"Photo Processor Compliance Certification Form" - Massachusetts

Photo Processor Compliance Certification Form is a legal document that was released by the Massachusetts Department of Environmental Protection - a government authority operating within Massachusetts.

Form Details:

  • Released on July 1, 2015;
  • The latest edition currently provided by the Massachusetts Department of Environmental Protection;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

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Download "Photo Processor Compliance Certification Form" - Massachusetts

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Massachusetts Department of Environmental Protection
Environmental Results Program
Photo Processor Compliance Certification for 20
Facility ID Number
A. Facility Information
Complete Year
Field Above
Important: When
Facility Name
Facility SIC Code
Facility ID Number
filling out forms
on the computer,
use only the tab
Facility Street Address
key to move your
MA
cursor - do not
City
State
Zip Code
use the return
key.
Federal Employer Identification Number – FEIN/TIN*
Phone Number
Fax Number
Contact Person Name
Title
Phone Number
Contact Person Email Address
This is a New Facility since last year’s filing deadline of September 15.
Date Opened (mm/dd/yyyy)
This is a Pre-Existing Facility under New Ownership.
New Owner as of Date (mm/dd/yyyy)
DEP USE ONLY
*I certify that the FEIN/TIN above is not a Social Security number.
Date Received
If you don’t have a TIN or have a question about this checkbox, email:
baw.edep@state.ma.us
(mm/dd/yyyy)
B. Compliance Questions
Answer all questions, unless you are directed to skip a question. Do not answer questions that you are
directed to skip.
Section I applies to all photo processors.
Section II has been deleted.
Section III applies to all photo processors that use a Publicly Owned Treatment Works (POTW)
other than MWRA.
Section IV applies to all photo processors that haul or ship hazardous photo processing
wastewater to a treatment, recycling, or disposal facility.
The Certification Statement (Part C) applies to all photo processors.
.
Section I: Questions For All Photo Processors
1. Do you discharge photo processing wastewater
yes - you must cease your discharging and
submit a Return to Compliance Plan.
to a septic system, leachfield, or cesspool?
(Refer to Section 4.0 [4.0b] in the W
)
ORKBOOK
no
2. Do you discharge photo processing wastewater
yes - you must cease your discharging and
to the ground or surface? (Refer to Section 4.0
submit a Return to Compliance Plan.
[4.0b] in the W
)
ORKBOOK
no
3. Did you have any spills or releases that were
yes - submit a Spill or Release Report
required to be reported to the DEP? (Refer to
Summary
Appendix K [8.0 - 8.3] in the W
)
ORKBOOK
no
ppcert • Rev. July 2015
Compliance Certification for Photo Processors • Page 1 of 7
Massachusetts Department of Environmental Protection
Environmental Results Program
Photo Processor Compliance Certification for 20
Facility ID Number
A. Facility Information
Complete Year
Field Above
Important: When
Facility Name
Facility SIC Code
Facility ID Number
filling out forms
on the computer,
use only the tab
Facility Street Address
key to move your
MA
cursor - do not
City
State
Zip Code
use the return
key.
Federal Employer Identification Number – FEIN/TIN*
Phone Number
Fax Number
Contact Person Name
Title
Phone Number
Contact Person Email Address
This is a New Facility since last year’s filing deadline of September 15.
Date Opened (mm/dd/yyyy)
This is a Pre-Existing Facility under New Ownership.
New Owner as of Date (mm/dd/yyyy)
DEP USE ONLY
*I certify that the FEIN/TIN above is not a Social Security number.
Date Received
If you don’t have a TIN or have a question about this checkbox, email:
baw.edep@state.ma.us
(mm/dd/yyyy)
B. Compliance Questions
Answer all questions, unless you are directed to skip a question. Do not answer questions that you are
directed to skip.
Section I applies to all photo processors.
Section II has been deleted.
Section III applies to all photo processors that use a Publicly Owned Treatment Works (POTW)
other than MWRA.
Section IV applies to all photo processors that haul or ship hazardous photo processing
wastewater to a treatment, recycling, or disposal facility.
The Certification Statement (Part C) applies to all photo processors.
.
Section I: Questions For All Photo Processors
1. Do you discharge photo processing wastewater
yes - you must cease your discharging and
submit a Return to Compliance Plan.
to a septic system, leachfield, or cesspool?
(Refer to Section 4.0 [4.0b] in the W
)
ORKBOOK
no
2. Do you discharge photo processing wastewater
yes - you must cease your discharging and
to the ground or surface? (Refer to Section 4.0
submit a Return to Compliance Plan.
[4.0b] in the W
)
ORKBOOK
no
3. Did you have any spills or releases that were
yes - submit a Spill or Release Report
required to be reported to the DEP? (Refer to
Summary
Appendix K [8.0 - 8.3] in the W
)
ORKBOOK
no
ppcert • Rev. July 2015
Compliance Certification for Photo Processors • Page 1 of 7
Massachusetts Department of Environmental Protection
Environmental Results Program
Photo Processor Compliance Certification for 20
Facility ID Number
B. Compliance Information (cont.)
Section II: Questions #4 to 6 have been deleted
Note: Photo processors discharging photo processing wastewater into a sewer in the MWRA service area
do not have to submit an ERP Compliance Certification form to DEP. However; if photo processors haul /
ship untreated photo processing wastewater to Treatment, Storage, Disposal facility (TSDF), then they
must continue to certify to DEP. Excluded from submitting an ERP Certification are photo processors
who haul / ship their silver solution from a cartridge system or their filter column from the small-scale
precipitation system.
Do you haul or ship hazardous photo processing
yes - skip to section IV on page 6
wastewater to a treatment, recycling or disposal
facility.
no
Section III: Questions For Photo Processors that Use Publicly Owned Treatment Works (POTW)
outside of the MWRA Service Area
7. Fill in the number of:
7a. Photo processing machines typically used at
Number of Machines
your facility.
7b. Hours per typical week your facility operates
these machines.
Number of Hours Per Week
8. What is the average volume discharged from
your photo processing operation, including rinse
Gallons Per Day
water? (Refer to Appendix L in the W
)
ORKBOOK
8a. How did you determine the flow?
water supply meter readings
wastewater flow meter readings
manufacturer’s processing specifications
estimated (describe method)
Describe Method
9. Are you in compliance with the 2 parts per
yes
million silver discharge limit set by DEP for
photo processing wastewater? (Refer to Section
no - submit a Return to Compliance Plan
3.0: 3.5: [3.5a, 3.5b] in the W
ORKBOOK
Note: You must sample your wastewater before
answering this question. Refer to section 3.5 in
the Workbook)
ppcert • Rev. July 2015
Compliance Certification for Photo Processors • Page 2 of 7
Massachusetts Department of Environmental Protection
Environmental Results Program
Photo Processor Compliance Certification for 20
Facility ID Number
B. Compliance Information (cont.)
10. Do you have a permit from a local sewer
yes
authority with a silver discharge limit of 2 parts
per million or less? (Refer to Section 3.1: [3.1b]
no - skip to question 11
in the W
)
ORKBOOK
10a. Are you in compliance with the terms of
yes
that permit?
no - you must meet the requirements of your
local permit and submit a Return to Compliance
Plan
10b. Fill in the permit expiration date:
mm/dd/yyyy
11. Are you in compliance with the industrial
yes
wastewater requirements defined in the
no - submit a Return to Compliance Plan
workbook for the operation and maintenance of
your silver recovery system? (Refer to Section
3.4: [3.4a] in the W
)
ORKBOOK
12. Are you subject to the requirements of the
yes
Massachusetts Board of Certified Wastewater
no – skip to question 13
Treatment Plant Operators? (Answer No if you
are using cartridge system or small scale
precipitation)
12a. If Yes, are you in compliance with the
yes
Board’s requirements? (Refer to Section 3.4:
[3.4b] in the W
)
no - submit a Return to Compliance Plan
ORKBOOK
13. Is your photo processing operation directly piped
yes - skip to question 14
to the silver recovery system? (Refer to Section
5.3 in the W
)
no - answer 13a & 13b
ORKBOOK
13a. Are you in compliance with the
yes
requirements for storing untreated wastewater in
appropriate tanks and containers as defined in
no - submit a Return to Compliance Plan
the workbook? (Refer to Section 5.3: [5.3a -
5.3g] in the W
)
ORKBOOK
13b. How many gallons of silver bearing
wastewater did you treat through your silver
Gallons Per Year
recovery system? (Refer to Appendix L in the
W
)
ORKBOOK
ppcert • Rev. July 2015
Compliance Certification for Photo Processors • Page 3 of 7
Massachusetts Department of Environmental Protection
Environmental Results Program
Photo Processor Compliance Certification for 20
Facility ID Number
B. Compliance Information (cont.)
14. Do you haul / ship treated photo processing
yes
wastewater to a POTW?
no - skip to question 15
14a. If Yes, are you in compliance with the
yes
requirements for storing non-hazardous (i.e.
treated) photo processing wastewater as defined
no - submit a Return to Compliance Plan
in the workbook? (Refer to Sections 5.2: [5.2a -
5.2e] & 5.4: [5.4a - 5.4g] in the W
)
ORKBOOK
Complete a separate log for each silver recovery system. A silver recovery “system” may be
composed of one or more units such as cartridge and electrolytic units used in tandem. Fill in the
maintenance record that applies to the types of silver recovery system used at your facility. If the type of
silver recovery system you use is not listed below, complete sections 15a, 15b, and 15c only.
15. Complete the following Maintenance and Sampling Log Summary. (Refer to Sections 3.5, 3.6 &
Appendix D in the W
)
ORKBOOK
15a. Total capacity of the silver recovery
system:
Gallons Per Day
15b. Average daily flow:
Gallons Per Day
15c. Yearly sampling and analysis results
Sample Date
Silver Concentration
for the 12-month period ending the day you
completed this certification
mm/dd/yyyy
mg/l (Parts Per Million)
Cartridge silver recovery systems,
electrolytic silver recovery systems and
mm/dd/yyyy
mg/l (Parts Per Million)
small-scale precipitation systems must be
sampled at least once per year.
mm/dd/yyyy
mg/l (Parts Per Million)
All other systems must be sampled
monthly.
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
mm/dd/yyyy
mg/l (Parts Per Million)
ppcert • Rev. July 2015
Compliance Certification for Photo Processors • Page 4 of 7
Massachusetts Department of Environmental Protection
Environmental Results Program
Photo Processor Compliance Certification for 20
Facility ID Number
B. Compliance Information (cont.)
15d. Maintenance record for silver recovery unit
or system for past year.
Cartridge Unit or System
Number of Cartridges In Series
Dates you replaced cartridges:
mm/dd/yyyy
mm/dd/yyyy
mm/dd/yyyy
mm/dd/yyyy
Electrolytic silver recovery unit
Cleaning and service dates:
mm/dd/yyyy
mm/dd/yyyy
mm/dd/yyyy
mm/dd/yyyy
Small-scale precipitation system
How many times over past year did you
change the filter cartridge?
Number of Changes
List the chemical names and the amounts
used for precipitation:
Chemical Name
Gallons Per Year
Chemical Name
Gallons Per Year
Chemical Name
Gallons Per Year
ppcert • Rev. July 2015
Compliance Certification for Photo Processors • Page 5 of 7
Page of 7