DEP Form 62-710.901(7) "Used Oil Processing Facility Closing Cost Estimate Form" - Florida

What Is DEP Form 62-710.901(7)?

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

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the Florida 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 fillable version of DEP Form 62-710.901(7) by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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DEP Form # 62-710.901(7)
Department of Environmental Protection
Form Title: Used Oil Processing Facility
Closing Cost Estimate Form
Effective Date: 12/2019
Bob Martinez Center
Incorporated in Rule 62-710.800(6)(b)
2600 Blair Stone Road MS 4560, Tallahassee, Florida 32399-2400
Used Oil Processing Facility Closing Cost Estimate Form
I. GENERAL INFORMATION:
EPA ID Number:
Facility Name:
Permit Number:
Facility Address:
Owner or Operator (Permittee/Applicant):
Mailing Address:
II. TYPE OF FINANCIAL ASSURANCE DOCUMENT (Check Type):
____ Letter of Credit*
____ Performance Bond*
____ Financial Guaranty Bond*
*Indicate mechanisms that
require use of a Standby
____ Insurance Certificate*
____ Financial Test
____ Trust Fund Agreement
Trust Fund Agreement
III. ESTIMATE (Complete either Part A or Part B):
Rule 62-710.800(6)(c), Florida Administrative Code (F.A.C.), sets forth the requirements for cost estimate calculation.
Estimates adjusted for inflation are due annually between January 1 and March 1.
Part A – Inflation Factor Adjustment
An inflation adjustment using an inflation factor may only be used when recalculation is not required by rule. When
inflation-factor adjusting, only page 1 of this form must be submitted. The appropriate inflation factor for adjusting an
estimate may be obtained from the Solid Waste website –
http://FloridaDEP.gov/waste/permitting-compliance-assistance/content/solid-waste-financial-assurance
– or by sending a request to
Solid.Waste.Financial.Coordinator@floridadep.gov
This estimate is based on the estimate dated
that was approved by the Department on
.
(signature date)
(leave blank if not approved)
Last Year’s
Current Year Inflation
Inflation Adjusted
Closing Cost Estimate:
Factor (e.g.1.0xx)
Closing Cost Estimate:
$
X
=
$
Signature (representative of Owner/Operator)
Date
Telephone
Name and Title
E-mail
If you have questions concerning this form, please contact the Used Oil Permitting Coordinator at the address below or by
phone at (850) 245-8707.
Please send this completed cost estimate to:
Please e-mail a copy of this completed cost
Used Oil Permitting Coordinator
estimate to:
Department of Environmental Protection
Solid.Waste.Financial.Coordinator@floridadep.gov
2600 Blair Stone Road MS 4560
Tallahassee, Florida 32399-2400
DEP FORM 62-710.901(7)
Page 1 of 3
SAVE
PRINT
CLEAR
DEP Form # 62-710.901(7)
Department of Environmental Protection
Form Title: Used Oil Processing Facility
Closing Cost Estimate Form
Effective Date: 12/2019
Bob Martinez Center
Incorporated in Rule 62-710.800(6)(b)
2600 Blair Stone Road MS 4560, Tallahassee, Florida 32399-2400
Used Oil Processing Facility Closing Cost Estimate Form
I. GENERAL INFORMATION:
EPA ID Number:
Facility Name:
Permit Number:
Facility Address:
Owner or Operator (Permittee/Applicant):
Mailing Address:
II. TYPE OF FINANCIAL ASSURANCE DOCUMENT (Check Type):
____ Letter of Credit*
____ Performance Bond*
____ Financial Guaranty Bond*
*Indicate mechanisms that
require use of a Standby
____ Insurance Certificate*
____ Financial Test
____ Trust Fund Agreement
Trust Fund Agreement
III. ESTIMATE (Complete either Part A or Part B):
Rule 62-710.800(6)(c), Florida Administrative Code (F.A.C.), sets forth the requirements for cost estimate calculation.
Estimates adjusted for inflation are due annually between January 1 and March 1.
Part A – Inflation Factor Adjustment
An inflation adjustment using an inflation factor may only be used when recalculation is not required by rule. When
inflation-factor adjusting, only page 1 of this form must be submitted. The appropriate inflation factor for adjusting an
estimate may be obtained from the Solid Waste website –
http://FloridaDEP.gov/waste/permitting-compliance-assistance/content/solid-waste-financial-assurance
– or by sending a request to
Solid.Waste.Financial.Coordinator@floridadep.gov
This estimate is based on the estimate dated
that was approved by the Department on
.
(signature date)
(leave blank if not approved)
Last Year’s
Current Year Inflation
Inflation Adjusted
Closing Cost Estimate:
Factor (e.g.1.0xx)
Closing Cost Estimate:
$
X
=
$
Signature (representative of Owner/Operator)
Date
Telephone
Name and Title
E-mail
If you have questions concerning this form, please contact the Used Oil Permitting Coordinator at the address below or by
phone at (850) 245-8707.
Please send this completed cost estimate to:
Please e-mail a copy of this completed cost
Used Oil Permitting Coordinator
estimate to:
Department of Environmental Protection
Solid.Waste.Financial.Coordinator@floridadep.gov
2600 Blair Stone Road MS 4560
Tallahassee, Florida 32399-2400
DEP FORM 62-710.901(7)
Page 1 of 3
Part B – Calculated Cost Estimates
A third-party Estimate/Quote must be provided for each item.
Costs must be for a third party providing all materials and labor.
DESCRIPTION
UNIT
QUANTITY
UNIT COST
TOTAL
‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾
1. Decontamination and Disposal
Note: These costs must be broken down by individual waste stream. If contamination is found, the cost estimate
must be recalculated to include remediation costs.
a. Used oil tanks, containers, piping, equipment and secondary containment
decontamination
$
$
waste characterization
$
$
disposal
$
$
b. Wash Water
waste characterization
$
$
disposal
$
$
c. Sludges/Sediment
waste characterization
$
$
disposal
$
$
d. Used Oil Filter Management
waste characterization
$
$
disposal
$
$
e. Petroleum Contaminated Water (PCW), tanks, containers, piping, equipment and secondary containment
waste characterization
$
$
disposal
$
$
f. Mobilization Costs
$
$
g. Other
$
$
Subtotal (1) Decontamination/Disposal:
$
DEP FORM 62-710.901(7)
Page 2 of 3
2. Engineering (On-site Inspections and Quality Assurance are to be included in this item).
a. Closure sampling and analysis plan implementation as described in the permit application
$
b. Closure Certification Report
$
Subtotal (2) Professional Services:
$
Subtotal of (1) and (2) Above:
$
3. Contingency (10% of the Subtotal)
$
TOTAL CLOSING COST:
$
IV. SIGNATURES:
CERTIFICATION BY ENGINEER
This is to certify that the Cost Estimates pertaining to the engineering features of this solid waste management
facility have been examined by me and found to conform to engineering principals applicable to such facilities.
In my professional judgment, the Cost Estimates are a true, correct and complete representation of the financial
liabilities for closing of the facility, and comply with the requirements of Rule 62-710, F.A.C. and all other
Department of Environmental Protection rules, and statutes of the State of Florida.
Signature
Date
Name and Title
Address
Florida Registration Number
City, State, Zip
Telephone
E-mail
SIGNATURE BY OWNER/OPERATOR
I understand that Cost Estimates, adjusted for inflation, must be submitted to the Department annually.
Revised or adjusted Cost Estimates will be submitted as required by Rule 62-710.800(6), F.A.C.
Signature (authorized representative of Owner/Operator)
Telephone
Name and Title
E-mail
DEP FORM 62-710.901(7)
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