Transcript
NPDES FORM 3510 -6
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY WASHINGTON, DC 20460 NOTICE OF INTENT (NOI) FOR STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY UNDER THE NPDES MULTI-SECTOR GENERAL PERMIT
Form Approved. OMB No. 2040-0086
Submission of this completed Notice of Intent (NOI) constitutes notice that the operator identified in Section B of this form requests authorization to discharge pollutants to waters of the United States from the facility or site identified in Section C under EPA’s NPDES Stormwater Multi-Sector General Permit (MSGP) for industrial stormwater. Submission of this NOI constitutes your notice to EPA that the facility identified in Section C of this form meets the eligibility conditions of Part 1.1 of the MSGP. Please read and make sure you comply with all eligibility requirements, including the requirement to prepare a stormwater pollution prevention plan. Refer to the instructions at the end of this form to complete your NOI.
A. Permit Number:
PR
R
050000
(see Appendix C of the MSGP for the list of eligible permit numbers)
Tracking Number (EPA Use Only): Only):
PRR 0 5 C 0 3 9
B. Facility Operator Information
1. Name:
F EDERAC I ON DE A SOC I AC I ONE S P ECU 66
–
2. IRS Employer Identification Number (EIN): 3. Mailing Address: a. Street: b. City:
0274608
PO BOX 2 6 3 5 MA Y AGUE Z 787
c. State: f. Fax (optional):
PR
d. Zip Code:
00681
-
e. Phone:
834 -9191
787
-
833 - 1055
g. E-mail:
[email protected]
C. Facility Information
1. Facility Name:
F E D E R A C I ON D E A SOC I A C I ON E S P E CU
YES
2. Have stormwater discharges from your site been covered previously under an NPDES permit? a. If yes, provide the Tracking Number if you had coverage under EPA’s MSGP 2000 or the NPDES permit number if you had coverage under an EPA individual permit. b.1 If no, was your facility in operation and discharging stormwater prior to October 30, 2005?
NO
NO
YES
YES
b.2 If no to C.2.b.1, did your facility commence discharging after October 30, 2005 and before January 5, 2009? 3. Location Address: a. Street b. City:
NO
P R 5 4 MA L E CON Z ON A POR T U A R I A MA Y AGU E Z MA Y AGU E Z
d. State:
c. County or similar government subdivision: f. Latitude: (use any one of the three formats provided.)
PR
e. Zip Code:
00681
-
2 ___ 3 ˝ N (degrees, minutes, seconds) g. Longitude: 1. ___ ___ 1 ___° 8 ___ 1 ___ 3 ΄ ___ 1 ___ 0 ΄ ___ 0 ___ 9 ˝ W (degrees, minutes, seconds) 1. ___ 6 ___° 7 ___ (use any of 2. ___ ___° ___ ___. ___ ___΄ N (degrees, minutes, decimal) these 3 2. ___ ___ ___° ___ ___. ___ ___΄ W (degrees, minutes, decimal) formats) 3. ___ ___. ___ ___ ___ ___° N ( degrees decimal) 3. ___ ___ ___. ___ ___ ___ ___° W (degrees decimal)
h. Lat/Long Data Source:
USGS topographic map
EPA web site
GPS
Other: _______________________________________________
GOOGLE MAPS
If you used a USGS topographic map, what was the scale? __________________________________________________________________________ 4. Estimated area of industrial activity at your site exposed to stormwater:10.07 (acres) 5. Is this a federal facility?
YES
NO
YES
NO
6. Is your facility located on Indian Country lands?
If yes, name of reservation, or if not part of a reservation, put “Not Applicable:” ___________________________________________________________
EPA FORM 3510-6 (Revised 09-2008)
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D. Discharge information
1. Does your facility discharge stormwater into a Municipal Separate Storm Sewer System (MS4)? YES NO
Municipio Autonomo de Mayaguez If yes, name of MS4 operator: ___________________________________________________________________________________________________
2. Receiving Waters and Wetlands (Note: If additional space is needed for this question, fill out Attachment 1.) b. Are any of your discharges directly into any segment of If your receiving water is impaired then identify the an “impaired” name of the impaired segment, if applicable, in water? parentheses following the receiving water name. a. What is the name(s) of your receiving water(s) that receive stormwater directly and/or through an MS4)? If you answered yes to question D.2.b, then answer the following three questions: b.1. What pollutant(s) are causing the impairment? b.2. Are the pollutant(s) causing the impairment present in your discharge? YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO b.3. Has a TMDL been completed for the pollutant(s) causing the impairment? YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO
Mayaguez Bay
YES YES YES YES YES YES YES YES YES YES
NO NO NO NO NO NO NO NO NO NO
3. Water Quality Standards (for new dischargers only) a. Are any of your discharges into any portion of a receiving water designated by the state or tribal authority under its antidegradation policy as a Tier 2 (or Tier 2.5) water (water quality exceeds levels necessary to support propagation of fish, shellfish, and wildlife and recreation in and on the water)? Water)? YES NO YES NO b. Has the receiving water(s) been designated by the state or tribal authority under its antidegradation policy as a Tier 3 water (Outstanding Natural Resource
4. Federal Effluent Limitation Guidelines and Sector-Specific Requirements a. Are you requesting permit coverage for any stormwater discharges subject to effluent limitation guidelines? b. If yes, which effluent limitation guidelines apply to your stormwater discharges? 40 CFR Part/Subpart Part 411, Subpart C Part 418 Subpart A Part 423 Part 429, Subpart I Part 436, Subpart B, C, or D Part 443, Subpart A Part 445, Subparts A & B Eligible Discharges Runoff from material storage piles at cement manufacturing facilities Runoff from phosphate fertilizer manufacturing facilities that comes into contact with any raw materials, finished product, by-products or waste products (SIC 2874) Coal pile runoff at steam electric generating facilities Discharges resulting from spray down or intentional wetting of logs at wet deck storage areas Mine dewatering discharges at crushed stone mines, construction sand and gravel mines, or industrial sand mines Runoff from asphalt emulsion facilities Runoff from hazardous waste and non-hazardous waste landfills Affected MSGP Sector E C O A J D K, L Check if Applicable YES NO
c. If you are a Sector S (Air Transportation) facility, do you anticipate using more than 100,000 gallons of glycol-based deicing/anti-icing chemicals and/or 100 tons or more of urea on an average annual basis? YES NO
5. Identify the 4-digit Standard Industrial Classification (SIC) code or 2-letter Activity Code that best represents the products produced or services rendered for which your facility is primarily engaged, as defined in MSGP: Primary SIC Code:
2048
Subsector Subsector
OR
Primary Activity Code
6. Identify the applicable sector(s) and subsector(s) of industrial activity, including co-located industrial activity, for which you are requesting permit coverage: a. d. Sector Sector
Q
1
b. e.
Sector Sector
U
Subsector Subsector
1
c. f.
Sector Sector
Subsector Subsector
7.a. Is your site presently inactive and unstaffed?
YES
NO YES NO
b1. If yes, is your site expected to be inactive and unstaffed for the entire permit term?
b2. If you select “no” in 7.b1 above, then indicate the length of time that you expect your facility to be inactive and unstaffed _______________________________ EPA FORM 3510-6 (Revised 09-2008) Page 2 of 7
E. Stormwater Pollution Prevention Plan (SWPPP) Contact Information
1a. SWPPP Contact Name: b. Phone: -
Ande r e
Lopez
Ext. c. E-mail:
[email protected]
2. URL of SWPPP (if applicable): __________________________________________________________________________________________________________
F. Endangered Species Protection
1. Using the instructions in Appendix E of the MSGP, under which criterion listed in Part 1.1.4.5 are you eligible for coverage under this permit?
A
B
C
D
E
F
2. If you select criterion E from Part 1.1.4.5: a. What federally-listed species or federally-designated critical habitat are in your “action area?”_______________________________________________________ __________________________________________________________________________________________________________________________________ b. List the pollutants expected to be present in your discharge ________________________________________________________________________________ __________________________________________________________________________________________________________________________________ c. If you are an existing discharger, do you have effluent monitoring data from EPA’s MSGP 2000, or another previous NPDES permit? c.1 If no, why not?
YES
NO
No monitoring required for my sector
Inactive/unstaffed site
Other _______________________________
YES
NO
YES
NO
c.2 Do you have any other data characterizing pollutants in your stormwater (describe)? ____________________________________________________ c.3 If you have benchmark monitoring data, did you exceed any of the applicable benchmarks?
c.4 Did you exceed any applicable effluent limitation guideline or cause or contribute to an exceedance of a State or Tribal water quality standard?
c.5 If you answered “yes” to either question F.2.c.3 or F.2.c.4 above, for what pollutant(s)? _______________________________________________________ d. Attach documentation supporting criterion E eligibility. Documentation should address species and habitat listed in F.2.a and the potential effects of pollutants listed in F.2.b (including any monitoring data for these pollutants) on the listed species and habitat. 3. If you select criterion F from Part 1.1.4.5, provide the operator’s NPDES Tracking Number under which you are certifying eligibility:
G. Historic Preservation
Using the instructions in Appendix F of the MSGP, under which criterion listed in Part 1.1.4.6 are you eligible for coverage under this permit?
A
B
C
D
H. Certifier Name and Title
I certify under penalty of law that I meet the eligibility conditions of this permit and that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, I certify that the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I certify that I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. Print Name: Title:
A N T ON I O J
S I S CO Ge n e r a l
Date:
Execu t i ve P r es i den t
Signature: _________________________________________________________________________________ E-mail:
ANTONIO J SISCO
073013
[email protected]
NOI Preparer (Complete if NOI was prepared by someone other than the certifier)
Prepared by: Organization: Phone: Ext. E-mail:
EPA FORM 3510-6 (Revised 09-2008)
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Attachment 1. (Fill in as necessary if more space is required for D.2 a-e)
b. Are any of your discharges directly into any segment of If your receiving water is impaired then identify the an “impaired” name of the impaired segment, if applicable, in water? parentheses following the receiving water name. YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES EPA FORM 3510-6 (Revised 09-2008) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO a. What is the name(s) of your receiving water(s) that receive stormwater from your facility (directly and/or through an MS4)? If you answered yes to question D.2.b, then answer the following three questions: b.3. Has a TMDL b.2. Are the pollutant(s) causing been completed for the pollutant(s) the impairment causing the present in your impairment? discharge? YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO
b.1. What pollutant(s) are causing the impairment?
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Instructions for Completing the Notice of Intent for Stormwater Discharges Associated with INDUSTRIAL ACTIVITY under the Multi-Sector General Permit (MSGP)
NOI Submittal Deadlines/Discharge Authorization Dates Category NOI Deadline Discharge Authorization Date1 30 days after EPA posts your Existing Dischargers - in No later than January NOI. Your authorization under operation as of October 5, 2009. the MSGP 2000 is automatically 30, 2005 and authorized continued until you have been for coverage under granted coverage under this MSGP 2000. permit or an alternative permit, or coverage is otherwise terminated. 30 days after EPA posts your As soon as possible New Dischargers or NOI. but no later than New Sources - have commenced discharging January 5, 2009. between October 30, 2005 and January 5, 2009. A minimum of 60 days If you post your SWPPP on the New Dischargers or Internet, 30 days after EPA prior to commencing New Sources operation of the facility, posts your NOI. Otherwise, 60 commence discharging days after EPA posts your NOI. or a minimum of 30 after January 5, 2009. days if your SWPPP is posted on the Internet during this period and the Internet address (i.e., URL) to your SWPPP is provided on the NOI form. New Owner/Operator of A minimum of 30 days 30 days after EPA posts your NOI. prior to date that the Existing Discharger transfer will take place transfer of ownership to the new and/or operation of a facility whose discharge owner/operator. is authorized under this permit If you post your SWPPP on the Immediately, to Other Eligible Internet, 30 days after EPA minimize the time Dischargers - in posts your NOI. Otherwise, 60 discharges from the operation prior to days after EPA posts your NOI. facility will continue to October 30, 2005 but be unauthorized. not covered under the MSGP 2000 or another NPDES permit.
1
accuracy and completeness of your NOI. You will also need a copy of the MSGP once you have obtained coverage so that you can comply with the implementation requirements of the permit. Where to File the NOI Form EPA encourages you to complete the NOI form electronically via the Internet. EPA’s Electronic Notice of Intent System (eNOI) can be found at www.epa.gov/npdes/enoi. Filing electronically is the fastest way to obtain permit coverage and help ensure that your NOI is complete. If you choose not to file electronically, you must send the NOI to one of the addresses listed below. NOIs sent regular mail: Stormwater Notice Processing Center (4203M) USEPA 1200 Pennsylvania Avenue, NW Washington, DC 20460 NOIs sent overnight/express mail: Stormwater Notice Processing Center EPA East Building, Rm. 7420 1201 Constitution Avenue, NW Washington, DC 20004 202-564-9545 If you have questions, please contact EPA’s Stormwater Notice Processing Center toll free at (866) 352-7755. • If you file a paper NOI, please submit the original with a signature in ink – Do Not Send Copies. Also, faxed copies will not be accepted. • Your SWPPP does not need to be submitted for review unless specifically requested by EPA or as otherwise required in Part 9 of the MSGP (State, Territory, and Tribal requirements). You must keep a copy of your SWPPP on-site or otherwise make it available to facility personnel responsible for implementing provisions of the permit. Completing the NOI Form To complete this form, type or print in uppercase letters in the appropriate areas only. Please make sure you complete all questions. Make sure you make a photocopy for your records before you send the completed original form to the address above. You may also use this paper form as a checklist for the information you will need when filing an NOI electronically via EPA’s eNOI system. Section A. Permit Number Appendix C of the MSGP 2008 contains a list of geographic areas covered by the permit. If your facility is located in one of the listed areas, include the appropriate permit number in this section. (For example, if you facility is located in Massachusetts, and not on Indian Lands, you would write MAR050000 in this space.) If your facility is located in an area not covered by the MSGP, please contact your EPA Region, state or territorial NPDES stormwater coordinator (see www.epa.gov/npdes/stormwatercontacts for a list of contacts). Section B. Facility Operator Information 1. Provide the legal name of the person, firm, public organization or any other public entity that operates the facility described in this application. An operator of a facility is a legal entity that controls the operation of the facility. 2. Provide the Employer Identification Number (EIN from the Internal Revenue Service (IRS)), commonly referred to as your taxpayer ID number. If the operator does not have an EIN, enter “NA” in the space provided. 3. Provide the operator’s mailing address, telephone number, fax number (optional), and email address. Correspondence will be sent to this address. Section C. Facility Information 1. Enter the facility’s official or legal name. Unless the name of your facility has changed, please use the same name provided on prior NOIs or permit applications. You can use EPA’s NOI Search website (www.epa.gov/npdes/noisearch) to view your previous NOI. 2. Indicate if industrial stormwater discharges from your facility were previously covered by an NPDES permit. 2a.If your facility was covered by EPA’s MSGP-2000, please include the tracking number that you received in your confirmation letter or email from EPA’s Stormwater Notice Processing Center. You can find the tracking number assigned to your previous NOI on EPA’s NOI Search website (www.epa.gov/npdes/noisearch). 2b1.If your facility was not previously covered by an NPDES permit and discharged industrial stormwater, then indicate if it was in operation before October 30, 2005 and not covered under the MSGP 2000. If you select “yes” to this question then you have a 30 day waiting period before you are authorized to discharge. 2b2.If you select “no” in C.2.b.1, then indicate if your facility discharged stormwater between October 30, 2005 and January 5, 2009. If you select “yes” to this
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Based on a review of your NOI or other information, EPA may delay your authorization for further review, notify you that additional effluent limitations are necessary, or may deny coverage under this permit and require submission of an application for an individual NPDES permit, as detailed in MSGP Part 1.6. In these instances, EPA will notify you in writing of the delay or the request for submission of an individual NPDES permit application. EPA will post these NOIs on its website at www.epa.gov/npdes/enoi.
Who Must File a Notice of Intent with EPA? Under section 402(p) of the Clean Water Act (CWA) and regulations at 40 CFR Part 122, stormwater discharges associated with industrial activity are prohibited to waters of the United States unless authorized under a National Pollutant Discharge Elimination System (NPDES) permit. You can obtain coverage under the MSGP by submitting a completed NOI if you operate a facility: • that is located in a jurisdiction where EPA is the permitting authority, listed in Appendix C of the MSGP, • that discharges stormwater associated with industrial activities, identified in Appendix D of the MSGP, • that meets the eligibility requirements in Part 1.1 of the permit, • that develops a stormwater pollution prevention plan (SWPPP) in accordance with Part 5 of the MSGP; and • that installs and implements control measures in accordance with Part 2 to meet numeric and non-numeric effluent limits. If you are unsure if you need an NPDES stormwater permit, contact your EPA or State NPDES stormwater permit program. Contacts are listed at www.epa.gov/npdes/stormwatercontacts. One NOI must be submitted for each facility or site for which you are seeking permit coverage. You do not need to submit separate NOIs for each type of industrial activity present at your facility, provided your SWPPP covers all activities. When to File the NOI Form Do not file your NOI until you have obtained and thoroughly read a copy of the MSGP. A copy of the MSGP is located on the EPA website (www.epa.gov/npdes/stormwater/msgp). The MSGP describes procedures to ensure your eligibility, prepare your SWPPP, install and implement appropriate stormwater control measures, and complete the NOI form questions – all of which must be done before you sign the NOI certification statement attesting to the
EPA FORM 3510-6 (Revised 09-2008)
question then you have a 30 day waiting period before you are authorized to discharge. If you select “no” to this question and you post your SWPPP on the Internet and provide EPA the URL in E.2, then you have a 30 day waiting period before you are authorized to discharge. If you select “no” to this question, but do not post your SWPPP on the Internet and therefore do not answer E.2, then you have a 60 day waiting period before you are authorized to discharge. 3.a-e. Enter the street address, including city, state, zip code, county or similar government subdivision of the actual physical location of the facility. Do not use a P.O. Box. 3.f-g. Provide the facility latitude and longitude in one of three formats: (1) degrees, minutes, seconds; (2) degrees, minutes, decimal; or(3) degrees decimal. You can obtain your facility’s latitude and longitude though Global Positioning System (GPS) receivers, U.S. Geological Survey (USGS) quadrangle or topographic maps, and EPA’s web-based siting-tools, among other methods. Refer to www.epa.gov/npdes/stormwater/msgp for guidance on the use of these methods. For consistency, EPA requests you take measurements from the location of your facility’s stormwater outfall. Outfalls are locations where the stormwater exits the facility, including pipes, ditches, swales, and other structures that transport stormwater. If there is more than one outfall present, measure at the primary outfall (i.e., the outfall with the largest volume of stormwater discharge associated with industrial activity). 3.h. Identify the data source that you used to determine the facility latitude and longitude. If you did not use a USGS quadrangle or topographic map, the EPA website, or GPS receivers, then select “Other” and write the method used on the line provided. If you used a USGS quadrangle or topographic map, write the map scale on the line provided. Scale should be identified on the map. 4. Enter the estimated area of industrial activity at your site exposed to stormwater, in acres. 5. Indicate if the facility is considered a “federal facility” - Federal facilities include any buildings, installations, structures, land, public works, equipment, aircraft, vessels, and other vehicles and property, owned or leased by the federal government. 6. Indicate whether the facility is located in Indian Country, and, if so, provide the name of the reservation, if applicable. Section D. Discharge Information 1. Indicate whether stormwater from your site will be discharged into a municipal separate storm sewer system (MS4). An MS4 is a conveyance or system of conveyances, including roads with drainage systems, municipal streets, catch basins, storm drains, curbs and gutters, ditches and man-made channels, owned or operated by a state, city, town, borough, county, parish, district, association or other public body, used to collect or convey stormwater. If you check “Yes” then identify the name of the MS4 operator on the line provided. If you are uncertain of the MS4 operator, contact your local government for that information. MS4s are different than combined sewers, which are designed to convey both stormwater and sanitary wastewater. Discharges to combined sewers do not require an NPDES permit but may be subject to other CWA requirements (contact the combined sewer operator for more information). 2. Enter information regarding your discharge. If additional space is needed fill out Attachment 1. 2a. Indicate in column “a” of the table the name(s) of the receiving water(s) into which stormwater from your facility will discharge. Also provide in parentheses the name of the impaired water (and segment, if applicable) into which your stormwater is discharged. If you identified more than on receiving water for your facility, indicate the first receiving water and complete question 2b and 2.b.1-3 (if applicable), before entering the next receiving water. The EPA’s Water Locator Tool can help you identify the closest receiving water to your facility (www.epa.gov/npdes/msgp). Your receiving water may be a lake, stream, river, ocean, wetland or other waterbody, and may or may not be located adjacent to your facility. Your stormwater may discharge directly to the receiving water or indirectly via a storm sewer system, an open drain or ditch, or other conveyance structure. Do NOT list a man-made conveyance, such as a storm sewer system, as your receiving water. Indicate the first receiving water your stormwater discharge enters. For example, if your discharge enters a storm sewer system, that empties into Trout Creek, which flows into Pine River, your receiving water is Trout Creek, because it is the first waterbody your discharge will reach. Similarly, a discharge into a ditch that feeds Spring Creek should be identified as “Spring Creek” since the ditch is a manmade conveyance. If you discharge into a municipal separate storm sewer system (MS4), you must identify the waterbody into which that portion of the storm sewer discharges. That information should be readily available from the operator of the MS4. 2b. Indicate in column “b” of the table whether you discharge directly to an impaired water (lake, stream segment, estuary, etc), listed as “impaired” under section 303(d) of the Clean Water Act. Each state water quality agency maintains a list of waters that are impaired. Most state agencies publish these lists online. The EPA’s Water Locator Tool may also help you identify if the nearest receiving water is impaired (www.epa.gov/npdes/msgp). If you discharge into a stream
EPA FORM 3510-6 (Revised 09-2008)
segment that is upstream of a listed impaired water but which is not itself on the State’s impaired waters list, answer “no” to this question. In this case, requirements in the MSGP for discharges into impaired waters do not apply to you, unless notified otherwise by EPA. Answer the following three questions only if you answered “Yes” to D 2.b: 2b1. Provide the pollutant(s) listed as causing the impairment in the water identified in D.2.b.1 above. Enter each pollutant individually on a separate row in the table. 2b2. Out of the pollutant(s) that you identified in D.2.b.1 above, indicate which pollutants you believe will be present in your discharge. If you do not expect the pollutant(s) to be in your discharge, then select “no.” 2b3.Indicate the pollutant(s) that have a Total Maximum Daily Load (TMDL) for the impaired stream segment that you identified in D.2.b.2 above. Check with your state water quality agency for lists of waters with approved or established TMDLs. See www.epa.gov/npdes/msgp for more information. 3. Water Quality Standards 3a.If you selected “no” in C.2 indicating that stormwater discharges from your facility have not been previously covered under an NPDES permit, then you are considered a new discharger and must answer this question; otherwise you are considered an existing discharger and may skip this question. State water quality agencies are responsible for setting water quality standards for waters within the state’s boundaries. Check EPA’s website (www.epa.gov/npdes/msgp) to determine if the water(s) that you discharge into are designated as a “Tier 2 (or Tier 2.5) water” (See Appendix A of the MSGP 2008 for definitions of “Tier 2 water” and “Tier 2.5 water”). If you discharge into these waters, EPA may impose additional permit conditions to ensure that you do not violate the State’s antidegradation policy. 3.b Idenitfy whether your receiving water is designated as a Tier 3 waterbody. Go to www.epa.gov/npdes/msgp for a list of Tier 3 waterbodies. Note that new discharges into designated Tier 3 waters are not eligible for coverage under the MSGP 2008. 4. Federal Effluent Limitation Guidelines and Sector-Specific Requirements 4.a-b. Depending on your industrial activities, your facility may be subject to effluent limitation guidelines which include additional effluent limits and monitoring requirements for your facility. Please review these requirements, described in Part 2.1.3 of the MSGP, and check any appropriate boxes on the NOI form. 4.c. For Sector S facilities (Air Transportation), indicate whether you anticipate that the entire airport facility will use more than 100,000 gallons of glycol-based deicing/anti-icing chemicals and/or 100 tons or more of urea on an average annual basis. If so, additional effluent limits and monitoring conditions apply to your discharge (see Part 8 Sector S of the MSGP 2008). 5. List the four-digit Standard Industrial Classification (SIC) code and/or two character activity code that best describes the primary industrial activities performed by your facility under which you are required to obtain permit coverage. Your primary industrial activity includes any activities performed onsite which are (1) identified by the facility’s one SIC code for which the facility is primarily engaged; and (2) included in the narrative descriptions of 40 CFR 122.26(b)(14)(i), (iv), (v), or (vii), and (ix). See Appendix D of the MSGP for a complete list of SIC codes and activities codes. 6. If your site has co-located industrial activities that are not identified as your primary industrial activity, identify the sector and subsector codes that describe these other industrial activities. For a complete list of sector and subsector codes, see Appendix D of the MSGP. 7.a-b Indicate whether your facility is currently inactive and unstaffed. If so then indicate whether your facility will be inactive and unstaffed for the entire permit term, or if not, specify the specific length of time in units of days, weeks, months, or years (e.g. 3 months) that you expect the facility to be inactive and unstaffed. Section E. Facility Contact Information and SWPPP Location 1.a-c. Identify the name, telephone number, and email address of the person who will serve as a contact for EPA on issues related to stormwater management at your facility. This person should be able to answer questions related to stormwater discharges, the SWPPP, and other issues related to stormwater permit coverage, or have immediate access to individuals with that knowledge. This person does not have to be the facility operator, but should have intimate knowledge of stormwater management activities at the facility. 2. If you are making your Stormwater Pollution Prevention Plan publicly available on a website provide the appropriate Internet URL address. (Please note that by posting your SWPPP on the web, you may qualify for a shortened authorization waiting period. See Table 1-2 of the MSGP for more information.) Section F. Endangered Species Protection 1. Based on the instruction provided in Appendix E of the MSGP 2008, indicate which permit criterion (A,B,C,D,E, or F) listed in Part 1.1.4.5 you are using to satisfy your eligibility obligations for protection of endangered and threatened species, and designated critical habitat.
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2.a. If you select criterion E (not likely to adversely affect), list those federally-listed endangered or threatened species and any federally-listed designated critical habitat expected to exist in proximity to your facility. 2.b List the pollutants that you expect to be present in your stormwater discharge. Include any pollutants that you may have included in D.2.b.3 above. 2.c If you selected “yes” in C.2 then you are considered an existing discharger and must answer all the questions in F.2.c.1--5; otherwise you are considered a new discharger and may skip the questions under F.2.c. If you are an existing discharger who was previously covered under the MSGP 2000, indicate whether you have any previous effluent monitoring data. 2.c1-2.If you select “No,” to F.2.c then indicate why you don’t have any data. Also indicate if you have any other data characterizing pollutants in your stormwater discharge. 2.c.3. If you select “Yes,” to F.2.c then indicate whether you exceeded any benchmark. 2.c.4 Indicate whether you have exceeded any applicable effluent limitation guideline, or caused or contributed to an exceedance of state or tribal water quality requirement(s). 2.c.5. If you select “Yes” to F.2.c.3.and/or F.2.c.4 then indicate the pollutant parameters for which you exceeded the benchmark, applicable effluent limitation guideline, or State or Tribal water quality requirement(s). 2.d. Attach your supporting rationale for your determination of the applicability of Criterion E for your facility (applies to both new and existing dischargers). Your documentation should address species and habitat listed in F.2.a and the potential effects of pollutants listed in F.2.b on the listed species and habitat. This should include consideration of any available data characterizing pollutants in your stormwater discharge, or in the discharge of similar facilities if data for you facility is not available, that may be of concern to listed species. 3. If you select Criterion F (already addressed in another operator’s valid certification), provide the tracking number that the operator received in their confirmation letter or email from EPA’s NOI Processing Center (see Appendix E). You can find the tracking number assigned to your previous NOI on EPA’s NOI Search website (www.epa.gov/npdes/noisearch). An example where criterion F may apply includes airports where several individual airlines have applied for coverage under the MSGP, and the entire airport also has applied for or obtained coverage. If the airport has already certified under Appendix E, and that certification addresses any potential impacts from the individual airlines, then the airlines may reference the airport’s permit tracking number. Section G. Historic Preservation Based on the instruction provided in Appendix F of the MSGP 2008, indicate which permit criterion (A, B, C, or D) listed in Part 1.1.4.6 of the MSGP you used to satisfy your eligibility obligations for protection of historic properties. Section H. Certification Certification statement and signature (see Section B.11 of Appendix B of the MSGP for more information). Enter certifier’s printed name, title and email address. Sign and date the form. (CAUTION: An unsigned or undated NOI form will prevent the granting of permit coverage.) Federal statutes provide for severe penalties for submitting false information on this application form. Federal regulations require this application to be signed as follows: For a corporation: by a responsible corporate officer, which means: (i) 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; For a partnership or sole proprietorship: by a general partner or the proprietor; or For a municipal, State, Federal, or other public facility: by either a principal executive or ranking elected official. If the NOI was prepared by someone other than the certifier (for example, if the NOI was prepared by the facility SWPPP contact or a consultant for the certifier’s signature), include the name, organization, phone number and email address of the NOI preparer. Paperwork Reduction Act Notice Public reporting burden for this certification is estimated to average 3.7 hours per certification, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose to provide
EPA FORM 3510-6 (Revised 09-2008)
information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding the burden estimate, any other aspect of the collection of information, or suggestions for improving this form, including any suggestions which may increase or reduce this burden to: Director, Office of Environmental Information Services, Collection Services Division (2823), USEPA, 1200 Pennsylvania Avenue, NW, Washington, DC 20460. Include the OMB control number of this form on any correspondence. Do not send the completed NOI form to this address.
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