3510-2D NPDES Application Form 2D

National Pollutant Discharge Elimination System (NPDES) Program (Non-Substantive Change)

NPDES Application Form 2D

Consolidated NPDES ICR - Public Sector

OMB: 2040-0004

Document [pdf]

Download: pdf | pdf

Print All Pages
Print Form Only

United States
Environmental Protection Agency

Office of Water
Washington, D.C.

OMB No. 2040-0004
Expires MM/DD/YYYY

Water Permits Division

Application Form 2D

New Manufacturing,
Commercial, Mining, and
Silvicultural Operations That
Have Not Yet Commenced
Discharge of Process
Wastewater
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.

Paperwork Reduction Act Notice
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C.
3501 et seq. (OMB Control No. 2040-0004). Responses to this collection of information are mandatory
(40 CFR 122.21). An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The public reporting
and recordkeeping burden for this collection of information is estimated to be 2.7 hours per response.
Send comments on the Agency’s need for this information, the accuracy of the provided burden
estimates and any suggested methods for minimizing respondent burden to the Regulatory Support
Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW,
Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the
completed form to this address.

FORM 2D—INSTRUCTIONS
General Instructions
Who Must Complete Form 2D?

submit Section 7 of NPDES Application Form 2C; see
requirements at 40 CFR 122.21(g)(7). 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.

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.

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.

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.

Line-by-Line Instructions
EPA Identification Number, Facility Name, and Outfall
Number
Provide your EPA Identification Number from the Facility
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.

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 2D (or related attachments) as
confidential.

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 or equivalent decimal degrees (e.g.,
38.893829, -77.029289) 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.

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 its business confidentiality
regulations at Part 2 of Title 40 of the Code of Federal
Regulations (CFR).
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.
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.

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.

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.
Follow-up Requirements
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
2D-1

FORM 2D—INSTRUCTIONS (CONTINUED)
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
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.

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.

Applicable
ELGs

Item 6.2. Complete Item 6.2 by indicating the applicable ELG
category, ELG subcategory, and corresponding regulatory
citation. See the example below.

6.2

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.
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.

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.
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).
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.

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.

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. See also www.epa.gov/eg. 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

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.
2D-2

FORM 2D—INSTRUCTIONS (CONTINUED)
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 in Table A, indicate whether
a waiver has been requested. If you have requested a
waiver for all pollutants for a given outfall, check the box
indicating this at the top of Table A.

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 contractor 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 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).
For those pollutants you believe will be present in the discharge,
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:

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 in 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.

Data Source
Engineering report
Actual data from pilot plants
Estimates from other engineering reports
Data from other similar plants
Best professional estimates

Code
1
1
2
3
4
5 and specify
Others
on the table
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.
Reporting of Intake Data

Item 7.2. Indicate the outfalls for which you have requested a
waiver or check the appropriate box to indicate that you are
requesting a waiver for some or all pollutants at all outfalls.
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.

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)).
Reporting of Effluent Data

Certain Conventional and Non-Conventional Pollutants
Items 7.4, 7.5 and 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 in 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.

Report all estimated pollutant or parameter levels as
concentration and as total mass, with the exception of discharge
flow, temperature, and pH.
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)
2D-3

FORM 2D—INSTRUCTIONS (CONTINUED)
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 in Table C will be
present or absent in your discharge for each applicable outfall.
For those pollutants you 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, in 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.
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.
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 https://apps.bea.gov/national/pdf/SNTables.pdf.
Items 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, in 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:
• 2,4,5-trichlorophenoxy acetic acid (2,4,5-T) (CAS # 93765).
• 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, in 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.
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.
2D-4

FORM 2D—INSTRUCTIONS (CONTINUED)
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.”

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.

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 vicepresident 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).

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.
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.
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.
Item 8.4. Provide the names and locations of any existing plants
that resemble your production facility. You do not need to
conduct any studies to respond to this item.
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.

END
Submit your completed Form 1, Form 2D, and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.

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.
Item 10.2. The CWA provides for severe penalties for submitting
false information on this application form. Section 309(c)(2) of
2D-5

FORM 2D—INSTRUCTIONS (CONTINUED)
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.
2–A ............... Carbon adsorption
2–B ............... Chemical oxidation
2–C ............... Chemical precipitation
2–D ............... Coagulation
2–E ............... Dechlorination
2–F................ Disinfection (chlorine)
3.
3–A ............... Activated sludge
3–B ............... Aerated lagoons
3–C ............... Anaerobic treatment
3–D ............... Nitrification–denitrification

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
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
BIOLOGICAL TREATMENT PROCESSES
3–E................Pre-aeration
3–F ................Spray irrigation/land application
3–G................Stabilization ponds
3–H................Trickling filtration
4.

4–A ............... Discharge to surface water
4–B ............... Ocean discharge through outfall

OTHER PROCESSES
4–C ...............Reuse/recycle of treated effluent
4–D ...............Underground injection

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

2D-6

FORM 2D—INSTRUCTIONS (CONTINUED)
Exhibit 2D–2. Example Line Drawing

2D-7

FORM 2D—INSTRUCTIONS (CONTINUED)
Exhibit 2D–3. Hazardous Substances
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
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 (dichlorodiphenyltrichloroethane)
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. EDTA (ethylene diaminetetracetic acid)
136. Ferric ammonium citrate
137. Ferric ammonium oxalate
138. Ferric chloride
139. Ferric fluoride
140. Ferric nitrate
141. Ferric sulfate
142. Ferrous ammonium sulfate

2D-8

143. Ferrous chloride
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. PCBs (polychlorinated biphenyls)

FORM 2D—INSTRUCTIONS (CONTINUED)
Exhibit 2D–3. Hazardous Substances
214. Potassium arsenate
215. Potassium arsenite
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

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

2D-9

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

This page intentionally left blank.

EPA Identification Number

Form
2D
NPDES

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
NEW MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURAL OPERATIONS
THAT HAVE NOT YET COMMENCED DISCHARGE OF PROCESS WASTEWATER

Outfall Location

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

Expected
Discharge
Date

SECTION 2. EXPECTED DISCHARGE DATE (40 CFR 122.21(K)(2))
2.1
Month

Day

Longitude

Year

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
mgd

Average Flows and Treatment

mgd

EPA Form 3510-2D

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

Page 1

EPA Identification Number

3.1
Cont.

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

**Outfall Number** _________
Operations Contributing to Flow
Operation

Average Flow
mgd
mgd
mgd
mgd
mgd

Treatment Units

Average Flows and Treatment Continued

Description
(include size, flow rate through each treatment unit,
retention time, etc.)

Code from
Exhibit 2D–1

**Outfall Number** _________
Operations Contributing to Flow
Operation

Final Disposal of Solid or Liquid
Wastes Other Than by Discharge

Average Flow
mgd
mgd
mgd
mgd
mgd

Treatment Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.)

EPA Form 3510-2D

Code from
Exhibit 2D–1

Final Disposal of Solid or Liquid
Wastes Other Than by Discharge

Page 2

EPA Identification Number

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

Line
Drawing

SECTION 4. LINE DRAWING (40 CFR 122.21(K)(3)(II))
4.1
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 2D–2 at end of instructions for example.)



Yes

SECTION 5. INTERMITTENT OR SEASONAL FLOWS (40 CFR 122.21(K)(3)(III))
5.1
Except for stormwater runoff, leaks, or spills, are any expected discharges described in Sections 1 and 3 intermittent
or seasonal?



Intermittent or Seasonal Flows

5.2



Yes

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

Outfall
Number

Operations
(list)

Outfall
Number

Operations
(list)

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

Rate and Volume
Maximum Daily
Maximum Total
Discharge
Volume

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

Rate and Volume
Maximum Daily
Maximum Total
Discharge
Volume

Duration

days/week

months/year

mgd

gallons

days

days/week

months/year

mgd

gallons

days

days/week

months/year

mgd

gallons

days

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

EPA Form 3510-2D

Yes



Provide the following information on applicable ELGs.
ELG Category

No  SKIP to Section 7.

ELG Subcategory

Regulatory Citation

Page 3

EPA Identification Number

6.3

OMB No. 2040-0004
Expires MM/DD/YYYY

Are the limitations in the applicable ELGs expressed in terms of production (or other measure of operation)?


6.4

Facility Name

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 1
Year 2
Year 3
Year 1
Year 2
Year 3

SECTION 7. EFFLUENT CHARACTERISTICS (40 CFR 122.21(K)(5))
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
7.1
Are you requesting a waiver from your NPDES permitting authority for any Table A parameters for any of your
outfalls?

Effluent Characteristics


7.2

7.3



Yes

No  SKIP to Item 7.3.

If yes, indicate the applicable outfalls below or check the appropriate box to indicate that you are requesting a waiver
for all outfalls. Attach waiver request and other required information to the application.
Outfall number ________
Outfall number ________
Outfall number ________




I am requesting a waiver for some pollutants at all outfalls.

I am requesting a waiver for all pollutants at all outfalls  SKIP to Item 7.4.
Have 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 attached the results to this application package?
 Yes

Table B. Certain Conventional and Non-Conventional Pollutants
7.4
Have you checked “Believed Present” for all pollutants listed in Table B that are limited directly or indirectly by an
applicable ELG?
Yes

 Not applicable
7.5
Have you checked “Believed Present” or “Believed Absent” for all remaining pollutants listed in Table B?



EPA Form 3510-2D

Yes

Page 4

EPA Identification Number

7.6

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

Have you provided estimated data for those Table B pollutants for which you have indicated are “Believed Present”
in your discharge?



Yes

Table C. Toxic Metals, Total Cyanide, and Total Phenols
7.7
Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed in Table C
for all outfalls?
Yes

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

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 in Table D
for all outfalls?

Effluent Characteristics Continued


7.10

Yes
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

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?
7.11



Yes



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

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

Engineering Report

Intake Credits, Tables A through E
7.15 Are you applying for net credits for the presence of any of the pollutants in 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.

Yes



Are you aware of any existing plant(s) whose production processes, wastewater constituents, or wastewater
treatment resemble those at your facility?



EPA Form 3510-2D



Have you provided the technical evaluation and all related documents to this application package?


8.3

Yes



No  SKIP to Section 9.

Page 5

Engineering Report
Continued

EPA Identification Number

8.4

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

Provide the names and locations of the similar plants.
Name of Similar Plant

Location of Similar Plant

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)?

Other Information


9.2

Yes

 No  SKIP to Section 10.

List the additional items and briefly note why you have included them.
1.
2.
3.
4.
5.

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

EPA Form 3510-2D



Section 4: Line Drawing



w/ line drawing



Section 5: Intermittent or
Seasonal Flows



w/ attachments



Section 6: Production



w/ attachments




Section 7: Effluent
Characteristics



Section 8: Engineering
Report



Section 9: Other Information



Section 10: Checklist and
Certification Statement



w/ additional attachments

w/ Table A waiver
request or
approval



Table A



Table B



Table C



Table D



Table E



w/ other
attachments




w/ optional information



w/ attachments

w/ technical evaluations and related attachments

Page 6

EPA Identification Number

Checklist and Certification Statement
Continued

10.2

EPA Form 3510-2D

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

Provide the following certification. (See instructions to determine the appropriate person to sign the application.)
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

Page 7

This page intentionally left blank.

EPA Identification Number

Facility Name

Outfall 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.

Biochemical oxygen
demand (BOD5)



Chemical oxygen demand
(COD)



Total organic carbon
(TOC)

Total suspended solids
(TSS)



Ammonia (as N)



Flow



Rate

Temperature (winter)



°C

Temperature (summer)



°C

pH (minimum)



Standard units

s.u.

pH (maximum)



Standard units

s.u.



Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass

OMB No. 2040-0004
Expires MM/DD/YYYY

Intake Water
Believed Present?

(check only one response per
parameter)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



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

Page 1

This page intentionally left blank.

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

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.

Bromide
(24959-67-9)



Chlorine, total
residual



Color



Fecal coliform



Fluoride
(16984-48-8)



Nitrate-nitrite



Nitrogen, total
organic (as N)



Oil and grease



Phosphorus (as P),
total (7723-14-0)



10.

Sulfate (as SO4)
(14808-79-8)



11.

Sulfide (as S)



EPA Form 3510-2D

Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 3

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

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

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent

12.

Sulfite (as SO3)
(14265-45-3)



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)



EPA Form 3510-2D

Units
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass

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)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 4

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

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

23.

Titanium, total
(7440-32-6)

24.

Radioactivity

24.1 Alpha, total

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent



Units
Concentration
Mass
Concentration
Mass

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)



Yes



Yes



Concentration
 Yes  No
Mass
Concentration
24.3. Radium, total


 Yes  No
Mass
Concentration
24.4 Radium 226, total


 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).
24.2 Beta, total

EPA Form 3510-2D



Page 5

This page intentionally left blank.

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

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

Believed
Absent

(Provide both concentration and mass estimates for each pollutant.)

Units

Effluent
Maximum
Average
Daily
Daily
Discharge Discharge
(required)

(if available)

Source of Information
(Use codes in Instructions.)

Intake Water
Believed Present?
(Check only one
response per pollutant.)

Check () 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
 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

Page 7

This page intentionally left blank.

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

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

(CAS Number, if available)

Believed
Present

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.

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.
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



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



No
Page 9

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(provide both concentration and mass estimates for each pollutant)

Believed
Present

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

Tetrachloroethylene
(127-18-4)



1.23

Toluene
(108-88-3)



1.24

1,2-trans-dichloroethylene
(156-60-5)



(CAS Number, if available)

1.12
1.13
1.14

EPA Form 3510-2D

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 10

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(CAS Number, if available)

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent

1.25

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)
2.2

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

4-nitrophenol
(100-02-7)



2.8

p-chloro-m-cresol
(59-50-7)



2.9

Pentachlorophenol
(87-86-5)



EPA Form 3510-2D

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 11

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(CAS Number, if available)

2.10

Phenol
(108-95-2)

Believed
Present

(provide both concentration and mass estimates for each pollutant)

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
3.2
Acenaphthylene
Concentration


(208-96-8)
Mass
3.3
Anthracene
Concentration


(120-12-7)
Mass



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

Benzo (k) fluoranthene
(207-08-9)



3.10

Bis (2-chloroethoxy) methane
(111-91-1)



3.11

Bis (2-chloroethyl) ether
(111-44-4)



EPA Form 3510-2D

Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 12

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(CAS Number, if available)

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent

3.12

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

3,3-dichlorobenzidine
(91-94-1)



3.24

Diethyl phthalate
(84-66-2)



3.25

Dimethyl phthalate
(131-11-3)



EPA Form 3510-2D

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 13

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(CAS Number, if available)

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent

3.26

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

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)



EPA Form 3510-2D

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 14

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(CAS Number, if available)

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent

3.40

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)



4. Organic Toxic Pollutants (GC/MS Fraction—Pesticides)
4.1. Aldrin

(309-00-2)



4.2

α-BHC
(319-84-6)



4.3

β-BHC
(319-85-7)



4.4

γ-BHC
(58-89-9)



4.5

δ-BHC
(319-86-8)



4.6

Chlordane
(57-74-9)



EPA Form 3510-2D

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 15

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(CAS Number, if available)

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent

4.7

4,4’-DDT
(50-29-3)



4.8

4,4’-DDE
(72-55-9)



4.9

4,4’-DDD
(72-54-8)



4.10

Dieldrin
(60-57-1)



4.11

α-endosulfan
(115-29-7)



β-endosulfan
(115-29-7)



Endosulfan sulfate
(1031-07-8)



Endrin
(72-20-8)



Endrin aldehyde
(7421-93-4)



4.12
4.13
4.14
4.15

EPA Form 3510-2D

Units
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Yes



Page 16

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Pollutant

(CAS Number, if available)

(provide both concentration and mass estimates for each pollutant)

Believed
Present

Believed
Absent

4.16

Heptachlor
(76-44-8)



4.17

Heptachlor epoxide
(1024-57-3)



4.18

PCB-1242
(53469-21-9)



4.19

PCB-1254
(11097-69-1)



4.20

PCB-1221
(11104-28-2)



4.21

PCB-1232
(11141-16-5)



Units
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass
Concentration
Mass

Maximum
Daily
Discharge

Effluent
Average
Source of
Daily
Information
Discharge (use codes in instructions)

Intake Water
Believed Present?

(check only one response per
pollutant)



Yes



Yes



Yes



Yes



Yes



Concentration
 Yes 
Mass
4.22 PCB-1248
Concentration


 Yes 
(12672-29-6)
Mass
4.23 PCB-1260
Concentration


 Yes 
(11096-82-5)
Mass
4.24 PCB-1016
Concentration


 Yes 
(12674-11-2)
Mass
4.25 Toxaphene
Concentration


 Yes 
(8001-35-2)
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



No
No
No
No
No

Page 17

This page intentionally left blank.

EPA Identification Number

Facility Name

Outfall Number

TABLE E. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(K)(5)(V))1
Presence or Absence
(check one)
Pollutant
Reason Pollutant Believed Present in Discharge
Believed
Believed
Present
Absent

OMB No. 2040-0004
Expires MM/DD/YYYY

Available Quantitative Data
(specify units)



Check () here if you believe all pollutants listed to be absent from the discharge. You need not complete Table E for the noted outfall unless you have quantitative data available.

Asbestos



Acetaldehyde



Allyl alcohol



Allyl chloride



Amyl acetate



Aniline



Benzonitrile



Benzyl chloride



Butyl acetate



10. Butylamine



11. Captan



12. Carbaryl



13. Carbofuran



14. Carbon disulfide



15. Chlorpyrifos



16. Coumaphos



17. Cresol



18. Crotonaldehyde



EPA Form 3510-2D

Page 19

EPA Identification Number

Facility Name

Outfall Number

TABLE E. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(K)(5)(V))1
Presence or Absence
(check one)
Pollutant
Reason Pollutant Believed Present in Discharge
Believed
Believed
Present
Absent
19. Cyclohexane



20. 2,4-D (2,4-dichlorophenoxyacetic acid)



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



31. Disulfoton



32. Diuron



33. Epichlorohydrin



34. Ethion



35. Ethylene diamine



36. Ethylene dibromide



37. Formaldehyde



EPA Form 3510-2D

OMB No. 2040-0004
Expires MM/DD/YYYY

Available Quantitative Data
(specify units)

Page 20

EPA Identification Number

Facility Name

Outfall Number



39. Guthion



40. Isoprene



41. Isopropanolamine



42. Kelthane



43. Kepone



44. Malathion



45. Mercaptodimethur



46. Methoxychlor



47. Methyl mercaptan



48. Methyl methacrylate



49. Methyl parathion



50. Mevinphos



51. Mexacarbate



52. Monoethyl amine



53. Monomethyl amine



54. Naled



55. Naphthenic acid



56. Nitrotoluene



EPA Form 3510-2D

OMB No. 2040-0004
Expires MM/DD/YYYY

Available Quantitative Data
(specify units)

Page 21

EPA Identification Number

Facility Name

Outfall Number



58. Phenolsulfonate



59. Phosgene



60. Propargite



61. Propylene oxide



62. Pyrethrins



63. Quinoline



64. Resorcinol



65. Strontium



66. Strychnine



67. Styrene



71. Trichlorofon



72. Triethanolamine



73. Triethylamine



74. Trimethylamine



75. Uranium



68.

2,4,5-T (2,4,5-trichlorophenoxyacetic
acid)

69. TDE (tetrachlorodiphenyl ethane)
70.

2,4,5-TP [2-(2,4,5-trichlorophenoxy)
propanoic acid]

EPA Form 3510-2D

OMB No. 2040-0004
Expires MM/DD/YYYY

Available Quantitative Data
(specify units)

Page 22

EPA Identification Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY



77. Vinyl acetate



78. Xylene



79. Xylenol



80. Zirconium



Available Quantitative Data
(specify units)

Click to go back to the beginning of Form

EPA Form 3510-2D

Page 23

File Type	application/pdf
File Title	NPDES Permitting Program: New Manufacturing, Commercial, Mining, and Silvicultural Operations That Have Not Yet Commenced Discha
Subject	U.S. Environmental Protection Agency, office of water, National Pollutant Discharge Elimination System, NPDES, Permitting Progra
Author	U.S. Environmental Protection Agency, Office of Water
File Modified	2021-06-30
File Created	2021-06-15