FOR OFFICIAL USE ONLY

Transcription

1 FORM E [Rules 8, 10] THE WATER POLLUTION RULES 2001 (as amended) THE ENVIRONMENTAL MANAGEMENT ACT CHAPTER 35:05 APPLICATION FOR A WATER POLLUTION PERMIT TO DISCHARGE WATER POLLUTANTS FROM MANUFACTURING, COMMERCIAL, INSTITUTIONAL AND MINING OPERATIONS. GENERAL INSTRUCTIONS: This form shall be completed in triplicate for any facility identified in rule 8 of the Water Pollution Rules, 2001 (as amended), Environmental Management Act Chapter 35:05. Unless otherwise specified on this form all items are to be completed. Refer to instructional booklet and sample completed application form for detailed item descriptions and instructions. If an item does not apply to you, enter NA (for not applicable) to show that you considered the question. Any forms with blank fields will be considered incomplete and the application will not be processed. Please Print (Block Letters) or Type all information. This form must be signed by the principal executive officer where the application is with respect to a company and in other instances by the person owning or operating the facility in respect of which the permit is being sought. Certification. "I hereby certify that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that competent 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 the submission of any information which is false, which I know or believe to be false or do not believe to be true is an offence of law." Principal Executive Officer (last,first): SMITH, JOHN Official Position: CHIEF EXECUTIVE OFFICER Mailing Address (number, street, city, village and country): (PRINT NAME) P.O Box XYZ, PORT OF SPAIN Phone No.: Fax No.: Mobile No.: abc@xyz.com 21/04/2009 Principal Executive Officer Signature Date Application Received: Payment Received: YES Date Application Signed: FOR OFFICIAL USE ONLY (Day/Month/Year) NO Amount Received: Permit Reference Number: W P P - / (DD/MM/YYYY) EMA Personnel Received by $2500 $5000 Major Group Code according to Standard Industrial Classification (SIC) Systems: ISIC NAICS Watershed ID Watershed Name Region / Parish Name Region / Parish ID DISCLAIMER: Please note that this document watermarked SAMPLE does not represent any real facility or real data from any known facility. This document is intended for use as GUIDANCE ONLY for applicants when completing this permit application for their facility and to be used with the Instructional Booklet. [Type text]

2 SECTION I. APPLICANT AND FACILITY DESCRIPTION 1. Application Type. Type of Permit for which application is to be made (Please tick): Initial Renewal. For renewal give Permit No.: WPP If the facility has a Source Registration Certificate, please provide the Certificate No.: WWG XX 2. Name of Parent Facility. ISLAND FISHERIES COMPANY LIMITED 3a. Name of Facility Site (If different from Item 2 above). ISLAND FISHERIES COMPANY LIMITED, PROCESSING DIVISION 3b. Type of Facility (Please Tick) Manufacturing Institutional Commercial Mining Industrial 3c. Provide a Description of the Facility s Operations (attach additional sheets if necessary to provide further details such as flow charts, process maps etc.): PROCESSING AND PRESERVING OF FISH AND FISH PRODUCTS 4. Number of Employees at the Facility Site. Permanent: 80 Temporary: Facility Location (ref. Item 3a) Number and Street:1234 EASTERN MAIN ROAD Town /Village/City: PORT OF SPAIN Lot No: NA Regional Corporation / Parish: PORT OF SPAIN Universal Transverse Mercator (UTM) Eastings (me): Universal Transverse Mercator (UTM) Northings (mn): Age of Facility. Give the exact date that this facility began operations: 22/ 01/1979 DD/ MM/ YYYY Approximate age in years: 29 (Where exact date of commencement is unknown) E - 2

3 7. Facility Contact. Name (last, first): STONE, JIM Official Title: OPERATIONS MANAGER Mailing Address (number, street, city, village and country): ISLAND FISHERIES COMPANY LIMITED, EASTERN MAIN ROAD, PORT OF SPAIN, TRINGO, W.I. address: Fax No.: (868) Phone No. (office): (868) Phone No. (mobile): Facility Ownership: Ownership type (Please tick) Individual Corporation Governmental Entity Partnership Institution Other (please specify) Name of Owner: ISLAND FISHERIES COMPANY LIMITED 9. Does the Owner of the Facility also own the Property on which the Facility is Located? (Please tick) Yes No If No, what is the nature of the facility owner s interest in the property? Please attach supporting documents justifying your claim (e.g. lease). NA 10. Property Ownership (if not owned by facility owner): Ownership Type (Please tick) Individual Corporation Governmental Agency Partnership Other (specify) Name of Owner: _ NA Address: NA Contact Person: (Name): NA address: NA Fax No.: NA Phone No. (office): NA Phone No. (mobile): NA E - 3

4 11. Name(s) and Address(es) of Adjoining Property Owners: (1) F&R PAINTS COMPANY LIMITED, EASTERN MAIN ROAD, PORT OF SPAIN; (2) BR BISCUITS COMPANY LIMITED, EASTERN MAIN ROAD, PORT OF SPAIN; 12. Corporate Data. Date of Incorporation or Continuance: 22/01/1979 (CONTINUANCE ON 14/02/1999) DD/ MM/YYYY Please ensure Registrar s Certificate of Incorporation/Continuance, furnished by the Registrar of Companies, is attached to this application. Corporate Officers: Official Title Name Business Address CHIEF EXECUTIVE OFFICER COMPANY SECRETARY JOHN SMITH JANE DOE EASTERN MAIN ROAD, PORT OF SPAIN EASTERN MAIN ROAD, PORT OF SPAIN Directors: Name of Director MS. D. SMITH 3 MRS. Z. JONES 4 MR. W. SINGH 4 MR. S. ALI 4 MS. D. SMITH 3 Term of Office (Yrs) Identify below any individual, corporation or other business organization having ownership or controlling interest in the facility. If applicable, the chain of ownership should be traced to the parent company. NAME: NA ADDRESS: NA NATURE OF CONTROL: NA E - 4

5 13. Other Permits/Certificates/Licenses/Approvals. List all Permits, Certificates, Licenses and Approvals granted by the Authority or any other government entity in relation to the facility that are currently in effect or have been in effect at any time in 5 years prior to the date on which this form has been submitted. Issuing Agency Type of Permit, Certificate or License ID No. Date Issued dd/mm/yyyy Expiration Date dd/mm/yyyy MINISTRY OF HEALTH PUBLIC HEALTH INSPECTION CERTIFICATE / /03/ /03/2007 CERTIFICATE IS ATTACHED IN SOURCE REGISTRATION APPLICATION WWGXX 14. Environmental Studies. Are there any Environmental Studies (other than any done as part of a requirement for an Environmental Impact Assessment or for a Certificate of Environmental Clearance) which pertain to this facility? (Please tick) Yes No If yes, please attach a copy of any such report to this application. State the reference number below, if the report/study was submitted as a component of a Certificate of Environmental Clearance (CEC) Application. CEC Reference No.: NA 15. Location. Attach to this application a map of an appropriate scale, showing the area extending to at least one-kilometer beyond the property boundaries. The map must show the outline of the facility, major pipes through which wastewater enters and is discharged, areas where wastewater is either injected underground or into surface water bodies, all springs, surface water bodies and wells within 1 km of the facility and any area where sewage sludge is stored, treated or disposed. SEE FIGURE A1 INSTRUCTIONAL BOOKLET 16. Pollution Prevention and Control. a. Attach additional sheets describing any planned or existing water pollution control programme, environmental technology, or other environmental projects which may affect the quality and volume of your discharge. DESCRIPTION OF CONTROL PROGRAMME / ENVIRONMENTAL TECHNOLOGY / PROJECT ATTACHED (Please tick) Yes No Indicate whether each programme is now underway or planned and indicate your actual or planned schedules for completion. E - 5

6 Programme Name Underway or Planned Schedule Date of Completion (DD/MM/YY) GREASE TRAPS UNDERWAY NA OIL SPILL RESPONSE UNDERWAY NA PROGRAMME SETTLING POND AND PLANNED MARCH 2011 AERATOR FOR EFFLUENT FROM DISCHARGE # 1 SETTLING POND FOR EFFLUENT FROM DISCHARGE # 2 PLANNED FEBRUARY 2012 b. For planned programmes, complete a separate table below for each discharge point or outfall: Discharge No: #1 Parameter/ Substance Present Concentration (use information from Section II, item 5) 1 Programme Name 2 Expected Effluent Concentration Levels after implementation of pollution control programme Proposed Final date of Effluent achievement Levels Interim Effluent Levels (Units) 3 Proposed date of achievement (Units) 4 DISSOLVED 3.5 mg/l AERATOR NA NA 5.0 mg/l MARCH OXYGEN 2011 BOD 5 55 mg/l AERATOR NA NA 25 mg/l MARCH 2011 TOTAL 95 mg/l SETTLING NA NA 25 mg/l MARCH SUSPENDED POND 2011 SOLIDS TOTAL OIL & GREASE 30 mg/l GREASE TRAP NA NA 5 mg/l MARCH 2011 Use additional sheets as required. 1. Effluent concentrations of parameter/substance presently exceeding levels in Schedule II of the WPR. 2. Pollution Control Programme Name 3. Proposed interim effluent concentration levels and expected date that these can be achieved. 4. Proposed final effluent concentration levels and expected date that these can be achieved. E - 6

7 Discharge No: #2 Parameter/ Substance TOTAL SUSPENDED SOLIDS Present Concentration (use information from Section II, item 5) 1 Programme Name 2 95 mg/l SETTLING POND Expected Effluent Concentration Levels after implementation of pollution control programme Proposed Final date of Effluent achievement Levels Interim Effluent Levels (Units) 3 Proposed date of achievement (Units) 4 NA NA 25 mg/l APRIL 2010 Use additional sheets as required. 1. Effluent concentrations of parameter/substance presently exceeding levels in Schedule II of the WPR. 2. Pollution Control Programme Name 3. Proposed interim effluent concentration levels and expected date that these can be achieved. 4. Proposed final effluent concentration levels and expected date that these can be achieved. E - 7

8 SECTION II. SITE MAP, INTAKE AND DISCHARGE DESCRIPTION 1. Site Map. A detailed site map must accompany this application. You must complete this section for each existing or proposed intake and discharge structure. Discharges to wells from this facility must also be stated. For multiple intakes and discharges, separate descriptions must be submitted. For proposed intakes or discharges, values should reflect best engineering estimates. 2. Intake Location. For each intake, give the Universal Transverse Mercator (UTM) projections, in Zone 20N referencing WGS 1984 Datum, and the name of the source water. A. INTAKE NUMBER (list) B. EASTINGS (me) C. NORTHINGS (mn) D. SOURCE WATER (name) # Discharge Location. For each discharge point or outfall, give the Universal Transverse Mercator (UTM) projections, in Zone 20N referencing WGS 1984 Datum, and the name of the receiving water. (SEE FIGURE 1 ATTACHED) A. DISCHARGE NUMBER (list) B. EASTINGS (me) C. NORTHINGS (mn) D. RECEIVING WATER (name) DISCHARGE # WXYZ RIVER DISCHARGE # ABCD RIVER 4. Flows, Sources of Pollution and Treatment Technologies. 4A. Attach a line drawing showing the water flow through the facility. Indicate sources of intake water, operations contributing wastewater to the effluent and treatment units labelled to correspond to the more detailed descriptions in Item B. Construct a water balance on the line drawing by showing average flows (in m 3 /day) between intakes, operations, treatment units, final discharge as well as any other significant losses of water. If a water balance cannot be determined provide a pictorial description of the nature and amount of any sources of water and any collection or treatment measures. SEE FIGURE E-2 INSTRUCTIONAL BOOKLET E - 8

9 4B. For each discharge point or outfall, provide a description in the table below of: 1. The discharge number 2. All operations contributing wastewater to the each discharge point; including process wastewater, sanitary wastewater, cooling water and storm water runoff and 3. i) A description of the treatment applied to the wastewater prior to the final discharge (if any) ii) The appropriate code for that type of treatment, which can be obtained from Table E-1 of the Instructional Booklet for this form. You must attach a wastewater flow diagram to accompany this item. Continue on additional sheets if necessary. SEE FIGURE E-3 INSTRUCTIONAL BOOKLET 1. DISCHARGE NUMBER (list) 2. OPERATION(S) CONTRIBUTING TO DISCHARGE (list) Estimated Volume (m 3 /day) 3. TREATMENT i. DESCRIPTION ii. LIST CODES FROM TABLE E-1 1-U, 1-G & FLOCCULATION DISCHARGE #1 EFFLUENT FROM SINKS IN PROCESSING PLANT 25 SEDIMENTATION VEHICLE WASH BAY 5 NONE 4-A RUNOFF STORMWATER RUNOFF 5 NONE 4-A SLUDGE TREATMENT 10 DRYING BEDS 5-H DISCHARGE #2 STORMWATER RUNOFF 10 NONE 4-A E - 9

10 5. Discharge Characteristics. Read instructions before proceeding Complete one set of tables for each discharge point or outfall - Annotate the discharge number in the space provided. If you have analytical data you must report it. Complete one table for each discharge point or outfall leaving the facility Annotate the outfall or discharge number in the space provided. See instruction booklet for additional details. 2. EFFLUENT DATA DISCHARGE DESCRIPTION No. 1 PERIOD OF SAMPLING Name Discharge 1 (UTM) me (UTM) mn PARAMETER/SUBSTANCE FROM: 29 NOVEMBER 2006 TO: 30 OCTOBER 2009 a. Daily Value* b. Average Value (if available) c. No. of Analyses (if averaged) 3. UNITS i. Five day Biological Oxygen Demand (BOD5 at 20 o C) NA mg/l ii. Chemical Oxygen Demand (COD) NA NA NA mg/l iii. Total Suspended Solids (TSS) NA mg/l iv. Total Oil and Grease (TO&G) or n-hexane Extractable Material (HEM) NA mg/l v. Ammoniacal Nitrogen (as NH3-N) 25 NA 4 mg/l vi. Total Phosphorus (as P) NA NA NA mg/l vii. Total Residual Chlorine ( as Cl2) NA NA NA mg/l viii. Faecal Coliforms NA Counts / 100ml ix. Temperature NA NA NA o C x.hydrogen ion (ph) 3.0 NA 4 Standard units xi. Dissolved Oxygen Content (DO) NA NA NA mg/l xii. Flow rate NA NA NA m 3 /day xiii. Sulphide (as H2S) NA NA NA mg/l xiv. Chloride (as Cl - ) NA NA NA mg/l xv. Dissolved Hexavalent Chromium(Cr 6+ ) NA NA NA mg/l xvi. Total Chromium (Cr) NA NA NA mg/l xvii. Dissolved Iron (Fe) NA NA NA mg/l xviii.total Petroleum Hydrocarbons (TPH) 35 NA 2 mg/l xix.total Nickel (Ni) NA NA NA mg/l xx. Total Copper (Cu) NA NA NA mg/l xxi. Total Zinc (Zn) NA NA NA mg/l xxii. Total Arsenic (As) NA NA NA mg/l xxiii. Total Cadmium (Cd) NA NA NA mg/l xxiv. Total Mercury (Hg) NA NA NA mg/l xxv. Total Lead (Pb) NA NA NA mg/l xxvi. Total Cyanide (as CN - ) NA NA NA mg/l xxvii. Phenolic Compounds (as phenol) NA NA NA mg/l xxviii. Radioactivity NA NA NA q/l xxix. Toxicity NA NA NA Toxic unit xxx. Solid Waste NA NA NA NA *Daily Value is an average of four grab samples taken at equal intervals over an operational daily cycle. E.g. 4 grab samples (one (1) every two (2) hours) over an eight hour cycle. E - 10

11 6. Use the space below to list any of the toxic chemical(s) or products stored on site, which you know or have reason to believe is stored and/or used or discharged or may be discharged from any outfall. For every toxic chemical or product you list, briefly describe the reason you believe it to be present and report any analytical data in your possession (use additional sheets if necessary). 1. Toxic Chemical / Products 2. REASON ACIDS TO BALANCE ph INSECTICIDES, PESTICIDES & WEEDICIDES DIESEL LUBRICANTS, SOLVENTS, COOLANTS, DEGREASERS, RUST INHIBITORS PEST & WEED CONTROL FUELLING OF VEHICLES, GENERATORS VEHICLE & MACHINERY MAINTENANCE 7. Biological Toxicity Testing Data Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made on any of your discharges or on any receiving water in relation to your discharge within the last 3 years? (Please tick) Yes No If Yes, identify the test(s) and describe their purposes below. E - 11

12 8. Laboratory Analysis Information a. Were any of the analyses reported in Item 5 performed by a contract laboratory or consulting firm? (Please tick) Yes No In each case, list the name, address, telephone number and parameters analysed of each such laboratory or firm and indicate which parameter(s) analysed have been certified and name the certifying body. A. Name B. Address C. Telephone No. TTT Lab Inc. #16 NORTHEASTERN MAIN ROAD D. Substance/ Parameter Analyzed (list) TOTAL OIL & GREASE FAECAL COLIFORMS ph DISSOLVED OXYGEN E. Certification Yes/No Certifying Body YES UKNAS b. Does your facility have an in house laboratory? (Please tick) Yes No Please list the substances / parameters that the in house laboratory is capable of analysing and indicate which parameter(s) have certification and name the certifying body. NA A. Substance/Parameter B. Certification Yes/No Certifying Body 9. Data Records Attach records describing all the procedures used in obtaining the monitoring data for item 4 and 5. At a minimum the document should cover sample records, chain of custody records, quality control sample records, general field procedures, sample data, sample management records, test methods, quality assurance/quality control reports, competence of personnel / testing laboratory and data handling records. SEE INSTRUCTIONAL BOOKLET FOR DETAILS E - 12