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United States Environmental Protection Agency Office of Water Washington, D.C. EPA Form 3510-2S Revised <INSERT DATE>



### Water Permits Division 

# Application Form 2S Sewage Sludge Management
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 fo r comment purposes only. Comments and suggestions regarding this draft document should be submitted through electronic comments to http://www.regulations.gov.

Note: Complete Form 2S if you are a new or exis ting treatment works treating domestic sewage.

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### Paperwork Reduction Act Notice

The U.S. Environmental Protecti on Agency estimates the average burden to collect and complete Form 2S to be 8.7 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 estim ate 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 17 th 

### Street, NW, Washington, DC 20503, marked “Attention: Desk Officer for EPA.”2S-3 

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FORM 2S—GENERAL INSTRUCTIONS Who Must Complete Form 2S? A person must complete Form 2S to apply for a National Pollutant Discharge Elimination System (NPDES) permit covering sewage sludge (biosolids) use or disposal standards if they own or operate a treatment works treating domestic sewage (TWTDS). A person is an owner or operator of a TWTDS if the facility generates, changes the quality of, or provides final disposition of solids, practices for which are ultimately subject to Part 503 of Title 40 of the Code of Federal Regulations (CFR). 1

The TWTDS that are required to apply for an NPDES permit include the following:

 All generators of sewage sludge that are regulated by 40 CFR Part 503 (i.e., it is applied to the land, placed on a surface disposal site, fired in a sew age sludge incinerator, or placed in a municipal solid waste landfill unit).

 Industrial facilities that separately treat domestic sewage and generate sewage sludge that are regulated by 40 CFR Part 503.

 All surface disposal site owners/operators.

 All sewage sludge inciner ator owners/operators.

 Any person (e.g., individual, corporation, or government entity) who changes the quality of sewage sludge regulated by 40 CFR Part 503 (e.g., sewage sludge blenders or
processors. 2 )

 Any other person or facility designated by the NPDES permitting authority as a TWTDS.
TWTDS and other persons that may be required to apply for an NPDES permit 3 include the following:

 Sewage sludge land appliers, hauler s, persons who store, or transporters who do not generate or do not change the quality of the sewage sludge.

 Landowners of property on which sewage sludge are applied.

 Domestic septage pumpers/haulers/treaters/appliers.

 Sewage sludge packagers/baggers that do not change the quality of the sewage sludge. If any of the above TWTDS categories are owned and operated by different persons/entities, it is the operator’s duty to obtain the NPDES permit.

Notes

1 The U.S. Environmental Pr otection Agency (EPA) develope d regulations in 1993 as required by the Clean Water Act (CWA ) Amendments of 1987 to protect public health and the environment from any reas onably anticipated adverse effects of pollutants that might be present in se wage sludge biosolids. The regulation, The Standards for the Use or Disposal of Sewage Sludge (40 CFR Part 503) was published in the Federal Register (FR) on February 19, 1993 (58 CFR 9248 to 9404) and became effective March 22, 1993. The regul ations are often referred to as “the Part 503 rule” or “Part 503.”

2 If all the sewage sludge received by a sewage sludge blender or composter are of exceptional quality (EQ) per 40 CFR Part 503, then no per mit will be required for the person who receives or processes the EQ sludge.

3 The NPDES permitting authority may req uest permit applications from these facilities when necessary to protect public health and the environment from reasonably anticipated effects of pollutant s that may be present in sewage sludge. If you are a TWTDS and discharge wastewater to surface water, you must also complete NPDES application Form 2A.

Part 503 defines sewage sludge as a solid, semi-solid, or liquid residue generated during the treatment of domestic sewage in a treatment works. Sewage sludge includes scum or solids removed in primary, secondary, or advanced wastewater treatment processes and any material derived from sewage sludge (e.g., a blended sewage sludge/fertilizer product) but does not include grit and screenings or ash generated by the firing of sewage sludge in an incinerator.
Part 503 considers domestic septage as sewage sludge and sets separate requirements for domestic septage applied to agricultural land, forests, or reclamation sites. Domestic septage is defined as a liquid or solid material removed from a septic tank, cesspool, portable toilet, Type III marine sanitation device, or similar system that receives only domestic sewage. The Part 503 definition of domestic septage excludes grease-trap pumpings and commercial or industrial waste.
At the state level, either EPA or an approved state agency operates 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 2S. 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. Often states develop their own application forms rather than use the federal forms. See http://www.epa.gov/npdes/npdes-stateprogram-information for a list of states that have approved NPDES permit programs and those that do not.

Exhibit 2S

– 1 (see end of this section) provides contact information for each of EPA’s 10 regional offices. Since the content of Exhibit 2S

– 1 is subject to change, consult EPA’s website for the latest information: http://www.epa.gov/aboutepa#regional

. Where to File Your Completed Form

 If you are in a jurisdiction with an approved state sewage sludge NPDES permit program, file according to the instructions on the state forms.

 If you are in a jurisdiction where EPA is the sewage sludge NPDES permitting authority (i.e., the state is not a sewage sludge authorized state), mail the completed application forms to the EPA regional office that covers the state in which your facility is located (see Exhibit 2S

– 1).

 To determine where to send your completed Form 2S, pleasevisit: http://www.epa.gov/biosolids/forms/contact-us-aboutbiosolids.
When to File Your Completed Form
A TWTDS with a currently effective NPDES permit must submit a permit application at the time of its next NPDES permit renewal application. Any other TWTDS must submit the information in Part 1 of Form 2S within 1 year after publication of a standard applicable to its sewage sludge or disposal practice(s). The NPDES permitting authority will determine when such TWTDS must submit a full permit application. The NPDES permitting authority may require2S-4 

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FORM 2S—GENERAL INSTRUCTIONS CONTINUED permit applications from a TWTDS at any time if the authority determines that a permit is necessary to protect public health and the environment from any potential adverse effects that may occur from toxic pollutants in sewage sludge. Any TWTDS that commences operations after promulgation of an applicable “standard for sewage sludge use or disposal” must submit an application to the NPDES permitting authority at least 180 days prior to the date proposed for commencing operations.

Fees
EPA does not require applicants to pay a fee for applying for NPDES permits. However, states that administer the NPDES programs may charge fees. Consult wi th state officials for further information.
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. You may not claim any information on Form 2S (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 2S. Note that NPDES authorities will deny claims for treating any biosolids 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 Identificati on Number from the Federal Registry Service, NPDES Permit Number, and facility name at the top of each page of Form 2S 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 Permit Number. If you do not know your EPA Identification Number, contact your NPDES permitting authority. See Exhibit 2S

– 1 for contact information. Do not leave any response areas 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 show that you considered the item and determined a response was not necessary for your facility.
Upon request of the NPDES permitting authority, you must submit any other information necessary to assess sewage sludge use or disposal practices at your facili ty or identify appropriate permitting requirements.
The NPDES permitting authority w ill 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.
Which Parts of the Form Apply
Form 2S is presented in a modular format, enabling information collection to be tailored to your facility’s sewage sludge generation, treatment, use, or disposal practices. The form specifies which parts must be filled out for each type of applicant.
Part 1 requests a limited amount of information from ‘‘sludge-only’’ facilities (facilities without a current ly effective NPDES permit) that are not directed by the permitting authority to submit a full permit application at this time. It is intended to allow the permitting authority to identify these facilities, track sewage sludge use and disposal, and establish priorities for permitting.
Part 2 of Form 2S is for facilities that are submitting a full NPDES permit application. See Exhibit 2S-2, located at the end of these General Instructions, to determine which sections of Part 2 cover your facility’s sewage sludge use or disposal practices.
Complete the Preliminary Information section on page 1 of Form 2S by indicating whether your facility has an effective NPDES permit or you have been directed by your NPDES permitting authority to submit a full Form 2S permit application. If “yes”, skip Part 1 and complete Part 2 of the application package (see Part 2 Line-By-Line Instructions). If “no”, only complete Part 1 of the application package.

Definitions
Definitions of all significant te rms used in these Instructions and Form 2S are in the “Glossary” located at the end of these Instructions.

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FORM 2S—GENERAL INSTRUCTIONS CONTINUED

Exhibit 2S–1. Addresses of EPA Regional Contacts and Covered States

REGION 1 U.S. Environmental Prot ection Agency, Region 1 5 Post Office Square, Suite 100, Boston, MA 02109-3912 Phone: (617) 918-1111, Fax: (617) 918-0101, Toll fr ee within Region 1: (888) 372-7341 Website: http://www.epa.gov/aboutepa/ epa-region-1-new-england Covered States: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont REGION 6 U.S. Environmental Prot ection Agency, Region 6 1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733 Phone: (214) 665-2200, Fax: (214) 665-7113, Toll fr ee within Region 6: (800) 887-6063 Website: http://www.epa.gov/aboutepa/epa -region-6-south-central Covered States: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas

REGION 2 U.S. Environmental Prot ection Agency, Region 2 290 Broadway, New York, NY 10007-1866 Phone: (212) 637-3000, Fax: (212) 637-3526, Toll fr ee within Region 2: (877) 251-4575 Website: http://www.epa.gov/aboutepa/epa-region-2 Covered States: New Jersey, New York, Virgin Islands, and Puerto Rico REGION 7 U.S. Environmental Prot ection Agency, Region 7 11201 Renner Boulevard, Lenexa, KS 66219 Phone: (913) 551-7003, Toll free: (800) 223-0425 Website: http://www.epa.gov/aboutepa/epa-region-7-midwest Covered States: Iowa, Kansas, Missouri, and Nebraska

REGION 3 U.S. Environmental Prot ection Agency, Region 3 1650 Arch Street, Ph iladelphia, PA 19103-2029 Phone: (215) 814-5000, Fax: (215) 814-5103, To ll free: (800) 438-2474 Website: http://www.epa.gov/aboutepa/e pa-region-3-mid-atlantic Covered States: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia REGION 8 U.S. Environmental Prot ection Agency, Region 8 1595 Wynkoop Street, Denver, CO 80202-1129 Phone: (303) 312-6312, Fax: (303) 312-6339, To ll free: (800) 227-8917 Website: http://www.epa.gov/aboutepa/epa-r egion-8-mountai ns-and-plains Covered States: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

REGION 4 U.S. Environmental Prot ection Agency, Region 4 Sam Nunn Atlanta Federal Center 61 Forsyth Street, SW, Atlanta, GA 30303-8960 Phone: (404) 562-9900, Fax: (404) 562-8174, To ll free: (800) 241-1754 Website: http://www.epa.gov/aboutepa/a bout-epa-region-4-southeast Covered States: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee REGION 9 U.S. Environmental Prot ection Agency, Region 9 75 Hawthorne Street, San Francisco, CA 94105 Phone: (415) 947-8000, Fax: (415) 947-3553, Toll fr ee within Region 9: (866) EPA-WEST Website: http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest Covered States: Arizona, California, Ha waii, Nevada, Guam, American Samoa, and Trust Territories

REGION 5 U.S. Environmental Prot ection Agency, Region 5 77 West Jackson Boulevard, Chicago, IL 60604-3507 Phone: (312) 353-2000, Fax: (312) 353-4135, Toll fr ee within Region 5: (800) 621-8431 Website: http://www.epa.gov/aboutepa/epa-region-5 Covered States: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. REGION 10 U.S. Environmental Prot ection Agency, Region 10 1200 Sixth Avenue, Suite 900, Seattle, WA 98101 Phone: (206) 553-1200, Fax: (206) 553-2955, To ll free: (800) 424-4372 Website: http://www.epa.gov/aboutepa/epa -region-10-pacific-northwest Covered States: Alaska, Idaho, Oregon, and Washington2S-6 

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FORM 2S—GENERAL INSTRUCTIONS CONTINUED

Exhibit 2S–2. Part 2 Sections to Complete

Activity(ies) Performed Part 2 Sections to Complete
1 2 3 4 5GENERAL INFORMATIONGENERATION OFSEWAGE SLUDGE ORPREPARATION OF AMATERIAL DERIVEDFROM SEWAGE SLUDGELAND APPLICATION OFBULK SEWAGE SLUDGESURFACE DISPOSALINCINERATION

Generates sewage sludge or derives material from sewage sludge that: Meets ceiling concentrations in Table 1 of 40 CFR 503.13, pollutant concentrations in Table 3 of Section 503.13, Class A pathogen requirements in Section 503.32, and one of the eight vector attraction reduction options in 40 CFR 503.33(b)(1)-(8). Is sold or given away in bag or other container for application to the land [and not already addressed in Item 2.4] Is shipped off-site for treatment or blending Is placed on a surface disposal site
Is fired in an incinerator Is sent to a municipal solid waste landfill  

Generates sewage sludge or derives material from sewage sludge that is applied to the land in bulk form   

Applies bulk sewage sludge to land or generates sewage sludge that is applied to the land by others  

Owns or operates a surface disposal site   Owns or operates a sewage sludge incinerator  2S-7 

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FORM 2S—PART 1 LINE-BY-LINE INSTRUCTIONS Part 1 – Limited Background Information
Complete Part 1 if your facility is a “sludge-only” facility (i.e., a facility that does not currently have, and is not applying for, an NPDES permit for a direct discharge to a surface body of water).
Section 1. Facility Information

Item 1.1. Enter the facility’s official or legal name. Do not use a colloquial name. Provide the mailing address of the facility. Next, give the name (first and last), title, work telephone number, and electronic mail (email) address of the person who is thoroughly familiar with the operation of the facility and with the facts reported in this application.
Include a complete location address for the facility if different from the mailing address. If the facility or site 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”).
Provide the latitude and longitude to the nearest second for the facility. Provide the associated metadata in the subsequent columns of the table. In the column marked “Reference Point,” indicate where the coordinates were collected (e.g., from the main entrance of the facility or the center of the facility). 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 inte rsection, 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 19 th 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.

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.

Item 1.2. Indicate the legal status of the owner 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) gov ernment, tribal government, school district, water district, or other local government entity, check the box for “Public—Other) 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 previously listed, check the box for “Other” and specify the type of entity.
Section 2. Applicant Information

Item 2.1. Indicate if the applicant is different from the entity listed under Item 1.1. If “yes,” continue to Item 2.2. If “no,” skip to Item 2.3 (Part 1, Section 2).

Item 2.2. Enter the applicant’s name and mailing address. Provide the name (first and last), title, work telephone number, and email address of the contact person for the applicant.

Item 2.3. Indicate if the applicant is the facility’s owner, operator, or both.

Item 2.4. Specify whether the NPDES permitting authority should send correspondence to the facility or the applicant.
Section 3. Sewage Sludge Amount

Item 3.1. Provide the total dry metric tons of sewage sludge generated, treated, used (i.e., received from off-site), and disposed over the last 365-day period.

Section 4. Pollutant Concentrations

Item 4.1. Provide the most recent sewage sludge monitoring data available on the quality of the sewage sludge, including for pollutants for which limits in sewage sludge have been established in 40 CFR Part 503 for your facility’s expected us e or disposal practices. Provide the average monthly concentration in milligrams per kilogram (mg/kg) dry weight, analytical method, and detection level. If available, base data on three or more samples taken at least 1 month apart, that are no more than 4.5 years old. If providing the monitoring data in a separate attachment, check the box to indicate that this information has been attached to the application package.
Section 5. Treatment Provided at Your Facility

Item 5.1. In the “Use or Disposal Practice” column, check the sewage sludge use or disposal practice used at your facility. In the following columns, indicate the amount of sewage sludge used or disposed,2S-8 

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FORM 2S—PART 1 LINE-BY-LINE INSTRUCTIONS CONTINUED pathogen class and reduction alternative, and the vector attraction reduction option associated with the practice. To determine the applicable pathogen class and reduction alternative, see 40 CFR 503.32. To determine the applicable vector attraction reduction option, see 40 CFR 503.33. Vector attraction reduction options 1 through 8 are typically met at the point where sewage sludge is generated or where a material is derived from sewage sludge, and options 9 through 11 are typically met at the point of use or disposal. Complete Item 5.1 for each sewage sludge use or disposal practice by attaching additional sheets, as necessary.

Item 5.2. For each use or disposal practice indicated in Item 5.1, identify the treatment process(es) used at your facility to reduce pathogens or vector attraction properties in sewage sludge. If you check “Other”, specify the treatment process(es) in the space provided or in a separate attachment.
Section 6. Sewage Sludge Sent to Other Facilities

Item 6.1 Indicate whether or not the sewage sludge meets ceiling concentrations in Table 1 of 40 CFR 503.13, pollutant concentrations in Table 3 of 40 CFR 53.13, Class A pathogen reduction requirements at 40 CFR 503.32(a), and one of the vector attraction reduction requirements at 40 CFR 503.33(b)(1)- (8). If “yes,” skip to Item 8.1 (Part 1, Section 8). If “no,” continue to Item 6.2.

Item 6.2. Indicate whether sewage sludge from your facility is provided to another facility for treatment, distribution or disposal. If “yes” continue to Item 6.3. If “no” skip to Item 7.1 (Part 1, Section 7).

Item 6.3. Enter the name and mailing address of the receiving facility. Provide the name (first and last), title, work telephone number, and email address of the contact person for the receiving facility.

Item 6.4. Indicate the activities provided by the receiving facility. If you check “Other”, provide a description in the space provided or in a separate attachment.
Section 7. Use and Disposal Sites
Complete Items 7.1 through 7.2 for each site on which sewage sludge from the facility is used or disposed. Check the box to indicate that this information has been attached to the application package.

Item 7.1. Specify the site name or number and mailing address. Provide the name (first and last), title, work telephone number, and email address of the contact person for the use or disposal site.
Include a complete location address for the site if different from the mailing address. If the facility or site 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”).
Provide the latitude and longitude to the nearest second for the site and the associated metadata (e.g., horizontal collection method, scale of source map or photo, if applicable, and horizontal reference datum). The location of the use or disposal site (i.e., where the coordinates are collected) sha ll be the approximate center of the area where the sewage sludge is directly released to the environment. (See Part 1 Line-By-Line Instructions to Item 1.1 for guidance on supplying method of collection information.)

Item 7.2. Identify the type of use or disposal site (e.g., agricultural, surface disposal, reclamation, lawn or home garden, public contact, municipal solid waste landfill, forest, incineration). If you check “Other”, provide a description in the space provided or in a separate attachment.

Section 8. Certification Statement

Item 8.1. The Clean Water Act provides for severe penalties for submitting false information on this application form. CWA Section 309(c)(2) provides that, “Any pers on 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 proprieto rship, 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 princi pal 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 OF PART 1
Submit your completed Part 1 of Form 2S and all associated attac h ments to your NPDES permitting authority.2S-9 

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS Part 2 – Permit Application Information
Complete Part 2 if you have an effective NPDES permit or have been directed by the NPDES permitting authority to submit a full permit application. Part 2 is divided into five sections. Section 1 pertains to all applicants. The applicability of Sections 2 to 5 depends on your facility’s sewage sludge use or disposal practices. See Exhibit 2S-2 at the end of the General Instructions to determine the sections that you are required to complete.

Section 1. General Information
Facility Information

Item 1.1. Enter the facility’s official or legal name. Do not use a colloquial name. Provide the mailing address of the facility. Next, give the name (first and last), title, work telephone number, and electronic mail (email) address of the person who is thoroughly familiar with the operation of the facility and with the facts reported in this application.
Include a complete location address for the facility if different from the mailing address. If the facility or site 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”).
Provide the latitude and longitude to the nearest second for the facility. Provide the associated metadata in the subsequent columns of the table. In the column marked “Reference Point,” indicate where the coordinates were collected (e.g., from the main entrance of the facility or the center of the facility). 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 19 th 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.

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.

Item 1.2. Indicate whether the facility is a Class I sludge management facility.

Item 1.3. Provide the facility design flow rate in million gallons per day (mgd).

Item 1.4. Provide the total population served by the facility. Enter the best estimate of the actual population served at the time of application for all areas served by the treatment works (municipalities and unincorporated service areas). If another treatment works discharges into this treatment works, provide on a separate attachment the name of the other treatment works and the actual population it serves. It is not necessary to list the communities served by the other treatment works.

Item 1.5. Indicate the legal status of the owner 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) gov ernment, tribal government, school district, water district, or other local government entity, check the box for “Public—Other) 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 previously listed, check the box for “Other” and specify the type of entity.
Applicant Information

I tem 1.6. I ndicate if the applicant is different from the entity listed under Item 1.1. If “yes,” continue to Item 1.7. If “no,” skip to Item 1.18 (Part 2, Section 1).

Item 1.7. Enter the applicant’s name and mailing address. Provide the name (first and last), title, work telephone number, and email address of the contact person for the applicant.

Item 1.8. Indicate if the applicant is the facility’s owner, operator, or both.

Item 1.9. Specify whether the NPDES permitting authority should send correspondence to the facility or the applicant.2S-10 

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED
Permit Information

Item 1.10. Provide the facility’s NPDES permit number or check the box to indicate that you do not have an NPDES permit number but are otherwise required to submit Part 2 of Form 2S by your NPDES permitting authority.

Item 1.11. Indicate all other federal, state, and local permits or construction approvals received or applied for that regulate the facility’s sewage sludge management practices. If you check “Other”, specify the permit or approval in the space provided. You may provide a listing of permits or approvals and corresponding permit numbers in a separate attachment. If so, check the box to indicate that this information has been attached to the application package.
Indian Country

Item 1.12. Indicate whether any generation, treatment, storage, application to land, or disposal of sewage sludge from the facility occurs in Indian Country. If “yes” continue to Item 1.13. If “no” skip to Item 1.14 (Part 2, Section 1).

Item 1.13. In the space provided or in a separate attachment, describe the generation, treatment, storage, land application, or disposal of sewage sludge that occurs in Indian Country.
Topographic Map

Item 1.14. Provide a topographic map(s) of the area extending at least 1 mile beyond the property boundaries of the facility that clearly shows the following:

 The legal boundaries of the facility;

 All sewage sludge management facilities, including on-site treatment, storage, and disposal sites;

 Wells, springs, and other surface water bodies that are within 1⁄4 mile of the property boundaries and listed in public records or otherwise known to applicant. On the map, include the map scale, a meridian arrow showing north, and latitude and longitude to the nearest second.
You may develop your map by going to USGS’s National Map website at http://nationalmap.gov/ . Use the traditional 7.5-minute quadrangle format. If none is available, you may use a USGS 15- minute series map. You may also use a plat or other appropriate
map. Answer “yes” when a topographic map containing all required information has been attached to the application.
Line Drawing

Item 1.15. Provide a line drawing and/or narrative description that identifies all sewage sludge practices that will be employed during the permit term, including all units used for collecting, dewatering, storing, or treating sewage sludge, the destination(s) of all liquids and solids leaving each such unit, and all processes used for pathogen reduction and vector attraction reduction. Answer “yes” when a line drawing and/or narrati ve description containing all required information has been attached to the application. Contractor Information

Item 1.16. Indicate whether contractors have any operational or maintenance responsibilities related to sewage sludge generation, treatment, use, or disposal at the facility. If “yes” continue to Item 1.17. If “no” skip to Item 1.8 (Part 2, Section 1).

Item 1.17. Provide the company name, mailing address, contact name (first and last), telephone number, and email address for each contractor and describe the contractor’s responsibilities. The application form provides reporting s pace for three contractors. If your facility has more than three contractors, attach additional sheets as
necessary.

Pollutant Concentrations

Item 1.18. Provide the most recent sewage sludge monitoring data available on the quality of the sewage sludge, including for pollutants for which limits in sewage sludge have been established in 40 CFR, Part 503 for your facility’s expected us e or disposal practices. Provide the average monthly concentration in milligrams per kilogram (mg/kg) dry weight, analytical method, and detection level. If available, base data on three or more samples taken at least 1 month apart, that are no more than 4.5 years old. If providing the monitoring data in a separate attachment, check the box to indicate that this information has been attached to the application package.

Checklist and Certification Statement

Item 1.19. Review the checklist provided. In Column 1, mark the sections of Form 2S, Part 2 that you have completed and are submitting with your application. For each section that you have completed, indicate in Column 2 whether you are submitting attachments.

Item 1.20. The Clean Water Act provides for severe penalties for submitting false information on this application form. Section 309(c)(2) of the Clean Water Act 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. 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 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 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

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED authority to sign documents has been assigned or delegated to the manager in accordance wi th corporate procedures.
B. For partnership or sole proprie torship, by a general partner or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by either a principal executive office r 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).
Section 2. Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge
Complete this section if you are a ‘‘person who prepares sewage sludge.’’ This section pertains to any POTW or other TWTDS that generates sewage sludge, as well as to any facility that derives a material from sewage sludge (e.g., it composts sewage sludge or blends sewage sludge with another material). Simply distributing sewage sludge or placing it in a bag or other container for sale or give-away for application to the l and is not considered ‘‘deriving a material’’ from sewage sludge (because it does not change sludge quality), and thus a facility that only distributes or bags a sewage sludge is not required to provide the information in this section.

Item 2.1. Answer “yes” or “no” to indicate if the facility generates sewage sludge or derives a material from sewage sludge (e.g., it composts sewage sludge or blends sewage sludge with another material). If “yes”, continue to Item 2.2. If “no”, skip to Part 2, Section 3.

Amount Generated Onsite

Item 2.2. Provide the total dry metric tons of sewage sludge generated at the facility over a 365-day period.
Amount Received from Off-site Facility

Item 2.3. Indicate whether the facility receives sewage sludge from another facility for treatment, use, or disposal. If “yes”, continue to Item 2.4. If “no”, skip to Item 2.7 (Part 2, Section 2).

Item 2.4. Indicate the total number of facilities from which your facility receives sewage sludge for treatment, use, or disposal.

Item 2.5. Complete Items 2.5 through 2.7 for each facility from which your facility receives sewage sludge for treatment, use or disposal. Check the box to indicate that this information has been attached to the application package.
Enter the name and mailing address of the facility. Provide the name (first and last), title, work telephone number, and email address of the contact person for the facility.
Provide a complete location address for the facility if different from the mailing address. If the fac ility or site 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”). Provide the latitude and longitude to the nearest second for the facility and the associated metadata (e.g., horizontal collection method, scale of source map or photo, if applicable, and horizontal reference datum). In the column marked “Reference Point,” indicate where the coordinates were collected (e.g., from the main entrance of the facility

or the center of the facility). (See Part 2 Line-By-Line Instructions to Item 1.1 for guidance on supplying method of collection information.)

Item 2.6. Indicate the amount of sewage sludge received, the applicable pathogen class and reduction alternative, and the applicable vector attraction reducti on option provided at the off-site facility. To determine the applicable pathogen class and reduction alternative, see 40 CFR 503.32. To determine the applicable vector attraction reduction option, see 40 CFR 503.33. Vector attraction reduction options 1 through 8 are typically met at the point where sewage sludge is generated or where a material is derived from sewage sludge, and options 9 through 11 are typically met at the point of use or disposal.

Item 2.7. Identify the treatment process(es) that are known to occur at the off-site facility, including blending activities and treatment to reduce pathogens or vector attracti on properties in sewage sludge. If you check “Other”, specify the treatment process(es) in the space provided or in a separate attachment.
Treatment Provided at Your Facility

Item 2.8. In the “Use or Disposal Practice” column, check the sewage sludge use or disposal practice used at your facility. In the following columns, indicate the pathogen class and reduction alternative and the vector attraction reduction option associated with the practice. To determine the applicable pathogen class and reduction alternative, see 40 CFR 503.32. To determine the applicable vector attraction reduction option, see 40 CFR 503.33. Vector attraction reduction options 1 through 8 are typically met at the point where sewage sludge is generated or where a mate rial is derived from sewage sludge, and options 9 through 11 are typically met at the point of use or disposal. Complete Item 2.8 for each sewage sludge use or disposal practice by attaching additional sheets, as necessary.

Item 2.9. For each use or disposal practice indicated in Item 2.8, identify the treatment process(es) used at your facility to reduce pathogens or vector attraction properties in sewage sludge. If you check “Other”, specify the treatment process(es) in the space provided or in a separate attachment.

Item 2.10. Use the space provided to describe any other sewage sludge treatment or blending activities not identified in Items 2.8 and 2.9. Check the box if your description has been attached to the application package.
Preparation of Sewage Sludge Meeting Ceiling and Pollutant Concentrations, Class A Pathogen Requirements, and One of Vector Attraction Reduction Options 1-8.

Item 2.11. Indicate whether the sewage sludge meets the ceiling concentrations in Table 1 of 40 CFR 503.13, the pollutant concentrations in Table 3 of 40 CFR 503.12, Class A pathogen reduction requirements at 40 CFR 503.32(a), an d one of the vect or attraction reduction requirements at 40 CFR 503.33(b)(1)-(8) and is land applied. Sewage sludge meeting all of these criteria is often

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED referred to as “exceptional quality (EQ)” and is exempt from the general requirements of §503.12 and the management practices of §503.14, and thus fewer permitting and permit application requirements typically pertain to facilities generating such sludge. For this reason, if you check “yes” to Item 2.11 complete Items 2.12 and 2.13, and then you may skip Items 2.14 through 2.16 (Sale or Give-away in a Bag or Other Container for Application to the Land), Items 2.17 through 2.26 (Shipment Off-site for Treatment or Blending), and Items 2.27 through 2.31 (Land Application of Bulk Sewage Sludge) unless specifically required to complete any of them by the permitting authority. If “no,” skip to Item 2.14 (Part 2, Section 2).

Item 2.12. Provide the total dry metric tons of sewage sludge, meeting the requirements specified in Item 2.11 that is applied to land per 365-day period.

Item 2.13. Indicate whether the subject sewage sludge is placed in a bag or other container and sold or given away for land application. Check the box indicating completion of Items 2.11 through 2.13 and skip to Item 2.32 (Part 2, Section 2).
Sale or Give-away in a Bag or Other Container for Application to the Land.

Item 2.14. Indicate whether the subject sewage sludge is placed in a bag or other container and sold or given away for land application. If “yes” continue to Item 2.15. If “no” skip to Item 2.17 (Part 2, Section 2).

Item 2.15. Provide the dry metric tons of sewage sludge place in a bag or other container and sold or given away for land application per 365-day period.

Item 2.16. When sewage sludge is placed in a bag or other container for sale or give-away for application to the land, either a label must be affixed to the bag or other container, or an information sheet must be provided to the person receiving the sewage sludge. The information that must be on the label or information sheet is listed at 40 CFR Part 503.14(e). Attach copies of all labels or notices that accompany sewage sludge being sold or given away in a bag or other container for land application. Check the box to indicate that these copies have been attached to the application package.
Check the box indicating completion of Items 2.14 through 2.16 and skip to Item 2.32 (Part 2, Section 2).
Shipment Off-site for Treatment or Blending

Item 2.17. Indicate whether another facility provides treatment or blending of your facility’s sewage sludge. This does not pertain to dewatered sludge sent directly to a land application or surface disposal site. If “yes” continue to Item 2.18. If “no” skip to Item 2.32 (Part 2, Section 2).

Item 2.18. Indicate the total number of facilities that provide treatment or blending of your facility’s sewage sludge. Complete Items 2.19 through 2.26 for each facility that provides treatment or blending of your facility’s sewage sludge. Check the box to indicate if this information has been attached to the application package. Item 2.19. Enter the name and mailing address of the receiving facility. Provide the name (first and last), title, work telephone number, and email address of the contact person for the receiving facility.
Include a complete location address for the facility if different from the mailing address. If the facility or si te 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”).

Item 2.20. Provide the dry metric tons of sewage sludge provided to the receiving facility per 365-day period.

Item 2.21 Indicate whether the receiving facility provides any additional treatment to reduce pathogens in, or vector attraction properties of the sewage sludge from your facility. If “yes” continue to Item 2.22. If “no” skip to Item 2.24 (Part 2, Section 2).

Item 2.22. Indicate the pathogen class and reduction alternative and the vector attraction reduction option met for the sewage sludge at the receiving facility. To determine the applicable pathogen class and reduction alternative, see 40 CFR 503.32. To determine the applicable vector attraction reduction option, see 40 CFR 503.33. Vector attraction reduction options 1 through 8 are typically met at the point where sewage sludge is generated or where a material is derived from sewage sludge, and options 9 through 11 are typically met at the point of use or disposal.

Item 2.23. Identify the treatment process(es) used at the receiving facility to reduce pathogens or vector attraction properties of sewage sludge from your facility. If you check “Other”, specify the treatment process(es) in the space provided or in a separate attachment.

Item 2.24. Attach a copy of any information you provide to the receiving facility to comply with the “notice and necessary information” requirement under 40 CFR 503.12(g). Check the box to indicate that this information has been attached to the application package.

Item 2.25. Indicate whether the receiving facility places sewage sludge from your facility in a bag or other container to sell or give away for land application. If “yes” continue to Item 2.26. If “no” skip to Item 2.32 (Part 2, Section 2).

Item 2.26. When sewage sludge is placed in a bag or other container for sale or give-away for application to the land, either a label must be affixed to the bag or other container, or an information sheet must be provided to the person receiving the sewage sludge. The information that must be on the label or information sheet is listed at 40 CFR 503.14(e). Attach copies of all labels or notices that accompany sewage sludge being sold or given aw ay in a bag or other container for land application. Check the box to indicate that these copies have been attached to the application package.
Check the box indicating completion of Items 2.17 through 2.28 and skip to Item 2.32 (Part 2, Section 2).
Land Application of Bulk Sewage

Item 2.27. Answer “yes” or “no” to indicate whether or not sewage sludge from your facility is applied to the land. If “yes” continue to Item 2.28. If “no” skip to Item 2.32 (Part 2, Section 2).

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 2.28. Provide the total dry metric tons of sewage sludge applied to all land application sites per 365-day period.

Item 2.29. Indicate whether all land application sites were identified in Part 2, Section 3 of this application. If “no” submit a copy of the land application plan with your application package. Current regulations require you to submit a land application plan at the time of permit application if you intend to apply sewage sludge that does not meet the EQ requirements to land application sites that have not been identified at the time of permit application. The minimum requirements for this plan are listed in 40 CFR 122.21(q)(9)(v). The NPDES permitting authority will work with you to develop additional details of the land application plan on a case-by-case basis. Such details could include site selection criteria (site slope, r un-on and run-off control, etc.) and site management guidelines (sludge application rates, access controls, etc.). A land application plan provides for public notice when the land application plan is developed as part of the permit, and it discusses how the public will be notified about new sites.

Item 2.30. Indicate whether there are any land application sites located in states other than the state where you generate sewage sludge or derive a material from the sewage sludge. If “yes” continue to Item 2.31. If “no” skip to Item 2.32 (Part 2, Section 2).

Item 2.31. If any land application sites are located in states other than the state where you generate the bulk sewage sludge or derive the material from sewage sludge, the notice to the permitting authority in the states where the land application sites are located must contain the requirements listed at 40 CFR 503.12(i). In a separate attachment, describe how you notify the NPDES permitting authority for the states where the land application sites are located. Check the boxes to indicate if the explanation and/or the notification have been attached to the application package.
Surface Disposal

Item 2.32. Indicate whether sewage sludge from your facility is placed on a surface disposal site. If “yes” continue to Item 2.33. If “no” skip to Item 2.39 (Part 2, Section 2).

Item 2.33. Provide the total dry metric tons of sewage sludge from your facility placed on all surface disposal sites per a 365- day period.

Item 2.34. Indicate whether you own or operate all surface disposal sites to which you send sewage sludge for disposal. If “yes” skip to Item 2.39 (Part 2, Section 2). If “no” continue to Item 2.35.

Item 2.35. Provide the total number of surface disposal sites to which you send sewage sludge. Complete Items 2.36 through 2.38 for each surface disposal site to which you send your sewage sludge. Check the box to indicate that this information has been attached to the application package.

Item 2.36. Enter the site name or number and mailing address of the surface disposal site you do not own or operate. Provide the name (first and last), title, work telephone number, and email address of the contact person for the surface disposal site. Item 2.37. Indicate whether the site contact is the owner and/or operator of the surface disposal site.

Item 2.38. Provide the total dry metric tons of sewage sludge from your facility placed on the surface disposal site per 365-day period.

Incineration

Item 2.39. Answer “yes” or “no” to indi cate if sewage sludge from your facility is fired in a sewage sludge incinerator. If “yes” continue to Item 2.40. If “no” skip to Item 2.46 (Part 2, Section 2).

Item 2.40. Provide the total dry metric tons of sewage sludge from your facility fired in all sewage sludge incinerators per 365-day period.

Item 2.41. Answer “yes” or “no” to indi cate if you own or operate all sewage sludge incinerators to which you send sewage sludge for firing. If “yes” skip to Item 2.46. If “no” continue to Item 2.42 (Part 2, Section 2).

Item 2.42. Indicate the total number of sewage sludge incinerators used that you do not own or operate. Complete Items 2.43 through 2.45 for each sewage sludge incinerator used that you do not own or operate. Check the box to indicate that this information has been attached to the application package.

Item 2.43. Enter the name or number and mailing address of sewage sludge incinerator used that you do not own or operate. Provide the the name (first and last), title, work telephone number, and email address of the contact person for the incinerator.
Include a complete location address for the incinerator if different from the mailing address. If the incinerator 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”).

Item 2.44. Indicate whether the site contact is the owner and/or operator of the incinerator.

Item 2.45. Provide the total dry metric tons of sewage sludge from your facility fired in the sewage sludge incinerator per 365-day period.
Disposal in a Municipal Solid Waste Landfill

Item 2.46. Indicate whether sewage sludge from your facility is placed on a municipal solid waste landfill. If “yes” continue to Item 2.47. If “no” skip to Part 2, Section 3.

Item 2.47. Provide the total number of municipal solid waste landfills to which you send sewage sludge. Complete Items 2.48 through 2.52 for each landfill used. Check the box to indicate that this information has been attached to the application package.

Item 2.48. Enter the name and mailing address of the municipal solid waste landfill. Provide the name (first and last), title, work telephone number, and email address of the contact person for the landfill.
Include a complete location address for the landfill if different from the mailing address. If the landfill 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”).

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED Provide the latitude and longitude to the nearest second for the landfill and the associated metadata (e.g., horizontal collection method, scale of source map or photo, if applicable, and horizontal reference datum). In the column marked “Reference Point,” indicate where the coordinates were collected (e.g., from the main entrance of the landfill or the center of the landfill). (See Part 2 Line-By-Line Instructions to Item 1.1 for guidance on supplying method of collection information.)

Item 2.49. Provide the total dry metric tons of sewage sludge from your facility placed in each municipal solid waste landfill per 365-day period.

Item 2.50. In the space provided or in a separate attachment, list the number and type of all other federal, state, and local permits that regulate the operation of this municipal solid waste landfill.

Item 2.51. Attach information to determine whether the sewage sludge meets applicable requirements for disposal in a municipal solid waste landfill (e.g., results of paint filter liquids test and toxicity characteristic leaching procedure, or TCLP, test). Check the box to indicate that this information has been attached to the application package.

Item 2.54. Sewage sludge placed on a municipal solid waste landfill must meet requirements in 40 CFR Part 258 concerning the quality of materials placed on a landfill unit. Part 258 specifies minimum Federal criteria for municipal solid waste landfills, including landfills that accept sewage sludge along with household waste. In contrast to Part 503, Part 258 controls sewage sludge placed in municipal solid waste landfills through a facility design and management practice approach. In Part 503, EPA has adopted the Part 258 criteria as the appropriate standard for sewage sludge disposed of with municipal waste. EPA concluded that if sewage sludge is disposed of in a municipal solid waste landfill complying with Part 258 criteria, public health and the environment are protected. Note that the POTW is legally responsible for knowing whether a municipal solid waste landfill is in compliance with Part 258 and may be liable if it sends sludge to a municipal solid waste landfill that is not in compliance with Part 258. Indicate whether the municipal solid waste landfill complies with applicable criteria set forth in 40 CFR Part 258.
Section 3. Land Application of Bulk Sewage Sludge
Complete this section if you completed Section B, Items 2.27 through 2.31 (Land Application of Bulk Sewage Sludge). Unless the NPDES permitting authority specifically requires you to complete this section, you may skip this section for sewage sludge that is covered in any of the following portions of this application:

 Section B, Items 2.11 through 3.13 (Preparation of Sewage Sludge Meeting Ceiling and Pollutant Concentrations, Class A Pathogen Requirements, and One of Vector Attraction Reduction Options 1 to 8). Such sewage sludges are exempt from the general requirements and management practices of Part 503 when they are land applied (unless the permitting authority requires otherwise), and thus the site information in Section C is not required for permitting.

 Section B, Items 2.14 through 2.16 (Sale or Give-away in a Bag or Other Container for Application to the Land). Section C does not cover the sale or give-away of sewage sludge in a bag or other container for application to the land because EPA typically will not control the users of such sewage sludge (typically, home gardeners or other small-scale users), or the land on which the sludge is applied, through the generator’s permit.

 Section B, Items 2.17 through 2.26 (Shipment Off-site for Treatment or Blending). Section C does not apply to a generator that sends sewage sludge to another facility for treatment or for blending, because the Part 503 requirements addressed by Section C will largely be the responsibility of the receiving facility.
Provide the information in this section for each land application site that has been identified at the time of permit application. In cases where the sewage sludge is applied to numerous sites with similar characteristics, you may combine the information for several sites under a single response (the name and address of each site must still be provided, however).

Item 3.1. Indicate whether your facility applies sewage sludge to land. If “yes” continue to Item 3.2. If “no” skip to Part 2, Section 4.

Item 3.2. Indicate if any of the following conditions apply:

 The sewage sludge meets the ceiling concentrations in Table 1 of 40 CFR 503.13, the pollutant concentrations in Table 3 of 40 CFR 503.13, Class A pathogen requirements at 40 CFR 503.32(a), and one of the vector attraction reduction requirements at 40 CFR 503.33(b)(1)-(8);

 The sewage sludge is sold or gi ven away in a bag or other container for application to the land; or

 You provide the sewage sludge to another facility for treatment or blending.
If “yes” skip to Part 2, Section 4. If “no” continue to Item 3.3.

Item 3.3. Complete the remainder of section 3 for each site on which sewage sludge is applied. Check the box to indicate if this information has been attached to the application package.
Identification of Land Application Site

Item 3.4. Enter the name or number and location address for the land application site. If the site 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”).
Provide the latitude and longitude to the nearest second for the site and the associated metadata (e.g., horizontal collection method, scale of source map or photo, if applicable, and horizontal reference datum). The location of the land application site (i.e., where the coordinates are collected) shall be the approximate center of the area where the sewage sludge is directly released to the environment. (See Part 2 Line-By-Line Instructions to Item 1.1 for guidance on supplying method of collection information.)

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 3.5. Check the box to indicate that a topographic map (or other appropriate map if a topographic map is unavailable) showing the site location has been attached to the application. See Item 1.14 (Part 2, Section 1) for guidance on obtaining a topographic map.

Owner Information

Item 3.6. Indicate whether you are the owner of the land application site. If “yes” skip to Item 3.8 (Part 2, Section 3). If “no” continue to Item 3.7.

Item 3.7. Enter the name and mailing address of the owner of the land application site. Provide the name (first and last), title, work telephone number, and email address of the contact person for the owner.
Applier Information

Item 3.8. Indicate whether you are the person who applies, or is responsible for application of, sewage sludge to this land application site. If “yes” skip to Item 3.10 (Part 2, Section 3). If “no” continue to Item 3.9.

Item 3.9. Enter the name and mailing address of the applier. Provide the name (first and last), title, work telephone number, and email address of the contact person for the applier.
Site Type

Item 3.10. Identify the type of land application site (e.g., agricultural land, forest, reclamation site, public contact site, or other). If you check “Other”, provide a description in the space provided or in a separate attachment.
Crop or Other Vegetation Grown on Site

Item 3.11. In the space provided or in a separate attachment, describe the type of crop or other vegetation that is grown on the site. If the crop or vegetation to be grown on the site is not yet known, or is likely to change in an unforeseeable manner during the life of the permit, you may so indicate instead of providing the type of crop or other vegetation.

Item 3.12. In the space provided or in a separate attachment, indicate the nitrogen requirement for the crop or other vegetation identified in Item 3.11. Information on the nitrogen content of vegetation grown on the site may be obtained from local agricultural extension services, a local Farm Advisor’s Office, or published sources.

Vector Attraction Reduction

Item 3.13. Indicate whether the vector attraction reduction requirements at 40 CFR 503.33(b)(9) and (b)(10) are met when sewage sludge is applied to the land application site. If “yes” continue to Item 3.14. If “no” skip to Item 3.16 (Part 2, Section 3).

Item 3.14. Indicate which vector attraction option (Option 9 – injection below land surface; or Option 10 – incorporation into soil within 6 hours) is met when sewage sludge is applied to the land application site. Item 3.15. In the space provided or in a separate attachment, describe any treatment processes used at the land application site to reduce vector attraction properties of sewage sludge. Check the box to indicate that your description has been attached to the application package.
Cumulative Loadings and Remaining Allotments

Item 3.16. Indicate whether the sewage sludge applied to this site since July 20, 1993 is subject to the cumulative pollutant loading rates (CPLRs) at 40 CFR 503.13(b)(2). If “yes” continue to Item 3.17. If “no” skip to Part 2, Section 4.

Item 3.17. Indicate whether you have contacted the NPDES permitting authority in the state w here the bulk sewage sludge subject to CPLRs will be applied, to ascertain whether bulk sewage sludge subject to CPLRs has been applied to this site on or since July 20, 1993. If “yes” continue to Item 3.18. If “no”, because sewage sludge subject to CPLRs may not be applied to this site, skip to Part 2, Section 4.

Item 3.18. Provide your NPDES permitting authority’s name, contact person, telephone number, and email address.

Item 3.19. Indicate, based on your inquiry, whether bulk sewage sludge subject to CPLRs has been applied to the site since July 20, 1993. If “yes” continue to Item 3.20. If “no” skip to Part 2, Section 4.

Item 3.20. Provide the name and mailing address for every facility other than yours that is sending, or has sent, bulk sewage sludge subject to CPLRs to this site since July 20, 1993, Give the name (first and last), title, work telephone number, and email address of the contact person for the facility that is sending, or has sent, bulk sewage sludge subject to CPLRs to this site since July 20, 1993.
Section 4. Surface Disposal
Complete this section if you own or operate a surface disposal site and are required to submit a full permit application (i.e., Part 2 of Form 2S) at this time. A sewage sludge surface disposal site is, by definition, a TWTDS, and the owner/operator of the site is required to apply for a permit.

Item 4.1. Indicate whether you own or operate a surface disposal site. If “yes” continue to Item 4.2. If “no” skip to Part 2, Section 5.

Item 4.2. Complete the remainder of Section 4 for each active sewage sludge unit you own or operate. Check the box to indicate that this information has been attached to the application package.
Information on Active Sewage Sludge Units
Most requirements for surface disposal of sewage sludge under Part 503 pertain to individual active sewage sludge units at a surface disposal site. The information required in Items 4.3 through 4.15 may be developed on a unit-by-unit basis, or may be developed for the entire surface disposal site if all units are sufficiently similar.

Item 4.3. Enter the name or number and mailing address of the active sewage sludge unit. Provide the name (first and last), title, work telephone number, and email address of the contact person for the active sewage sludge unit.

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED Include a complete location address for the unit if different from the mailing address. If the unit 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”).
Provide the latitude and longitude to the nearest second for the unit and the associated metadata (e.g., horizontal collection method, scale of source map or photo, if applicable, and horizontal reference datum). The location of the unit (i.e., where the coordinates are collected) sh all be the approximate center of the area where the sewage sludge is directly released to the environment. (See Part 2 Line-By-Line Instructions to Item 1.1 for guidance on supplying method of collection information.)

Item 4.4. Check the box to indicate that a topographic map (or other appropriate map if a topographic map is unavailable) showing the site location has been attached to the application. See Item 1.14 (Part 2, Section 1) for guidance on obtaining a topographic map.

Item 4.5. Provide the total dry metric tons of sewage sludge placed on the active sewage sludge unit per 365-day period.

Item 4.6. Provide the total dry metric tons of sewage sludge placed on the active sewage sludge unit over the life of the unit.

Item 4.7. Indicate whether the active sewage sludge unit has a liner with a maximum permeability of 10 -7 centimeters per second (cm/sec). If “yes” continue to Item 4.8. If “no” skip to Item 4.9 (Part 2, Section 4).

Item 4.8. In the space provided or in a separate attachment, describe the liner. Check the box to indicate that a description has been attached to the application package.

Item 4.9. Indicate whether or not the active sewage sludge unit has a leachate collection system. If “yes” continue to Item 4.10. If “no” skip to Item 4.11 (Part 2, Section 4).

Item 4.10. In the space provided or in a separate attachment, describe the leachate collection system and the leachate disposal method. Also provide the numbers of any federal, state, or local permit(s) for leachate disposal. Check the box to indicate that this description has been attached to the application package.

Item 4.11. Indicate if the boundary of the active sewage sludge site is less than 150 meters from the property line of the surface disposal site. If “yes” continue to Item 4.12. If “no” skip to Item 4.13 (Part 2, Section 4).

Item 4.12. Provide the distance, in meters, between the active sewage sludge site boundary and the surface disposal site property line.

Item 4.13. Provide the remaining capacity of active sewage sludge in dry metric tons.

Item 4.14. List the anticipated closure date for the active sewage sludge unit, using the format MM/DD/YYYY, if known.

Item 4.15. Submit a copy of any closure plan that has been developed for this active sewage sludge unit. Check the box to indicate that you have attached a copy to the application package.
Sewage Sludge from Other Facilities

Item 4.16. Indicate whether sewage sludge is sent to this active sewage sludge unit from any facilities other than yours. If “yes” continue to Item 4.17. If “no” skip to Item 4.21 (Part 2, Section 4).

Item 4.17. Indicate the total number of facilities, other than yours, that send sewage sludge to this active sewage sludge unit. Complete Items 4.18 through 4.20 for each such facility. Check the box to indicate that this information has been attached to the application package.

Item 4.18. Enter the name and mailing address of the facility that sends sewage sludge to this active sewage sludge unit. Provide the name (first and last), title, work telephone number, and email address of the contact person for the facility.

Item 4.19. Indicate the pathogen class and reduction alternative and the vector attraction reduction option met for the sewage sludge before leaving the other facility. To determine the applicable pathogen class and reduction alternative, see 40 CFR 503.32. To determine the applicable vector attraction reduction option, see 40 CFR 503.33. Vector attraction reduction options 1 through 8 are typically met at the point where sewage sludge is generated or where a material is derived from sewage sludge, and options 9 through 11 are typically met at the point of use or disposal.

Item 4.20. Identify the treatment process(es) used at the other facility to reduce pathogens or vector attr action properties of sewage sludge before leaving the other facility. If you check “Other”, specify the treatment process(es) in the space provided or in a separate attachment.

Vector Attraction Reduction

Item 4.21. Indicate which, if any, vector attraction reduction option (Option 9 – injection below land surface; Option 10 – incorporation into soil within 6 hours; Option 11 – covering active sewage sludge unit daily; or None) is met when sewage sludge is placed on this active sewage sludge unit.

Item 4.22. In the space provided or in a separate attachment, describe any treatment processes used at the active sewage sludge unit to reduce vector attraction properties of sewage sludge. Check the box to indicate that this description has been attached to the application package.
Groundwater Monitoring
Placement of sewage sludge on an active sewage sludge unit must not contaminate an aquifer. Compliance must be demonstrated through either: (1) The results of a ground-water monitoring program developed by a qualified groundwater scientist, or (2) certification by a qualified groundwater scientist that contamination has not occurred. This section solicits existing groundwater monitoring data and other documentation to indicate the potential for contamination of an aquifer at the active sewage sludge unit, and the capability of the owner/operator of the surface disposal site to demonstrate that contamination has not occurred.

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 4.23. Indicate whether groundwater monitoring is currently conducted at, or ground monitoring data is otherwise available for, this active sewage sludge unit. If “yes” continue to Item 4.24. If “no” skip to Item 4.26 (Part 2, Section 4).

Item 4.24. Provide a copy of available groundwater monitoring data. Check the box to indicate that the data has been attached to the application package.

Item 4.25. In the space provided or in a separate attachment, describe the well locations, the approximate depth to groundwater and the groundwater monitoring procedures used to obtain the data. Check the box to indicate that the descriptions have been attached to the application package.

Item 4.26. Indicate whether a groundwater monitoring program has been prepared for this active sewage sludge unit. If “yes” continue to Item 4.27. If “no” skip to Item 4.28 (Part 2, Section 4).

Item 4.27. Submit a copy of the groundwater monitoring program that has been developed for this active sewage sludge unit. Check the box to indicate that this documentation has been attached to the application package.

Item 4.28. Indicate whether you have obtained certification from a qualified groundwater scientist that the aquifer below the active sewage sludge unit has not been contaminated. If “yes” continue to Item 4.29. If “no” skip to Item 4.30 (Part 2, Section 4).

Item 4.29. Submit a copy of the certification indicating that the aquifer below the active sewage sludge unit has not been contaminated. Check the box to indicate that this certification has been attached to the application package.
Site Specific Limits
After August 18, 1993, you are allowed to seek site-specific pollutant limits only for good cause, and must do so within 180 days of becoming aware that good cause exists. If you request site-specific pollutant limits with this permit application, you are required to submit information supporting the request, including a demonstration that existing values for site parameters specified by the permitting authority differ from the values for those parameters used to develop the pollutant limits in Table 1 of § 503.23. You must also submit follow-up information at the request of the NPDES permitting authority. If the NPDES permitting authority determines that site-specific pollutant limits are appropriate, he or she may specify site-specific limits in the permit as long as the existing concentrations of the pollutants in the sewage sludge are not exceeded.

Item 4.30. Indicate whether you are seeking site-specific pollutant limits for the sewage sludge placed on the active sewage sludge unit. If “yes” continue to Item 4.31. If “no” skip to Part 2, Section 5.

Item 4.31. Submit information to support the request for sitespecific pollutant limits. Check the box to indicate that this information has been attached to the application package. Section 5. Incineration
Complete this section if you own or operate a sewage sludge incinerator. A sewage sludge incinerator is, by definition, a treatment works treating domestic sewage, and the owner/ operator of a sewage sludge incinerator is requi red to submit a full permit application.

Incinerator Information

Item 5.1. Indicate whether or not you fire sewage sludge in a sewage sludge incinerator. If “yes” continue to Item 5.2. If “no” skip to END.

Item 5.2. Indicate the total number of incinerators used at your facility. Complete the remainder of Section 5 for each incinerator. Check the box to indicate that you have attached information for one or more incinerator.

Item 5.3. Enter the incinerator’s name or number. Include a complete location address for the incinerator. If the incinerator 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”).
Provide the latitude and longitude to the nearest second for the incinerator and the associated metadata (e.g., horizontal collection method, scale of source map or photo, if applicable, and horizontal reference datum). The location of the incinerator (i.e., where the coordinates are collected) shall be the approximate center of the area where the sewage sludge is directly released to the environment. (See Part 2 Line-By-Line Instructions to Item 1.1 for guidance on supplying method of collection information.)

Amount Fired

Item 5.4. Provide the dry metric tons of sewage sludge fired in the sewage sludge incinerator per 365-day period.
Beryllium NESHAP
The firing of sewage sludge in a sewage sludge incinerator must not violate the National Emission Standard (NESHAP) for beryllium as established in Subpart C of 40 CFR Part 61. The beryllium NESHAPonly applies, however, to sewage sludge incinerators firing ‘‘berylliumcontaining waste.’’ The beryllium NESHAP is 10 grams of beryllium in the exit gas over a 24-hour per iod, unless the incinerator owner/operator has been approved to meet a 30-day average ambient concentration limit on beryllium in the vicinity of the sewage sludge incinerator of 0.01 μ g/m 3 . Complete this section to demonstrate compliance with the beryllium NESHAP.

Item 5.5. Submit information, test data, and a description of measures taken that demonstrate whether the sewage sludge incinerated is beryllium-containing waste and will continue to remain as such. Check the box to indicate that this material has been attached to the application package.

Item 5.6. Indicate whether or not the sewage sludge fired in the incinerator is beryllium-containing waste as defined at 40 CFR Part 61.31. If “yes” continue to Item 5.7. If “no” skip to Item 5.8 (Part 2, Section 5).

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Item 5.7. Submit a complete report of the latest beryllium emission testing and documentation of ongoing incinerator operating parameters indicating that the NESHAP emission rate limit for beryllium has been and will continue to be met. Check the box to indicate that this documentation has been attached to the application package.
Mercury NESHAP
The firing of sewage sludge in a sewage sludge incinerator must not violate the NESHAP for mercury as established in Subpart E of 40 CFR Part 61. Complete this section to demonstrate compliance with the mercury NESHAP. Information on stack testing and sewage sludge sampling can be found at 40 CFR Parts 61.53 and 61.54.

Item 5.8. Indicate whether or not compliance with the mercury NESHAP is being demonstrated via stack testing. If “yes” continue to Item 5.9. If “no” skip to Item 5.11 (Part 2, Section 5).

Item 5.9. Submit a complete report of stack testing and documentation of ongoing incinerator operating parameters indicating that the NESHAP emission rate limit for mercury has been and will continue to be met. Check the box to indicate that this documentation has been attached to the application package.

Item 5.10. Provide copies of mercury emission rate tests for the two most recent years in which testing was conducted. Check the box to indicate that this information has been attached to the application package.

Item 5.11. Indicate whether you demonstrate compliance with the mercury NESHAP by performing sewage sludge sampling. If “yes” continue to Item 5.12. If “no” skip to Item 5.13 (Part 2, Section 5).

Item 5.12. Submit a complete report of sewage sludge sampling and documentation of ongoing incinerator operating parameters indicating that the NESHAP emission rate limit for mercury has been and will continue to be met by the incinerator. Check the box to indicate that this documentation has been attached to the application package.
Dispersion Factor

Item 5.13. Provide the dispersion fa ctor in micrograms/cubic meter per gram/second.

Item 5.14. Specify the name and type of dispersion model.

Item 5.15 Submit a copy of the modeling results and supporting documentation. Check the box to indicate that the documentation has been attached to the application package.
Control Efficiency

Item 5.16. Provide the control efficiency, in hundredths, for arsenic, cadmium, chromium, lead, and nickel.

Item 5.17. Submit the results of performance testing and supporting documentation, including test dates. Check the box to indicate that this documentation has been attached to the application package. Risk-specific Concentration for Chromium

Item 5.18. Provide the risk-specific concentration (RSC) used for chromium in micrograms per cubic meter.

Item 5.19. Indicate whether the RSC was determined using Table 2 at 40 CFR 503.43. If “yes” continue to Item 5.20. If “no” skip to Item 5.21 (Part 2, Section 5).

Item 5.20. Identify the incinerator used as the basis, as either fluidized bed with wet scrubber, other types with wet scrubber, fluidized bed with wet scrubber and we t electrostatic precipitator, or other types with wet scrubber and wet electrostatic precipitator.

Item 5.21. Indicate whether or not the RSC was determined using Table 2 at 40 CFR 503.43 (site-s pecific determination). If “yes” continue to Item 5.22. If “no” skip to Item 5.23 (Part 2, Section 5).

Item 5.22. Provide the decimal fraction of hexavalent chromium to total chromium concentration in the stack exit gas.

Item 5.23. Submit the results of incinerator stack testing for hexavalent and total chromium concentrations, including test dates. Check the box to indicate that these results have been attached to the application package, or check “not applicable”.

Incinerator Parameters

Item 5.24. Indicate whether you monitor total hydrocarbons (THC) in the exit gas of the sewage sludge incinerator.

Item 5.25. Indicate whether you monitor carbon monoxide (CO) in the exit gas of the sewage sludge incinerator.

Item 5.26. Specify the type of sewage sludge incinerator used.

Item 5.27. Provide the incinerator stack height in meters.

Item 5.28. Indicate whether the value submitted in Item 5.27 is the actual stack height or creditable stack height.
Performance Test Operating Parameters

Item 5.29. Provide the maximum performance test combustion temperature.

Item 5.30. Provide the performance test sewage sludge feed rate, in dry metric tons/day.

Item 5.31. Indicate whether the value submitted in Item 5.30 is the average use rate or maximum design rate.

Item 5.32. Supply supporting documentation describing how the feed rate was calculat ed. Check the box to indicate th at this documentation has been attached to the application package.

Item 5.33. Submit information documenting the performance test operating parameters for the air pollution control device(s) used for this sewage sludge incinerator. Check the box to indicate that this information has been attached to the application package.
Monitoring Equipment

Item 5.34. Use the table provided or a separate attachment, to indicate the equipment in place to monitor total hydrocarbons or

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED carbon monoxide, percent oxygen, percent moisture, combustion temperature, and any other parameters not listed.
Air Pollution Control Equipment

Item 5.35. List all air pollution control equipment used with this sewage sludge incinerator. Check the box to indicate that the list has been attached to the application package.

END OF PART 2
Submit your completed Part 2 of Form 2S and all associated attachments to your NPDES permitting authority.2S-20 

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FORM 2S

— GLOSSARY

NOTE: This Glossary includes terms used in the various NPDES applicat ion forms, including Form 2S. The definitions are from the NPDES regulations at 40 CFR 122.2 unless otherwise specified. If you have questions concerning the meaning of any of these term s, contact your NPDES permitting authority.

ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (oth er 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, in cluding any additions, revisions, or modifications to the forms; or forms approved by EPA for use in approved stat es, 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 harvestabl e freshwater, estuarine, or marine plants or animals. DESIGNATED PROJECT AREA means the portions of the waters of the United States with in which the permittee or permit applicant plans to confine the cultivated species, using a method or plan or operation (incl uding, but not limited to, physical confinement) which, on the bas is of reliable scientific evidence, is expected to ensure that specific i ndividual organisms comprising an aquaculture crop will enjoy increas ed 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 dur ing 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 dischar ges measured during a calendar week divided by the number of daily discharges measured during that week. BEST MANAGEMENT PRACTICES (BMP) 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, op eration procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw mater ial 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.

CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control A ct 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. COMBINED SEWER OVERFLOW (CSO) means a discharge of untreated wastewater fr om a combined sewer system at a point before the headworks of a publicly owned treatment works. CSOs generally occur during wet weather (rainfall or snowmelt). During perio ds of wet weather, these systems become overloaded, bypass treatment works, and discharge directly to receiving waters at designed overfl ow points. COMBINED SEWER SYSTEM (CSS) means a wastewater collection system tha t conv eys sanitary wastewaters (domestic, commercial and industrial wastewaters) and st ormwater through a single pipe to a publicly owned treatment works for treatment before disch arge to surface waters.

CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation which meets the criteria set forth in either (A) or (B) below or which the Di rector designates as such on a case-by-case basis:

A. More than the numbers of animals specified in any of the following categories are confined:

1. 1,000 slaughter or feeder cattle,

2. 700 mature dairy cattle (whether milked or dry cows),

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3. 2,500 swine each weighing over 25 kilograms (approximately 55 pounds),

4. 500 horses,

5. 10,000 sheep or lambs,
6. 55,000 turkeys,

7. 100,000 laying hens or broilers (if the fac ility has a continuous overflow watering),
8. 30,000 laying hens or broilers (if the facility has a liquid manure handling system),
9. 5,000 ducks, or
10. 1,000 animal units; or
B. More than the following numbers and types of animals are confined:

1. 300 slaughter or feeder cattle,
2. 200 mature dairy cattle (whether milked or dry cows),
3. 750 swine each weighing over 25 kilograms (approximately 55 pounds),
4. 150 horses,
5. 3,000 sheep or lambs,
6. 16,500 turkeys,
7. 30,000 laying hens or broilers (if the facility has continuous overflow watering),
8. 9,000 laying hens or broilers (if the facility has a liquid manure handling system),
9. 1,500 ducks, or
10. 300 animal units; AND
Either one of the following conditions are met: Pollutants are di scharged into waters of the United States through a manmade di tch, flushing system or other similar manmade device (“manmade” means constructed by man and used for the purpose of transporting wastes); or Pollutants are discharged directly into waters of the Unites States which originate outside of and pass over, acros s, or through the facility or otherwise come into direct contact with the animals confined in the operation.
Provided, however, that no animal feeding operation is a concent rated animal feeding operation as defined above if such animal feeding operation discharges only in the ev ent of a 25 year, 24 hour storm event.

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 followi ng categories, or which the Director designates as such on a c ase-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 kil ograms (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 dur ing 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.

DAILY DISCHARGE means the “discharge of a pollutant” measured duri ng a calendar day or any 24- hour period that reasonably represents the calendar day for purposes of sampling. For pollutant s with limitations expressed in units of mass, the “daily di scharge” is calculated a s 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 author ized representative. When there is no “approved State program,” and there is an EPA administered program, “Director” means the Regional Administrator. When the re is

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— GLOSSARY CONTINUED an approved State program, “Director” normally means the State Di rector. In some circumstances, however, EPA retains the author ity to take certain actions even when there is an approved State program. (For example, w hen EPA has issued an NPDES permit prior to t he approval of a State program, EPA may retain jurisdiction over t hat 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:

A. Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or
B. Any addition of any pollutant or combination of pollutants to t he waters of the contiguous zone or the ocean from any point sou rce 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 channeled by ma n; Discharges through pipes, sewers, or other c onveyances owned by a State, municipality, or other person which do not lead to POT W’s; and Discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not in clude 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 permi t, 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 oce an.

EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administra tor under section 304(b) of 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 an y 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 CWA.

INDIAN COUNTRY means: (1) All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstandin g the issuance of any patent, and, including rights-of-way running through the reservation;
(2) All dependent Indian communities with the borders of the United St ates whether within the originally or subsequently acquir ed territory thereof, and whether within or without the limits of a state; and
(3) All Indian allotments, the Indian titles to which have not been extinguished, including rights-of-way running through the s ame.

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 “pollut ants” to a “publicly owned treatment works.”

LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whos e discharges result from the holding of unprocessed wood, for example, logs or roundwood with bark or a fter 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 t he logs (wet decking). (See 40 CFR part 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.

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— GLOSSARY CONTINUED

MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable “daily discharge.”

MUNICIPALITY means a city, town, borough, county, parish, district, associ ation, 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 tri bal organization, or a designated and approved management agency under section 208 of CWA. MUNICIPAL SEPARATE STORM SEWER SYSTEM (MS4) (defined at § 122.26 (b)(4) and (b)(7)) means a conveyance or system of conveyances (including roads with drainage systems, municipal st reets, catch basins, curbs, gutters, ditches, man-made channels , or storm drains):

 Owned or operated by a state, city, town, borough, county, parish, district, associati on, or other public body ( created by or pursuant to state law ) having jurisdiction over disposal of sewage, indus trial 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 CWA section 208 that discharges to waters of the United States.

 Designed or used for collecting or conveying stormwater.

 [That] is not a combined sewer.

 [That] is not part of a Publicly Owned Treatm ent Works (POTW) as defined at § 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 secti ons 307, 402, 318, and 405 of CWA. The term includes an “approved program.”

NEW DISCHARGER means any building, structure, facility, or installation:
(a) From which there is or may be a “discharge of pollutants;”
(b) That did not commence the “discharge of pollutants” at a particular “site” prior to August 13, 1979;
(c) Which is not a “new source;” and
(d) Which has never received a finally effectiv e NDPES permit for discharges at that “site.”
This definition includes an “indirect discharger” which commences discharging into “waters of the United States” after August 1 3, 1979. It also means any existing mobile point source (other than an offs hore or coastal oil and gas exploratory drilling rig or a coasta l oil and gas developmental drilling rig) such as a seafood processing rig, s eafood processing vessel, or aggregate plant, that begins discha rging at a “site” for which it does not have a permit; and any offshore or c oastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas developmental drilling rig that commences the discharge of pollu tants after August 13, 1979, at a “site” under EPA's permitting jurisdiction for which it is not covered by an individual or general permi t and which is located in an area determined by the Regional Admin istrator in the issuance of a final permit to be an area of biological concer n. In determining whether an area is an area of biological con cern, the Regional Administrator shall consider the factors specified in 40 CFR 125.122(a) (1) through (10). An offshore or coastal mobil e exploratory drilling rig or coastal mobile developmental drilling rig will be considered a “new discharger” only for the durati on 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:
(a) After promulgation of standards of performance under se ction 306 of CWA which are applicable to such source, or
(b) After proposal of standards of performance in accordance with section 306 of CWA which are applicable to such source, but o nly 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 docu ment issued b y 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 includ e any permit which has not yet been the subject of final agency ac tion, such as a “draft permit” or a “proposed permit.”

PESTICIDE APPLICATIONS TO WA TERS OF THE UNITED STATES 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 definiti on of pesticide applications to waters of the United States, this does not in clude agricultural stormwater disc harges and return flows from irr igated agriculture, which are excluded by law (Id. § 1342(l)).

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FORM 2S

— GLOSSARY CONTINUED

POINT SOURCE means any discernible, confined, and discrete conveyance, in cluding 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 dischar ged. This term does not include return flows from irrigated agr iculture or agricultural stormwater runoff. (See § 122.3).

POLLUTANT means dredged spoil, solid waste, incinerator residue, f ilter backwash, sewage, garbage, sewage sludge, munitions, chemical wastes, biological materials, radioactive materials (e xcept those regulated under the Atomic Energy Act of 1954, as am ended (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:
(a) Sewage from vessels; or
(b) Water, gas, or other material which is injected into a we ll to facilitate production of oil or gas, or water derived in ass ociation 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 degra dation of ground or surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those encompassed in its definition o f source, byproduct, or special nuclear materials. Examples of material s not covered include radium and accelerator-produced isotopes. Se e 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 (a) used to treat wastes from any facility whose operator is not the operator of the treatment works and (b) 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, intermediat e product, finished product, byproduct, or waste product.

PROPOSED PERMIT means a State NPDES “permit” prepared after the clos e 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, or a State NPDES permit designated as a proposed permit under § 123.44(k). 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 Se ction 502(4)]. This definition includes any devices or systems u sed in the storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition al so includes sewers, pipes, and other conveyances only if they convey wastewat er to a POTW. The term also means the municipality as defined in CWA Section 502(4), which has jurisdiction over the indirect di scharges 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 representativ e 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 part 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 cat egory which is n ot 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 CWA, except that with respect to commercial ves sels on the Great Lakes this term includes gray water. For the purposes of this definition, “gray water” means galley, bath, and shower water.

SEWAGE SLUDGE means any solid, semi-solid, or liquid residue removed duri ng 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 treatm ent, scum, septage, portable toilet pumpings, type III marine sanita tion device pumpings (33 CFR part 159), and sewage sludge produc ts. Sewage sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge.

SlLVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock crushing, gravel washing, log sorting, or log storage facilit ies 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 nonpoint source silvicultural activities such as nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed burning, pest and f ire control, harvesting operations, surface drainage, or road construction and maintenance from whic h there is natural runoff. However, some of these

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FORM 2S

— GLOSSARY CONTINUED 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 SL UDGE USE OR DISPOSAL means the regulations promulgated purs uant to section 405(d) of the CWA which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage s ludge 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 Trus t Territory of the Pacific Islands, or an Indian Tribe as defi ned 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, “S tate Director” means the chief administrative officer of the State or inters tate agency authorized to perform t he particular procedure or func tion 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 c onveying stormwater and that is directly related to manufacturing, processing or raw materials storage areas at an industrial plant. The term does not include di scharges from facilities or activities excluded from the NPDE S program under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, sto rmwater 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 cr eated by the facility; material handling sites; refuse sites; sites used for the appli cation or disposal of process waste waters (as defined at part 401 of this chapt er); sites used for the storage and maintenance of material handli ng equipment; sites used for residual treatment, storage, or dispos al; shipping and receiving areas; manufacturing buildings; stor age areas (including tank farms) for raw materials, and intermediate and fi nal products; and areas where industrial activity has taken pl ace in the past and significant materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activitie s include storage, loading and unloading, transportation, or conveyance of an y 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 buildin gs and accompanying parking lots as long as the drainage from the excl uded areas is not mixed with stormwater drained from the above described areas. Industrial facilities (including industrial faci lities that are federally, Stat e, or municipally owned or oper ated that meet the description of the facilities listed in paragraphs (b)(14)(i) thr ough (xi) of this section) include those facilities designated under the provisions of paragraph (a)(1)(v) of this section. The following categor ies of facilities are considered engaging in “industrial activity” for purposes of paragraph (b)(14):
(i) Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effl uent standards under 40 CFR subchapter N (ex c ept facilities with toxic pollut ant effluent standards which are exempted under category (xi) in paragraph (b)(14) of this section);
(ii) Facilities classified as Standard Industr ial Classifications 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 Gro ups 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 si lvicultural facilities);
(iii) Facilities classified as Standard Industrial Classification s 10 through 14 (mineral industry) including active or inactiv e mining operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1) becau se the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of non-coal m ining operations which have been released from applic able State or Federal reclamation requirements after December 17, 1990) and oil and gas exploration, production, processing, or tr eatment operations, or transmission faciliti es that discharge stormwater contaminated by contact with or that has come into contact with, any overburden, ra w material, intermediate products, finished products, byproducts or waste products located on the site of such operations; (inactive mini ng operations are mining sites that are not being actively mined , but which have an identifiable owner/operator; inactive mining sites do not include sites where mining claims are being maintained prior to disturbances associated with the extraction, beneficiation, or pr ocessing of mined materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);

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– Not for Implementation

FORM 2S

— GLOSSARY CONTINUED (iv) Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a p ermit under subtitle C of RCRA;
(v) Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is receiv ed from any of the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA;
(vi) Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and auto mobile junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
(vii) Steam electric power generating fa cilities, including coal handling sites;
(viii) 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 air port deicing operations. Only those portions of the facility th at are either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication), equ ipment cleaning operations, airport deicing operations, or wh ich are otherwise identified under paragraphs (b)(14) (i)–(vii) or (ix)–(xi) of th is section are associated with industrial activity;
(ix) Treatment works treating domestic sew age 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 sludg e 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 pretreatmen t program under 40 CFR part 403. Not included are farm lands, domestic gardens or lands used for sludge management where sludge is benefi cially reused and which are not physically located in the confines of th e facility, or areas that are in compliance with section 405 o f the CWA;
(x) Construction activity including clearing, grading and excavati on, 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 pa rt of a larger common plan of development or sale if the larger comm on plan will ultimately disturb five acres or more;
(xi) 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 im plementing 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 n ot 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 tr eatment works. In States where there is no approved State sl udge management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standard s for sewage sludge use and disposal in 40 CFR part 503 as a “treatment works treating domestic sewage,” where he or she finds that t here is a potential for adverse effects on public health and the environm ent from poor sludge quality or poor sludge handling, use or d isposal practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR part 503..

UPSET (defined at § 122.41(n)) means an exceptional incident in wh ich there is unintentional and temporary noncompliance with technology based permit effluent limitations because of factor s beyond the reasonable control of the permittee. An upset does n ot include noncompliance to the extent caused by operational error, im properly designed treatment facilities, inadequate treatment facilit ies, lack of preventive maintenance, or ca reless or improper operation.

VARIAN CE means any mechanism or provision under section 301 or 316 of CWA or under 40 CFR part 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 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 CWA.

WATERS OF THE UNITED STATES (defined at § 122.2) means:
(a) All waters which are currently used, were used in the past, or may be susceptible to use in interstate or foreign commerce, including all waters which are subject to the ebb and flow of the tide; (b) All interstate waters, including interstate “wetlands;” (c) All other waters such as intrastate lakes, rivers, stream s (including intermittent streams), mudflats, sand flats, “wetlands,” sloughs, prairie potholes, wet meadows, playa lakes, or natural ponds the use, degradation, or destruction of which would affect or coul d affect interstate or foreign commerce including any such waters: (1) Which are or could be used by interstate or fo reign travelers for recreational or other purposes;

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FORM 2S

— GLOSSARY CONTINUED (2) From which fish or shellfish are or could be ta ken and sold in interstate or foreign commerce; or (3) Which are used or could be used for industrial pur poses by industries in interstate commerce; (d) All impoundments of waters otherwise defined as waters of the United States under this definition; (e) Tributaries of waters identified in paragraphs (a) through (d) of this definition; (f) The territorial sea; and (g) “Wetlands” adjacent to waters (other than waters that are themselves wetlands) identified in paragraphs (a) through (f) of this definition.
Waste treatment systems, including treatment ponds or lagoons designed to meet the requirements of CWA (other than cooling pond s as defined in 40 CFR 423.11(m) which also meet the criteria of this definition) are not waters of the United States. This exclusio n applies only to manmade bodies of water which neither were originally created in waters of the United States (such as disposal area in wetla nds) nor resulted from the impoundment of waters of the United States. [See Note 1 of this section.] Waters of the United States do not include prior converted cropland. Notwithstanding the determination of an area's status as prior converted cropland by any other federal agen cy, for the purposes of the Clean Water Act, the final authority r egarding Clean Water Act jurisdiction remains with EPA. WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test where the test results are based on acute (lethal) and/or chronic (lethal and sublethal) endpoints.EPA Form 3510-2S (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 This Part should be complete by “sludge-only” facilities (i.e., facilities that do not currently have, and are not applying for , an NPDES permit for a direct discharge to a surface body of water). PART 1, SECTION 1

. FACILITY INFORMATION (40 CFR 122.21(c)(2)(ii)(A))Facility Information 1.1 Facility Name

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Location Address (Street, Route Number, or Other Specific Identifier)  Same as mailing address
City or Town State ZIP Code

Facility Latitude/Longitude (See Instructions.) Latitude Longitude Degrees Minutes Seconds Degrees Minutes Seconds

Reference Point (Check one.) Collection Method Information 

##  Entrance to Facility Horizontal Collection Method (Type of method/device used to identify the coordinates) 

##  Center of Facility Scale (Proportional distance on the ground for one unit of measure)  Not Applicable 

##  Other (specify) Horizontal Reference Datum (Coordinate reference system)  NAD 27  NAD 83  WGS85  Other (specify)

1.2 Ownership Status 

##  Public—Federal 

##  Public—State 

##  Other Public (specify) 

##  Private 

##  Other (specify)

PART 1, SECTION 2. APPLICANT INFORMATION (40 CFR 122.21(c)(2)(ii)(B))Applicant Information 2.1 Is applicant different from entity listed under Item 1.1 above? 

##  Yes 

##  No  SKIP to Item 2.3 (Part 1, Section 2)

2.2 Applicant Name

Applicant Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

2.3 Is the applicant the facility’s owner, operator, or both? (Check only one response.) 

##  Owner 

##  Operator 

##  Both

2.4 To which entity should the NPDES permitting authority send correspondence? (Check only one response.) 

##  Facility 

##  Applicant 

##  Facility and Applicant (They are one and the same.) Form

2S NPDES U.S Environmental Protection Agency Application for NPDES Permit for Sewage Sludge Management

NEW AND EXISTING TREATMENT WORKS TREATING DOMESTIC SEWAGE
PRELIMINARY INFORMATION Does your facility currently have an effective NPDES permit or have you been directed by your NPDES permitting authority to sub mit a full Form 2S permit application? 

##  Yes  Complete Part 2 of application package (begins p. 5). 

##  No  Complete Part 1 of application package (below).

PART 1 LIMITED BACKGROUND INFORMATION (40 CFR 122.21(c)(2)(ii))EPA Form 3510-2S (Revised <INSERT DATE>) Page 2 EPA Identification Number NPDES Permit Number Facility Name Form Approved OMB No. <INSERT NO.> Form Expires <INSERT DATE>



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– Not for Implementation PART 1, SECTION 3

. SEWAGE SLUDGE AMOUNT (40 CFR 122.21(c)(2)(ii)(D))Sewage Sludge Amount 3.1 Provide the total dry metric tons per the latest 365 day period of sewage sludge generated, treated, used, and disposed:

Practice Dry Metric Tons per 365-Da y

Period Amount generated at the facility

Amount treated at the facility

Amount used (i.e., received from off-site) at the facility

Amount disposed at the facility
PART 1, SECTION 4

. POLLUTANT CONCENTRATIONS (40 CFR 122.21(c)(2)(ii)(E))Pollutant Concentrations 4.1 Using the table below or a separate attachment, provide existing sewage sludge monitoring data for the pollutants for which limits in sewage sludge have been established in 40 CFR Pa rt 503 for your facility’s expected use or disposal practices. If available, base data on three or more samples taken at least one month apart and no more than 4.5 years old. 

##  Check (  ) here if you have provided a separate attachment with this information.

Pollutant Concentration (mg/kg dry weight) Analytical Method Detection Level for Analysis Arsenic

Cadmium

Chromium

Copper

Lead

Mercury

Molybdenum

Nickel

Selenium

Zinc

Other (specify)

Other (specify)

Other (specify)

Other (specify)

Other (specify)

Other (specify)

Other (specify)

Other (specify)

Other (specify)EPA Form 3510-2S (Revised <INSERT DATE>) Page 3 EPA Identification Number NPDES Permit Number Facility Name Form Approved OMB No. <INSERT NO.> Form Expires <INSERT DATE>



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– Not for Implementation PART 1, SECTION 5

. TREATMENT PROVIDED AT YOUR FACI LITY (40 CFR 122.21(c)(2)(ii)(C))Treatment Provided At Your Facility 5.1 For each sewage sludge use or disposal practice, indi cate the amount of sewage sludge used or disposed, the applicable pathogen class and reduction alternative, and the applicable vector attraction reduction option. Attach additional pages, as necessary.
Use or Disposal Practice (Check one.) Amount (Dry Metric

Tons) Pathogen Class and Reduction Alternative Vector Attraction Reduction Option

 Land application of bulk sewage  Land application of biosolids (bulk)  Land application of biosolids (bags)  Surface disposal in a landfill  Other surface disposal  Incineration  Not Applicable  Class A – Alternative 1  Class A – Alternative 2  Class A – Alternative 3  Class A – Alternative 4  Class A – Alternative 5  Class A – Alternative 6  Class B – Alternative 1  Class B – Alternative 2  Class B – Alternative 3  Class B – Alternative 4  Domestic septage – pH adjustment  Not Applicable  Option 1  Option 2  Option 3  Option 4  Option 5  Option 6  Option 7  Option 8  Option 9  Option 10  Option 11

5.2 For each of the use and disposal practices specified in Ite m 5.1, identify the treatment process(es) used at your facility to reduce pathogens in sewage sludge or reduce the vector attraction properties of sewage sludge? (Check all that apply.) 

##  Preliminary operations (e.g., sludge grinding and degritting) 

##  Thickening (concentration)


##  Stabilization 

##  Anaerobic digestion 

##  Composting 

##  Conditioning


##  Disinfection (e.g., beta ray irradiation, gamma ray irradiation, pasteurization) 

##  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

##  Heat drying 

##  Thermal reduction 

##  Methane or biogas capture and recovery 

##  Other (specify)

PART 1, SECTION 6

. SEWAGE SLUDGE SENT TO OTHER FACI LITIES (40 CFR 122.21(c)(2)(ii)(C))Sewage Sludge Sent to Other Facilities 6.1 Does the sewage sludge from your facility meet the ceiling concentrations in Table 1 of 40 CFR 503.13, the pollutant concentrations in Table 3 of 40 CFR 503.13, Cla ss A pathogen reduction requirements at 40 CFR 503.32(a), and one of vector attraction reduction requirements at 40 CFR 503.33(b)(1)-(8)? 

##  Yes  SKIP to Part 1, Section 8 (Certification) 

##  No

6.2 Is sewage sludge from your facility provided to another facility for treatment, distribution, use, or disposal? 

##  Yes 

##  No  SKIP to Part 1, Section 7 (Use and Disposal Sites)
6.3 Receiving Facility Name

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

6.4 Which activities does the receiving facility provide? (Check all that apply.) 

##  Treatment or blending 

##  Sale or give-away in bag or other container 

##  Land application 

##  Surface disposal 

##  Incineration 

##  Other (describe) 

##  CompostingEPA Form 3510-2S (Revised <INSERT DATE>) Page 4 EPA Identification Number NPDES Permit Number Facility Name Form Approved OMB No. <INSERT NO.> Form Expires <INSERT DATE>



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– Not for Implementation PART 1, SECTION 7

. USE AND DISPOSAL SITES ( 40 CFR 122.21(c)(2)(ii)(C))Use and Disposal Sites Provide the following information for each site on which sewage sludge from this facility is used or disposed. 

##  Check (  ) here if you have provided separate attachments with this information.
7.1 Site Name or Number

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Location Address (Street, Route Number, or Other Specific Identifier)  Same as mailing address City or Town State ZIP Code

County County Code  Not Available

Latitude/Longitude of Use or Disposal Site (See Instructions.) 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)

7.2 Site type (Check all that apply.) 

##  Agricultural 

##  Lawn or home garden 

##  Forest 

##  Surface disposal 

##  Public contact 

##  Incineration 

##  Reclamation 

##  Municipal solid waste landfill 

##  Other (describe)

PART 1, SECTION 8

. CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))Certification Statement 8.1 I certify under penalty of law that this document and all a ttachments were prepared under my direction or supervision in accordance with a system designed to assure that qua lified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or per sons 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 Phone Number

Signature Date Signed



### PART 1 APPLICANTS STOP HERE.

Submit completed application package to your NPDES permitting authority.EPA Form 3510-2S (Revised <INSERT DATE>) Page 5 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 PART 2 PERMIT APPLICATION INFORM ATION (40 CFR 122.21(q)) Complete this part if you have an effective NPDES permit or have been directed by the NPDES permitting authority to submit a fu ll permit application. In other words, complete this part if your facility has, or is applying for, an NPDES permit. Part 2 is divided into five sections. Section 1 pertains to all applicants. The applicability of Sections 2 to 5 depends on your facility’s sewage sludge use or disposal practices. See the Instructions to determine the sections you are required to complete. PART 2, SECTION 1

. GENERAL INFORMATION (40 CFR 122.21(q)(1

– 7) and (q)(13))General Information This section must be completed by all Part 2 applicants. Facility Information

1.1 Facility Name

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code Phone Number

Contact Name (first and last) Title Email Address

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address

City or Town State ZIP Code

Facility Latitude/Longitude (See Instructions.) Latitude Longitude Degrees Minutes Seconds Degrees Minutes Seconds

Reference Point (Check one.) Collection Method Information 

##  Entrance to Facility Horizontal Collection Method (Type of method/device used to identify the coordinates) 

##  Center of Facility Scale (Proportional distance on the ground for one unit of measure)  Not Applicable 

##  Other (specify) Horizontal Reference Datum (Coordinate reference system)  NAD 27  NAD 83  WGS85  Other (specify)

1.2 Is this facility a Class I sludge management facility? 

##  Yes 

##  No
1.3 Facility Design Flow Rate million gallons per day (mgd)
1.4 Total Population Served
1.5 Ownership Status 

##  Public–Federal 

##  Public—State 

##  Other Public (specify) 

##  Private 

##  Other (specify)

Applicant Information

1.6 Is applicant different from entity listed under Item 1.1 above? 

##  Yes 

##  No  SKIP to Item 1.18 (Part 2, Section 1)
1.7 Applicant Name

Applicant Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

1.8 Is the applicant the facility’s owner, operator, or both? (Check only one response.) 

##  Operator 

##  Owner 

##  Both
1.9 To which entity should the NPDES permitting authority send correspondence? (Check only one response.) 

##  Facility 

##  Applicant 

##  Facility and Applicant (They are one and the same.)EPA Form 3510-2S (Revised <INSERT DATE>) Page 6 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 ImplementationGeneral Information Continued Permit Information
1.10 Facility’s NPDES permit number NPDES Permit Number 

##  Check (  ) here if you do not have an NPDES permit but are otherwise required to submit Part 2 of Form 2S.
1.11 Indicate all other federal, state, and local permits or cons truction approvals received or applied for that regulate this facility’s sewage sludge management practices below. 

##  Check (  ) here if you have provided a separate attachment with this information.
Existing Environment Permits (Check all that apply and print or type the corresponding permit number for each.) 

##  RCRA (hazardous wastes) 

##  Nonattainment program (CAA) 

##  NESHAPS (CAA)



##  PSD (air emissions) 

##  Dredge or fill (CWA Section 404) 

##  Other (specify)



##  Ocean dumping (MPRSA) 

##  UIC (underground injection of fluids)

Indian Country 1.12 Does any generation, treatment, storage, application to land, or disposal of sewage sludge from this facility occur in Indian Country? 

##  Yes 

##  No  SKIP to Item 1.14 (Part 2, Section 1) below. 1.13 Provide a description of the generation, treatment, storage, land application, or disposal of sewage sludge that occurs.

Topographic Map 1.14 Have you attached a topographic map containing all required information to this application? (See Instructions for specific requirements.) 

##  Yes 

##  No Line Drawing 1.15 Have you attached a line drawing and/or a narrative descrip tion that identifies all sewage sludge practices that will be employed during the term of the permit containing all the required information to this application? (See Instructions for specific requirements.) 

##  Yes 

##  No

Contractor Information 1.16 Do contractors have any operational or maintenance responsibilities related to sewage sludge generation, treatment, use, or disposal at the facility? 

##  Yes 

##  No  SKIP to Item 1.18 (Part 2, Section 1) below. 1.17 Provide the following information for each contractor. 

##  Check (  ) here if you have attached additional sheets to the application package.

Contractor 1 Contractor 2 Contractor 3
Contractor Company Name
Mailing Address (Street or P.O. Box)
City, State, and ZIP Code

Contact Name (first and last)

Telephone Number

Email Address  Not Available  Not Available  Not AvailableEPA Form 3510-2S (Revised <INSERT DATE>) Page 7 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 ImplementationGeneral Information Continued 1.17 Contractor 1 Contractor 2 Contractor 3
cont. Responsibilities of Contractor

Pollutant Concentrations Using the table below or a separate attachment, provide sewage sludge monitoring data for the pollutants for which limits in sewage sludge have been established in 40 CFR Part 503 for this facilit y’s expected use or disposal practices. All data must be based on three or more samples taken at least one month apart and must be no more than 4.5 years old. 

##  Check (  ) here if you have attached additional sheets to the application package.

1.18 Pollutant Average Monthly Concentration (mg/kg dry weight) Analytical Method Detection Level

Arsenic
Cadmium
Chromium Copper
Lead Mercury Molybdenum
Nickel
Selenium
Zinc Checklist and Certification Statement

1.19 In Column 1 below, mark the Form 2S, Part 2 section you have completed and are submitting with your application. For each section, specify in Column 2 if you are enclosing attachments. Note that not all applicants are required to complete all sections or provide attachments. See Exhibit 2S-2 in the Instructions.

Column 1 Column 2 

##  Section 1 (General Information) 

##  w/ attachments 

##  Section 2 (Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge) 

##  w/ attachments 

##  Section 3 (Land Application of Bulk Sewage Sludge) 

##  w/ attachments 

##  Section 4 (Surface Disposal) 

##  w/ attachments 

##  Section 5 (Incineration) 

##  w/ attachments
1.20 I certify under penalty of law that this document and all atta chments were prepared under my direction or supervision in accordance with a system designed to assure that qualif ied personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or per sons 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

Telephone Number

Upon the request of the NPDES permitting authority, you must su bmit any other information the authority deems necessary to assess sewage sludge use or disposal practices at your facility and identify appropriate permitting requirements.EPA Form 3510-2S (Revised <INSERT DATE>) Page 8 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 PART 2, SECTION 2

. GENERATION OF SEWAGE SLUDGE OR PREPARATION OF A MATERIAL DERIVED FROM SEWAGE SLUDGE (40 CFR 122.21( q)(8) through (12))Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge 2.1 Does your facility generate sewage sludge or derive a material from sewage sludge? 

##  Yes 

##  No  SKIP to Part 2, Section 3.
Amount Generated Onsite 2.2 Total dry metric tons per 365-day period generated at your facility:

Amount Received from Off-site Facility 2.3 Does your facility receive sewage sludge from another facility for treatment use or disposal? 

##  Yes 

##  No  SKIP to Item 2.7 (Part 2, Section 2) below. 2.4 Indicate the total number of facilities from which you receive sewage sludge for treatment, use, or disposal:
Provide the following information for each of the facilities from which you receive sewage sludge. 

##  Check (  ) here if you have attached additional sheets to the application package. 2.5 Name of Facility

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address

City or Town State ZIP Code

County County Code  Not Available

Latitude/Longitude of Off-site Facility (See Instructions.) Latitude Longitude Degrees Minutes Seconds Degrees Minutes Seconds

Reference Point (Check one.) Collection Method Information 

##  Entrance to Facility Horizontal Collection Method (Type of method/device used to identify the coordinates) 

##  Center of Facility Scale (Proportional distance on the ground for one unit of measure)  Not Applicable 

##  Other (specify) Horizontal Reference Datum (Coordinate reference system)  NAD 27  NAD 83  WGS85  Other (specify)EPA Form 3510-2S (Revised <INSERT DATE>) Page 9 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 ImplementationGeneration of Sewage Sludge or Preparation of aMaterial Derived from Sewage Sludge Continued 2.6 Indicate the amount of sewage sludge received, the applicable pathogen class and reduction alternative, and the applicable vector reduction option provided at the off-site facility. Amount (Dry Metric Tons) Pathogen Class and Reduction Alternative Vector Attraction Reduction Option

 Not Applicable  Class A – Alternative 1  Class A – Alternative 2  Class A – Alternative 3  Class A – Alternative 4  Class A – Alternative 5  Class A – Alternative 6  Class B – Alternative 1  Class B – Alternative 2  Class B – Alternative 3  Class B – Alternative 4  Domestic septage – pH adjustment  Not Applicable  Option 1  Option 2  Option 3  Option 4  Option 5  Option 6  Option 7  Option 8  Option 9  Option 10  Option 11 2.7 Identify the treatment process(es) that are known to o ccur at the off-site facility, including blending activities and treatment to reduce pathogens or vector a ttraction properties? (Check all that apply.) 

##  Preliminary operations (e.g., sludge grinding and degritting) 

##  Thickening (concentration)


##  Stabilization 

##  Anaerobic digestion 

##  Composting 

##  Conditioning


##  Disinfection (e.g., beta ray irradiation, gamma ray irradiation, pasteurization) 

##  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

##  Heat drying 

##  Thermal reduction 

##  Methane or biogas capture and recovery 

##  Other (specify)

Treatment Provided at Your Facility 2.8 For each sewage sludge use or disposal practice, indica te the applicable pathogen class and reduction alternative and the applicable vector attraction reduction option provided at your facility. Attach additional pages, as necessary. Use or Disposal Practice (Check one.) Pathogen Class and Reduction Alternative Vector Attraction Reduction Option

 Land application of bulk sewage  Land application of biosolids (bulk)  Land application of biosolids (bags)  Surface disposal in a landfill  Other surface disposal  Incineration  Not Applicable  Class A – Alternative 1  Class A – Alternative 2  Class A – Alternative 3  Class A – Alternative 4  Class A – Alternative 5  Class A – Alternative 6  Class B – Alternative 1  Class B – Alternative 2  Class B – Alternative 3  Class B – Alternative 4  Domestic septage – pH adjustment  Not Applicable  Option 1  Option 2  Option 3  Option 4  Option 5  Option 6  Option 7  Option 8  Option 9  Option 10  Option 11EPA Form 3510-2S (Revised <INSERT DATE>) Page 10 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 ImplementationGeneration of Sewage Sludge or Preparation of aMaterial Derived from Sewage Sludge Continued 2.9 Identify the treatment process(es) used at your facilit y to reduce pathogens in sewage sludge or reduce the vector attraction properties of sewage sludge? (Check all that apply.) 

##  Preliminary operations (e.g., sludge grinding and degritting) 

##  Thickening (concentration) 

##  Stabilization 

##  Anaerobic digestion 

##  Composting 

##  Conditioning


##  Disinfection (e.g., beta ray irradiation, gamma ray irradiation, pasteurization) 

##  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

##  Heat drying 

##  Thermal reduction 

##  Methane or biogas capture and recovery
2.10 Describe any other sewage sludge treatment or blending activities not identified in Items 2.8 and 2.9 (Part 2, Section 2) above. 

##  Check (  ) here if you have attached the description to the application package.

Preparation of Sewage Sludge Meetin g Ceiling and Pollutant Concentrations , Class A Pathogen Requirements, and One of Vector Attraction Reduction Options 1 to 8 2.11 Does the sewage sludge from your facility meet the ceiling concentrations in Table 1 of 40 CFR 503.13, the pollutant concentrations in Table 3 of 40 CFR 503.13, Cla ss A pathogen reduction requirements at 40 CFR 503.32(a), and one of the vector attraction reduction requirements at 40 CFR 503.33(b)(1)-(8) and is it land applied? 

##  Yes 

##  No  SKIP to Item 2.14 (Part 2, Section 2) below. 2.12 Total dry metric tons per 365-day period of sewage sludge subject to this subsection that is applied to the land:
2.13 Is sewage sludge subject to this subsection placed in bags or other containers for sale or give-away for application to th e land? 

##  Yes 

##  No 

##  Check (  ) here once you have completed Items 2.11 to 2.13 then  SKIP to Item 2.32 (Part 2, Section 2) below. Sale or Give-away in a Bag or Other Container for Application to the Land 2.14 Do you place sewage sludge in a bag or other container for sale or give-away for land application? 

##  Yes 

##  No  SKIP to Item 2.17 (Part 2, Section 2) below.

2.15 Total dry metric tons per 365-day period of sewage sludge placed in a bag or other container at your facility for sale or give-away for application to the land:
2.16 Attach a copy of all labels or notices that accompan y the sewage sludge being sold or given away in a bag or other container for application to the land. 

##  Check (  ) here to indicate that you have attached all labels or notices to this application package.


##  Check (  ) here once you have completed Items 2.14 to 2.16 then  SKIP to Part 2, Section 2, Item 2.32.EPA Form 3510-2S (Revised <INSERT DATE>) Page 11 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 ImplementationGeneration of Sewage Sludge or Preparation of aMaterial Derived from Sewage Sludge Continued Shipment Off-site for Treatment or Blending
2.17 Does another facility provide treatment or blending of your facility’s sewage sludge? (This question does not pertain to dewatered sludge sent directly to a land application or surface disposal site.) 

##  Yes 

##  No  SKIP to Item 2.32 (Part 2, Section 2) below.

2.18 Indicate the total number of facilities that prov ide treatment or blending of your facility’s sewage sludge: (Provide the information in Items 2.19 to 2.26 (Part 2, Section 2) below for each facility.) 

##  Check (  ) here if you have attached additional sheets to the application package.
2.19 Name of Receiving Facility

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address

City or Town State ZIP Code

2.20 Total dry metric tons per 365-day period of sewage sludge provided to receiving facility:

2.21 Does the receiving facility provide additional treatment to reduce pathogens in sewage sludge from your facility or reduce the vector attraction properties of sewage sludge from your facility? 

##  Yes 

##  No  SKIP to Item 2.24 (Part 2, Section 2) below. 2.22 Indicate the pathogen class and reduction alternative and the vector attraction reduction option met for the sewage sludge at the receiving facility. Pathogen Class and Reduction Alternative Vector Attraction Reduction Option  Not Applicable  Class A – Alternative 1  Class A – Alternative 2  Class A – Alternative 3  Class A – Alternative 4  Class A – Alternative 5  Class A – Alternative 6  Class B – Alternative 1  Class B – Alternative 2  Class B – Alternative 3  Class B – Alternative 4  Domestic septage – pH adjustment  Not Applicable  Option 1  Option 2  Option 3  Option 4  Option 5  Option 6  Option 7  Option 8  Option 9  Option 10  Option 11 2.23 Which treatment process(es) are used at the receiving faci lity to reduce pathogens in sewage sludge or reduce the vector attraction properties of sewage sludge from your facility? (Check all that apply.) 

##  Preliminary operations (e.g., sludge grinding and degritting) 

##  Thickening (concentration)


##  Stabilization 

##  Anaerobic digestion 

##  Composting 

##  Conditioning


##  Disinfection (e.g., beta ray irradiation, gamma ray irradiation, pasteurization) 

##  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

##  Heat drying 

##  Thermal reduction 

##  Methane or biogas capture and recovery 

##  Other (specify)EPA Form 3510-2S (Revised <INSERT DATE>) Page 12 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 2.24 Attach a copy of any information you provide the receiving facility to comply with the “notice and necessary information” requirement of 40 CFR 503.12(g). 

##  Check (  ) here to indicate that you have attached material. 2.25 Does the receiving facility place sewage sludge from your fa cility in a bag or other container for sale or give-away for application to the land? 

##  Yes 

##  No  SKIP to Item 2.32 (Part 2, Section 2) below. 2.26 Attach a copy of all labels or notices that accompany the product being sold or given away. 

##  Check (  ) here to indicate that you have attached material. 

##  Check (  ) here once you have completed Items 2.17 to 2.26 (Part 2, Section 2) then  SKIP to Item 2.32 (Part 2, Section 2) below. Land Application of Bulk Sewage Sludge 2.27 Is sewage sludge from your facility applied to the land? 

##  Yes 

##  No  SKIP to Item 2.32 (Part 2, Section 2) below. 2.28 Total dry metric tons per 365-day period of sewage sludge applied to all land application sites:
2.29 Did you identify all land application sites in Part 2, Section 3 of this application? 

##  Yes 

##  No  Submit a copy of the land application plan with your application. 2.30 Are any land application sites located in states other than the state where you generate sewage sludge or derive a material from sewage sludge? 

##  Yes 

##  No  SKIP to Item 2.32 (Part 2, Section 2) below. 2.31 Describe how you notify the NPDES permitting authority for the states where the land application sites are located. Attach a copy of the notification. 

##  Check (  ) here if you have attached the explanation to the application package. 

##  Check (  ) here if you have attached the notification to the application package. Surface Disposal 2.32 Is sewage sludge from your facili ty placed on a surface disposal site? 

##  Yes 

##  No  SKIP to Item 2.39 (Part 2, Section 2) below. 2.33 Total dry metric tons of sewage sludge from your facility placed on all surface disposal sites per 365-day period: 2.34 Do you own or operate all surface disposal si tes to which you send sewage sludge for disposal?



##  Yes  SKIP to Item 2.39 (Part 2, Section 2) below. 

##  No
2.35 Indicate the total number of surface disposal sites to which you send your sewage sludge: (Provide the information in Items 2.36 to 2.38 of Part 2, Section 2 for each facility.) 

##  Check (  ) here if you have attached additional sheets to the application package.EPA Form 3510-2S (Revised <INSERT DATE>) Page 13 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 ImplementationGeneration of Sewage Sludge or Preparation of aMaterial Derived from Sewage Sludge Continued 2.36 Site name or number of surface disposal site you do not own or operate

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

2.37 Site Contact (Check all that apply.) 

##  Owner 

##  Operator
2.38 Total dry metric tons of sewage sludge fr om your facility placed on this surface disposal site per 365-day period:
Incineration 2.39 Is sewage sludge from your facility fired in a sewage sludge incinerator? 

##  Yes 

##  No  SKIP to Item 2.46 (Part 2, Section 2) below. 2.40 Total dry metric tons of sewage sludge from your facility fired in all sewage sludge incinerators per 365-day period: 2.41 Do you own or operate all sewage sludge incinerators in which sewage sludge from your facility is fired? 

##  Yes  SKIP to Item 2.46 (Part 2, Section 2) below. 

##  No
2.42 Indicate the total number of sewage sludge incinerators used that you do not own or operate: (Provide the information in Items 2.43 to 2.45 directly below for each facility.) 

##  Check (  ) here if you have attached additional sheets to the application package.
2.43 Incinerator Name or Number

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address

City or Town State ZIP Code

2.44 Contact (Check all that apply.) 

##  Incinerator Owner 

##  Incinerator Operator 2.45 Total dry metric tons of sewage sludge from your facility fired in this sewage sludge incinerator per 365-day period: Disposal in a Municipal Solid Waste Landfill 2.46 Is sewage sludge from your facility placed on a municipal solid waste landfill? 

##  Yes 

##  No  SKIP to Part 2, Section 3. 2.47 Indicate the total number of municipal solid waste landfills used: (Provide the information in Items 2.48 to 2.52 directly below for each facility.) 

##  Check (  ) here if you have attached additional sheets to the application package.EPA Form 3510-2S (Revised <INSERT DATE>) Page 14 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 ImplementationGeneration of Sewage Sludge or Preparation of aMaterial Derived from Sewage Sludge Continued 2.48 Name of Landfill

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address

County County Code  Not Available

City or Town State ZIP Code

Latitude/Longit ude of Landfill (See Instructions.) Latitude Longitude Degrees Minutes Seconds Degrees Minutes Seconds

Reference Point (Check one.) Collection Method Information 

##  Entrance to Facility Horizontal Collection Method (Type of method/device used to identify the coordinates) 

##  Center of Facility Scale (Proportional distance on the ground for one unit of measure)  Not Applicable 

##  Other (specify) Horizontal Reference Datum (Coordinate reference system)  NAD 27  NAD 83  WGS85  Other (specify)

2.49 Total dry metric tons of sewage sludge from your facility placed in this municipal solid waste landfill per 365-day period: 2.50 List the numbers of all other federal, state, and local permits that regulate the operation of this municipal solid waste landfill.
Permit Number Type of Permit

2.51 Attach to the application information to determine whet her the sewage sludge meets applicable requirements for disposal of sewage sludge in a municipal solid waste landfill (e.g., results of paint filter liquids test and TCLP test)? 

##  Check here (  ) to indicate you have attached the requested information.

2.52 Does the municipal solid waste landfill comply with applicable criteria set forth in 40 CFR Part 258? 

##  Yes 

##  NoEPA Form 3510-2S (Revised <INSERT DATE>) Page 15 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 PART 2, SECTION 3

— LAND APPLICATION OF BULK SEWAGE SLUDGE (40 CFR 122.21(q)(9))Land Application of Bulk Sewage Sludge 3.1 Does your facility apply sewage sludge to land? 

##  Yes 

##  No  SKIP to Part 2, Section 4.
3.2 Do any of the following conditions apply?

 The sewage sludge meets the ceiling concentrations in Table 1 of 40 CFR 503.12, the pollutant concentrations in Table 3 of 40 CFR 503.13, Class A pathogen reduction requirements at 40 CFR 503.32(a), and one of the vector attraction reduction requirements at 40 CFR 503.33(b)(1)-(8);

 The sewage sludge is sold or given away in a bag or other container for application to the land; or

 You provide the sewage sludge to another facility for treatment or blending. 

##  Yes  SKIP to Part 2, Section 4. 

##  No
3.3 Complete Section 3 for every site on which the sewage sludge is applied. 

##  Check here (  ) if you have attached sheets to the application package for one or more land application sites. Identification of Land Application Site 3.4 Site Name or Number

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address

County County Code  Not Available

City or Town State ZIP Code

Latitude/Longitude of Land Application Site (See Instructions.) 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)

3.5 Provide a topographic map (or other appropriate map if a t opographic map is unavailable) that shows the site location. 

##  Check here (  ) to indicate you have attached a topographic map for this site.
Owner Information 3.6 Are you the owner of this land application site? 

##  Yes  SKIP to Item 3.8 (Part 2, Section 3) below. 

##  No
3.7 Owner Name

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Applier Information 3.8 Are you the person who applies, or who is responsible for application of, sewage sludge to this land application site?


##  Yes  SKIP to Item 3.10 (Part 2, Section 3) below. 

##  NoEPA Form 3510-2S (Revised <INSERT DATE>) Page 16 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 ImplementationLand Application of Bulk Sewage Sludge Continued 3.9 Applier’s Name

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Site Type 3.10 Type of Land Application: 

##  Agricultural land 

##  Forest 

##  Reclamation site 

##  Public contact site 

##  Other (describe) Crop or Other Vegetation Grown on Site 3.11 What type of crop or other vegetation is grown on this site?

3.12 What is the nitrogen requirement for this crop or vegetation?

Vector Attraction Reduction 3.13 Are the vector attraction reduction requirements at 40 CFR 503.33(b)(9) and (b)(10) met when sewage sludge is applied to the land application site? 

##  Yes 

##  No  SKIP to Item 3.16 (Part 2, Section 3) below. 3.14 Indicate which vector attraction reduction option is met. (Check only one response.) 

##  Option 9 (Injection below land surface) 

##  Option 10 (Incorporation into soil within 6 hours) 3.15 Describe any treatment processes used at the land applicat ion site to reduce vector attraction properties of sewage sludge. 

##  Check here (  ) if you have attached your description to the application package. Cumulative Loadings and Remaining Allotments 3.16 Is the sewage sludge applied to this site since July 20, 1993 subject to the cumulative pollutant loading rates (CPLRs) in 40 CFR 503.13(b)(2)? 

##  Yes 

##  No  SKIP to Part 2, Section 4. 3.17 Have you contacted the NPDES permitting authority in the state where the bulk sewage sludge subject to CPLRs will be applied to ascertain whether bulk sewage sludge subject to CPLRs has been applied to this site on or since July 20, 1993?



##  Yes 

##  No  Sewage sludge subject to CPLRs may not be applied to this site. SKIP to Part 2, Section 4. 3.18 Provide the following information r egarding your NPDES permitting authority: NPDES Permitting Authority Name
Contact Person Telephone Number
Email Address
3.19 Based upon your inquiry, has bulk sewage sludge subject to CPLRs been applied to this site since July 20, 1993? 

##  Yes 

##  No  SKIP to Part 2, Section 4.EPA Form 3510-2S (Revised <INSERT DATE>) Page 17 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 ImplementationLand Application of Bulk Sewage SludgeContinued 3.20 Provide the following information for every facility other t han yours that is sending, or has sent, bulk sewage sludge subject to CPLRs to this site since July 20, 1993. If more than one such facility sends sewage sludge to this site, attach additional pages as necessary. 

##  Check here (  ) to indicate that additional pages are attached.
Facility Name

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email AddressEPA Form 3510-2S (Revised <INSERT DATE>) Page 18 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 PART 2, SECTION 4

— SURFACE DISPOSAL (40 CFR 122.21(q)(10))Surface Disposal 4.1 Do you own or operate a surface disposal site? 

##  Yes 

##  No  SKIP to Part 2, Section 5.

4.2 Complete all items in Section 4 for each active sewage sludge unit that you own or operate. 

##  Check here (  ) to indicate that you have attached material to the application package for one or more active sewage sludge units. Information on Active Sewage Sludge Units 4.3 Unit Name or Number

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address

County County Code  Not Ava

City or Town State ZIP Code

Latitude/Longitude of Active Sewage Sludge Unit (See Instructions.) 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)

4.4 Provide a topographic map (or other appropriate map if a t opographic map is unavailable) that shows the site location. 

##  Check here (  ) to indicate that you have completed and attached a topographic map. 4.5 Total dry metric tons of sewage sludge placed on the active sewage sludge unit per 365-day period: 4.6 Total dry metric tons of sewage sludge placed on the active sewage sludge unit over the life of the unit: 4.7 Does the active sewage sludge unit have a liner with a maximum permeability of 1 × 10 -7 centimeters per second (cm/sec)? 

##  Yes 

##  No  SKIP to Item 4.9 (Part 2, Section 4) below. 4.8 Describe the liner: 

##  Check here (  ) to indicate that you have attached a description to the application package.

4.9 Does the active sewage sludge unit have a leachate collection system? 

##  Yes 

##  No  SKIP to Item 4.11 (Part 2, Section 4) below. 4.10 Describe the leachate collection system and the method used for leachate disposal and provide the numbers of any federal, state, or local permit(s) for leachate disposal. 

##  Check here (  ) to indicate that you have attached the description to the application package.EPA Form 3510-2S (Revised <INSERT DATE>) Page 19 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 ImplementationSurface DisposalContinued 4.11 Is the boundary of the active sewage sludge unit less than 150 mete rs from the property line of the surface disposal site? 

##  Yes 

##  No  SKIP to Item 4.13 (Part 2, Section 4) below. 4.12 Provide the actual distance in meters: meters
4.13 Remaining capacity of active sewage sludge unit in dry metric tons: dry metric tons
4.14 Anticipated closure date for active sewage sludge unit, if known (MM/DD/YYYY):

4.15 Attach a copy of any closure plan that has been developed for this active sewage sludge unit. 

##  Check here (  ) to indicate that you have attached a copy of the closure plan to the application package. Sewage Sludge from Other Facilities 4.16 Is sewage sludge sent to this active sewage sludge unit from any facilities other than your facility? 

##  Yes 

##  No  SKIP to Item 4.21 (Part 2, Section 4) below. 4.17 Indicate the total number of facilities (other than your facility) that send sewage sludge to this active sewage sludge unit: Complete Items 4.18 to 4.20 directly below for each such facility. 

##  Check here (  ) to indicate that you have attached responses for each facility to the application package. 4.18 Facility Name

Mailing Address (Street or P.O. Box)

City or Town State ZIP Code

Contact Name (first and last) Title Phone Number Email Address

4.19 Indicate the pathogen class and reduction alternative and the vector attraction reduction option met for the sewage sludge before leaving the other facility. Pathogen Class and Reduction Alternative Vector Attraction Reduction Option  Not Applicable  Class A – Alternative 1  Class A – Alternative 2  Class A – Alternative 3  Class A – Alternative 4  Class A – Alternative 5  Class A – Alternative 6  Class B – Alternative 1  Class B – Alternative 2  Class B – Alternative 3  Class B – Alternative 4  Domestic septage – pH adjustment  Not Applicable  Option 1  Option 2  Option 3  Option 4  Option 5  Option 6  Option 7  Option 8  Option 9  Option 10  Option 11 4.20 Which treatment process(es) are used at the other facilit y to reduce pathogens in sewage sludge or reduce the vector attraction properties of sewage sludge before leavi ng the other facility? (Check all that apply.) 

##  Preliminary operations (e.g., sludge grinding and degritting) 

##  Thickening (concentration) 

##  Stabilization 

##  Anaerobic digestion 

##  Composting 

##  Conditioning 

##  Disinfection (e.g., beta ray irradiation, gamma ray irradiation, pasteurization) 

##  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

##  Heat drying 

##  Thermal reduction 

##  Methane or biogas capture and recovery 

##  Other (specify)EPA Form 3510-2S (Revised <INSERT DATE>) Page 20 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 Vector Attraction Reduction 4.21 Which vector attraction reduction option, if any, is me t when sewage sludge is placed on this active sewage sludge unit? 

##  Option 9 (Injection below and surface) 

##  Option 11 (Covering active sewage sludge unit daily) 

##  Option 10 (Incorporation into soil within 6 hours) 

##  None 4.22 Describe any treatment processes used at the active sew age sludge unit to reduce vector attraction properties of sewage sludge. 

##  Check here (  ) if you have attached your description to the application package.

Groundwater Monitoring 4.23 Is groundwater monitoring currently conducted at this active sewage sludge unit, or are groundwater monitoring data otherwise available for this active sewage sludge unit? 

##  Yes 

##  No  SKIP to Item 4.26 (Part 2, Section 4) below. 4.24 Provide a copy of available groundwater monitoring data. 

##  Check here (  ) to indicate you have attached the monitoring data.
4.25 Describe the well locations, the approximate depth to gr oundwater, and the groundwater monitoring procedures used to obtain these data. 

##  Check here (  ) if you have attached your description to the application package.

4.26 Has a groundwater monitoring program been pr epared for this active sewage sludge unit? 

##  Yes 

##  No  SKIP to Item 4.28 (Part 2, Section 4) below. 4.27 Submit a copy of the groundwater monitoring program with this permit application. 

##  Check here (  ) to indicate you have attached the monitoring program.
4.28 Have you obtained a certification from a qualified groundwat er scientist that the aquifer below the active sewage sludge unit has not been contaminated? 

##  Yes 

##  No  SKIP to Item 4.30 (Part 2, Section 4) below. 4.29 Submit a copy of the certification with this permit application. 

##  Check here (  ) to indicate you have attached the certification to the application package.
Site-Specific Limits 4.30 Are you seeking site-specific pollutant limits for the sewage sludge placed on the active sewage sludge unit? 

##  Yes 

##  No  SKIP to Part 2, Section 5. 4.31 Submit information to support the request for site-specific pollutant limits with this application 

##  Check here (  ) to indicate you have attached the requested information.EPA Form 3510-2S (Revised <INSERT DATE>) Page 21 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 PART 2, SECTION 5

— INCINERATION (40 CFR 122.21(q)(11))Incineration Incinerator Information 5.1 Do you fire sewage sludge in a sewage sludge incinerator? 

##  Yes 

##  No  SKIP to END. 5.2 Indicate the total number of incinerators used at your facility? (Complete the remainder of Section 5 for each such incinerator.) 

##  Check (  ) here to indicate that you have attached information for one or more incinerators. 5.3 Incinerator Name or Number

Location Address (Street, Route Number or Other Specific Identifier)

County County Code  Not Available

City or Town State ZIP Code

Latitude/Longitude of Incinerator (See Instructions.) 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)

Amount Fired

5.4 Dry metric tons per 365-day period of sewage sludge fired in the sewage sludge incinerator: Beryllium NESHAP

5.5 Submit information, test data, and a description of measures taken that demonstrate whether the sewage sludge incinerated is beryllium-containing waste and will continue to remain as such. 

##  Check (  ) here to indicate that you have attached this material to the application package.
5.6 Is the sewage sludge fired in this incinerator “beryllium-containing wa ste” as defined at 40 CFR Part 61.31? 

##  Yes 

##  No  SKIP to Item 5.8 (Part 2, Section 5) below.

5.7 Submit with this application a complete report of the latest beryllium emission rate testing and documentation of ongoing incinerator operating parameters indicating that the NESH AP emission rate limit for beryllium has been and will continue to be met. 

##  Check (  ) here to indicate that you have attached this information. Mercury NESHAP

5.8 Is compliance with the mercury NESHAP being demonstrated via stack testing? 

##  Yes 

##  No  SKIP to Item 5.11 (Part 2, Section 5) below. 5.9 Submit a complete report of stack testing and documentati on of ongoing incinerator operating parameters indicating that the incinerator has met and will continue to m eet the mercury NESHAP emission rate limit. 

##  Check (  ) here to indicate that you have attached this information.
5.10 Provide copies of mercury emission rate tests for t he two most recent years in which testing was conducted? 

##  Check (  ) here to indicate that you have attached this information.EPA Form 3510-2S (Revised <INSERT DATE>) Page 22 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 ImplementationIncineration Continued 5.11 Do you demonstrate compliance with the mercury NESHAP by sewage sludge sampling? 

##  Yes 

##  No  SKIP to Item 5.13 (Part 2, Section 5) below.
5.12 Submit a complete report of sewage sludge sampling and documentation of ongoing incinerator operating parameters indicating that the incinerator has met and will conti nue to meet the mercury NESHAP emission rate limit. 

##  Check (  ) here to indicate that you have attached this information.
Dispersion Factor 5.13 Dispersion factor in micrograms/cubic meter per gram/second:

5.14 Name and type of dispersion model:

5.15 Submit a copy of the modeling results and supporting documentation. 

##  Check (  ) here to indicate that you have attached this information. Control Efficiency 5.16 Provide the control efficiency, in hundredths, for each of the pollutants listed below. Pollutant Control efficiency, in hundredths
Arsenic
Cadmium
Chromium
Lead
Nickel
5.17 Attach a copy of the results or performance testi ng and supporting documentation (including testing dates). 

##  Check (  ) here to indicate that you have attached this information.
Risk-Specific Concentration for Chromium 5.18 Provide the risk-specific concent ration (RSC) used for chromium in micrograms per cubic meter: 5.19 Was the RSC determined via Table 2 in 40 CFR 503.43? 

##  Yes 

##  No  SKIP to Item 5.21 (Part 2, Section 5) below.
5.20 Identify the type of incinerator used as the basis. 

##  Fluidized bed with wet scrubber 

##  Other types with wet scrubber


##  Fluidized bed with wet scrubber and wet electrostatic precipitator 

##  Other types with wet scrubber and wet electrostatic precipitator 5.21 Was the RSC determined via Table 6 in 40 CFR 503.43 (site-specific determination)? 

##  Yes 

##  No  SKIP to Item 5.23 (Part 2, Section 5) below.

5.22 Provide the decimal fraction of hexavalent chromium concentration to total chromium concentration in stack exit gas: 5.23 Attach the results of incinerator stack tests for hexava lent and total chromium concentrations, including the date(s) of any test(s), with this application. 

##  Check (  ) here to indicate that you have attached this information. 

##  Not Applicable

Incinerator Parameters 5.24 Do you monitor total hydrocarbons (THC) in the exit gas of the sewage sludge incinerator? 

##  Yes 

##  No
5.25 Do you monitor carbon monoxide (CO) in t he exit gas of the sewage sludge incinerator? 

##  Yes 

##  No
5.26 Indicate the type of sewage sludge incinerator.EPA Form 3510-2S (Revised <INSERT DATE>) Page 23 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 ImplementationIncineration Continued 5.27 Incinerator stack height in meters:

5.28 Indicate whether the value submitted in Item 5.27 is (check only one response): 

##  Actual stack height 

##  Creditable stack height Performance Test Operating Parameters 5.29 Maximum Performance Test Combustion Temperature:

5.30 Performance test sewage sludge feed rate, in dry metric tons/day

5.31 Indicate whether value submitted in Item 5.30 is (check only one response): 

##  Average use 

##  Maximum design
5.32 Attach supporting documents describing how the feed rate was calculated. 

##  Check (  ) here to indicate that you have attached this information. 5.33 Submit information documenting the performance test operating parameters for the air pollution control device(s) used for this sewage sludge incinerator. 

##  Check (  ) here to indicate that you have attached this information. Monitoring Equipment 5.34 List the equipment in place to monitor the listed parameters.

Parameter Equipment in Place for Monitoring
Total hydrocarbons or carbon monoxide

Percent oxygen

Percent moisture

Combustion temperature

Other (describe)
Air Pollution Control Equipment 5.35 List all air pollution control equipment used with this sewage sludge incinerator. 

##  Check (  ) here if you have attached the list to the application package for the noted incinerator.



### END of PART 2
Submit completed application package to your NPDES permitting authority.