Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

United States 

Environmental Protection Agency 

Office of Water 

Washington, D.C. 

EPA Form 3510-2E 

Revised <INSERT DATE> 

Water Permits Division 

Application Form 2E 

Facilities That Do Not 

Discharge Process Wastewater 

NPDES Permitting Program 

NPDES Proposed Application Forms for Public Docket ID No. EPA-HQ-OW-2016-

0145 & Docket ID No. EPA-HQ-OW-2016-0146. 

This document is being distributed for comment purposes only. Comments and 

suggestions regarding this draft document should be submitted through electronic 

comments to http://www.regulations.gov. 

Note: Complete this form and Form 1 if your facility is a new or existing facility that discharges only 

nonprocess wastewater. 

 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Paperwork Reduction Act Notice 

The U.S. Environmental Protection Agency estimates the average burden to collect and complete 

Form 2E to be 14 hours. This 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 regarding 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 17th Street, Washington, DC 20503, marked 

“Attention: Desk Officer for EPA.” 

For Comment Only
2E-1 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Follow-up Requirements for New Dischargers

Note that no later than 18 months after commencement of 

discharge from the proposed facility, you must complete and 

submit Section 4 of this form. At that time you must test and report 

actual rather than estimated data for the pollutants or parameters 

listed, unless waived by the NPDES permitting authority. 

FORM 2E—INSTRUCTIONS 

General Instructions 

Who Must File Form 2E? 

Applicants who answered “yes” to Item 1.2.2 on Form 1 must 

complete Form 2E. This means that you are a new or existing 

facility (including manufacturing, commercial, mining, and 

silvicultural facilities) that discharges only nonprocess wastewater. 

Where to File Your Completed Form 

Submit your completed application package (Forms 1 and 2E) to 

your National Pollutant Discharge Elimination System (NPDES) 

permitting authority. Consult Exhibit 1–1 of the “General 

Instructions” section of Form 1 to determine your NPDES permitting 

authority. 

Public Availability of Submitted Information 

EPA will make information provided on the various (NPDES) permit 

application forms available to the public for inspection and copying 

upon request. No information on Form 2E (or related attachments) 

may be claimed 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 

2E. Note that NPDES permitting authorities will deny claims for 

treating any effluent data 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 at 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 Federal Registry 

Service, NPDES Permit Number, and facility name at the top of 

each page of Form 2E and any attachments. If you do not know 

your EPA Identification Number, contact your NPDES permitting 

authority. See Exhibit 1–1 of the “General Instructions” of Form 1 

for contact information.

Do not leave any response area blank unless the form directs you 

to skip the item. 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 demonstrate 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 

Definitions of all significant terms used in these Instructions and 

Form 2E are in the “Glossary”, which follows the “General 

Instructions” in Form 1. 

Line-By-Line Instructions 

If you have multiple outfalls, you must submit a separate Form 2E 

for each (Sections 1, 3, and 4 only).

Section 1. Outfall Location 

Item 1.1. Complete sections 1 through 6 for each outfall. Provide 

the latitude and longitude to the nearest second for the outfall. The 

location of each outfall (i.e., where the coordinates are collected) 

shall be the point where the discharge is released into a water of 

the United States. Provide associated metadata in the subsequent 

columns of the table. In the column marked “Collection Method 

Information,” indicate the following: (a) horizontal collection method, 

which is the type of method/device used to identify the coordinates 

(e.g., global positioning system or GPS device, census block 

centroid, an address, State Plane Coordinate System or SPCS, 

etc.); (b) the scale of your source map or photo if applicable (e.g., 

the proportional distance on the ground for one unit of measure 

typically expressed in ratio form such as 1:24,000); and (c) the 

horizontal reference datum (i.e., the coordinate reference system) 

to which your coordinates relate. 

GPS devices are commonly used to electronically record the 

latitude and longitude coordinates of a property. It is also possible 

to use geographic information systems (e.g., ArcView), online 

sources (e.g., Terra Server or Google Earth), or paper maps from 

trusted sources (e.g., U.S. Geological Survey or USGS) to identify 

coordinates. The online services require that you enter a property 

address, the nearest intersection, or zip code. The system then 

generates the coordinates. The horizontal collection method for 

such sources is “Interpolation—Satellite.” You would not report a 

source map scale if you used a GPS device or one of the online 

systems. For the horizontal reference datum, you would report one 

of the following three options: 

1. North American Datum of 1927 (NAD27): This datum was 

based on the ground survey in Europe and North America in the 

19th century. NAD27 was the standard for many years because 

the USGS published its topographic maps in this datum. If you 

are reporting a location using a USGS 7.5-minute map, NAD27 

is your default datum. 

For Comment Only
2E-2 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2E—INSTRUCTIONS CONTINUED

2. North American Datum of 1983 (NAD83): NAD83 updated 

NAD27 with current measurements using radio astronomy and 

satellite observations. When the USGS began publishing digital 

data, the NAD83 was used, which provided a more accurate 

representation of the earth’s shape and a more accurate 

depiction of the location of objects on the earth. 

3. World Geodetic System of 1984 (WGS84): This datum was 

developed from the measurements calculated in NAD83. If you 

used a GPS to calculate your latitude/longitude coordinates, 

WGS84 is the default datum. 

If you need further guidance in responding to Item 1.1, refer to 

http://www.epa.gov/geospatial/latitudelongitude-data-standard. 

Section 2. Discharge Date 

Item 2.1. Indicate whether you are a new or an existing discharger. 

If you are an existing discharger, skip to Section 3 after completing 

this item. 

Item 2.2. Indicate the date on which the facility will or is estimated 

to commence discharge.

Section 3. Waste Types 

Item 3.1. Indicate the general type(s) of wastes being discharged or 

to be discharged, depending on whether you are an existing or new 

discharger. If you mark the response “Other Nonprocess 

Wastewater,” specify the nature of your discharge. 

Item 3.2. Indicate if the facility uses cooling water additives. If “yes,” 

continue. If “no,” skip to Section 4. 

Item 3.3. List the cooling water additives being used (or to be used) 

and specify the composition of the additives, if such information is 

available to you. You can generally find composition information on 

product labels or from manufacturers’ data sheets. 

Section 4. Effluent Characteristics

Items 4.1 to 4.8. These items require you to collect and report data 

for the parameters and pollutants listed in Section 4. The 

instructions are distinct for applicants with existing discharges 

versus applicants that are new. 

IMPORTANT NOTE: Read the “General Instructions for Reporting, 

Sampling, and Analysis” on pages 2E-4 and 2E-5 before 

completing Section 4. 

Item 4.1. Indicate whether you have completed monitoring for all 

parameters in the table under Item 4.2 and attached it to the 

application package. If you answer “no” because you have 

requested a waiver from your NPDES authority, skip to Section 5. If 

“yes,” continue to Item 4.2. 

Item 4.2. Provide the sampling data requested in the table per the 

“General Instructions for Reporting, Sampling, and Analysis” for 

biochemical oxygen demand (BOD), total suspended solids (TSS), 

oil and grease, and ammonia (as N). 

Item 4.3. Answer whether you believe fecal coliform to be present 

in your discharge or whether sanitary waste is discharged (or will be 

discharged). If you answer “no,” skip to Item 4.5. Otherwise, 

continue to Item 4.4. 

Item 4.4. Provide the sampling data requested in the table per the 

“General Instructions for Reporting, Sampling, and Analysis” for 

fecal coliform, Escherichia coli (E. coli), and Enterococci. 

Item 4.5. Indicate whether chlorine is used (or will be used). If “no,” 

skip to Item 4.7. Otherwise, continue to Item 4.6. 

Item 4.6. Provide the sampling data requested in the table per the 

“General Instructions for Reporting, Sampling, and Analysis” for 

total residual chlorine. 

Item 4.7. Answer whether non-contact cooling water is (or will be) 

discharged from your facility? If “no,” skip to Section 5. If “yes,” 

continue to Item 4.8. 

Item 4.8. Provide the sampling data requested in the table per the 

“General Instructions for Reporting, Sampling, and Analysis” for 

chemical oxygen demand (COD), total organic carbon (TOC), flow, 

pH, and temperature (winter and summer). 

Section 5. Flow 

Item 5.1. Indicate whether any of the discharges that you described 

in Sections 1 and 3 (except for stormwater runoff, leaks, or spills) 

are intermittent or seasonal. If “yes”, continue to Item 5.2. If “no”, 

skip to Section 6. 

Item 5.2. Describe the average frequency of flow and duration of 

any intermittent or seasonal discharge (except for stormwater 

runoff, leaks, or spills) in gallons or million gallons per day (gpd or 

mgd), whichever is appropriate. The frequency of flow means the 

number of days or months per year there is an intermittent 

discharge. Duration means the number of days or hours per 

discharge. For new dischargers, report your best estimate. 

Section 6. Treatment System 

Briefly describe any treatment system(s) used (or to be used for 

new dischargers), indicating whether the treatment system is 

physical, chemical, biological, sludge and disposal, or other. Also 

give the particular type(s) of process(es) used (or to be used). For 

example, if a physical treatment system is used (or will be used), 

specify the processes applied (or to be applied), such as grit 

removal, ammonia stripping, dialysis, etc. 

Section 7. Other Information 

Item 7.1. OPTIONAL ITEM. Report any additional information or 

data (such as sampling results) that you believe the NPDES 

permitting authority should consider when establishing permit 

limitations. If you wish to demonstrate your eligibility for a “net” 

effluent limitation (i.e., an effluent limitation adjusted to provide 

credit for the pollutant(s) present in your intake water) add a short 

statement as to why you believe you are eligible. See also 40 CFR 

122.45(g). You will be contacted by the NPDES permitting authority 

with further instructions.

For Comment Only
2E-3 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2E—INSTRUCTIONS CONTINUED 

Section 8. Certification Statement

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 REQUIRE THIS APPLICATION TO 

BE SIGNED AS FOLLOWS: 

A. By a responsible corporate officer. For the purpose of this 

section, a responsible corporate officer means: (i) 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 

(ii) 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 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: (i) The chief executive officer of the 

agency, or (ii) 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 Forms 1 and 2E (and all other 

applicable forms and attachments) to your NPDES 

permitting authority. 

For Comment Only
2E-4 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

General Instructions for Reporting, Sampling, and Analysis 

IMPORTANT NOTICE: Read these instructions prior to Section 4 of 

Form 2E. 

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 page of any associated attachments. 

You may report some or all of the required data by attaching 

separate sheets of paper instead of completing Section 4 for each 

of your outfalls so long as the sheets contain all of the required 

information and are similar in format to Section 4. 

Reporting of Effluent Data 

Report pollutant levels for all pollutants in Section 4 as 

concentration and total mass, with the exception of flow, pH, and 

temperature. Total mass is the total weight of pollutants 

discharged over a day. 

Flow, temperature, pH, and fecal coliform organisms must be 

reported as mgd, degrees Celsius (°C), standard units, and most 

probable number per 100 milliliters (MPN/100 mL), respectively. 

Use the following abbreviations in the columns requiring “units” in 

Section 4. 

Concentration Mass 

ppm = parts per million lbs = pounds 

mg/L = milligrams per liter ton = Tons (English tons) 

ppb = parts per billion mg = milligrams 

μg/L = micrograms per liter g = grams 

MPN = most probable number kg = kilograms 

per 100 milliliters T = tonnes (metric tons)

Existing Dischargers 

You are required to provide at least one analysis for each 

parameter or pollutant, including the following: BOD, TSS, oil and 

grease, ammonia (as N), fecal coliform including E. coli and 

Enterococci (if believed present or if sanitary waste is or will be 

discharged), total residual chlorine (if chlorine is or will be used), 

COD, and TOC (if noncontact cooling water is or will be 

discharged), discharge flow, pH, and temperature (winter and 

summer). 

You may report quantitative data that you have collected over the 

past 365 days if they are representative of your current operations. 

The data reported must include maximum daily discharge, average 

daily discharge, and number of analyses. Most existing facilities 

routinely monitor the pollutants and parameters listed in Section 4 

as part of their existing NPDES permit requirements. 

You must collect and analyze samples in accordance with 40 CFR 

Part 136. Grab samples must be used for analyses of pH, 

temperature, total residual chlorine, oil and grease, fecal coliform 

(including E. coli), and Enterococci (previously known as fecal 

streptococcus) and volatile organic compounds. Twenty-four (24) 

hour composite samples must be used for all other pollutants, using 

a minimum of four (4) grab samples unless otherwise specified at 

40 CFR Part 136. For a composite sample, only one analysis of the 

composite of aliquots is required. 

If you have sampling and analysis questions, direct them to your 

NPDES permitting authority. The authority may request that you do 

additional testing, if appropriate, on a case-by-case basis under 

CWA Section 308. 

New Dischargers 

Applicants are required to provide maximum daily and average 

daily discharge estimates for the parameters or pollutants listed in 

Section 4, unless specifically indicated on the form. Note that if you 

have the results of actual analyses for the listed parameters or 

pollutants, you are required to report those results rather than 

submit estimates. 

Report or estimate all parameter or pollutant levels as concentration 

and as total mass, except for flow, pH, and temperature. Indicate 

the source of all estimates in the appropriate column in the 

Section 4 tables using the engineering study codes below. Note 

that you are required to conduct follow-up testing and reporting no 

later than two years once your facility commences discharge. 

Engineering Study Codes 

Actual data from pilot plants ................................... 1 

Estimates from other engineering studies ............. 2 

Data from other similar plants ................................ 3 

Best professional estimates ................................... 4 

Others ..........................................specify on the form

Base your determination of whether a pollutant will be present in 

your discharge on your knowledge of the proposed facility’s use of 

maintenance chemicals and any analyses of your effluent or of any 

similar effluent. You may also provide the estimates based on 

available in-house or contractor engineering reports or any other 

studies performed on the proposed facility. 

Pollutants Solely in Intake Water 

If you expect a pollutant to be present solely because of its 

presence in your intake water, you must still provide an estimate or 

analytical result in Section 4; however, you should indicate in 

Section 7 in Item 7.1 that you believe the pollutant or parameter to 

be present only due to its presence in your source water. See 

Instructions under Item 7.1. 

Testing Waivers 

The NPDES permitting authority may waive the testing and 

reporting requirements for flow or any of the pollutants listed in 

Section 4 if the applicant submits a written request for such a 

waiver before or with his application. Contact your NPDES 

permitting authority for further information. 

Sampling: The collection of samples for the reported analyses 

should be supervised by a person experienced in performing 

sampling of industrial wastewater. 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 contained in the 

For Comment Only
2E-5 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

General Instructions for Reporting, Sampling, and Analysis Continued

applicable analytical methods must be followed, including factors 

related to sample containers, sample preservation, holding times, 

and the collection of duplicate samples. 

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. Samples should be 

collected 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. 

Analysis 

Except as specified below, all required quantitative data shall be 

collected in accordance with sufficiently sensitive analytical 

methods approved under 40 CFR part 136 or required under 

40 CFR chapter I, subchapter N or O. A method is “sufficiently 

sensitive” when: 

(1) The method minimum level (ML) is at or below the level of the 

applicable water quality criterion for the measured pollutant or 

pollutant parameter. 

(2) 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.

(3) The method has the lowest ML of the analytical methods 

approved under 40 CFR part 136 or required under 40 CFR 

chapter I, subchapter N or O for the measured pollutant or pollutant 

parameter. 

Consistent with 40 CFR part 136, you may provide matrix or sample 

specific MLs rather than the published levels. Further, where you 

can demonstrate that, despite a good faith effort to use a method 

that would otherwise meet the definition of “sufficiently sensitive”, 

the analytical results are not consistent with the quality assurance 

(QA) / quality control (QC) specifications for that method, then the 

NPDES permitting authority may determine that the method is not 

performing adequately and the NPDES permitting authority should 

select a different method from the remaining EPA-approved 

methods that is sufficiently sensitive consistent with 40 CFR 

122.21(e)(3)(i). Where no other EPA-approved methods exist, you 

must select a method consistent with 40 CFR 122.21(e)(3)(ii). 

When there is no analytical method that has been approved under 

40 CFR part 136, required under 40 CFR chapter I, subchapter N or 

O, and is not otherwise required by the NPDES permitting authority, 

you may use any suitable method but shall provide a description of 

the method. When selecting a suitable method, other factors such 

as a method’s precision, accuracy, or resolution, may be 

considered when assessing the performance of the method. 

For Comment Only
EPA Form 3510-2E (revised <INSERT DATE>) Page 1 

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE>

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 

2E 

NPDES 

U.S. Environmental Protection Agency 

Application for NPDES Permit to Discharge Wastewater 

FACILITIES THAT DO NOT DISCHARGE PROCESS WASTEWATER

SECTION 1. OUTFALL LOCATION (40 CFR 122.21(h)(1)) Outfall Location 

1.1 Provide information on each of the facility’s outfalls in the table below. 

Outfall 

Number Receiving Water Name Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Collection Method Information 

Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable

Horizontal Reference Datum

(Coordinate reference system)

 NAD 27  NAD 83  WGS85  Other (specify)

Outfall 

Number Receiving Water Name Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Collection Method Information 

Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable

Horizontal Reference Datum

(Coordinate reference system)

 NAD 27  NAD 83  WGS85  Other (specify)

Outfall 

Number Receiving Water Name Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Collection Method Information 

Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable

Horizontal Reference Datum

(Coordinate reference system)

 NAD 27  NAD 83  WGS85  Other (specify)

SECTION 2. DISCHARGE DATE (40 CFR 122.21(h)(2)) Discharge Date 

2.1 Are you a new or existing discharger? (Check only one response.)

 New Discharger  Existing Discharger  SKIP to Section 3. 

2.2 Specify your anticipated discharge date:

SECTION 3. WASTE TYPES (40 CFR 122.21(h)(3)) Waste Types

3.1 What types of wastes are currently being discharged if you are an existing discharger or will be discharged if you are a 

new discharger? (Check all that apply.) 

 Sanitary Wastes  Other Nonprocess Wastewater (Describe / explain 

directly below.)  Restaurant or Cafeteria Waste 

 Noncontact Cooling Water 

3.2 Does the facility use cooling water additives? 

 Yes  No  SKIP to Section 4. 

For Comment Only
EPA Form 3510-2E (revised <INSERT DATE>) Page 2 

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE>

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Waste Types 

Continued 

3.3 List the cooling water additives used and describe their composition. 

Cooling Water Additives 

(list) 

Composition of Additives 

(if available to you)

SECTION 4. EFFLUENT CHARACTERISTICS (40 CFR 122.21(h)(4)) Effluent Characteristics

4.1 Have you completed monitoring for all parameters in the table below at each of your outfalls and attached the results to 

this application package?

 Yes  No; A waiver has been requested from my NPDES permitting authority 

(Attach waiver request and additional information).  SKIP to Section 5. 

4.2 Provide data as requested in the table below1. (See Instructions for specifics.) 

Parameter or Pollutant 

Number of 

Analyses 

(if actual data 

reported)

Maximum Daily 

Discharge 

(specify units) 

Average Daily 

Discharge 

(specify units)

Source 

(Use codes 

per 

Mass Conc. Mass Conc. Instructions.) 

 Biochemical Oxygen Demand (BOD5

) 

 Total Suspended Solids (TSS) 

 Oil and Grease 

 Ammonia (as N) 

4.3 Is fecal coliform believed present, or is sanitary waste discharged (or will it be discharged)? 

 Yes  No  SKIP to Item 4.5. 

4.4 Provide data as requested in the table below1. (See Instructions for specifics.) 

Parameter or Pollutant 

Number of 

Analyses 

(if actual data 

reported)

Maximum Daily 

Discharge 

(specify units) 

Average Daily 

Discharge 

(specify units)

Source 

(Use codes 

per 

Mass Conc. Mass Conc. Instructions.) 

 Fecal Coliform 

E. Coli 

Enterococci 

4.5 Is chlorine used (or will it be used)? 

 Yes  No  SKIP to Item 4.7. 

4.6 Provide data as requested in the table below1. (See Instructions for specifics.) 

Parameter or Pollutant 

Number of 

Analyses 

(if actual data 

reported)

Maximum Daily 

Discharge 

(specify units) 

Average Daily 

Discharge 

(specify units)

Source 

(Use codes 

per 

Mass Conc. Mass Conc. Instructions.) 

 Total Residual Chlorine 

4.7 Is non-contact cooling water discharged (or will it be discharged)?

 Yes  No  SKIP to Section 5. 

4.8 Provide data as requested in the table below1. (See Instructions for specifics.) 

Parameter or Pollutant 

Number of 

Analyses 

(if actual data 

reported)

Maximum Daily 

Discharge 

(specify units) 

Average Daily 

Discharge 

(specify units)

Source 

(Use codes 

per 

Mass Conc. Mass Conc. Instructions.) 

Chemical Oxygen Demand (COD) 

Total Organic Carbon (TOC)

Discharge Flow 

pH (report as range) 

Temperature (winter) 

Temperature (summer) 1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136 for the analysis of pollutants or pollutant 

parameters or required under 40 CFR chapter I, subchapter N or O. See Instructions and 40 CFR 122.21(e)(3). 

For Comment Only
EPA Form 3510-2E (revised <INSERT DATE>) Page 3 

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE>

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

SECTION 5. FLOW (40 CFR 122.21(h)(5)) Flow 

5.1 Except for stormwater water runoff, leaks, or spills, are any of the discharges you described in Sections 1 and 3 of this 

application intermittent or seasonal?

 Yes  Complete this section.  No  SKIP to Section 6. 

5.2 Briefly describe the frequency and duration of flow. 

SECTION 6. TREATMENT SYSTEM (40 CFR 122.21(h)(6)) Treatment System

6.1 Briefly describe any treatment system(s) used (or to be used). 

SECTION 7. OTHER INFORMATION (40 CFR 122.21(h)(7)) Other Information 

7.1 Use the space below to expand upon any of the above items. Use this space to provide any information you believe the 

reviewer should consider in establishing permit limitations. Attach additional sheets as needed. 

SECTION 8. CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d)) 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 (first and last) Official Title 

 

Signature Date Signed 

 

For Comment Only