Form SFN8391 "Permit Application for Transporting Solid Waste" - North Dakota

What Is Form SFN8391?

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

Form Details:

  • Released on March 1, 2013;
  • The latest edition provided by the North Dakota Department of Health;
  • 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 SFN8391 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN8391 "Permit Application for Transporting Solid Waste" - North Dakota

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PERMIT APPLICATION FOR TRANSPORTING SOLID WASTE
NORTH DAKOTA DEPARTMENT OF HEALTH
Telephone:
701-328-5166
DIVISION OF WASTE MANAGEMENT
Clear Fields
Fax Number: 701-328-5200
SFN 8391 (3-2013)
Website:
www.ndhealth.gov/wm
SECTION 1. BUSINESS INFORMATION
Business Name
Contact Person
Mailing Address
City
State
ZIP Code
Telephone Number
Fax Number
E-Mail Address (optional)
Application Type
New
Renewal-Permit Number: WH-
SECTION 2. WASTE COLLECTION
Check Types of Wastes Collected (see definitions on the reverse side).
Inert
Infectious (medical)
Other (specify):
Municipal
Hazardous-EPA ID Number (Required):
Scrap Tires
Used Oil-EPA ID Number (Required):
Industrial
Asbestos
PCB's
Sump and Pit (non-sewage)
Special Wastes (specify):
SECTION 3. COLLECTION VEHICLES (attach additional pages if needed)
Quantity
Type
Capacity
SECTION 4. COLLECTION SOURCES - communities, industries (attach additional pages if needed)
SECTION 5. FINAL DISPOSAL FACILITIES (attach additional pages if needed)
Name
Address
SECTION 6. SIGNATURE
I certify that: the information in this application is true, correct, and complete to the best of my knowledge; a disclosure
statement is not required (see Section 5 on reverse side); and, that if this permit is approved, I will comply with the North
Dakota Solid and Hazardous Waste Management laws and rules, the conditions noted above, and that I will submit the
required $25.00 annual permit renewal fee by July 31 of each year.
Print Name
Date
Signature
Send your completed application and $75.00 application processing fee to:
North Dakota Department of Health
, Division of Waste Management,
918 E. Divide Ave., 3rd Floor; Bismarck, ND 58501-1947
PERMIT APPLICATION FOR TRANSPORTING SOLID WASTE
NORTH DAKOTA DEPARTMENT OF HEALTH
Telephone:
701-328-5166
DIVISION OF WASTE MANAGEMENT
Clear Fields
Fax Number: 701-328-5200
SFN 8391 (3-2013)
Website:
www.ndhealth.gov/wm
SECTION 1. BUSINESS INFORMATION
Business Name
Contact Person
Mailing Address
City
State
ZIP Code
Telephone Number
Fax Number
E-Mail Address (optional)
Application Type
New
Renewal-Permit Number: WH-
SECTION 2. WASTE COLLECTION
Check Types of Wastes Collected (see definitions on the reverse side).
Inert
Infectious (medical)
Other (specify):
Municipal
Hazardous-EPA ID Number (Required):
Scrap Tires
Used Oil-EPA ID Number (Required):
Industrial
Asbestos
PCB's
Sump and Pit (non-sewage)
Special Wastes (specify):
SECTION 3. COLLECTION VEHICLES (attach additional pages if needed)
Quantity
Type
Capacity
SECTION 4. COLLECTION SOURCES - communities, industries (attach additional pages if needed)
SECTION 5. FINAL DISPOSAL FACILITIES (attach additional pages if needed)
Name
Address
SECTION 6. SIGNATURE
I certify that: the information in this application is true, correct, and complete to the best of my knowledge; a disclosure
statement is not required (see Section 5 on reverse side); and, that if this permit is approved, I will comply with the North
Dakota Solid and Hazardous Waste Management laws and rules, the conditions noted above, and that I will submit the
required $25.00 annual permit renewal fee by July 31 of each year.
Print Name
Date
Signature
Send your completed application and $75.00 application processing fee to:
North Dakota Department of Health
, Division of Waste Management,
918 E. Divide Ave., 3rd Floor; Bismarck, ND 58501-1947
SFN 8391 (3-2013) Page 2
Section 1. Business Information: (Self-explanatory.)
Section 2. Waste Collection: (Mark the appropriate box with an “X.”)
Asbestos
Any waste material containing asbestos in the regulated concentration of 1 percent (%) or greater.
Industrial
Such waste may include, but is not limited to, residues or spills of any industrial or manufacturing process and
waste resulting from the following: fertilizer/agricultural chemicals; food and related products/byproducts;
inorganic chemicals; iron and steel manufacturing; leather and leather products; nonferrous metals
manufacturing and foundries; organic chemicals; plastics and resins manufacturing; pulp and paper industry;
rubber and miscellaneous plastic products; textile manufacturing; transportation equipment; petroleum refining,
and the combustion of municipal waste or regulated infectious waste.
Inert
Nonputrescible solid waste which will not generally contaminate water or form a contaminated leachate. Inert
waste does not serve as food for vectors. Inert waste includes, but is not limited to: construction and demolition
material such as metal, wood, bricks, masonry and cement concrete; asphalt concrete; metal; tree branches;
bottom ash from coal-fired boilers; and, waste coal fines from air pollution control equipment.
Infectious
Solid waste that may contain pathogens with sufficient virulence and in sufficient quantity that exposure of a
susceptible human or animal to the solid waste could cause the human or animal to contract an infectious
disease.
Municipal
Solid waste includes garbage, refuse, and trash generated by households, motels, hotels, and recreation
facilities, by public and private facilities, and by commercial, wholesale, and private and retail businesses.
Putrescible solid waste includes animal and vegetable waste resulting from the handling, preparation, cooking,
and consumption of food, including wastes from markets, storage facilities, and processing plants. The term
includes commercial waste, which is solid waste generated by stores, offices, restaurants, warehouses, and
other nonmanufacturing activities exclusive of household waste, industrial waste, and special waste. The term
does not include special waste or industrial waste.
PCB's
Any waste material containing Polychlorinated Biphenyls (PCB's) in the regulated concentration of 50 parts per
million (ppm) or greater.
Special
Solid waste, that is not a hazardous waste, generated from energy conversion facilities; waste from crude oil and
natural gas exploration and production; waste from mineral and ore mining, beneficiation, and extraction; and
Waste
waste generated by surface coal mining operations.
Sump
Solid waste from sumps, pits, or sand-traps that is not classified as sewage or is oilfield related, i.e, carwash pits,
automotive repair shop sumps/pits. This waste should not contain any free or liquid used oil other than in trace
and Pit
amounts before disposal.
If additional information is required, provide that information in the allotted space.
Section 3. Collection Vehicles:
Quantity - actual number of the type of vehicle used for transportation.
Type - body style of vehicle, such as flatbed, van trailer, compactor, tanker, etc.
Capacity - carrying capacity of vehicle, such as 20 cubic yards, 5 tons, 2,500 gallons, etc.
Section 4. Collection Area Serviced:
Communities, localities or industries served - self-explanatory. “Statewide” is permissible.
Section 5. Final Disposal Facilities:
Name and address of disposal facility - self-explanatory. “Per customer” is permissible for hazardous waste transporters
only. The “Disposal facility” is the final facility where the waste is going to be destroyed, interred, or recycled.
Section 6. Signature. The applicant must sign the form and print their name and the date the form was completed.
The applicant must provide a disclosure statement executed under oath or affirmation if it has: 1) any civil and administrative
complaints against it for the violation of any state or federal environmental protection law which has resulted in a fine or
penalty of more than $10,000 within 5 years before the date of submission of this application; 2) any pending criminal
complaint alleging the violation of any state or federal environmental protection law; 3) any judgment of criminal conviction
entered against it within 5 years before the date of submission of this application for the violation of any state or federal
environmental protection law; or, 4) any judgment of criminal conviction of a felony constituting a crime involving fraud or
misrepresentation under the law of any state or of the United States which has been entered against it within 5 years before
the date of submission of the application. The statement must fully address all of the above provisions. The Department will
verify and may investigate the information in the statement and may deny the application based on the findings. Applicants
are subject to enforcement action if: 1) the Department discovers, after a permit has been issued, that the applicant was
required to but did not provide a disclosure statement with the application; or 2) the Department discovers that the applicant
intentionally misrepresented or concealed any material fact in the disclosure statement.
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