WT002804_Kleen Tech Stormwater EPA Form_20191030

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1
EPA IderOmB n Number NPDES Permit Number �� Faulty Name M' Form Approved 03AIN19
.I -zqi �!`r OMB No.20404M
Form U.S.Environmental Protection Agency
1 10411EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION •WRING AN N PDESr
1.1 Applicants Nof Required to Submit Form f
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 treatment works? 1.1.2 treating domestic sawage? �/
if yes,STOP.Do NOT complete No If yes,STOP.Do NOT ih No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Requfnldto Submit Form 1
e 1.2.1 Is the facility a concentrated animal feeding 1.2.2 is the facility an existing manufacturing,
operation or a concentrated aquatic animal ommmerel !,mining,or Silviculturai facility that Is
a production facility? currently discharging process wastewater?
w FI Yes+ Complete Form 1 Ul( No E] Yes 4 Complete Form E/ No
a and Form 28. 1 and Form 2C.
z
1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess waste or?
c Yes� Complete Form 1 No E] Yes 4 Complete Form (PNo
and Form 2D. _ 1 and Form 2E.
ro 1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of atormwater
a associated with industrial activity or whose
discharge is composed of both stormwater and
- - no •stormwater7 -
Yes-*Compete Form 1 0 No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION l40 CFR 122.21(f)(2))
b 15.
2.1 Facility Name
Kf Er N -7-C- 0-H INC
9 2.2 EPA Identification Number
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2.3 Facility Contact
Name(first and last) Title Phone number
e Email Wdress TI r /�
l C, C®
a; 2.4 Facility Malting Address
Z Street or P.O.box 10 Q 6/X 13 0
City or town State ZIP code
Hjr-xo NG RTIJ CA R
EPA Form 351GO(whoed 3.19) Page 1

EPA ldonlirmtion Number NPOES Permit Number radliV Name \ Form Approved 03/05119
I r ri1 OMB No.2040-M
V 2.5 Facility Location
rStreet,route number,or other specific identifier
M� I10 RD �+E
g County name County code(if known)
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City or town State ZIP code
CODESSECTION 3.SIC AND NAICS r
3.1 SIC Code(s) Description(optional)
0°
3.2 NAICS Code(s) Description(optional)
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A
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O.
4.1 Name of Operator
SEEN TEc
0 4.2 Is the name you listed in Item 4.1 also the owner?
o If Yes ❑ No
4.3 Operator Status
to ,.❑,/Pubiic—federal ❑Public—state ❑Other public(specfy)
IJ
o Private ❑Other specify
4.4 Phone Number of 0 erator
4.5 0 eralorAddress
° Street or P.O.Box
110 3RD 5T. NE
r City or town State ZIP code
g Email address of operator
0
SECTION 5. . • r •t
C 5.1 Is the facility located on Indian Land?
e ❑Yes MN.
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No.2040-0004
SECTION • I CFR 122.21(f)(6))J�
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
d ❑ NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
o w
water) fluids)
.5 -E
r` a ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CAA)
rn
c
K ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑ Other(specify)
w
CT
• 1
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
21 Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTIONOF C 1
8.1 Describe the nature of your business.
�'�' "�l J � Z� 4oDe n per.
/lJG-i r�S WiL` ^Gvc�GQC n
w I �r7V-G,t uvr�i72M S,
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COOLINGSECTION 9. 1
9.1 Does your facility use coaling water?
,^ ❑ Yes O No 4 SKIP to Item 10.1.
9.2 Identify the source of cooling water.(Note that facilities that use a coaling water intake structure as described at
a 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
65 NPDES permitting authority to determine what specific information needs to be submitted and when.)
O Y
U C
SECTION1 VARIANCE REQUESTSI I
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
H apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
d ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
c on 301(c)and(g))
Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA beMifica0en Number NPDES Permit Number K L� F ryy Form MB Noo.2040MN
SECTION1 CERTIFICATION STATE M ENT(40 and
11.1 In Column 1 below,mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to provide attachments.
Column 1 Column 2
Section 1:Activities Requiring an NPDES Permit ❑ wl attachments
Section 2:Name,Mailing Address,and Location ❑ wl attachments
Section 3:SIC Codes ❑ wl attachments
Section 4:Operator Information ❑ wl attachments
❑ Section 5:Indian Land ❑ wl attachments
❑ Section 6: Existing Environmental Permits ❑ wl attachments
a.
E wl topographic
Section 7:Map d map ❑ wl additional attachments
g Section 8:Nature of Business ❑ wl attachments
❑ Section 9:Cooling Water Intake Structures ❑ wl attachments
U
,o ❑ Section 10:Variance Requests ❑ wl attachments
c
H Section 11:Checklist and Certification Statement ❑ wl attachments
32
11.2 Certification Statement -
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted.Based on my inquiry of the person or persons who manage the system,or those persons
directly responsible forgathering the information,the information submitted is,to the best of my knowledge and
belief,true,accurate,and complete.I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Signature Date signed
EPA Form 3510-1(rease4 319) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
K r CC N T W I" OMB No.2040-0004
Form U.S Environmental Protection Agency
2F `�/EPA Application for NPDES Permit to Discharge Wastewater
NPDES STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY
SECTIONOUTFALL LOCATION •r
1.1 Provide information on each of the facili 'sou s in the table below
Outfall Receiving Water Name Latitude Longitude
Number
C
O
14
ING 35 ° v
m
0
SECTION • 1
2.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application? J
❑ Yes d No 4 SKIP to Section 3.
2.2 Briefly identify each applicable project in the table below.
Brief Identification and Affected Ouffalls Final Compliance Dates
Description-of-Pro ist-ootralFrmmbe Source s of Discharge
Required Projected
2
C
E
O
O.
E
2.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(Optional Item)
❑ Yes ❑ No
EPA Form 3510-2F(Revised 3-19) Page t

EPA Identification Number NPDES Permit Number ! Facility Name Form Approved 03105/19'
_• �l I-'rr l�' `fY/�l I I ►I C�• OMB No.2040-0004
3.1 Have you attached a site drainage map containing all required information to this application?(See instructions for
a specific guidance.)
o` Yes ❑ No
SECTION 4.POLLUTANT SOURCES I
4.1 Provide information on the facility's pollutant sources in the table below. Q
Ouffall Impervious Surface Area Total Surface Area Drained
Number (within a mile radius of the facility) (within a mile radius of the facility)
specify units specify units
specify units specify units
specify units specilyunits
specilyunits specilyunits
specilyunits specilyunits
specify units specilyunits
4.2 Provide a narrative descripti of the facility's significant material in the space below.(See instructions for content
requirements.) NO4/E)
N
N
U
O
fn
c
O
C
4.3 Provide the location and a description of existing structural and non-structur ontrol measures to reduce pollutants in
stormwater runoff. See instructions forspecificguidance.) C
Stormwater Treatment
Codes
Outfall from
Number Control Measures and Treatment Exhibit
2F-1
(list)
EPA Form 3510-2F(Revised 3-19) Page 2

EPA Identification Number NPDES Per Number Facility Name Form Approved 03/05/19
.�..o. �• I.CIY TEn `�' OMB No.2040-0004
SECTION • •• r •r �V l.. 1Vv
5.1 I certify under penalty of law that the outfall(s) covered by this application have been tested or evaluated for the
presence of non-stormwater discharges. Moreover, 1 certify that the outfalls identified as having non-stormwater
discharges are described in either an accompanying NPDES Form 2C, 2D,or 2E application.
Name(print or type first and last name) Official title
�RU� Sll'GS PR6ms5I44L � �l
Signature Date signed
tq
/0 `2 I
M 5.2 Provide t e testing in ormation reqV6sted in the table below.
r Onsite Drainage Points
y Outfall Description of Testing Method Used Date(s)of Testing Directly Observed
o Number During Test
m
E Ajo�C
0
in
0
Z
SECTION 6.SIGNIFICANT LEAKS OR SPILLS
r r
6.1 Describe any significant leaks or spills of toxic or hazardous pollutants in the last three years.
y
0
Y
N
J
C
U
C
0I
SECTIONDISCHARGE INFORMATIONr
See the instructions to determine the pollutants and para eters you are required to mo itor and,' turn the tables you must
o com lete.Not all applicants need to complete each tabl
7.1 Is this a new source or new discharge?
w ❑ Yes+ See instructions regarding submission of ❑ No 4 See instructions regarding submission of
a,
estimated data. actual data.
Tables A,B,C,and D
H 7.2 Have you completed Table A for each outfall?
❑ Yes ❑ No
EPA Form 3510-21'(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19'
1 l p/ OMB No.2040-0004
7.3 Is the facility subject to an effluent limitation guideline(ELL`G))or effluent limitations in an NPDES permit for its process
wastewater? J
❑ Yes No 4 SKIP to Item 7,5.
7.4 Have you completed Table B by providing quantitative data for those pollutants that are(1)limited either directly or
indirectly in an ELG and/or(2)subject to effluent limitations in an NPDES permit for the facility's process wastewater?
❑ Yes ❑ No
7.5 Do you know or have reason to believe any pollutants in Exhibit 2E 2 are present in the discharge?
El Yes Exhibit
4 SKIP to Item 7.7.
7.6 Have you listed all pollutants in Exhibit 2F-2 that you know or have reason to believe are present in the discharge and
provided quantitative data or an explanation for those pollutants in Table C?
❑ Yes ❑ No
7.7 Do you qualify for a small business exemption under the criteria_specified in the Instructions?
El Yes Yes 4SKIP to Item 7.18. No
7.8 Do you know or have reason to believe any pollutants in Exhibit 2F-3 are present in the discharge?
❑ Yes ET No 4 SKIP to Item 7.10.
7.9 Have you listed all pollutants in Exhibit 2F-3 that you know or have reason to believe are present in the discharge in
'c Table C?
c
o ❑ Yes ❑ No
U
0 7.10 Do you expect any of the pollutants in Exhibit 2F-3 to be discharged in concentrations of 10 ppb or greater?
E ❑ Yes 02 No 4 SKIP to Item 7.12.
0
7.11 Have you provided quantitative data in Table C for those pollutants in Exhibit 2F-3 that you expect to be discharged in
a Concentrations
_oL10 pp
A
u ❑ Yes ❑ No
N
7.12 Do you expect acrolein,acrylonitrile,2,4-dinitrophenol,or 2-methyl-4,6-dinitrophenol to be discharged in concentrations
of 100 ppb or greater? �//
El Yes M No 4 SKIP to Item 7.14.
7.13 Have you provided quantitative data in Table C for the pollutants identified in Item 7.12 that you expect to be
discharged in concentrations of 100 ppb or greater?
❑ Yes ❑ No
7.14 Have you provided quantitative data or an explanation in Table C for pollutants you expect to be present in the
discharge at concentrations less than 10 ppb(or less than 100 ppb for the pollutants identified in Item 7.12)?
❑ Yes [7 No
7.15 Do you know or have reason to believe any pollutants in Exhibit 2F are present in the discharge?
❑ Yes No 4 SKIP to Item 7.17.
7.16 Have you listed pollutants in Exhibit 2F-4 that you know or believe to be present in the discharge and provided an
explanation in Table C?
❑ Yes ❑ No
7.17 Have you provided information for the storm event(s)sampled in Table D?
❑ Yes No
EPA Form 3510-2F(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number F icility Name Form Approved 03105119
OMB No.2040-0004
o Used or Manufactured Toxics f l t�I VVV
7.18 Is any pollutant listed on Exhibits 2F-2 through 2F-4 a substance or a component of a substance used or
manufactured as an intermediate or final product or byproduct?
❑ Yes
� [}�' No 4 SKIP to Section 8.
0
7.19 List the pollutants below,including TCDD if applicable.
E
1. 4. 7.
a
2. 5. 8.
s
U
0 3. 6. 9.
SECTIONBIOLOGICAL T• DATA r
8.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made on
any of your discharges or on a receiving water in relation to your7No
rge within the last three years?
0
.y
❑ Yes 4 SKIP to Section 9.
8.2 Identify the tests and their purposes below.
'u Test(s) Purpose of Testis) Submitted to NPDES Date Submitted
x Permitting Authority?
0
~ ❑ Yes ❑ No
U
o ❑ Yes ❑ No
0
m
❑ Yes ❑ No
SECTION • • • ,t
9. re any ofthe-anatyses-repor#ed-in-SeetienT*Fables-kkou"-performed-h asontract Iaberatoryo
consulting firm? /
❑ Yes E No 4 SKIP to Section 10,
9.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm
o
0
H Laboratory address
N
a
N
a
A
o0 Phone number
Pollutant(s)analyzed
EPA Form 3510-2F(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
1-- 7 �G A 1 n r ' Al n OMB No.2040-0004 '
SECTION1 CHECKLIST AND CERTIFICATION STATEMENT(40
10.1 In Column 1 below,mark the sections of Form 2F that you have completed and are submitting with your application.For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to com lete all sections or provide attachments.
Column Column
Section 1 w/attachments(e.g.,responses for additional outfalls)
❑ Section 2 ❑ w/attachments
Section 3 w/site drainage map
❑ Section 4 ❑ w/attachments
❑ Section 5 ❑ wl attachments
c
❑ Section 6 ❑ w/attachments
d
El Section 7 ❑ Table A ❑ w/small business exemption request
A
❑ Table B ❑ w/analytical results as an attachment
0
❑ Table C ❑ Table D
r
❑ Section 8 ❑ w/attachments
c
y ❑ ection 9 ❑ wlattachments(e.g.,responses for additional contact laboratories or firms)
r Section 10 ❑
10.2
Cecttfication5tatemenf
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Signature Date signed
EPA Form 3510-2F(Revised 3.19) Page 6