Industrial Wastewater Discharge Permit

Industrial Wastewater Discharge Permit Application
Section A - General Information
Company Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tax Map/Block Book Number
Name of Signing Official

First NameLast Name
Title of Signing Official
Phone Number of Signing Official
Please enter a valid phone number.Format: (000) 000-0000.
Email Address of Signing Official
example@example.com
YesNo
Name of Primary Contact Concerning Information Provided Herein

First NameLast Name
Title of Primary Contact
Phone Number of Primary Contact
Please enter a valid phone number.Format: (000) 000-0000.
Email Address of Primary Contact
example@example.com
Alternate Contact Concerning Information Provided Herein

First NameLast Name
Title of Alternate Contact
Phone Number of Alternate Contact
Please enter a valid phone number.Format: (000) 000-0000.
Email Address of Alternate Contact
example@example.com
PrimaryAlternate
Renewal of Existing Discharge PermitExisting Discharge Not Previously PermittedProposed Discharge
If proposed discharge, anticipated date of discharge commencement

MonthDayYear
Date
Note To Signing Official: In accordance with Title 40 of the Code of Federal Regulations Part 403 Section 403.14 and SCDES R61-9 Section 403.14, information and data provided in this questionnaire which identifies the nature and frequency of discharge shall be available to the public without restriction. Requests for confidential treatment of other information shall be governed by procedures specified in Section 6.4 of the Greer CPW Sewer Use and Pretreatment Ordinance and 40 CFR Part 2. Should a discharge permit be required for your facility, the information in this questionnaire will be used to issue the permit.

Signature Requirements

In accordance with 40 CFR 403.12 (l)(1) and SCDES R61-9 403.12 (l)(1), all reports required by an Industrial User Discharge Permit, Low Volume Discharger Letter of Acceptance or other applicable law or regulation shall include the certification statement as set forth in 40 CFR 403.6(a)(2)(ii) and SCDES R61-9 Section 403.6(a)(2)(ii), and shall be signed as follows:
1. By a responsible corporate officer, if the Industrial User submitting the reports required by paragraphs (b), (d), and (e) of 40 CFR 403.12 and SCDES R61-9 Section 403.12 is a corporation. For the purpose of this paragraph, 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 initiate and direct other comprehensive measures to assure long-term environmental compliance with environmental laws and regulations; can ensure that the necessary systems are established or actions taken to gather complete and accurate information for control mechanism requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.
2. By a general partner or proprietor if the Industrial User submitting the reports required by paragraphs (b), (d), and (e) of 40 CFR 403.12 and SCDES R61-9 Section 403.12 is a partnership, or sole proprietorship respectively.
3. By a duly authorized representative of the individual designated in paragraph (l)(1) or (l)(2) of 40 CFR 403.12 and SCDES R61-9 Section 403.12 if:
  1. The authorization is made in writing by the individual described in paragraph (l)(1) or (l)(2) of 40 CFR 403.12 and SCDES R61-9 Section 403.12 ;
  2. The authorization specifies either an individual or a position having responsibility for the overall operation of the facility from which the Industrial Discharge originates, such as the position of plant manager, operator of a well, or well field superintendent, or a position of equivalent responsibility, or having overall responsibility for environmental matters for the company; and
  3. written authorization is submitted to Greer CPW
4. If an authorization under paragraph (l)(3) of 40 CFR 403.12 and SCDES R61-9 Section 403.12 is no longer accurate because a different individual or position has responsibility for the overall operation of the facility, or overall responsibility for environmental matters for the company, a new authorization satisfying the requirements of paragraph (l)(3) of 40 CFR 403.12 and SCDES R61-9 Section 403.12 must be submitted to Greer CPW prior to or together with any reports to be signed by an authorized representative.
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.
Signature

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Title
Date

MonthDayYear
Date

SECTION B – PRODUCT OR SERVICE INFORMATION
1. If any process, production area, or wastestream in your facility is subject to National Categorical Pretreatment Standards, then please check the appropriate categories and complete the Compliance and Certification in the Attachment located at the end of the permit application.
Applicants must fill out the NAICS NO. for all of the following industrial categories or business activities which are a part of operations at their facility.
b. OTHER BUSINESS ACTIVITIES

If your facility is not covered under one of the National Categories listed above, please complete the following section:

SECTION B (Continued)
2. Give a brief narrative description of the primary manufacturing or service activity at the premise address and the applicable North American Industry Classification System (NAICS) No.:
3. Principal Raw Materials used, including any Process Chemicals (Please avoid trade names):
4. Principal Products Produced:
Note: Those users subject to production based National Categorical Pretreatment Standards must provide average and maximum quantities of raw materials or finished products, rate of production, and other pertinent information by process or product as needed for Greer CPW to establish limitations according to the applicable Pretreatment Standards.

SECTION D – WATER CONSUMPTION
Municipal Water ServicePrivate ContractPrivate WellCounty Water CompanySurface WaterOther
2. List name of water supplier(s):
3. List all water service account number(s):
4. Summarize most recent twelve months water usage from water bills:
a. 1st 6-month period
b. 2nd 6-month period
c. Average volume from other source(s):
Gallons per day
5. List water consumption and indicate whether the figure is estimated or measured. **Be sure to indicate Total Water Consumption**
Specify if you selected Other
6. List average water consumption for all processes itemized in Section B:

SECTION F – WASTEWATER DISCHARGES
1. Sewer Connection Information:
a. How many points of connection (or points of discharge) to the public sewer system does your facility have?
b. Provide a sketch (schematic) to show each connection relative to your facility. Indicate locations of any City water and discharge flow meter(s). Please identify street(s) and buildings in the sketch such that these connection point locations can be generally located in the field. Number each connection point in the sketch and indicate in the Table on the next page whether the wastewater at that point from your facility is domestic only or process only or combined. Label all process wastewater by classification. Use Categorical Pretreatment Standards category names as they apply. Attach a separate sheet for sketch if needed, or engineered print.

1 document and 10 MB Max Size
Cancelof
Note: Indicate type wastewater discharged at each connection to public sewer (e.g. Domestic Only, Process Only, Combined)
Total Discharge (gpd)
(Note: The Total Discharge should be consistent with theTotal of Discharges given in Section E, Question 2)
YesNo
If yes, indicate the location of the sampling or monitoring point(s) on the sketch on Page 11.
YesNo
a. Meter type and brand (e.g. ultrasonic / AZ Company)
b. Totalizer multiplier (e.g. 100X)
YesNo
c. Sampler pacing rate (if applicable)
gallons/pulse
d. Recorder brand
e. Recorder chart type (e.g. strip or circular; 1 day, 7 day, etc.)
f. Flow control device: Flume type (e.g. Parshall; Palmer-Bowlus)
f. Flow control device: Weir type (e.g. Rectangular; 45 degree V-notch)
g. Date of most recent calibration
h. Name of calibration service company
YesNoUnknown

SECTION I – COMPLIANCE AND CERTIFICATION
COMPLIANCE AND CERTIFICATION TO BE COMPLETED BY ALL USERS
SUBJECT TO NATIONAL CATEGORICAL PRETREATMENT STANDARDS

COMPLIANCE SCHEDULE [40 CFR 403.12(b)(7), 40 CFR 403.12(c), SC R61-9 403.12(b)(7) and R61-9 403.12(c)]

If additional pretreatment and/or Operation and Maintenance (O&M) will be required to meet the applicable pretreatment standards or alternative pretreatment standards as calculated by the combined wastestream formula, provide a compliance schedule which gives the shortest schedule which will provide such additional pretreatment or O&M. The completion date in this schedule shall not be later than the compliance date established for the applicable national categorical pretreatment standards.

The schedule shall contain increments of progress in the form of dates for the commencement and completion of major events leading to the construction and operation of additional pretreatment required for the Industrial User to meet the applicable categorical pretreatment standards (e.g. hiring an engineer, completing preliminary plans, completing final plans, executing contract for major components, commencing construction, completing construction, etc.).

No increment of progress shall exceed nine months.

Not later than 14 days following each date in the schedule and the final date for compliance, the Industrial User shall submit a progress report to Greer Commission of Public Works including, at a minimum, whether or not it complied with the increment of progress, if not, the reason for delay, and the steps being taken by the Industrial User to return the construction to the schedule established. In no event shall more than nine months elapse between such progress reports to Greer Commission of Public Works.

If a compliance schedule is needed, it is to be typed or printed on a separate sheet(s) and attached.

CERTIFICATION [40 CFR 403.12(d) and SC R61-9 403.12(d)]

Report on compliance with categorical pretreatment standard deadline. Within 90 days following the date for final compliance with applicable categorical pretreatment standards or in the case of a New Source following commencement of the introduction of wastewater into the Greer Commission of Public Works treatment works, any Industrial User subject to Pretreatment Standards and Requirements shall submit to Greer Commission of Public Works a report containing the information described in paragraphs (b) (4)–(6) of this section. For Industrial Users subject to equivalent mass or concentration limits established by Greer Commission of Public Works in accordance with the procedures in §403.6(c), this report shall contain a reasonable measure of the User's long term production rate. For all other Industrial Users subject to categorical pretreatment standards expressed in terms of allowable pollutant discharge per unit of production (or other measure of operation), this report shall include the User's actual production during the appropriate sampling period. For new source discharges, this certification shall be submitted within ninety (90) days of the initial discharge. For existing source discharges, this certification shall be submitted within ninety (90) days following the date for final compliance with applicable Categorical Pretreatment Standards.

CERTIFICATION [40 CFR 403.12 (b)(6) and SC R61-9 403.12(b)(6)]

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.
are being met on a consistent basisare not being met on a consistent basis
Signature

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Date

MonthDayYear
Date
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Industrial Wastewater Discharge Permit Application

Section A - General Information

SECTION B – PRODUCT OR SERVICE INFORMATION

SECTION B (Continued)

SECTION C – PLANT OPERATIONAL CHARACTERISTICS

SECTION D – WATER CONSUMPTION

SECTION E – WATER LOSSES

SECTION F – WASTEWATER DISCHARGES

SECTION G – WASTEWATER VOLUME, CHARACTERISTICS, PERMITTING, AND RESIDUALS INFORMATION

SECTION H – PRETREATMENT FACILITIES

SECTION I – COMPLIANCE AND CERTIFICATION