Supplemental Permit Questionnaire

This form must be completed for NPDES Industrial Activity for any facilities that manufacture or process any of the following products or activities:

• Timber Products
• Paper and Allied Products
• Chemical and Allied Products
• Asphalt Paving, Roofing Materials and Lubricants
• Glass Clay, Cement, Concrete and Gypsum Products
• Primary Metals
• Metal Mining (Ore Mining and Dressing)
• Coal Mines and Coal Mining Related Facilities
• Oil and Gas Extraction and Refining
• Mineral Mining and Dressing
• Hazardous Waste Treatment, Storage, or Disposal Facilities
• Landfills and Land Application Sites
• Automobile Salvage Yards
• Scrap Recycling Facilities
• Steam Electric Generating Facilities
• Water Transportation
• Ship and Boat Building or Repairing Yards
• Air Transportation
• Treatment Works, Sewerage 1.0 MGD, Land Dedicated for Disposal
• Food and Kindred Products
• Textile Mills, Apparel, and Other Fabric Product Manufacturing, Leather and Leather Products
• Furniture and Fixtures
• Printing and Publishing
• Rubber, Miscellaneous Plastic Products, and Miscellaneous Manufacturing Industries
• Transportation Equipment, Industrial or Commercial Machinery
• Electronic, Electrical, Photographic, and Optical Goods
• Food Service Establishment
• Commercial Facility with a Cafeteria
• Non-Domestic Categorical Industry as defined by 40 CFR Parts 405-471
• Groundwater Reclamation/Remediation Project
• Photographic or X-Ray Equipment Installed
• Discharges of Wastewaters other than Domestic or Boiler Blow-Downs
• Wastewater flows greater than 25,000 gallons per day

Supplemental Permit Application Form(PDF, 237KB)