Form 5600-PM-BMP0012 "Coal Ash Quality Assessment for Beneficial Use" - Pennsylvania

What Is Form 5600-PM-BMP0012?

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 July 1, 2017;
  • 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-BMP0012 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-BMP0012 "Coal Ash Quality Assessment for Beneficial Use" - Pennsylvania

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5600-PM-BMP0012
Rev. 7/2017
COMMONWEALTH OF PENNSYLVANIA
DEP USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Date Received
BUREAU OF MINING PROGRAMS
COAL ASH QUALITY ASSESSMENT
FOR BENEFICIAL USE
COAL ASH GENERATOR AND FACILITY INFORMATION
1. Name of Coal Ash Generator (Facility)
2. CA or GP No..
3. Contact Person
4. Phone No.
5. Email address:
5. Beneficial Use(s):
Placement (Reclamation)
Soil additive/amendment
Alkaline addition
Low-permeability material
CRD Stabilization
Other
6. Sampling location and description of sample (combined, etc.):
7. Sample Collection Date(s):
8. Submission type:
New source request
Quarterly Sampling results
Additional
COAL ASH AND LEACHATE ANALYSES
9. Ash solid and leachate results – Complete the attached table for all constituents and any additional
measurements, as applicable. Attached
LABORATORY REPORTS AND AFFIDAVIT
10. Documentation - Attach copies of lab reports. Lab reports must contain the test method used or attach separate
sheet with details. All numbers and letters on the report must be readable.
Attached
Analytical Laboratory Name, Address
Analyst(s) Name
Phone No.
Lab Certification No.
I,
, certify under penalty of law that I have personally examined and
am familiar with the information submitted under this Coal Ash Quality Assessment for Beneficial Use and the attached
analytical results. Based upon my inquiry of those individuals immediately responsible for obtaining the information, 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.
Day of
(month)
(year)
Signature of Responsible Official
Name (Typed)
Address
Title
- 1 -
5600-PM-BMP0012
Rev. 7/2017
COMMONWEALTH OF PENNSYLVANIA
DEP USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Date Received
BUREAU OF MINING PROGRAMS
COAL ASH QUALITY ASSESSMENT
FOR BENEFICIAL USE
COAL ASH GENERATOR AND FACILITY INFORMATION
1. Name of Coal Ash Generator (Facility)
2. CA or GP No..
3. Contact Person
4. Phone No.
5. Email address:
5. Beneficial Use(s):
Placement (Reclamation)
Soil additive/amendment
Alkaline addition
Low-permeability material
CRD Stabilization
Other
6. Sampling location and description of sample (combined, etc.):
7. Sample Collection Date(s):
8. Submission type:
New source request
Quarterly Sampling results
Additional
COAL ASH AND LEACHATE ANALYSES
9. Ash solid and leachate results – Complete the attached table for all constituents and any additional
measurements, as applicable. Attached
LABORATORY REPORTS AND AFFIDAVIT
10. Documentation - Attach copies of lab reports. Lab reports must contain the test method used or attach separate
sheet with details. All numbers and letters on the report must be readable.
Attached
Analytical Laboratory Name, Address
Analyst(s) Name
Phone No.
Lab Certification No.
I,
, certify under penalty of law that I have personally examined and
am familiar with the information submitted under this Coal Ash Quality Assessment for Beneficial Use and the attached
analytical results. Based upon my inquiry of those individuals immediately responsible for obtaining the information, 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.
Day of
(month)
(year)
Signature of Responsible Official
Name (Typed)
Address
Title
- 1 -
5600-PM-BMP0012
Rev. 7/2017
CHEMICAL AND PHYSICAL PROPERTIES OF ASH
Submit one sheet for each source and sample/composite date. Complete the entire table. Do not leave
blanks. If value is less than detection/quantification limit, use ‘<’ with limit value. Ex. <0.001.
Corresponding lab documentation must be attached.
CA #
Source Name
Date(s) Sampled
Date Analyzed
Dry weight and leachate chemical analysis using EPA Publication No. SW-846 or comparable methods approved by the
Department. Leachate concentrations determined with EPA Method 1312 SPLP
Dry Wt.
SPLP
Dry Wt.
SPLP
mg/kg or
Leachate
Certification
mg/kg or
Leachate
Certification
Constituent
ppm
mg/l
Limit
Constituent
ppm
mg/l
Limit
pH, solid (std. units)
7 or greater
Nickel (Ni)
2.5 mg/l
Aluminum (Al)
5.0 mg/l
Potassium (K)
N/A
Antimony (Sb)
0.15 mg/l
Selenium (Se)
0.5 mg/l
Arsenic (As)
0.25 mg/l
Silver (Ag)
2.5 mg/l
Barium (B)
50.0 mg/l
Thallium (Tl)
0.05 mg/l
Beryllium (Be)
0.10 mg/l
Vanadium (V)
6.125 mg/l
Boron (Ba)
15.0 mg/l
Zinc (Zn)
50.0 mg/l
Cadmium (Cd)
0.125 mg/l
Sulfur (S)
N/A
Calcium (Ca)
N/A
Sulfate (SO
)
2500 mg/l
4
Chromium (Cr)
2.5 mg/l
Chloride (Cl)
250 mg/l
Cobalt (Co)
17.5 mg/l
Fluoride (F)
N/A
Copper (Cu)
25.0 mg/l
Sodium (Na)
N/A
Iron (Fe)
7.5 mg/l
Lead (Pb)
0.375 mg/l
Leachate using ASTM D3987 (mg/l)
Magnesium (Mg)
N/A
Manganese (Mn)
2.5 mg/l
Nitrate (NO
)
10 mg/l
3
Mercury (Hg)
0.05 mg/l
Nitrite (NO
)
1 mg/l
2
Molybdenum (Mo)
4.375 mg/l
Ammonia (NH
)
30 mg/l
3
Acid Neutralizing Potential
In tons of CaCO3
100 or greater
CaCO
equivalent
3
per 1,000 tons of ash
only if used for alkaline addition
Permeability
1.0 x 10
-6
cm/sec or lower
Hydraulic conductivity
In cm/sec
only if used for low permeability material
Nitrogen Content
For Total Kjeldahl Nitrogen (TKN) use Standard Method 4500.
TKN
In mg/l
- 2 -
5600-PM-BMP0012
Rev. 7/2017
YEARLY TONNAGE REPORTING
Complete the following table and submit ONLY with the January 31 submittal.
This reporting fulfills the requirements in 25 Pa Code §290.201(d)(3). This page must also be
completed if NO ash was sent to mine sites for the year.
CA number
Year
Ash amount in dry tons
Site operator name
Mine site permit number or project number
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