FORM D: CHECK LIST FOR AN INDUSTRIAL WASTE DISCHARGE PERMIT SUBMITTAL COMPANY NAME: 1. 2. Permit Application From................................................................................................................... Plans (Minimum size: 11" x 17"; maximum size 30" x 42")............................................................ a. Required Plans: Sewerage Plan (location of equipment, process tanks and sewer lines) ...................................... Plot Plan (location of facility, sampling point and connection to the public sewer).................... Plans of Pretreatment Facilities ................................................................................................... b. Additional Plans (if needed) Spill Containment System............................................................................................................ Flow Monitoring System ............................................................................................................. Rainwater Management ............................................................................................................... Combustible Gas Monitoring System .......................................................................................... 3. Supporting Information: Applicant's Questionnaire (Form A) .............................................................................. Estimation of Discharge Flow Rate and Water Bills (Form B) ...................................... ALWAYS REQUIRED Tank Schedule and Spill Containment Calculations (Form C)....................................... Checklist (Form D) ......................................................................................................... Process Description......................................................................................................... Waste Minimization Plan................................................................................................ Material Safety Data Sheets............................................................................................ COMPLETE FORM A TO DETERMINE WHICH OF THESE ARE NECESSARY Wastewater Analyses ...................................................................................................... Baseline Monitoring Report (for EPA categorical companies) ...................................... Pump Curves................................................................................................................... Catalog Cuts of Pretreatment Equipment ....................................................................... Baseline Credit Information............................................................................................ Equipment Costs ............................................................................................................. Notification Report of the Discharge of Hazardous Wastes (if applicable).................... American LegalNet, Inc. www.FormsWorkflow.com