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United States Environmental Protection Agency Office of Water Washington, D.C. EPA Form 3510-2F

Revised <INSERT DATE>



### Water Permits Division 

# Application Form 2F

Stormwater Discharges

Associated with Industrial Activity

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 this form and Form 1 if you are a new or existing f acility whose discha rge is composed entirely of stormwater associated with industr ial activity, excluding discha rges from construction activity under 40 CFR 122.26(b)(14)(x) or (b)(15). If your discharge is composed of stormwater and non-stormwater, you must complete Forms 1 and 2F, and you must complete Form 2C, 2D, or 2E, as appropriate. See the “Instructions ” inside for further details.

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### Paperwork Reduction Act Notice

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

Form 2F to be 28.6 hours. The estimate includes time for reviewing instructions , searching existing data sources, gathering and maintaining the needed data , and completing and reviewing the collection of information. Send comments regarding the burden estim ate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Chief, Information Policy Branch (PM-223), U.S. Environmental Protection Agenc y, 1200 Pennsylvania Avenue, NW, Washington, DC 20460 and to the Office of Information and Regulator y Affairs, Office of Management and Budget,

725 17 th 

### Street, NW, Washington, DC 20503, marked “Attention: Desk Officer for EPA.”2F-1 

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FORM 2F—INSTRUCTIONS

General Instructions

Who Must Complete Form 2F?

Applicants who answered “yes” to Item 1.2.3 on Form 1 should complete Form 2F. This means that you are a new or existing facility and your discharge is co mposed entirely of stormwater

associated with industrial acti vity (excluding discharges from construction activity under 40 CF R 122.26(b)(14)(x) or (b)(15)) or composed of stormwater and non-stormwater and are seeking coverage under an individual NPDES permit. Note that applicants in the latter category must also complete Form 2C, 2D, or 2E, as applicable. See inset below. Where to File Your Completed Form

Submit your completed application package (Forms 1 and 2F plus any other applicable forms) to your NPDES permitting authority.

Consult Exhibit 1

– 1 of the “General Instructions” section of Form 1 to identify your NPDES permitting authority.

Public Availability of Submitted Information

EPA will make information provided on the various NPDES permit application forms available to the public for inspection and copying upon request. No information on Form 2F (or related attachments) may be claimed as confidential.

You may make a claim of confidentiality for any information that you submit to EPA that goes beyond the information required by Form 2F. Note that NPDES permitting authorities will deny claims for treating any effluent data (estimated or actual) as confidential. If you do not assert a claim of confidentiality at the time you submit your information to the NPDES permitting authority, EPA may make the information available to the public without further notice to you. EPA will handle claims of confidentiality in accordance with the Agency’s business confidentiality regulations in Part 2 of Title 40 of the Code of Federal Regulations (CFR).

Completion of Forms

Print or type in the specified areas only. If you do not have enough space on the form to answer a question, you may continue on additional sheets, as necessary, usi ng a format consistent with the

form.

Provide your EPA Identification Nu mber from the Federal Registry Service, NPDES Permit Number, and facility name at the top of each page of Form 2F and any attachments. If your facility is new (i.e., not yet constructed), write or type “New Facility”. If you do not know your EPA Identification Number, contact your NPDES permitting authority. See Exhibit 1

– 1 of the “General Instructions” of

Form 1 for contact information. A dditionally, for Tables A through D, provide the applicable Outfall Number at the top of each page.

Do not leave any response areas blank unless the form directs you to skip 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.

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.

Definitions

Definitions of all significant te rms used in these Instructions and Form 2F are in the “Glossary”, which follows the “General

Instructions” in Form 1. Notes

 Form 2F must be completed by operators of facilities who discharge stormwater associated with industrial activity or by operators of stormwater discharges who EPA is evaluating for designation as a significant contributor of pollutants to waters of the United States, or as contributing to a violation of a water quality

standard.

 Operators of discharges that are composed entirely of stormwater must complete Form 2F in conjunction with Form 1.

 Operators of discharges of stormwater that is combined with process wastewater must complete and submit Form 2F, Form 1, and

Form 2C. Process wastewater is water that

comes into direct contact with or results from the production or use of any raw material, intermediate product, finished product, byproduct, waste product, or wastewater.

 Operators of discharges of stormwater that is combined with nonprocess wastewater must complete Form 2F, Form 1, and Form 2E. Nonprocess wastewater includes noncontact cooling water and sanitary wastes that are not regulated by effluent guidelines, except discharges by educational, medical, or

commercial chemical laboratories.

 Operators of new disc harges of stormwater associated with industrial activity that will be

combined with other non-stormwater new discharges must submit Form 2F, Form 1, and

Form 2D.2F-2 

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FORM 2F—INSTRUCTIONS CONTINUED

Line-By-Line Instructions

Section 1. Outfall Location

Item 1.1. Identify each of the facility’s outfalls by number. For each outfall, specify the latitude and longitude, method of collection, and name of the receiving water. The location of each outfall (i.e., where the coordinates are collected) sha ll be the location where collected

and concentrated stormwater flows are discharged from the facility such that the first receiving water body into which the discharge flows, either directly or through a separate storm sewer system, is a

water of the United States. 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) 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) horizontal reference datum (i.e., the coordinate reference system) to which your coordinates relate.

Note: In EPA’s stormwater permits , “outfalls” are referred to as “discharge points”.

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) 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 U.S. Geological Survey (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

. Note that space has been provided on the form for six outfalls. If you have more than this number, type your information on a separate sheet of paper in a format similar to that of the form. Make sure you note the EPA Identification Number, NPDES Permit Number, and facility name at the top of the page and indicate the specific Item of the form to which you are responding, which is Item 1.1 in this instance. Note that in other sections of the form, you will be asked to provide information by outfall number (Sections 2, 4, 5, and 7). Note that space has been provided on the form for six outfalls. If you have more than this number, type your information on a separate sheet of paper in a format similar to that of the form. Make sure you note the EPA Identification Number, NPDES Permit Number, and facility name at the top of the page and indicate the specific Item of the form to which you are responding, which is Item 1.1 in this instance. Note that in other sections of the form, you will be asked to provide information by outfall number (Sections 2, 4, 5, and 7).

Section 2. Improvements

Item 2.1. Indicate if you are required by any federal, state, or local authority to meet an implementation schedule for constructing, upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could affect the discharges described in this application. The requirements include, but are not limited to, permit conditions, administrative enforcement orders, enforcement compliance sc hedule letters, stipulations, court orders, and grant or loan conditions. If “yes”, continue to Item 2.2. If “no,” skip to Section 3.

Item 2.2. Briefly identify and describe each applicable project (e.g., consent decree, enforcement orde r, or permit condition). For each condition, specify the affected outfall number(s), the source(s) of the discharge, the required final compliance date, and the projected final compliance date.

Item 2.3. OPTIONAL ITEM. Indicate if you have attached any sheets describing any additional water pollution control programs (or other environmental projects t hat could affect your discharges) that you may now have underway or planned. If you attach additional sheets, indicate in the attachment whether each program is actually underway or is planned, and indicate your actual or planned schedule for construction. Be sure to note your EPA Identification Number, NPDES Permit Number, and facility name at the top of any attached pages.

Section 3. Site Drainage Map

Item 3.1 Attach a site drainage map showing the topography of the facility. If a topographic map is unavailable, you may provide an outline of drainage areas served by the outfall(s) covered in the application. The site map must include the following information:

 Each of its drainage and discharge structures;

 The drainage area of each stormwater outfall;

 Paved areas and buildings within the drainage area of each stormwater outfall; each past or present area used for outdoor storage or disposal of significant materials; each existing structural control measure to reduce pollutants in stormwater runoff; materials loading and access areas; areas where2F-3 

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pesticides, herbicides, soil c onditioners, and fertilizers are applied;

 Each hazardous waste treatment, storage, or disposal facility (including each area not required to have a Resource Conservation and Recovery Act (RCRA) permit and is used foraccumulating hazardous waste for less than 90 days under 40 CFR 262.34);

 Each well where fluids from the facility are injected underground; and

 Springs and other surface water bodies that receive stormwater discharges from the facility.

When you have completed and attached your site map to Form 2F, answer “yes” to Item 3.1.

Section 4. Pollutant Sources

Item 4.1. List all outfalls dischargi ng stormwater. Provide an estimate of the impervious surface area drained by the outfall. Specify units of measure. Impervious surfaces are surfaces where

stormwater runs off at rates t hat are significantly higher than background rates (e.g., predevelopment levels) and include paved areas, building roofs, parking lots, and roadways.

Provide an estimate of the total surface area (impervious and pervious areas) drained by each outfall (within a mile radius of the facility). You may use the site map developed under Item 3.1 to estimate the total area drained by each outfall. For areas under 5 acres, consult your NPDES permitting authority to determine whether the area should be reported to the nearest tenth of an acre or nearest quarter of an acre.

Item 4.2. Provide a narrative description of the following:

 Significant materials that in three years prior to the submittal of this application have been treated, stored, or disposed in a manner to allow exposure to stormwater;

 Method of treatment, storage, or disposal of such materials;

 Materials management practices employed, in the three years prior to the submittal of this application, to minimize contact by these materials with stormwater runoff;

 Materials loading and access areas; and

 The location, manner, and frequency in which pesticides, herbicides, soil conditioners, and fertilizers are applied.

You should identify your significant materials by chemical name, form (e.g., powder, liquid, etc.), and type of container or treatment unit. Indicate any materials treated, stored, or disposed of together.

The term significant materials includes, but is not limited to: raw materials; fuels; materials such as solvents, detergents, and plastic pellets; finished materials such as metallic products; raw materials used in food processing or production; hazardous substances designated under Section 101 (14) of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA); any chemical the facilit y is required to report pursuant to Section 313 of Title III of the Superfund Amendments and Reauthorization Act (SARA); and fertilizers; pesticides; and waste products such as ashes, slag, and sludge that have the potential to be released with stormwater discharges.

Item 4.3. For each outfall, list the location and type of existing

structural and non-structural contro l measure(s) to reduce pollutants

in stormwater runoff. Structural controls include structures that enclose materials handling or storage areas; structures that cover materials; and berms, dikes, or diversion ditches around manufacturing, production, storage, or treatment units and retention ponds. Spill prevention plans, employee training, visual inspections, preventive maintenance, and housekeeping measures are examples of non-structural controls.

Describe the treatment, including the schedule and type of maintenance activities performed, and the ultimate disposal of any solid or fluid wastes other than by discharge. For each structural control identified, indicate the type of treatment the stormwater receives using the codes in Exhibit 2F-1, located at the end of the Instructions. For each non-structural control identified, indicate “Not Applicable” in the “Codes from Exhibit 2F-1” column.

Section 5. Non-Stormwater Discharges

Item 5.1. Provide a certification that all outfalls that should contain stormwater discharges associated with industrial activity have been tested or evaluated for the presence of non- stormwater discharges. Tests for such non-stormwater discharges can include smoke tests, fluorometric dye tests, analysis of accurate schematics, and others.

Item 5.2. Include a description of the method used, the date of any testing, and the onsite drainage points that were directly observedduring a test used to support the certification in Item 5.1. All nonstormwater discharges must be identified in a Form 2C, 2D, or 2E. See the above section on “Who Must Complete Form 2F” for further

information.

Section 6. Significant Leaks or Spills

Item 6.1. Describe any significant leaks or spills of toxic or hazardous pollutants at the facility within the three years prior to the submittal of this application. Include the approximate date and location of the spill or leak and t he type and amount of material

released.

Section 7. Discharge Information

Item 7.1. Answer whether you are a new source or new discharge. Contact your NPDES permitting author ity to determine if you are a new source or new discharge.

Tables A, B, C, and D

Items 7.2 to 7.17. These items require you to collect and report data in Tables A through D, located at the end of Form 2F, for the parameters and pollutants listed in Exhibits 2F

– 2, 2F

– 3, and 2F

– 4 (located at the end of the Instructions). The instructions for completing Tables A through D are table-specific in addition to the criteria for determining who should complete them.

IMPORTANT NOTE: Read the “General Instructions for Reporting, Sampling, and Analysis” below before completing Items 7.2 to 7.17.2F-4 

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Item 7.2 and Table A. All applicants must complete Table A. If the discharge is an existing discharge and your discharge is composed exclusively of stormwater (i .e., no process or nonprocess wastewater) then you only need to provide monitoring data for oil and grease, total phosphorus, total Kjeldahl nitrogen, and total nitrogen. Indicate “NA” for “Not Applicable” in the columns for all other parameters. Answer “yes” to Item 7.2 once you have completed this

task.

Item 7.3 and Table B. Indicate whether the facility is subject to an effluent limitations guideline (ELG) (see 40 CFR Subchapter N to determine which pollutants are limited in ELGs) or if the facility is subject to effluent limitations in an NPDES permit for its process wastewater or stormwater (if the facility is operating under an existing NPDES permit). If “yes”, continue to Item 7.4. If “no”, skip to Item 7.5.

Note: Stormwater discharges from certain industrial sources or activities have specific ELGs for which they must comply. These stormwater-specific ELGs include:

Regulated Discharge 40 CFR Section

Discharges resulting from spray down or intentional wetting of logs at wet deck storage areas Part 429, Subpart I

Runoff from phosphate fertilizer manufacturing facilities that comes into contact with any raw materials, finished product, by-products or wa ste products (SIC 2874) Part 418, Subpart A

Runoff from asphalt emulsion fa cilities Part 443, Subpart A

Runoff from material storage piles at cement manufacturing facilities Part 411, Subpart C

Mine dewatering dischar ges at crushed stone, construction sand and gravel , or industrial sand mining

facilities Part 436, Subparts B, C, and D

Runoff from hazardous waste and non-hazardous waste

landfills Part 445, Subparts A

and B

Runoff from coal storage piles at steam electric generating facilities Part 423

Runoff containing urea from airfield pavement deicing at existing and new primary air ports with 1,000 or more annual non-propeller aircraft departures Part 449

Item 7.4. In Table B, list all pollutants that are limited in an ELG to which the facility is subject and all pollutants listed in the facility's NPDES permit for its process wastew ater (if the facility is operating under an existing NPDES permit) and provide quantitative data for each pollutant (provide actual data for existing dischargers and estimated data for new sources and new dischargers). If a pollutant in Exhibits 2F–2 or 2F–3 is indirectly limited by an ELG through an indicator (e.g., use of total suspended solids as an indicator to control the discharge of iron and aluminum), you must provide data for the pollutant in Table B. Complete one table for each outfall. Answer “yes” to Item 7.4 once you have completed this task.

Item 7.5 and Table C. Table C requires you to address the pollutants in Exhibits 2F

– 2, 2F

– 3, and 2F

– 4 for each outfall.

Pollutants in each of these exhi bits are addressed differently.

Indicate whether you know or have reason to believe any pollutants

in Exhibit 2F

– 2 are present in the discharge. If “yes”, continue to Item 7.6. If “no”, skip to Item 7.7. Item 7.6. For each outfall, list all pollutants in Exhibit 2F–2 that you know or have reason to believe are present in the discharge in Table C (except pollutants previously listed in Table B that are limited directly or indirectly by an ELG) and either report quantitative data or briefly descri be the reasons the pollutant is expected to be discharged. Answer “yes” to Item 7.6 once you have completed this task.

Item 7.7. This item asks if you qualify as a “small business”. If so, you are exempt from the reporting requirements for the organic toxic pollutants listed in Exhibit 2F–3.

You can qualify as a “small business” in two ways: (1) If your facility is a coal mine and if your probable total annual production is less than 100,000 tons per year, you may submit past production data or estimated future production (such as a schedule of estimated total production under 30 CFR § 795.14(c)) instead of conducting analyses for the organic toxic pollutants; (2) If your facility is not a coal mine and if your gross total annual sales for the most recent three years average less than $100,000 per year (in second quarter 1980 dollars), you may submit sales data for those years instead of conducting analyses for the organic toxic pollutants. The production or sales data must be for the facility that is the source of the discharge. The data should not be limited to production or sales for the process or processes that contribute to the discharge, unless those are the only processes at your facility. For sales data, in si tuations involving intra-corporate transfer of goods and services, the transfer price per unit should approximate market prices for those goods and services as closely as possible. Sales figures for years after 1980 should be indexed to the second quarter of 1980 by using the gross national product price deflator (second quarter of 1980=100). This index is available online from the U.S. Department of Commerce, Bureau of Economic Analysis at http://www.bea.gov/national/pdf/SNTables.pdf

. If you qualify as a small business according to the criteria above, answer “yes” to Item 7.7 and skip to Item 7.18. Otherwise, answer

“no” and continue to Item 7.8.

Item 7.8. Indicate whether you know or have reason to believe any pollutants in Exhibit 2F

– 3 are present in the discharge. If ‘yes”, continue to Item 7.9. If “no”, skip to Item 7.10.

Item 7.9. For each outfall, list all pollutants in Exhibit 2F

– 3 that you know or have reason to believe are present in the discharge in Table C (except pollutants previous ly listed in Table B). Answer “yes” to Item 7.9 once you have completed this task.

Item 7.10. Indicate whether you expect any of the pollutants from

Exhibit 2F

– 3 to be discharged in concentrations of 10 parts per billion (ppb) or greater? If “yes”, continue to Item 7.11. If “no”, skip

to Item 7.12.

Item 7.11 . Provide quantitative data in Table C for those pollutants

in Exhibit 2F

– 3 that you expect to be discharged in concentrations of 10 ppb or greater (provide actual data for existing dischargers and estimated data for new sources and new dischargers). Answer “yes” to Item 7.11 once you have completed this task.2F-5 

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Item 7.12. Indicate whether you expect acrolein, acrylonitrile, 2,4- dinitrophenol, or 2-methyl-4,6-dinitrophenol to be discharged in concentrations of 100 ppb or greater? If “yes”, continue to Item 7.13. If “no”, skip to Item 7.14.

Item 7.13. Provide quantitative data in Table C for the pollutants identified in Item 7.12 that you expect to be discharged in concentrations of 100 ppb or greater (provide actual data for existing dischargers and estimated data for new sources and new dischargers). Answer “yes” to Item 7.13 once you have completed

this task.

Item 7.14. For any pollutants you expect to be present in the discharge at concentrations less than 10 ppb (or less than 100 ppb for the above four pollutants), either submit quantitative data or briefly describe the reasons the pollutant is expected to be discharged in Table C. Answer “yes” to Item 7.14 once you have completed this task.

Item 7.15. Indicate whether you know or have reason to believe any pollutants in Exhibit 2F–4 are present in the discharge. If ‘yes”, continue to Item 7.16. If “no”, skip to Item 7.17.

Item 7.16. For each outfall, list any pollutant in Exhibit 2F

– 4 that you know or believe to be present in the discharge in Table C and explain why you believe it to be present. No analysis is required, but if you have analytical data, you must report it. Answer “yes” to Item 7.16 once you have completed this task.

Item 7.17 and Table D. Provide data for the storm event(s) that resulted in the maximum daily discharges for the flow weighted composite sample in Table D. If sampling is conducted during more than one storm event, you only need to report the information requested on Table D for the storm event(s) that resulted in any maximum pollutant concentration reported on Tables A through C.

Provide flow measurements or estimates of the flow rate, and the total amount of discharge for the storm event(s) sampled, the method of flow measurement, or estimation. Provide the data and duration of the storm event(s) sampled, rainfall measurements, or estimates of the storm event that generated the sampled runoff and the duration between the storm event sampled and the end of the previous measurable (greater than 0.1 inch rainfall) storm event. Answer “yes” to Item 7.17 once you have completed this task.

Used or Manufactured Toxics

Item 7.18. Review Exhibits 2F-2 through 2F-4 and determine if you currently use or manufacture any of the pollutants listed as an intermediate or final product or byproduct. If so, answer “yes” to Item 7.18. You should also answer “yes” if you know or have reason to believe that 2,3,7,8-te trachloro-dibenzo-p- dioxin (TCDD) is discharged or if you use or manufacture 2,4,5-trichlorphenoxy acetic acid (2,4,5-T); 2-(2,4,5-trichlorophenoxy) propanoic acid (Silvex, 2,4,5-TP); 2-(2,4,5-trichlorophenoxy) ethyl, 2,2- dichloropropionate (Erbon); 0,0-dimethyl 0-(2,4,5-trichlorphenyl) phosphorothioate (Ronnel); 2,4,5-trichlorophenol (TCP); or hexachlorophene (HCP). If your answer to Item 7.18 is “no,” skip to

Section 8.

Item 7.19. List all of the toxic pollutants identified under Item 7.18, including TCDD. Note that the NPDES permitting authority may waive or modify the requirement if you demonstrate that it would be unduly burdensome to identify each toxic pollutant and the NPDES permitting authority has adequate information to issue your permit. You may not claim any information submitted in response to Item 7.18 as confidential; however, you do not have to distinguish between use or production of the pollutants or list the amounts.

Section 8. Biological Toxicity Testing Data

Item 8.1. Answer whether you know of or have reason to believe that biological toxicity testing has been conducted of your wastewater treatment, including engi neering reports or pilot plant studies. If “no,” skip to Section 9. Otherwise, continue.

Item 8.2. List any tests of which you are aware and their purposes.

Section 9. Contract Analysis Information

Item 9.1. Indicate if any of the analyses performed in Section 7 were performed by a contract labora tory or consulting firm. If “no,” skip to Section 10. If “yes,” continue to Item 9.2.

Item 9.2. Provide the name, address, phone number, and pollutants analyzed by the laboratory or cons ulting firm(s) in the spaces provided.

Section 10. Checklist and Certification Statement

Item 10.1. Review the checklist provided on the application. In Column 1, mark the sections of Form 2F that you have completed and are submitting with your application. For each section in Column 2, indicate whether you are submitting attachments. Note: Under 40 CFR 117.12(a)(2), certain discharges of hazardous substances may be exempted from the requirements of CWA Section 311, which establishes reporting requirements, civil penalties, and liability for cleanup costs for spills of oil and hazardous substances. A discharge of a particular substance can be exempted if the origin, source, and amount of the discharged substances are identified in the NPDES permit application or in the permit, if the permit contains a requirement for treatment of the discharge, and if the treatment is in place. If you would like to apply for an exemption from the requirements of CWA Section 311, attach additional sheets of paper to your application, setting forth the following information:

1. The substance and the amount of each substance that might

be discharged.
2. The origin and source of the discharge of the substance.
3. The treatment to be provided for the discharge by:

a. An onsite treatment system separate from any treatment system treating your normal discharge;
b. A treatment system designed to treat your normal discharge and that is additionally capable of treating the amount of the substance identified under paragraph 1 above; or
c. Any combination of the above.

See 40 CFR 117.12(a)(2) and (c) or contact your NPDES permitting authority for further information on exclusions from

CWA Section 311.2F-6 

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Item 10.2. The CWA 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 material statement, representation, or certification in any application, ...shall upon conviction be punished by a fine of not more than $10,000 or by imprisonment for not more than six

months or both.”

FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS

APPLICATION TO BE SIGNED AS FOLLOWS:

A. By a responsible corporate officer. For the purpose of this section, a responsible corporate officer means: (i) A president, secretary, treasurer, or vice-p resident of the corporation in charge of a principal business function, or any person who performs 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 authority to sign documents has been assigned or delegated to the manager in accordance with 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 officer or ranking elected official. For purposes of this section, a principal executive officer of a Federal agency includes: (i) the chief officer of the agency, or (ii) a senior executive office r having responsibility for the overall operations of a principal geographic unit of the agency (e.g., Regional Administrators of EPA).

END

Submit your completed Form 1, Form 2F, and

all associated attachments (and any other required NPDES application forms) to your NPDES permitting authority.2F-7 

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General Instructions for Reporting, Sampling, and Analysis

IMPORTANT NOTICE: Read these instructions prior to completing Tables A through C and Section 7 of Form 2F.

General Items

Complete the applicable tables for each outfall at your facility. Be sure to note the EPA Identification Number, NPDES Permit Number, facility name, and applicable outfall number at the top of each table page and any associated attachments.

You may report some or all of the required data by attaching separate sheets of paper instead of completing Tables A through C for each of your outfalls so long as the sheets contain all of the required information and are similar in format to Tables A through C. For example, you may be able to print a report in a compatible format from the data system used in your Gas Chromatography/ Mass Spectrometry analysis completed under Table B.

If you are an existing discharger , you are required to report actual quantitative data. See “Use of Historic Data” below for use of historic data. If you are a new sour ce or discharge, you may supply

estimated data along with the source of each estimate. If you have quantitative data available, however, you must provide it. Base estimates on available, in-house or contractor engineering reports, or any other studies performed on the proposed facility. Use the following codes to report your source information in the “Source of

Information” column:

Data Source Code Engineering study 1

A ctual data from pilot plants 1 Estimates from other engineering

studies 2

Data from other similar plants 3 Best professional estimates 4

Others 5 and specify on

the table

No later than two years after your facility commences to discharge, you must complete and submit sampling and analysis data for the pollutants and parameters in Tables A through C. However, you need not report results for tests you have already performed and reported under the discharge monitoring requirements of your NPDES permit.

Table A requires you to report at least one analysis for each pollutant listed. Tables B and C require you to report analytical data in two ways. For some pollutants addressed in Tables B and C, if you know or have reason to know that the pollutant is present in your discharge, you may be required to list the pollutant and test (sample and analyze) and report the levels of the pollutants in your discharge. For all other pollutants addressed in Tables B and C, you must list the pollutant if you know or have reason to know that the pollutant is present in the discharge, and either report quantitative data for the pollutant or briefly describe the reasons the pollutant is expected to be discharged. (See Items 7.2 through 7.17 of the instructions for completing Tables A through C.). Base your determination that a pollutant is/will be present in your discharge on your knowledge of the facility’s raw materials, material management practices, maintenance chemicals, history of spills and releases, intermediate and final products and byproducts, and any previous analyses known to you of your

effluent or similar effluent.

Sampling

The collection of the samples for the reported analyses should be supervised by a person experienced in performing sampling of

industrial wastewater or stormw ater discharges. You may contact NPDES permitting authority for detailed guidance on sampling techniques and for answers to specific questions. Refer to Exhibit 1– 1 of Form 1 for contact information. Any specific requirements in the analytical methods must be followed, including factors related to sample containers, sample preservation, holding times, and the collection of duplicate samples.

The time when you sample should be representative of your normal operation, to the extent feasible, with all processes that contribute wastewater in normal operation, and with your treatment system operating properly with no system upsets. Samples should be collected from the center of the flow channel, where turbulence is at a maximum, at a site specified in your present permit, or at any site adequate for the collection of a representative sample.

Grab samples must be taken in the first 30 minutes of discharge (or as soon thereafter as practicable) for pH, temperature, cyanide, total phenols, residual chlorine, oil and grease, fecal coliform (including

E. coli) and Enterococci (previously known as fecal streptococcus at 40 CFR 122.26(d)(2)(iii)(A)(3)), and volatile organic chemicals. You are not required to analyze a flow-weighted composite for these parameters.

For all other pollutants, both a grab sample collected during the first 30 minutes (or as soon thereafter as practicable) of the discharge and a flow-weighted composite sample must be analyzed. However, a minimum of one grab sample may be taken for effluents from holding ponds or other impoundments with a retention period of greater than 24 hours.

All samples must be collected from the discharge resulting from a storm event that is greater than 0.1 inches and at least 72 hours from the previously measurable (gr eater than 0.1 inch rainfall) storm event. Where feasible, the variance in the duration of the event and the total rainfall of the event should not exceed 50 percent from the average or median rainfall event in that area.

A grab sample must be taken during the first 30 minutes of the discharge (or as soon thereafter as practicable), and a flowweighted composite must be taken for the entire event or for the first

three hours of the event.

Grab and composite samples are defined as follows:

Grab sample: An individual sample of at least 100 milliliters collected during the first 30 minutes (or as soon thereafter as practicable) of the discharge. This sample is to be analyzed separately from the composite sample.

Flow-weighted Composite sample: A flow-weighted composite sample may be taken with a continuous sampler that proportions the amount of sample collected with the flow rate or as a combination of a minimum of three sample aliquots taken in each hour of discharge2F-8 

### Contains Nonbinding Recommendations

Draft Application Forms

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General Instructions for Reporting, Sampling, and Analysis Continued

for the entire event or for the first three hours of the event, with each aliquot being at least 100 milliliters and collected with a minimum period of 15 minutes between aliquot collections. The composite must be flow proportional; the time interval between either each aliquot or the volume of each aliquot must be proportional to either the stream (effluent) flow at the time of sampling or the total stream (effluent) flow since the collection of the previous aliquot. Aliquots may be collected manually or automatically. Where GC/MS Volatile Organic Analysis (VOA) is required, aliquots must be combi ned in the laboratory immediately before analysis. Only one analysis for the composite sample is required.

Use of Historic Data

Existing data may be used, if available, in lieu of sampling conducted solely for the purposes of this application, provided it is representative of the present discharge and was collected within three years of the application due date. If you sample for a listed pollutant on a monthly or more frequent basis, summarize the data collected within one year of the application for the pollutant(s) at

issue.

Among the factors that would cause the data to be unrepresentative are significant changes in production level, changes in raw materials, processes, or final products, and changes in stormwater treatment. The NPDES permitting authority may request additional information, including current quantitative data, if they determine it to be necessary to assess your discharges. The NPDES permitting authority may allow or establish appropriate site-specific sampling procedures or requirements including sampling locations, the season in which the sampling takes place, the minimum duration between the previous measurable storm event and the storm event sampled, the minimum or maximum level of precipitation required for an appropriate storm event, the form of precipitation sampled (snow melt or rainfall), protocols for collecting samples under 40 CFRPart 136, and additional time for submitting data on a case-bycase basis.

Reporting

Report sampling results for all pollutants in Tables A through C as

concentration and mass, with the exception of flow, temperature, pH, color, and fecal coliform organisms.

Flow, temperature, pH, color, and fecal coliform organisms must be reported as mgd, degrees Celcius (°C), standard units, color units, and most probable number per 100 milliliters (MPN/100 mL), respectively. Use the following abbreviations in the columns requiring “units” in Tables A through C.

Concentration Mass
ppm = parts per million lbs = pounds
mg/L = milligrams per liter ton = Tons (English tons)
ppb = parts per billion mg = milligrams
μg/L = micrograms per liter g = grams MPN = most probable number kg = kilograms
per 100 milliliters T = tonnes (metric tons) All reporting of values for metals must be in terms of “total

recoverable metal” unless:

1. An applicable, promulgated ELG specifies the limitation for the metal in dissolved, valent, or total form;

2. All approved analytical methods for the metal inherently measure only its dissolved form (e.g., hexavalent chromium);

or

3. The NPDES permitting authority has determined that in establishing case-by-case limitations it is necessary to express the limitations of the metal in dissolved, valent, or total form to carry out the provisions of the C WA.

If you measure only one grab sample and one flow-weighted composite sample for a given outfall, complete only the “Maximum Daily Discharge” columns in the tables and insert “1” under the “Number of Storm Events Sampled” column. The NPDES permitting authority may require you to conduct additional analyses to further characterize your discharges.

If you measure more than one value for a grab sample or a flowweighted composite sample for a given outfall and those values are representative of your discharge, you must report them. You must describe your method of testing and analysis. You must also determine the average of all values within the last year and report the concentration and mass under the “Average Daily Discharge” columns of the tables and the total number of storm events sampled under the “Number of Storm Events Sampled” columns.

The “Average Daily Discharge” column on Tables A to C is not compulsory but should be filled out if data are available.

Substantially Identical Outfalls

If you have two or more substantially identical outfalls, you may request permission from your NPD ES permitting authority to sample and analyze only one outfall and submit the results of the analysis for all substantially identical outfalls. If your request is granted by the NPDES permitting authority, submit the following information on a separate sheet attached to the application form: the identity of the outfall you did test and an explanation of how it is substantially identical to the outfall(s) that you did not test.

Analysis

Except as specified below, all required quantitative data shall be

collected in accordance with suffici ently sensitive analytical methods approved under 40 CFR part 136 or required under 40 CFR chapter I, subchapter N or O. A method is “sufficiently sensitive”

when:

(1) The method minimum level (ML) is at or below the level of the applicable water quality criterion for the measured pollutant or pollutant parameter.

(2) The method ML is above the water quality criterion, but the amount of the pollutant or pollutant parameter in the facility’s discharge is high enough that the method detects and quantifies the level of the pollutant or pollut ant parameter in the discharge.

(3) The method has the lowest ML of the analytical methods approved under 40 CFR part 136 or required under 40 CFR2F-9 

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Draft Application Forms

– Not for Implementation

General Instructions for Reporting, Sampling, and Analysis Continued

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

Consistent with 40 CFR part 136, you may provide matrix or sample specific MLs rather than the published levels. Further, where you can demonstrate that, despite a good faith effort to use a method that would otherwise meet the definition of “sufficiently sensitive”, the analytical results are not consistent with the quality assurance (QA) / quality control (QC) specifications for that method, then the NPDES permitting authority may determine that the method is not performing adequately and the NPDES permitting authority should select a different method from the remaining EPA-approved methods that is sufficiently sensitiveconsistent with 40 CFR 122.21(e)(3)(i). Where no other EPAapproved methods exist, you must select a method consistent with 40 CFR 122.21(e)(3)(ii).

When there is no analytical method that has been approved under 40 CFR part 136, required under 40 CFR chapter I, subchapter N or O, and is not otherwise required by the NPDES permitting authority, you may use any suitable method but shall provide a description of the method. When selecting a suitable method, other factors such as a method’s precision, accuracy, or resolution, may be considered when assessing the performance of the method.2F-10 

### Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation

Exhibit 2F

– 1. Codes for Treatment Units and Di sposal of Wastes Not Discharged

1. PHYSICAL TREATMENT PROCESSES

1–A ................. Ammonia Stripping 1–B ................. Dialysis

1–C ................ Diatomaceous Earth Filtration

1–D ................ Distillation 1–E ................. Electrodialysis 1–F ................. Evaporation

1–G ................ Flocculation

1–H ................ Flotation

1–I .................. Foam Fractionation 1–J ................. Freezing 1–K ................. Gas–Phase Separation 1–L ................. Grinding ( Comminutors ) 1–M ................ Grit Removal 1–N ................ Microstraining 1–O ................ Mixing 1–P ................ Moving Bed Filters
1–Q ................ Multimedia Filtration 1–R ................ Rapid Sand Filtration 1–S ................ Reverse Osmosis ( Hyperfiltration ) 1–T ................ Screening 1–U ................ Sedimentation ( Settling )

1–V ................ Slow Sand Filtration

1–W ............... Solvent Extraction 1–X ................ Sorption

2. CHEMICAL TREATMENT PROCESSES

2–A ................. Carbon Adsorption

2–B ................. Chemical Oxidation 2–C ................ Chemical Precipitation 2–D ................ Coagulation

2–E ................. Dechlorination 2–F ................. Disinfection ( Chlorine ) 2–G ................ Disinfection ( Ozone ) 2–H ................ Disinfection ( Other )

2–I .................. Electrochemical Treatment 2–J ................. Ion Exchange

2–K ................ Neutralization

2–L ................. Reduction

3. BIOLOGICAL TREATMENT PROCESSES

3–A ................. Activated Sludge 3–B ................. Aerated Lagoons

3–C ................ Anaerobic Treatment

3–D ................ Nitrification–Denitrification 3–E ................ Pre-Aeration 3–F ................ Spray Irrigation/Land Application

3–G ................ Stabilization Ponds 3–H ................ Trickling Filtration

4. WASTEWATER DISPOSAL PROCESSES

4–A ................. Discharge to Surface Water 4–B ................. Ocean Discharge Through Outfall 4–C ................ Reuse/Recycle of Treated Effluent 4–D ................ Underground Injection

5. SLUDGE TREATMENT AND DISPOSAL PROCESSES

5–A ................. Aerobic Digestion 5–B ................. Anaerobic Digestion

5–C ................ Belt Filtration 5–D ................ Centrifugation 5–E ................. Chemical Conditioning

5–F ................. Chlorine Treatment 5–G ................ Composting 5–H ................ Drying Beds

5–I .................. Elutriation 5–J ................. Flotation Thickening 5–K ................. Freezing 5–M ................ Heat Drying

5–N ................ Heat Treatment

5–O ................ Incineration 5–P ................ Land Application
5–Q ................ Landfill

5–R ................ Pressure Filtration 5–S ................ Pyrolysis 5–T ................ Sludge Lagoons

5–U ................ Vacuum Filtration

5–V ................ Vibration

5–W ............... Wet Oxidation 5–L ................. Gravity Thickening2F-11 

### Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation

Exhibit 2F–2. Conventional and No nconventional Pollutants (40 CFR 122.21, Appendix D, Table IV)

Bromide Chlorine, Total Residual

Color

Fecal Coliform

Fluoride

Nitrate-Nitrite Nitrogen, Total Organic (as N)

Oil and Grease Phosphorus (as P), Total Radioactivity ( as Alpha, Total; Beta, Total; Radium, Total; and Radium 226, Total) Sulfate (as SO 4 ) Sulfide (as S) Sulfite (as SO 3 )

Surfactants Aluminum, Total Barium, Total Boron, Total Cobalt, Total Iron, Total Magnesium, Total Molybdenum, Total Manganese, Total Tin, Total Titanium, Total2F-12 

### Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation

Exhibit 2F–3. Toxic Pollutants (40 CFR 122.21, Appendix D, Tables II and III)

Toxic Pollutants and Total Phenol

Antimony, Total Copper, Total Silver, Total Arsenic, Total Lead, Total Thallium, Total Beryllium, Total Mercury, Total Zinc, Total Cadmium, Total Nickel, Total Cyanide, Total Chromium, Total Selenium, Total Phenols, Total

GC/MS Fraction—Volatile Compounds

Acrolein Dichlorobromomethane 1,1,2,2- Tetrachloroethane Acrylonitrile 1,1-Dichloroethane Tetrachloroethylene Benzene 1,2-Dichloroethane Toluene Bromoform 1,1-Dichloroethyl ene 1,2-Trans- Dichloroethylene

Carbon Tetrachloride 1,2-Dich loropropane 1,1,1-Trichloroethane Chlorobenzene 1,3-Dichloroprop ylene 1,1,2-Trichloroethane Chlorodibromomethane Ethylbenzene Trichloroethylene

Chloroethane Methyl Bromide Vinyl Chloride 2-Chloroethylvinyl Ether Methyl Chloride Chloroform Methylene Chloride

GC/MS Fraction—Acid Compounds

2-Chlorophenol 2,4-Dinitrophenol Pentachlorophenol 2,4-Dichlorophenol 2-Nitrophenol Phenol 2,4-Dimethylphenol 4-Nitr ophenol 2,4,6-Trichlorophenol 4,6-Dinitro-O-Cresol P-Chloro-M-Cresol

GC/MS Fraction—Base/Neutral Compounds

Acenaphthene 4-Chlorophenyl Phenyl Ether Hexachlorobenzene Acenaphtylene Chrysene Hexachlorobutadiene

Anthracene Dibenzo (a,h) Anthracene Hexachlorocyclopentadiene Benzidine 1,2-Dichlorobenzene Hexachloroethane Benzo (a) Anthracene 1,3-Dichlorobenzene Indeno (1,2,3-cd) Pyrene Benzo (a) Pyrene 1,4-Dichlorobenzene Isophorone 3,4-Benzofluoranthene 3,3-Dichlorobenzidine Naphthalene Benzo (ghi) Perylene Diethyl Phthalate Nitrobenzene Benzo (k) Fluoranthene Dimethyl Ph thalate N-Nitrosodimethylamine Bis (2-Chloroethoxy) Methane Di-N-Butyl Phthalate N-Nitrosodi-N-Propylamine Bis (2-Chloroethyl) Ether 2,4-Di nitrotoluene N-Nitrosodiphenylamine Bis (2-Chloroisopropyl) Ether 2,6-Dinitrotoluene Phenanthrene Bis (2-Ethylhexyl) Phthalate Di-N-Octyl Phthalate Pyrene 4-Bromophenyl Phenyl Ether 1,2-Diphenylhydra zine (as Azobenzene) 1,2,4-Trichlorobenzene Butyl Benzyl Phthalate Fluoranthene 2-Chloronaphthalene Fluorene

GC/MS Fraction—Pesticides

Aldrin Dieldrin PCB-1254

α -BHC α -Enosulfan PCB-1221 β -BHC β -Endosulfan PCB-1232

γ -BHC Endosulfan Sulfate PCB-1248

δ -BHC Endrin PCB-1260

Chlordane Endrin Aldehyde PCB-1016 4,4’-DDT Heptachlor Toxaphene 4,4’-DDE Heptachlor Epoxide 4,4’-DDD PCB-12422F-13 

### Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation

Exhibit 2F–4. Certain Hazardous Substances and Asbestos (40 CFR 122.21, Appendix D, Table V)

Toxic Pollutant

Asbestos

Hazardous Substances

Acetaldehyde Dintrobenzene Napthenic acid Allyl alcohol Diquat Nitrotoluene Allyl chloride Disulfoton Parathion Amyl acetate Diuron Phenolsulfonate Aniline Epichlorohydrin Phosgene Benzonitrile Ethion Propargite Benzyl chloride Ethylene diamine Propylene oxide Butyl acetate Ethylene dibromide Pyrethrins Butylamine Formaldehyde Quinoline Captan Furfural Resorcinol Carbaryl Guthion Strontium Carbofuran Isoprene Strychnine Carbon disulfide Isopropanolamine Styrene

Chlorpyrifos Kelthane 2,4,5-T (2,4,5-Trichlorophenoxyacetic acid) Coumaphos Kepone TDE (Tetrachlorodiphenyl ethane)

Cresol Malathion 2,4,5-TP [2-(2,4,5-Trichlorophenoxy) propanoic acid] Crotonaldehyde Mercaptodimethur Trichlorofon Cyclohexane Methoxychlor Triethanolamine 2,4-D (2,4-Dichlorophenoxyacetic acid) Methyl mercaptan Triethylamine Diazinon Methyl methacrylate Trimethylamine Dicamba Methyl parathion Uranium

Dichlobenil Mevinphos Vanadium Dichlone Mexacarbate Vinyl acetate 2,2-Dichloropropionic acid Monoethyl amine Xylene Dichlorvos Monomethyl amine Xylenol Diethyl amine Naled Zirconium Dimethyl amineEPA Form 3510-2F (Revised <INSERT DATE> Page 1 EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> Form Expires <INSERT DATE>



### Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation Form

2F

NPDES U.S Environmental Protection Agency Application for NPDES Permit to Discharge Wastewater



### STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY

SECTION 1. OUTFALL LOCATION (40 CFR 122.21(g)(1))Outfall Location 1.1 Provide information on each of the facility’s outfalls in the table below

Outfall

Number Receiving Water Name Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of method/device used to identify the coordinates)
Scale (Proportional distance on the ground for one unit of measure)  Not Applicable

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

Outfall

Number Receiving Water Name Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of method/device used to identify the coordinates)
Scale (Proportional distance on the ground for one unit of measure)  Not Applicable

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

Outfall

Number Receiving Water Name Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of method/device used to identify the coordinates)
Scale (Proportional distance on the ground for one unit of measure)  Not Applicable

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

Outfall

Number Receiving Water Name 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)EPA Form 3510-2F (Revised <INSERT DATE> Page 2 EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> Form Expires <INSERT DATE>



### Contains Nonbinding Recommendations

Draft Application Forms

– Not for ImplementationOutfall Location Continued 1.1 Outfall

Number Receiving Water Name cont. Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of method/device used to identify the coordinates)
Scale (Proportional distance on the ground for one unit of measure)  Not Applicable

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

Outfall

Number Receiving Water Name Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of method/device used to identify the coordinates)
Scale (Proportional distance on the ground for one unit of measure)  Not Applicable

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

SECTION 2. IMPROVEMENTS (40 CFR 122.21(g)(6))Improvements 2.1 Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing, upgrading, or operating wastewater treatment equipment or practices or any other envir onmental programs that could affect the discharges described in this application?


##  Yes 

##  No  SKIP to Section 3.

2.2 Briefly identify each applicable project in the table below.

Brief Identification and Description of Project Affected Outfalls (List Outfall Numbers) Source(s) of Discharge Final Compliance Dates

Required Projected

2.3 Have you attached sheets describing any additional water po llution control programs (or other environmental projects that may affect your discharges) that you now have underway or planned? (Optional Item)


##  Yes 

##  NoEPA Form 3510-2F (Revised <INSERT DATE> Page 3 EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> Form Expires <INSERT DATE>



### Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation SECTION 3. SITE DRAINAGE MAP (40 CFR 122.26(c)(1)(i)(A))SiteDrainageMap 3.1 Have you attached a site drainage map containing all requir ed information to this application? (See Instructions for specific guidance.)



##  Yes 

##  No

SECTION 4. POLLUTANT SOURCES (40 CFR 122.26(c)(1)(i)(B))Pollutant Sources 4.1 Provide information on the facility’s pollutant sources in the table below.

Outfall

Number Impervious Surface Area (within a mile radius of the facility) Total Surface Area Drained (within a mile radius of the facility)
specify units specify units

specify units specify units

specify units specify units

specify units specify units

specify units specify units

specify units specify units

4.2 Narrative Description of Significant Materials. Provide a narrative description of the facility’s significant material in the space below. (See Instructions for content requirements.)

4.3 Provide the location and a description of existing structural and non-structural control measures to reduce pollutants in stormwater runoff. (See Instructions for specific guidance.)

Stormwater Treatment

Outfall

Number Control Measures and Treatment Codes

from

Exhibit

2F-1 (list)EPA Form 3510-2F (Revised <INSERT DATE> Page 4 EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> Form Expires <INSERT DATE>



### Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation SECTION 5. NON-STORMWATER DISCHARGES (40 CFR 122.26(c)(1)(i)(C))Non-Stormwater Discharges 5.1 I certify under penalty of law that the outfall(s) covered by this application have been tested or evaluated for the presence of non-stormwater discharges. Moreover, I certify that the outfalls identified as having non-stormwater discharges are described in either an accompanyi ng NPDES Form 2C, 2D, or 2E application.
Name (first and last) Official Title

Signature Date Signed

5.2 Provide the testing information requested in the table below.

Outfall

Number Description of Testing Method Used Date(s) of Testing Onsite Drainage Points Directly Observed During Test

SECTION 6. SIGNIFICANT LEAKS OR SPILLS (40 CFR 122.26(c)(1)(i)(D))Significant Leaks or Spills 6.1 Description of Significant Leaks or Spills. Provide a description of any significant leaks or spills of toxic or hazardous pollutants in the last three years.

SECTION 7. DISCHARGE INFORMATION (40 CFR 122.26(c)(1)(i)(E))Discharge Information See the Instructions to determine the pollutants and parameters y ou are required to monitor and, in turn, the tables you must complete. Not all applicants need to complete each table.

7.1 Is this a new source or new discharge?



##  Yes  See Instructions regarding submission of

estimated data. 

##  No  See Instructions regarding submission of

actual data.

Tables A, B, C, and D

7.2 Have you completed Table A for each outfall?



##  Yes 

##  NoEPA Form 3510-2F (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 ImplementationDischarge Information Continued 7.3 Is the facility subject to an ELG or effluent limit ations in an NPDES permit for its process wastewater?


##  Yes 

##  No  SKIP to Item 7.5.

7.4 Have you completed Table B by providing quantitative data fo r those pollutants that are (a) limited either directly or indirectly in an ELG and/or (b) subject to effluent limitati ons in an NPDES permit for the facility’s process wastewater?


##  Yes 

##  No

7.5 Do you know or have reason to believe any pollutants in Exhibit 2F

– 2 are present in the discharge?



##  Yes 

##  No  SKIP to Item 7.7.

7.6 Have you listed all pollutants in Exhibit 2F

– 2 that you know or have reason to believe are present in the discharge and provided quantitative data or an explanation for those pollutants in Table C?


##  Yes 

##  No

7.7 Do you qualify for a small business exemption un der the criteria specified in the Instructions?


##  Yes  SKIP to Item 7.18. 

##  No

7.8 Do you know or have reason to believe any pollutants in Exhibit 2F

– 3 are present in the discharge?



##  Yes 

##  No  SKIP to Item 7.10.

7.9 Have you listed all pollutants in Exhibit 2F

– 3 that you know or have reason to believe are present in the discharge in

Table C?


##  Yes 

##  No

7.10 Do you expect any of the pollutants in Exhibit 2F

– 3 to be discharged in concentrations of 10 ppb or greater?



##  Yes 

##  No  SKIP to Item 7.12.

7.11 Have you provided quantitative data in Table C for those pollutants in Exhibit 2F

– 3 that you expect to be discharged in concentrations of 10 ppb or greater?


##  Yes 

##  No

7.12 Do you expect acrolein, acrylonitrile, 2,4-dinitrophenol, or 2-methyl-4,6-dinitrophenol to be discharged in concentrations of 100 ppb or greater?


##  Yes 

##  No  SKIP to Item 7.14.

7.13 Have you provided quantitative data in Table C for the pollutants identified in Item 7.12 that you expect to be discharged in concentrations of 100 ppb or greater?


##  Yes 

##  No

7.14 Have you provided quantitative data or an explanation in Table C for pollutants you expect to be present in the discharge at concentrations less than 10 ppb (or less than 100 ppb for the pollutants identified in Item 7.12)?


##  Yes 

##  No

7.15 Do you know or have reason to believe any pollutants in Exhibit 2F–4 are present in the discharge?


##  Yes 

##  No  SKIP to Item 7.17.

7.16 Have you listed pollutants in Exhibit 2F–4 that you k now or believe to be present in the discharge and provided an explanation in Table C?


##  Yes 

##  No

7.17 Have you provided information for the storm event(s) sampled in Table D?


##  Yes 

##  NoEPA Form 3510-2F (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 ImplementationDischarge Information Continued Used or Manufactured Toxics

7.18 Is any pollutant listed on Exhibits 2F

– 2 through 2F

– 4 a substance or a component of a substance used or manufactured as an intermediate or final product or byproduct?


##  Yes 

##  No  SKIP to Section 8.

7.19 List the pollutants below, including TCDD if applicable.

1. 4. 7.

2. 5. 8.

3. 6. 9.

SECTION 8. BIOLOGICAL TOXICITY T ESTING DATA (40 CFR 122.21(g)(11))Biological Toxicity Testing Data 8.1 Do you have any knowledge or reason to believe that any bi ological test for acute or chronic toxicity has been made on any of your discharges or on a receiving water in rela tion to your discharge within the last three years?



##  Yes 

##  No  SKIP to Section 9.

8.2 Identify the tests and their purposes below.

Test(s) Purpose of Test(s) Submitted to NPDES Permitting Authority? Date Submitted



##  Yes 

##  No



##  Yes 

##  No



##  Yes 

##  No

SECTION 9. CONTRACT ANALYSIS INFORMATION (40 CFR 122.21(g)(12))Contract Analysis Information 9.1 Were any of the analyses reported in Section 7 (on Tabl es A through C) performed by a contract laboratory or consulting firm?



##  Yes 

##  No  SKIP to Section 10.

9.2 Provide information for each contract laboratory or consulting firm below.

Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of Laboratory/Firm

Laboratory Address

Phone Number

Pollutant(s) AnalyzedEPA Form 3510-2F (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 Implementation SECTION 10. CHECKLIST AND CERTIFICATIO N STATEMENT (40 CFR 122.22(a) and (d))Checklist and Certification Statement 10.1 In Column 1 below, mark the Form 2F sections you hav e completed and are submitting with your application. For each section, specify in Column 2 the attachments you are enclosi ng. Note that not all applicants are required to complete all

sections or attachments.

Column 1 Column 2 

##  Section 1 

##  w/attachments (e.g., responses for additional outfalls)


##  Section 2 

##  w/attachments


##  Section 3 

##  w/site drainage map


##  Section 4 

##  w/attachments


##  Section 5 

##  w/attachments


##  Section 6 

##  w/attachments


##  Section 7 

##  Table A 

##  w/small business exemption request


##  Table B 

##  w/analytical results as an attachment


##  Table C 

##  Table D


##  Section 8 

##  w/attachments


##  Section 9 

##  w/attachments (e.g., responses for additional contact laboratories or firms)


##  Section 10 

## 

10.2 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 persons who manage the system or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for su bmitting false information, including the possibility of fine and imprisonment for knowing violations. Name (first and last) Official Title

Signature Date SignedEPA Form 3510-2F (Revised <INSERT DATE>Page 8EPA Identification NumberNPDES Permit NumberFacility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE A. CONVENTIONAL ANDNON-CONVENTIONALPARAMETERS (40 CFR 122.26(c)(1)(i)(E)(3))1You must provide the results of at least one analysis for everypollutant in this table. Complete one table for each outfall. See Instructions for additional details.Pollutant or ParameterMaximum Daily Discharge(specify units)Average Daily Discharge(specify units)Number of StormEvents SampledSource ofInformation(New Source/NewDischargers only. Usecodes in Instructions.)Grab Sample TakenDuring First30 MinutesFlow-weightedCompositeGrab Sample TakenDuring First30 MinutesFlow-weightedComposite1. Oil and Grease2. Biochemical Oxygen Demand (BOD5)3. Chemical Oxygen demand (COD)4. Total Suspended Solids (TSS)5.TotalPhosphorus6. Total Kjeldahl Nitrogen (TKN)7. Total Nitrogen (as N)8.pH (minimum)pH (maximum)1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter N orO. See Instructions and 40 CFR 122.21(e)(3).ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationThis page intentionally left blank.EPA Form 3510-2F (Revised <INSERT DATE>)Page 10EPA Identification NumberNPDES Permit NumberFacility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE B. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.26(c)(1)(i)(E)(4) and 40 CFR 122.21(g)(7)(vi)(A))1List each pollutant that is limited in an ELG that the facility is subject to or any pollutant listed in the facility’s NPDES permit for its process wastewater (if the facility is operating under anexisting NPDES permit). Complete one table for each outfall. See the Instructions for additional details and requirements.Pollutant and CAS Number (if available)Maximum Daily Discharge(specify units)Average Daily Discharge(specify units)Number of StormEvents SampledSource ofInformation(New Source/NewDischargers only. Usecodes in Instructions.)Grab Sample TakenDuring First30 MinutesFlow-weightedCompositeGrab Sample TakenDuring First30 MinutesFlow-weightedComposite1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter Nor O. See Instructions and 40 CFR 122.21(e)(3).ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationThis page intentionally left blank.EPA Form 3510-2F (Revised <INSERT DATE>)Page 12EPA Identification NumberNPDES Permit NumberFacility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE C. TOXIC POLLUTANTS, CERTAIN HAZARDOUS SUBSTANCES, AND ASBESTOS (40 CFR122.26(c)(1)(i)(E)(4) and 40 CFR 122.21(g)(7)(vi)(B) and (vii))1List each pollutant shown in Exhibits 2F-2, 2F-3, and 2F-4 thatyou know or have reason to believe is present. Complete one table for each outfall. See the Instructions for additional detailsand requirements.Pollutant and CAS Number(if available)Maximum Daily Discharge(specify units)Average Daily Discharge(specify units)Number of StormEvents SampledSource ofInformation(New Source/NewDischargers only. Usecodes in Instructions.)Grab Sample TakenDuring First30 MinutesFlow-weightedCompositeGrab Sample TakenDuring First30 MinutesFlow-weightedComposite1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter Nor O. See Instructions and 40 CFR 122.21(e)(3).ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationThis page intentionally left blank.EPA Form 3510-2F (Revised <INSERT DATE>)Page 14EPA Identification NumberNPDES Permit NumberFacility nameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. STORM EVENT INFORMATION (40 CFR 122.26(c)(1)(i)(E)(6))Provide data for the storm event(s) that resulted in the maximum daily discharges for the flow weighted composite sample.Date of Storm EventDuration of Storm Event(in hours)Total Rainfall DuringStorm Event(in inches)Number of Hours betweenBeginning of Storm Measured andEnd of Previous Measurable RainEventMaximum Flow RateDuring Rain Event(in gpm or specify units)Total Flow from Rain Event(in gallons or specify units)Provide a description of the method of flow measurement or estimate.