Form 7300 "Solid Waste Permit Application - Type I / Type Ii Surface Impoundments" - Louisiana

What Is Form 7300?

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

Form Details:

  • Released on October 12, 2017;
  • The latest edition provided by the Louisiana 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 printable version of Form 7300 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Environmental Quality.

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Download Form 7300 "Solid Waste Permit Application - Type I / Type Ii Surface Impoundments" - Louisiana

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LOUISIANA
Department of Environmental Quality
Office of Environmental Services
Waste Permits Division
Solid Waste Permit Application
P.O. Box 4313
Type I / Type II Surface
Baton Rouge, LA 70821-4313
(225) 219-3181
Impoundments
NOTE: A Guidance document has been prepared by the Louisiana Department of Environmental Quality (LDEQ) to
assist the permit applicant in completing this Louisiana Solid Waste Permit Application for Type I/Type II Surface
Impoundments. The Guidance should be consulted and utilized prior to providing responses to the information
required to be contained in this application.
ALL facility plans, specifications, and operations represented and described in this application shall be prepared under the
supervision of and certified by a professional engineer licensed in the State of Louisiana.
Site geology and groundwater conditions at facilities shall be characterized by a geologist or a professional engineer licensed
in the State of Louisiana with expertise in geotechnical engineering and hydrogeology.
PLEASE TYPE OR PRINT
1. Facility and Permit Applicant Information
A. Facility Name
B. Agency Interest (AI) Number
C. SIC code
D. Mailing Address
City
State
Zip
E. Type of Application:
F. Attach in Attachment 1 proof of publication of the notice
New application
Renewal application
regarding the submittal of the permit application for new, renewal,
Major Modification
Minor Modification
and major modification applications only.
G. Type of Operation (check each applicable box)
Site
Existing
Proposed
H. Operational Status of:
Type I industrial
Type II residential/commercial
Facility
Existing
Proposed
I. Individual/Company - Name of Owner
Permittee/Permit Holder
J. Individual/Company - Name of Operator (if different from Owner)
Permittee/Permit Holder
K. Parent Company (if applicable)
Permittee/Permit Holder
L. Ownership Status (if leased, attach a copy of lease in Attachment 2)
M. Ownership (Check the appropriate box.)
Owned by Applicant
Leased
yrs. of lease
corporation, partnership, or sole proprietorship
regulated utility
N. Solid Waste Permit or Order to Upgrade Number
municipal government
state government
O. Solid Waste Facility Number
federal government
other, specify
Q. Acreage to be used for disposal
P. Total site acreage
R. Anticipated proposed remaining life:
S. Maximum proposed capacity:
3
mos.
yrs.
yds
and
wet tons
T. Provide a brief history of solid waste permitting actions for the surface impoundment(s), including, but not limited to,
permits, modifications, and closure activities.
U. List the name of all units of the facility that are included in the application.
V. List of all environmental permits issued to this site (include dates of issuance, permit numbers).
W. List of all environmental permits for which the applicant has applied or intends to apply for, related to this site.
Solid Waste Permit Application – Type I / II Surface Impoundments
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Page 1 of 15
LOUISIANA
Department of Environmental Quality
Office of Environmental Services
Waste Permits Division
Solid Waste Permit Application
P.O. Box 4313
Type I / Type II Surface
Baton Rouge, LA 70821-4313
(225) 219-3181
Impoundments
NOTE: A Guidance document has been prepared by the Louisiana Department of Environmental Quality (LDEQ) to
assist the permit applicant in completing this Louisiana Solid Waste Permit Application for Type I/Type II Surface
Impoundments. The Guidance should be consulted and utilized prior to providing responses to the information
required to be contained in this application.
ALL facility plans, specifications, and operations represented and described in this application shall be prepared under the
supervision of and certified by a professional engineer licensed in the State of Louisiana.
Site geology and groundwater conditions at facilities shall be characterized by a geologist or a professional engineer licensed
in the State of Louisiana with expertise in geotechnical engineering and hydrogeology.
PLEASE TYPE OR PRINT
1. Facility and Permit Applicant Information
A. Facility Name
B. Agency Interest (AI) Number
C. SIC code
D. Mailing Address
City
State
Zip
E. Type of Application:
F. Attach in Attachment 1 proof of publication of the notice
New application
Renewal application
regarding the submittal of the permit application for new, renewal,
Major Modification
Minor Modification
and major modification applications only.
G. Type of Operation (check each applicable box)
Site
Existing
Proposed
H. Operational Status of:
Type I industrial
Type II residential/commercial
Facility
Existing
Proposed
I. Individual/Company - Name of Owner
Permittee/Permit Holder
J. Individual/Company - Name of Operator (if different from Owner)
Permittee/Permit Holder
K. Parent Company (if applicable)
Permittee/Permit Holder
L. Ownership Status (if leased, attach a copy of lease in Attachment 2)
M. Ownership (Check the appropriate box.)
Owned by Applicant
Leased
yrs. of lease
corporation, partnership, or sole proprietorship
regulated utility
N. Solid Waste Permit or Order to Upgrade Number
municipal government
state government
O. Solid Waste Facility Number
federal government
other, specify
Q. Acreage to be used for disposal
P. Total site acreage
R. Anticipated proposed remaining life:
S. Maximum proposed capacity:
3
mos.
yrs.
yds
and
wet tons
T. Provide a brief history of solid waste permitting actions for the surface impoundment(s), including, but not limited to,
permits, modifications, and closure activities.
U. List the name of all units of the facility that are included in the application.
V. List of all environmental permits issued to this site (include dates of issuance, permit numbers).
W. List of all environmental permits for which the applicant has applied or intends to apply for, related to this site.
Solid Waste Permit Application – Type I / II Surface Impoundments
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2. Facility Physical Location and Process Description
A. Nearest Town (in same parish as the facility)
B. Parish(es)
C. Geographic Location: Section
Township
Range
D. GPS coordinates
Location
Latitude
Longitude
Centerpoint of the site
decimal degrees
decimal degrees
Centerpoint of unit
decimal degrees
decimal degrees
Centerpoint of unit
decimal degrees
decimal degrees
decimal degrees
decimal degrees
Centerpoint of unit
decimal degrees
decimal degrees
Centerpoint of unit
decimal degrees
decimal degrees
Centerpoint of unit
decimal degrees
decimal degrees
Centerpoint of unit
Centerpoint of unit
decimal degrees
decimal degrees
Centerpoint of unit
decimal degrees
decimal degrees
Front gate of the site
decimal degrees
decimal degrees
E. Physical Location (identify by street number, by intersection of roads, or by mileage and direction from an intersection.)
F. Provide a brief description of the site operations.
G. Provide a description of the modifications/changes proposed in this application.
3. Local Zoning
(updated zoning is not required unless facility is new or expanding, however we recommend providing a
copy of most recent zoning if the permit application will be going on public notice)
A. Facility Zoning Classification of the Facility at Time of Application Submittal
B. Local Zoning Authority
C. Local Zoning Authority Contact
Address (Including Suite, Mail Drop, or Division)
City
Zip
Business Phone
D. Attach zoning in Attachment 3
Zoning affidavit
Zoning confirmation (if required by LAC 33:VII.513.B.2)
Other
4. Confidentiality
Is confidentiality being requested for any information contained in the application?
Yes
No
If “yes,” list the sections for which confidentiality is requested below. Confidentiality requests require a submittal
that is separate from this application. Information for which confidentiality is requested should not be submitted with
this application. Consult Guidance document for instructions.
5. Fee Information
Has the required fee been paid in accordance with LAC 33:VII.1501?
Yes
No
6. LAC 33:I.1701 Requirements
A. Does the applicant have federal or state environmental permits (other than the ones listed in Section 1) identical to, or of
a similar nature to, the permit for which this application is being submitted? (This requirement applies to all individuals,
partnerships, corporations, or other entities who own a controlling interest of 50% or more in your company, or who
participate in the environmental management of the facility for an entity applying for the permit or an ownership interest
in the permit.)
Yes
No
 If “yes,” list permits in Louisiana:
 list states in which permits are held:
B. Does the applicant owe any outstanding fees or final penalties to the LDEQ?
Yes
No
 If “yes”, provide an explanation.
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C. Is the applicant a corporation or limited liability company?
Yes
No
 If “yes,” attach a copy of the Certificate of Registration and/or Certificate of Good Standing from the Secretary of
State. Attach the appropriate certificate(s) in Attachment 4.
7. Certification and Signatures
CERTIFICATION OF RESPONSIBLE OFFICIAL: “I have personally examined and am familiar with the information
submitted in the attached document, and I hereby certify under penalty of law that this information is true, accurate, and
complete to the best of my knowledge, information, and belief. I am aware that there are significant penalties for submitting
false information, including the possibility of fine and/or imprisonment.”
Name
Title
Company
Suite, mail drop, or division
Street or P.O. Box
City
State
Zip
Business Phone
Signature of responsible official (as defined in LAC 33:VII.115):
Date:
CERTIFICATION OF APPLICATION PREPARER: "I certify under penalty of law that I have personally examined
and I am familiar with the information submitted in this permit application and that the facility as described in this permit
application meets the requirements of LAC 33:VII.Subpart 1. I am aware that there are significant penalties for knowingly
submitting false information, including the possibility of fine and imprisonment."
Name
Title
Company
Suite, mail drop, or division
Street or P.O. Box
City
State
Zip
Business phone
Cell Phone (Optional)
Email (optional)
Signature of preparer:
Date:
CERTIFICATION OF ENGINEER: "I certify that the facility plans, specifications, and operations represented and
described in the permit application were prepared under my supervision and are true and accurate to the best of my
knowledge, information, and belief in accordance with LAC 33:VII.713.B.1."
Name
Title
Company
Suite, mail drop, or division
Street or P.O. Box
City
State
Zip
Business Phone
Signature of engineer:
Date:
Louisiana Registration Number
and Seal:
Solid Waste Permit Application – Type I / II Surface Impoundments
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8. Facility Contact Information/Personnel
Select the primary contact by checking the box after the person whom will be the primary contact for questions regarding this
application. Only one primary contact should be selected.
a. Manager of Facility who is located at site
Name
Primary Contact
Title
Company
Suite, Mail Drop, or Division
Street or P.O. Box
City
State
Zip
Business Phone
Cell Phone (Optional)
E-mail (Optional)
b. On-site contact regarding waste permit
Name
Primary Contact
Title
Company
Suite, Mail Drop, or Division
Street or P.O. Box
City
State
Zip
Business Phone
Cell Phone (Optional)
E-mail (Optional)
c. Person to whom written correspondence should be directed
Name
Primary Contact
Title
Company
Suite, Mail Drop, or Division
Street or P.O. Box
City
State
Zip
Business Phone
Cell Phone (Optional)
E-mail (Optional)
d. Person to contact regarding Annual Maintenance Fees
a
b
c
other (specify below)
Name
Primary Contact
Title
Company
Suite, Mail Drop, or Division
Street or P.O. Box
City
State
Zip
Business Phone
Cell Phone (Optional)
E-mail (Optional)
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9. Waste Description and Service Areas
A. Maximum quantities of waste disposed:
Wet tons/week
Wet tons/year
Waste Type
On-Site
Off-Site
On-Site
Off-Site
If ‘Other’ is filled out, provide a brief
Residential
description of the waste here:
Industrial
Commercial
Other
B. Approximate percentage of waste received from onsite:
offsite from generators within Louisiana:
offsite from generators outside of Louisiana:
C. Areas serviced by the facility:
Only waste generated by the
Claiborne
Livingston
St. Martin
facility
Concordia
Madison
St. Mary
All parishes
De Soto
Morehouse
St. Tammany
Out-of-state
East Baton Rouge
Natchitoches
Tangipahoa
East Carroll
Orleans
Tensas
Acadia
East Feliciana
Ouachita
Terrebonne
Allen
Evangeline
Plaquemines
Union
Ascension
Franklin
Pointe Coupee
Vermilion
Assumption
Grant
Rapides
Vernon
Avoyelles
Iberia
Red River
Washington
Beauregard
Iberville
Richland
Webster
Bienville
Jackson
Sabine
West Baton Rouge
Bossier
Jefferson Davis
St. Bernard
West Carroll
Caddo
Jefferson
St. Charles
West Feliciana
Calcasieu
La Salle
St. Helena
Winn
Caldwell
Lafayette
St. James
Cameron
Lafourche
St. John the Baptist
Other
Catahoula
Lincoln
St. Landry
D. Provide the maximum days of operation per week and hours per facility operating day (maximum hours of operation
within a 24-hour period).
days/week
hrs/day
Provide the normal days or operation per week and hours per facility operating day (within a 24-hour period).
days/week
hrs/day
List the hours of operation during normal operating hours:
Sunday
am to
pm
Monday
am to
pm
Tuesday
am to
pm
Wednesday
am to
pm
Thursday
am to
pm
Friday
am to
pm
Saturday
am to
pm
10. Enforcement Actions
Does the facility presently have any current requirements, conditions, or limitations that have been imposed upon the facility
pursuant to any enforcement actions, settlement agreements, and consent decrees?
Yes
No
If “yes,” attach a list of all such enforcement actions, settlement agreements, and consent decrees from the federal
government or LDEQ issued to the facility and/or entered into between the federal government and/or LDEQ. For each
action, list the type of action, its tracking number, and the date that the action was issued. Summarize the conditions
imposed by the enforcement action, settlement agreement, and/or consent decree in Attachment 5. It is not necessary
to submit a copy of the referenced action.
If “no,” has the facility been issued any enforcement actions and/or entered into any settlement agreements, and/or
consent decrees within the last three (3) years?
Yes
No
If “yes,” attach a summary as described above in Attachment 5.
11. Location Area Information
Airports
A. List the distance from the facility to the nearest airport.
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