Clean Water Branch

Forms

Forms to be used in E-Permitting Portal for the National Pollution Discharge Elimination System (NPDES) Program

(1) CWB Individual NPDES Form – Application to request Individual NPDES Permit coverage (read the instructions, then click on the “Submit online form” button in the E-Permitting portal to begin the application process).

Forms to be completed and uploaded as specified in the CWB Individual NPDES Form:

Transmittal Requirements and Certification Statement for E-Permitting Individual NPDES Application Submissions (required for all submissions) Note: You must download this form in the “Certify & Submit” step during your portal submission to continue to the next step in the e-permitting application.
Tax Map Key (TMK) Spreadsheet (required in Section 5 of CWB Individual NPDES Form)
Discharge Specific Attachment(s) – Select the form(s) for the discharge(s)/activity(ies) that you are requesting NPDES Permit coverage (required in Section 9 of CWB Individual NPDES Form):

(a) Form B – Discharges of storm water associated with industrial activities. NPDES permit coverage is required for discharges of storm water runoff associated with industrial activity(ies), as categorized in 40 CFR 122.26(b)(14)(i) through 122.26(b)(14)(ix) and 122.26(b)(14)(xi).

(b) Form C– Discharges of storm water associated with construction activities. NPDES permit coverage is required for activities that disturb one (1) acre or more of total land area. NPDES permit coverage is also required for activities that disturb less than one (1) acre of total land area that are part of a larger common plan of development or sale if the larger common plan will ultimately disturb one (1) acre or more of total land area [40 CFR 122.26(b)(15)].

(c) Form D – Discharges of treated effluent from leaking underground storage tank remedial activities. NPDES permit coverage is required for the release or discharge of treated ground water to State waters from the cleanup (or remedial action) of underground storage tanks that have leaked petroleum hydrocarbons.

(d) Form E – Discharges of once through cooling water less than (1) million gallons per day. NPDES permit coverage is required for discharges to State waters of once through cooling water with a total flow of less than one (1) million gallons per day. “Once through cooling water” means water passed through the main cooling condensers one or two times for the purpose of removing waste heat.

(e) Form F – Discharges of hydrotesting waters. NPDES permit coverage is required for the release or discharge of hydrotesting waters to State waters. “Hydrotesting Waters” means water used to test the integrity of a tank or pipeline, pipeline disinfection, and/or pipeline flushing.

(f) Form G – Discharges of construction activity dewatering. NPDES permit coverage is required for discharges to State waters of construction activity dewatering effluent. “Dewatering Effluent” is any type of water (e.g. ground water, storm water, stream water, ocean water, etc.) pumped from a construction area.

(g) Form H – Discharges of treated process wastewater associated with petroleum bulk stations and terminals. NPDES permit coverage is required for discharges to State waters of treated process wastewater effluent from petroleum bulk stations and terminals. Treated process wastewater effluent includes tank water draws, product displacement process wastewater, wash down and fire hydrant system test waters, service station tank draws, recovered groundwater, and contaminated storm water runoff from the product storage and handling areas.

(h) Form I -Discharges of treated process wastewater associated with well drilling activities. NPDES permit coverage is required for discharges to State waters of treated process wastewater associated with well drilling activities. Treated process wastewater includes well drilling slurries, lubricating fluids wastewaters, and well purge wastewaters.

(i) Form K – Discharges of storm water and certain non-storm water discharges from small Municipal Separate Storm Sewer Systems (MS4s). NPDES permit coverage is required for storm water and certain non-storm water discharges to State waters from small MS4s.

(j) Form L – Discharges of circulation water from decorative ponds or tanks. NPDES permit coverage is required for discharges to State waters of circulation water from decorative ponds or tanks containing fish or other aquatic species.

(k) Form M – Point source discharges from the application of pesticides. NPDES permit coverage is required for the application of pesticides to State waters.

(l) Form 2A – Pollutant discharges from a publically owned treatment works to a State water.

(m) Form 2B – Pollutant discharges from a concentrated animal feeding operation (CAFO) or aquaic animal production facility to a State water.

(n) Form 2C – Discharges of wastewater to a State water from an existing facility, other than described in Form 2A and 2B.

(o) Form 2D – Discharges of process wastewater to a State water from a new, proposed facility, other than described in Form 2A and 2B. Process wastewater is water that comes into direct contact with or results from the production or use of raw materials, intermediate product, finished product, byproduct, waste product, or wastewater.

(p) Form 2E – Discharges of nonprocess wastewater which is not regulated by effluent limitation guidelines or new source performance standards. This form is intended primarily for use by dischargers (new or existing) of sanitary wastes and noncontact cooling water. It may not be used for discharges of storm water runoff or by educational, medical, or commercial chemical laboratories, or by publicly owned treatment works.

(q) Form 2S – Sewage sludge (biosolids) for new and existing treatment works treating domestic sewage.

(r) ZID/ZOM Form – Zone of Initial Dilution (ZID)/Zone of Mixing (ZOM) form.

For Renewals ONLY: Historic Effluent Limitations and Monitoring Data Spreadsheet and Effluent Violation Spreadsheet (required in Section, 1b of CWB Individual NPDES Form).

(2) CWB NOI Form – Notice of Intent (NOI) application to request coverage under NPDES General Permit (read instructions, then click on the “Submit online form” button in the E-Permitting portal to begin the application process).

Forms to be completed and uploaded as specified in the CWB NOI Form:

Transmittal Requirements and Certification Statement for E-Permitting Notice of Intent (NOI) Submissions (required for all submissions) Note: You must download this form in the “Certify & Submit” step during your portal submission to continue to the next step in the e-permitting application.
Operator Applying on Behalf of Owner Agreement – Agreement required to be signed by the Owner of a project or facility to authorize an operator to apply for and obtain NPDES permit coverage on behalf of the Owner.
Non-Automatic Transfer of Ownership Agreement – Agreement required to be signed by the current Permittee and new Permittee to apply for a new permit coverage for a currently permitted facility issued to a different Permittee.
Water Quality Parameters Table (required for coverages under Appendices D, F, G, H, I, L)
Toxic Parameters Table (required for coverages under Appendices D, F, G, H, I, L)
Toxic Parameters Glossary – A glossary of the parameters contained in the Toxic Parameters Table
Cooling Water Parameters (required for coverage under Appendix E)
Treatment System Operations Plan Requirements – Requirements for the Treatment System Operations Plan for coverages under Appendix D.
Site-Specific Dewatering Plan Requirements – Requirements for the Site-Specific Dewatering Plan for coverages under Appendix G.
Site-Specific Detailed Well Drilling BMPs Plan Requirements – Requirements for the Site-Specific Detailed Well Drilling BMPs Plan for coverages under Appendix I.

(3) CWB “No Exposure” Certification Form – Form to request a Conditional “No Exposure” Exclusion from NPDES storm water associated with industrial activity permitting (read instructions, then click on the “Submit online form” button in the E-Permitting portal to proceed with the application process).

Form to be completed and uploaded as specified in the CWB “No Exposure” Certification Form:

Transmittal Requirements and Certification Statement for E-Permitting “No Exposure” Certification Submissions (required for all submissions) Note: You must download this form in the “Certify & Submit” step during your portal submission to continue to the next step in the e-permitting application.

See Industrial Storm Water SIC Codes for a list of applicable industrial activities. As reference, EPA Guidance Manual for Conditional Exclusion from Storm Water Permitting Based on “No Exposure” of Industrial Activities to Storm Water is provided for your information, however, please note that the CWB is delegated NPDES Permitting authority and the entire document is for reference only (Note: do not submit forms in this Guidance Manual).

(4) Forms Used to Report NPDES Individual and General Permit Compliance Data

CWB Compliance Submittal Form for Individual NPDES Permits and NGPCs – Form to submit all NPDES Permit and NGPC compliance information, including Discharge Monitoring Reports (DMRs) (read instructions, then click on “Submit online form” button in the E-Permitting portal to proceed with Compliance Submittal). Please reference your issued NPDES Permit and/or NGPC for your required compliance submittals.

Forms to be completed and uploaded as specified in the CWB Compliance Submittal Form for Individual NPDES Permits and NGPCs:

Transmittal Requirements and Certification Statement for E-Permitting NPDES/NGPC Compliance Submissions (required for all submissions) note: you must download this form in the “Certify & Submit” step during your portal submission to continue to the the next step in the e-permitting compliance process.
Blank DMR – If your NPDES Permit and/or NGPC has water quality sampling requirements, you will be required to complete a Blank DMR and upload it to Section 4.a of the CWB Compliance Submittal Form. DMR Instructions are available for your reference.
Automatic Transfer of Ownership Written Agreement Form – If you are requesting a Transfer of Ownership, you will be required to complete and upload the Automatic Transfer of Ownership Written Agreement Form, in Form Section 8. Transfer of Ownership.
MS4 NPDES Individual Permit – Industrial Storm Water Discharge Notification Form – This form is to request coverage of a facility’s industrial storm water discharge under an Individual NPDES MS4 permit. This form is for Individual MS4 permit holders only. Complete the MS4 NPDES Individual Permit – Industrial Storm Water Discharge Notification Form, and upload it to Section 7 of the CWB Compliance Submittal Form.
MS4 NPDES Individual Permit – No Exposure Notification Form – This form is to notify the DOH a “No Exposure” condition exists for all industrial activity from a facility covered under an Individual NPDES MS4 permit. This form is for Individual MS4 permit holders only. Complete the MS4 NPDES Individual Permit – No Exposure Notification Form, and upload it to Section 7 of the CWB Compliance Submittal Form.

(5) Forms to be used in E-permitting portal for the Section 401 Water Quality Certification (WQC) Program.

(a) Section 401 WQC Form – Application to request a Section 401 WQC.

(b) Electronic Signature Vessel General Permit (VGP) DOH Notification Form – Form for the Owner or Operator of a vessel seeking coverage under the 2013 VGP (read instructions, then click on the “Begin Form Entry” button in the E-Permitting portal to begin the application process).

(c) CWB Compliance Submittal Form for Section 401 WQCs – Form to submit all WQC compliance information (read instructions, then click on “Submit online form” button in the e-Permitting portal to proceed with WQC compliance submittal). Please reference your issued Section 401 WQC or NWP Blanket WQC for your compliance submittal.

Forms to be completed and uploaded as specified in the CWB Compliance Submittal Form for Section 401 WQCs:

Transmittal Requirements and Certification Statement for e-Permitting Section 401 WQC Compliance Submissions (required for all WQC compliance submissions). Note: You must download this form in the “Certify & Submit” step during your portal submission to continue to the next step in the e-Permitting compliance submission process.
Transfer of Ownership Written Agreement for Section 401 WQCs – Only use this form for a Transfer of Ownership.

(6) Other Forms

(a) Form Used to Request Funding

Polluted Runoff Control Program Request for Proposals Form

(b) Request to Access a Government Record Form

The WPC Viewer provides public access to Clean Water Branch NPDES permit and Section 401 WQC information, including facility/project, inspection, and enforcement information. Please search the WPC Viewer. If you cannot locate the desired documents, then print, complete, and email ([email protected]) the Request to Access a Government Record form to the Clean Water Branch. Other related forms include the Notice to Requester form and Acknowledgment to Requester form. Please obtain the compliance reports from EPA’s Environmental Compliance History Online (ECHO).