Form Center

City of Port Arthur

Pretreatment Program Permit Application

General Information

Facility Name

Facility Street Address

Mailing Address

(Street or PO Box)

Address

Business Activity

If your facility employs or will be employing processes in any of the industrial categories or business activities listed below (regardless of whether they generate wastewater, waste sludge or hazardous waste), place a check beside the category of activity (check all that apply).

Note: Report required under 40CFR§§403.12(b), (d), (e), and (h) must be based on data obtained using appropriate sampling and analysis performed during the period covered by the report, which data are representative of conditions occurring during the reporting period, according to 40CFR§403.12(g)(3).

INDUSTRIAL CATEGORIES

A facility with processes inclusive in these business areas may be covered by Environmental Protection Agency's (EPA) categorical pretreatment standards. These facilities are termed “categorical users".

Give a brief description of all operations at this facility including primary products or services.

Indicate applicable Standard Industrial Classification (SIC) for all processes (If more than one applies, list in descending order of importance.)

Municipality or "Other" explanation:

Name on Water Bill

Address

List Pollution Prevention

List any other previous environmental permit

Identification of sources of discharge (e.g. regulated, dilution flow, unregulated)

(Used for combined wastestream formula to derive pollutant limits, if applicable)

List any hazardous waste(s) and description of any storage areas of hazardous waste

List size, descriptive location, and flow of each facility sewer which connects to the City's sewer system.

Wastewater Discharge Information

Does (or will) this facility discharge any wastewater other than from restrooms to the City sewer?

Yes
No

If yes, complete remainder of application. If no, skip to Section X.

Schematic Flow Diagram – For each major activity in which wastewater is or will be generated, draw a diagram of the flow of materials, products, water, and wastewater from the start of the activity to its completion, showing all unit processes. Indicate which processes use water and which generate waste streams. Include average daily volume and maximum daily volume of each waste stream [new facility may estimate]. If estimate are used for flow data this MUST be indicated.
Plans and specifications covering any work proposed to be performed under this permit is attached hereto as EXHIBIT “A”.
A plan to the property showing accurately all sewer and drains attached hereto as EXHIBIT “B”.
A complete schedule of all process water and industrial waste produced or expected to be produced at said property, including a description of the character of each waste, the daily volume and maximum rates of discharge, representative analysis and compliance with any pretreatment standard or requirements, is attached hereto as EXHIBIT “C”.

IN CONSIDERATION OF THE GRANTING OF THIS PERMIT THE UNDERSIGNED AGREES:
1. To furnish any additional information relating to the installation or use of the Industrial sewer for which this permit is sought as may be requested by the City.IN CONSIDERATION OF THE GRANTING OF THIS PERMIT THE UNDERSIGNED AGREES: 1. To furnish any additional information relating to the installation or use of the Industrial sewer for which this permit is sought as may be requested by the City. 2. To accept and abide by all provision of Ordinance No. 95-01 of the City of Port Arthur, and all other pertinent Ordinances or regulations that may be adopted in the future. 3. To operate and maintain any waste pretreatment facilities, as may be required as a condition of the acceptance into the wastewater treatment system of the industrial wastes involved in an efficient manner at all times, and at no expense to the City. 4. To cooperate at all times with the City and its representatives in the inspection, sampling and study of the industrial wastes, and any facilities provided for pretreatment. 5. To notify the City immediately in the event of any accident, or other circumstance that causes discharge to the wastewater collection and/or treatment system of any wastewater or substance prohibited or not covered by the this permit. “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 assure 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, 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 fine and imprisonment for knowing violations.
2. To accept and abide by all provision of Ordinance No. 95-01 of the City of Port Arthur, and all other pertinent Ordinances or regulations that may be adopted in the future.
3. To operate and maintain any waste pretreatment facilities, as may be required as a condition of the acceptance into the wastewater treatment system of the industrial wastes involved in an efficient manner at all times, and at no expense to the City.
4. To cooperate at all times with the City and its representatives in the inspection, sampling and study of the industrial wastes, and any facilities provided for pretreatment.
5. To notify the City immediately in the event of any accident, or other circumstance that causes discharge to the wastewater collection and/or treatment system of any wastewater or substance prohibited or not covered by the this permit.

“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 assure 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, 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 fine and imprisonment for knowing violations.”

Search Forms:

Permit for Pretreatment Program Entry

Contact Us

Helpful Links

Using This Site