Form 2E "Facilities Which Do Not Discharge Process Wastewater" - Montana

What Is Form 2E?

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

Form Details:

  • Released on February 12, 2010;
  • The latest edition provided by the Montana Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

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

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Download Form 2E "Facilities Which Do Not Discharge Process Wastewater" - Montana

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Agency Use
Permit No.:
Date Rec’d
Amount Rec’d
Check No.
Rec’d By
WATER PROTECTION BUREAU
FORM
Facilities Which Do Not Discharge Process Wastewater
2E
This form is to be completed by manufacturing, commercial, mining, silvicultural, or other dischargers applying for
MPDES permits which discharge only non-process wastewater not regulated by an effluent limit guideline or new source
performance standard [ARM 17.30.1322 (8)]. See attached instructions. Do not leave blank spaces; if a question does not
apply, put “NA” in the space provided. You must print or type legibly; forms that are not legible or are not complete or are
unsigned will be returned. You must maintain a copy of the completed Form 2E for your records.
Section A - Form 2E Status
(Check one)
New
No prior Form 2E submitted for this site.
Resubmitted
Permit Number: MT __ __ __ __ __ __ __
Renewal
Permit Number: MT __ __ __ __ __ __ __
Modification
Permit Number: MT __ __ __ __ __ __ __ (Discuss Modification in Section I)
Section B - Facility or Site Information
(See instruction sheet.):
Site Name
Site Location
Nearest City or Town
County
Latitude
Longitude
Is this facility or site located on Indian Lands?
Yes
No
Section C - Applicant (Owner/Operator) Information
Owner or Operator (Legal Entity)
Mailing Address
City, State, and Zip Code
Phone Number (
)
Is the applicant listed above the owner?
Yes
No
Status of Applicant (Check one)
Federal
State
Private
Public
Other (specify)
Version 1.2
Revised 2-12-10
2E
Page 1 of 11
Agency Use
Permit No.:
Date Rec’d
Amount Rec’d
Check No.
Rec’d By
WATER PROTECTION BUREAU
FORM
Facilities Which Do Not Discharge Process Wastewater
2E
This form is to be completed by manufacturing, commercial, mining, silvicultural, or other dischargers applying for
MPDES permits which discharge only non-process wastewater not regulated by an effluent limit guideline or new source
performance standard [ARM 17.30.1322 (8)]. See attached instructions. Do not leave blank spaces; if a question does not
apply, put “NA” in the space provided. You must print or type legibly; forms that are not legible or are not complete or are
unsigned will be returned. You must maintain a copy of the completed Form 2E for your records.
Section A - Form 2E Status
(Check one)
New
No prior Form 2E submitted for this site.
Resubmitted
Permit Number: MT __ __ __ __ __ __ __
Renewal
Permit Number: MT __ __ __ __ __ __ __
Modification
Permit Number: MT __ __ __ __ __ __ __ (Discuss Modification in Section I)
Section B - Facility or Site Information
(See instruction sheet.):
Site Name
Site Location
Nearest City or Town
County
Latitude
Longitude
Is this facility or site located on Indian Lands?
Yes
No
Section C - Applicant (Owner/Operator) Information
Owner or Operator (Legal Entity)
Mailing Address
City, State, and Zip Code
Phone Number (
)
Is the applicant listed above the owner?
Yes
No
Status of Applicant (Check one)
Federal
State
Private
Public
Other (specify)
Version 1.2
Revised 2-12-10
2E
Page 1 of 11
Section D - Existing or Pending Permits, Certifications, or Approvals
None
MPDES
RCRA
PSD (Air Emissions)
Other
404 Permit (dredge & fill)
Other
Section E - Nature of Business (provide a brief description)
Standard Industrial Classification (SIC) Codes
Provide at least one SIC code which best reflects the principal products or services provided by this
business.
Code
Code
A. Primary
B. Second
1
2
| | |
| | |
Code
C. Third
Code
D. Fourth
3
4
| | |
| | |
Section F - Facility or Site Contact Person/Position
Name and Title, or Position Title
Mailing Address
City, State, and Zip Code
Phone Number
Section G - Receiving Surface Water(s)
For each outfall, list the latitude and longitude to the nearest second and the name of the receiving waters.
Outfall
Latitude
Longitude
Receiving Surface Waters
Number
001
002
003
004
005
MAP: Attach a USGS topographic quadrangle map extending one mile beyond the property boundaries of the
site or activity identified in Section B depicting the facility or activity boundaries, major drainage patterns, and
the receiving surface waters stated above.
Version 1.2
Revised 2-12-10
2E
Page 2 of 11
Section H - Type of Waste
Check the box(es) indicating the general type(s) of wastes discharged.
Sanitary Wastes
Restaurant or Cafeteria Wastes
Non-contact Cooling Water
Construction Dewatering
Contaminated Groundwater
Disinfected Water (Hydrostatic Testing)
Suction Dredge (specify intake size)
Other Non-process Wastewater (identify)
If any additives are used, list them here. Briefly describe their composition and amounts, (or attach MSDS).
Outfall #
Section I - Outfall Information
(This section must completed for each outfall identified in Section G)
Treatment System - describe any treatment system(s) or best management practices (BMP’s) used to reduce
pollutants.
Frequency and Duration of Discharge
Except for leaks or spills, will the discharge described in this form be intermittent or seasonal?
Yes
No
If yes, describe the frequency of flow and duration:
Other Information (Optional)
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. Attach additional sheets, if
necessary.
Version 1.2
Revised 2-12-10
2E
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Outfall #:
Section J - Effluent Characteristics (See Instructions)
(This section must completed for each outfall identified in Section G)
1
Pollutant or
Maximum
Average
No. of
Analytical
Source of
Parameter
Samples
Method
Estimate
Concentration
Units
Concentration
Units
pH (Minimum)
NA
pH (Maximum)
NA
Flow
Total Suspended Solids (TSS)
Biochemical Oxygen Demand (BOD
)
5
Chemical Oxygen Demand (COD)
Total Organic Carbon (TOC)
Oil & Grease
Chlorine, Total Residual (TRC)
Fecal Coliform Bacteria
Ammonia, Total, as N
Dissolved Oxygen
Kjeldahl Nitrogen, Total, as N
Nitrate + Nitrite, as N
Phosphorus, Total, as P
Total Dissolved Solids
Specific Conductivity
Chloride
Sulfate
Alkalinity, as CaCO
3
Acidity, as CaCO
3
Other:
Other:
Metals (Total Recoverable), Cyanide, Phenols and Hardness
Antimony
Arsenic
Beryllium
Cadmium
Chromium
Copper
Lead
Mercury
Nickel
Selenium
Silver
Thallium
Zinc
Cyanide
Total Phenolic Compounds
Hardness, as CaCO
3
Use this space (or a separate sheet) to provide information on other metals requested by the permit writer, or general permit.
Footnote:
1. Except pH, enter minimum and maximum value in applicable row and column.
Version 1.2
Revised 2-12-10
2E
Page 4 of 11
Section K - Mixing Zone
Is the Applicant requesting a mixing zone in the receiving water pursuant to the Administrative Rules of Montana
(ARM) Title 17, Chapter 30, Subchapter 5?
Yes, see below
No
Type of Mixing Zone:
Standard Mixing Zone for surface water, see ARM 17.30.516 for informational requirements.
Source Specific Mixing Zone, see ARM 17.30.518 for informational requirements.
Specify which outfalls will require a mixing zone:
001
002
003
004
005
Section L - Supplemental Information
Section M - CERTIFICATION
Applicant Information: This form must be completed, signed, and certified as follows:
 For a corporation, by a principal officer of at least the level of vice president;
 For a partnership or sole proprietorship, by a general partner or the proprietor, respectively; or
 For a municipality, state, federal, or other public facility, by either a principal executive officer or ranking
elected official.
All Applicants Must Complete 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 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. [75-5-633, MCA]
A. Name (Type or Print)
B. Title (Type or Print)
C. Phone No.
D. Signature
E. Date Signed
The Department will not process this form until all of the requested information is supplied, and the appropriate
fees are paid. Return this form and the applicable fee to:
Department of Environmental Quality
Water Protection Bureau
PO Box 200901
Helena, MT 59620-0901
(406) 444-3080
Version 1.2
Revised 2-12-10
2E
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