"Wet Storage Permit Application" - New Hampshire

Wet Storage Permit Application is a legal document that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire.

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  • Released on October 1, 2014;
  • The latest edition currently provided by the New Hampshire Department of Health and Human Services;
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STATE OF NEW HAMPSHIRE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
MAIL TO: BUREAU OF FINANCE/RECEIPTS UNIT-FOOD PROTECTION
129 PLEASANT STREET, CONCORD, NH 03301
Telephone: 603-271-4589
FAX: 603-271-4859
TDD Access: 1-800-735-2964
Website: www.dhhs.nh.gov
E-mail: dhhs.foodprotection@dhhs.nh.gov
Wet Storage Permit Application
RS 407582
Send completed applications and fee of $50 (payment to be in form of check or money order made payable to
Treasurer, State of NH) to:
NH Department of Health and Human Services
Bureau of Finance/Receipts Units - Food Protection Section
129 Pleasant St., Concord, NH 03301
To allow time for processing, applications must be submitted 60 days prior to the requested date of activity.
Note that due to the complexity of some wet storage processes, the permit process may take more than 60 days.
PLEASE TYPE OR PRINT
DATE OF REQUEST: ____________________
CERTIFICATE # NH: __________________
Applicant Name/Name on Certificate: ________________________________________________________________
(Print Name to Appear on Permit/Name on Certificate)
Address: _________________________________________________________________________________________
(Street)
(City, State, Zip Code)
Business Phone: ______________ Fax: _____________ email: ____________________________________________
Submit all supporting documentation. Incomplete applications will be returned.
□ If a land-based facility, an operational plan as required by NSSP Guide (2013), Chapter 7, Section .01 B (2) and Section .04 B (1)-(3).
□ Water system documentation which meets the requirements in He-P 2153.06 for wet storage in artificial bodies of water (land-based).
□ Water treatment system description and maintenance plan for wet storage in artificial bodies of water (land-based).
□ A flow chart identifying each step in the wet storage process for natural bodies of water (offshore), and in artificial bodies of water (land-
based).
□ A description of cleaning procedures and a cleaning schedule.
□ NH department of environmental services letter of no impact.
□ Army Corps of Engineers documentation/permit.
PART I – PURPOSE OF WET STORAGE ACTVITIES
Provide a narrative explaining the purpose for the wet storage activities, such as holding or conditioning.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
SSWSAPP 10-01-14
Page 1
STATE OF NEW HAMPSHIRE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
MAIL TO: BUREAU OF FINANCE/RECEIPTS UNIT-FOOD PROTECTION
129 PLEASANT STREET, CONCORD, NH 03301
Telephone: 603-271-4589
FAX: 603-271-4859
TDD Access: 1-800-735-2964
Website: www.dhhs.nh.gov
E-mail: dhhs.foodprotection@dhhs.nh.gov
Wet Storage Permit Application
RS 407582
Send completed applications and fee of $50 (payment to be in form of check or money order made payable to
Treasurer, State of NH) to:
NH Department of Health and Human Services
Bureau of Finance/Receipts Units - Food Protection Section
129 Pleasant St., Concord, NH 03301
To allow time for processing, applications must be submitted 60 days prior to the requested date of activity.
Note that due to the complexity of some wet storage processes, the permit process may take more than 60 days.
PLEASE TYPE OR PRINT
DATE OF REQUEST: ____________________
CERTIFICATE # NH: __________________
Applicant Name/Name on Certificate: ________________________________________________________________
(Print Name to Appear on Permit/Name on Certificate)
Address: _________________________________________________________________________________________
(Street)
(City, State, Zip Code)
Business Phone: ______________ Fax: _____________ email: ____________________________________________
Submit all supporting documentation. Incomplete applications will be returned.
□ If a land-based facility, an operational plan as required by NSSP Guide (2013), Chapter 7, Section .01 B (2) and Section .04 B (1)-(3).
□ Water system documentation which meets the requirements in He-P 2153.06 for wet storage in artificial bodies of water (land-based).
□ Water treatment system description and maintenance plan for wet storage in artificial bodies of water (land-based).
□ A flow chart identifying each step in the wet storage process for natural bodies of water (offshore), and in artificial bodies of water (land-
based).
□ A description of cleaning procedures and a cleaning schedule.
□ NH department of environmental services letter of no impact.
□ Army Corps of Engineers documentation/permit.
PART I – PURPOSE OF WET STORAGE ACTVITIES
Provide a narrative explaining the purpose for the wet storage activities, such as holding or conditioning.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
SSWSAPP 10-01-14
Page 1
PART II – LOCATION OF WET STORAGE SITE and SOURCE WATER:
Type of Wet Storage:
Land Based/Flow Through System
Land Based/Recirculating System
Offshore/ Approved or Conditionally Approved (open status), as well as harvested from approved or conditionally
approved areas.
“I certify that all information provided in or attached to this application is complete, accurate and up-to-date as of the
date specified below. I further certify that there are no willful misrepresentations of the answers to questions herein,
and that I have made no omissions with respect to any of my answers to the questions presented. I understand that it is
my responsibility to immediately notify the Food Protection Section with regard to any changes, corrections or updates
to the information provided.”
Signature of applicant: _____________________________________________________ Date: _____________________________
Printed Last/First Name of Applicant: ____________________________________________________________________________
-----------------------------------------------DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY---------------------------------------------------
Wet Storage Permit Number: ________________________
Approved
Denied
Effective Period: _________________________________ Date App. Received: ________ Effective Period: _____________
[relay app has SSO approval. Add?]
Comments: _________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
SSWSAPP 10-01-14
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