NCG210479_Mail Informing Them to Get an Individual Permit_20191150

Strickland, Shane
From: Lambe, Brian
Sent: Tuesday, November 5, 2019 10:12 AM
To: Strickland, Shane; Garcia, Lauren V
Cc: [e-mail]
Subject: National Salvage Southport
Attachments: form_2f_epa_form_3510-2f.pdf, form_1_epa_form_3510-1.pdf
Mr. Anderson is inquiring of the status of the permit application NCG210479 Timber. The site processes creosote
railroad ties. We had discussed that they need an individual permit. Also, the site is located on CPI, which is undergoing
renewal this year. I am unsure how the segregation of National Salvage will affect the renewal for CPI.
Mr. Anderson, Please find the required forms by following the link or the attachments.
https://deg.nc.gov/about/divisions/energy-mineral-land-resources/npdes-stormwater-
individualhttps://deg.nc.gov/about/divisions/energy-mineral-land-resources/npdes-stormwater-individual
Brian Lambe
Environmental Specialist
910-796-7313
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
127 Cardinal Drive Extension I Wilmington, NC 28405
910 796 7215 T 1910 350 2004 F I httu://portal.ncdenr.oreweb/ir/

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United States Office of Water EPA Form 3510-1
Environmental Protection Agency Washington, D.C. Revised March 2019
Water Permits Division
� E�► Application Form 1
General Information
NPDES Permitting Program
Note: All applicants to the National Pollutant Discharge Elimination System (NPDES) permits
program, with the exception of publicly owned treatment works and other treatment works treating
domestic sewage, must complete Form 1. Additionally, all applicants must complete one or more of the
following forms: 213, 2C, 21), 2E, or 2F. To determine the specific forms you must complete, consult the
"General Instructions" for this form.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information
and complete Form 1 to be 2.9 hours for new applicants and 0.9 hours for applicants renewing
existing permits. This estimate includes time to review instructions, search existing data sources,
gather and maintain the needed data, and complete and review the collection of information.
New respondents must also prepare a topographic map. Send comments about the burden
estimate or any other aspect of this collection of information to the Chief, Information Policy
Branch (PM-223), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW,
Washington, DC 20460, and to the Office of Information and Regulatory Affairs, Office of
Management and Budget, 725 17ffi Street, NW, Washington, DC 20503, marked "Attention:
Desk Officer for EPA."

DESCRIPTION OF NPDES PERMIT APPLICATION FORMS
The application forms for individual National Pollutant Discharge
Elimination System (NPDES) permits include the following:
Form 1—General Information (included in this package).
Form 2—Forms Based on Facility or Activity Type (not included
in this package):
2A. New and Existing Publicly Owned Treatment Works
2B. Concentrated Animal Feeding Operations and
Concentrated Aquatic Animal Production Facilities
2C. Existing Manufacturing, Commercial, Mining, and
Silvicultural Operations
2D. New Manufacturing, Commercial, Mining, and Silvicultural
Operations That Have Not Yet Commenced Discharge of
Process Wastewater
2E. Manufacturing, Commercial, Mining, and Silvicultural
Facilities Which Discharge Only Nonprocess Wastewater
2F. Stormwater Discharges Associated with Industrial Activity
2S. New and Existing Treatment Works Treating Domestic
Who Must Apply for an NPDES Permit?
CONTENTS OF FORM 1 PACKAGE
Form 1—General
Instructions
Form 1—Line-by-Line
Instructions
Form 1—Activities
That Do Not Require Permits
Form 1—Glossary
Form 1—Application
FORM 1—GENERAL INSTRUCTIONS
With the exceptions described in "Form 1—Activities That Do Not
Require Permits," the federal Clean Water Act (33 U.S.C. 1251 et
seq.) prohibits any person from discharging pollutants into waters
of the United States without first having been issued a permit
under the NPDES program.
Who Must Complete Form 1?
All applicants, other than publicly owned treatment works
(POTWs) and treatment works treating domestic sewage
(TWTDS), must submit Form 1. If you operate one of the
following facilities, you must submit Form 1: concentrated animal
feeding operations and aquatic animal production facilities;
manufacturing, commercial, mining, and silvicultural operations;
or other industrial facilities.
At the state level, either the U.S. Environmental Protection
Agency (EPA) or an approved state agency administers the
NPDES permit program. If you are located in a jurisdiction in
which an EPA regional office administers the NPDES permit
program, you should use Form 1 and all other applicable forms
described in these instructions. If you are located in a jurisdiction
where a state administers the NPDES permit program, contact
the state to determine the forms you should complete. States
often develop their own application forms rather than use the
federal forms. See http://www.epa.gov/npdes/npdes-state-
program-information for a list of states that have approved
NPDES permit programs and those that do not.
Exhibit 1-1 (see end of this section) provides contact information
for each of EPA's 10 regional offices. Since the exhibit's content is
subject to change, consult EPA's website for the latest information:
http://www.epa.gov/aboutepa#regional.
Upon your request, and based on information supplied by you,
EPA or the authorized NPDES state will determine whether you
are required to obtain a permit for a particular facility or activity.
Be sure to contact EPA or your state if you have a question.
Form 1 collects general information only. You must also complete
a more detailed application based on your proposed discharge
activity, as follows:
• If your facility is a concentrated animal feeding operation
or a concentrated aquatic animal production facility, you
must also complete Form 2B.
• If your facility is an existing manufacturing, commercial,
mining, or silvicultural facility that currently discharges
process wastewater, you must also complete Form 2C.
• If your facility is a new manufacturing, commercial, mining,
or silvicultural facility that has yet to commence discharge of
process wastewater, you must also complete Form 2D.
• If your facility is a new or existing facility (including
manufacturing, commercial, mining, and silvicultural
facilities) that discharges only nonprocess wastewater,
you must also complete Form 2E.
• If your facility is a new or existing facility whose discharge
is composed entirely of stormwater associated with industrial
activity —excluding discharges from construction activity
under 122.26(b)(14)(x) or (b)(15)—you must also complete
Form 2F. If the discharge is composed of stormwater and
non-stormwater, you must complete Form 2F and you must
also complete Forms 2C, 2D, and/or 2E, as appropriate. See
Form 2F's instructions for further details.

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Where to File Your Completed Form
• If you are in a jurisdiction with an approved state NPDES
permit program, file according to the instructions on the state
forms.
• If you are in a jurisdiction where EPA is the NPDES
permitting authority (i.e., the state is not an NPDES-
authorized state), mail the completed application forms to the
EPA regional office that covers the state in which your facility
is located (see Exhibit 1-1).
When to File Your Completed Form
Because of statutory and regulatory requirements, the deadlines
for filing applications vary according to your facility or activity type
and the type of permit you need. The various permit application
deadlines are listed in Exhibit 1-2 at the end of this section.
Fees
EPA does not require applicants to pay a fee for applying for
NPDES permits. However, states that administer the NPDES
permit program may charge fees. Consult with state officials for
further information.
Public Availability of Submitted Information
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request.
You may not claim any information on Form 1 (or related
attachments) as confidential.
You may make a claim of confidentiality for any information that
you submit to EPA that goes beyond the information required by
Form 1. If you do not assert a claim of confidentiality at the time
you submit your information to the NPDES permitting authority,
EPA may make the information available to the public without
further notice to you. EPA will handle claims of confidentiality in
accordance with the Agency's business confidentiality regulations
at Part 2 of Title 4 of the Code of Federal Regulations (CFR).
Completion of Forms
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
The NPDES permitting authority could consider your application
incomplete if you do not provide an answer (or indicate "NA" for
"not applicable") for all questions on Form 1 and the applicable
Form 2.
Provide your EPA Identification Number from the Facility Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 1 and any attachments. If your facility is new
(i.e., not yet constructed), write or type "New Facility" in the space
provided for the EPA Identification Number and NPDES number.
If you do not know your EPA Identification Number, contact your
NPDES permitting authority. See Exhibit 1-1 for contact
information.
Do not leave any response areas blank unless the form directs
you to skip them. If the form directs you to respond to an item that
does not apply to your facility or activity, enter "NA" for "not
applicable" to show that you considered the item and determined
a response was not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received
and completed according to the authority's satisfaction. The
NPDES permitting authority will judge the completeness of any
application independently of the status of any other permit
application or permit for the same facility or activity.
1-2

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Exhibit 1-1. Addresses of EPA Regional Contacts and Covered States
REGION 1
REGION 6
U.S. Environmental Protection Agency, Region 1
U.S. Environmental Protection Agency, Region 6
5 Post Office Square, Suite 100, Boston, MA 02109-3912
1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733
Phone: [phone]; toll free: [phone]
Phone: [phone]; toll free: [phone]
Fax: [phone]
Fax: [phone]
Website: http://www.epa.gov/aboutepa/epa-region-l-new-england
Website: http://www.epa.gov/aboutepalepa-region-6-south-central
Covered states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Covered states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
Island, and Vermont
REGION 2
REGION 7
U.S. Environmental Protection Agency, Region 2
U.S. Environmental Protection Agency, Region 7
290 Broadway, New York, NY 10007-1866
11201 Renner Boulevard, Lenexa, KS 66219
Phone: [phone]; toll free: (877) 2514575
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: http://www.epa.gov/aboutepa/epa-region-7-midwest
Website: http://www.epa.gov/aboutepa/epa-region-2
Covered states: Iowa, Kansas, Missouri, and Nebraska
Covered states: New Jersey, New York, Virgin Islands, and Puerto Rico
REGION 3
REGION 8
U.S. Environmental Protection Agency, Region 3
U.S. Environmental Protection Agency, Region 8
1650 Arch Street, Philadelphia, PA 19103-2029
1595 Wynkoop Street, Denver, CO 80202-1129
Phone: [phone]; toll free: [phone]
Phone: [phone]; toll free: [phone]
Fax: [phone]
Fax: [phone]
Website: http://www.epa.gov/aboutepa/epa-region-3-mid-atlantic
Website: http://www.epa.gov/aboutepa/epa-region-8-mountains-and-plains
Covered states: Colorado, Montana, North Dakota, South Dakota, Utah, and
Covered states: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia,
and West Virginia
Wyoming
REGION 4
REGION 9
U.S. Environmental Protection Agency, Region 4
U.S. Environmental Protection Agency, Region 9
Sam Nunn Atlanta Federal Center
75 Hawthorne Street, San Francisco, CA 94105
61 Forsyth Street, SW, Atlanta, GA 30303-8960
Phone: [phone]; toll free: (866) EPA -WEST
Phone: [phone]; toll free: [phone]
Fax: [phone]
Fax: [phone]
Website: http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest
Website: http://www.epa.gov/aboutepa/about-epa-region-4-southeast
Covered states: Arizona, California, Hawaii, Nevada, Guam, American Samoa,
Covered states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
and Trust Territories
South Carolina, and Tennessee
REGION 5
REGION 10
U.S. Environmental Protection Agency, Region 5
U.S. Environmental Protection Agency, Region 10
77 West Jackson Boulevard, Chicago, IL 60604-3507
1200 Sixth Avenue, Suite 900, Seattle, WA 98101
Phone: [phone]; toll free: [phone]
Phone: [phone]; toll free: (800) 4244372
Fax: [phone]
Fax: [phone]
Website: http://www.epa.gov/aboutepa/epa-region-5
Website: http://www.epa.gov/aboutepa/epa-region-10-pacific-northwest
Covered states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
Covered states: Alaska, Idaho, Oregon, and Washington
Exhibit 1-2. Filing Dates for NPDES Permit Applications
Permit Application
When to File
180 days before your present NPDES permit expires or, if you are a
2A
new discharger, 180 days before the date on which the discharge is
to commence unless the NPDES permitting authority has granted
permission for a later date.
2B
180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
2C
180 days before your present NPDES permit expires.
2D
180 days prior to startup.
2E
180 days before your present NPDES permit expires, or 180 days
prior to startup if you are a new facility.
Construction: 90 days prior to date construction is to commence.
2F
Nonconstruction: 180 days before your present NPDES permit
expires or 180 days prior to startup if you are a new facility.
2S
180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
1-3

FORM 1—LINE-BY-LINE INSTRUCTIONS
Section 1. Activities Requiring an NPDES Permit
Item 1.1. Review the questions in Item 1.1 to determine if you are
required to submit Form 1. Be sure to check the Form 1—
Glossary for the legal definitions of any key terms.
If you answer "Yes" to a question in Item 1.1, then you do not
need to complete Form 1, but you must comply with the
application requirements specified.
Item 1.2. Respond to the questions in Items 1.2.1 to 1.2.5. If you
answer "Yes" to any question, you must complete Form 1 and the
Form 2 application specified. See Exhibit 1-2 for filing deadlines.
If you answer "No" to every question in Items 1.1 and 1.2, then
you do not need an NPDES permit, and you do not need to
complete and return any of the NPDES application forms.
Section 2. Name, Mailing Address, and Location
Item 2.1. Enter the facility's official or legal name. Do not use a
colloquial name.
Item 2.2. Provide your EPA Identification Number from the
Facility Registry Service if you have an existing facility. If you do
not know your EPA Identification Number, contact your NPDES
permitting authority. If your facility is new (i.e., not yet
constructed), write or type "New Facility."
Item 2.3. Give the name (first and last), title, work telephone
number, and email address of the person who is thoroughly
familiar with the operation of the facility and with the facts
reported in this application. The NPDES permitting authority will
contact the person listed if they have questions on the material
submitted.
Item 2.4. Give the complete mailing address of the office to which
the NPDES permitting authority should send correspondence.
This often is not the address used to designate the location of the
facility or activity.
Item 2.5. Give the address or location of the facility identified
under Item 2.1. If the facility lacks a street name or route number,
give the most accurate, alternative geographic information (e.g.,
section number or quarter section number from county records or
"at intersection of Routes 425 and 22"). Also provide the county
name, county code (if known), city or town, state, and zip code.
For concentrated aquatic animal production facilities, provide the
address or location of the production area (i.e., the location where
the animals are contained, grown, or held).
Section 3. SIC and NAICS Codes
Items 3.1 and 3.2. List, in descending order of significance, up to
four 4-digit standard industrial classification (SIC) codes and
North American Industrial Classification System (NAICS) codes
that best describe your facility in terms of the principal products or
services it produces or provides. If the SIC or NAICS codes do
not adequately describe your facility's products or services, you
have the option to provide additional descriptive information.
You can find SIC code numbers and descriptions in the
1987 Standard Industrial Classification Manual, prepared by the
Executive Office of the President, Office of Management and
Budget. This document is available from the Government Printing
Office, Washington, D.C. An online version of the manual is also
available courtesy of the Occupational Safety and Health
Administration at http://www.osha.gov/pls/imis/sic manual.html.
You can find NAICS code numbers and descriptions in the North
American Industrial Classification System Manual prepared by the
Executive Office of the President, Office of Management and
Budget. This document is available from the National Technical
Information Service (NTIS) in Alexandria, Virginia. It is also
available online at http://www.census.aov/eos/www/naics/.
Use the latest edition of the manuals. If you have any questions
about the appropriate SIC or NAICS codes for your facility,
contact your NPDES permitting authority.
Section 4.Operator Information
Item 4.1. Give the legal name of the person, firm, public
organization, or other entity that operates the facility described in
this application. This may or may not be the same as the facility's
name. The operator of the facility is the legal entity that controls
the facility's operation rather than the plant or site manager. Do
not use a colloquial name.
Item 4.2. Indicate whether the entity listed in response to Item 4.1
also owns the facility by marking the appropriate box.
Item 4.3. Indicate the ownership status of the operator of the
facility by marking the appropriate box. If the facility is a federal
facility (i.e., owned by the U.S. government), check the box for
"Public —federal." If the facility is owned by a state government,
check the box for "Public —state." If the facility is owned by a
county government, municipal (e.g., city or town) government,
tribal government, school district, water district, or other local
government entity, check the box for "Other public" and specify
the type of government entity. If the facility is owned by a
corporation or other private entity, check the box for "Private." If
the facility has mixed ownership (e.g., public/private) or is not
owned by an entity of the types previously listed, check the box
for "Other" and specify the type of entity.
Items 4.4 to 4.6. Enter the telephone number, address, and email
address of the operator identified in Item 4.1.
Section 5. Indian Land
Item 5.1. Indicate whether the facility is located on Indian Land
Section 6. Existing Environmental Permits
Item 6.1. Check the appropriate boxes and provide the permit
numbers for all relevant federal, state, and local environmental
permits or construction approvals received or applied for under
any of the programs listed below. If you have more than one
currently effective permit under a particular permit program for
your facility, list the additional permit numbers on the application
form or on a separate sheet of paper.
1-4

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
• Hazardous waste management program under the Resource
Conservation and Recovery Act (RCRA).
• Underground Injection Control (UIC) program under the Safe
Drinking Water Act (SDWA).
• NPDES program under the Clean Water Act (CWA).
• Prevention of Significant Deterioration (PSD) program under
the Clean Air Act (CAA).
• Nonattainment program under the CAA.
• National Emission Standards for Hazardous Pollutants
(NESHAPs) preconstruction approval under the CAA.
• Ocean dumping permits under the Marine Protection
Research and Sanctuaries Act (MPRSA).
• Dredge or fill permits under Section 404 of the CWA.
• Other federal, state, or local environmental permits.
Section 7. Map
Unless the facility is a concentrated animal feeding operation,
provide a topographic map(s) of the area extending at least one
mile beyond the property boundaries of the facility that clearly
shows the following:
• The legal boundaries of the facility.
• The location and serial number of each of your existing and
proposed intake and discharge structures.
• All hazardous waste management, storage, and disposal
facilities.
• Each well where you inject fluids underground.
• All wells, springs, surface water bodies, and drinking water
wells that are in the public record or otherwise known to you
and that are located in the map area.
If the facility has associated water intakes, discharge structures,
hazardous waste disposal sites, or injection wells and these items
are located more than one mile from the facility, include them on
the map if possible. If you cannot, attach additional sheets
describing the location of the structures, disposal site(s), or well(s)
and identify the U.S. Geological Survey (USGS) or other map
corresponding to the location(s).
On each map, include the map scale, a meridian arrow showing
north, and latitude and longitude to the nearest second. Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., USGS).
On all maps of rivers, show the direction of the current. In tidal
waters, show the directions of ebb and flow tides.
You may develop your map by going to USGS's National Map
website at http://nationalmap.gov/. (For a map from this site, use
the traditional 7.5-minute quadrangle format. If none is available,
use a USGS 15-minute series map.) You may also use a plat or
other appropriate map. Briefly describe land uses in the map area
(e.g., residential, commercial). An example of an acceptable
location map is shown as Exhibit 1-3 at the end of these
instructions. Note: Exhibit 1-3 is provided for illustration only; it
does not show an actual facility.
If the facility is a concentrated animal feeding operation, you are
not required to provide the topographic map required by this
section of Form 1. Instead, you are required to provide a
topographic map as specified in Section 4 of Form 2B.
Item 7.1. Note that you have completed your topographic map
and attached it to the application.
Section 8. Nature of Business
Briefly describe the nature of your business (e.g., products
produced or services provided). See Examples 1 and 2.
Example 1
Facilities Subject to 40 CFR 426, Subparts F and G
Industry A is an auto tempered and auto laminated glass
manufacturing facility subject to effluent limitation guidelines
(ELGs) for the "Automotive Glass Tempering" and "Automotive
Glass Laminating" subcategories of the "Glass Manufacturing"
point source category at 40 CFR 426, subparts F and G. At the
facility, glass is cut and then passed through a series of
processes that grind and polish the edges, bend the glass, and
then temper the glass to produce side and back windows for
automobiles. Tempering involves heating the glass near the
melting point, then rapidly cooling it to increase its mechanical
and thermal endurance. The facility also produces automobile
windshields and undertakes processes that laminate a plastic
sheet between two layers of glass and that prepare the glass for
lamination (e.g., cutting, bending, and washing).
Example 2
Facility Not Subject to ELGs
Industry B undertakes batch -type resin manufacturing operations.
It has aboveground storage tanks for raw materials and finished
goods, resin loading operations, and warehouses for 55-gallon
drums of finished product. Industry B manufactures alkyd,
saturated and unsaturated polyester resins in batches using
reactor vessels and mix tanks. Most of the feedstock liquids are
pumped from storage tanks to the kettles and mixers via a closed
piping system. Additional feedstocks are added manually as
solids from bags and sacks via manways, which are located on
top of the kettles. The resin is then chemically reacted in the
kettles. After the reaction step finishes, the resin is transferred
from the kettles to the mix tanks, where solvents are added to
thin it. The primary byproduct of the reaction is water vapor
containing condensed soluble organics. The byproduct flows to
an isolation tank where the vapors are directed to an onsite
thermal oxidizer. The finished resin is then pumped through one
of three types of filtration systems into finished goods storage
tanks, 55-gallon drums, 350-gallon intermediate bulk container
totes, or directly into tanker trucks. A typical batch takes about 30
hours to complete.
1-5

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
Section 9. Cooling Water Intake Structures
Item 9.1. Indicate whether the facility uses cooling water. If yes,
continue to Item 9.2. If no, skip to Item 10.1.
Item 9.2. Identify the source of the cooling water. For example,
indicate whether the cooling water is from a surface water,
groundwater well, public water system, or treated effluent that
would otherwise be discharged to a water of the U.S.
If the facility uses a cooling water intake structure as described in
40 CFR 125, Subparts I and J, the facility may have additional
application requirements under 40 CFR 122.21(r). Note that the
information required by 40 CFR 122.21(r) is not requested as part
of Form 1. Contact your NPDES permitting authority to determine
the specifics of what you should provide and when.
Section 10. Variance Requests
An applicant (other than a POTW) may request a variance from
otherwise applicable effluent limitations under certain conditions
described at 40 CFR 122.21(m).
Item 10.1. If known at the time of application, check all of the
authorized variances that you plan to request or renew. Note that
you are not being asked to submit any other information at this
time. Contact your NPDES permitting authority to determine the
specifics of what you should provide and when. The ability to
request a variance is not limited to the time of application, and an
applicant may request a variance consistent with statutory and
regulatory requirements.
Section 11. Checklist and Certification
Item 11.1. Review the checklist provided. In Column 1, mark the
sections of Form 1 that you have completed and are submitting
with your application. In Column 2, indicate for each section
whether you are submitting attachments.
Item 11.2. The Clean Water Act provides for severe penalties for
submitting false information on this application form. CWA Section
309(c)(2) provides that, "Any person who knowingly makes any
false statement, representation, or certification in any application,
...shall upon conviction, be punished by a fine of no more than
$10,000 or by imprisonment for not more than six months, or
both."
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A. For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer
means: (1) a president, secretary, treasurer, or vice-president
of the corporation in charge of a principal business function,
or any other person who performs similar policy- or decision -
making functions for the corporation, or (2) the manager of
one or more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
1-6

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1-7

FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge
is in one of the following categories, as provided by the CWA and
NPDES regulations at 40 CFR 122 to 125. (However, under CWA
Sections 510 and 312, some discharges exempted from the
federal NPDES requirements may still be regulated by a state
permitting authority.)
Any discharge of sewage from vessels and any effluent from
properly functioning marine engines, laundry, shower, and
galley sink wastes, or any other discharge incidental to the
normal operation of a vessel, including vessels of the Armed
Forces within the meaning of section 312 of the CWA and
recreational vessels within the meaning of section 502(25) of
the CWA. None of these exclusions apply to rubbish, trash,
garbage, or other such materials discharged overboard; nor
to other discharges when the vessel is operating in a
capacity other than as a means of transportation such as
when used as an energy or mining facility, a storage facility
or a seafood processing facility, or when secured to a
storage facility or a seafood processing facility, or when
secured to the bed of the ocean, contiguous zone or waters
of the United States for the purpose of mineral or oil
exploration or development.
• Discharges of dredged or fill material into waters of the
United States that are regulated under CWA Section 404
The introduction of sewage, industrial wastes, or other
pollutants into publicly owned treatment works by indirect
dischargers. Plans or agreements to switch to this method of
disposal in the future do not relieve dischargers of the
obligation to have and comply with permits until all
discharges of pollutants to waters of the United States are
eliminated. (See also 40 CFR 122.47(b).) This exclusion
does not apply to the introduction of pollutants to privately
owned treatment works or to other discharges through pipes,
sewers, or other conveyances owned by a state, municipality,
or other party not leading to treatment works.
• Any discharge in compliance with the instructions of an On -
Scene Coordinator pursuant to 40 CFR 300 (The National Oil
and Hazardous Substances Pollution Contingency Plan) or
33 CFR 153.10(e) (Pollution by Oil and Hazardous
Substances).
Any introduction of pollutants from non point -source
agricultural and silvicultural activities, including stormwater
runoff from orchards, cultivated crops, pastures, range lands,
and forest lands, but not discharges from concentrated
animal feeding operations as defined in 40 CFR 122.23,
discharges from concentrated aquatic animal production
facilities as defined in 40 CFR 122.23, discharges from
concentrated aquatic animal production facilities as defined
in 40 CFR 122.24, discharges to aquaculture projects as
defined in 40 CFR 122.25, and discharges from silvicultural
point sources as defined in 40 CFR 122.27. Note: Per 40
CFR 122.26(b)(14)(ii), facilities classified within SIC 24,
Industry Group 241, that are rock crushing, gravel washing,
log sorting, or log storage facilities operated in connection
with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)
and Industry Groups 242 through 249; 26 (except 265 and
267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441,
and 373 (not included are all other types of silviculture
facilities) are considered stormwater discharges associated
with industrial activity, and are required to obtain an NPDES
permit.
• Return flows from irrigated agriculture.
• Discharges into a privately owned treatment works, except as
the NPDES permitting authority may otherwise require under
40 CFR 122.44(m).
Discharges from a water transfer. "Water transfer" means an
activity that conveys or connects waters of the United States
without subjecting the transferred water to intervening
industrial, municipal, or commercial use. This exclusion does
not apply to pollutants introduced by the water transfer
activity itself to the water being transferred.
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FORM 1—GLOSSARY
Note: This glossary includes terms used in the various NPDES application forms, including Form 1. The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (other than an aquatic animal production facility) where the
following conditions are met;
• Animals (other than aquatic animals) have been, are, or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period; and
• Crops, vegetation, forage growth, or post -harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
APPLICATION means the EPA standard national forms for applying for a permit, including any additions, revisions, or modifications to the
forms; or forms approved by EPA for use in approved states, including any approved modifications or revisions.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
AQUACULTURE PROJECT (defined at § 122.25) means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater, estuarine, or marine plants or animals. DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species, using a method or plan or operation (including, but not limited to, physical confinement) which, on the basis of reliable
scientific evidence, is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants, and be harvested within a defined geographic area.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES (BMPs) means schedules of activities, prohibitions of practices, maintenance procedures, and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements, operation
procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage.
BIOSOLIDS (see sewage sludge).
BYPASS (defined at § 122.41(m)) means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW (CSO) means a discharge from a combined sewer system (CSS) at a point prior to the Publicly Owned
Treatment Works (POTW) Treatment Plant (defined at § 403.3(r)).
COMBINED SEWER SYSTEM (CSS) means a wastewater collection system owned by a State or municipality (as defined by section
502(4) of the CWA) which conveys sanitary wastewaters (domestic, commercial and industrial wastewaters) and storm water through a
single -pipe system to a Publicly Owned Treatment Works (POTW) Treatment Plant (as defined at § 403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of (A) or (B) below, or that is designated as a CAFO in accordance with 40 CFR 122.23(c). Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation, if they adjoin each other or if they use a common area or system for the disposal of wastes.
A. LARGE CONCENTRATED ANIMAL FEEDING OPERATION (LARGE CAFO) means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows, whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
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FORM 1—GLOSSARY CONTINUED
6. 500 horses;
7. 10,000 sheep or Iambs;
8. 55,000 turkeys;
9. 30,000 laying hens or broilers, if the AFO uses a liquid manure handling system;
10. 125,000 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
11. 82,000 laying hens, if the AFO uses other than a liquid manure handling system;
12. 30,000 ducks (if the AFO uses other than a liquid manure handling system); or
13. 5,000 ducks (if the AFO uses a liquid manure handling system).
B. MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION (MEDIUM CAFO) means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO. An AFO is defined as a
Medium CAFO if:
1. The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows, whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or Iambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers, if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens, if the AFO uses other than a liquid manure handling system;
I. 10,000 to 29,999 ducks (if the AFO uses other than a liquid manure handling system); ore
m. 1,500 to 4,999 ducks (if the AFO uses a liquid manure handling system); and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch, flushing system, or other similar man-
made device; or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over, across, or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY (defined at § 122.24) means a hatchery, fish farm, or other facility which
contains, grows, or holds aquatic animals in either of the following categories, or which the Director designates as such on a case -by -case
basis:
A. Cold water fish species or other cold water aquatic animals including, but not limited to, the Salmonidae family of fish (e.g., trout and
salmon) in ponds, raceways, or other similar structures which discharge at least 30 days per year but does not include:
1. Facilities which produce less than 9,090 harvest weight kilograms (approximately 20,000 pounds) of aquatic animals per year;
and
2. Facilities which feed less than 2,272 kilograms (approximately 5,000 pounds) of food during the calendar month of maximum
feeding.
B. Warm water fish species or other warm water aquatic animals including, but not limited to, the Ameiuridae, Cetrarchiclae, and
Cyprinidae families of fish (e.g., respectively, catfish, sunfish, and minnows) in ponds, raceways, or other similar structures which
discharge at least 30 days per year, but does not include;
1. Closed ponds which discharge only during periods of excess runoff; or
2. Facilities which produce less than 45,454 harvest weight kilograms (approximately 100,000 pounds) of aquatic animals per year.

FORM 1—GLOSSARY CONTINUED
CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972) Public Law 92-500, as amended by Public Law 95-217, Public Law 95-576, Public Law 96-483 and Public Law
97-117, 33 U.S.C. 1251 et seq.
CWA AND REGULATIONS means the Clean Water Act (CWA) and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
DAILY DISCHARGE means the "discharge of a pollutant" measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass, the "daily discharge" is
calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of
measurement, the "daily discharge" is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the "discharge of a pollutant."
DIRECTOR means the Regional Administrator or the State Director, as the context requires, or an authorized representative. When there
is no "approved State program," and there is an EPA administered program, "Director" means the Regional Administrator. When there is
an approved State program, "Director" normally means the State Director. In some circumstances, however, EPA retains the authority to
take certain actions even when there is an approved State program. (For example, when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval, see § 123.1.) In such cases, the term
"Director" means the Regional Administrator and not the State Director.
DISCHARGE (OF A POLLUTANT) means:
• Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or
• Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source
other than a vessel or other floating craft which is being used as a means of transportation.
This definition includes discharges into waters of the United States from: surface runoff which is collected or channelled by man;
discharges through pipes, sewers, or other conveyances owned by a State, municipality, or other person which do not lead to a treatment
works; and discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not
include an addition of pollutants by any "indirect discharger".
DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions, revisions, or
modifications for the reporting of self -monitoring results by permittees. DMRs must be used by "approved States" as well as by EPA. EPA
will supply DMRs to any approved State upon request. The EPA national forms may be modified to substitute the state agency name,
address, logo, and other similar information, as appropriate, in place of EPA's.
DRAFT PERMIT means a document prepared under § 124.6 indicating the Director's tentative decision to issue or deny, modify, revoke
and reissue, terminate, or reissue a "permit." A notice of intent to terminate a permit, and a notice of intent to deny a permit, as discussed
in § 124.5, are types of "draft permits." A denial of a request for modification, revocation and reissuance, or termination, as discussed in
§ 124.5, is not a "draft permit." A "proposed permit" is not a "draft permit."
EFFLUENT LIMITATION means any restriction imposed by the Director on quantities, discharge rates, and concentrations of "pollutants"
which are "discharged" from "point sources" into "waters of the United States," the waters of the "contiguous zone," or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b) of the CWA to adopt or
revise "effluent limitations."
ENVIRONMENTAL PROTECTION AGENCY (EPA) means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES "point source" or any other facility or activity (including land or appurtenances thereto) that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES "permit" issued under § 122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of the CWA.
INDIAN COUNTRY (or INDAN LANDS) means:
• All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the
issuance of any patent, and, including rights -of -way running through the reservation;
• All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof, and whether within or without the limits of a state; and
• All Indian allotments, the Indian titles to which have not been extinguished, including rights -of -way running through the same.

FORM 1—GLOSSARY CONTINUED
INDIAN TRIBE means any Indian Tribe, band, group, or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing "pollutants" to a "publicly owned treatment works."
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(4)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census (Appendix F of 40 CFR 122); or
(ii) Located in the counties listed in appendix H of 40 CFR 122, except municipal separate storm sewers that are located in the
incorporated places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraphs (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; and
(E) Other relevant factors; or
(iv) The Director may, upon petition, designate as a large municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii).
LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whose discharges result from the holding of
unprocessed wood, for example, logs or roundwood with bark or after removal of bark held in self-contained bodies of water (mill ponds or
log ponds) or stored on land where water is applied intentionally on the logs (wet decking). (See 40 CFR 429, subpart I, including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES "facility or activity" classified as such by the Regional Administrator, or, in the case of "approved
State programs," the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable "daily discharge."
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(7)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 100,000 or more but less than 250,000, as determined by the 1990 Decennial
Census by the Bureau of the Census (appendix G of 40 CFR 122); or
(ii) Located in the counties listed in appendix I of 40 CFR 122, except municipal separate storm sewers that are located in the incorporated
places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraph (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; or
(E) Other relevant factors; or
EVA

FORM 1—GLOSSARY CONTINUED
(iv) The Director may, upon petition, designate as a medium municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii) of this section.
MUNICIPALITY means a city, town, borough, county, parish, district, association, or other public body created by or under State law and
having jurisdiction over disposal of sewage, industrial wastes, or other wastes, or an Indian tribe or an authorized Indian tribal organization,
or a designated and approved management agency under section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER (defined at § 122.26(b)(8)) means a conveyance or system of conveyances (including roads
with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains):
• Owned or operated by a State, city, town, borough, county, parish, district, association, or other public body (created by or pursuant to
State law) having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, including special districts under
State law such as a sewer district, flood control district or drainage district, or similar entity, or an Indian tribe or an authorized Indian
tribal organization, or a designated and approved management agency under section 208 of the CWA that discharges to waters of the
United States.
• Designed or used for collecting or conveying stormwater.
• Which is not a combined sewer; and
• Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE (see sewage sludge)
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) means the national program for issuing, modifying, revoking
and reissuing, terminating, monitoring and enforcing permits, and imposing and enforcing pretreatment requirements, under sections 307,
402, 318, and 405 of the CWA. The term includes an "approved program."
NEW DISCHARGER means any building, structure, facility, or installation:
• From which there is or may be a "discharge of pollutants;"
• That did not commence the "discharge of pollutants" at a particular "site" prior to August 13, 1979;
• Which is not a "new source;" and
• Which has never received a finally effective NPDES permit for discharges at that "site."
This definition includes an "indirect discharger" which commences discharging into "waters of the United States" after August 13, 1979. It
also means any existing mobile point source (other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig) such as a seafood processing rig, seafood processing vessel, or aggregate plant, that begins discharging at a
"site" for which it does not have a permit; and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979, at a "site" under EPA's permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern, the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1) through (10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a "new discharger" only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building, structure, facility, or installation from which there is or may be a "discharge of pollutants," the
construction of which commenced:
• After promulgation of standards of performance under section 306 of the CWA which are applicable to such source, or
• After proposal of standards of performance in accordance with section 306 of the CWA which are applicable to such source, but only
if the standards are promulgated in accordance with section 306 within 120 days of their proposal.
OWNER OR OPERATOR means the owner or operator of any "facility or activity" subject to regulation under the NPDES program.
PERMIT means an authorization, license, or equivalent control document issued by EPA or an "approved State" to implement the
requirements of this part and parts 123 and 124. "Permit" includes an NPDES "general permit" (§ 122.28). Permit does not include any
permit which has not yet been the subject of final agency action, such as a "draft permit" or a "proposed permit."
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides, and the application of chemical pesticides that leave a residue, from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application, this does not include
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FORM 1—GLOSSARY CONTINUED
agricultural storm water discharges and return flows from irrigated agriculture, which are excluded by law (33 U.S.C. 1342(I); 33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether a NPDES permit is needed for discharges to waters of the United States
from pesticide application, means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
POINT SOURCE means any discernible, confined, and discrete conveyance, including but not limited to, any pipe, ditch, channel, tunnel,
conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill leachate collection system, vessel or
other floating craft from which pollutants are or may be discharged. This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff. (See § 122.3).
POLLUTANT means dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions,
chemical wastes, biological materials, radioactive materials (except those regulated under the Atomic Energy Act of 1954, as amended (42
U.S.C. 2011 et seq.)), heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal, and agricultural waste
discharged into water. It does not mean:
• Sewage from vessels; or
• Water, gas, or other material which is injected into a well to facilitate production of oil or gas, or water derived in association with oil
and gas production and disposed of in a well, if the well used either to facilitate production or for disposal purposes is approved by
authority of the State in which the well is located, and if the State determines that the injection or disposal will not result in the
degradation of ground or surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source, byproduct, or special nuclear materials. Examples of materials not covered include radium
and accelerator -produced isotopes. See Train v. Colorado Public Interest Research Group, Inc., 426 U.S. 1 (1976).
PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement (Natural Resources Defense
Council et al. v. Train, 8 E.R.C. 2120 (D.D.C. 1976), modified 12 E.R.C. 1833 (D.D.C. 1979)); also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is (1) used to treat wastes from any facility whose
operator is not the operator of the treatment works and (2) not a "POTW."
PROCESS WASTEWATER means any water which, during manufacturing or processing, comes into direct contact with or results from the
production or use of any raw material, intermediate product, finished product, byproduct, or waste product.
PROPOSED PERMIT means a state NPDES "permit" prepared after the close of the public comment period (and, when applicable, any
public hearing and administrative appeals) which is sent to EPA for review before final issuance by the State. A "proposed permit" is not a
"draft permit."
PUBLICLY OWNED TREATMENT WORKS or POTW (defined at § 403.3) means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality (as defined by CWA Section 502(4)). This definition includes any devices or systems used in the
storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition also includes
sewers, pipes, and other conveyances only if they convey wastewater to a POTW. The term also means the municipality as defined in
CWA Section 502(4), which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES (defined at § 122.27) means facilities which process crushed and broken
stone, gravel, and riprap (See 40 CFR 436, subpart B, including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a "permit', including an enforceable sequence of
interim requirements (for example, actions, operations, or milestone events) leading to compliance with the CWA and regulations.
SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under section 312 of the CWA, except that with respect to commercial
vessels on the Great Lakes this term includes graywater. For the purposes of this definition, "graywater" means galley, bath, and shower
water.
SEWAGE SLUDGE means any solid, semi -solid, or liquid residue removed during the treatment of municipal waste water or domestic
sewage. Sewage sludge includes, but is not limited to, solids removed during primary, secondary, or advanced waste water treatment,
scum, septage, portable toilet pumpings, type III marine sanitation device pumpings (33 CFR 159), and sewage sludge products. Sewage
sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge.
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FORM 1—GLOSSARY CONTINUED
SILVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock
crushing, gravel washing, log sorting, or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States. This term does not include non -point source silvicultural activities such as
nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed burning, pest and fire control,
harvesting operations, surface drainage, or road construction and maintenance from which there is natural runoff. However, some of these
activities (such as stream crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit (see 33 CFR 209.120 and part 233).
SITE means the land or water area where any "facility or activity" is physically located or conducted, including adjacent land used in
connection with the facility or activity.
SLUDGE -ONLY FACILITY means any "treatment works treating domestic sewage" whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to section 405(d) of the CWA and is required to obtain a permit under § 122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d) of the CWA
which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Virgin Islands, American
Samoa, the Commonwealth of the Northern Mariana Islands, the Trust Territory of the Pacific Islands, or an Indian Tribe as defined in
these regulations which meets the requirements of § 123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an "approved program," or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies, "State Director"
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER (or STORM WATER) (defined at § 122.26(b)(13)) means stormwater runoff, snow melt runoff, and surface runoff and
drainage.
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY (defined at § 122.26(b)(14)) means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing, processing or raw materials
storage areas at an industrial plant. The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, stormwater discharges
from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products,
waste material, or by-products used or created by the facility; material handling sites; refuse sites; sites used for the application or disposal
of process waste waters (as defined at 40 CFR 401); sites used for the storage and maintenance of material handling equipment; sites
used for residual treatment, storage, or disposal; shipping and receiving areas; manufacturing buildings; storage areas (including tank
farms) for raw materials, and intermediate and final products; and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include storage, loading
and unloading, transportation, or conveyance of any raw material, intermediate product, final product, by-product or waste product. The
term excludes areas located on plant lands separate from the plant's industrial activities, such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities (including industrial facilities that are federally, State, or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below) include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v). The
following categories of facilities are considered to be engaging in "industrial activity" for purposes of 40 CFR 122.26(b)(14):
1. Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effluent standards
under 40 CFR Subchapter N (except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
2. Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing, gravel washing, log sorting, or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3) and Industry Groups 242
through 249; 26 (except 265 and 267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441, 373; (not included are all other types of
silvicultural facilities);
3. Facilities classified as Standard Industrial Classifications 10 through 14 (mineral industry) including active or inactive mining
operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of
non —coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17, 1990) and oil and gas exploration, production, processing, or treatment operations, or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with, any overburden, raw material, intermediate
products, finished products, byproducts or waste products located on the site of such operations; (inactive mining operations are
mining sites that are not being actively mined, but which have an identifiable owner/operator; inactive mining sites do not include sites

FORM 1-GLOSSARY CONTINUED
where mining claims are being maintained prior to disturbances associated with the extraction, beneficiation, or processing of mined
materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
4. Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a permit under
subtitle C of RCRA;
5. Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is received from any
of the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and automobile
junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
7. Steam electric power generating facilities, including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40, 41, 42 (except 4221-25), 43, 44, 45, and 5171 which have
vehicle maintenance shops, equipment cleaning operations, or airport deicing operations. Only those portions of the facility that are
either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication),
equipment cleaning operations, airport deicing operations, or which are otherwise identified under paragraphs 1-7 or 9-11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the
storage treatment, recycling, and reclamation of municipal or domestic sewage, including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility, with a design flow of 1.0 mgd or more, or required to have an approved
pretreatment program under 40 CFR 403. Not included are farm lands, domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility, or areas that are in compliance
with section 405 of the CWA;
10. Construction activity including clearing, grading and excavation, except operations that result in the disturbance of less than five acres
of total land area. Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20, 21, 22, 23, 2434, 25, 265, 267, 27, 283, 285, 30, 31 (except 311), 323, 34
(except 3441), 35, 36, 37 (except 373), 38, 39, and 4221-25.
TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1) or, in the case of "sludge use or disposal practices," any
pollutant identified in regulations implementing section 405(d) of the CWA.
TREATMENT WORKS TREATING DOMESTIC SEWAGE (TWTDS) means a POTW or any other sewage sludge or waste water
treatment devices or systems, regardless of ownership (including federal facilities), used in the storage, treatment, recycling, and
reclamation of municipal or domestic sewage, including land dedicated for the disposal of sewage sludge. This definition does not include
septic tanks or similar devices. For purposes of this definition, "domestic sewage" includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a "treatment works treating domestic sewage," where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling, use or disposal
practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET (defined at § 122.41(n)) means an exceptional incident in which there is unintentional and temporary noncompliance with
technology based permit effluent limitations because of factors beyond the reasonable control of the permittee. An upset does not include
noncompliance to the extent caused by operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of
preventive maintenance, or careless or improper operation.
VARIANCE means any mechanism or provision under section 301 or 316 of the CWA or under 40 CFR 125, or in the applicable "effluent
limitations guidelines" which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA. This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
sections 301(c), 301(g), 301(h), 301(i), or 316(a) of the CWA.
WATERS OF THE UNITED STATES as defined at § 122.2.
WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test.
BRI

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
Form
U.S. Environmental Protection Agency
1
\8/EPA
Application for NPDES Permit to Discharge Wastewater
NPDES
GENERAL INFORMATION
SECTION•
•• r
1.1
Applicants Not Required to Submit Form 1
1.1.1
Is the facility a new or existing publicly owned
1.1.2
Is the facility a new or existing treatment works
treatment works?
treating domestic sewage?
If yes, STOP. Do NOT complete No
If yes, STOP. Do NOT No
Form 1. Complete Form 2A.
complete Form 1. Complete
Form 2S.
1.2
Applicants Required to Submit Form 1
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
commercial, mining, or silvicultural facility that is
a
production facility?
currently discharging process wastewater?
oYes
4 Complete Form 1 ❑ No
❑ Yes -* Complete Form ❑ No
a
and Form 2B.
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 wastewater?
Yes 4 Complete Form 1 No
❑ Yes 4 Complete Form No
and Form 2D.
1 and Form 2E.
Vl
1.2.5
Is the facility a new or existing facility whose
'—
discharge is composed entirely of stormwater
a
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
Yes -+ Complete Form 1 No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b (15).
SECTIONDD•
• •
Facility Name
2.1
7r
0
2.2
EPA Identification Number
0
0
J
2.3
Facility Contact
Vl
L
Name (first and last)
Title
Phone number
Q
Email address
2.4
Facility Mailing Address
ZStreet
or P.O. box
City or town
State
ZIP code
EPA Form 3510-1 (revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
y
2.5
Facility Location
Street, route number, or other specific identifier
a o
U
�
0
County name
County code (if known)
._
E J
City or town
State ZIP code
z @
SECTION
•DI
3.1
SIC Code(s)
Description (optional)
d
0
U
N
U
Z
3.2
NAICS Code(s)
Description (optional)
U
N
4.1
Name of Operator
4.2
Is the name you listed in Item 4.1 also the owner?
r0
0
El Yes El No
0
4.3
Operator Status
❑ Public —federal ❑ Public —state ❑ Other public (specify)
0
❑ Private ❑ Other (specify)
4.4
Phone Number of Operator
4.5
Operator Address
r
Street or P.O. Box
M
E
City or town
State
ZIP code
0 0
� U
Q
Email address of operator
0
SECTIONI
5.1
Is the facility located on Indian Land?
❑ Yes ❑ No
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'•
6.1 Existing Environmental Permits (check
1
all that apply and print or type the corresponding permit number for each)
❑ NPDES (discharges to surface
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
c
water)
fluids)
w a
rn
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
x
❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ❑ Other (specify)
SECTIONLU
I
7.1
Have you attached a topographic map containing all required information to this application? (See instructions for
C
specific requirements.)
❑ Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 213.)
SECTIONOF
I
8.1
Describe the nature of your business.
y
y
G7
C
.y
7
m
O
L
{Q
Z
SECTION••
I
9.1 Does your facility use cooling water?
❑ Yes ❑ No-* SKIP to Item 10.1.
R
�a,
9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
Y
NPDES permitting authority to determine what specific information needs to be submitted and when.)
•o
O @
U �
SECTION
I 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
y
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
C
❑ 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))
cc
Section 301(c) and (g))
❑ Not applicable
EPA Form 3510-1 (revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION1
CERTIFICATION STATEMENT (40
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
❑ w/ attachments
❑ Section 2: Name, Mailing Address, and Location
❑ w/ attachments
❑ Section 3: SIC Codes
❑ w/ attachments
❑ Section 4: Operator Information
❑ w/ attachments
❑ Section 5: Indian Land
❑ w/ attachments
❑ Section 6: Existing Environmental Permits
❑ w/ attachments
a�
❑ Section 7: Map
w/ topographic
❑ ❑ w/ additional attachments
map
C
c
❑ Section 8: Nature of Business
❑ w/ attachments
w
❑ Section 9: Cooling Water Intake Structures
❑ w/ attachments
a�
❑ Section 10: Variance Requests
❑ w/ attachments
T
❑ Section 11: Checklist and Certification Statement
❑ w/ attachments
d
11.2
Certification Statement
U
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
Click to go back to the beginning of Form
EPA Form 3510-1 (revised 3-19) Page 4

Print All Pages
Print Form Only
United States Office of Water EPA Form 3510-21F
Environmental Protection Agency Washington, D.C. Revised March 2019
Water Permits Division
� E�► Application Form 2F
Stormwater Discharges
Associated with Industrial
Activity
NPDES Permitting Program
Note: Complete this form and Form 1 if you are a new or existing facility whose discharge is composed
entirely of stormwater associated with industrial activity, excluding discharges from construction
activity under 40 CFR 122.26(b)(14)(x) or (b)(15). If your discharge is composed of stormwater and
non-stormwater, you must complete Forms 1 and 2F, and you must complete Form 2C, 21), or 2E, as
appropriate. See the "Instructions" inside for further details.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect and complete
Form 2F to be 28.1 hours. The estimate includes time for reviewing instructions, searching existing data
sources, gathering and maintaining the needed data, and completing and reviewing the collection of
information. Send comments about the burden estimate or any other aspect of this collection of
information, including suggestions for reducing the burden, to the Chief, Information Policy Branch
(PM-223), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC
20460, and to the Office of Information and Regulatory Affairs, Office of Management and Budget,
725 171h Street, NW, Washington, DC 20503, marked "Attention: Desk Officer for EPA."

FORM 2F—INSTRUCTIONS
General Instructions
Who Must Complete Form 2F?
You must complete Form 2F if you answered "Yes" to Item 1.2.5 on
Form 1—that is, you are a new or existing facility and your
discharge is composed entirely of stormwater associated with
industrial activity (excluding discharges from construction activity
under 40 CFR 122.26(b)(14)(x) or (b)(15)) or composed of
stormwater and non-stormwater and are seeking coverage under
an individual National Pollutant Discharge Elimination System
(NPDES) permit. Note that applicants in the latter category must
also complete Forms 2C, 2D, or 2E, as applicable. See inset
below.
Notes
• Form 2F must be completed by any operator of
a facility that discharges stormwater associated
with industrial activity or the operator of any
stormwater discharger that EPA is evaluating for
designation as a significant contributor of
pollutants to waters of the United States, or as
contributing to a violation of a water quality
standard.
• For discharges composed entirely of
stormwater, the operator must complete
Form 2F in conjunction with Form 1.
• For discharges of stormwater combined with
process wastewater, the operator must
complete and submit Form 2F, Form 1, and
Form 2C. Process wastewater is water that
comes into direct contact with or results from
the production or use of any raw material,
intermediate product, finished product,
byproduct, waste product, or wastewater.
• For discharges of stormwater combined with
nonprocess wastewater, the operator must
complete Form 2F, Form 1, and Form 2E.
Nonprocess wastewater includes noncontact
cooling water and sanitary wastes that are not
regulated by effluent guidelines, except
discharges by educational, medical, or
commercial chemical laboratories.
• For new discharges of stormwater associated
with industrial activity that will be combined with
other new non-stormwater discharges, the
operator must submit Form 2F, Form 1, and
Form 2D.
Where to File Your Completed Form
Submit your completed application package (Forms 1 and 2F plus
any other applicable forms) to your NPDES permitting authority.
Consult Exhibit 1-1 of Form 1's "General Instructions" to identify
your NPDES permitting authority.
Public Availability of Submitted Information
The U.S. Environmental Protection Agency (EPA) will make
information from NPDES permit application forms available to the
public for inspection and copying upon request. You may not claim
any information on Form 2F (or related attachments) as confidential.
You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by Form
2F. Note that NPDES permitting authorities will deny claims for
treating any effluent data (estimated or actual) as confidential. If you
do not assert a claim of confidentiality at the time you submit your
information to the NPDES permitting authority, EPA may make the
information available to the public without further notice to you. EPA
will handle claims of confidentiality in accordance with the Agency's
business confidentiality regulations in Part 2 of Title 40 of the Code
of Federal Regulations (CFR).
Completion of Forms
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
Provide your EPA Identification Number from the Facility Registry
Service, NPDES permit number, and facility name at the top of each
page of Form 2F and any attachments. If your facility is new (i.e.,
not yet constructed), write or type "New Facility" in the space
provided for the EPA Identification Number an NPDES permit
number. If you do not know your EPA Identification Number, contact
your NPDES permitting authority. See Exhibit 1-1 of Form 1's
"General Instructions" for contact information. Additionally, for
Tables A through D, provide the applicable outfall number at the top
of each page.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter "NA" for "not applicable" to
show that you considered the item and determined a response was
not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority's satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
Definitions
The legal definitions of all key terms used in these instructions and
Form 2F are in the "Glossary" at the end of the "General
Instructions" in Form 1.
2F-1

FORM 21F—INSTRUCTIONS CONTINUED
Line -by -Line Instructions
Section 1.Outfall Location
Item 1.1. Identify each of the facility's outfalls by number. For each
outfall, specify the latitude and longitude to the nearest 15 seconds
and name of the receiving water. Latitude and longitude
coordinates may be obtained in a variety of ways, including use of
hand held devices (e.g., a GPS enabled smartphone), internet
mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS). The
location of each outfall (i.e., where the coordinates are collected)
shall be the location where collected and concentrated stormwater
flows are discharged from the facility such that the first receiving
water body into which the discharge flows, either directly or
through a separate storm sewer system, is a water of the United
States. If you need further guidance in responding to Item 1.1, refer
to http://www.epa.gov/geospatial/latitudelongitude-data-standard.
Note: In EPA's stormwater permits, "outfalls" are referred to as
"discharge points."
Note that space has been provided on the form for six outfalls. If
you have more than this number, type your information on a
separate sheet of paper in a format similar to that of the form.
Make sure you note the EPA Identification Number, NPDES permit
number, and facility name at the top of the page and indicate the
specific item of the form to which you are responding —Item 1.1 in
this case. In other sections of the form, you will be asked to provide
information by outfall number (Sections 2, 4, 5, and 7).
Section 2. Improvements
Item 2.1. Indicate if you are 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. The requirements include,
but are not limited to, permit conditions, administrative enforcement
orders, enforcement compliance schedule letters, stipulations,
court orders, and grant or loan conditions. If yes, continue to Item
2.2. If no, skip to Section 3.
Item 2.2. Briefly identify and describe each applicable project (e.g.,
consent decree, enforcement order, or permit condition). For each
condition, specify the affected outfall number(s), the source(s) of
the discharge, the required final compliance date, and the
projected final compliance date.
Item 2.3.OPTIONAL ITEM. Indicate if you have attached any
sheets describing any additional water pollution control programs
(or other environmental projects that could affect your discharges)
that you may now have underway or planned. If you attach
additional sheets, indicate in the attachment whether each program
is actually underway or is planned, and indicate your actual or
planned schedule for construction. Be sure to note your EPA
Identification Number, NPDES permit number, and facility name at
the top of any attached pages.
Section 3. Site Drainage Map
Item 3.1 Attach a site drainage map showing the topography of the
facility. If a topographic map is unavailable, you may provide an
outline of drainage areas served by the outfall(s) covered in the
application. The site map must include the following information:
• Each of its drainage and discharge structures.
• The drainage area of each stormwater outfall.
Paved areas and buildings within the drainage area of each
stormwater outfall; each past or present area used for outdoor
storage or disposal of significant materials; each existing
structural control measure to reduce pollutants in stormwater
runoff; materials loading and access areas; and areas where
pesticides, herbicides, soil conditioners, and fertilizers are
applied.
• Each hazardous waste treatment, storage, or disposal facility
(including each area not required to have a Resource
Conservation and Recovery Act permit and is used for
accumulating hazardous waste for less than 90 days under
40 CFR 262.34).
• Each well where fluids from the facility are injected
underground.
• Springs and other surface water bodies that receive stormwater
discharges from the facility.
When you have completed and attached your site map to Form 2F,
answer "Yes" to Item 3.1.
Section 4. Pollutant Sources
Item 4.1. List all outfalls discharging stormwater. Provide an
estimate of the impervious surface area drained by the outfall.
Specify units of measure. (Impervious surfaces are surfaces where
stormwater runs off at rates significantly higher than background
rates—e.g., predevelopment levels. They include paved areas,
building roofs, parking lots, and roadways.)
Provide an estimate of the total surface area (impervious and
pervious areas) drained by each outfall (within a mile radius of the
facility). You may use the site map developed under Item 3.1 to
estimate the total area drained by each outfall. For areas under
5 acres, consult your NPDES permitting authority to determine
whether the area should be reported to the nearest tenth of an acre
or nearest quarter of an acre.
Item 4.2. Provide a narrative description of the following:
• Significant materials that in three years prior to the submittal of
this application have been treated, stored, or disposed of in a
manner to allow exposure to stormwater.
• Method of treatment, storage, or disposal of such materials.
• Materials management practices employed, in the three years
prior to the submittal of this application, to minimize contact by
these materials with stormwater runoff.
• Materials loading and access areas.
• The location, manner, and frequency in which pesticides,
herbicides, soil conditioners, and fertilizers are applied.
You should identify your significant materials by chemical name,
2F-2

FORM 21F—INSTRUCTIONS CONTINUED
form (e.g., powder, liquid, etc.), and type of container or treatment
unit. Indicate any materials treated, stored, or disposed of
together. The term "significant materials" includes, but is not
limited to: raw materials; fuels; materials such as solvents,
detergents, and plastic pellets; finished materials such as metallic
products; raw materials used in food processing or production;
hazardous substances designated under Section 101(14) of the
Comprehensive Environmental Response, Compensation, and
Liability Act; any chemical the facility is required to report pursuant
to Section 313 of Title III of the Superfund Amendments and
Reauthorization Act; and fertilizers; pesticides; and waste products
such as ashes, slag, and sludge that have the potential to be
released with stormwater discharges.
Item 4.3. For each outfall, list the location and type of existing
structural and non-structural control measure(s) to reduce
pollutants in stormwater runoff. Structural controls include
structures that enclose materials handling or storage areas;
structures that cover materials; and berms, dikes, or diversion
ditches around manufacturing, production, storage, or treatment
units and retention ponds. Spill prevention plans, employee
training, visual inspections, preventive maintenance, and
housekeeping measures are examples of non-structural controls.
Describe the treatment, including the schedule and type of
maintenance activities performed, and the ultimate disposal of any
solid or fluid wastes other than by discharge. For each structural
control identified, indicate the type of treatment the stormwater
receives using the codes in Exhibit 2F-1, at the end of the
instructions. For each non-structural control identified, indicate
"Not Applicable" in the "Codes from Exhibit 2F-1" column.
Section 5. Non-Stormwater Discharges
Item 5.1. Provide a certification that all outfalls that should contain
stormwater discharges associated with industrial activity have
been tested or evaluated for the presence of non-stormwater
discharges. Tests for such non-stormwater discharges can include
smoke tests, fluorometric dye tests, analysis of accurate
schematics, and others.
Item 5.2. Include a description of the method used, the date of any
testing, and the onsite drainage points that were directly observed
during a test used to support the certification in Item 5.1. All non-
stormwater discharges must be identified in a Form 2C, 2D, or 2E.
See "Who Must Complete Form 2F?" above for more information.
Section 6. Significant Leaks or Spills
Item 6.1. Describe any significant leaks or spills of toxic or
hazardous pollutants at the facility within the three years prior to
the submittal of this application. Include the approximate date and
location of the spill or leak and the type and amount of material
released.
Section 7. Discharge Information
Item 7.1. Answer whether you are a new source or new discharge.
Contact your NPDES permitting authority to determine if you are a
new source or new discharge.
Tables A, B, C, and D
Items 7.2 to 7.17. These items require you to collect and report data
in Tables A through D, at the end of Form 2F, for the parameters and
pollutants listed in Exhibits 2F-2, 2F-3, and 2F-4 (at the end of the
instructions). The instructions for completing Tables A through D are
table -specific, as are the criteria for determining who should
complete them.
Important note: Read the "General Instructions for Reporting,
Sampling, and Analysis" below before completing Items 7.2 to 7.17.
Item 7.2 and Table A. All applicants must complete Table A. If the
discharge is an existing discharge and your discharge is composed
exclusively of stormwater (i.e., no process or nonprocess
wastewater) then you only need to provide monitoring data for oil and
grease, total phosphorus, total Kjeldahl nitrogen, and total nitrogen.
Indicate "NA" for "not applicable" in the columns for all other
parameters. Answer "Yes" to Item 7.2 once you have completed this
task.
Item 7.3 and Table B. Indicate whether the facility is subject to an
effluent limitations guideline (ELG) (see 40 CFR Subchapter N to
determine which pollutants are limited in ELGs) or if the facility is
subject to effluent limitations in an NPDES permit for its process
wastewater or stormwater (if the facility is operating under an existing
NPDES permit). If yes, continue to Item 7.4. If no, skip to Item 7.5.
Note: Stormwater discharges from certain industrial sources or
activities have specific ELGs for which they must comply. These
stormwater-specific ELGs include:
Regulated Discharge
40 CFR Section
Discharges resulting from spraydown or intentional
Part 429, Subpart I
wetting of logs at wet deck storage areas
Runoff from phosphate fertilizer manufacturing facilities
Part 418, Subpart A
that comes into contact with any raw materials, finished
product, byproducts or waste products (SIC 2874)
Runoff from asphalt emulsion facilities
Part 443, Subpart A
Runoff from material storage piles at cement
Part 411, Subpart C
manufacturing facilities
Mine dewatering discharges at crushed stone,
Part 436, Subparts B,
construction sand and gravel, or industrial sand mining
C, and D
facilities
Runoff from hazardous waste and non -hazardous waste
Part 445, Subparts A
landfills
and B
Runoff from coal storage piles at steam electric
Part 423
generating facilities
Runoff containing urea from airfield pavement deicing at
Part 449
existing and new primary airports with 1,000 or more
annual non -propeller aircraft departures
Item 7.4. In Table B, list all pollutants that are limited in an ELG to
which the facility is subject and all pollutants listed in the facility's
NPDES permit for its process wastewater (if the facility is operating
under an existing NPDES permit) and provide quantitative data for
each pollutant (provide actual data for existing dischargers and
estimated data for new sources and new dischargers). If a pollutant
in Exhibits 2F-2 or 2F-3 is indirectly limited by an ELG through an
indicator (e.g., use of total suspended solids as an indicator to
control the discharge of iron and aluminum), you must provide data
for the pollutant in Table B. Complete one table for each outfall.
Answer "Yes" to Item 7.4 once you have completed this task.
2F-3

FORM 2F—INSTRUCTIONS CONTINUED
Item 7.5 and Table C. Table C requires you to address the
pollutants in Exhibits 2F-2, 2F-3, and 2F-4 for each outfall.
Pollutants in each of these exhibits are addressed differently
Indicate whether you know or have reason to believe any pollutants
in Exhibit 2F-2 are present in the discharge. If yes, continue to Item
7.6. If no, skip to Item 7.7.
Item 7.6. For each outfall, list all pollutants in Exhibit 2F-2 that you
know or have reason to believe are present in the discharge in
Table C (except pollutants previously listed in Table B that are
limited directly or indirectly by an ELG) and either report quantitative
data or briefly describe the reasons the pollutant is expected to be
discharged. Answer "Yes" to Item 7.6 once you have completed this
task.
Item 7.7. This item asks if you qualify as a "small business." If so,
you are exempt from the reporting requirements for the organic toxic
pollutants listed in Exhibit 2F-3.
You can qualify as a small business in two ways: (1) If your facility is
a coal mine and if your probable total annual production is less than
100,000 tons per year, you may submit past production data or
estimated future production (such as a schedule of estimated total
production under 30 CFR 795.14(c)) instead of conducting analyses
for the organic toxic pollutants; (2) If your facility is not a coal mine
and if your gross total annual sales for the most recent three years
average less than $100,000 per year (in second quarter 1980
dollars), you may submit sales data for those years instead of
conducting analyses for the organic toxic pollutants. The production
or sales data must be for the facility that is the source of the
discharge. The data should not be limited to production or sales for
the process or processes that contribute to the discharge, unless
those are the only processes at your facility. For sales data, in
situations involving intra-corporate transfer of goods and services,
the transfer price per unit should approximate market prices for
those goods and services as closely as possible. Sales figures for
years after 1980 should be indexed to the second quarter of 1980 by
using the gross national product price deflator (second quarter of
1980 = 100). This index is available online from the U.S. Department
of Commerce, Bureau of Economic Analysis at
htto://www.bea.aov/national/ptlf/SNTables.i)df.
If you qualify as a small business according to the criteria above,
answer "Yes" to Item 7.7 and skip to Item 7.18.Otherwise, answer
"No" and continue to Item 7.8.
Item 7.8. Indicate whether you know or have reason to believe any
pollutants in Exhibit 2F-3 are present in the discharge. If yes,
continue to Item 7.9. If no, skip to Item 7.10.
Item 7.9. For each outfall, list all pollutants in Exhibit 2F-3 that you
know or have reason to believe are present in the discharge in
Table C (except pollutants previously listed in Table B). Answer
"Yes" to Item 7.9 once you have completed this task.
Item 7.10. Indicate whether you expect any of the pollutants from
Exhibit 2F-3 to be discharged in concentrations of 10 parts per
billion (ppb) or greater. If yes, continue to Item 7.11. If no, skip to
Item 7.12.
Item 7.11. Provide quantitative data in Table C for those pollutants
in Exhibit 2F-3 that you expect to be discharged in concentrations
of 10 ppb or greater (provide actual data for existing dischargers
and estimated data for new sources and new dischargers). Answer
"Yes" to Item 7.11 once you have completed this task.
Item 7.12. Indicate whether you expect acrolein, acrylonitrile, 2,4-
dinitrophenol, or 2-methyl -4,6-dinitrophenol to be discharged in
concentrations of 100 ppb or greater. If yes, continue to Item 7.13.
If no, skip to Item 7.14.
Item 7.13. Provide 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 (provide actual data for
existing dischargers and estimated data for new sources and new
dischargers). Answer "Yes" to Item 7.13 once you have completed
this task.
Item 7.14. For any pollutants you expect to be present in the
discharge at concentrations less than 10 ppb (or less than 100 ppb
for the above four pollutants), either submit quantitative data or
briefly describe the reasons the pollutant is expected to be
discharged in Table C. Answer "Yes" to Item 7.14 once you have
completed this task.
Item 7.15. Indicate whether you know or have reason to believe
any pollutants in Exhibit 2F-4 are present in the discharge. If yes,
continue to Item 7.16. If no, skip to Item 7.17.
Item 7.16. For each outfall, list any pollutant in Exhibit 2F-4 that
you know or believe to be present in the discharge in Table C and
explain why you believe it to be present. No analysis is required,
but if you have analytical data, you must report it. Answer "Yes" to
Item 7.16 once you have completed this task.
Note: Under 40 CFR 117.12(a)(2), certain discharges of hazardous
substances (listed in Exhibit 2F-5) may be exempted from the requirements of
CWA Section 311, which establishes reporting requirements, civil penalties,
and liability for cleanup costs for spills of oil and hazardous substances. A
discharge of a particular substance can be exempted if the origin, source, and
amount of the discharged substances are identified in the NPDES permit
application or in the permit, if the permit contains a requirement for treatment
of the discharge, and if the treatment is in place. If you would like to apply for
an exemption from the requirements of CWA Section 311, attach additional
sheets of paper to your application, setting forth the following information:
1. The substance and the amount of each substance that might be
discharged.
2. The origin and source of the discharge of the substance.
3. The treatment to be provided for the discharge by:
a. An onsite treatment system separate from any treatment system
treating your normal discharge;
b. A treatment system designed to treat your normal discharge and that
is additionally capable of treating the amount of the substance
identified under paragraph 1 above; or
c. Any combination of the above.
See 40 CFR 117.12(a)(2) and (c) or contact your NPDES permitting authority
for further information on exclusions from CWA Section 311.
Item 7.17 and Table D. Provide data for the storm event(s) that
resulted in the maximum daily discharges for the flow weighted
composite sample in Table D. If sampling is conducted during more
than one storm event, you only need to report the information
2F-4

FORM 21F—INSTRUCTIONS CONTINUED
requested on Table D for the storm event(s) that resulted in any
maximum pollutant concentration reported on Tables A through C.
Provide flow measurements or estimates of the flow rate, as well as
the total amount of discharge for the storm event(s) sampled, the
method of flow measurement, or estimation. Provide the data and
duration of the storm event(s) sampled, rainfall measurements, or
estimates of the storm event that generated the sampled runoff and
the duration between the storm event sampled and the end of the
previous measurable (greater than 0.1 inch rainfall) storm event.
Answer "Yes" to Item 7.17 once you have completed this task.
Used or Manufactured Toxics
Item 7.18. Review Exhibits 2F-2 through 2F-4 and determine if you
currently use or manufacture any of the pollutants listed as
intermediate or final products or byproducts. If so, answer "Yes."
You should also answer "Yes" if you know or have reason to
believe that 2,3,7,8-tetrachloro-dibenzo-p-dioxin (TCDD) is
discharged or if you use or manufacture 2,4,5-trichlorphenoxy
acetic acid (2,4,5-T); 2-(2,4,5-trichlorophenoxy) propanoic acid
(Silvex, 2,4,5-TP); 2-(2,4,5-trichlorophenoxy) ethyl, 2,2-
dichloropropionate (Erbon); 0,0-dimethyl 0-(2,4,5-trichlorphenyl)
phosphorothioate (Ronnel); 2,4,5-trichlorophenol (TCP); or
hexachlorophene (HCP). If your answer to Item 7.18 is "No," skip to
Section 8.
Item 7.19. List all of the toxic pollutants identified under Item 7.18,
including TCDD. Note that the NPDES permitting authority may
waive or modify the requirement if you demonstrate that it would be
unduly burdensome to identify each toxic pollutant and the NPDES
permitting authority has adequate information to issue your permit.
You may not claim any information submitted in response to Item
7.18 as confidential; however, you do not have to distinguish
between use or production of the pollutants or list the amounts.
Section 8. Biological Toxicity Testing Data
Item 8.1. Answer whether you know of or have reason to believe
that biological toxicity testing has been conducted of your
wastewater treatment, including engineering reports or pilot plant
studies. If no, skip to Section 9.Otherwise, continue.
Item 8.2. List any tests of which you are aware and their purposes
Section 9. Contract Analysis Information
Item 9.1. Indicate if any of the analyses performed in Section 7
were performed by a contract laboratory or consulting firm. If no,
skip to Section 10. If yes, continue to Item 9.2.
Item 9.2. Provide the name, address, phone number, and pollutants
analyzed by the laboratory or consulting firm(s) in the spaces
provided.
Section 10. Checklist and Certification Statement
Item 10.1. Review the checklist provided on the application. In
Column 1, mark the sections of Form 2F that you have completed
and are submitting with your application. For each section in
Column 2, indicate whether you are submitting attachments.
Item 10.2. The Clean Water Act (CWA) provides for severe
penalties for submitting false information on this application form.
Section 309(c)(2) of the CWA provides that, "Any person who
knowingly makes any false material statement, representation, or
certification in any application, ...shall upon conviction be punished
by a fine of not more than $10,000 or by imprisonment for not more
than six months or both."
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A. For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer means:
(1) a president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function, or any
other person who performs similar policy- or decision -making
functions for the corporation, or (2) the manager of one or
more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
END
Submit your completed Form 1, Form 2F, and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
2F-5

General Instructions for Reporting, Sampling, and Analysis
Important note: Read these instructions before completing Tables
A through C and Section 7 of Form 2F.
General Items
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number, NPDES permit
number, facility name, and applicable outfall number at the top of
each table page and any associated attachments.
You may report some or all of the required data by attaching
separate sheets of paper instead of completing Tables A through C
for each of your outfalls so long as the sheets contain all of the
required information and are similar in format to Tables A through
C. For example, you may be able to print a report in a compatible
format from the data system used in your gas chromatography/
mass spectrometry (GC/MS) analysis completed under Table B.
If you are an existing discharger, you are required to report actual
quantitative data. See "Use of Historic Data" below for use of
historic data. If you are a new source or discharge, you may supply
estimated data along with the source of each estimate. If you have
quantitative data available, however, you must provide it. Base
estimates on available, in-house or contractor engineering reports,
or any other studies performed on the proposed facility. Use the
following codes to report your source information in the "Source of
Information" column:
Data Source
Code
Engineering reports
1
Actual data from pilot plants
1
Estimates from other engineering
reports
2
Data from other similar plants
3
Best professional estimates
4
Others
5 and specify on
the table
No later than 24 months after your facility commences to
discharge, you must complete and submit sampling and analysis
data for the pollutants and parameters in Tables A through C.
However, you need not report results for tests you have already
performed and reported under the discharge monitoring
requirements of your NPDES permit.
Table A requires you to report at least one analysis for each
pollutant listed. Tables B and C require you to report analytical data
in two ways. For some pollutants addressed in Tables B and C, if
you know or have reason to know that the pollutant is present in
your discharge, you may be required to list the pollutant and test
(sample and analyze) and report the levels of the pollutants in your
discharge. For all other pollutants addressed in Tables B and C,
you must list the pollutant if you know or have reason to know that
the pollutant is present in the discharge, and either report
quantitative data for the pollutant or briefly describe the reasons
the pollutant is expected to be discharged. (See Items 7.2 through
7.17 of the instructions for completing Tables A through C.). Base
your determination that a pollutant is/will be present in your
discharge on your knowledge of the facility's raw materials,
material management practices, maintenance chemicals, history of
spills and releases, intermediate and final products and
byproducts, and any previous analyses known to you of your
effluent or similar effluent.
Sampling
The collection of the samples for the reported analyses should be
supervised by a person experienced in performing sampling of
industrial wastewater or stormwater discharges. You may contact
your NPDES permitting authority for detailed guidance on sampling
techniques and for answers to specific questions. See Exhibit 1-1 of
Form 1 for contact information. Any specific requirements in the
analytical methods —for example, sample containers, sample
preservation, holding times, and the collection of duplicate
samples —must be followed.
The time when you sample should be representative of your normal
operation, to the extent feasible, with all processes that contribute
wastewater in normal operation, and with your treatment system
operating properly with no system upsets. Collect samples from the
center of the flow channel, where turbulence is at a maximum, at a
site specified in your present NPDES permit, or at any site adequate
for the collection of a representative sample.
Grab samples must be taken in the first 30 minutes of discharge (or
as soon thereafter as practicable) for pH, temperature, cyanide, total
phenols, residual chlorine, oil and grease, fecal coliform (including
E. coli) and enterococci (previously known as fecal streptococcus at
40 CFR 122.26(d)(2)(iii)(A)(3)), and volatile organic compounds.
You are not required to analyze a flow -weighted composite for these
parameters.
For all other pollutants, both a grab sample collected during the first
30 minutes (or as soon thereafter as practicable) of the discharge
and a flow -weighted composite sample must be analyzed. However,
a minimum of one grab sample may be taken for effluents from
holding ponds or other impoundments with a retention period of
greater than 24 hours.
All samples must be collected from the discharge resulting from a
storm event that is greater than 0.1 inches and at least 72 hours
from the previously measurable (greater than 0.1 inch rainfall) storm
event. Where feasible, the variance in the duration of the event and
the total rainfall of the event should not exceed 50 percent from the
average or median rainfall event in that area.
A grab sample must be taken during the first 30 minutes of the
discharge (or as soon thereafter as practicable), and a flow -
weighted composite must be taken for the entire event or for the first
three hours of the event.
Grab and composite samples are defined as follows:
Grab sample: An individual sample of at least 100 milliliters
collected during the first 30 minutes (or as soon thereafter as
practicable) of the discharge. This sample is to be analyzed
separately from the composite sample.
Flow -weighted composite sample: A flow -weighted composite
sample may be taken with a continuous sampler that proportions the
amount of sample collected with the flow rate or as a combination of
a minimum of three sample aliquots taken in each hour of discharge
2F-6

General Instructions for Reportinq, Samplinq, and Analvsis Continued
for the entire event or for the first three hours of the event, with
each aliquot being at least 100 milliliters and collected with a
minimum period of 15 minutes between aliquot collections. The
composite must be flow proportional; the time interval between
either each aliquot or the volume of each aliquot must be
proportional to either the stream (effluent) flow at the time of
sampling or the total stream (effluent) flow since the collection of
the previous aliquot. Aliquots may be collected manually or
automatically. Where GC/MS volatile organic analysis is required,
aliquots must be combined in the laboratory immediately before
analysis. Only one analysis for the composite sample is required.
Use of Historical Data
Existing data may be used, if available, in lieu of sampling
conducted solely for the purposes of this application, provided it is
representative of the present discharge and was collected within
3 years of the application due date. If you sample for a listed
pollutant on a monthly or more frequent basis, summarize the data
collected within one year of the application for the pollutant(s) at
issue.
Among the factors that would cause the data to be
unrepresentative are significant changes in production level;
changes in raw materials, processes, or final products; and
changes in stormwater treatment. The NPDES permitting authority
may request additional information, including current quantitative
data, if they determine it to be necessary to assess your
discharges. The NPDES permitting authority may allow or establish
appropriate site -specific sampling procedures or requirements
including sampling locations, the season in which the sampling
takes place, the minimum duration between the previous
measurable storm event and the storm event sampled, the
minimum or maximum level of precipitation required for an
appropriate storm event, the form of precipitation sampled (snow
melt or rainfall), protocols for collecting samples under 40 CFR 136,
and additional time for submitting data on a case -by -case basis.
Reporting
Report sampling results for all pollutants in Tables A through C as
concentration and mass, with the exception of flow, temperature,
pH, color, and fecal coliform organisms.
Flow, temperature, pH, color, and fecal coliform organisms must
be reported as million gallons per day (mgd), degrees Celsius
(°C), standard units, color units, and most probable number per
100 milliliters (MPN/100 mL), respectively. Use the following
abbreviations in the columns requiring "units" in Tables A through
C.
Concentration
Mass
m = parts per million
Ibs = pounds
m /L = milligrams per liter
ton = tons (English tons
b = parts per billion
mg = milligrams
N /L = micrograms per liter
g = grams
MPN = most probable number per
100 milliliters
kg = kilograms
T = tonnes metric tons
All reporting of values for metals must be in terms of "total
recoverable metal" unless:
• An applicable, promulgated ELG specifies the limitation for the
metal in dissolved, valent, or total form;
• All approved analytical methods for the metal inherently
measure only its dissolved form (e.g., hexavalent chromium);
or
• The NPDES permitting authority has determined that in
establishing case -by -case limitations it is necessary to express
the limitations of the metal in dissolved, valent, or total form to
carry out the provisions of the CWA.
If you measure only one grab sample and one flow -weighted
composite sample for a given outfall, complete only the "Maximum
Daily Discharge" columns in the tables and enter 1" in the "Number
of Storm Events Sampled" column. The NPDES permitting authority
may require you to conduct additional analyses to further
characterize your discharges.
If you measure more than one value for a grab sample or a flow -
weighted composite sample for a given outfall and those values are
representative of your discharge, you must report them. You must
describe your method of testing and analysis.
The "Average Daily Discharge" column on Tables A to C is not
compulsory but should be filled out if data are available. To
complete the "Average Daily Discharge" column, determine the
average of all values within the last year and report the
concentration and mass. Report the total number of storm events
sampled under the "Number of Storm Events Sampled" column.
Substantially Identical Outfalls
If you have two or more substantially identical outfalls, you may
request permission from your NPDES permitting authority to sample
and analyze only one outfall and submit the results of the analysis
for all substantially identical outfalls. If your request is granted,
submit the following information on a separate sheet attached to the
application form: the identity of the outfall you did test and an
explanation of how it is substantially identical to the outfall(s) that
you did not test.
Analysis
Except as specified below, all required quantitative data shall be
collected in accordance with sufficiently sensitive analytical methods
approved under 40 CFR 136 or required under 40 CFR chapter I,
subchapter N or 0. A method is "sufficiently sensitive" when:
• The method minimum level (ML) is at or below the level of the
applicable water quality criterion for the measured pollutant or
pollutant parameter.
• The method ML is above the water quality criterion, but the
amount of the pollutant or pollutant parameter in the facility's
discharge is high enough that the method detects and
quantifies the level of the pollutant or pollutant parameter in the
discharge.
2F-7

General Instructions for Reporting, Sampling, and Analysis Continued
• The method has the lowest ML of the analytical methods
select a different method from the remaining EPA -approved
approved under 40 CFR 136 or required under 40 CFR
methods that is sufficiently sensitive consistent with 40 CFR
chapter I, subchapter N or 0, for the measured pollutant or
122.21(e)(3)(i). Where no other EPA -approved methods exist, you
pollutant parameter.
must select a method consistent with 40 CFR 122.21(e)(3)(ii).
Consistent with 40 CFR 136, you may provide matrix- or sample-
When there is no analytical method that has been approved under
specific MLs rather than the published levels. Further, where you
40 CFR 136; required under 40 CFR chapter I, subchapter N or 0,
can demonstrate that, despite a good faith effort to use a method
and is not otherwise required by the NPDES permitting authority,
that would otherwise meet the definition of "sufficiently sensitive,"
you may use any suitable method but shall provide a description of
the analytical results are not consistent with the quality assurance
the method. When selecting a suitable method, other factors such
(QA)Iquality control (QC) specifications for that method, then the
as a method's precision, accuracy, or resolution, may be considered
NPDES permitting authority may determine that the method is not
when assessing the performance of the method.
performing adequately and the NPDES permitting authority should
2F-8

Exhibit 2F-1. Codes for Treatment Units and Disposal of Wastes Not Discharged
1.
PHYSICAL TREATMENT PROCESSES
1—A.................Ammonia
stripping
1—M ................
Grit removal
1—B.................
Dialysis
1—N ................
Microstraining
1—C ................
Diatomaceous earth filtration
1-0 ................
Mixing
1—D ................
Distillation
1—P ................
Moving bed filters
1—E.................
Electrodialysis
1—Q ................
Multimedia filtration
1—F.................Evaporation
1—R................
Rapid sand filtration
1—G ................
Flocculation
1—S ................
Reverse osmosis (hyperfiltration)
1—H ................
Flotation
1—T ................
Screening
1-1..................
Foam fractionation
1—U ................
Sedimentation (settling)
1—J .................
Freezing
1—V ................
Slow sand filtration
1—K.................
Gas -phase separation
1—W ...............
Solvent extraction
1—L.................Grinding
(comminutors)
1—X ................
Sorption
2.
CHEMICAL TREATMENT PROCESSES
2—A.................Carbon
adsorption
2—G ................
Disinfection (ozone)
2—B.................Chemical
oxidation
2—H ................
Disinfection (other)
2—C ................Chemical
precipitation
2—I..................
Electrochemical treatment
2—D ................Coagulation
2—J.................
Ion exchange
2—E.................
Dechlorination
2—K ................
Neutralization
2—F.................
Disinfection (chlorine)
2—L.................
Reduction
3—A.................Activated
sludge
3—B.................Aerated
lagoons
3—C ................Anaerobic
treatment
3—D ................
Nitrification—denitrification
3. BIOLOGICAL TREATMENT PROCESSES
3—E ................ Pre -aeration
3—F ................ Spray irrigation/land application
3—G................Stabilization ponds
3—H ................ Trickling filtration
4. WASTEWATER DISPOSAL PROCESSES
4—A................. Discharge to surface Water 4—C ................ Reuse/recycle of treated effluent
4—B.................Ocean discharge through outfall 4—D ................ Underground injection
5.
SLUDGE TREATMENT AND DISPOSAL PROCESSES
5—A.................Aerobic
digestion
5—M ................
Heat drying
5—B.................Anaerobic
digestion
5—N ................
Heat treatment
5—C ................
Belt filtration
5-0 ................
Incineration
5—D ................Centrifugation
5—P ................
Land application
5—E.................Chemical
conditioning
5—Q ................
Landfill
5—F.................Chlorine
treatment
5—R ................
Pressure filtration
5—G ................
Composting
5—S ................
Pyrolysis
5—H ................
Drying beds
5—T ................
Sludge lagoons
5-1..................
Elutriation
5—U ................
Vacuum filtration
5—J .................
Flotation thickening
5—V ................
Vibration
5—K.................
Freezing
5—W ...............
Wet oxidation
5—L.................Gravity
thickening
2F-9

Exhibit 2F-2. Conventional and Nonconventional Pollutants (40 CFR 122.21, Appendix D, Table IV)
Bromide
Chlorine, total residual
Color
Fecal coliform
Fluoride
Nitrate -nitrite
Nitrogen, total organic (as N)
Oil and grease
Phosphorus (as P), total
Radioactivity (as alpha, total; beta, total; radium, total; and radium 226, total)
Sulfate (as SO4)
Sulfide (as S)
Sulfite (as S03)
Surfactants
Aluminum, total
Barium, total
Boron, total
Cobalt, total
Iron, total
Magnesium, total
Molybdenum, total
Manganese, total
Tin, total
Titanium, total
2F-10

Exhibit 2F-3. Toxic Pollutants (40 CFR 122.21, Appendix D, Tables II and III)
Toxic Pollutants and Total Phenol
Antimony, total
Copper, total
Silver, total
Arsenic, total
Lead, total
Thallium, total
Beryllium, total
Mercury, total
Zinc, total
Cadmium, total
Nickel, total
Cyanide, total
Chromium, total
Selenium, total
Phenols, total
GC/MS Fraction —Volatile Compounds
Acrolein
Dichlorobromomethane
1,1,2,2-tetrachloroethane
Acrylonitrile
1,1-dichloroethane
Tetrachloroethylene
Benzene
1,2-dichloroethane
Toluene
Bromoform
1,1-dichloroethylene
1,2-trans-dichloroethylene
Carbon tetrachloride
1,2-dichloropropane
1,1,1-trichloroethane
Chlorobenzene
1,3-dichloropropylene
1,1,2-trichloroethane
Chlorodibromomethane
Ethylbenzene
Trichloroethylene
Chloroethane
Methyl bromide
Vinyl chloride
2-Chloroethylvinyl ether
Methyl chloride
Chloroform
Methylene chloride
GC/MS Fraction —Acid Compounds
2-chlorophenol
2,4-dinitrophenol
Pentachlorophenol
2,4-dichlorophenol
2-nitrophenol
Phenol
2,4-dimethylphenol
4-nitrophenol
2,4,6-trichlorophenol
4,6-dinitro-o-cresol
P-chloro-m-cresol
GC/MS Fraction—Base/Neutral Compounds
Acenaphthene
4-chlorophenyl phenyl ether
Hexachlorobenzene
Acenaphthylene
Chrysene
Hexachlorobutadiene
Anthracene
Dibenzo (a,h) anthracene
Hexachlorocyclopentadiene
Benzidine
1,2-dichlorobenzene
Hexachloroethane
Benzo (a) anthracene
1,3-dichlorobenzene
Indeno (1,2,3-cd) pyrene
Benzo (a) pyrene
1,4-dichlorobenzene
Isophorone
3,4-benzofluoranthene
3,3-dichlorobenzidine
Naphthalene
Benzo (ghi) perylene
Diethyl phthalate
Nitrobenzene
Benzo (k) fluoranthene
Dimethyl phthalate
N-nitrosodimethylamine
Bis (2-chloroethoxy) methane
Di-n-butyl phthalate
N-nitrosodi-n-propylamine
Bis (2-chloroethyl) ether
2,4-dinitrotoluene
N-nitrosodiphenylamine
Bis (2-chloroisopropyl) ether
2,6-dinitrotoluene
Phenanthrene
Bis (2-ethylhexyl) phthalate
Di-n-octyl phthalate
Pyrene
4-bromophenyl phenyl ether
1,2-diphenylhydrazine (as azobenzene)
1,2,4-trichlorobenzene
Butyl benzyl phthalate
Fluoranthene
2-chloronaphthalene
Fluorene
GCIMS Fraction —Pesticides
Aldrin
Dieldrin
PCB-1254
a-BHC
a-endosulfan
PCB-1221
R-BHC
R-endosulfan
PCB-1232
y-BHC
Endosulfan sulfate
PCB-1248
b-BHC
Endrin
PCB-1260
Chlordane
Endrin aldehyde
PCB-1016
4,4'-DDT
Heptachlor
Toxaphene
4,4'-DDE
Heptachlor epoxide
4,4'-DDD
PCB-1242
2F-11

Exhibit 2F-4. Certain Hazardous Substances and Asbestos (40 CFR 122.21, Appendix D, Table V)
Asbestos
Acetaldehyde
Allyl alcohol
Allyl chloride
Amyl acetate
Aniline
Benzonitrile
Benzyl chloride
Butyl acetate
Butylamine
Captan
Carbaryl
Carbofuran
Carbon disulfide
Chlorpyrifos
Coumaphos
Cresol
Crotonaldehyde
Cyclohexane
2,4-D (2,4-dichlorophenoxyacetic acid)
Diazinon
Dicamba
Dichlobenil
Dichlone
2,2-dichloropropionic acid
Dichlorvos
Diethyl amine
Dimethyl amine
Toxic Pollutant
Hazardous Substances
Dintrobenzene
Naphthenic acid
Diquat
Nitrotoluene
Disulfoton
Parathion
Diuron
Phenolsulfonate
Epichlorohydrin
Phosgene
Ethion
Propargite
Ethylene diamine
Propylene oxide
Ethylene dibromide
Pyrethrins
Formaldehyde
Quinoline
Furfural
Resorcinol
Guthion
Strontium
Isoprene
Strychnine
Isopropanolamine
Styrene
Kelthane
2,4,5-T (2,4,5-trichlorophenoxyacetic
acid)
Kepone
TIDE (tetrachlorodiphenyl ethane)
Malathion
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
propanoic acid]
Mercaptodimethur
Trichlorofon
Methoxychlor
Triethanolamine
Methyl mercaptan
Triethylamine
Methyl methacrylate
Trimethylamine
Methyl parathion
Uranium
Mevinphos
Vanadium
Mexacarbate
Vinyl acetate
Monoethyl amine
Xylene
Monomethyl amine
Xylenol
Naled
Zirconium
2F-12

1. Acetaldehyde
2. Acetic acid
3. Acetic anhydride
4. Acetone cyanohydrin
5. Acetyl bromide
6. Acetyl chloride
7. Acrolein
8. Acrylonitrile
9. Adipic acid
10. Aldrin
11. Allyl alcohol
12. Allyl chloride
13. Aluminum sulfate
14. Ammonia
15. Ammonium acetate
16. Ammonium benzoate
17. Ammonium bicarbonate
18. Ammonium bichromate
19. Ammonium bifluoride
20. Ammonium bisulfite
21. Ammonium carbamate
22. Ammonium carbonate
23. Ammonium chloride
24. Ammonium chromate
25. Ammonium citrate
26. Ammonium fluoroborate
27. Ammonium fluoride
28. Ammonium hydroxide
29. Ammonium oxalate
30. Ammonium silicofluoride
31. Ammonium sulfamate
32. Ammonium sulfide
33. Ammonium sulfite
34. Ammonium tartrate
35. Ammonium thiocyanate
36. Ammonium thiosulfate
37. Amyl acetate
38. Aniline
39. Antimony pentachloricle
40. Antimony potassium tartrate
41. Antimony tribromide
42. Antimony trichloride
43. Antimony trifluoride
44. Antimony trioxide
45. Arsenic disulfide
46. Arsenic pentoxide
47. Arsenic trichloride
48. Arsenic trioxide
49. Arsenic trisulfide
50. Barium cyanide
51. Benzene
52. Benzoic acid
53. Benzonitrile
54. Benzoyl chloride
55. Benzyl chloride
56. Beryllium chloride
57. Beryllium fluoride
58. Beryllium nitrate
59. Butylacetate
60. n-butylphthalate
61. Butylamine
62. Butyric acid
63. Cadmium acetate
64. Cadmium bromide
65. Cadmium chloride
66. Calcium arsenate
67. Calcium arsenite
68. Calcium carbide
69. Calcium chromate
70. Calcium cyanide
71. Calcium dodecylbenzenesulfonate
72. Calcium hypochlorite
Exhibit 2F-5. Hazardous Substances
73. Captan
74. Carbaryl
75. Carbofuran
76. Carbon disulfide
77. Carbon tetrachloride
78. Chlordane
79. Chlorine
80. Chlorobenzene
81. Chloroform
82. Chloropyrifos
83. Chlorosulfonic acid
84. Chromic acetate
85. Chromic acid
86. Chromic sulfate
87. Chromous chloride
88. Cobaltous bromide
89. Cobaltous formate
90. Cobaltous sulfamate
91. Coumaphos
92. Cresol
93. Crotonaldehyde
94. Cupric acetate
95. Cupric acetoarsenite
96. Cupric chloride
97. Cupric nitrate
98. Cupric oxalate
99. Cupric sulfate
100. Cupric sulfate ammoniated
101. Cupric tartrate
102. Cyanogen chloride
103. Cyclohexane
104.2,4-D acid (2,4-dichlorophenoxyacetic acid)
105. 2,4-D esters (2,4-dichlorophenoxyacetic acid esters)
106. DDT
107. Diazinon
108. Dicamba
109. Dichlobenil
110. Dichlone
111. Dichlorobenzene
112. Dichloropropane
113. Dichloropropene
114. Dichloropropene-dichloproropane mix
115.2,2-dichloropropionic acid
116. Dichlorvos
117. Dieldrin
118. Diethylamine
119. Dimethylamine
120. Dinitrobenzene
121. Dinitrophenol
122. Dinitrotoluene
123. Diquat
124. Disulfoton
125. Diuron
126. Dodecylbenzesulfonic acid
127. Endosulfan
128. Endrin
129. Epichlorohydrin
130. Ethion
131. Ethylbenzene
132. Ethylenediamine
133. Ethylene dibromide
134. Ethylene dichloride
135. Ethylene diaminetetracetic acid (EDTA)
136. Ferric ammonium citrate
137. Ferric ammonium oxalate
138. Ferric chloride
139. Ferric fluoride
140. Ferric nitrate
141. Ferric sulfate
142. Ferrous ammonium sulfate
143. Ferrous chloride
144. Ferrous sulfate
145. Formaldehyde
146. Formic acid
147. Fumaric acid
148. Furfural
149. Guthion
150. Heptachlor
151. Hexachlorocyclopentadiene
152. Hydrochloric acid
153. Hydrofluoric acid
154. Hydrogen cyanide
155. Hydrogen sulfide
156. Isoprene
157. Isopropanolamine dodecylbenzenesulfonate
158. Kelthane
159. Kepone
160. Lead acetate
161. Lead arsenate
162. Lead chloride
163. Lead fluoborate
164. Lead fluorite
165. Lead iodide
166. Lead nitrate
167. Lead stearate
168. Lead sulfate
169. Lead sulfide
170. Lead thiocyanate
171. Lindane
172. Lithium chromate
173. Marathion
174. Maleic acid
175. Maleic anhydride
176. Mercaptodimethur
177. Mercuric cyanide
178. Mercuric nitrate
179. Mercuric sulfate
180. Mercuric thiocyanate
181. Mercurous nitrate
182. Methoxychlor
183. Methyl mercaptan
184. Methyl methacrylate
185. Methyl parathion
186. Mevinphos
187. Mexacarbate
188. Monoethylamine
189. Monomethylamine
190. Naled
191. Naphthalene
192. Naphthenic acid
193. Nickel ammonium sulfate
194. Nickel chloride
195. Nickel hydroxide
196. Nickel nitrate
197. Nickel sulfate
198. Nitric acid
199. Nitrobenzene
200. Nitrogen dioxide
201. Nitrophenol
202. Nitrotoluene
203. Paraformaldehyde
204. Parathion
205. Pentachlorophenol
206. Phenol
207.Phosgene
208. Phosphoric acid
209. Phosphorus
210. Phosphorus oxychloride
211. Phosphorus pentasulfide
212. Phosphorus trichloride
213. Polychlorinated biphenyls (PCB)
214. Potassium arsenate
215. Potassium arsenite
2F-13

Exhibit 2F-5. Hazardous Substances
216. Potassium bichromate
245. Sodium phosphate (dibasic)
271. Uranyl acetate
217. Potassium chromate
246. Sodium phosphate (tribasic)
272. Uranyl nitrate
218. Potassium cyanide
247. Sodium selenite
273. Vanadium penoxide
219. Potassium hydroxide
248. Strontium chromate
274. Vanadyl sulfate
220. Potassium permanganate
249. Strychnine
275. Vinyl acetate
221. Propargite
250. Styrene
276. Vinylidene chloride
222. Propionic acid
251. Sulfuric acid
277. Xylene
223. Propionic anhydride
252. Sulfur monochloride
278. Xylenol
224. Propylene oxide
253.2,4,5-T acid (2,4,5-trichlorophenoxyacetic acid)
279. Zinc acetate
225. Pyrethrins
254.2,4,5-T amines (2,4,5-trichlorophenoxy acetic acid
280. Zinc ammonium chloride
226. Quinoline
amines)
281. Zinc borate
227. Resorcinol
255.2,4,5-T esters (2,4,5-trichlorophenoxy acetic acid
282. Zinc bromide
228. Selenium oxide
esters)
283. Zinc carbonate
229. Silver nitrate
256.2,4,5-T salts (2,4,5-trichlorophenoxy acetic acid
284. Zinc chloride
230. Sodium
salts)
285. Zinc cyanide
231. Sodium arsenate
257.2,4,5-TP acid (2,4,5-trichlorophenoxy propanoic
286. Zinc fluoride
232. Sodium arsenite
acid)
287. Zinc formate
233. Sodium bichromate
258.2,4,5-TP acid esters (2,4,5-trichlorophenoxy
288. Zinc hydrosulfite
234. Sodium bifluoride
propanoic acid esters)
289. Zinc nitrate
235. Sodium bisulfate
259. TIDE (tetrachlorodiphenyl ethane)
290. Zinc phenolsulfonate
236. Sodium chromate
260. Tetraethyl lead
291. Zinc phosphide
237. Sodium cyanide
261. Tetraethyl pyrophosphate
292. Zinc silicofluoride
238. Sodium dodecylbenzenesulfonate
262. Thallium sulfate
293. Zinc sulfate
239. Sodium fluoride
263. Toluene
294. Zirconium nitrate
240. Sodium hydrosulfide
264. Toxaphene
295. Zirconium potassium fluoride
241. Sodium hydroxide
265. Trichlorofon
296. Zirconium sulfate
242. Sodium hypochlorite
266. Trichloroethylene
297. Zirconium tetrachloride
243. Sodium methylate
267. Trichlorophenol
244. Sodium nitrite
268. Triethanolamine dodecylbenzenesulfonate
269. Triethylamine
270. Trimethylamine
2F-14

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
Form U.S Environmental Protection Agency
2F 1W. �� Application for NPDES Permit to Discharge Wastewater
NPDES STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY
SECTIONOUTFALL LOCATION
1.1 Provide information on each of the facilit 's outfalls in the table below
Outfall Receiving Water Name Latitude Longitude
Number
„ o
0
�a
c�
0
O
SECTION' • I
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?
❑ Yes ❑ No 4 SKIP to Section 3.
2.2 Briefly identify each applicable project in the table below.
Brief Identification and Affected Outfalls Source(s) of Discharge Final Compliance Dates
Description of Project (list outfall numbers)
Required Projected
c
m
E
as
0
L
Q
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 3510-21F (Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTIONDRI
a� 3.1 Have you attached a site drainage map containing all required information to this application? (See instructions for
.: _ CL specific guidance.)
R
N iE M
In ❑ Yes ❑ No
SECTIONPOLLUTANT SOURCESi
4.1 Provide information on the facility's pollutant sources in the table below.
Outfall
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
specify units
specify units
specify units
specify units
specify units
specify units
specify units
4.2
Provide a narrative description of the facility's significant material in the space below. (See instructions for content
requirements.)
N
N
7
O
N
C
R
7
O
a
4.3
Provide the location and a description of existing structural and non-structural control measures to reduce pollutants in
stormwater runoff. See instructions for specificguidance.)
Stormwater Treatment
Codes
Outfall
from
Number
Control Measures and Treatment
Exhibit
2F-1
list
EPA Form 3510-21F (Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION•N STORMWATER I I
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, I 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
Signature
Date signed
tp
tM
5.2
Provide the testing information requested in the table below.
Outfall
Onsite Drainage Points
A
o
Number
Description of Testing Method Used
Date(s) of Testing
Directly Observed
L
During Test
d
R
3
E
i
O
N
C
O
Z
SECTIONOR
I I
6.1
Describe any significant leaks or spills of toxic or hazardous pollutants in the last three years.
tp
.Q
N
O
Y
O
N
J
C
!Q
V
w
T
co
SECTIONDISCHARGE
INFORMATIONI
See the
instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
o
complete.
Not all applicants need to complete each table.
7.1
Is this a new source or new discharge?
❑ Yes 4 See instructions regarding submission of ❑ No 4 See instructions regarding submission of
d
estimated data. actual data.
Tables A, B, C, and D
y
7.2
Have you completed Table A for each outfall?
❑ Yes ❑ No
EPA Form 3510-21F (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
7.3
Is the facility subject to an effluent limitation guideline (ELG) or effluent limitations in an NPDES permit for its process
wastewater?
❑ Yes ❑ No + 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 2F-2 are present in the discharge?
❑ Yes ❑ No -+ 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?
❑ 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 ❑ No -+ 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
Table C?
❑ Yes ❑ No
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
L
❑ Yes ❑ No -* 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
concentrations of 10 ppb or greater?
❑ Yes ❑ No
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?
❑ Yes ❑ No -+ 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 ❑ No
7.15
Do you know or have reason to believe any pollutants in Exhibit 2F-4 are present in the discharge?
❑ Yes ❑ No -+ 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 3510-21F (Revised 3-19) Page 4

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
Used or Manufactured Toxics
7.18
Is any pollutant listed on Exhibits 2F-2 through 2F-4 a substance or a component of a substance used or
C
manufactured as an intermediate or final product or byproduct?
0
❑ Yes ❑ No SKIP to Section 8.
0
7.19
List the pollutants below, including TCDD if applicable.
E
1. 4. 7.
d
2. 5. 8.
0
3. 6. 9.
SECTION•
• • i
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 your discharge within the last three years?
0
❑ Yes ❑ No 4 SKIP to Section 9.
.N
8.2
Identify the tests and their purposes below.
Test(s)
Purpose of Test
Submitted to NPDESs)
Permitting Authority?
Date Submitted
X
0
~
❑ Yes ❑ No
R
V
M
El Yes El No
0
m
❑ Yes ❑ No
SECTION•
•- • i
9.1
Were any of the analyses reported in Section 7 (on Tables A through C) performed by a contract laboratory or
consulting firm?
❑ Yes ❑ 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
0
E
L
O
tiLaboratory
M
address
T
C
Q
C)
R
L
o
Phone number
U
Pollutant(s) analyzed
EPA Form 3510-21F (Revised 3-19) Page 5

EPA Identification Number
NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION
I
I
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 complete all sections or provide attachments.
Column 1
Column 2
❑ Section 1
❑ wl attachments (e.g., responses for additional outfalls)
❑ Section 2
❑ wl attachments
❑ Section 3
❑ wl site drainage map
❑ Section 4
❑ wl attachments
❑ Section 5
❑ wl attachments
❑ Section 6
❑ wl attachments
E
❑ Section 7
❑ Table A ❑ wl small business exemption request
R
N
c
❑ Table B ❑ wl analytical results as an attachment
❑ Table C ❑ Table D
❑ Section 8
❑ wlattachments
ti❑
Section 9
❑ wlattachments (e.g., responses for additional contact laboratories or firms)
Y
L
❑ Section 10
❑
U
10.2
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
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 3510-21F (Revised 3-19) Page 6

EPA Identification Number I NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
TABLE A. CONVENTIONAL AND NON CONVENTIONALI
You must provide the results of at least one anal sis for every pollutant in this table. Complete one table for each outfall. See instructions for additional details and requirements.
Pollutant or Parameter
Maximum Daily Discharge
(specify units)
Average Daily Discharge
(specify units)
Number of Storm
Events Sampled
Source of
Information
(new source/new
dischargers only; use
codes in instructions )
Grab Sample Taken
During First
30 Minutes
Flow -Weighted
Composite
Grab Sample Taken
During First
30 Minutes
Flow -Weighted
Composite
1.
Oil and grease
2.
Biochemical oxygen demand (BOD5)
3.
Chemical oxygen demand (COD)
4.
Total suspended solids (TSS)
5.
Total phosphorus
6.
Total Kjeldahl nitrogen (TKN)
7.
Total nitrogen (as N)
pH (minimum)
8.
pH (maximum)
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-21F (Revised 3-19) Page 7

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EPA Identification Number I NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS (40 CIFIR 122.26(c)(1)(i)(E)(4) and 40 CIFIR 1122.211(g)(7)(vi)(A))'
List each pollutant that is limited in an effluent limitation guideline (ELG) that the facility is subject to or any pollutant listed in the facility's NPDES permit for its process wastewater (if the
facility is operating under an existing NPDES permit). Complete one table for each outfall. See the instructions for additional details and requirements.
Pollutant and CAS Number (if available)
Maximum Daily Discharge
(specify units)
Average Daily Discharge
(specify units)
Number of Storm
Events Sampled
Source of
Information
(new source/new
dischargers only; use
codes in instructions)
Grab Sample Taken
During First
30 Minutes
Flow -Weighted
Composite
Grab Sample Taken
During First
30 Minutes
Flow -Weighted
Composite
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-21F (Revised 3-19) Page 9

This page intentionally left blank.

EPA Identification Number I NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
TABLE C. TOXIC POLLUTANTS, CERTAIN HAZARDOUS SUBSTANCES, AND ASBESTOS (40 CFR 122.26(c)(1)(l)(E)(4) and 40 CFR 122.21(g)(7)(vi)(B) and (vil))'
List each pollutant shown in Exhibits 2F-2, 2F-3, and 2F-4 that you know or have reason to believe is present. Complete one table for each outfall. See the instructions for additional
details and requirements.
Pollutant and CAS Number (if available)
Maximum Daily Discharge
s ecify units)
Average Daily Discharge
s ecify units)
Number of Storm
Events Sampled
Source of
Information
(new source/new
dischargers only; use
codes in instructions)
Grab Sample Taken
During First
30 Minutes
Flow -Weighted
Composite
Grab Sample Taken
During First
30 Minutes
Flow -Weighted
Comosite
p
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-21F (Revised 3-19) Page 11

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility name Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
STORMTABLE D. •' • I
Provide data for the storm event(s) that resulted in the maximum daily discharges for the flow -weighted composite sample.
Number of Hours Between
Duration of Storm Event
Total Rainfall During
Beginning of Storm Measured and
Maximum Flow Rate
Total Flow from Rain Event
Date of Storm Event
(in hours)
Storm Event
End of Previous Measurable Rain
During Rain Event
(in gallons or specify units)
(in inches)
Event
(in gpm or specify units)
Provide a description of the method of flow measurement or estimate.
Click to go back to the beginning of Form
EPA Form 3510-21F (Revised 3-19)
Page 13