Permit Re-App1_typer.pdf

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CITY OF NORTHAMPTON DEPARTMENT OF PUBLIC WORKS APPLICATION FOR INDUSTRIAL WASTE DISCHARGE PERMIT

INSTRUCTIONS: Please type or print Submit form to: Department of Public Works Wastewater Treatment Plant 33 Hockanum Road Northampton MA 01060 Attn: Permit Coordinator

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SECTION A

GENERAL INFORMATION

1. Company name and mailing address: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ telephone number: ______________________fax number _______________________ 2. Name, title and telephone number of person authorized to represent this firm in official dealings with the City: ____________________________________________________ ________________________________________________________________________ 3. What are the manufacturing, production or service activities of this facility; what does this facility do? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 4. Standard Industrial Classification Number(s) SIC Code for your facility: _________________________________________________________ 5. Number of employees: Maximum: __________________ Minimum: ____________________ Average: ___________________ 6. Work Schedule : Hours per day ____________ From __________To__________ Days per week____________ From__________ To__________ 7. Is this facility work schedule subject to seasonal variations? ( ) No ( ) Yes , if so, explain: _________________________________________________________________

Page 2 Is there an annual shutdown planned ? When and how long? ___________________ ______________________________________________________________________ SECTION B

FACILITY OPERATIONS

1. List raw materials used in production, including chemicals used in processing or cleaning: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 2. Describe production process: __________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 3. Have there been any changes or modifications made to the process since the last permit renewal application? Explain_____________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. Total daily flow of process water (mgd) _________________________________________ _________________________________________________________________________ 5. How is flow measured and where are meters located? ______________________________ __________________________________________________________________________ __________________________________________________________________________ 6. Where are floor drains located and where is the discharge point_______________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 7. Identify sources of noncontact cooling water and amount of discharge _________________ __________________________________________________________________________ __________________________________________________________________________ 8. Identify sources of contact cooling water and amount of discharge_____________________ ___________________________________________________________________________ ___________________________________________________________________________ 9. Is contact cooling water pretreated before discharge? What contaminants may be in contact cooling water_________________________________________________________ ___________________________________________________________________________ 10. Cooling tower blowdown: please list frequency and amount: __________________________

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Page 3 11. Boiler Discharges: Frequency of blowdown and amount of water discharged ________________________________________________________________________ ________________________________________________________________________ 12. How often are boilers drained and cleaned? _____________________________________ ________________________________________________________________________ 13. Floor Washing: Frequency_______________________amount of water used __________ _________________________________________________________________________ 14. Equipment Washing: list equipment, frequency of washing, and volume of water used: __________________________________________________________________________ __________________________________________________________________________ Where is rinse water discharged?_____________________________________________ ________________________________________________________________________ 15. Are any solvents used in washing? ____________________How are solvent wastes handled? _________________________________________________________________________ _________________________________________________________________________ SECTION C

WASTE DISPOSAL INFORMATION

1. This facility generates the following types of wastes in gallons per day: check all that apply: a. ( ) Domestic wastes (restrooms, employee showers sinks, etc) b. ( ) Cooling water, non-contact c. ( ) Boiler/Tower blowdown d. ( ) Cooling water, contact e. ( ) Process f. ( ) Equipment/facility washdown g. ( ) Air pollution control unit h. ( ) Other (describe) 2. Wastes are discharged to: (check all that apply): a. b. c. d. e. f. g. h. Page 4

( ( ( ( ( ( ( (

) ) ) ) ) ) ) )

Sanitary sewer Storm drain Surface water Ground water Waste Haulers Evaporation Grease trap Other (describe)

____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Gallons per day ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ _____________________

3. Does this facility discharge wastewater to any surface water? If yes, provide National Pollution Discharge Elimination System Permit number (NPDES number) ________________________________________________________________________ 4. Provide name and address of waste hauler(s) used, if any: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. Are any liquid wastes or sludges from this firm disposed of by means other than to the sewer system? ( ) Yes

( ) No

6. These wastes may best be described as: ( ( ( ( ( ( ( ( ( ( ( (

) ) ) ) ) ) ) ) ) ) ) )

Acids and alkaloids Heavy metal sludges Inks/Dyes Oil and/or Grease Organic Compounds Paints Settling pit solids Plating wastes Pretreatment sludges Solvents/thinners Other hazardous wastes Other wastes (specify)

Estimated gallons or pounds/year

_______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ ________________________________________

7. For the above checked wastes, does this company practice ( ) on-site storage ( ) off-site storage ( ) on-site disposal ( ) off-site disposal Briefly describe the method(s) of storage or disposal checked above. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8. Does this facility have a written spill prevention plan on file with the City? Yes_________________No_________________ When was the spill prevention plan last reviewed and updated? Date: _______________ ________________________________________________________________________ Page 5

SECTION D PRETREATMENT SYSTEMS 1. Describe any pretreatment systems at the facility___________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 2. How much flow is generated by pretreatment system, how is it measured, are wastestreams combined with domestic wastes or separate________________________________________ ____________________________________________________________ _______________ ____________________________________________________________________________ 3. Is any form of wastewater treatment (or changes to an existing wastewater treatment system) planned for this facility in the next year____________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________________________________________________________ 4. Is pretreatment a continuous or batch operation? ____________________________________ If batch, describe the frequency and duration of operation. ____________________________ ________________________________________________________________________________ ________________________________________________________________________________ 5. Is the pretreatment system classified by the Massachusetts Dept. of Environmental Protection? ( ) No ( ) Yes Grade of System __________________________ 6. Name of operator in responsible charge of this system: ___________________________ 7. Is the operator certified by the Mass. Board of Certification of Operators of Wastewater Treatment facilities? ( ) no ( ) yes License # ______________________________ SECTION E INSTRUMENTATION 1. What instruments or devices are permanently installed for monitoring wastewater parameters? ( Include flow meters , totalizers, ph meters, Parshall flumes, weirs, etc.) ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________________________

2. What is the frequency of calibration, and who performs the calibration? Are written logs or other documentation kept of maintenance and calibration? _________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Page 6

SECTION F HAZARDOUS WASTE 1. Is the facility a RCRA hazardous waste generator? If yes, provide EPA number _________ _________________________________________________________________________ 2. Describe the methods for handling, storing and disposing of hazardous waste: provide name and business address of contract haulers. Describe the containment systems. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 3. Is there any oil disposal or recycling?___________ What is the quantity?________________ Is recycling done in-house or taken off-site? _______________________________________

SECTION G SIGNATORY REQUIREMENT Name and title of responsible individual in charge of facility: ____________________________________________________________________________ ____________________________________________________________________________ Signature: ____________________________________________________________________ Date:

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For Office Use Only

Received by: ______________________________Date: ___________________________ Reviewed by: ______________________________Date: ___________________________ Comments: ________________________________________________________________ __________________________________________________________________________