions, check “Testing
Required” for each of the pollutants in the required fraction in
Sections 2 through 5 of Table B. Answer “Yes” to Item 7.7 once you
have completed this task.
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Table
A
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Item 7.2. Specify the outfalls for which you are requesting a waiver.
Next, indicate on Table A for the applicable outfalls the pollutants
for which the waiver is being requested. Attach your waiver request
and supporting information to your completed Form 2C.
D
Item 7.3. Test your effluent from each outfall for each pollutant
listed in Table A for which you have not requested a waiver. You
may also conduct optional tests of your intake water for the Table A
pollutants. See the “General Instructions for Reporting, Sampling,
and Analysis” on pages 2C-5 and 2C-6 for further information.
Item 7.4 and Table B. This item asks whether any of the facility’s
processes that contribute wastewater fall into one or more of the
primary industry categories listed in Exhibit 2C-3. If you are
applying for a permit for a privately owned treatment works,
determine your testing requirements based on the industrial
categories of your contributors. This exercise is simply to determine
your testing requirements only. You are not giving up your right to
challenge your inclusion in the category determined for testing (e.g.,
for deciding whether an ELG is applicable) before your permit is
issued. If yes, continue to Item 7.5. If no, skip to Item 7.8.
Complete a separate Table B for each outfall. Section 1 of Table B
lists toxic metals, cyanide, and total phenols. Sections 2 through 5
of Table B list the pollutants in each of the gas
chromatography/mass spectrometry (GC/MS) fractions. Note that
inclusion of total phenols in Section 1 of Table B does not mean
that EPA is classifying the group as toxic pollutants.
Item 7.9 and Section 1 of Table B. For each pollutant you know or
have reason to believe is present in your discharge from each
applicable outfall in concentrations of 10 parts per billion (ppb) or
greater, you must report quantitative data. For every pollutant
expected to be discharged in concentrations less than 10 ppb, you
must submit quantitative data or briefly describe the reasons the
pollutant is expected to be discharged. For pollutants in intake
water, see the discussion under “General Instructions for Reporting,
Sampling, and Analysis” below. Answer “Yes” to Item 7.9 once you
have completed Section 1 of Table B.
Item 7.10. This item asks if you qualify as a “small business.” If so,
you are exempt from submitting quantitative data for the organic
toxic pollutants on Table B (Sections 2 through 5). You still must
indicate, though, whether you believe any of the pollutants listed in
Sections 1 through 5 are present in your discharge per the
Instructions at Item 7.8 above.
You can qualify as a small business in two ways: (1) If your facility
is a coal mine and if your probable total annual production is less
than 100,000 tons per year, you may submit past production data
or estimated future production (such as a schedule of estimated
total production under 30 CFR 795.14(c)) instead of conducting
analyses for the organic toxic pollutants. (2) If your facility is not a
coal mine and if your gross total annual sales for the most recent
three years average less than $100,000 per year (in second
quarter 1980 dollars), you may submit sales data for those years
instead of conducting analyses for the organic toxic pollutants.
The production or sales data must be for the facility that is the
source of the discharge. The data should not be limited to
production or sales for the process or processes that contribute to
the discharge, unless those are the only processes at your facility.
2C-3
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2C—INSTRUCTIONS CONTINUED
If you qualify as a small business according to the criteria above,
answer “Yes” to Item 7.10. Check the box at the top of Table B to
show that you are not required to submit quantitative data for the
organic toxic pollutants (Sections 2 through 5 of Table B), then
skip to Item 7.12. Otherwise, answer “No” and continue to Item
7.11.
Item 7.15. Answer “Yes” to this Item when you have completed
Table D.
Under 40 CFR 117.12(a)(2), certain discharges of hazardous substances
(listed in Exhibit 2C-4 at the end of these instructions) may be exempted from
the requirements of Section 311 of the CWA, which establishes reporting
requirements, civil penalties, and liability for cleanup costs for spills of oil and
hazardous substances. A discharge of a particular substance can be exempted
if the origin, source, and amount of the discharged substances are identified in
the NPDES permit application or in the permit, if the permit contains a
requirement for treatment of the discharge, and if the treatment is in place.
Exemptions are allowed from the requirements of CWA Section 311.
Applications for exemptions must set forth the following information:
1. The substance and the amount of each substance that may be discharged.
2. The origin and source of the discharge of the substance.
3. The treatment to be provided for the discharge by:
a. An onsite treatment system separate from any treatment system
treating your normal discharge;
b. A treatment system designed to treat your normal discharge and that is
additionally capable of treating the amount of the substance identified
under paragraph 1 above; or
c. Any combination of the above.
AF
Item 7.11 and Sections 2 through 5 of Table B. Unless you
qualify as a small business (see Item 7.10), you must provide
quantitative data for all pollutants for which you marked “Testing
Required” in Sections 2 through 5 of Table B. You must also
provide quantitative data for all pollutants you marked as “Believed
Present” in Sections 2 through 5 of Table B if you discharge those
pollutants in concentrations of 10 ppb or greater, except for
acrolein, acrylonitrile, 2,4-dinitrophenol, and 2-methyl-4,6dinitrophenol. If you discharge any of the four latter pollutants in
concentrations of 100 ppb or greater, you must report quantitative
data. If you discharge the pollutants in Sections 2 through 5 of
Table B less than these thresholds (i.e., <100 ppb for acrolein,
acrylonitrile, 2,4-dinitrophenol, and 2-methyl-4,6-dinitrophenol and
<10 ppb for all others), you must submit quantitative data or briefly
describe the reasons the pollutant is in your discharge.
Item 7.14 and Table D. For each outfall, indicate if you believe that
any pollutant listed in Table D is “Believed Present” or “Believed
Absent” in your facility’s effluent. Check the boxes in the applicable
columns on Table D next to each pollutant. For every pollutant
believed present, you must briefly describe the reasons the
pollutant is expected to be discharged and report any quantitative
data you have for that pollutant. Note that you are not required to
perform analytical tests for any of the Table D pollutants at this time.
However, if you have prior test results, you must report them.
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For sales data, in situations involving intra-corporate transfer of
goods and services, the transfer price per unit should approximate
market prices for those goods and services as closely as possible.
Sales figures for years after 1980 should be indexed to the second
quarter of 1980 by using the gross national product price deflator
(second quarter of 1980 = 100). This index is available online from
the U.S. Department of Commerce, Bureau of Economic Analysis
at http://bea.gov/national/pdf/SNTables.pdf.
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For pollutants in intake water, see the discussion under “General
Instructions for Reporting, Sampling, and Analysis” on pages
2C-5 and 2C-6 for further information.
Once you have completed these tasks, answer “Yes” to Item 7.11.
D
Item 7.12 and Table C. For each outfall (including outfalls
containing only noncontact cooling water or stormwater runoff),
indicate whether you know or have reason to believe that any of
the pollutants listed on Table C are present in your discharge. If
so, mark the box in the “Believed Present” column for each
applicable pollutant. If not, mark the box in the “Believed Absent”
column for each applicable pollutant. Answer “Yes” to Item 7.12
once you have completed the required task for each outfall.
Item 7.13 and Table C. You are required to report quantitative
data for any Table C pollutants that are directly limited in an
applicable ELG or are indirectly limited in an applicable ELG
through an expressed limitation on an indicator (e.g., use of total
suspended solids (TSS) as an indicator to control the discharge
of iron and aluminum). For all other pollutants that you marked as
“Believed Present,” you must either report quantitative data or
briefly describe the reasons the pollutant is expected to be
discharged.
For pollutants in intake water, see the discussion under “General
Instructions for Reporting, Sampling, and Analysis” on pages
2C-5 and 2C-6 for further information.
Answer “Yes” to Item 7.13 when you have fully completed the
tasks associated with Table C and Items 7.12 and 7.13 above.
See 40 CFR 117.12(a)(2) and (c) or contact your NPDES permitting authority
for further information on exclusions from CWA Section 311.
Item 7.16. Indicate whether:
Your facility uses or manufactures 2,4,5-trichlorophenoxy
acetic acid (2,4,5-T); 2-(2,4,5-trichlorophenoxy) propanoic acid
(Silvex, 2,4,5-TP); 2-(2,4,5-trichlorophenoxy) ethyl 2,2-dichloropropionate (Erbon); 0,0-dimethyl 0-(2,4,5-trichlorophenyl)
phosphorothioate (Ronnel); 2,4,5,-trichlorophenol (TCP); or
hexachlorophene (HCP).
You know or have reason to believe that 2.3.7,8tetrachlorodibenzo-p-dioxin (TCDD) is or may be present in an
effluent.
If yes, continue to Item 7.17. If no, skip to Section 8.
Item 7.17 and Table E. If you answered “Yes” to Item 7.16, you
must report qualitative data, generated using a screening procedure
not calibrated with analytical standards, for TCDD. Your screening
analyses must be performed using gas chromatography with an
electron capture detector. A TCDD standard for quantitation is not
required. Describe the results of your screening analysis (e.g., “no
measurable baseline deflection at the retention time of TCDD” or “a
measurable peak within the tolerances of the retention time of
TCDD.”) on Table E. The NPDES permitting authority may require
you to perform a quantitative analysis if you report a positive result.
Answer “Yes” to Item 7.17 when you have completed Table E.
2C-4
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
General Instructions for Reporting, Sampling, and Analysis
Important note: Read these instructions before completing Tables
A through E and Section 7 of Form 2C.
All reporting of values for metals must be in terms of “total
recoverable metal,” unless:
General Items
An applicable, promulgated ELG specifies the limitation for
the metal in dissolved, valent, or total form;
All approved analytical methods for the metal inherently
measure only its dissolved form (e.g., hexavalent chromium);
or
The permitting authority has determined that in establishing
case-by-case limitations it is necessary to express the
limitations of the metal in dissolved, valent, or total form to
carry out the provisions of the CWA.
You may report some or all of the required data by attaching
separate sheets of paper instead of completing Tables A through E
for each of your outfalls so long as the sheets contain all of the
required information and are similar in format to Tables A through
E. For example, you may be able to print a report in a compatible
format from the data system used in your GC/MS analysis
completed under Table B.
If you measure only one daily value, complete the “Maximum Daily
Discharge” columns of the tables and enter “1” in the “Number of
Analyses” columns. The NPDES permitting authority may require
additional analyses to further characterize your discharges.
For composite samples, the daily value is the total mass or
average concentration found in a composite sample taken over the
operating hours of the facility during a 24-hour period. For grab
samples, the daily value is the arithmetic or flow-weighted total
mass or average concentration found in a series of at least four
grab samples taken over the operating hours of the facility during a
24-hour period.
AF
Table A requires you to report at least one analysis for each
pollutant listed. Tables B through D require you to report analytical
data in two ways. For some pollutants, you may be required to
check the box in the “Testing Required” column and test and report
the levels of the pollutants in your discharge whether or not you
expect them to be present in your discharge. For all other
pollutants, you must check the box in either the “Believed Present”
or “Believed Absent” columns based on your best estimate and test
for those you believe to be present (with some exceptions). Base
your determination that a pollutant is present in or absent from your
discharge on your knowledge of your raw materials, maintenance
chemicals, intermediate and final products and byproducts, and any
previous analyses known to you of your effluent or similar effluent.
For example, if you manufacture pesticides, you should expect
those pesticides to be present in contaminated stormwater runoff.
Note that you are not required to complete the “Maximum Monthly
Discharge” and the “Long-Term Average Daily Discharge” columns
of Tables A through C; however, these fields should be completed
if data are available.
T
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number, NPDES permit number,
facility name, and applicable outfall number at the top of each page
of the tables and any associated attachments.
R
If you would expect a pollutant to be present solely because of its
presence in your intake water, you must mark “Believed Present”
but you are not required to analyze for that pollutant. Instead, mark
an “X” in the long-term average value of the “Intake” column;
optionally, you may instead provide intake data.
Reporting of Effluent Data
D
Report sampling results for all pollutants in Tables A through C as
concentration and total mass, except for flow, temperature, pH,
color, and fecal coliform organisms. If you are reporting
quantitative data under Table D, report concentration only.
Flow, temperature, pH, color, and fecal coliform organisms must be
reported as mgd, degrees Celsius (°C), standard units, color units,
and most probable number per 100 milliliters (MPN/100 mL),
respectively. Use the following abbreviations in the columns
requiring “units” in Tables A through D.
Concentration
Mass
ppm = parts per million
lbs = pounds
mg/L = milligrams per liter
ton = tons (English tons)
ppb = parts per billion
mg = milligrams
µg/L = micrograms per liter
g = grams
kg = kilograms
T = tonnes (metric tons)
MPN = most probable number per
100 milliliters
If you measure more than one daily value for a pollutant and those
values are representative of your wastestream, you must report
them. You must describe your method of testing and data analysis.
When an applicant has two or more outfalls with substantially
identical effluents, the NPDES permitting authority may allow the
applicant to test only one outfall and report those quantitative data
as applying to the substantially identical outfall. If the permitting
authority grants your request, attach a separate sheet to the
application form identifying the outfall tested and describing why the
other outfall(s) are substantially identical.
Reporting of Intake Data
You are not required to report data under the “Intake” columns of
Tables A through C unless you wish to demonstrate your eligibility
for a “net” effluent limitation for one or more pollutants in Tables A
through C (i.e., an effluent limitation adjusted by subtracting the
average level of the pollutant(s) present in your intake water).
NPDES regulations allow net limitations only in certain
circumstances. To demonstrate your eligibility, under the “Intake”
columns report the average of the results of analyses of your intake
water and discuss the requirements for a net limitation with your
NPDES permitting authority. If your water is treated before use, test
the water after it has been treated.
2C-5
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
General Instructions for Reporting, Sampling, and Analysis Continued
Sampling
Aliquots may be collected manually or automatically. For “GC/MS
Fraction—Volatile Compounds” in Table B, aliquots must be
combined in the laboratory immediately before analysis. Four
(rather than eight) aliquots or grab samples should be collected for
this fraction. These four samples should be collected during actual
hours of discharge over a 24-hour period and need not be flow
proportioned. Only one analysis is required.
The collection of samples for the reported analyses should be
supervised by a person experienced in performing sampling of
industrial wastewater. You may contact your NPDES permitting
authority for detailed guidance on sampling techniques and for
answers to specific questions. See Exhibit 1–1 of Form 1 for
contact information. Any specific requirements in the applicable
analytical methods—for example, sample containers, sample
preservation, holding times, and the collection of duplicate
samples—must be followed.
Use of Historical Data
Except as specified below, all required quantitative data shall be
collected in accordance with sufficiently sensitive analytical
methods approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or O. A method is “sufficiently sensitive”
when:
AF
Grab samples must be used for pH, temperature, cyanide, total
phenols, residual chlorine, oil and grease, fecal coliform (including
E. coli), and enterococci (previously known as fecal streptococcus
at 40 CFR 122.26(d)(2)(iii)(A)(3)), and volatile organic compounds.
Analysis
T
The time when you sample should be representative of your normal
operation, to the extent feasible, with all processes that contribute
wastewater in normal operation, and with your treatment system
operating properly with no system upsets. Collect samples from the
center of the flow channel, where turbulence is at a maximum, at a
site specified in your present NPDES permit, or at any site
adequate for the collection of a representative sample.
Existing data may be used, if available, in lieu of sampling
conducted solely for the purposes of this application, provided that:
all data requirements are met; sampling was performed, collected,
and analyzed no more than 4.5 years prior to submission; all data
are representative of the discharge; and all available representative
data are considered in the values reported.
For all other pollutants, a 24-hour composite sample, using a
minimum of four grab samples, must be used unless specified
otherwise at 40 CFR 136. However, a minimum of one grab
sample may be taken for effluents from holding ponds or other
impoundments with a retention period greater than 24 hours.
R
For stormwater discharges, a minimum of one to four grab
samples must be taken, depending on the duration of the
discharge. One grab sample must be taken in the first hour (or
less) of discharge, with one more grab sample (up to a minimum of
four) taken in each succeeding hour of discharge for discharges
lasting four hours or more.
D
Except for stormwater discharges, the NPDES permitting authority
may waive composite sampling requirements for any outfall for
which you demonstrate that use of an automatic sampler is
infeasible and that the minimum of four grab samples will be
representative of your discharge. Results of analyses of individual
grab samples for any parameter may be averaged to obtain the
daily average. Grab samples that are not required to be analyzed
immediately may be composited in the laboratory, if the container,
preservation, and holding time requirements are met and if sample
integrity is not compromised during compositing. See Table II at 40
CFR 136.3 for further information.
A grab sample is an individual sample of at least 100 milliliters
collected at a randomly chosen time over a period not exceeding
15 minutes.
A composite sample is a combination of at least eight sample
aliquots of at least 100 milliliters, collected at periodic intervals
during the operating hours of a facility over a 24-hour period. The
composite must be flow proportional; either the time interval
between each aliquot or the volume of each aliquot must be
proportional to either the stream flow at the time of sampling or the
total stream flow since the collection of the previous aliquot.
The method minimum level (ML) is at or below the level of the
applicable water quality criterion for the measured pollutant or
pollutant parameter.
The method ML is above the water quality criterion, but the
amount of the pollutant or pollutant parameter in the facility’s
discharge is high enough that the method detects and
quantifies the level of the pollutant or pollutant parameter in
the discharge.
The method has the lowest ML of the analytical methods
approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or O for the measured pollutant or
pollutant parameter.
Consistent with 40 CFR 136, you may provide matrix- or samplespecific MLs rather than the published levels. Further, where you
can demonstrate that, despite a good faith effort to use a method
that would otherwise meet the definition of “sufficiently sensitive,”
the analytical results are not consistent with the quality assurance
(QA)/quality control (QC) specifications for that method, then the
NPDES permitting authority may determine that the method is not
performing adequately and the NPDES permitting authority should
select a different method from the remaining EPA-approved
methods that is sufficiently sensitive consistent with 40 CFR
122.21(e)(3)(i). Where no other EPA-approved methods exist, you
must select a method consistent with 40 CFR 122.21(e)(3)(ii).
When there is no analytical method that has been approved under
40 CFR 136; required under 40 CFR chapter I, subchapter N or O,
and is not otherwise required by the NPDES permitting authority,
you may use any suitable method but shall provide a description of
the method. When selecting a suitable method, other factors such
as a method’s precision, accuracy, or resolution, may be
considered when assessing the performance of the method.
2C-6
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2C—INSTRUCTIONS CONTINUED
Section 8. Used or Manufactured Toxics
Section 12. Checklist and Certification Statement
Item 8.1. Indicate if any pollutant listed in Table B is used or
manufactured in your facility as an intermediate or final product or
byproduct. If yes, continue to Item 8.2. If no, skip to Section 9.
Item 12.1. Review the checklist provided. In Column 1, mark the
sections of Form 2C that you have completed and are submitting
with your application. In Column 2, indicate for each section
whether you are submitting attachments.
Section 9. Biological Toxicity Tests
Item 9.1. Indicate if you have any knowledge or reason to believe
that any biological test for acute or chronic toxicity has been made
on any of your discharges or on a receiving water in relation to your
discharge within the last three years. If yes, continue to Item 9.2. If
no, skip to Section 10.
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A.
For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer means:
(1) 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 (2) the manager of one or
more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
END
AF
Item 9.2. Identify the tests known to have been performed and the
purposes of each. For each test, check “Yes” or “No” to indicate if
you have submitted the test results to the NPDES permitting
authority and the date the results were submitted. The NPDES
permitting authority may ask you to provide additional details after
reviewing your application.
Item 12.2. The CWA provides for severe penalties for submitting
false information on this application form. Section 309(c)(2) of the
CWA provides that “Any person who knowingly makes any false
statement, representation, or certification in any application, ...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.”
T
Item 8.2. List the applicable toxic pollutants. Note that the NPDES
permitting authority may waive or modify the requirement if you
demonstrate that it would be unduly burdensome to identify each
toxic pollutant and the permitting authority has adequate
information to issue you a permit. You may not claim this
information as confidential. Note that you do not need to distinguish
between use or production of the pollutants or list amounts.
Section 10. Contract Analyses
Item 10.1. Indicate if any of the analyses reported in Section 7 were
performed by a contract laboratory or consulting firm. If yes,
continue to Item 10.2. If no, skip to Section 11.
R
Item 10.2. Identify each laboratory or firm used in the table
provided. For each, provide the name, address, and phone number
of the laboratory or firm and the pollutants analyzed.
Section 11. Additional Information
D
Item 11.1. In addition to the information reported on the application
form, the NPDES permitting authority may request additional
information reasonably required to assess the discharges of the
facility and to determine whether to issue an NPDES permit. The
additional information may include additional quantitative data and
bioassays to assess the relative toxicity of discharges to aquatic life
and requirements to determine the cause of the toxicity. Indicate
under Item 11.1 whether the NPDES permitting authority has
requested additional information from you. If yes, continue to Item
11.2. If no, skip to Section 12.
Item 11.2. List the items requested and attach the required
information to the application.
2C-7
Submit your completed Form 1, Form 2C, and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
Exhibit 2C–1. Example Line Drawing
2C-8
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2C–2. Codes for Treatment Units and Disposal of Wastes Not Discharged
PHYSICAL TREATMENT PROCESSES
1–M ................ Grit removal
1–N ................ Microstraining
1–O ................ Mixing
1–P................. Moving bed filters
1–Q ................ Multimedia filtration
1–R ................ Rapid sand filtration
1–S................. Reverse osmosis (hyperfiltration)
1–T ................. Screening
1–U ................ Sedimentation (settling)
1–V................. Slow sand filtration
1–W................ Solvent extraction
1–X................. Sorption
2.
CHEMICAL TREATMENT PROCESSES
2–G ................ Disinfection (ozone)
2–H ................ Disinfection (other)
2–I .................. Electrochemical treatment
2–J ................. Ion exchange
2–K................. Neutralization
2–L ................. Reduction
1–A ................ Ammonia stripping
1–B ................ Dialysis
1–C ................ Diatomaceous earth filtration
1–D ................ Distillation
1–E ................ Electrodialysis
1–F................. Evaporation
1–G ................ Flocculation
1–H ................ Flotation
1–I .................. Foam fractionation
1–J ................. Freezing
1–K ................ Gas–phase separation
1–L ................. Grinding (comminutors)
AF
2–A ................ Carbon adsorption
2–B ................ Chemical oxidation
2–C ................ Chemical precipitation
2–D ................ Coagulation
2–E ................ Dechlorination
2–F................. Disinfection (chlorine)
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1.
3.
BIOLOGICAL TREATMENT PROCESSES
3–E................. Pre-aeration
3–F ................. Spray irrigation/land application
3–G ................ Stabilization ponds
3–H ................ Trickling filtration
4.
WASTEWATER DISPOSAL PROCESSES
4–C ................ Reuse/recycle of treated effluent
4–D ................ Underground injection
3–A ................ Activated sludge
3–B ................ Aerated lagoons
3–C ................ Anaerobic treatment
3–D ................ Nitrification–denitrification
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4–A ................ Discharge to surface water
4–B ................ Ocean discharge to outfall
5.
D
5–A ................ Aerobic digestion
5–B ................ Anaerobic digestion
5–C ................ Belt filtration
5–D ................ Centrifugation
5–E ................ Chemical conditioning
5–F................. Chlorine treatment
5–G ................ Composting
5–H ................ Drying beds
5–I .................. Elutriation
5–J ................. Flotation thickening
5–K ................ Freezing
5–L ................. Gravity thickening
SLUDGE TREATMENT AND DISPOSAL PROCESSES
5–M ................ Heat drying
5–N ................ Heat treatment
5–O ................ Incineration
5–P................. Land application
5–Q ................ Landfill
5–R ................ Pressure filtration
5–S................. Pyrolysis
5–T ................. Sludge lagoons
5–U ................ Vacuum filtration
5–V................. Vibration
5–W................ Wet oxidation
2C-9
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2C–3. Testing Requirements for Organic Toxic Pollutants Industry Categories*
GC/MS FRACTION†
Acid
Base/Neutral
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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AF
Adhesives and sealants ........................................................
Aluminum forming .................................................................
Auto and other laundries.......................................................
Battery manufacturing...........................................................
Coal mining ...........................................................................
Coil coating ...........................................................................
Copper forming .....................................................................
Electric and electronic compounds .......................................
Electroplating ........................................................................
Explosives manufacturing .....................................................
Foundries ..............................................................................
Gum and wood chemicals (all subparts except D and F) .....
Gum and wood chemicals, Subpart D (tall oil rosin) .............
Gum and wood chemicals, Subpart F (rosin-based
derivatives) ...........................................................................
Inorganic chemicals manufacturing ......................................
Iron and steel manufacturing ................................................
Leather tanning and finishing
Mechanical products manufacturing .....................................
Nonferrous metals manufacturing .........................................
Ore mining, Subpart B (base and precious metals) ..............
Organic chemicals manufacturing ........................................
Paint and ink formulation ......................................................
Pesticides .............................................................................
Petroleum refining.................................................................
Pharmaceutical preparations ................................................
Photographic equipment and supplies..................................
Plastic and synthetic materials manufacturing ......................
Plastic processing .................................................................
Printing and publishing .........................................................
Pulp and paperboard mills ....................................................
Rubber processing................................................................
Soap and detergent manufacturing ......................................
Steam electric power plants..................................................
Textile mills (except Subpart C, Greige Mills) .......................
Timber products processing .................................................
Volatile
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Pesticide
X
X
X
T
INDUSTRY CATEGORY
X
X
X
X
X
X
X
X
X
X
X
X
D
* See note at conclusion of 40 CFR 122, Appendix D (1983) for explanation of effect of suspensions on testing requirements for primary
industry categories.
† The pollutants in each fraction are listed in Table B.
X = Testing is required.
= Testing is not required.
2C-10
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2C–4. Hazardous Substances
144. Ferrous sulfate
145. Formaldehyde
146. Formic acid
147. Fumaric acid
148. Furfural
149. Guthion
150. Heptachlor
151. Hexachlorocyclopentadiene
152. Hydrochloric acid
153. Hydrofluoric acid
154. Hydrogen cyanide
155. Hydrogen sulfide
156. Isoprene
157. Isopropanolamine dodecylbenzenesulfonate
158. Kelthane
159. Kepone
160. Lead acetate
161. Lead arsenate
162. Lead chloride
163. Lead fluoborate
164. Lead fluorite
165. Lead iodide
166. Lead nitrate
167. Lead stearate
168. Lead sulfate
169. Lead sulfide
170. Lead thiocyanate
171. Lindane
172. Lithium chromate
173. Malathion
174. Maleic acid
175. Maleic anhydride
176. Mercaptodimethur
177. Mercuric cyanide
178. Mercuric nitrate
179. Mercuric sulfate
180. Mercuric thiocyanate
181. Mercurous nitrate
182. Methoxychlor
183. Methyl mercaptan
184. Methyl methacrylate
185. Methyl parathion
186. Mevinphos
187. Mexacarbate
188. Monoethylamine
189. Monomethylamine
190. Naled
191. Naphthalene
192. Naphthenic acid
193. Nickel ammonium sulfate
194. Nickel chloride
195. Nickel hydroxide
196. Nickel nitrate
197. Nickel sulfate
198. Nitric acid
199. Nitrobenzene
200. Nitrogen dioxide
201. Nitrophenol
202. Nitrotoluene
203. Paraformaldehyde
204. Parathion
205. Pentachlorophenol
206. Phenol
207. Phosgene
208. Phosphoric acid
209. Phosphorus
210. Phosphorus oxychloride
211. Phosphorus pentasulfide
212. Phosphorus trichloride
213. Polychlorinated biphenyls (PCB)
214. Potassium arsenate
215. Potassium arsenite
AF
T
73. Captan
74. Carbaryl
75. Carbofuran
76. Carbon disulfide
77. Carbon tetrachloride
78. Chlordane
79. Chlorine
80. Chlorobenzene
81. Chloroform
82. Chloropyrifos
83. Chlorosulfonic acid
84. Chromic acetate
85. Chromic acid
86. Chromic sulfate
87. Chromous chloride
88. Cobaltous bromide
89. Cobaltous formate
90. Cobaltous sulfamate
91. Coumaphos
92. Cresol
93. Crotonaldehyde
94. Cupric acetate
95. Cupric acetoarsenite
96. Cupric chloride
97. Cupric nitrate
98. Cupric oxalate
99. Cupric sulfate
100. Cupric sulfate ammoniated
101. Cupric tartrate
102. Cyanogen chloride
103. Cyclohexane
104. 2,4-D acid (2,4-dichlorophenoxyacetic acid)
105. 2,4-D esters (2,4-dichlorophenoxyacetic acid esters)
106. DDT
107. Diazinon
108. Dicamba
109. Dichlobenil
110. Dichlone
111. Dichlorobenzene
112. Dichloropropane
113. Dichloropropene
114. Dichloropropene-dichloproropane mix
115. 2,2-dichloropropionic acid
116. Dichlorvos
117. Dieldrin
118. Diethylamine
119. Dimethylamine
120. Dinitrobenzene
121. Dinitrophenol
122. Dinitrotoluene
123. Diquat
124. Disulfoton
125. Diuron
126. Dodecylbenzesulfonic acid
127. Endosulfan
128. Endrin
129. Epichlorohydrin
130. Ethion
131. Ethylbenzene
132. Ethylenediamine
133. Ethylene dibromide
134. Ethylene dichloride
135. Ethylene diaminetetracetic acid (EDTA)
136. Ferric ammonium citrate
137. Ferric ammonium oxalate
138. Ferric chloride
139. Ferric fluoride
140. Ferric nitrate
141. Ferric sulfate
142. Ferrous ammonium sulfate
143. Ferrous chloride
D
R
1. Acetaldehyde
2. Acetic acid
3. Acetic anhydride
4. Acetone cyanohydrin
5. Acetyl bromide
6. Acetyl chloride
7. Acrolein
8. Acrylonitrile
9. Adipic acid
10. Aldrin
11. Allyl alcohol
12. Allyl chloride
13. Aluminum sulfate
14. Ammonia
15. Ammonium acetate
16. Ammonium benzoate
17. Ammonium bicarbonate
18. Ammonium bichromate
19. Ammonium bifluoride
20. Ammonium bisulfite
21. Ammonium carbamate
22. Ammonium carbonate
23. Ammonium chloride
24. Ammonium chromate
25. Ammonium citrate
26. Ammonium fluoroborate
27. Ammonium fluoride
28. Ammonium hydroxide
29. Ammonium oxalate
30. Ammonium silicofluoride
31. Ammonium sulfamate
32. Ammonium sulfide
33. Ammonium sulfite
34. Ammonium tartrate
35. Ammonium thiocyanate
36. Ammonium thiosulfate
37. Amyl acetate
38. Aniline
39. Antimony pentachloricle
40. Antimony potassium tartrate
41. Antimony tribromide
42. Antimony trichloride
43. Antimony trifluoride
44. Antimony trioxide
45. Arsenic disulfide
46. Arsenic pentoxide
47. Arsenic trichloride
48. Arsenic trioxide
49. Arsenic trisulfide
50. Barium cyanide
51. Benzene
52. Benzoic acid
53. Benzonitrile
54. Benzoyl chloride
55. Benzyl chloride
56. Beryllium chloride
57. Beryllium fluoride
58. Beryllium nitrate
59. Butylacetate
60. n-butylphthalate
61. Butylamine
62. Butyric acid
63. Cadmium acetate
64. Cadmium bromide
65. Cadmium chloride
66. Calcium arsenate
67. Calcium arsenite
68. Calcium carbide
69. Calcium chromate
70. Calcium cyanide
71. Calcium dodecylbenzenesulfonate
72. Calcium hypochlorite
2C-11
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2C–4. Hazardous Substances
271. Uranyl acetate
272. Uranyl nitrate
273. Vanadium penoxide
274. Vanadyl sulfate
275. Vinyl acetate
276. Vinylidene chloride
277. Xylene
278. Xylenol
279. Zinc acetate
280. Zinc ammonium chloride
281. Zinc borate
282. Zinc bromide
283. Zinc carbonate
284. Zinc chloride
285. Zinc cyanide
286. Zinc fluoride
287. Zinc formate
288. Zinc hydrosulfite
289. Zinc nitrate
290. Zinc phenolsulfonate
291. Zinc phosphide
292. Zinc silicofluoride
293. Zinc sulfate
294. Zirconium nitrate
295. Zirconium potassium fluoride
296. Zirconium sulfate
297. Zirconium tetrachloride
T
D
R
245. Sodium phosphate (dibasic)
246. Sodium phosphate (tribasic)
247. Sodium selenite
248. Strontium chromate
249. Strychnine
250. Styrene
251. Sulfuric acid
252. Sulfur monochloride
253. 2,4,5-T acid (2,4,5-trichlorophenoxyacetic acid)
254. 2,4,5-T amines (2,4,5-trichlorophenoxy acetic acid
amines)
255. 2,4,5-T esters (2,4,5-trichlorophenoxy acetic acid
esters)
256. 2,4,5-T salts (2,4,5-trichlorophenoxy acetic acid salts)
257. 2,4,5-TP acid (2,4,5-trichlorophenoxy propanoic acid)
258. 2,4,5-TP acid esters (2,4,5-trichlorophenoxy propanoic
acid esters)
259. TDE (tetrachlorodiphenyl ethane)
260. Tetraethyl lead
261. Tetraethyl pyrophosphate
262. Thallium sulfate
263. Toluene
264. Toxaphene
265. Trichlorofon
266. Trichloroethylene
267. Trichlorophenol
268. Triethanolamine dodecylbenzenesulfonate
269. Triethylamine
270. Trimethylamine
AF
216. Potassium bichromate
217. Potassium chromate
218. Potassium cyanide
219. Potassium hydroxide
220. Potassium permanganate
221. Propargite
222. Propionic acid
223. Propionic anhydride
224. Propylene oxide
225. Pyrethrins
226. Quinoline
227. Resorcinol
228. Selenium oxide
229. Silver nitrate
230. Sodium
231. Sodium arsenate
232. Sodium arsenite
233. Sodium bichromate
234. Sodium bifluoride
235. Sodium bisulfite
236. Sodium chromate
237. Sodium cyanide
238. Sodium dodecylbenzenesulfonate
239. Sodium fluoride
240. Sodium hydrosulfide
241. Sodium hydroxide
242. Sodium hypochlorite
243. Sodium methylate
244. Sodium nitrite
2C-12
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
Form
2C
NPDES
EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
Outfall Location
SECTION 1. OUTFALL LOCATION (40 CFR 122.21(g)(1))
1.1
Provide information on each of the facility’s outfalls in the table below.
Outfall
Receiving Water Name
Latitude
Number
Longitude
Yes
No
T
Line
Drawing
SECTION 2. LINE DRAWING (40 CFR 122.21(g)(2))
2.1
Have you attached a line drawing to this application that shows the water flow through your facility with a water
balance? (See instructions for drawing requirements. See Exhibit 2C–1 at end of instructions for example.)
SECTION 3. AVERAGE FLOWS AND TREATMENT (40 CFR 122.21(g)(3))
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AF
For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets if
necessary.
**Outfall Number** __________
Operations Contributing to Flow
Operation
Average Flow
Treatment Units
Description
Code from
(include size, flow rate through each treatment unit,
Table 2C-1
retention time, etc.)
mgd
mgd
mgd
mgd
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
D
Average Flows and Treatment
3.1
EPA Form 3510-2C (Revised )
Page 1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
3.1
cont.
Form Approved
OMB No.
Form Expires
**Outfall Number** __________
Operations Contributing to Flow
Operation
Average Flow
mgd
mgd
mgd
mgd
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
AF
T
Average Flows and Treatment Continued
Treatment Units
Description
Code from
(include size, flow rate through each treatment unit,
Table 2C-1
retention time, etc.)
**Outfall Number** __________
Operations Contributing to Flow
Average Flow
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Operation
mgd
mgd
mgd
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
D
Treatment Units
Description
Code from
(include size, flow rate through each treatment unit,
Table 2C-1
retention time, etc.)
mgd
System
Users
3.2
Are you applying for an NPDES permit to operate a privately owned treatment works?
3.3
Yes
No SKIP to Section 4.
Have you attached a list that identifies each user of the treatment works?
Yes
No
EPA Form 3510-2C (Revised )
Page 2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
SECTION 4. INTERMITTENT FLOWS (40 CFR 122.21(g)(4))
4.1
Except for storm runoff, leaks, or spills, are any discharges described in Sections 1 and 3 intermittent or seasonal?
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
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Intermittent Flows
4.2
Yes
No SKIP to Section 5.
Provide information on intermittent or seasonal flows for each applicable outfall. Attach additional pages, if necessary.
Frequency
Flow Rate
Outfall
Operation
Duration
Average
Average
Long-Term
Maximum
Number
(list)
Days/Week
Months/Year
Average
Daily
SECTION 5. PRODUCTION (40 CFR 122.21(g)(5))
5.1
Do any effluent limitation guidelines (ELGs) promulgated by EPA under Section 304 of the CWA apply to your facility?
5.2
Yes
No SKIP to Section 6.
Provide the following information on applicable ELGs.
ELG Category
ELG Subcategory
Regulatory Citation
Are any of the applicable ELGs expressed in terms of production (or other measure of operation)?
D
5.3
Production-Based Limitations
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Applicable ELGs
5.4
Yes
No SKIP to Section 6.
Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall
Operation, Product, or Material
Quantity per Day
Number
EPA Form 3510-2C (Revised )
Unit of
Measure
Page 3
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
SECTION 6. IMPROVEMENTS (40 CFR 122.21(g)(6))
6.1
Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing,
upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
6.3
Briefly identify each applicable project in the table below.
Affected
Brief Identification and Description of
Outfalls
Project
(list outfall
number)
No SKIP to Item 6.3.
Final Compliance Dates
Source(s) of
Discharge
Required
Projected
T
6.2
Yes
Have you attached sheets describing any additional water pollution control programs (or other environmental projects
that may affect your discharges) that you now have underway or planned? (optional item)
Yes
No
AF
Upgrades and Improvements
Not applicable
SECTION 7. EFFLUENT AND INTAKE CHARACTERISTICS (40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
complete. Not all applicants need to complete each table.
Table A. Conventional and Non-Conventional Pollutants
7.1
Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
Yes
No SKIP to Item 7.3.
7.2
If yes, indicate the applicable outfalls below. Attach waiver request and other required information to the application.
R
Outfall Number _____
Outfall Number _____
7.3
Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
requested and attached the results to this application package?
a waiver has been requested from my NPDES
Yes
No;
permitting authority for all pollutants at all outfalls.
Table B. Toxic Metals, Cyanide, Total Phenols, and Organic Toxic Pollutants
7.4
Do any of the facility’s processes that contribute wastewater fall into one or more of the primary industry categories
listed in Exhibit 2C-3? (See end of instructions for exhibit.)
D
Effluent and Intake Characteristics
Outfall Number _____
7.5
No SKIP to Item 7.8.
Have you checked “Testing Required” for all toxic metals, cyanide, and total phenols in Section 1 of Table B?
7.6
Yes
Yes
No
List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s) identified
in Exhibit 2C-3.
Required GC/MS Fraction(s)
Primary Industry Category
(Check applicable boxes.)
EPA Form 3510-2C (Revised )
Volatile
Acid
Base/Neutral
Pesticide
Volatile
Acid
Base/Neutral
Pesticide
Volatile
Acid
Base/Neutral
Pesticide
Page 4
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
7.7
Have you checked “Testing Required” for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
Yes
No
7.8
Have you checked “Believed Present” or “Believed Absent” for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
Yes
No
Have you provided (1) quantitative data for those Section 1, Table B, pollutants for which you have indicated testing is
required or (2) quantitative data or other required information for those Section 1, Table B, pollutants that you have
indicated are “Believed Present” in your discharge?
Yes
No
Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
that you qualify at the top of Table B,
Yes Note
No
then SKIP to Item 7.12.
7.9
7.10
Have you provided (1) quantitative data for those Sections 2 through 5, Table B, pollutants for which you have
determined testing is required or (2) quantitative data or an explanation for those Sections 2 through 5, Table B,
pollutants you have indicated are “Believed Present” in your discharge?
Yes
No
Table C. Certain Conventional and Non-Conventional Pollutants
7.12 Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed on Table C
for all outfalls?
Yes
No
7.13 Have you completed Table C by providing (1) quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated
“Believed Present”?
Yes
No
Table D. Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed in Table D for
all outfalls?
Yes
No
7.15 Have you completed Table D by (1) describing the reasons the applicable pollutants are expected to be discharged
and (2) by providing quantitative data, if available?
Yes
No
Table E. 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (2,3,7,8-TCDD)
7.16 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions, or do you
know or have reason to believe that TCDD is or may be present in the effluent?
AF
T
7.11
D
R
Effluent and Intake Characteristics Continued
Form Approved
OMB No.
Form Expires
7.17
Yes Complete Table E.
No SKIP to Section 8.
Have you completed Table E by reporting qualitative data for TCDD?
Yes
No
Used or Manufactured
Toxics
SECTION 8. USED OR MANUFACTURED TOXICS (40 CFR 122.21(g)(9))
8.1
Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
Yes
No SKIP to Section 9.
8.2
List the pollutants below.
1.
4.
7.
2.
5.
8.
3.
6.
9.
EPA Form 3510-2C (Revised )
Page 5
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
Biological Toxicity Tests
SECTION 9. BIOLOGICAL TOXICITY TESTS (40 CFR 122.21(g)(11))
9.1
Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on (1) any of your discharges or (2) on a receiving water in relation to your discharge?
9.2
Yes
No SKIP to Section 10.
Identify the tests and their purposes below.
Test(s)
Purpose of Test(s)
Submitted to NPDES
Permitting Authority?
Yes
No
Yes
No
Yes
No
Date Submitted
Yes
No SKIP to Section 11.
Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1
Laboratory Number 2
Name of laboratory/firm
Contract Analyses
AF
10.2
T
SECTION 10. CONTRACT ANALYSES (40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
Laboratory Number 3
Laboratory address
R
Phone number
D
Pollutant(s) analyzed
Additional Information
SECTION 11. ADDITIONAL INFORMATION (40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
11.2
Yes
No SKIP to Section 12.
List the information requested and attach it to this application.
1.
4.
2.
5.
3.
6.
EPA Form 3510-2C (Revised )
Page 6
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
NPDES Permit Number
Facility Name
EPA Identification Number
Form Approved
OMB No.
Form Expires
SECTION 12. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
12.1 In Column 1 below, mark the sections of Form 2C that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to complete all sections or provide attachments.
Column 1
Column 2
Section 1: Outfall Location
w/ attachments
Section 2: Line Drawing
w/ line drawing
w/ additional attachments
Section 3: Average Flows and
Treatment
w/ attachments
w/ list of each user of
privately owned treatment
works
Section 4: Intermittent Flows
w/ attachments
Section 5: Production
w/ attachments
T
w/ attachments
w/ request for a waiver and
supporting information
w/ small business exemption
request
w/ other attachments
w/ Table A
w/ Table B
w/ Table C
w/ Table D
w/ Table E
w/ analytical results as an
attachment
w/ attachments
Section 8: Used or Manufactured
Toxics
Section 9: Biological Toxicity
Tests
w/ attachments
Section 10: Contract Analyses
w/ attachments
Section 11: Additional Information
w/ attachments
w/ attachments
AF
Section 6: Improvements
Section 7: Effluent and Intake
Characteristics
R
Checklist and Certification Statement
w/ optional additional
sheets describing any
additional pollution control
plans
w/ explanation for identical
outfalls
Section 12: Checklist and
Certification Statement
Certification Statement
D
12.2
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Signature
EPA Form 3510-2C (Revised )
Date signed
Page 7
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
Form Approved
OMB No.
Form Expires
TABLE A. CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(g)(7)(iii))1
Intake
Effluent
Pollutant
Waiver
Requested
Units
(specify)
(if applicable)
(Optional)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
Long-Term
Average Daily
Discharge
(required)
(if available)
(if available)
Number of
Analyses
Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1.
Biochemical oxygen demand
(BOD5)
2.
Chemical oxygen demand
(COD)
3.
Total organic carbon (TOC)
4.
Total suspended solids (TSS)
5.
Ammonia (as N)
6.
Flow
8.
AF
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
Concentration
Mass
Rate
°C
°C
°C
°C
pH (minimum)
Standard units
s.u.
pH (maximum)
Standard units
s.u.
Temperature (winter)
Temperature (summer)
Number of
Analyses
T
Mass
D
7.
Concentration
Long-Term
Average Value
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
1
EPA Form 3510-2C (Revised )
Page 8
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Believed
Present
Units
Believed
Absent
(specify)
Intake
Effluent
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
Long-Term
Average
Daily
Discharge
(if available)
(optional)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
Check here if you qualify as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note, however, that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1. Toxic Metals, Cyanide, and Total Phenols
1.2
Arsenic, total
(7440-38-2)
1.3
Beryllium, total
(7440-41-7)
1.4
Cadmium, total
(7440-43-9)
1.5
Chromium, total
(7440-47-3)
1.6
Copper, total
(7440-50-8)
1.7
Lead, total
(7439-92-1)
1.8
Mercury, total
(7439-97-6)
1.9
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
AF
Antimony, total
(7440-36-0)
R
1.1
Nickel, total
(7440-02-0)
1.10
Selenium, total
(7782-49-2)
1.11
Silver, total
(7440-22-4)
D
EPA Form 3510-2C (Revised )
Page 10
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Testing
Required
Pollutant/Parameter
Believed
Present
Units
Believed
Absent
(specify)
Intake
Effluent
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
Long-Term
Average
Daily
Discharge
(if available)
(optional)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
T
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
Concentration
Mass
Concentration
Zinc, total
1.13
(7440-66-6)
Mass
Concentration
Cyanide, total
1.14
(57-12-5)
Mass
Concentration
1.15 Phenols, total
Mass
Section 2. Organic Toxic Pollutants (GC/MS Fraction—Volatile Compounds)
Acrolein
(107-02-8)
2.2
Acrylonitrile
(107-13-1)
2.3
Benzene
(71-43-2)
2.4
Bromoform
(75-25-2)
2.5
Carbon tetrachloride
(56-23-5)
2.6
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
2.1
AF
Thallium, total
1.12
(7440-28-0)
Chlorobenzene
(108-90-7)
2.7
Chlorodibromomethane
(124-48-1)
2.8
Chloroethane
(75-00-3)
D
EPA Form 3510-2C (Revised )
Page 11
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
2.9
2-chloroethylvinyl ether
(110-75-8)
Units
Believed
Absent
(specify)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
2.11
Dichlorobromomethane
(75-27-4)
2.12
1,1-dichloroethane
(75-34-3)
2.13
1,2-dichloroethane
(107-06-2)
2.14
1,1-dichloroethylene
(75-35-4)
2.15
1,2-dichloropropane
(78-87-5)
2.16
1,3-dichloropropylene
(542-75-6)
2.17
Ethylbenzene
(100-41-4)
2.18
Methyl bromide
(74-83-9)
2.19
(if available)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
D
R
Long-Term
Average
Daily
Discharge
(optional)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
AF
2.10 Chloroform (67-66-3)
Believed
Present
Intake
Effluent
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
Methyl chloride
(74-87-3)
2.20
Methylene chloride
(75-09-2)
2.21
1,1,2,2- tetrachloroethane
(79-34-5)
EPA Form 3510-2C (Revised )
Page 12
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Units
Believed
Absent
(specify)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
2.23
Toluene
(108-88-3)
2.24
1,2-trans-dichloroethylene
(156-60-5)
2.25
1,1,1-trichloroethane
(71-55-6)
2.26
1,1,2-trichloroethane
(79-00-5)
2.27
Trichloroethylene
(79-01-6)
2.28
Vinyl chloride
(75-01-4)
(if available)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
R
Long-Term
Average
Daily
Discharge
(optional)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
AF
Tetrachloroethylene
2.22
(127-18-4)
Believed
Present
Intake
Effluent
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
Section 3. Organic Toxic Pollutants (GC/MS Fraction—Acid Compounds)
3.1
2-chlorophenol
(95-57-8)
3.2
2,4-dichlorophenol
(120-83-2)
3.3
2,4-dimethylphenol
(105-67-9)
3.4
4,6-dinitro-o-cresol
(534-52-1)
3.5
2,4-dinitrophenol
(51-28-5)
D
EPA Form 3510-2C (Revised )
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Page 13
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Testing
Required
Pollutant/Parameter
Believed
Present
Believed
Absent
Units
(specify)
Intake
Effluent
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
Long-Term
Average
Daily
Discharge
(if available)
(optional)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
T
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
Concentration
3.6
Mass
Concentration
4-nitrophenol
3.7
(100-02-7)
Mass
Concentration
p-chloro-m-cresol
3.8
(59-50-7)
Mass
Concentration
Pentachlorophenol
3.9
(87-86-5)
Mass
Concentration
Phenol
3.10
(108-95-2)
Mass
Concentration
2,4,6-trichlorophenol
3.11
(88-05-2)
Mass
Section 4. Organic Toxic Pollutants (GC/MS Fraction—Base /Neutral Compounds)
Concentration
Acenaphthene
4.1
(83-32-9)
Mass
Concentration
Acenaphthylene
4.2
(208-96-8)
Mass
Concentration
Anthracene
4.3
(120-12-7)
Mass
Concentration
Benzidine
4.4
(92-87-5)
Mass
Concentration
Benzo (a) anthracene
4.5
(56-55-3)
Mass
Concentration
Benzo (a) pyrene
4.6
(50-32-8)
Mass
D
R
AF
2-nitrophenol
(88-75-5)
EPA Form 3510-2C (Revised )
Page 14
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Units
Believed
Absent
(specify)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
4.7
4.8
Benzo (ghi) perylene
(191-24-2)
4.9
Benzo (k) fluoranthene
(207-08-9)
4.10
Bis (2-chloroethoxy) methane
(111-91-1)
4.11
Bis (2-chloroethyl) ether
(111-44-4)
4.12
Bis (2-chloroisopropyl) ether
(102-80-1)
4.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
4.14
4-bromophenyl phenyl ether
(101-55-3)
4.15
Butyl benzyl phthalate
(85-68-7)
4.16
2-chloronaphthalene
(91-58-7)
4.17
(if available)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
D
R
Long-Term
Average
Daily
Discharge
(optional)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
3,4-benzofluoranthene
(205-99-2)
AF
Believed
Present
Intake
Effluent
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
4-chlorophenyl phenyl ether
(7005-72-3)
4.18
Chrysene
(218-01-9)
4.19
Dibenzo (a,h) anthracene
(53-70-3)
EPA Form 3510-2C (Revised )
Page 15
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Units
Believed
Absent
(specify)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
4.21
1,3-dichlorobenzene
(541-73-1)
4.22
1,4-dichlorobenzene
(106-46-7)
4.23
3,3-dichlorobenzidine
(91-94-1)
4.24
Diethyl phthalate
(84-66-2)
4.25
Dimethyl phthalate
(131-11-3)
4.26
Di-n-butyl phthalate
(84-74-2)
4.27
2,4-dinitrotoluene
(121-14-2)
4.28
2,6-dinitrotoluene
(606-20-2)
4.29
Di-n-octyl phthalate
(117-84-0)
4.30
(if available)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
D
R
Long-Term
Average
Daily
Discharge
(optional)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
1,2-dichlorobenzene
4.20
(95-50-1)
AF
Believed
Present
Intake
Effluent
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
1,2-Diphenylhydrazine
(as azobenzene) (122-66-7)
4.31
Fluoranthene
(206-44-0)
4.32
Fluorene
(86-73-7)
EPA Form 3510-2C (Revised )
Page 16
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Units
Believed
Absent
(specify)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
4.34
Hexachlorobutadiene
(87-68-3)
4.35
Hexachlorocyclopentadiene
(77-47-4)
4.36
Hexachloroethane
(67-72-1)
4.37
Indeno (1,2,3-cd) pyrene
(193-39-5)
4.38
Isophorone
(78-59-1)
4.39
Naphthalene
(91-20-3)
4.40
Nitrobenzene
(98-95-3)
4.41
N-nitrosodimethylamine
(62-75-9)
4.42
N-nitrosodi-n-propylamine
(621-64-7)
4.43
(if available)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
D
R
Long-Term
Average
Daily
Discharge
(optional)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
AF
Hexachlorobenzene
4.33
(118-74-1)
Believed
Present
Intake
Effluent
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
N-nitrosodiphenylamine
(86-30-6)
4.44
Phenanthrene
(85-01-8)
4.45
Pyrene
(129-00-0)
EPA Form 3510-2C (Revised )
Mass
Page 17
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Believed
Present
Units
Believed
Absent
1,2,4-trichlorobenzene
4.46
(120-82-1)
Section 5. Organic Toxic Pollutants (GC/MS Fraction—Pesticides)
5.1
Aldrin
(309-00-2)
5.2
α-BHC
(319-84-6)
5.3
β-BHC
(319-85-7)
5.4
γ-BHC
(58-89-9)
5.5
δ-BHC
(319-86-8)
5.6
Chlordane
(57-74-9)
5.7
4,4’-DDT
(50-29-3)
5.8
4,4’-DDE
(72-55-9)
5.9
4,4’-DDD
(72-54-8)
5.10
Dieldrin
(60-57-1)
5.11
α-endosulfan
(115-29-7)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
Long-Term
Average
Daily
Discharge
(if available)
(optional)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
AF
(specify)
Intake
Effluent
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
D
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EPA Form 3510-2C (Revised )
Page 18
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
β-endosulfan
5.12
(115-29-7)
Believed
Present
Endosulfan sulfate
(1031-07-8)
5.14
Endrin
(72-20-8)
5.15
Endrin aldehyde
(7421-93-4)
5.16
Heptachlor
(76-44-8)
(specify)
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
Heptachlor epoxide
5.17 (1024-57-3)
PCB-1242
5.18 (53469-21-9)
PCB-1221
5.20 (11104-28-2)
D
PCB-1232
5.21 (11141-16-5)
(if available)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
R
PCB-1254
5.19 (11097-69-1)
Long-Term
Average
Daily
Discharge
(optional)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
AF
5.13
Units
Believed
Absent
Intake
Effluent
T
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Form Approved
OMB No.
Form Expires
PCB-1248
5.22 (12672-29-6)
PCB-1260
5.23 (11096-82-5)
PCB-1016
5.24 (12674-11-2)
EPA Form 3510-2C (Revised )
Page 19
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
Outfall Number
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one)
Testing
Required
Pollutant/Parameter
(and CAS Number, if available)
Believed
Present
Believed
Absent
Intake
Effluent
Maximum
Daily
Discharge
Maximum
Monthly
Discharge
(required)
(if available)
Long-Term
Average
Daily
Discharge
(if available)
(optional)
Number
of
Analyses
LongNumber
Term
of
Average
Analyses
Value
T
Toxaphene
5.25 (8001-35-2)
Units
(specify)
Form Approved
OMB No.
Form Expires
D
R
AF
Concentration
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised )
Page 20
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
TABLE C. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one)
Pollutant
Believed
Present
Believed
Absent
Units
(specify)
Maximum Daily
Discharge
(required)
Outfall Number
Form Approved
OMB No.
Form Expires
Intake
Effluent
(Optional)
Maximum
Monthly
Discharge
Long-Term
Average Daily
Discharge
(if available)
(if available)
Number of
Analyses
Long-Term
Average
Value
Number of
Analyses
Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall. You need not complete the “Presence or Absence” column of Table C for
each pollutant.
Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall. You need not complete the “Presence or Absence” column of Table C for
each pollutant.
2.
Chlorine, total
residual
3.
Color
4.
Fecal coliform
Fluoride
(16984-48-8)
6
Nitrate-nitrite
7.
Nitrogen, total
organic (as N)
8.
Oil and grease
9.
Phosphorus (as
P), total (7723-14-0)
(as SO4)
10. Sulfate
(14808-79-8)
11. Sulfide (as S)
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5.
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
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AF
Bromide
(24959-67-9)
1.
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EPA Form 3510-2C (Revised )
Page 21
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
TABLE C. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one)
Pollutant
Believed
Present
Units
Believed
Absent
(specify)
Maximum Daily
Discharge
13. Surfactants
total
14. Aluminum,
(7429-90-5)
15. Barium, total
16. Boron, total
total
17. Cobalt,
(7440-48-4)
18. Iron, total
19. Magnesium, total
(7439-95-4)
Molybdenum,
20. total
(7440-39-3)
(7440-42-8)
(7439-89-6)
(7439-98-7)
21. Manganese, total
22. Tin, total
(7440-31-5)
23. Titanium, total
(7440-32-6)
Maximum
Monthly
Discharge
Long-Term
Average Daily
Discharge
(if available)
(if available)
Number of
Analyses
Long-Term
Average
Value
Number of
Analyses
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
D
(7439-96-5)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
(Optional)
AF
(14265-45-3)
Intake
Effluent
R
12. Sulfite (as SO3)
Form Approved
OMB No.
Form Expires
T
(required)
Outfall Number
EPA Form 3510-2C (Revised )
Page 22
EPA Identification Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
NPDES Number
TABLE C. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one)
Pollutant
Believed
Present
Believed
Absent
Units
(specify)
Maximum Daily
Discharge
(required)
Form Approved
OMB No.
Form Expires
Intake
Effluent
(Optional)
Maximum
Monthly
Discharge
Long-Term
Average Daily
Discharge
(if available)
(if available)
Number of
Analyses
Long-Term
Average
Value
Number of
Analyses
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24. Radioactivity
Outfall Number
Concentration
Mass
Concentration
Beta, total
Mass
Concentration
Radium, total
Mass
Concentration
Radium 226, total
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
D
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AF
Alpha, total
EPA Form 3510-2C (Revised )
Page 23
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
EPA Identification Number
NPDES Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
Asbestos
2.
Acetaldehyde
3.
Allyl alcohol
4.
Allyl chloride
5.
Amyl acetate
6.
Aniline
7.
Benzonitrile
8.
Benzyl chloride
9.
Butyl acetate
10. Butylamine
11. Captan
15. Chlorpyrifos
16. Coumaphos
17. Cresol
18. Crotonaldehyde
19. Cyclohexane
13. Carbofuran
D
14. Carbon disulfide
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12. Carbaryl
(specify units)
AF
1.
Available Quantitative Data
T
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(g)(7)(vii))1
Presence or Absence
(check one)
Pollutant
Reason Pollutant Believed Present in Discharge
Believed
Believed
Present
Absent
Form Approved
OMB No.
Form Expires
EPA Form 3510-2C (Revised )
Page 25
EPA Identification Number
NPDES Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
21. Diazinon
22. Dicamba
23. Dichlobenil
24. Dichlone
25. 2,2-dichloropropionic acid
26. Dichlorvos
27. Diethyl amine
28. Dimethyl amine
29. Dintrobenzene
30. Diquat
35. Ethylene diamine
36. Ethylene dibromide
37. Formaldehyde
38. Furfural
32. Diuron
34. Ethion
D
33. Epichlorohydrin
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31. Disulfoton
(specify units)
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20. 2,4-D (2,4-dichlorophenoxyacetic acid)
Available Quantitative Data
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TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(g)(7)(vii))1
Presence or Absence
(check one)
Pollutant
Reason Pollutant Believed Present in Discharge
Believed
Believed
Present
Absent
Form Approved
OMB No.
Form Expires
EPA Form 3510-2C (Revised )
Page 26
EPA Identification Number
NPDES Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
40. Isoprene
41. Isopropanolamine
42. Kelthane
43. Kepone
44. Malathion
45. Mercaptodimethur
46. Methoxychlor
47. Methyl mercaptan
48. Methyl methacrylate
49. Methyl parathion
53. Monomethyl amine
54. Naled
55. Naphthenic acid
56. Nitrotoluene
57. Parathion
51. Mexacarbate
D
52. Monoethyl amine
R
50. Mevinphos
(specify units)
AF
39. Guthion
Available Quantitative Data
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TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(g)(7)(vii))1
Presence or Absence
(check one)
Pollutant
Reason Pollutant Believed Present in Discharge
Believed
Believed
Present
Absent
Form Approved
OMB No.
Form Expires
EPA Form 3510-2C (Revised )
Page 27
EPA Identification Number
NPDES Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
59. Phosgene
60. Propargite
61. Propylene oxide
62. Pyrethrins
63. Quinoline
64. Resorcinol
65. Strontium
66. Strychnine
67. Styrene
2,4,5-T (2,4,5-trichlorophenoxyacetic
acid)
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68.
69. TDE (tetrachlorodiphenyl ethane)
70.
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
propanoic acid]
D
71. Trichlorofon
(specify units)
AF
58. Phenolsulfonate
Available Quantitative Data
T
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(g)(7)(vii))1
Presence or Absence
(check one)
Pollutant
Reason Pollutant Believed Present in Discharge
Believed
Believed
Present
Absent
Form Approved
OMB No.
Form Expires
72. Triethanolamine
73. Triethylamine
74. Trimethylamine
75. Uranium
76. Vanadium
EPA Form 3510-2C (Revised )
Page 28
EPA Identification Number
NPDES Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
Outfall Number
77. Vinyl acetate
78. Xylene
79. Xylenol
80. Zirconium
Available Quantitative Data
(specify units)
T
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(g)(7)(vii))1
Presence or Absence
(check one)
Pollutant
Reason Pollutant Believed Present in Discharge
Believed
Believed
Present
Absent
Form Approved
OMB No.
Form Expires
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
D
R
AF
1
EPA Form 3510-2C (Revised )
Page 29
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
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T
This page intentionally left blank.
EPA Identification Number
NPDES Number
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Facility Name
2,3,7,8-TCDD
Results of Screening Procedure
D
R
AF
Form Approved
OMB No.
Form Expires
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TABLE E. 2,3,7,8-TETRACHLORODIBENZO-P-DIOXIN (2,3,7,8-TCDD) (40 CFR 122.21(g)(7)(viii))
Presence or
TCDD
Absence
Congeners
(check one)
Pollutant
Used or
Believed Believed
Manufactured Present
Absent
Outfall Number
EPA Form 3510-2C (Revised )
Page 31
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-2D
Revised
Water Permits Division
Application Form 2D
AF
T
New Manufacturing,
Commercial, Mining, and
Silvicultural Operations That
Have Not Yet Commenced
Discharge of Process
Wastewater
D
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NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is a new manufacturing, commercial, mining, or
silvicultural facility that has yet to commence discharge of process wastewater.
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to complete Form 2D to
average 32 hours for some minor facilities and 46 hours for some major facilities, with a weighted
average for major and minor facilities of 33.2 hours per response. This estimate includes time for
reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and
completing and reviewing the collection of information. Send comments about the burden estimate or
any other aspect of this collection of information to the Chief, Information Policy Branch (PM-223),
U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460, and
to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street,
NW, Washington, DC 20503, marked “Attention: Desk Officer for EPA.”
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Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2D—INSTRUCTIONS
General Instructions
Follow-up Requirements
Who Must Complete Form 2D?
Form 2D requires that you submit estimated data on your
effluent. Note that no later than 24 months after you commence
discharging from the proposed facility, you must complete and
submit Section 7 of NPDES Application Form 2C. However, you
need not complete those portions of Section 7 that require tests
you have already performed under the discharge monitoring
requirements of your NPDES permit. In addition, your NPDES
permitting authority may waive the requirements of Form 2C,
Section 7, if you make the demonstrations required under 40
CFR 122.22(g)(7)(i)(B) and 122.21(g)(9).
You must complete Form 2D if you answered “Yes” to Item 1.2.3 on
Form 1—that is, if you are a new manufacturing, commercial,
mining, or silvicultural facility that has yet to commence discharge
of process wastewater.
Where to File Your Completed Forms?
Submit your completed application package (Forms 1 and 2D) to
your National Pollutant Discharge Elimination System (NPDES)
permitting authority. Consult Exhibit 1–1 of Form 1’s “General
Instructions” to identify your NPDES permitting authority.
The U.S. Environmental Protection Agency (EPA) will make
information from NPDES permit application forms available to the
public for inspection and copying upon request. You may not claim
any information on Form 2D (or related attachments) as
confidential.
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Public Availability of Submitted Information
Line-by-Line Instructions
Section 1. Expected Outfall Location
Item 1.1. Identify each of the facility’s outfall structures by
number. For each outfall, specify the latitude and longitude to the
nearest 15 seconds and name of the receiving water. The
application form provides reporting space for three outfalls. If
your facility has more than this number, attach additional sheets
as necessary. The location of each outfall (i.e., where the
coordinates are collected) shall be the point where the discharge
is released into a water of the United States. Latitude and
longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS).
For further guidance, refer to
http://www.epa.gov/geospatial/latitudelongitude-data-standard.
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You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by Form
2D. Note that NPDES permitting authorities will deny claims for
treating any effluent data (estimated or actual) as confidential. If
you do not assert a claim of confidentiality at the time you submit
your information to the NPDES permitting authority, EPA may make
the information available to the public without further notice to you.
EPA will handle claims of confidentiality in accordance with the
Agency’s business confidentiality regulations at Part 2 of Title 40 of
the Code of Federal Regulations (CFR).
Completion of Forms
Definitions
The legal definitions of all key terms used in these instructions
and Form 2D are in the “Glossary” at the end of the “General
Instructions” in Form 1.
R
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
D
Provide your EPA Identification Number from the Federal Registry
Service and facility name at the top of each page of Form 2D and
any attachments. If you do not know your EPA Identification
Number, contact your NPDES permitting authority. See Exhibit 1–1
of Form 1’s “General Instructions” for contact information.
Additionally, for Tables A through E, provide the applicable outfall
number at the top of each page.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter “NA” for “not applicable” to
show that you considered the item and determined a response was
not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority’s satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
2D-1
Section 2. Expected Discharge Date
Item 2.1. Report the expected date the facility will commence
discharging (month, day, and year).
Section 3. Average Flows and Treatment
Item 3.1. For each outfall, report the operations expected to
contribute wastewater to the effluent and an estimated average
flow from each. Briefly describe the planned wastewater
treatment for each operation or list the applicable treatment
code(s) from Exhibit 2D–1, located at the end of these
instructions. Finally, for each operation, note the ultimate
disposal of any solid or liquid wastes not expected to be
discharged.
Section 4. Line Drawing
Item 4.1. Attach a line drawing showing the expected water flow
through your facility, from intake to discharge. Indicate the
sources of intake water (e.g., city, well, stream, other); all
sources of wastewater contributing to the effluent, including
process and production areas, sanitary flows, cooling water, and
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2D—INSTRUCTIONS CONTINUED
Applicable ELGs
stormwater runoff; and labeled treatment units. You may group
similar operations into a single unit.
Construct a water balance on the line drawing by showing average
flows (specify units) between intakes, operations, treatment units,
and outfalls. Show all significant losses of water to products, the
atmosphere, and discharge. You should use your best estimate. If
you cannot determine a water balance for your activities (such as
mining activities), provide a pictorial description of the nature and
amount of any sources of water and any collection and treatment
measures. An example of an acceptable line drawing is provided in
Exhibit 2D–2 at the end of these instructions.
ELG Category
Pulp, Paper,
and
Paperboard
Point Source
Category
ELG
Subcategory
Secondary
Fiber NonDeink
Subcategory
Regulatory
Citation
40 CFR 430,
Subpart J
Item 6.3. Indicate whether the limitations in the applicable ELGs
are expressed in terms of production (or other measure of
operation). An ELG is expressed in terms of production (or
another measure of operation) if the limitation is expressed as
mass of pollutant per operational parameter (e.g., “pounds of
biological oxygen demand per cubic foot of logs from which bark
is removed,” or “pounds of total suspended solids per megawatt
hour of electrical energy consumed by smelting furnace.”). An
example of an ELG not expressed in terms of a measure of
operation is one that limits the concentration of pollutants. If you
answer “No” to this item, skip to Section 7.
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Section 5. Intermittent or Seasonal Flows
Item 5.1. Specify whether any of the expected discharges
described in Sections 1 and 3 will be intermittent or seasonal. If
yes, continue to Item 5.2. If no, skip to Section 6.
6.2
Item 6.4. For each applicable outfall to which an applicable
production-based ELG applies, list the estimated level of
production (projection of actual production level, not design), for
each of the first three years of operation. The estimated
production level must be a long-term average estimate (e.g.,
average production on an annual basis). If production will vary
depending on long-term shifts in operating schedule or capacity,
you may report alternative production estimates, but you must
provide the basis for such alternatives. If known, report
quantities in units of measurements used in the applicable ELG.
If an ELG specifies a method for estimating production, you must
follow that method.
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Item 5.2. List applicable outfalls that will have intermittent or
seasonal flows. For each, indicate the operations that will contribute
to the flow. For each operation, indicate the average days per week
and average months per year the discharge will occur, the
maximum daily flow rate, the maximum total volume, and the
duration of the discharge in days. The estimated flow rate and
volume should not include stormwater runoff, spillage, or leaks. A
discharge is intermittent if it occurs with interruptions during the
operating hours of the facility. Discharges caused by routine
maintenance shutdowns, process changes, or other similar
activities are not considered to be intermittent. A discharge is
seasonal if it occurs only during certain parts of the year. The
frequency is the average recurrence rate of the discharge (in days
per week and months per year). The duration is the average value
of the time duration during which the discharge occurs (in days).
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The maximum daily flow rate is the highest daily value and should
be reported in million gallons per day (mgd). Maximum total volume
means the total volume of any one discharge within 24 hours and is
measured in units such as gallons.
D
Section 6. Production
Item 6.1. Indicate whether any effluent limitation guidelines (ELGs)
promulgated under Section 304 of the Clean Water Act (CWA)
apply to your facility. All ELGs promulgated by EPA appear in the
Federal Register and are published annually in 40 CFR
Subchapter N. An ELG applies if you have any operations
contributing process wastewater in any subcategory covered by
New Source Performance Standards (NSPS). If you are unsure
whether you are covered by a promulgated ELG, consult your
NPDES permitting authority (see Exhibit 1–1 of Form 1’s “General
Instructions”). You must check “Yes” if an applicable ELG has been
promulgated, even if the ELG is being contested in court. If you
believe that a promulgated ELG has been remanded for
reconsideration by a court and does not apply to your operations,
you may answer “No” to item 6.1 and skip to Section 7.
Item 6.2. Complete Item 6.2 by indicating the applicable ELG
category, ELG subcategory, and corresponding regulatory citation.
See the example below.
Section 7. Effluent Characteristics and Tables A through E
General Information. Section 7 requires you to report estimated
flow data for the parameters and pollutants listed in Tables A
through E, located at the end of Form 2D. You are not required
to conduct actual sampling and analysis at this time. If, however,
data from such analyses are available, you must report those
data. Note that no later than 24 months after you begin
discharging from the proposed facility, you must complete and
submit quantitative data for the pollutants and parameters in
Tables A through E. However, you need not report results for
tests you have already performed and reported under the
discharge monitoring requirements of your NPDES permit.
Complete a set of tables (Tables A through E) for each outfall at
your facility. Be sure to note the EPA Identification Number,
facility name, and outfall number at the top of each table page
and any associated attachments.
Tables A through D require you to report estimated effluent data,
with some exceptions, as discussed further below. Base your
estimates on available in-house or contractors’ engineering
reports or any other studies performed on the proposed facility.
Table E requires you to report quantitative data for the pollutants
listed, but only if it is already available.
Several tables require you to provide estimates for pollutants you
believe will be present in your discharge or will be limited directly
by an ELG or indirectly through promulgated limitations on an
2D-2
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2D—INSTRUCTIONS CONTINUED
For those pollutants you believe will be present in the discharge,
you are to provide the maximum daily and average daily
concentration and total mass and the source of the information.
Use the following codes to report your source information:
Data Source
Engineering report
Actual data from pilot plants
Estimates from other engineering
reports
Data from other similar plants
Best professional estimates
Others
Code
1
1
2
3
4
5 and specify on
the table
To request a waiver, submit a written request to the NPDES
permitting authority in advance or with the permit application. The
written request should specify the parameters that should be waived
and for what outfall(s) and why. The NPDES permitting authority
may waive Table A requirements upon a determination that less
stringent reporting requirements are adequate to support issuance
of an NPDES permit. Attach a copy of any waiver approval notice(s)
received, if applicable, to this application.
Answer Item 7.1 by indicating if you are requesting a waiver for any
of your outfalls. If yes, continue to Item 7.2. Otherwise, complete
Table A by estimating your maximum daily and average daily
discharge. Provide the source(s) of your information. Also on
Table A, indicate whether you believe each of the parameters will
be present in the facility’s intake water. See “Reporting of Intake
Data” above for further information. Skip to Item 7.3.
Item 7.2. Indicate the outfalls for which you have requested a
waiver.
Item 7.3. Indicate if you have provided estimates or actual data for
all Table A parameters for each of your outfalls for which a waiver
has not been requested and attach the results to your application
package.
AF
You may report some or all of your estimates (or actual data
when available) by attaching separate sheets of paper instead
of completing Tables A through E for each of your outfalls, so
long as the sheets contain all of the required information and
are similar in format to Tables A through E.
waiver for all pollutants for a given outfall, check the box indicating
this at the top of Table A.
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indicator pollutant. Base your determination of whether a
pollutant will be present in your discharge on your knowledge of
the proposed facility’s raw materials, maintenance chemicals,
intermediate and final products, byproducts, and any analyses of
any pollutant (you are required to report it).
Reporting of Intake Data
If you expect a pollutant to be present solely because of its
presence in your intake water, you must mark “Yes” under the
“Intake Water” column of Tables A through D. If you wish to
obtain credits for pollutants or parameters present in your
intake water, insert a separate sheet with a short statement of
why you believe you are eligible (see 40 CFR 122.45(g)).
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Reporting of Effluent Data
Report all estimated pollutant or parameter levels as
concentration and as total mass, with the exception of discharge
flow, temperature, and pH.
D
Use the following abbreviations in the columns requiring “units”
in Tables A through E.
Concentration
ppm = parts per million
Mass
lbs = pounds
mg/L = milligrams per liter
ton = tons (English tons)
ppb = parts per billion
mg = milligrams
µg/L = micrograms per liter
g = grams
MPN = most probable number
per 100 milliliters
kg = kilograms
T = tonnes (metric tons)
Conventional and Non-Conventional Parameters
Item 7.1 and Table A. All applicants are required to complete
Table A for each outfall, including outfalls discharging only
noncontact cooling water or nonprocess water unless a waiver
has been received or requested from the NPDES permitting
authority. For each parameter listed on Table A, indicate
whether a waiver has been requested. If you have requested a
Certain Conventional and Non-Conventional Pollutants
Items 7.4 through 7.6 and Table B. Complete one table for each
outfall, including outfalls discharging only noncontact cooling water
or nonprocess wastewater. Check the box at the top of Table B if
you believe all pollutants listed will be absent in the discharge. If so,
you do not need to complete Table B for the noted outfall. (You still
need to complete Items 7.4 through 7.6.) Otherwise, for each
pollutant listed in Table B, indicate whether you expect it will be
present or absent in the discharge or whether the pollutant is limited
directly by an ELG or indirectly through promulgated limitations or
an indicator pollutant. (For example, total suspended solids is used
as an indicator to control the discharge of iron and aluminum.) Next,
provide an estimated maximum daily and average daily value,
including the source of the information. If you have quantitative data
available, report it. Also on Table B, indicate whether you believe
the listed pollutants will be present in the facility’s intake water. See
“Reporting of Intake Data” above for further information. Answer
“Yes” to Items 7.4 through 7.6 once you have completed the above
tasks.
Toxic Metals, Total Cyanide, and Total Phenols
Items 7.7 and 7.8 and Table C. Complete one table for each
outfall, including outfalls discharging only noncontact cooling water
or nonprocess wastewater. Check the box at the top of Table C if
you believe all pollutants listed will be absent in the discharge. If so,
you do not need to complete Table C for the noted outfall (unless
you have quantitative data available). You still need to respond to
Items 7.7 and 7.8, however. Otherwise, indicate whether you
believe each pollutant on Table C will be present or absent in your
discharge for each applicable outfall. For those pollutants you
2D-3
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2D—INSTRUCTIONS CONTINUED
2,4,5-trichlorophenoxy acetic acid (2,4,5-T) (CAS # 93-765).
2-(2,4,5-trichlorophenoxy) propanoic acid (Silvex, 2,4,5-TP)
(CAS # 93-72-1).
2-(2,4,5-trichlorophenoxy) ethyl 2,2-dichloropropionate (Erbon)
(CAS # 136-25-4).
0,0-dimethyl 0-(2,4,5-trichlorophenyl) phosphorothioate
(Ronnel) (CAS # 299-84-3).
2,4,5-trichlorophenol (TCP) (CAS # 95-95-4).
Hexachlorophene (HCP) (CAS # 70-30-4).
Certain Hazardous Substances and Asbestos
Table E. Complete Table E for each outfall. Check the box at the
top of Table E if you believe all pollutants listed will be absent in the
discharge. Otherwise, for each pollutant listed in Table E, indicate
whether you believe it will be present or absent in the discharge. If
you have quantitative estimates available for any of the pollutants
listed, provide the maximum daily and average daily average value
and the source of the information. Also, on Table E, if you believe
the pollutant is or will be present in your facility’s intake water, state
so in the “Reason Pollutant Believed Present in Discharge” column.
AF
The sales or production figures must be for the facility that will
be the source of the discharge. The data should not be limited
only to production or sales for the process or processes that will
contribute to the discharge, unless those are the only processes
at the facility.
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believe will be present, provide an estimated maximum daily and
average daily value and source of the information. (Provide
quantitative data if you have them available.) Also, on Table C,
indicate whether you believe the pollutant is or will be present in
your facility’s intake water. See “Reporting of Intake Data” above
for more information. Answer “Yes” to Items 7.7 and 7.8 when
you have completed the above tasks.
Organic Toxic Pollutants
(Gas Chromatography/Mass Spectrometry or GC/MS
Fractions)
Item 7.9. Applicants are exempt from the reporting requirements
associated with Table D if they expect to have gross sales of
less than $100,000 per year for the next three years; also
exempt are coal mines with expected average production of less
than 100,000 tons of coal per year. If you believe you meet one
of these criteria, answer “Yes” to Item 7.9, check the small
business box at the top of Table D, and attach projected sales or
production figures. Skip to Item 7.12.
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For sales data, where intra-corporate transfers of goods and
services will be involved, the transfer price per unit should
approximate market process for those goods and services as
closely as possible. If necessary, you may index your sales
figures to the second quarter of 1980 to demonstrate your
eligibility for a small business exemption. You may accomplish
this by using the gross national product price deflator (second
quarter of 1980 = 100). This index is available online from the
U.S. Department of Commerce, Bureau of Economic Analysis at
http://bea.gov/national/pdf/SNTables.pdf.
D
Item 7.10 and 7.11 and Table D. Complete one table for each
outfall, including outfalls discharging only noncontact cooling
water or nonprocess wastewater. Check the box at the top of
Table D if you believe all pollutants listed will be absent in the
discharge from the outfall. If so, you do not need to complete
Table D for the noted outfall (unless you have quantitative data
available). Otherwise, for each pollutant listed, indicate whether
you believe it will be present or absent in the discharge. For
those you believe will be present, provide an estimated
maximum daily and average daily value and the source of the
information. Also, on Table D, indicate whether you believe the
pollutant is or will be present in your facility’s intake water. See
“Reporting of Intake Data” above for further information. Finally,
answer “Yes” to Items 7.10 and 7.11 when you have completed
the above tasks.
2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD)
Item 7.12. Answer whether the facility uses or manufactures one
or more of the 2,3,7,8-TCDD congeners listed below or if you
know or have reason to believe that TCDD is or may be present
in effluent from any of your outfalls:
Item 7.13. Indicate whether, for each of your outfalls, you have
indicated whether you know or have reason to believe that any
pollutants listed in Table E are discharged.
Item 7.14. Indicate whether, for each of your outfalls, you have
completed and attached Table E to the application describing the
reasons the applicable pollutants are expected to be discharged
and providing quantitative data if available.
Under 40 CFR 117.12(a)(2), certain discharges of hazardous substances
(listed in Exhibit 2D-3 at the end of these instructions) may be exempted from
the requirements of Section 311 of the CWA, which establishes reporting
requirements, civil penalties, and liability for cleanup costs for spills of oil and
hazardous substances. A discharge of a particular substance can be exempted
if the origin, source, and amount of the discharged substances are identified in
the NPDES permit application or in the permit, if the permit contains a
requirement for treatment of the discharge, and if the treatment is in place.
Exemptions are allowed from the requirements of CWA Section 311.
Applications for exemptions must set forth the following information:
1. The substance and the amount of each substance that may be discharged.
2. The origin and source of the discharge of the substance.
3. The treatment to be provided for the discharge by:
a. An onsite treatment system separate from any treatment system
treating your normal discharge;
b. A treatment system designed to treat your normal discharge and that is
additionally capable of treating the amount of the substance identified
under paragraph 1 above; or
c. Any combination of the above.
See 40 CFR 117.12(a)(2) and (c) or contact your NPDES permitting authority
for further information on exclusions from CWA Section 311.
Intake Credits
Item 7.15. Answer whether you are seeking to obtain credits for any
of the pollutants or parameters listed in Section 7 (Tables A through
E) in your intake water for any of the facility’s outfalls.
2D-4
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
FORM 2D—INSTRUCTIONS CONTINUED
Section 8. Engineering Report
Item 8.1. Indicate if any technical evaluations have been
conducted of your wastewater treatment, including engineering
reports or pilot plant studies. If yes, continue to Item 8.2. If no,
skip to Item 8.3.
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A.
Item 8.2. Attach the technical evaluation(s) you considered when
responding to Item 8.1 and any related documentation, then
answer “Yes” to Item 8.2. The NPDES permit writer will use this
information to determine appropriate treatment methods and
associated permit conditions and limits.
Item 8.3. Answer “Yes” if you are aware of any existing plant(s)
that resemble your production processes, wastewater
constituents, or wastewater treatment. If you are unaware of such
plants, answer “No” and skip to Section 9.
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Item 8.4. Provide the name and location of any existing plant(s)
that resemble(s) your production facility. You do not need to
conduct any studies to respond to this item.
For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer
means: (1) 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 decisionmaking functions for the corporation, or (2) the manager of
one or more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
END
Submit your completed Form 1, Form 2D, and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
AF
Section 9. Other Information
Item 9.1. Indicate whether you have attached to the application
any optional information that you would like considered as part of
the application review process. These should be items beyond
those you have already noted as being included in the package.
Skip to Section 10 if you do not have further information to
provide.
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Item 9.2. List the additional materials attached and note why you
think the NPDES permitting authority should consider them when
reviewing your application and developing your permit.
Section 10. Checklist and Certification Statement
Item 10.1. Review the checklist provided. In column 1, mark the
sections of Form 2D that you have completed and are submitting
with your application. For each section, indicate in column 2
whether you are submitting attachments.
D
Item 10.2. The CWA provides for severe penalties for submitting
false information on this application form. Section 309(c)(2) of the
CWA provides that “Any person who knowingly makes any false
statement, representation, or certification in any application,
...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.”
2D-5
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2D–1. Codes for Treatment Units and Disposal of Wastes Not Discharged
1.
1–A................. Ammonia stripping
1–B................. Dialysis
1–C ................ Diatomaceous earth filtration
1–D ................ Distillation
1–E................. Electrodialysis
1–F ................. Evaporation
1–G ................ Flocculation
1–H ................ Flotation
1–I .................. Foam fractionation
1–J ................. Freezing
1–K................. Gas-phase separation
1–L ................. Grinding (comminutors)
2.
CHEMICAL TREATMENT PROCESSES
2–G ................ Disinfection (ozone)
2–H ................ Disinfection (other)
2–I.................. Electrochemical treatment
2–J ................. Ion exchange
2–K ................ Neutralization
2–L................. Reduction
AF
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2–A................. Carbon adsorption
2–B................. Chemical oxidation
2–C ................ Chemical precipitation
2–D ................ Coagulation
2–E................. Dechlorination
2–F ................. Disinfection (chlorine)
PHYSICAL TREATMENT PROCESSES
1–M................ Grit removal
1–N ................ Microstraining
1–O ................ Mixing
1–P ................ Moving bed filters
1–Q ................ Multimedia filtration
1–R ................ Rapid sand filtration
1–S ................ Reverse osmosis (hyperfiltration)
1–T ................ Screening
1–U ................ Sedimentation (settling)
1–V ................ Slow sand filtration
1–W ............... Solvent extraction
1–X ................ Sorption
3.
3–A................. Activated sludge
3–B................. Aerated lagoons
3–C ................ Anaerobic treatment
3–D ................ Nitrification–denitrification
BIOLOGICAL TREATMENT PROCESSES
3–E ................ Pre-aeration
3–F ................ Spray irrigation/land application
3–G ................ Stabilization ponds
3–H ................ Trickling filtration
4.
OTHER PROCESSES
4–C ............... Reuse/recycle of treated effluent
4–D ............... Underground injection
R
4–A................. Discharge to surface water
4–B................. Ocean discharge through outfall
SLUDGE TREATMENT AND DISPOSAL PROCESSES
5–A................. Aerobic digestion
5–M................ Heat drying
5–B................. Anaerobic digestion
5–N ................ Heat treatment
5–C ................ Belt filtration
5–O ................ Incineration
5–D ................ Centrifugation
5–P ................ Land application
5–E................. Chemical conditioning
5–Q ................ Landfill
5–F ................. Chlorine treatment
5–R ................ Pressure filtration
5–G ................ Composting
5–S ................ Pyrolysis
5–H ................ Drying beds
5–T ................ Sludge lagoons
5–I .................. Elutriation
5–U ................ Vacuum filtration
5–J ................. Flotation thickening
5–V ................ Vibration
5–K................. Freezing
5–W ............... Wet oxidation
5–L ................. Gravity thickening
D
5.
2D-6
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2D–2. Example Line Drawing
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AF
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2D-7
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2D–3. Hazardous Substances
144. Ferrous sulfate
145. Formaldehyde
146. Formic acid
147. Fumaric acid
148. Furfural
149. Guthion
150. Heptachlor
151. Hexachlorocyclopentadiene
152. Hydrochloric acid
153. Hydrofluoric acid
154. Hydrogen cyanide
155. Hydrogen sulfide
156. Isoprene
157. Isopropanolamine dodecylbenzenesulfonate
158. Kelthane
159. Kepone
160. Lead acetate
161. Lead arsenate
162. Lead chloride
163. Lead fluoborate
164. Lead fluorite
165. Lead iodide
166. Lead nitrate
167. Lead stearate
168. Lead sulfate
169. Lead sulfide
170. Lead thiocyanate
171. Lindane
172. Lithium chromate
173. Malathion
174. Maleic acid
175. Maleic anhydride
176. Mercaptodimethur
177. Mercuric cyanide
178. Mercuric nitrate
179. Mercuric sulfate
180. Mercuric thiocyanate
181. Mercurous nitrate
182. Methoxychlor
183. Methyl mercaptan
184. Methyl methacrylate
185. Methyl parathion
186. Mevinphos
187. Mexacarbate
188. Monoethylamine
189. Monomethylamine
190. Naled
191. Naphthalene
192. Naphthenic acid
193. Nickel ammonium sulfate
194. Nickel chloride
195. Nickel hydroxide
196. Nickel nitrate
197. Nickel sulfate
198. Nitric acid
199. Nitrobenzene
200. Nitrogen dioxide
201. Nitrophenol
202. Nitrotoluene
203. Paraformaldehyde
204. Parathion
205. Pentachlorophenol
206. Phenol
207. Phosgene
208. Phosphoric acid
209. Phosphorus
210. Phosphorus oxychloride
211. Phosphorus pentasulfide
212. Phosphorus trichloride
213. Polychlorinated biphenyls (PCB)
214. Potassium arsenate
215. Potassium arsenite
AF
T
73. Captan
74. Carbaryl
75. Carbofuran
76. Carbon disulfide
77. Carbon tetrachloride
78. Chlordane
79. Chlorine
80. Chlorobenzene
81. Chloroform
82. Chloropyrifos
83. Chlorosulfonic acid
84. Chromic acetate
85. Chromic acid
86. Chromic sulfate
87. Chromous chloride
88. Cobaltous bromide
89. Cobaltous formate
90. Cobaltous sulfamate
91. Coumaphos
92. Cresol
93. Crotonaldehyde
94. Cupric acetate
95. Cupric acetoarsenite
96. Cupric chloride
97. Cupric nitrate
98. Cupric oxalate
99. Cupric sulfate
100. Cupric sulfate ammoniated
101. Cupric tartrate
102. Cyanogen chloride
103. Cyclohexane
104. 2,4-D acid (2,4-dichlorophenoxyacetic acid)
105. 2,4-D esters (2,4-dichlorophenoxyacetic acid esters)
106. DDT
107. Diazinon
108. Dicamba
109. Dichlobenil
110. Dichlone
111. Dichlorobenzene
112. Dichloropropane
113. Dichloropropene
114. Dichloropropene-dichloproropane mix
115. 2,2-dichloropropionic acid
116. Dichlorvos
117. Dieldrin
118. Diethylamine
119. Dimethylamine
120. Dinitrobenzene
121. Dinitrophenol
122. Dinitrotoluene
123. Diquat
124. Disulfoton
125. Diuron
126. Dodecylbenzesulfonic acid
127. Endosulfan
128. Endrin
129. Epichlorohydrin
130. Ethion
131. Ethylbenzene
132. Ethylenediamine
133. Ethylene dibromide
134. Ethylene dichloride
135. Ethylene diaminetetracetic acid (EDTA)
136. Ferric ammonium citrate
137. Ferric ammonium oxalate
138. Ferric chloride
139. Ferric fluoride
140. Ferric nitrate
141. Ferric sulfate
142. Ferrous ammonium sulfate
143. Ferrous chloride
D
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1. Acetaldehyde
2. Acetic acid
3. Acetic anhydride
4. Acetone cyanohydrin
5. Acetyl bromide
6. Acetyl chloride
7. Acrolein
8. Acrylonitrile
9. Adipic acid
10. Aldrin
11. Allyl alcohol
12. Allyl chloride
13. Aluminum sulfate
14. Ammonia
15. Ammonium acetate
16. Ammonium benzoate
17. Ammonium bicarbonate
18. Ammonium bichromate
19. Ammonium bifluoride
20. Ammonium bisulfite
21. Ammonium carbamate
22. Ammonium carbonate
23. Ammonium chloride
24. Ammonium chromate
25. Ammonium citrate
26. Ammonium fluoroborate
27. Ammonium fluoride
28. Ammonium hydroxide
29. Ammonium oxalate
30. Ammonium silicofluoride
31. Ammonium sulfamate
32. Ammonium sulfide
33. Ammonium sulfite
34. Ammonium tartrate
35. Ammonium thiocyanate
36. Ammonium thiosulfate
37. Amyl acetate
38. Aniline
39. Antimony pentachloricle
40. Antimony potassium tartrate
41. Antimony tribromide
42. Antimony trichloride
43. Antimony trifluoride
44. Antimony trioxide
45. Arsenic disulfide
46. Arsenic pentoxide
47. Arsenic trichloride
48. Arsenic trioxide
49. Arsenic trisulfide
50. Barium cyanide
51. Benzene
52. Benzoic acid
53. Benzonitrile
54. Benzoyl chloride
55. Benzyl chloride
56. Beryllium chloride
57. Beryllium fluoride
58. Beryllium nitrate
59. Butylacetate
60. n-butylphthalate
61. Butylamine
62. Butyric acid
63. Cadmium acetate
64. Cadmium bromide
65. Cadmium chloride
66. Calcium arsenate
67. Calcium arsenite
68. Calcium carbide
69. Calcium chromate
70. Calcium cyanide
71. Calcium dodecylbenzenesulfonate
72. Calcium hypochlorite
2D-8
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
Exhibit 2D–3. Hazardous Substances
271. Uranyl acetate
272. Uranyl nitrate
273. Vanadium penoxide
274. Vanadyl sulfate
275. Vinyl acetate
276. Vinylidene chloride
277. Xylene
278. Xylenol
279. Zinc acetate
280. Zinc ammonium chloride
281. Zinc borate
282. Zinc bromide
283. Zinc carbonate
284. Zinc chloride
285. Zinc cyanide
286. Zinc fluoride
287. Zinc formate
288. Zinc hydrosulfite
289. Zinc nitrate
290. Zinc phenolsulfonate
291. Zinc phosphide
292. Zinc silicofluoride
293. Zinc sulfate
294. Zirconium nitrate
295. Zirconium potassium fluoride
296. Zirconium sulfate
297. Zirconium tetrachloride
T
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245. Sodium phosphate (dibasic)
246. Sodium phosphate (tribasic)
247. Sodium selenite
248. Strontium chromate
249. Strychnine
250. Styrene
251. Sulfuric acid
252. Sulfur monochloride
253. 2,4,5-T acid (2,4,5-trichlorophenoxyacetic acid)
254. 2,4,5-T amines (2,4,5-trichlorophenoxy acetic acid
amines)
255. 2,4,5-T esters (2,4,5-trichlorophenoxy acetic acid
esters)
256. 2,4,5-T salts (2,4,5-trichlorophenoxy acetic acid
salts)
257. 2,4,5-TP acid (2,4,5-trichlorophenoxy propanoic
acid)
258. 2,4,5-TP acid esters (2,4,5-trichlorophenoxy
propanoic acid esters)
259. TDE (tetrachlorodiphenyl ethane)
260. Tetraethyl lead
261. Tetraethyl pyrophosphate
262. Thallium sulfate
263. Toluene
264. Toxaphene
265. Trichlorofon
266. Trichloroethylene
267. Trichlorophenol
268. Triethanolamine dodecylbenzenesulfonate
269. Triethylamine
270. Trimethylamine
AF
216. Potassium bichromate
217. Potassium chromate
218. Potassium cyanide
219. Potassium hydroxide
220. Potassium permanganate
221. Propargite
222. Propionic acid
223. Propionic anhydride
224. Propylene oxide
225. Pyrethrins
226. Quinoline
227. Resorcinol
228. Selenium oxide
229. Silver nitrate
230. Sodium
231. Sodium arsenate
232. Sodium arsenite
233. Sodium bichromate
234. Sodium bifluoride
235. Sodium bisulfite
236. Sodium chromate
237. Sodium cyanide
238. Sodium dodecylbenzenesulfonate
239. Sodium fluoride
240. Sodium hydrosulfide
241. Sodium hydroxide
242. Sodium hypochlorite
243. Sodium methylate
244. Sodium nitrite
2D-9
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
Contains Nonbinding Recommendations
NPDES
NumberForms - Not for Implementation
Facility Name
Draft Permit
Application
EPA Identification Number
Form Approved
OMB No.
Form Expires
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
Form
2D
NPDES
NEW MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURAL OPERATIONS
THAT HAVE NOT YET COMMENCED DISCHARGE OF PROCESS WASTEWATER
SECTION 1. EXPECTED OUTFALL LOCATION (40 CFR 122.21(k)(1))
1.1 Provide information on each of the facility’s outfalls in the table below.
Outfall
Receiving Water
Latitude
Number
Name
Outfall Location
Longitude
Day
Year
T
Expected
Discharge
Date
SECTION 2. EXPECTED DISCHARGE DATE (40 CFR 122.21(k)(2))
2.1
Month
AF
R
mgd
mgd
mgd
mgd
mgd
Treatment Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
Code from
Exhibit 2D-1
Final Disposal of Solid or Liquid
Wastes Other Than by Discharge
D
Average Flows and Treatment
SECTION 3. AVERAGE FLOWS AND TREATMENT (40 CFR 122.21(k)(3)(i))
3.1 For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets as
necessary.
**Outfall Number** _________
Operations Contributing to Flow
Operation
Average Flow
EPA Form 3510-2D (Revised )
Page 1
Contains Nonbinding Recommendations
NPDES
NumberForms - Not for Implementation
Facility Name
Draft Permit
Application
EPA Identification Number
Form Approved
OMB No.
Form Expires
3.1
**Outfall Number** _________
Operations Contributing to Flow
Operation
Cont.
Average Flow
mgd
mgd
mgd
mgd
mgd
Treatment Units
Final Disposal of Solid or Liquid
Wastes Other Than by Discharge
AF
T
Code from
Exhibit 2D-1
R
**Outfall Number** _________
Operations Contributing to Flow
Operation
D
Average Flows and Treatment Continued
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
mgd
mgd
mgd
mgd
mgd
Treatment Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
EPA Form 3510-2D (Revised )
Average Flow
Code from
Exhibit 2D-1
Final Disposal of Solid or Liquid
Wastes Other Than by Discharge
Page 2
Contains Nonbinding Recommendations
NPDES
NumberForms - Not for Implementation
Facility Name
Draft Permit
Application
EPA Identification Number
Form Approved
OMB No.
Form Expires
Line
Drawing
SECTION 4. LINE DRAWING (40 CFR 122.21(k)(3)(ii))
Have you attached a line drawing to this application that shows the water flow through your facility with a water
4.1
balance? (See instructions for drawing requirements. See Exhibit 2D–2 at end of instructions for example.)
Yes
No
SECTION 5. INTERMITTENT OR SEASONAL FLOWS (40 CFR 122.21(k)(3)(iii))
Except for stormwater runoff, leaks, or spills, are any expected discharges described in Sections 1 and 3 intermittent
5.1
or seasonal?
No SKIP to Section 6.
Provide information on intermittent or seasonal flows for each applicable outfall. Attach additional pages, if
necessary.
Frequency
Rate and Volume
Outfall Operations
Duration
Average
Average
Maximum Daily
Maximum Total
Number
(list)
Days/Week Months/Year
Discharge
Volume
Operations
(list)
months/year
mgd
gallons
days/week
months/year
mgd
gallons
days
days/week
months/year
mgd
gallons
days
Frequency
Average
Average
Days/Week Months/Year
Rate and Volume
Maximum Daily
Maximum Total
Discharge
Volume
AF
Outfall
Number
days/week
T
Intermittent or Seasonal Flows
5.2
Yes
Outfall
Number
Operations
(list)
days
Duration
days/week
months/year
mgd
gallons
days
days/week
months/year
mgd
gallons
days
days/week
months/year
mgd
gallons
days
Frequency
Average
Average
Days/Week Months/Year
Duration
months/year
mgd
gallons
days
days/week
months/year
mgd
gallons
days
days/week
months/year
mgd
gallons
days
R
days/week
Rate and Volume
Maximum Daily
Maximum Total
Discharge
Volume
D
SECTION 6. PRODUCTION (40 CFR 122.21(k)(4))
6.1
Do any effluent limitation guidelines (ELGs) promulgated by EPA under CWA Section 304 apply to your facility?
Production
6.2
Yes
No SKIP to Section 7.
Provide the following information on applicable ELGs.
ELG Category
EPA Form 3510-2D (Revised )
ELG Subcategory
Regulatory Citation
Page 3
Contains Nonbinding Recommendations
NPDES
NumberForms - Not for Implementation
Facility Name
Draft Permit
Application
EPA Identification Number
6.3
Are the limitations in the applicable ELGs expressed in terms of production (or other measure of operation)?
6.4
Form Approved
OMB No.
Form Expires
Yes
No SKIP to Section 7.
Provide an expected measure of average daily production expressed in terms and units of applicable ELGs.
Outfall
Number
Year
Expected Actual Average Daily Production for First Three Years
Quantity per Day
Operation, Product, or Material
(note basis if applicable)
Unit of Measure
Year 1
Production Continued
Year 2
Year 3
Year 2
AF
Year 3
T
Year 1
Year 1
Year 2
Year 3
SECTION 7. EFFLUENT CHARACTERISTICS (40 CFR 122.21(k)(5))
R
See the instructions to determine the parameters and pollutants you are required to monitor and, in turn, the tables you must
complete. Note that not all applicants need to complete each table.
Table A. Conventional and Non-Conventional Parameters
Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A parameters for any
7.1
of your outfalls?
No SKIP to Item 7.3.
If yes, indicate the applicable outfalls below. Attach waiver request and other required information to the application.
Outfall number ________
Outfall number ________
Outfall number ________
Have
you
have
provided
estimates
or
actual
data
for
all
Table
A
parameters
for
each
of your outfalls for which a
7.3
waiver has not been requested and attached the results to this application package?
No; a waiver has been requested from my
Yes
NPDES permitting authority for all parameters at
all outfalls.
Table B. Certain Conventional and Non-Conventional Pollutants
Have you checked “Believed Present” for all pollutants listed in Table B that are limited directly or indirectly by an
7.4
applicable ELG?
Yes
No
D
Effluent Characteristics
7.2
Yes
7.5
Have you checked “Believed Present” or “Believed Absent” for all remaining pollutants listed in Table B?
7.6
Yes
No
Have you provided estimated data for those Table B pollutants for which you have indicated are “Believed Present”
in your discharge?
Yes
EPA Form 3510-2D (Revised )
No
Page 4
Contains Nonbinding Recommendations
NPDES
NumberForms - Not for Implementation
Facility Name
Draft Permit
Application
EPA Identification Number
Form Approved
OMB No.
Form Expires
Table C. Toxic Metals, Total Cyanide, and Total Phenols
Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed on Table C
7.7
for all outfalls?
Yes
No
7.8
Have you completed Table C by providing estimated data for pollutants you indicated are “Believed Present,”
including the source of the information, for each applicable outfall?
Yes
No
Table D. Organic Toxic Pollutants (GC/MS Fractions)
7.9
Do you qualify for a small business exemption under the criteria specified in the Instructions?
Yes Note that you qualify at the top of
No
Table D, then SKIP to Item 7.12.
Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed on Table D
for all outfalls?
7.10
Yes
No
7.11 Have you completed Table D by providing estimated data for pollutants you indicated are “Believed Present,”
including the source of the information, for each applicable outfall?
Yes
No
2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD)
7.12 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the Instructions, or do you
know or have reason to believe that TCDD is or may be present in effluent from any of your outfalls?
T
AF
Effluent Characteristics Continued
Yes
No
Table E. Certain Hazardous Substances and Asbestos
7.13 Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed in Table E
for all outfalls?
7.14
Yes
No
Have you completed Table E by reporting the reason the pollutants are expected to be present and available
quantitative data for pollutants you indicated are “Believed Present” for each applicable outfall?
Yes
No
Engineering Report
D
R
Intake Credits, Tables A through E
7.15 Are you applying for net credits for the presence of any of the pollutants on Tables A through E for any of your
outfalls?
Yes Consult with your NPDES permitting
No
authority.
SECTION 8. ENGINEERING REPORT (40 CFR 122.21(k)(6))
8.1
Do you have any technical evaluations of your wastewater treatment, including engineering reports or pilot plant
studies?
8.2
No SKIP to Item 8.3.
Have you provided the technical evaluation and all related documents to this application package?
8.3
Yes
Yes
No
Are you aware of any existing plant(s) that resemble production processes, wastewater constituents, or wastewater
treatment at your facility?
Yes
EPA Form 3510-2D (Revised )
No SKIP to Section 9.
Page 5
Contains Nonbinding Recommendations
NPDES
NumberForms - Not for Implementation
Facility Name
Draft Permit
Application
EPA Identification Number
Form Approved
OMB No.
Form Expires
Engineering Report
Continued
8.4
Provide the name and location of the similar plants.
Name of Similar Plants
Location of Similar Plants
SECTION 9. OTHER INFORMATION (40 CFR 122.21(k)(7))
9.1
Have you attached any optional information that you would like considered as part of the application review process
(i.e., material beyond that which you have already noted in the application as being attached)?
9.2
Yes
No SKIP to Section 10.
List the additional items and briefly note why you have included them.
1.
2.
T
Other Information
3.
5.
AF
4.
R
Section 4: Line Drawing
w/ line drawing
Section 5: Intermittent or
Seasonal Flows
w/ attachments
Section 6: Production
w/ attachments
D
Checklist and Certification Statement
SECTION 10. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
10.1 In Column 1 below, mark the sections of Form 2D that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to complete all sections or tables, or provide attachments.
Column 1
Column 2
Section 1: Expected Outfall
w/ attachments (e.g., responses for additional outfalls)
Location
Section 2: Expected
w/ attachments
Discharge Date
Section 3: Average Flows
w/ attachments
and Treatment
Section 7: Effluent
Characteristics
Section 8: Engineering
Report
Section 9: Other Information
Section 10: Checklist and
Certification Statement
EPA Form 3510-2D (Revised )
w/ additional attachments
w/ Table A waiver
request or
approval
Table A
Table B
Table C
Table D
Table E
w/ other
attachments
w/ technical evaluations and related attachments
w/ optional information
w/ attachments
Page 6
Contains Nonbinding Recommendations
NPDES
NumberForms - Not for Implementation
Facility Name
Draft Permit
Application
EPA Identification Number
Form Approved
OMB No.
Form Expires
10.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Signature
Date signed
D
R
AF
T
Checklist and Certification Statement
Continued
EPA Form 3510-2D (Revised )
Page 7
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
Contains Nonbinding Recommendations
FacilityDraft
NameApplication Forms - Not for Implementation
Outfall Number
EPA Identification Number
TABLE A. CONVENTIONAL AND NON-CONVENTIONAL PARAMETER ESTIMATES (40 CFR 122.21(k)(5)(i))1
Effluent Data
Waiver
Units
Maximum Daily Average Daily
Pollutant
Requested
Source of Information
Discharge
Discharge
(if applicable)
(use codes in instructions)
(required)
(if available)
Check here if you have applied to your NPDES authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1.
Biochemical oxygen
demand (BOD5)
2.
Chemical oxygen demand
(COD)
3.
Total organic carbon
(TOC)
4.
Total suspended solids
(TSS)
5.
Ammonia (as N)
6.
Flow
8.
Temperature (summer)
T
Concentration
AF
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
Temperature (winter)
Mass
Rate
°C
°C
°C
°C
D
7.
Concentration
pH (minimum)
Standard units
s.u.
pH (maximum)
Standard units
s.u.
Form Approved
OMB No.
Form Expires
Intake Water
Believed Present?
(check only one response per
parameter)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2D (Revised )
Page 1
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
Contains Nonbinding Recommendations
Facility
Name
Outfall Number
Draft
Application Forms - Not for Implementation
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE B. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(k)(5)(ii))1
Presence or Absence
Estimated Data for Pollutants Expected to be Present or Limited by an ELG
(check one)
Pollutant
Believed
Present
(Provide both concentration and mass estimates for each pollutant.)
Believed
Absent
Units
Effluent
Maximum Daily Average Daily
Discharge
Discharge
(required)
(if available)
Source of Information
Intake Water
Believed Present?
(check only one
response per item)
(use codes in instructions)
Check () here if you believe all pollutants listed to be absent from the discharge. You need not complete Table B for the noted outfall unless you have quantitative data available.
1.
Bromide
(24959-67-9)
2.
Chlorine, total
residual
3.
Color
4.
Fecal coliform
5.
Fluoride
(16984-48-8)
6.
Nitrate-nitrite
7.
Nitrogen, total
organic (as N)
8.
Oil and grease
9.
Phosphorus (as P),
total (7723-14-0)
Sulfate (as SO4)
(14808-79-8)
Sulfide (as S)
11.
Mass
Concentration
Mass
AF
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
R
Mass
Concentration
Mass
Concentration
Mass
D
10.
Concentration
EPA Form 3510-2D (Revised )
T
Concentration
Mass
Concentration
Mass
Concentration
Mass
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 3
Contains Nonbinding Recommendations
Facility
Name
Outfall Number
Draft
Application Forms - Not for Implementation
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE B. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(k)(5)(ii))1
Presence or Absence
Estimated Data for Pollutants Expected to be Present or Limited by an ELG
(check one)
Pollutant
Believed
Present
(Provide both concentration and mass estimates for each pollutant.)
Believed
Absent
Units
Effluent
Maximum Daily Average Daily
Discharge
Discharge
(required)
13.
Surfactants
14.
Aluminum, total
(7429-90-5)
15.
Barium, total
(7440-39-3)
16.
Boron, total
(7440-42-8)
17.
Cobalt, total
(7440-48-4)
18.
Iron, total
(7439-89-6)
19.
Magnesium, total
(7439-95-4)
20.
Molybdenum, total
(7439-98-7)
21.
Manganese, total
(7439-96-5)
22.
Tin, total
(7440-31-5)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
D
Mass
EPA Form 3510-2D (Revised )
Concentration
Mass
Concentration
Mass
(check only one
response per item)
(use codes in instructions)
T
AF
Sulfite (as SO3)
(14265-45-3)
R
12.
(if available)
Source of Information
Intake Water
Believed Present?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 4
Contains Nonbinding Recommendations
Facility
Name
Outfall Number
Draft
Application Forms - Not for Implementation
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE B. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(k)(5)(ii))1
Presence or Absence
Estimated Data for Pollutants Expected to be Present or Limited by an ELG
(check one)
Pollutant
Believed
Present
(Provide both concentration and mass estimates for each pollutant.)
Believed
Absent
Units
Effluent
Maximum Daily Average Daily
Discharge
Discharge
(required)
Titanium, total
(7440-32-6)
24.
Radioactivity
24.1 Alpha, total
Concentration
Mass
Concentration
Mass
(check only one
response per item)
(use codes in instructions)
T
23.
(if available)
Source of Information
Intake Water
Believed Present?
Yes
No
Yes
No
D
R
AF
Concentration
Yes No
Mass
Concentration
24.3. Radium, total
Mass
Yes No
Concentration
24.4 Radium 226, total
Mass
Yes No
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
24.2 Beta, total
EPA Form 3510-2D (Revised )
Page 5
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
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T
This page intentionally left blank.
Contains Nonbinding Recommendations
Facility
DraftName
Application Forms - Not for Implementation Outfall Number
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE C. TOXIC METALS, TOTAL CYANIDE, AND TOTAL PHENOLS (40 CFR 122.21(k)(5)(iii)(A))1
Presence or Absence
Estimated Data for Pollutants Expected to be Present in Discharge
(check one)
Pollutant
(CAS Number, if available)
Believed
Present
(Provide both concentration and mass estimates for each pollutant.)
Believed
Absent
Units
Effluent
Maximum
Average
Daily
Daily
Discharge Discharge
(required)
Intake Water
Source of Information
(Use codes in Instructions.)
(if available)
Believed Present?
(Check only one
response per pollutant.)
D
R
AF
T
() here if you believe all pollutants listed to be absent from the discharge. You need not complete Table C for the noted outfall unless you have quantitative data
Check
available.
1. Antimony, Total
Concentration
Yes
No
(7440-36-0)
Mass
2. Arsenic, Total
Concentration
Yes
No
(7440-38-2)
Mass
3. Beryllium, Total
Concentration
Yes
No
(7440-41-7)
Mass
4. Cadmium, Total
Concentration
Yes
No
(7440-43-9)
Mass
5. Chromium, Total
Concentration
Yes
No
(7440-47-3)
Mass
6. Copper, Total
Concentration
Yes
No
(7440-50-8)
Mass
7. Lead, Total
Concentration
Yes
No
(7439-92-1)
Mass
8. Mercury, Total
Concentration
Yes
No
(7439-97-6)
Mass
9. Nickel, Total
Concentration
Yes
No
(7440-02-0)
Mass
10. Selenium, Total
Concentration
Yes
No
(7782-49-2)
Mass
11. Silver, Total
Concentration
Yes
No
(7440-22-4)
Mass
12. Thallium, Total
Concentration
Yes
No
(7440-28-0)
Mass
13. Zinc, Total
Concentration
Yes
No
(7440-66-6)
Mass
14. Cyanide, Total
Concentration
Yes
No
(57-12-5)
Mass
15. Phenols, Total
Concentration
Yes
No
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or O. See Instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2D (Revised )
Page 7
Contains Nonbinding Recommendations
Draft Application Forms - Not for Implementation
D
R
AF
T
This page intentionally left blank.
Contains Nonbinding Recommendations
Facility
Name
Draft Application
Forms - Not for Implementation Outfall Number
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE D. ORGANIC TOXIC POLLUTANTS (Gas Chromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1
Presence or Absence
Estimated Data for Pollutants Expected to Be Present in Discharge
(check one)
Pollutant
Believed
Present
(CAS Number, if available)
Believed
Absent
(provide both concentration and mass estimates for each pollutant)
Units
Maximum
Daily
Discharge
Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)
Intake Water
Believed Present?
(check only one response per
pollutant)
Check here if all pollutants listed in Table D are expected to be absent from your facility’s discharge.
Check here if the facility believes it is exempt from Table D reporting requirements because it is a qualified small business. See the instructions for exemption criteria and for a list
of materials you must attach to the application.
T
Note: If you check either of the above boxes, you do not need to complete Table D for the noted outfall unless you have quantitative data available.
D
R
AF
1. Organic Toxic Pollutants (GC/MS Fraction—Volatile Compounds)
1.1
Acrolein
Concentration
(107-02-8)
Mass
1.2
Acrylonitrile
Concentration
(107-13-1)
Mass
1.3
Benzene
Concentration
(71-43-2)
Mass
1.4
Bromoform
Concentration
(75-25-2)
Mass
1.5
Carbon tetrachloride
Concentration
(56-23-5)
Mass
1.6
Chlorobenzene
Concentration
(108-90-7)
Mass
1.7
Chlorodibromomethane
Concentration
(124-48-1)
Mass
1.8
Chloroethane
Concentration
(75-00-3)
Mass
1.9
2-chloroethylvinyl ether
Concentration
(110-75-8)
Mass
1.10 Chloroform (67-66-3)
Concentration
Mass
1.11 Dichlorobromomethane
Concentration
(75-27-4)
Mass
EPA Form 3510-2D (Revised )
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 9
Contains Nonbinding Recommendations
Facility
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Draft Application
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EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE D. ORGANIC TOXIC POLLUTANTS (Gas Chromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1
Presence or Absence
Estimated Data for Pollutants Expected to Be Present in Discharge
(check one)
Believed
Absent
1,1-dichloroethane
(75-34-3)
1,2-dichloroethane
(107-06-2)
1,1-dichloroethylene
(75-35-4)
1.15
1,2-dichloropropane
(78-87-5)
1.16
1,3-dichloropropylene
(542-75-6)
1.17
Ethylbenzene
(100-41-4)
1.18
Methyl bromide
(74-83-9)
1.19
Methyl chloride
(74-87-3)
1.20
Methylene chloride
(75-09-2)
1.21
1,1,2,2-tetrachloroethane
(79-34-5)
1.22
1.13
1.14
Tetrachloroethylene
(127-18-4)
1.23
Toluene
(108-88-3)
1.24
1,2-trans-dichloroethylene
(156-60-5)
D
EPA Form 3510-2D (Revised )
Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
1.12
Units
Maximum
Daily
Discharge
AF
Believed
Present
(CAS Number, if available)
T
Pollutant
(provide both concentration and mass estimates for each pollutant)
Intake Water
Believed Present?
(check only one response per
pollutant)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 10
Contains Nonbinding Recommendations
Facility
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EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE D. ORGANIC TOXIC POLLUTANTS (Gas Chromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1
Presence or Absence
Estimated Data for Pollutants Expected to Be Present in Discharge
(check one)
Believed
Present
Believed
Absent
1,1,1-trichloroethane
(71-55-6)
1.26
1,1,2-trichloroethane
(79-00-5)
1.27
Trichloroethylene
(79-01-6)
1.28
Vinyl chloride
(75-01-4)
2. Organic Toxic Pollutants (GC/MS Fraction—Acid Compounds)
2.1
2-chlorophenol
(95-57-8)
2,4-dichlorophenol
(120-83-2)
2.3
2,4-dimethylphenol
(105-67-9)
2.4
4,6-dinitro-o-cresol
(534-52-1)
2.5
2,4-dinitrophenol
(51-28-5)
2.6
2-nitrophenol
(88-75-5)
2.7
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
2.2
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
4-nitrophenol
(100-02-7)
2.8
p-chloro-m-cresol
(59-50-7)
2.9
Pentachlorophenol
(87-86-5)
D
EPA Form 3510-2D (Revised )
Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)
AF
1.25
Units
Maximum
Daily
Discharge
T
Pollutant
(CAS Number, if available)
(provide both concentration and mass estimates for each pollutant)
Intake Water
Believed Present?
(check only one response per
pollutant)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 11
Contains Nonbinding Recommendations
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OMB No.
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TABLE D. ORGANIC TOXIC POLLUTANTS (Gas Chromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1
Presence or Absence
Estimated Data for Pollutants Expected to Be Present in Discharge
(check one)
Believed
Present
2.10
Phenol
(108-95-2)
Believed
Absent
Units
Concentration
Mass
2.11 2,4,6-trichlorophenol
Concentration
(88-05-2)
Mass
3. Organic Toxic Pollutants (GC/MS Fraction—Base /Neutral Compounds)
3.1
Acenaphthene
Concentration
(83-32-9)
Mass
Acenaphthylene
(208-96-8)
3.3
Anthracene
(120-12-7)
3.4
Benzidine
(92-87-5)
3.5
Benzo (a) anthracene
(56-55-3)
3.6
Benzo (a) pyrene
(50-32-8)
3.7
3,4-benzofluoranthene
(205-99-2)
3.8
Benzo (ghi) perylene
(191-24-2)
3.9
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
3.2
Benzo (k) fluoranthene
(207-08-9)
3.10
Bis (2-chloroethoxy) methane
(111-91-1)
3.11
Bis (2-chloroethyl) ether
(111-44-4)
D
EPA Form 3510-2D (Revised )
Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)
AF
Maximum
Daily
Discharge
T
Pollutant
(CAS Number, if available)
(provide both concentration and mass estimates for each pollutant)
Intake Water
Believed Present?
(check only one response per
pollutant)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 12
Contains Nonbinding Recommendations
Facility
Name
Draft Application
Forms - Not for Implementation Outfall Number
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE D. ORGANIC TOXIC POLLUTANTS (Gas Chromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1
Presence or Absence
Estimated Data for Pollutants Expected to Be Present in Discharge
(check one)
Believed
Present
Believed
Absent
Bis (2-chloroisopropyl) ether
(102-80-1)
3.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
3.14
4-bromophenyl phenyl ether
(101-55-3)
3.15
Butyl benzyl phthalate
(85-68-7)
3.16
2-chloronaphthalene
(91-58-7)
3.17
4-chlorophenyl phenyl ether
(7005-72-3)
3.18
Chrysene
(218-01-9)
3.19
Dibenzo (a,h) anthracene
(53-70-3)
3.20
1,2-dichlorobenzene
(95-50-1)
3.21
1,3-dichlorobenzene
(541-73-1)
3.22
1,4-dichlorobenzene
(106-46-7)
3.23
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
D
3,3-dichlorobenzidine
(91-94-1)
3.24
Diethyl phthalate
(84-66-2)
3.25
Dimethyl phthalate
(131-11-3)
EPA Form 3510-2D (Revised )
Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)
AF
3.12
Units
Maximum
Daily
Discharge
T
Pollutant
(CAS Number, if available)
(provide both concentration and mass estimates for each pollutant)
Intake Water
Believed Present?
(check only one response per
pollutant)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 13
Contains Nonbinding Recommendations
Facility
Name
Draft Application
Forms - Not for Implementation Outfall Number
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE D. ORGANIC TOXIC POLLUTANTS (Gas Chromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1
Presence or Absence
Estimated Data for Pollutants Expected to Be Present in Discharge
(check one)
Believed
Present
Believed
Absent
Di-n-butyl phthalate
(84-74-2)
3.27
2,4-dinitrotoluene
(121-14-2)
3.28
2,6-dinitrotoluene
(606-20-2)
3.29
Di-n-octyl phthalate
(117-84-0)
3.30
1,2-diphenylhydrazine
(as azobenzene) (122-66-7)
3.31
Fluoranthene
(206-44-0)
3.32
Fluorene
(86-73-7)
3.33
Hexachlorobenzene
(118-74-1)
3.34
Hexachlorobutadiene
(87-68-3)
3.35
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
R
Hexachlorocyclopentadiene
(77-47-4)
3.36
Hexachloroethane
(67-72-1)
3.37.
Indeno (1,2,3-cd) pyrene
(193-39-5)
3.38
Isophorone
(78-59-1)
3.39
Naphthalene
(91-20-3)
D
EPA Form 3510-2D (Revised )
Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)
AF
3.26
Units
Maximum
Daily
Discharge
T
Pollutant
(CAS Number, if available)
(provide both concentration and mass estimates for each pollutant)
Intake Water
Believed Present?
(check only one response per
pollutant)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 14
Contains Nonbinding Recommendations
Facility
Name
Draft Application
Forms - Not for Implementation Outfall Number
EPA Identification Number
Form Approved
OMB No.
Form Expires
TABLE D. ORGANIC TOXIC POLLUTANTS (Gas Chromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1
Presence or Absence
Estimated Data for Pollutants Expected to Be Present in Discharge
(check one)
Believed
Present
Believed
Absent
Nitrobenzene
(98-95-3)
3.41
N-nitrosodimethylamine
(62-75-9)
3.42
N-nitrosodi-n-propylamine
(621-64-7)
3.43
N-nitrosodiphenylamine
(86-30-6)
3.44
Phenanthrene
(85-01-8)
3.45
Pyrene
(129-00-0)
3.46
1,2,4-trichlorobenzene
(120-82-1)
α-BHC
(319-84-6)
4.3
β-BHC
(319-85-7)
4.4
R
4. Organic Toxic Pollutants (GC/MS Fraction—Pesticides)
4.1. Aldrin
(309-00-2)
4.2
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
γ-BHC
(58-89-9)
4.5
δ-BHC
(319-86-8)
4.6
Chlordane
(57-74-9)
D
EPA Form 3510-2D (Revised )
Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)
AF
3.40
Units
Maximum
Daily
Discharge
T
Pollutant
(CAS Number, if available)
(provide both concentration and mass estimates for each pollutant)
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Intake Water
Believed Present?
(check only one response per
pollutant)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Page 15
Contains Nonbinding Recommendations
Facility
Name
Draft Application
Forms - Not for Implementation Outfall Number
EPA Identification Number
Form Approved
OMB No.
Form Expires