Instructions for ADEQ Form 1 "Arizona Pollutant Discharge Elimination System Permit Application" - Arizona

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Download Instructions for ADEQ Form 1 "Arizona Pollutant Discharge Elimination System Permit Application" - Arizona

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Arizona Pollutant Discharge Elimination System
FORM 1 INSTRUCTIONS
Description of AZPDES Permit Application Forms
Form 1
This form contains general information and is used in combination with Forms 2B, 2C,
2D, and 2F. Form 1 provides information such as nature of business, name, mailing
address, location, existing permit numbers, etc.
Form 2A
This form is used for publicly-owned or any other treatment works that treats domestic
sewage and currently discharges, is permitted to discharge, or proposes to discharge
treated wastewater to waters of the United States.
Form 2B
This form is used for concentrated animal feeding operations and aquatic animal
production facilities that currently discharge, are permitted to discharge, or propose to
discharge wastewater to waters of the United States.
Form 2C
This form is used by industrial, commercial and other operations that currently
discharge or are permitted to discharge non-domestic wastewater to waters of the
United States. Examples of such discharges include those from water treatment plants,
groundwater remediation efforts, mining and silvicultural operations, noncontact cooling
waters, etc.
Form 2D
This form is used by industrial, commercial and other operations that propose to
discharge non-domestic wastewater (new sources and new dischargers) to waters of
the United States. Examples of such discharges include those from water treatment
plants, groundwater remediation efforts, mining and silvicultural operations, noncontact
cooling waters, etc.
Form 2F
This form is used for facilities that currently discharge, are permitted to discharge or
propose to discharge storm water or a combination of storm water and non-storm water
associated with an industrial activity.
Form 2S
This form is used for facilities that currently treat or dispose of, are permitted to treat or
dispose of or propose to treat or dispose of sewage sludge. The form is also used for
facilities that currently treat, are permitted to treat or propose to treat domestic sewage.
Form 1 Instructions
July 2011
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Arizona Pollutant Discharge Elimination System
FORM 1 INSTRUCTIONS
Description of AZPDES Permit Application Forms
Form 1
This form contains general information and is used in combination with Forms 2B, 2C,
2D, and 2F. Form 1 provides information such as nature of business, name, mailing
address, location, existing permit numbers, etc.
Form 2A
This form is used for publicly-owned or any other treatment works that treats domestic
sewage and currently discharges, is permitted to discharge, or proposes to discharge
treated wastewater to waters of the United States.
Form 2B
This form is used for concentrated animal feeding operations and aquatic animal
production facilities that currently discharge, are permitted to discharge, or propose to
discharge wastewater to waters of the United States.
Form 2C
This form is used by industrial, commercial and other operations that currently
discharge or are permitted to discharge non-domestic wastewater to waters of the
United States. Examples of such discharges include those from water treatment plants,
groundwater remediation efforts, mining and silvicultural operations, noncontact cooling
waters, etc.
Form 2D
This form is used by industrial, commercial and other operations that propose to
discharge non-domestic wastewater (new sources and new dischargers) to waters of
the United States. Examples of such discharges include those from water treatment
plants, groundwater remediation efforts, mining and silvicultural operations, noncontact
cooling waters, etc.
Form 2F
This form is used for facilities that currently discharge, are permitted to discharge or
propose to discharge storm water or a combination of storm water and non-storm water
associated with an industrial activity.
Form 2S
This form is used for facilities that currently treat or dispose of, are permitted to treat or
dispose of or propose to treat or dispose of sewage sludge. The form is also used for
facilities that currently treat, are permitted to treat or propose to treat domestic sewage.
Form 1 Instructions
July 2011
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General Instructions
Who Must Apply
With the exceptions described in Section C of these instructions, federal and state laws prohibit you from
discharging pollutants into the water of the United States in Arizona without an Arizona Pollutant
Discharge Elimination System (AZPDES) permit (Clean Water Act, 33 U.S.C. 1251 and Arizona Revised
Statute (A.R.S.) § 49-255). (Note: Discharges to Indian Country still require a federal NPDES permit from
EPA.)
You must use this form in conjunction with supplementary forms 2B, 2C, 2D, or 2F as appropriate to apply
for an AZPDES permit. Form 1 collects general information that applies to all the above-listed discharging
facilities and operations. Form 1 does not need to be submitted with Form 2A or Form 2S as these forms
contain Form 1 information. Item VII of Form 1 will guide you to the appropriate supplementary forms.
If you have any questions about whether you need a permit or if you need to obtain application forms,
contact Arizona Department of Environmental Quality (ADEQ). Upon your request and based upon
information supplied by you, ADEQ will determine whether you are required to obtain a permit for a
particular facility. Be sure to contact ADEQ if you have a question, because federal and state laws provide
that you may be heavily penalized if you do not apply for a permit when a permit is required.
You should note that there are certain exclusions to the permit requirements listed above. The exclusions
are described in detail in Section C of these instructions. If your activities are excluded from permit
requirements, then you do not need to complete and return any forms.
Where to File
The application forms must be mailed to: Surface Water Permits Unit
Arizona Department of Environmental Quality
1110 West Washington Street
Phoenix, AZ 85007
When to File
State regulations require that an application for an AZPDES permit be submitted 180 days before your
present NPDES or AZPDES permit expires or at least 180 days prior to discharge if your facility is
currently not a permitted discharging facility. (Note that it may take longer than 180 days to obtain your
permit.
If you submit a complete and accurate application for renewal by the specified date, your permit will be
administratively continued while ADEQ processes your application. If the application is not complete or
accurate, you are not authorized to discharge past your permit expiration date.
For new facilities, you are not authorized to discharge until a permit is issued. As such, it may be prudent
to submit your application earlier than 180 days.
Fees
A $2,000 initial fee is required along with your application in accordance with A.A.C. R18-14-103. The
permit team assigned to your project will bill at a rate of $122.00 per hour up to a maximum fee of $30,000
in accordance with A.A.C. R18-14-102. Please see
http://www.azdeq.gov/environ/water/permits/fees.html
for more information.
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Availability of Information to Public
Information contained in these application forms will, upon request, be made available to the public for
inspection and copying. No information on Forms 1 and 2A through 2S may be claimed as confidential. If
you send in more information than is requested in these forms that is considered company-privileged
information, you may ask ADEQ to keep that extra information confidential. Otherwise, ADEQ may make
the information public without letting you know in advance. For more information on claims of
confidentiality, see A.R.S. § 49-205.
Completion of Forms
Unless otherwise specified in instructions to the forms, each item in each form must be answered. To
indicate that each item has been considered, enter “NA”, for not applicable if a particular item does not fit
the circumstances or characteristics of your facility or activity.
If you have previously submitted information to EPA/ ADEQ that answers a question, you may either
repeat the information in the space provided or attach a copy of the previous submission. Some items in
the form require narrative explanation. If more space is needed to answer a question, attach a sheet
entitled “Additional Information.”
Please also note that per 40 CFR 130.12, before an AZPDES permit can be issued for a facility, it must
not be in conflict with the Regional 208 Water Quality Management Plan. Owners of new or modified
facilities need to check with their planning council to determine if the discharge will be consistent or obtain
appropriate plan amendments. ADEQ cannot find the application administratively complete until an
appropriate 208 finding has been made.
Application Information
Completing this Form
Please type or print in the unshaded areas only.
Item I. Facility Information
Space is provided at the upper right hand corner of Form 1 for insertion of your AZPDES or NPDES permit
number. If your facility does not have a permit, leave this item blank.
I.A
Name of Facility: Enter the facility’s official or legal name. Do not use a colloquial name.
I.B.
Facility Contact: Give the name, title and work telephone number (s) of a person who is
thoroughly familiar with the operation of the facility and with the facts reported in this
application and who can be contacted by ADEQ if necessary.
I.C.
Facility Mailing Address: Give the complete mailing address of the office where
correspondence should be sent. This often is not the address used to designate the location
of the facility or activity.
I.D.
Facility Location: Give the street (route) address or finding directions of the facility.
I.E.
Latitude/Longitude: Enter the latitude and longitude of the facility in degrees, minutes and
seconds.
I.F.
Legal Description: Enter the township, range, section and quarter section in which the facility
is located.
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July 2011
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I.G.
Indian Land: Indicate whether the facility is located on Indian Lands.
I.H.
Border Area: Indicate whether the facility is located within 100 kilometers (62 miles) north of
the Arizona -Sonora, Mexico border. If it is, then provide a description of the area into which
the discharges from the facility may flow and a statement explaining whether the flow is
expected to cross the border.
Item II. Facility SIC Codes
List, in descending order or significance, the four 4-digit standard industrial classification (SIC) codes that
best describe your facility in terms of the principal products or services you produce or provide. Also,
specify each classification in words.
These classifications may differ from the SIC codes describing the operation generating the discharge, air
emissions or hazardous wastes.
SIC code numbers are descriptions that may be found in the “Standard Industrial Classification Manual”
prepared by the executive Office of the President, Office of Management and Budget, which is available
from the Government Printing Office, Washington, D.C. Use the current edition of the manual.
Item III. Existing Environmental Permits
Give the number of each presently effective permit issued to the facility for each program or, if you have
previously filed an application but have not yet received a permit, give the number of the application, if
any. Fill in the unshaded area only. If you have more than one currently effective permit for your facility
under a particular permit program, you may list additional permit numbers on a separate sheet of paper.
List any relevant environmental federal (e.g., permits under the Ocean Dumping Act, section 404 of the
Clean Water Act or the Surface Mining Control and Reclamation Act), state (e.g., state permits for new air
emission sources in nonattainment areas under Part D of the Clean Air Act or state permits under section
404 of the Clean Water Act) or local permits or applications under “other”.
Item IV. Operator Information
IV.A. Name of operator: Provide the phone number(s) and name, as it is legally referred to, of the
person, firm, public organization or any other entity that operates the facility described in this
application. This may or may not be the same name as the facility. The operator of the facility
is the legal entity
IV.B. Operator’s Mailing Address: Enter the address of the operator identified in Item C.1.
IV.C. Owner-Operator: Indicate whether the person or entity that operates the facility also owns it by
marking the appropriate box.
IV.D. Operator’s Status: Mark the appropriate letter to indicate the legal status of the operator of the
facility. Indicate “public” for a facility solely owned by local government(s) such as a city, town
county, etc.
Item V. Nature of Business
Briefly describe the nature of your business (e.g., products or services provided).
Item VI. Map
Provide a topographic map or maps of the area extending at least to one mile beyond the property
boundaries of the facility that clearly show the following:
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July 2011
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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 facilities;
Each well where you inject fluids underground; and
All springs and surface water bodies in the area, plus all drinking water wells within 1/4 mile of
the facility that are identified in the public record or otherwise known to you.
If an intake or discharge structure, hazardous waste disposal site or injection well associated
with the facility is located more than one mile from the plant, include it on the map, if possible.
If not, attach additional sheets describing the location of the structure, disposal site or well and
identify the U. S. Geological Survey (or other) map corresponding to the location.
On each map, include the map scale, a meridian arrow showing north and latitude and
longitude at the nearest whole second. On all maps of rivers, show the direction of the current
and in tidal waters, show the directions of the ebb and flow tides. Use a 7-1/2 minute series
map published by the U.S. Geological Survey, which may be obtained through the U.S.
Geological Survey office listed below. If a 7-1/2 minute series map has not been published for
your facility site, then you may use a 15 minute series map from the U.S. Geological Survey.
If neither a 7-1/2 nor 15 minute series map has been published for your facility site, use a plat
map or other appropriate map, including all the requested information; in this case, briefly
describe land uses in the map area (e.g., residential, commercial). For map information you
may access the following or similar websites on the internet:
http://www.topozone.com
or
http://mapping.usgs.gov
Item VII. Pollutant Characteristics
Answer each question to determine which supplementary forms you need to fill out. Be sure to check the
glossary in Section D of these instructions for the legal definitions and check Section C of these
instructions to determine whether your activity is excluded from permit requirements.
If you answer “yes” to any question, then you must complete and file the supplementary form by the
deadline described under Section A above along with this form. (The applicable form number follows each
question and is enclosed in parentheses).
Item VIII. Certification
40 CFR Part 122.22 (d) incorporated by reference under A.A.C. R18-9-A905(A)(1)(c) provides in part, that
any person who signs an application for an AZPDES permit or a report required by an AZPDES permit
and other information requested by the Director shall make the following 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.
Federal and state statutes provide for severe penalties for submitting false information on this application
form.
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