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For each major activity in which wastewater is or will be generated, draw a diagram of the flow of materials, products, water, and wastewater. Indicate which processes use water discharges to the sanitary sewer. Use these numbers when showing the position of and which generates waste streams. Include the average daily volume and maximum daily volume of each waste stream. If using estimates, this must be stated. Number each unit process having wastewater that unit processes in the building layout diagram in the next section. Upload a scan or photograph of your diagram below.
If yes, provide the Groundwater Treatment System Operator's name, title, and phone number below.
Identify what groundwater contaminants will be present or are suspected to be present in the groundwater being treated (provide analytical results)
If you selected "yes" above, upload a copy of your Accidental Spill Plan here.
Will there be any waste liquids or sludges generated by the groundwater treatment process that will NOT be disposed of in the sanitary sewer?
List all other environmental permits applicable to this groundwater remediation (Federal, State, local).
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. 4) You agree with the following statement: I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure 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, hat the information submitted is to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
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