ADEQ Form 2D "Application for Manufacturing, Mining and Silvicultural Operations That Propose to Discharge Process Wastewater - New Sources and New Dischargers" - Arizona

What Is ADEQ Form 2D?

This is a legal form that was released by the Arizona Department of Environmental Quality - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2015;
  • The latest edition provided by the Arizona Department of Environmental Quality;
  • Easy to use and ready to print;
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  • Fill out the form in our online filing application.

Download a fillable version of ADEQ Form 2D by clicking the link below or browse more documents and templates provided by the Arizona Department of Environmental Quality.

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Download ADEQ Form 2D "Application for Manufacturing, Mining and Silvicultural Operations That Propose to Discharge Process Wastewater - New Sources and New Dischargers" - Arizona

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Arizona Dept. of Environmental Quality
AZPDES APPLICATION
AZPDES Individual Permits / Water Permits Section
FORM 2D
1110 W. Washington Street
Phoenix, AZ 85007
FOR MANUFACTURING, MINING AND SILVICULTURAL OPERATIONS
THAT PROPOSE TO DISCHARGE PROCESS WASTEWATER
New Sources and New DIschargers
Please print or type in the unshaded areas only
AZPDES (NPDES) Permit No.
I. OUTFALL LOCATION
For each outfall, list the latitude and longitude of its location to the nearest 15 seconds and the name of the receiving water.
1.
2. LATITUDE
3. LONGITUDE
4. RECEIVING WATER (list)
OUTFALL
NUMBER
DEG.
MIN.
SEC.
DEG
MIN.
SEC.
(list)
II. DISCHARGE DATE
(When Do You Expect to Begin Discharging?)
III. FLOWS, SOURCES OF POLLUTION AND TREATMENT TECHNOLOGIES
A. Attach a line drawing showing the water flow through the facility. Indicate sources of intake water, operations contributing
wastewater to the effluent and treatment units labeled to correspond to the more detailed descriptions in Part III. B. Construct a
water balance on the line drawing by showing average flows between intakes, operations, treatment units and outfalls. If a water
balance cannot be determined (e.g., for certain mining activities), provide a pictorial description of the nature and amount of any
sources of water and any collection or treatment measures.
B. For each outfall, provide a description of (1) All operations contributing wastewater to the effluent, including process
wastewater, sanitary wastewater, cooling water and stormwater runoff; (2) The average flow contributed by each operation; and
(3) The treatment received by the wastewater. Continue on additional sheets as necessary.
1.
2. OPERATION(S) CONTRIBUTING FLOW
3. TREATMENT
(OUTFALL
b. AVERAGE
b. LIST CODES
NUMBER
a. OPERATIONS
FLOW
a. DESCRIPTION
FROM
(list)
(list)
(include units)
TABLE 2D-1
Form 2D
June 2015
Page 1 of 4
Arizona Dept. of Environmental Quality
AZPDES APPLICATION
AZPDES Individual Permits / Water Permits Section
FORM 2D
1110 W. Washington Street
Phoenix, AZ 85007
FOR MANUFACTURING, MINING AND SILVICULTURAL OPERATIONS
THAT PROPOSE TO DISCHARGE PROCESS WASTEWATER
New Sources and New DIschargers
Please print or type in the unshaded areas only
AZPDES (NPDES) Permit No.
I. OUTFALL LOCATION
For each outfall, list the latitude and longitude of its location to the nearest 15 seconds and the name of the receiving water.
1.
2. LATITUDE
3. LONGITUDE
4. RECEIVING WATER (list)
OUTFALL
NUMBER
DEG.
MIN.
SEC.
DEG
MIN.
SEC.
(list)
II. DISCHARGE DATE
(When Do You Expect to Begin Discharging?)
III. FLOWS, SOURCES OF POLLUTION AND TREATMENT TECHNOLOGIES
A. Attach a line drawing showing the water flow through the facility. Indicate sources of intake water, operations contributing
wastewater to the effluent and treatment units labeled to correspond to the more detailed descriptions in Part III. B. Construct a
water balance on the line drawing by showing average flows between intakes, operations, treatment units and outfalls. If a water
balance cannot be determined (e.g., for certain mining activities), provide a pictorial description of the nature and amount of any
sources of water and any collection or treatment measures.
B. For each outfall, provide a description of (1) All operations contributing wastewater to the effluent, including process
wastewater, sanitary wastewater, cooling water and stormwater runoff; (2) The average flow contributed by each operation; and
(3) The treatment received by the wastewater. Continue on additional sheets as necessary.
1.
2. OPERATION(S) CONTRIBUTING FLOW
3. TREATMENT
(OUTFALL
b. AVERAGE
b. LIST CODES
NUMBER
a. OPERATIONS
FLOW
a. DESCRIPTION
FROM
(list)
(list)
(include units)
TABLE 2D-1
Form 2D
June 2015
Page 1 of 4
C. Except for storm runoff, leaks or spills, will any of the discharges described in Item III.A be intermittent or seasonal?
G
G YES (complete the following table)
NO (go to Item IV)
1. FREQUENCY
2. FLOW
1.
a. DAYS
2. OPERATION
OUTFALL
PER
b. MONTHS PER
a. MAXIMUM
b. MAXIMUM
c.
CONTRIBUTING FLOW
NUMBER
WEEK
YEAR (specify
DAILY FLOW
TOTAL VOLUME
DURATION
(list)
(list)
(specify
average)
(in MGD)
(specify with units)
(in days)
average)
IV. PRODUCTION
If there is an applicable production-based effluent guideline or New Source Performance Standards (NSPS), for each outfall list the
estimated level of production (projection of actual production level, not design capacity), expressed in the terms and units used in
the applicable effluent guideline or NSPS, for each of the first three years of operation. If production is likely to vary, you may also
submit alternative estimates (Attach a separate sheet as necessary to provide all alternative estimates or information on additional
outfalls).
5. UNITS
1. OUTFALL
2.
3. OPERATION, PRODUCT,
4. QUANTITY PER DAY
OF
NUMBER.
YEAR
MATERIAL, ETC. (Specify)
MEASURE
V. EFFLUENT CHARACTERISTICS
A, B, C & D: See instructions before proceeding. NOTE: Parts V.A, V.B, V.C, and V.D are included in the “ADDENDUM” to Form
2D. Complete one set of Parts V.A - V.D for each outfall. Annotate the outfall and AZPDES permit number in the space provided
at the bottom of each page.
E. Use the space below to list any of the 80 pollutants listed in Table 2D-2 “Toxic Pollutants and Hazardous Substances”, which
you know or have reason to believe will or may be discharged from any outfall. For every pollutant, briefly describe the reasons
you believe it to be present.
1. POLLUTANT
2. SOURCE
1. POLLUTANT
2. SOURCE
Form 2D
June 2015
Page 2 of 4
VI. ENGINEERING REPORT ON WASTEWATER TREATMENT
A. If there is any technical evaluation concerning your wastewater treatment, including engineering reports or pilot plant studies,
check the appropriate box below.
G
G
Report Available
No Report
B. Provide the name and address of any existing plant(s), to the best of your knowledge, resembles this production facility with
respect to production processes, wastewater constituents or wastewater treatments.
NAME
LOCATION
VI. OTHER INFORMATION
Use the space below to expand upon any of the above questions or to bring to the attention of the reviewer any other information
you feel should be considered in establishing permit limitations for the proposed facility. Attach additional sheets if necessary.
VIII. CERTIFICATION
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.
A. NAME & OFFICIAL TITLE (type or print)
B. PHONE NO. (telephone and area code)
C. SIGNATURE
D. DATE SIGNED
Form 2D
June 2015
Page 3 of 4
Pursuant to A.R.S. § 41-1030:
(1) ADEQ shall not base a licensing decision, in whole or in part, on a requirement or condition not specifically authorized by
statute or rule. General authority in a statute does not authorize a requirement or condition unless a rule is made pursuant
to it that specifically authorizes the requirement or condition.
(2) Prohibited licensing decisions may be challenged in a private civil action. Relief may be awarded to the prevailing party
against ADEQ, including reasonable attorney fees, damages, and all fees associated with the license application.
(3) ADEQ employees may not intentionally or knowingly violate the requirement for specific licensing authority. Violation is
cause for disciplinary action or dismissal, pursuant to ADEQ’s adopted personnel policy. ADEQ employees are still
afforded the immunity in A.R.S. §§ 12-821.01 and 12-820.02.
Form 2D
June 2015
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