Form 5600-PM-BMP0011 "Coal Ash Beneficial Use Certification" - Pennsylvania

What Is Form 5600-PM-BMP0011?

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

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the Pennsylvania Department of Environmental Protection;
  • 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 printable version of Form 5600-PM-BMP0011 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Environmental Protection.

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Download Form 5600-PM-BMP0011 "Coal Ash Beneficial Use Certification" - Pennsylvania

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5600-PM-BMP0011
Rev. 3/2018
COMMONWEALTH OF PENNSYLVANIA
DEP Use Only
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF MINING PROGRAMS
COAL ASH BENEFICIAL USE CERTIFICATION
1. COAL ASH GENERATION SITE INFORMATION
Name of Coal Ash Generation Facility
Company Name
Mailing Address
(Street Number and Name or P.O. Box)
(City)
(State)
(Zip Code + Four)
Ext.
Email address
Telephone Number
FAX Number
Location of Coal Ash Generation Facility
Municipality
County
State
Latitude
°
Longitude
°
Coal Ash Generation Facility Contact
(Last Name)
(First Name)
(MI)
(Title)
(Street Number and Name or P.O. Box)
(City)
(State)
(Zip Code + Four)
Ext.
Email Address
Telephone Number
FAX Number
Consultant or other contact
(Last Name)
(First Name)
(MI)
Ext.
Email Address
Telephone Number
FAX Number
IMPORTANT: Email contact will be used by the Department to provide reminders, information and forms. Please make sure the email
address provided is regularly monitored. Notify RA-coalash@pa.gov of changes.
2. BENEFICIAL USE
a. This request is for:
Coal ash certification
Qualification of general permit material
b. The following Beneficial Use is requested for this ash source:
Placement
Soil substitute/additive
If placement select all that apply:
Reclamation/Fill
Alkaline Addition
Low-permeability material
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5600-PM-BMP0011
Rev. 3/2018
COMMONWEALTH OF PENNSYLVANIA
DEP Use Only
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF MINING PROGRAMS
COAL ASH BENEFICIAL USE CERTIFICATION
1. COAL ASH GENERATION SITE INFORMATION
Name of Coal Ash Generation Facility
Company Name
Mailing Address
(Street Number and Name or P.O. Box)
(City)
(State)
(Zip Code + Four)
Ext.
Email address
Telephone Number
FAX Number
Location of Coal Ash Generation Facility
Municipality
County
State
Latitude
°
Longitude
°
Coal Ash Generation Facility Contact
(Last Name)
(First Name)
(MI)
(Title)
(Street Number and Name or P.O. Box)
(City)
(State)
(Zip Code + Four)
Ext.
Email Address
Telephone Number
FAX Number
Consultant or other contact
(Last Name)
(First Name)
(MI)
Ext.
Email Address
Telephone Number
FAX Number
IMPORTANT: Email contact will be used by the Department to provide reminders, information and forms. Please make sure the email
address provided is regularly monitored. Notify RA-coalash@pa.gov of changes.
2. BENEFICIAL USE
a. This request is for:
Coal ash certification
Qualification of general permit material
b. The following Beneficial Use is requested for this ash source:
Placement
Soil substitute/additive
If placement select all that apply:
Reclamation/Fill
Alkaline Addition
Low-permeability material
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5600-PM-BMP0011
Rev. 3/2018
3. FUEL SOURCE
a. Provide information on the fuel source(s) used to produce coal ash for beneficial use. (Sources of fuel,
location of source, blending, percentages, etc.)
b. List any non-coal materials (other than limestone) used in the combustion process (tire-derived fuel, paper,
waste products, etc.) and justification for their use. If coproducts are used, include in the list and provide the
determination information.
Describe how often each fuel source is used, the percentage of the fuel stream they constitute, the volume
used, the chemical variability of these additional materials and any resulting chemical and/or physical
property changes that may occur in the resulting ash. Identify particular chemical parameters that may
increase in the ash due to use of these products. If any of these organic or inorganic parameters are not
included on the Coal Ash Quality form, include sample analyses for them as part of the ash sampling
requirements.
c. List all Bureau of Waste Management General Permits (WMGR) issued to this facility that authorize the
operator to burn alternate fuels, mix residual waste, and/or authorize the beneficial use of ash generated by
this facility. Attach a copy of the approval.
How frequently is ash generated from pure coal or waste coal only?
%
4. COAL ASH GENERATION PROCESS
a. Type of coal combustion:
Pulverized Coal
Circulating Fluidized Bed
Other (Describe):
b. Does this source location include multiple boilers/processes for generation of beneficially used ash?
Yes
No
Is the ash obtained from another location or process besides present-day generation?
Yes
No
If yes, describe each individual process in item 4.c. And, describe the ratio of ash from each process that will
comprise the final source stream of ash to the mine site as part of 4.d.
c. Combustion process. Provide a description of the combustion process that generates coal ash for beneficial
use. Describe pollution control processes utilized and how these affect the physical and chemical properties
of the ash. For example, describe how NOx controls affect ash chemistry (e.g., effects on nitrogen in the
ash). Provide diagrams, charts and tables as necessary to supplement this narrative description.
d. Collection and storage. Provide a description of the process that collects and stores coal ash to be used for
beneficial use. Describe how ash is stored prior to beneficial use: type of storage (silo, impoundment,
stockpile, etc.), lined/unlined, covered/uncovered, other material placed in storage with ash (other wastes,
FGD material, etc.), age of material in storage, etc.
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5600-PM-BMP0011
Rev. 3/2018
e. Indicate the expected percentage of each type of ash (fly, bottom, from each individual unit) for the final
stream that goes to the mine site (i.e. 80% fly ash, 20% bottom ash). Describe any blending process.
f.
How much ash will be produced per year from the entire plant (estimated)?
tons
How much of this is expected to be used beneficially for mine sites in Pennsylvania?
% or
tons.
5. PHYSICAL AND CHEMICAL CHARACTERISTICS OF COAL ASH
Describe the procedures used to obtain representative samples of beneficially used coal ash for analytical
a.
purposes (including timing and location of sampling, compositing and/or grab samples). A coal ash sampling
plan must be developed describing the procedure to obtain a representative sample in accordance with EPA’s
Test Methods for Evaluating Solid Waste, SW-846 and/or EPA’s Methods of Chemical Analysis of Water and
Waste EPA 600/4-79-020.
b. Describe the amount of and processes by which water and/or other materials are added to or mixed with the
coal ash at any point between collection at the generation site to final use at the mine site. Include the
following: processing with additives to adjust the pH or alter any other properties of the ash, mixing with any
other product. List every other materials deposited directly with the ash when placed at any mine site (plastic
bed liners, soil, spoil, water treatment cake, etc.).
c. Analyze the coal ash and coal ash leachate for the constituents listed in Department form number
5600-PM-BMP0012 “Coal Ash Quality Assessment”. Results from four (4) samples over a 2- to 6- month
period within the last year must be submitted with the initial request for certification to the Department.
At least four (4) ash analyses are attached.
d. Contingency plan. If, at any time, the generator has knowledge that the ash does not meet quality criteria to
be used at the beneficial use site, describe where this ash will be stockpiled, segregated and/or removed and
disposed.
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5600-PM-BMP0011
Rev. 3/2018
6.
CERTIFICATION OF COAL ASH GENERATOR
I,
, certify under penalty of law that I have personally examined and am
familiar with the information submitted herein and the attached analytical results. I believe the submitted
information is true and correct to the best of my knowledge and belief. I am aware that there are significant
penalties for submitting false information, including the possibility of fine and imprisonment.
Sworn and Subscribed This
Day of
(month)
(year)
Signature of Responsible Official
Title
Name (Typed)
Address
ACKNOWLEDGEMENT
COMMONWEALTH/STATE OF
COUNTY OF
On this
day of
,
, before me, the undersigned officer,
personally appeared the above named
, known to me (or satisfactorily proven)
to be the person(s) whose name(s) are subscribed to the within instrument, and acknowledged that he/she,
in such capacity, being authorized to do so, executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
(Signature)
(Seal)
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