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Oil Pollution Control Technology by wcf20370

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									                                                                                               Yes   No

Air Quality Standards

Permits - Operating Permits
        1 Have you obtained the proper state operating permit?



        2 Is the facility in compliance with the following permit provisions to the extent
           contained in each permit:
                 a) Expiration date;
                 b) Emission limitations;
                 c) Limits on hours of operation;
                 d) Limits on the nature or quantity of fuel burned or raw material
                 processed;
                 e) Stack testing requirements and/or continuous emission monitoring
                 requirements;
                 f) Recordkeeping and reporting requirements;
                 g) Maintenance requirements; and
                 h) Alternate operating scenarios, where applicable?
Permits - Operating Permits - Registration Permits
        3 Are all sources registered with the appropriate state or local authorities?
        4 Does the owner or operator of EACH registered source:
                 a) Maintain all registration documentation at the site for the time period
                 specified by applicable state or local regulations; and
                 b) Comply with all registration permit requirements?
Permits - Construction Permits
        5 Has the facility obtained a state permit for all new or modified sources of air
           contaminants before the construction and operation of the source depending on
           the level of emissions (22a-174-3a RCSA, 22a-174-3b RCSA, 22a-174-3c
           RCSA, and 22a-174-33 RCSA)?




        6 Was an assessment performed to determine whether or not the facility is
          required to obtain an air permit-to-construct?
        7 Was the facility required to obtain an air permit-to-construct from the applicable
          regulatory agency?
        8 Did the facility obtain an air permit-to-construct from the applicable regulatory
          agency?
NSPS - General Provisions
        9 To the extent practical, is the facility maintained and operated in a manner
          consistent with good air pollution control practices for minimizing emissions,
          including during periods of startup, shutdown, and malfunction?
       10 Has the owner or operator used any article or process that would conceal
          emissions from the compliance-testing analysis?
NSPS - Modification/Reconstruction
       11 Have there been any modifications to your facility that are subject to NSPS
          requirements?
       12 Was compliance with the NSPS standards achieved within 180 days of the
          completion of any modification?
        13 Have any reconstruction projects occurred or been planned that meet BOTH of
           the following conditions:
                 a) Components at an existing facility are replaced; and
                 b) The capital cost of the new components exceeds 50% of the fixed
                 capital cost that would be required to construct a comparable and entirely
                 new component?
        14 Did the owner/operator of the facility notify EPA of the proposed replacement at
           least 60 days before commencement of the replacement construction?

NSPS - Performance Testing
       15 Has the facility conducted performance tests for its NSPS-regulated sources?

        16 Was a performance test conducted within 60 days after achieving maximum
           production rate at the affected facility, but not later than 180 days after initial
           startup of the facility?
        17 Were performance tests conducted under conditions which are representative of
           the performance of the affected facility?
        18 Was EPA notified of the performance test at least 30 days prior to conducting
           the test?
        19 Were the performance tests conducted in ONE of the following manners:
                 a) In accordance with the test methods specified in each applicable
                 subpart of 40 CFR 60; or
                 b) By using an equivalent test previously approved by EPA?
        20 Were ALL of the following test procedures implemented for each performance
           test:
                 a) Each performance test consists of three separate runs;
                 b) Each run is conducted for the time specified in the test method; and

                 c) The arithmetic mean of the results of the three runs is used in
                 determining compliance with the applicable standard?
        21 Did the owner/operator provide ALL of the following performance testing issues:

                 a) Sampling ports adequate for the test method applicable to that facility;

                b) Safe sampling platforms;
                c) Safe access to sampling platforms; and
                d) Utilities for sampling and testing equipment?
       22 Was a written report of performance test results sent to EPA?
       23 Based on the written report of performance test results, did EPA determine that
          the facility was NOT in compliance with the applicable NSPS?
NSPS - Opacity
       24 Have opacity observations been conducted at your facility?
       25 Were the opacity observations conducted in the following manner:
                a) Concurrently with the initial performance testing; and
                b) In accordance with EPA-approved methods?
       26 Has EPA determined that the facility failed to meet the applicable opacity
          standard?
       27 Has the facility addressed the failure and made the necessary corrections to
          meet the opacity standards?
NSPS - Written Requirements
       28 Has the owner/operator of the facility provided written or electronic notification to
          EPA of the following dates, whenever applicable:
                a) The date which construction (or reconstruction) of an affected facility is
                commenced, postmarked no later than 30 days after such date; and

                b) The actual initial startup date, postmarked within 15 days of such date?

       29 Has the owner/operator of the facility provided written or electronic notification to
          EPA of the following events, whenever applicable:
               a) The date upon which demonstration of the continuous monitoring
               system performance commences, no less than 30 days prior to such date;

                b) The anticipated date for conducting the required opacity observations,
                no less than 30 days prior to such date; and
                c) Any physical or operational change to an existing facility which may
                increase the emission rate of any air pollutant to which a standard applies,
                60 days or as soon as practical before the change is commenced?

       30 Are records maintained of the occurrence and duration of ALL of the following
          periods:
                a) Any startup, shutdown, or malfunction in the operation of your facility;

                b) Any malfunction of the air pollution control equipment; and
                c) And any periods during which a monitoring system or device is
                inoperative?
       31 Are continuous emission monitoring system records and reports maintained for
          at least two years?
       32 Do records and reports for continuous emission monitoring systems include the
          following information:
                a) Continuous monitoring system, monitoring device, and performance
                testing measurements;
                b) Continuous monitoring system performance evaluations;
                c) Calibration checks;
                d) System adjustments and maintenance; and
                e) Any other information required by 40 CFR 60.7?
       33 Does the facility meet BOTH of the following conditions:
                a) The CEMS installed at the facility is automated (i.e., records and
                reduces the measured data to the form of the pollutant emission standard
                through the use of a computerized data acquisition system); and

                b) The calculated data averages include periods of CEMS breakdown or
                malfunction?
       34 Are the following CEMS records retained at the facility:
                a) The most recent consecutive three averaging periods of subhourly
                measurements; and
                b) A file that contains a hard copy of the algorithm used by the automated
                CEMS to reduce the measured data into the reportable form of the
                standard?
       35 Are the subhourly measurements retained for 120 days from the date of the
          most recent summary or excess emission report submitted to the EPA
          Administrator?
NSPS - Steam Generating Units
       36 Was construction, reconstruction, or modification of the steam generating unit
          commenced after 6/9/89?
       37 Is the maximum design capacity between or equal to 2.9 MW to 29 MW (10 to
          100 MMBtu/hr)?
NSPS - Small Non-Utility Steam Generators - Particulate Matter Emissions
       38 Does the small non-utility steam generating unit meet ALL of the following
          criteria:
                 a) It combusts coal or mixtures of coal with other fuels; and
                 b) It has a heat input capacity of 8.7 MW (30 million Btu/hr) or greater?

       39 Does the small non-utility steam generating unit which combusts coal or coal
          mixtures, discharge any gases to the atmosphere which contain particulate
          matter at levels greater than ANY of the following emission limits:
                 a) 22 ng/J (0.051 lb/million Btu) heat input - if the affected facility combusts
                 coal alone or with other fuels and has an annual capacity factor for the
                 other fuels of 10 percent (0.10) or less; or
                 b) 43 ng/J (0.10 lb/million Btu) heat input - if the affected facility combusts
                 coal with other fuels, has an annual capacity factor for the other fuels
                 greater than 10 percent (0.10), and is subject to a federally enforceable
                 requirement limiting operation to this annual capacity factor?

       40 Does the small non-utility steam generating unit meet ALL of the following
          criteria:
                 a) It combusts wood or mixtures of wood with other fuels, except coal; and

                 b) It has a heat input capacity of 8.7 MW (30 million Btu/hr) or greater?

       41 Does the small non-utility steam generating unit which combusts wood or wood
          mixtures, discharge any gases to the atmosphere which contain particulate
          matter at levels greater than ANY of the following emission limits:

                 a) 43 ng/J (0.10 lb/million Btu) heat input - if the affected facility has an
                 annual capacity factor for wood greater than 30 percent (0.30); or
                 b) 130 ng/J (0.30 lb/million Btu) heat input - if the affected facility has an
                 annual capacity factor for wood of 30 percent (0.30) or less and is subject
                 to a federally enforceable requirement limiting operation to this level?

       42 Does the small non-utility steam generating unit meet ALL of the following
          criteria:
                 a) It combusts coal, wood or oil; and
                 b) It has a heat input capacity of 8.7 MW (30 million Btu/hour) or greater?

       43 Does the small non-utility steam generating unit which combusts coal, oil or
          wood, discharge any gases to the atmosphere which exhibit greater than 20
          percent opacity (6-minute average), except for one 6 minute period per hour of
          not more than 27 percent opacity?
NSPS - Small Non-Utility Steam Generators - SO2 Emissions
       44 Does the small non-utility facility combust coal along with other fuels?
       45 Does the facility that burns coal along with other fuels discharge any gases into
          the atmosphere that contain ANY of the following emissions:
                a) Sulfur dioxide in excess of 10 percent (.10) of the potential sulfur
                dioxide emission rate (90 percent reduction); or
                   b) Sulfur dioxide in excess of the emission limit determined by using the
                   formula in 40 CFR 60.42c(e)(2) of the full-text regulations?
        46   Does the small non-utility steam generating unit that burns coal along with other
             fuels, use an emerging technology for the control of sulfur dioxide?
        47   Does the facility that combusts coal with other fuels and uses an emerging sulfur
             dioxide control technology, discharge any gases into the atmosphere which
             contain ANY of the following emissions:
                   a) Sulfur dioxide in excess of 50 percent (0.50) of the potential sulfur
                   dioxide emission rate (50 percent reduction); or
                   b) Sulfur dioxide in excess of the emission limit determined by using the
                   formula in 40 CFR 60.42c(e)(2) of the full-text regulations?
        48   Does the small non-utility steam generating unit combust oil?
        49   Does the oil-burning steam generating unit meet ONE OR MORE of the
             following requirements:
                   a) No gases which contain sulfur dioxide in excess of 215 ng/J (.50
                   lb/million Btu) heat input are discharged into the atmosphere; or
                   b) No oil is combusted which contains greater than .5 weight percent
                   sulfur?
        50   Does the small non-utility steam generating unit combust coal, oil, or both with
             any other fuel?
        51   Does the facility which combusts coal, oil, or both, with another fuel discharge
             any gases into the atmosphere that contain sulfur dioxide in excess of the
             emission limit calculated using the formula in 40 CFR 60.42(e)(2) of the full-text
             regulations?
        52   Is compliance with the sulfur dioxide percent reduction requirements, fuel oil
             sulfur limits, and sulfur dioxide emission limits determined based on EITHER of
             the following:
                   a) A 30-day rolling average; or
                   b) A certification from the fuel supplier if the unit is ANY of the following
                   types of facilities: (a) Distillate oil-fired facility with heat input capacity
                   between 2.9 and 29 MW (10 and 100 million Btu/hour); (b) Residual oil-
                   fired facility with heat input capacity between 2.9 and 8.7 MW (10 and 30
                   million Btu/hour); or (c) Coal-fired facility with heat input capacity between
                   2.9 and 8.7 MW (10 and 30 million Btu/hour)?

NSPS - Small Non-Utility Steam Generators - Test Methods and Procedures
       53 Does the owner or operator of the facility which is subject to particulate matter
          and/or opacity standards, determine compliance with the standards by
          conducting an initial performance test, and subsequent performance tests as
          required by the EPA?
       54 When initial and subsequent performance tests are performed to demonstrate
          compliance with particulate matter and/or opacity standards, are the tests
          conducted using the procedures and reference methods specified in 40 CFR
          60.45c(a) of the full-text regulations?
       55 Does the small non-utility steam generating unit meet ALL of the following
          criteria:
                 a) It combusts wood or mixtures of wood with other fuels, except coal;

                  b) It has a heat input capacity of 8.7 MW (30 million Btu/hr) or greater;

                  c) It has an annual capacity factor for wood of 30 percent (0.30) or less;
                  and
         d) It is subject to a federally enforceable requirement limiting operation of
         the facility to an annual capacity factor for wood of 30 percent (0.30) or
         less?
56 In order to determine whether the wood/wood mixture combustion facility is in
   compliance with the heat input limit of 130 ng/J (0.30 lb/million Btu) in the
   particulate matter standard (40 CFR 60.43c(b)(2)), is the maximum design heat
   input capacity of the steam generating unit demonstrated by operating the unit at
   that capacity for 24 hours?
57 Is the annual capacity factor of the wood/wood mixture combustion facility
   demonstrated with EITHER of the following methods:
         a) By using the maximum design heat input capacity as provided by the
         manufacturer; or
         b) By using the demonstrated 24 hour average firing rate if the
         demonstrated 24 hour average firing rate is less than the maximum design
         heat input capacity as stated by the manufacturer?
58 Are initial performance tests for compliance with sulfur dioxide standards
   conducted in accordance with ALL of the following requirements:
         a) It is conducted over 30 consecutive operating days of the steam
         generating unit;
         b) The first operating day of the test is scheduled within 30 days after the
         facility achieves maximum production rate, but not later than 180 days
         after the initial startup of the facility;
         c) The load during the 30 day period does not have to be the maximum
         design heat input capacity, but is representative of future operating
         conditions; and
         d) Compliance with the sulfur dioxide percent reduction requirements and
         the sulfur dioxide emission limits is determined using a 30-day average?

59 After the initial performance test is conducted, is compliance with the sulfur
   dioxide percent reduction requirements and the sulfur dioxide emission limits
   demonstrated using ALL of the following methods:
         a) A separate performance test is completed at the end of each steam
         generating unit operating day;
         b) A new 30-day average percent reduction and a sulfur dioxide emission
         rate are calculated each day to show compliance with the standard; and

        c) Compliance is based on the average percent reduction and the average
        sulfur dioxide emission limits for 30 consecutive steam generating unit
        operating days?
60 Does the affected facility combust only coal, oil, or a mixture of coal and oil?

61 Are ALL of the following procedures used at the coal/oil combustion facility when
   determining compliance with the sulfur dioxide standard:
         a) The procedures in Method 19 (40 CFR Part 60, Appendix A) are used
         to determine the hourly sulfur dioxide emission rate and the 30-day
         average sulfur dioxide emission rate; and
         b) The hourly averages used to compute the 30-day averages are
         obtained from the continuous emission monitoring system?
62 Does the affected facility combust coal and/or oil with other fuels?
63 Is the adjusted hourly sulfur dioxide emission rate for the facility which combusts
   coal/oil with other fuels, computed using the formula presented in 40 CFR
   60.44c(e)(1) in the full-text regulations?
64 Does the small non-utility steam generating unit meet ANY of the following
   criteria:
          a) It combusts only coal; or
          b) It combusts only coal refuse in a fluidized bed combustion steam
          generating unit?
65 Does the coal combustion or coal refuse fluidized bed combustion facility
   determine compliance with ALL of the following sulfur dioxide standards using
   the methods specified:
          a) Sulfur dioxide emission limits - hourly sulfur dioxide emission rate and
          30-day average sulfur dioxide emission rate are computed using Method
          19 (40 CFR Part 60, Appendix A);
          b) Sulfur dioxide emission limits - hourly averages used to compute the 30-
          day averages are obtained from the continuous emission monitoring
          system;
          c) Sulfur dioxide emission limits - adjusted hourly sulfur dioxide emission
          rate is computed using the formula in 40 CFR 60.44c(e)(1) in the full-text
          regulations; and
          d) Sulfur dioxide percent reduction requirements - using the formulas at 40
          CFR 60.44c(f)(1) or (2) of the full-text regulations?
66 Does the small non-utility steam generating unit meet ALL of the following
   criteria:
          a) It combusts oil; and
          b) The owner or operator seeks to demonstrate compliance with fuel oil
          sulfur limits based on shipment fuel sampling?
67 Does the oil-combustion facility which is demonstrating compliance based on
   shipment fuel sampling, perform ALL of the following sampling:
          a) An initial performance test consisting of sampling and analyzing the oil
          in the initial tank of oil to be fired in the unit, to demonstrate that the oil
          contains 0.5 weight percent sulfur or less; and
          b) Sampling the oil in the fuel tank after each new shipment of oil is
          received, immediately after the tank is filled (whether or not it was empty)
          and before any oil is combusted, to demonstrate that the oil contains 0.5
          sulfur weight percent sulfur?
68 Does the small non-utility steam generating facility meet BOTH of the following
   criteria:
          a) The owner or operator seeks to demonstrate compliance with the sulfur
          dioxide standards based on fuel supplier certification; AND
          b) It falls into one of the following categories: (a) Distillate oil-fired facilities
          with heat input capacity between 2.9 and 29 MW (10 and 100 million
          Btu/hour); (b) Residual oil-fired facilities with heat input capacity between
          2.9 and 8.7 MW (10 and 30 million Btu/hour); or (c) Coal-fired facilities with
          heat input capacity between 2.9 and 8.7 MW (10 and 30 million Btu/hour)?

69 For the facility demonstrating compliance based on fuel supplier certification,
   does the performance test consist of fuel supplier certification that includes the
   following, as appropriate for the fuel combusted:
         a) For distillate oil: name of the oil supplier, and a statement from the
         supplier that the oil complies with the specifications under the definition of
         distillate oil;
         b) For residual oil: name of the oil supplier, location of the oil when the
         sample was taken for analysis, sulfur content of the shipment or the oil
         from which the shipment came, and the test method used; or
                 c) For coal: name of the coal supplier, location of the coal when a sample
                 was taken for analysis of its properties, the results of the analysis of the
                 shipment or the coal from which the shipment came, and the test method
                 used?
NSPS - Small Non-Utility Steam Generators - Monitoring Requirements
       70 Does the small non-utility steam generating unit meet ALL of the following
          criteria:
                 a) It combusts coal, residual oil or wood; and
                 b) It is subject to the opacity standards (40 CFR 60.43c)?
       71 Does the coal/wood/residual oil combustion facility which is subject to opacity
          standards perform ALL of the following required activities:
                 a) Install, calibrate, maintain and operate a continuous emission
                 monitoring system for measuring opacity of emissions discharged to the
                 atmosphere; and
                 b) Record the output of the system?
       72 Is the continuous emission monitoring system operated in accordance with the
          applicable procedures under Performance Specification 1 (40 CFR Part 60,
          Appendix B of the full-text regulations)?
       73 Does the small non-utility steam generating facility have a continuous emission
          monitoring system?
       74 Does the continuous emission monitoring system meet ALL of the following
          requirements:
                 a) The one hour average SO2 emission rates are expressed in ng/J or
                 lb/million Btu heat input;
                 b) The one hour average SO2 emission rates are used to calculate SO2
                 average emission rates;
                 c) Each one hour average SO2 emission rate is based on at least 30
                 minutes of operation and includes at least two data points representing two
                 15-minute periods; and
                 d) If the affected facility is operated less than 30 minutes in a one-hour
                 period, hourly SO2 emission rates are not calculated and are not counted
                 towards determining the steam generating unit operating day?

        75 Is the installation, evaluation, and operation of the continuous emission
           monitoring system conducted in accordance with the procedures of both 40 CFR
           60.13 and 40 CFR 60.46c(c) of the full-text regulations?
        76 Does the small non-utility steam generating facility conduct AT LEAST ONE of
           the following activities:
                 a) Conducts as-fired fuel sampling; or
                 b) Operates a continuous emission monitoring system?
        77 Does the owner of operator of the facility which operates a CEMS or conducts
           as-fired fuel sampling, meet AT LEAST ONE of the following requirements:

                 a) Emission data is obtained from the CEMS for 75 percent of the
                 operating hours at least 22 out of 30 successive operating days; or
                 b) Emission data from the CEMS is supplemented with data collected from
                 other monitoring systems, as approved by EPA?
NSPS - Small Non-Utility Steam Generators - Monitoring Requirements - SO2
       78 Is the small non-utility steam generating facility subject to sulfur dioxide emission
          limits (40 CFR 60.42c(a)-(f))?
       79 Does the owner or operator of the facility that is subject to sulfur dioxide
          emission limits conduct ALL of the following required activities:
                a) Install, calibrate, maintain, and operate a continuous emission
                monitoring system (CEMS) for measuring sulfur dioxide concentrations, as
                well as either oxygen or carbon dioxide, at the outlet of the SO2 control
                device (or at the outlet of the steam generating unit if no SO2 control
                device is used); and
                b) Record the output of the system?
       80 Is the small non-utility steam generating facility subject to sulfur dioxide percent
          reduction requirements (40 CFR 60.42c(a)-(f))?
       81 Does the owner or operator of the facility that is subject to sulfur dioxide percent
          reduction requirements install, calibrate, maintain, and operate a continuous
          emission monitoring system (CEMS) for measuring sulfur dioxide
          concentrations, as well as either oxygen or carbon dioxide, at both the inlet and
          outlet of the SO2 control device?
NSPS - Small Non-Utility Steam Generators - Reporting
       82 Did the owner or operator of the small non-utility steam generating facility submit
          to EPA notification of the date of construction or reconstruction, anticipated
          startup and actual startup, which included ALL of the following information:

                  a) Design heat input capacity and identification of fuels to be combusted;

                   b) A copy of any federally enforceable requirement that limits the annual
                   capacity factor for any fuel or mixture of fuels;
                   c) Annual capacity factor at which it is anticipated the facility will operate,
                   based on all fuels fired and on each individual fuel fired; and
                   d) Notification if an emerging technology will be used to control SO2
                   emissions (note that EPA must determine whether the technology qualifies
                   as an emerging technology)?
        83   Has the owner or operator of the small non-utility steam generating facility which
             is subject to particulate matter, opacity, or sulfur dioxide emission limits
             submitted ALL of the following to EPA:
                   a) Performance test data from the initial performance test;
                   b) Performance test data from subsequent performance tests; and
                   c) The performance evaluation of the CEMS, if applicable, using the
                   relevant performance specifications in 40 CFR 60 Appendix B of the full-
                   text regulations?
        84   Is the small non-utility steam generating unit a coal-fired, residual oil-fired, or
             wood-fired facility subject to opacity limits?
        85   Does the owner or operator submit excess emission reports for any excess
             emissions from the affected facility which occur during the reporting period?
        86   Were all reports postmarked by the 30th day following the end of the reporting
             period?
        87   Is the small non-utility steam generating unit facility subject to sulfur dioxide
             emission limits, fuel oil sulfur limits, or percent reduction requirements under 40
             CFR 60.42c?
        88   Did the owner or operator of the small non-utility steam generating facility that is
             subject to sulfur dioxide standards submit reports to EPA that contain ALL of the
             following information:
                   a) Calendar dates covered in the reporting period;
                   b) Each 30-day average SO2 emission rate or 30-day average sulfur
                   content; reasons for any noncompliance with emission standards; and
                   corrective actions taken;
                 c) Each 30-day average percent of potential SO2 emission rate; reasons
                 for any noncompliance with the emission standards; and corrective
                 actions;
                 d) Steam generating unit operating days for which sulfur dioxide or diluent
                 data have not been obtained for at least 75 percent of the operating hours;
                 justification; and corrective actions;
                 e) Times when emissions data were excluded from the calculation of
                 average emission rates; justification; and corrective actions taken; and

                 f) "F" factor used in calculations, method of determination, and type of fuel
                 combusted?
       89 Did the reports contain ALL of the following additional information:
                 a) Whether averages have been obtained based on a CEMS rather than
                 manual sampling methods;
                 b) If a CEMS is used - times when the pollutant concentration exceeded
                 the full span of the CEMS;
                 c) If a CEMS is used - modifications to the CEMS that could affect its
                 ability to comply with Performance Specifications 2 or 3 (40 CFR 60,
                 Appendix B of the full-text regulations);
                 d) If a CEMS is used - results of daily CEMS drift tests and quarterly
                 accuracy assessments; and
                 e) If fuel supplier certification is used to demonstrate compliance - records
                 of fuel supplier certification, and a certified statement by the owner or
                 operator that the submitted fuel supplier certifications represent all of the
                 fuel combusted during the reporting period?
NSPS - Small Non-Utility Steam Generators - Recordkeeping
       90 Is the small non-utility steam generating facility subject to sulfur dioxide emission
          limits, fuel oil sulfur limits, or percent reduction requirements under 40 CFR
          60.42c?
       91 Did the owner or operator of the affected facility keep records of ALL of the
          following information:
                 a) Calendar dates covered in the reporting period;
                 b) Each 30-day average SO2 emission rate or 30-day average sulfur
                 content; reasons for any noncompliance with emission standards; and
                 corrective actions taken;
                 c) Each 30-day average percent of potential SO2 emission rate; reasons
                 for any noncompliance with the emission standards; and corrective
                 actions;
                 d) Steam generating unit operating days for which sulfur dioxide or diluent
                 data have not been obtained for at least 75 percent of the operating hours;
                 justification; and corrective actions;
                 e) Times when emissions data were excluded from the calculation of
                 average emission rates; justification; and corrective actions taken; and

                 f) "F" factor used in calculations, method of determination, and type of fuel
                 combusted?
        92 Did the records contain ALL of the following additional information:
                 a) Whether averages have been obtained based on a CEMS rather than
                 manual sampling methods;
                 b) If a CEMS is used - times when the pollutant concentration exceeded
                 the full span of the CEMS;
                   c) If a CEMS is used - modifications to the CEMS that could affect its
                   ability to comply with Performance Specifications 2 or 3 (40 CFR 60,
                   Appendix B of the full-text regulations);
                   d) If a CEMS is used - results of daily CEMS drift tests and quarterly
                   accuracy assessments; and
                   e) If fuel supplier certification is used to demonstrate compliance - records
                   of fuel supplier certification, and a certified statement by the owner or
                   operator that the submitted fuel supplier certifications represent all of the
                   fuel combusted during the reporting period?
        93   Are fuel supplier certifications used to demonstrate compliance with emission
             standards?
        94   Do fuel supplier certifications for distillate oil, residual oil, or coal include the
             following information, for the appropriate fuel(s):
                   a) For distillate oil: name of the oil supplier, and a statement from the
                   supplier that the oil complies with the specifications under the definition of
                   distillate oil;
                   b) For residual oil: name of the oil supplier, location of the oil when the
                   sample was taken for analysis, sulfur content of the shipment or the oil
                   from which the shipment came, and the test method used; or
                   c) For coal: name of the coal supplier, location of the coal when a sample
                   was taken for analysis of its properties, the results of the analysis of the
                   shipment or the coal from which the shipment came, and the test method
                   used?
        95   Does the owner or operator of each small non-utility steam generating unit
             record and maintain records of the amounts of each fuel combusted during each
             day?
        96   Is the small non-utility steam generating unit subject to a federally enforceable
             requirement limiting the annual capacity factor for any fuel or mixture of fuels?

       97 Does the owner or operator of each affected facility subject to a federally
          enforceable requirement calculate the annual capacity factor individually for
          each fuel combusted?
       98 Is each required record maintained at the facility for at least two years following
          the date of the record?
NSPS - Storage Vessels for Organics
       99 Are vessels at the facility used for the storage of volatile organic liquids (VOL)?

     100 Was construction, reconstruction, or modification of the storage vessel
          commenced after 7/23/84?
     101 Does the vessel have a design capacity of greater than or equal to 40 m3
          (10,600 gallons)?
NSPS - Plastic Manufacture
     102 Is the affected facility involved in the manufacture of polypropylene,
          polyethylene, polystyrene, or polyethylene terephtalate?
     103 Is the affected facility process continuous?
     104 Was the affected facility constructed, reconstructed, or modified after 9/30/87?

NSPS - Glass Manufacture
     105 Is the affected facility a glass melting furnace?
     106 Was the affected facility constructed, reconstructed, or modified after 6/15/79?
      107 Is the facility a hand glass melting furnace, an experimental furnace, a glass
          melting furnace designed to produce less then 4550 kg/day, or an all electric
          meter?
National Emission Standards for Hazardous Air Pollutants (NESHAPs)
      108 Are procedures in place to ensure that substances collected as a result of efforts
          to control hazardous pollutants are properly disposed of in accordance with the
          RCRA requirements?
NESHAPs - Volatile HAPs - NESHAP Compliance
      109 Is ALL of the following equipment, which contains vinyl chloride or benzene,
          monitored for emissions of volatile hazardous air pollutants:
                 a) Pumps;
                 b) Compressors;
                 c) Pressure relief devices in gas/vapor service;
                 d) Open-end valves or lines;
                 e) Other valve sampling connecting systems;
                 f) Pressure relief devices in liquid service and flanges and other
                 connectors;
                 g) Product accumulators; and
                 h) Closed vent systems or control devices?
      110 Is all equipment at the site, such as pumps and compressors, operated to
          prevent releases of benzene and vinyl chloride?
      111 Is each piece of equipment in VHAP service marked so that it can be readily
          distinguished from other pieces of equipment?
      112 Are inspections and maintenance of on-site equipment conducted on a routine
          basis?
      113 Have any VHAP leaks been detected?
      114 Were the VHAP leaks repaired according to the following timetable:
                 a) The leak was repaired as soon as practical, not later than 15 days after
                 it was detected; and
                 b) A first attempt to repair the problem was made no later than five days
                 after the leak was detected?
      115 Was all leaking equipment marked with the equipment ID number?
      116 For each leak, was identification and repair information recorded in a log and
          kept for 2 years in a readily accessible location?
      117 Is identification information and emission information kept in a readily accessible
          log for all equipment in VHAP service?
      118 Does the facility submit semi-annual reports that contain ALL of the following
          information:
                 a) Process unit identification;
                 b) An inventory of detected leaks and subsequent repairs;
                 c) Dates of process unit shutdowns;
                 d) Revisions to equipment or processes; and
                 e) Monitoring and performance testing results?
      119 Are there any toxic substances with the following characteristics:
                 a) Added to or deliberately formed in a raw material or a finished product;

                b) Exceeds 0.25% by weight of any raw material or finished product;
                c) Emitted from any source operation, storage tank, or transfer operation
                at a rate in excess of 0.1 lb/hr?
      120 Are all benzene air contamination sources subject to NESHAP in compliance
          with all permit, certificate, and regulatory requirements?
     121 Is all equipment that contains benzene operated and maintained in compliance
          with the equipment leak provisions of 40 CFR 61 Subpart V?
     122 Are all non-exempt NESHAP sources at the facility registered with the permitting
          authority?
     123 If required to do stack sampling under NESHAP regulations: (1) has the testing:
          been conducted within proper time limitations; (2) have samples been analyzed;
          and (3) have hazardous pollutant emissions been determined within proper time
          limitations?
NESHAP - Part 61
     124 Unless properly exempted, are each of the NESHAPs sources at your facility
          registered with the permitting authority?
     125 Are ALL of the following true of stack sampling:
                 a) If required, stack sampling under NESHAPs regulations has been
                 conducted within the required time limitations;
                 b) Samples have been analyzed; and
                 c) Hazardous pollutant emissions have been determined within applicable
                 time limitations?
Excess Air Emissions Release Notification
     126 Has the facility been required to install a continuous monitoring device (40 CFR
          60.7)?




      127 Has the facility submitted a written excess emissions report to EPA
          semiannually, postmarked by the 30th day following the end of each six-month
          period and including the following information (40 CFR 60.7):
                a) The magnitude of excess emissions;
                b) Any conversion factors used;
                c) The date and time of commencement and completion of each time
                period of excess emissions;
                d) The process operating time during the reporting period;
                e) Specific identification of each period of excess emissions that occurs
                during startups, shutdowns, and malfunctions;
                f) The nature and cause of any malfunction causing the excess emissions
                (if known), and the corrective action taken or preventive measures
                adopted;
                g) The date and time identifying each period during which the continuous
                monitoring system was inoperative except for zero and span checks and
                the nature of the system repairs or adjustments; and
               h) When no excess emissions have occurred or the continuous monitoring
               system has not been inoperative, repaired, or adjusted?
Regional Haze and Best Available Retrofit Technology (BART)
     128 Is your facility one of the 26 named industrial source categories regulated by
          Regional Haze proposed rule (40 CFR 51.300 to 51.309)?
     129 Does the facility have the potential to emit more than 250 tons of visibility
          impairing pollutants, which are SO2, NOx, and PM10?
      130 Was the facility built or reconstructed between 1962 to 1977?




      131 Are any Federal Class I areas located within 300 km of the facility?




      132 Has the facility performed a visibility impairment modeling analysis on
          surrounding Federal Class I areas within 300 km?




      133 If the facility is required to install, operate, and maintain BART, has the facility
          applied to the EPA for an exemption from BART requirement?




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Water Quality

NPDES - Permit Application
      1 Is your facility's industrial activities and materials exposed to rain, snow,
        snowmelt, or run-off?
                                                                                                                       Please Input


        2 Does your facility have a NPDES permit or has a permit been submitted for the
          discharge?
                                                                                                                       Please Input


        3 Was the Notice of Intent (NOI) to discharge under the NPDES Storm Water
          Multi-Sector General Permit (MSGP) submitted by the following deadlines, as
          applicable:
                  a) By January 29, 2001, for existing discharge previously covered
                  under the 1995 MSGP that meets the conditions for interim coverage
                  under 65 CFR 64810 2.1.2;                                                                            Please Input
                  b) At least two days prior to commencing operation of the facility with
                  discharges to storm water associated with industrial activity for a new
                  discharge; and
                  c) At least two days prior to taking operational control of the facility for a
                  new owner or operator of an existing discharge?
        4 Did the NOI include ALL of the following facility information:
                  a) The 1995 MSGP permit number assigned to the facility, if it was
                  covered under that permit;
                  b) The operator's name, address, telephone number, and status as
                  Federal, State, private, public or other entity;
                  c) The address of the facility, description of its location, and an
                  indication whether the facility is located on Indian country lands;
                  d) The name of the receiving water, or the name of the municipal
                  separate storm sewer system;
                                                                                                                       Please Input
                  e) Certification that a Storm Water Pollution Prevention Plan (SWPPP)
                  meeting the requirements of 65 FR 62812 Part 4 has been developed;

                  f) Identification of those sectors listed in 65 FR 64804 Table 1-1 which
                  are applicable to the industrial activities covered under MSGP at the
                  facility; and
                  g) The SIC codes or two-letter activity codes that best represent the
                  principal products produced or services rendered by the facility and
                  major co-located activities?
        5 Did the NOI also include ALL of the following eligibility screening information:

                     a) A statement indicating whether any listed threatened or endangered
                     species, or designated critical habitat, are in proximity to the storm water
                     discharges or storm water discharge-related activities to be covered by
                     the MSGP;                                                                                         Please Input
                     b) A statement indicating whether any historic property listed or eligible
                     for listing on the National Register of Historic Places is located on the
                     facility or in proximity to the discharge; and
                     c) A signed and dated certification concerning the facility's eligibility to
                     discharge under the Multi-Sector General Permit?
        6   Was the NOI signed by ONE of the following individuals or a duly authorized
            representative of that person:
                     a) A responsible corporate officer of a corporation;
                                                                                                                       Please Input
                     b) A general partner of a partnership;
                     c) The proprietor of a sole proprietorship; or
                     d) A principal executive?
        7   Are all records of the data used in completing the permit application and any
            supplemental information submitted kept for a period of 5 years after the date                             Please Input
            the application was signed?
        8   If monitoring is required, are BOTH of the following TRUE:
                     a) Monitoring equipment is properly installed, used, and maintained;
                     and                                                                                               Please Input
                     b) The applicable discharge is properly monitored according to
                     Department guidelines?
        9   Have any of the following happened with regards to effluent monitoring:
                     a) Failure to submit a discharge monitoring report (DMR); or
                     b) Reporting of effluent values that would make the facility a serious                            Please Input
                     violator for parameters that are required to be reported less frequently
                     than monthly?
                                                                                                  Yes   No   N/A   Comment/Concerns
NPDES - No Exposure
    10 Has the operator of the facility met ALL of the following conditions to qualify for
        the "no exposure" exclusion:
                a) Provide a storm resistant shelter to protect industrial materials and
                activities from exposure to rain, snow, snow melt, and runoff;
                b) Complete and sign a certification including all the information
                required in 40 CFR 122.26(g)(4) that there are no discharges of storm
                water contaminated by exposure to industrial materials and activities
                from the entire facility;
                c) Submit the signed certification to the NPDES permitting authority
                once every five years;
                d) Allow the Director to inspect the facility to determine compliance with
                                                                                                                     Please Input
                the "no exposure" conditions and make any inspection reports available
                to the public upon request; and
                e) For facilities that discharge through an MS4, submit a copy of the
                certification to the MS4 operator and allow inspection and public
                reporting by the MS4 operator upon request?
                (NOTE: A storm resistance shelter is not required for the following: 1)
                drums, barrels, tanks, and similar containers that are tightly sealed,
                provided those containers are not deteriorated and do not leak; 2)
                adequately maintained vehicles used in material handling; and 3) final
                products, other than products that would be mobilized in storm water
                discharges (e.g., rock salt)).
NPDES - Storm Water Pollution Prevention Plan (SWPPP)
    11 Has the facility prepared and implemented a Storm Water Pollution Prevention
        Plan (SWPPP)?
                                                                                                                     Please Input


      12 Was the SWPPP signed by ONE of the following individuals or a duly
         authorized representative of that person:
                 a) A responsible corporate officer of a corporation;
                                                                                                                     Please Input
                 b) A general partner of a partnership;
                 c) The proprietor of a sole proprietorship; or
                 d) A principal executive?
      13 Does the SWPPP include a copy of the Multi-Sector General Permit?
                                                                                                                     Please Input
      14 Is the SWPPP retained at the facility which generates the storm water
                                                                                                                     Please Input
         discharge?
      15 If requested, does the facility make the SWPPP available to: the Director; a
         State, Tribal, or local agency approving storm water management plans; and/or
         the operator of a municipal separate storm sewer receiving discharge from the                               Please Input
         site, the public, the United States Fish and Wildlife Services (USFWS), and the
         National Marine Fisheries Service (NMFS)?
      16 Is the SWPPP revised if ANY of the following events occur:
                  a) There is a change in design, construction, operation, or maintenance
                  of the facility which has a significant effect on the potential for discharge
                  of pollutants from the facility;
                  b) The plan proves to be ineffective in eliminating or significantly
                                                                                                                     Please Input
                  minimizing the discharge of pollutants or is otherwise not achieving the
                  general objectives of controlling pollutants in discharges from the
                  facility; or
                  c) The facility is notified by the Director that the SWPPP does not meet
                  the previsions of the MGSP?
      17 Does the SWPPP identify and list the responsibilities of each individual member
                                                                                                                     Please Input
         of the facility's SWPPP team?
      18 Does the SWPPP include documentation supporting the facility's determination
         of permit eligibility with regard to endangered species, including:

                  a) Information on whether listed endangered species, or critical habitat,
                  are found in proximity to the facility;
                  b) Whether such species may be affected by the facility's storm water
                  discharges or storm water discharge-related activities;                                            Please Input
                  c) Results of Addendum A endangered species screening
                  determinations; and
                  d) A description of measures necessary to protect listed endangered or
                  threatened species, or critical habitat (including any terms or conditions
                  that are imposed under the eligibility requirements of Part 1.2.3.6)?
                                                                                           Yes   No   N/A   Comment/Concerns
19 Does the SWPPP include documentation supporting the facility's determination
   of permit eligibility with regard to historic places, including:
          a) Information on whether storm water discharge or storm water
          discharge-related activities would have an effect on property that is
          listed or eligible for listing on the National Register of Historic Places;

            b) Where effects may occur, any written agreements you have made
            with the State Historic Preservation Officer, Tribal Historic Preservation
                                                                                                              Please Input
            Officer, or other Tribal leader to mitigate those effects;
            c) Results of your Addendum B historic places screening determination;
            and
            d) Description of measures necessary to avoid or minimize adverse
            impacts on places listed, or eligible for listing, on the National Register
            of Historic Places (including any terms or conditions that are imposed
            under the eligibility requirements of Part 1.2.3.7)?

20 Does the SWPPP include the following general site information:
          a) A description of the nature of the industrial activities at the facility;
          b) A general location map with enough detail to identify the location of
          the facility and the receiving waters within one mile of the facility; and
                                                                                                              Please Input
            c) The name of the nearest receiving water(s), including intermittent
            streams, dry sloughs, arroyos and the area extent and description of
            wetland or other "special aquatic sites" that may receive discharges
            from the facility?
21 For all allowable non-storm water discharges, does the SWPPP include the
   following information:
            a) Identification of each allowable non-storm water source;
            b) The location where the non-storm water is likely to be discharged;                             Please Input
            and
            c) Descriptions of the appropriate Best Management Practices (BMPs)
            for each source?
22 Does the SWPPP include ALL of the following potential pollutant source
   information:
            a) Identification of each separate area at the facility where industrial
            materials or activities are exposed to storm water;
            b) A list of the activities that take place in each area identified; and
                                                                                                              Please Input
            c) A list of pollutant(s) or pollutant parameter(s) associated with each
            activity, including all significant materials that have been handled,
            treated, stored, or disposed in a manner to allow exposure to storm
            water between the time of the three years prior to being covered under
            the MSGP and the present?
23 Does the SWPPP include a legible site map which illustrates ALL of the
   following features:
            a) Direction of storm water flow;
            b) Locations of all existing structural BMPs;
            c) Locations of all surface water bodies;
            d) Locations of potential pollutant sources identified under 65 FR 64812
            4.2.4 and where significant materials are exposed to precipitation;

          e) Locations where major spills or leaks identified under 65 FR 64812
          4.2.5 have occurred;
          f) Locations of fueling stations, vehicle and equipment maintenance or
                                                                                                              Please Input
          cleaning areas, loading/unloading areas, locations used for treatment,
          storage, or disposal of wastes, and liquid storage tanks that are
          exposed to precipitation;
          g) Locations of storm water outfalls and an approximate outline of
          drainage patterns to each outfall;
          h) Location and description of non-storm water discharges;
          i) Locations of processing and storage areas, access roads, rail cars,
          and tracks, locations of transfer of bulk substances, and machinery
          exposed to precipitation; and;
          j) Location and source of runoff from adjacent property containing
          significant quantities of pollutants of concern?
24 Does the SWPPP include the following information for spills and leaks:
          a) Identification of areas, and their drainage points, where potential
          spills and leaks can occur and contribute to pollutants in storm water;
                                                                                                              Please Input
            b) For areas that are exposed to precipitation or that otherwise drain to
            a storm water conveyance, a list of significant spills and leaks of toxic or
            hazardous pollutants that occurred during the three year period prior to
            the date of the submission of a Notice of Intent (NOI)?
                                                                                          Yes   No   N/A   Comment/Concerns
25 Does the SWPPP include a signed certification proving the site was tested or
                                                                                                             Please Input
   evaluated for the presence of non-storm water discharges?
26 Does the certification for non-storm water discharge include ALL of the following
   items:
            a) The date of any testing and/or evaluation;
            b) Identification of potential significant sources of non-storm water at
            the site;                                                                                        Please Input
            c) A description of the results of any test and/or evaluation for the
            present testing method used: and
            d) A list of the outfalls or onsite drainage points that were directly
            observed during the test?
27 Does the SWPPP include a summary of existing storm water discharge
                                                                                                             Please Input
   sampling data taken at the facility?
28 Does the SWPPP include each of the following:
            a) Description of the type and location of existing non-structural and
            structural BMPs selected for each of the areas where industrial
            materials or activities are exposed to storm water and how they are
                                                                                                             Please Input
            implemented; and
            b) For areas where BMPS are not currently in place, a description of
            the appropriate BMPs that will be used to control pollution in storm water
            discharges and how they will be implemented?
29 Are all BMPs identified in the SWPPP maintained in effective operating
                                                                                                             Please Input
   condition?
30 Does the facility conduct comprehensive site compliance
                                                                                                             Please Input
   evaluations/inspections?
31 Does the facility conduct site compliance evaluations at the frequency specified
   in the pollution prevention plan or at least annually?                                                    Please Input

32 Are site compliance evaluations conducted by qualified personnel?
                                                                                                             Please Input
33 Do inspectors look in all areas where industrial materials or activities are
   exposed to storm water and where spills and leaks have occurred within the
   past three years for the following items:
             a) Industrial materials, residue, or trash on the ground that could
             contaminate or be washed away in storm water;
             b) Leaks or spills from industrial equipment, drums, barrels, tanks or
             similar containers;                                                                             Please Input
             c) Offsite tracking of industrial materials or sediment where vehicles
             enter or exit the site;
             d) Tracking or blowing of raw, final, or waste materials from areas of no
             exposure to exposed areas; and
             e) Evidence of, or the potential for, pollutants entering the drainage
             system?
34 Is the SWPPP revised within 14 calendar days of the site compliance inspection
   if the inspection indicates revision is necessary?                                                        Please Input

35 If necessary changes or additions to BMPs at the facility are identified during the
   site compliance inspections, are the changes or additions implemented before
                                                                                                             Please Input
   the next storm water event, or, if not practical, within twelve (12) weeks of
   completion of the evaluation?
36 Does the SWPPP include a report for EACH site compliance evaluation that has
   been conducted at the facility?                                                                           Please Input

37 Does each site compliance evaluation report contain ALL of the following
   information:
           a) Summary of the scope of the inspection, the name(s) of the
           inspector(s), and the date(s) of the inspection;
           b) Major observations relating to the implementation of the SWPPP,
           including location(s) of discharges of pollutants from the site; location(s)
           of BMPs that need to be maintained, failed to operate as designed, or                             Please Input
           proved inadequate for a particular location; and location(s) where
           additional BMPs are needed that did not exist at the time of inspection;
           and
           c) Identification of any incidents of non-compliance, or if there are no
           incidents of non-compliance, a certification that the facility is in
           compliance with the SWPPP and the MSGP?
38 Are ALL compliance evaluation reports signed by one of the following
   individuals or a duly authorized representative of that person:
           a) A responsible corporate officer of a corporation;
                                                                                                             Please Input
           b) A general partner of a partnership;
           c) The proprietor of a sole proprietorship; or
           d) A principal executive?
                                                                                    Yes   No   N/A   Comment/Concerns
39 Is EACH site compliance evaluation report retained as part of the SWPPP for at
   least three years from the date MSGP coverage expires or is terminated?
                                                                                                       Please Input
                                                                                                 Yes   No   N/A   Comment/Concerns
       40 Is the storm water discharge from each outfall visually examined quarterly,
          following the procedures specified in 65 FR 64816 5.1.1.1, 5.1.1.2, and 5.1.1.4?                          Please Input

    41 Are reports of the visual examinations of storm water discharges prepared and
                                                                                                                    Please Input
        maintained onsite with the SWPPP?
    42 If required, does the facility comply with all applicable benchmark monitoring
        requirements to determine the overall effectiveness of the SWPPP in controlling                             Please Input
        the discharge of pollutants?
NPDES - Permit Termination
    43 Is the facility discontinuing its NPDES permit?
                                                                                                                    Please Input
       44 Has the facility submitted a signed Notice of Termination (NOT)?




       45 Was the Notice of Termination (NOT) submitted within thirty (30) days after the
          permit termination conditions in 65 FR 64810 1.4.2 were met?



       46 Did the NOT include ALL of the following information:
                  a) The NPDES permit number for storm water discharge identified by
                  the Notice of Termination;
                  b) An indication of whether the storm water discharges associated with
                  industrial activity have been eliminated; a change in facility operator; or
                  a change in facility coverage under an alternate permit;

                   c) The name, address and telephone number of the permittee
                   submitting the NOT;
                   d) The name and the street address or location of the facility for which
                   the notification is submitted;
                   e) The latitude and longitude of the facility; and
                   f) A signed certification that all storm water discharges associated with
                   industrial activity have been eliminated or that the owner or operator is
                   no long the owner or operator of the facility?
Recordkeeping
     47 Is all monitoring data being retained for at least three years?
                 (This includes all calibration and maintenance records and all original
                 strip chart recordings for continuous monitoring instrumentation, copies                           Please Input
                 of all reports required by the permit, and records of all data used to
                 complete the permit application.)
     48 Do records of monitoring information include ALL of the following:
                 a) The date, exact place, and time of sampling or measurements;
                 b) The individuals who performed the sampling or measurements;
                                                                                                                    Please Input
                  c) The date analyses were performed;
                  d) The individual who performed the analyses;
                  e) The analytical techniques or methods used; and
                  f) The results of such analyses?
Requirements for Facility Alterations and Additions
      49 Has the facility been altered or have additions been made to the facility that fall
         under the following categories:
                  a) The alteration/addition meets one of the criteria for the definition of a
                  new source;
                  b) The alteration/addition could significantly change the nature or
                  increase the quantity of pollutants discharged;
                                                                                                                    Please Input
                  c) The alteration/addition is expected to result in a significant change in
                  the facility's residual use or disposal practices, and they may justify the
                  application of permit conditions that are different from or absent in the
                  existing permit; or
                  d) The planned alterations/changes in the facility or activity may result
                  in noncompliance with the permit?
Noncompliance Reporting
      50 Have ANY noncompliant actions occurred at the facility including but not limited
         to the following list:
                  a) Exceedance of effluent limitation that causes injury to persons;
                  b) Exceedance of effluent limitation that poses a threat to human
                  health;
                  c) Exceedance of effluent limitation that causes damage to the
                  environment;
                  d) Exceedance of effluent limitation that poses a threat to the                                   Please Input
                  environment;
                                                                                              Please Input
                                                                           Yes   No   N/A   Comment/Concerns
e) Exceedance of effluent limitation that violates a daily maximum limit
for a toxic pollutant;
f) Any discharge of any toxic or hazardous pollutant which is not
covered under a permit;
g) Any upset or bypass not covered in this list; or
h) Any anticipated bypass?
                                                                                              Yes   No   N/A   Comment/Concerns
       51 Has a serious violation occurred at this facility?
                                                                                                                 Please Input

Residuals Management
      52 Are there any residuals, grit, screenings, or other similar materials that must be
         dealt with for the water treatment system?                                                              Please Input

Permit/Control Mechanism - SIU
      53 Has the facility obtained the appropriate control mechanism for discharge to the
         Publicly Owned Treatment Works (POTW)?                                                                  Please Input

       54 Has the facility's permit to discharge to the POTW expired?
                                                                                                                 Please Input

Discharge Limitations - Prohibitions
      55 Has the facility's discharge caused a pass through or interference at the
         POTW?                                                                                                   Please Input

       56 Does the facility's discharge include ANY of the following pollutants:
                 a) Pollutants which create fire or explosion hazards in the POTW;
                 b) Pollutants which will cause corrosive structural damage to the
                 POTW, or discharges with a pH lower than 5.0, unless the POTW is
                 specifically designed to accommodate such discharges;
                 c) Solid or viscous pollutants in amounts which will cause obstruction to
                 the flow in the POTW resulting in interference;
                 d) Any pollutant, including oxygen demanding pollutants, at a flow rate
                 or concentration that would cause interference with the POTW;
                 e) Heat in amounts which will inhibit biological activity in the POTW
                 resulting in interference, or heat in such quantities that the temperature                      Please Input
                 at the POTW exceeds 40 degrees Celsius (103 degrees Fahrenheit),
                 unless an alternate temperature has been approved for the POTW;

                 f) Petroleum oil, nonbiodegradable cutting oil, or products of mineral oil
                 origin in amounts that will cause interference or pass through;
                 g) Pollutants which result in the presence of toxic gases, vapors, or
                 fumes within the POTW at a quantity that may cause acute worker
                 health and safety problems; or
                 h) Any trucked or hauled pollutants, except at discharge points
                 designated by the POTW?
Discharge Limitations - Local Limits
      57 Does the POTW have a sewer use ordinance approved by EPA or the state
         regulatory agency?
                                                                                                                 Please Input


       58 Is the facility in compliance with applicable local discharge limits?
                                                                                                                 Please Input

      59 Were periodic compliance reports submitted to the Control Authority that met
         BOTH of the following requirements:
                a) Reports were submitted at the required frequency; and                                         Please Input
                b) Reports included all of the required wastewater discharge
                information?
Discharge Limitations - Limits
      60 Does the facility dilute its discharges in order to meet any applicable standard?
                                                                                                                 Please Input


NPDES - Permit Requirements - Sampling and Monitoring
    61 Does the facility meet the monitoring frequency requirements for any permit
        limits or conditions established by a state or tribe?                                                    Please Input

       62 Does the facility use the following monitoring practices:
                 a) Collect samples at appropriate quarterly or annual time, based on the
                 monitoring year of October 1 to September 30; and
                 b) Assesses sampling requirements on an outfall by outfall basis?
                                                                                                  Yes   No   N/A   Comment/Concerns
       63 Are samples and measurements representative of the monitored activity?




NPDES - Permit Requirements - Monitoring Requirements
    64 Are records of ALL monitoring activities retained for at least three years from the
        date the sampling, measurement, evaluation, inspections, or report occurred?                                 Please Input

       65 Do the monitoring records include ALL of the following items:
                 a) The date, exact place, and time of sampling or measurement;
                 b) The initials or names of the individual(s) who performed the sampling
                 or measurements;
                 c) The date the analyses were performed;
                 d) The time the analyses was initiated;
                 e) The names or initials of the individual(s) who performed the analyses;                           Please Input

                f) References or written procedures for the analytical techniques or
                methods used; and
                g) The results of the analyses including all information such as bench
                sheets, instrument readouts, computer disks or tapes, etc. used to
                determine the results?
    66 Are samples analyzed using procedures approved under 40 CFR 136 or
        procedures listed in 65 FR 64819 Part 6 of the MSGP for specific industrial                                  Please Input
        sectors?
NPDES - Permit Requirements - Discharge Monitoring Report
    67 If required, are Discharge Monitoring Reports (DMRs) submitted to the Director
                                                                                                                     Please Input
        of the NPDES Program at the appropriate Regional EPA office?
    68 Is one DMR form submitted per outfall for each storm event sampled?
                                                                                                                     Please Input

Recordkeeping
     69 Does the facility maintain records for all sampling and analysis activities?
                                                                                                                     Please Input

       70 Does the facility maintain records for ALL samples which include ALL of the
          following information:
                   a) Sampling date, time, location, method, and name(s) of sampler;
                   b) Dates of analyses, names of analyses, methods, and techniques;
                   and
                   c) Results of all analyses?
       71 Are all the records related to monitoring kept for at least three years, or longer if
          relevant litigation is pending?
Noncompliance Notification
     72 Did the user notify the Control Authority within 24 hours after indicating that a
        violation of a pretreatment regulation had occurred?
                                                                                                                     Please Input


       73 Did the user repeat the sampling and analysis and report the results of the
          repeat analysis to the Control Authority if sampling was deemed noncompliance.
          Repeat analysis is not required if EITHER of the following conditions is true:

                  a) The Control Authority samples at the facility at least once per month;                          Please Input
                  or
                  b) The Control Authority samples at the facility between the time of the
                  initial sample and the time when the results of the initial sample are
                  received?
Reporting and Notification - Upset
     74 Did the categorical industrial user demonstrate that the noncompliance was the
         result of an "upset"?
                                                                                                                     Please Input


Charged Discharge Notification
     75 Has the facility notified the POTW in advance when there has been a
        substantial change in the volume or character of discharged wastewater?
                                                                                                                     Please Input


Baseline Monitoring Report
      76 Did the BMR contain ALL of the following information:
                 a) The name and address of the facility and the names of the operators
                 and owners;

                                                                                                                     Please Input
                                                                                                Yes   No   N/A   Comment/Concerns
                  b) A list of any environmental control permits held by or for the facility;
                                                                                                                   Please Input
                  c) A description of the nature, average rate of production, and Standard
                  Industrial Classification of the operation(s); and
                  d) A schematic process diagram indicating the points of discharge to
                  the POTW from the regulated processes?
       77 Did the BMR indicate the measured average daily flow and maximum daily flow
          (in GPD) to the POTW from EACH of the following:
                  a) Regulated process streams; and                                                                Please Input
                  b) Other streams as necessary to allow the use of the combined
                  wastestream formula?

       78 Did the BMR identify the pretreatment standards applicable to each regulated
          process?
                                                                                                                   Please Input


       79 Did the BMR contain the results of sampling and analysis that identified the
          nature and concentration (or mass, where required) of regulated pollutants from
                                                                                                                   Please Input
          each regulated process?

       80 Was the BMR signed and certified as detailed in 40 CFR 403.12(l)?
                                                                                                                   Please Input

Baseline Monitoring Report - Existing Source
      81 Was a BMR submitted to the Control Authority within 180 days after the
         effective date of a categorical pretreatment standard to which the facility is
         subject?                                                                                                  Please Input


       82 Did the POTW perform the required sampling and analysis of the discharge in
          lieu of the facility?                                                                                    Please Input

       83 Did the BMR contain a certified statement indicating whether the facility was
          meeting the applicable pretreatment standards on a consistent basis, and, if not,
          whether additional operation and maintenance and/or additional pretreatment
          was required in order to meet the pretreatment standards?
                                                                                               Yes   No   N/A   Comment/Concerns
      84 Did the BMR data indicate that additional pretreatment and/or operation and
         maintenance were required to meet pretreatment standards?                                                Please Input

Ninety-day Compliance Report
      85 Did the Ninety-day Compliance Report (NDCR) indicate the measured average
         daily flow and maximum daily flow (in GPD) to the POTW from EACH of the
         following:
                                                                                                                  Please Input
         a) Regulated process streams; and
         b) Other streams as necessary to allow the use of the combined wastestream
         formula?
      86 Did the NDCR identify the pretreatment standards applicable to each regulated
         process?
                                                                                                                  Please Input


      87 Did the NDCR contain the results of sampling and analysis that identified the
         nature and concentration (or mass, where required) of regulated pollutants from
         each regulated process?                                                                                  Please Input


      88 Is the facility subject to equivalent mass or concentration limits?
                                                                                                                  Please Input

      89 Did the NDCR indicate the facility's long term production rate?



      90 Is the facility subject to standards expressed only in terms of allowable pollutant
         discharge per unit of production (or other measure of operation)?                                        Please Input

      91 Did the POTW perform the required sampling and analysis of the discharge in
         lieu of the facility?                                                                                    Please Input

      92 Did the NDCR contain a certified statement indicating whether the facility was
         meeting the applicable pretreatment standards on a consistent basis, and, if not,
         whether additional operation and maintenance and/or additional pretreatment
         was required in order to meet the pretreatment standards?

      93 Was the NDCR signed and certified as detailed in 40 CFR 403.12(l)?
                                                                                                                  Please Input

      94 Is the facility a new source?                                                                            Please Input
      95 Was the NDCR submitted to the Control Authority within 90 days following the
         date for final compliance with the applicable categorical pretreatment standard?




Biannual Compliance Report
     96 Were biannual compliance reports (BCR) submitted on-time during the months
         of July and January (or on other dates as required by the Control Authority)?

                                                                                                                  Please Input



      97 Did the BCR include a record of measured or estimated average daily flow and
         maximum daily flow for the reporting period for the discharge reported in 40
                                                                                                                  Please Input
         CFR 403.12(b)(4)?

      98 Did the BCR indicate the nature and concentration (or mass, if required) of
         regulated pollutants in the discharge?
                                                                                                                  Please Input


      99 Is the facility subject to equivalent mass or concentration limits?
                                                                                                                  Please Input

     100 Did the BCR indicate the facility's long term production rate?
                                                                                               Yes   No   N/A   Comment/Concerns
     101 Is the facility subject to standards expressed only in terms of allowable pollutant
         discharge per unit of production (or other measure of operation)?
                                                                                                                  Please Input



     102 Did the BCR include the facility's actual average production rate for the
         reporting period?

     103 If the facility monitors any pollutant (using an EPA approved method) more
         frequently than required by the Control Authority, were the results of these
         analysis included in the BCR?                                                                            Please Input


     104 Was the BCR signed and certified as detailed in 40 CFR 403.12(l)?
                                                                                                                  Please Input

Potential Problem Notification
     105 Did the facility immediately notify the POTW regarding the discharge that could
          potentially cause problems for the POTW?                                                                Please Input

Additional Notes:
                                                                                                Yes   No   N/A   Comment/Concerns

Worker and Community Right To Know

Labeling Containers
       1 Is every container at the facility labeled using "universal labeling" which includes
         ALL of the following information:
                  a) The chemical name;
                  b) The CAS number of all environmental hazardous substances in the                               Please Input
                  container; and
                  c) The CAS number for all other substances that are among the five
                  most predominant substances in the container?
       2 If the contents of a container are unknown or partially unknown, does the
         container label state "CONTENTS UNKNOWN" or "CONTENTS PARTIALLY
         UNKNOWN"?
                                                                                                                   Please Input



        3 Are labels affixed to containers before being used or within five working days of
          the containers arrival at the facility, whichever is sooner?

                                                                                                                   Please Input



        4 If containers are received in laboratories with unknown materials for analysis,
          are the labels being completed as substances are identified?

                                                                                                                   Please Input



        5 Are containers which are two ounces (56.7 grams) or smaller labeled by means
          of a code or number system?

                                                                                                                   Please Input



        6 In the warehouse/transfer station where containers are stored on skids, are
          containers on the outside face of the skid and within reach of the employee
          properly labeled?
                                                                                                                   Please Input



        7 If skid is shrink-wrapped, are the labels placed on the shrink-wrap on all four
          sides of the skid?

                                                                                                                   Please Input



Labeling Pipelines
       8 Are all pipelines labeled at the valve or at the point at which a substance enters
         a facilities pipeline?
                                                                                                                   Please Input



        9 Are all valves, outlets, vents and drains which control the release or emission of
          any solid, liquid, semi-solid, or gaseous waste material properly labeled?
                                                                                                                   Please Input



Employee Training
     10 For facilities storing 20,000 gallons or more of hazardous substances other than
        petroleum or petroleum products or 200,000 gallons or more of all kinds of
        hazardous substances, was an employee training program implemented which
        included ALL of the following:
                 a) A written job description including the duties and responsibilities
                 relating to hazardous substances for each position and the education,
                 experience and training necessary to qualify for the position;

                                                                                                                   Please Input
                                                                                          Yes   No   N/A   Comment/Concerns
           b) Procedures to determine whether an employee has demonstrated the                               Please Input
           ability to carry out the duties and responsibilities of a specific position;
           and
           c) Specified time periods of in-house training for each position covering
           orientation, specific hazardous substances training and on-the-job
           training, trainee evaluation, final qualification, and periodic refresher
           training. A procedure shall be established for tracking the progress of
           each employee at regular intervals and shall be included in the written
           job description?
11 Did the training of all employees involved in the handling of hazardous
   substances include ALL of the following:
           a) General orientation and initial training of new employees before
           assignment to hazardous substances operations, which shall include
           instruction on the general site rules and practices and safety procedures;
                                                                                                             Please Input
           b) Classroom training for new or newly assigned employees involved
           with hazardous substances;
           c) On-the-job training for newly assigned employees; and
           d) Refresher training at least once a year?
12 For employees with duties and responsibilities including emergency response,
   chemical operations, or hazardous substance processing, was additional training
   given in ALL of the following:
           a) Safety equipment and procedures used in the cleanup and removal
           of a specific hazardous substance;
           b) Standard operating procedures, including a detailed review of the
           hazardous substance material safety data sheet, the safe handling
           practices of the hazardous substance, the hazards of the operation                                Please Input
           involving the hazardous substance, and the application of standard
           operating procedures to actual conditions;
           c) Emergency procedures regarding fires, leaks, and discharges;
           d) Equipment familiarization;
           e) Operating data collection and entry;
           f) Equipment start-up and shutdown; and
           g) Control and adjustment of operating conditions?
                                                                                                 Yes   No   N/A   Comment/Concerns
EPCRA - Emergency Planning Notification
    13 Have all mixtures or formulations containing one percent or more of an
        extremely hazardous substance been evaluated for notification purposes?                                     Please Input

      14 Was the quantity of each extremely hazardous substance in each mixture
         aggregated to determine whether the amount at the facility exceeds the
         threshold planning quantity?
                                                                                                                    Please Input




      15 Did the facility notify all State Emergency Response Commissions with
         jurisdiction over the facility that the facility is subject to the Emergency Planning
         requirements?                                                                                              Please Input


      16 Was the notification submitted prior to May 17, 1987, or within 60 days after the
         facility first became subject to the Emergency Planning requirements?




      17 Has the facility provided the Local Emergency Planning Committee (LEPC) with
         information concerning ALL of the following subjects:
                 a) The information the LEPC has requested and which is necessary for
                 developing the local comprehensive emergency response plan; and

                   b) Any relevant changes occurring at the facility?
      18 Has the owner or operator of the facility designated a representative to serve as
         a facility emergency response coordinator?                                                                 Please Input

    19 Did the facility emergency coordinator notify the Local Emergency Planning
        Committee of his appointment before September 17, 1987, or within 30 days
        after the Local Emergency Planning Committee was established, whichever was
        earlier?
EPCRA - MSDSs
    20 For all hazardous chemicals stored on-site above the minimum threshold level,
        has the facility submitted EITHER of the following:
                 a) An MSDS for each hazardous chemical; or
                 b) A list of the hazardous chemicals arranged by hazard category,                                  Please Input
                 including the chemical name or common name of each hazardous
                 chemical and any hazardous component of each chemical (except
                 mixtures) as provided on the MSDS?
    21 Has the facility submitted a list of hazardous chemicals or the MSDSs to ALL of
        the following authorities:
                 a) The State Emergency Response Commission;
                 b) The Local Emergency Planning Committee; and
                 c) The fire department with jurisdiction over the facility?
    22 Was the initial submission of MSDSs or list of chemicals completed prior to
        October 17, 1990, or within three months of the date the facility became subject
        to the reporting requirement?
    23 Does the facility submit a new or revised MSDS for a hazardous chemical within
        three months whenever significant new information is discovered about the
        chemical?



      24 Was an MSDS or a revised list submitted within three months after a threshold
         was exceeded because of EITHER of the following events:
                 a) A new chemical was brought on-site which exceeded the Reportable
                 Quantity (RQ); or
                 b) A chemical already on-site exceeded the RQ?
      25 Has the Local Emergency Planning Committee (LEPC) requested an MSDS
                                                                                                                    Please Input
         from the facility to respond to an information request?
      26 Was the requested MSDS provided within 30 days of the request?


      27 Has the facility ever been penalized for failure to comply with the MSDS
                                                                                                                    Please Input
         requirements?
                                                                                                 Yes   No   N/A   Comment/Concerns
      28 Was the problem corrected that led to the penalty for violations of the MSDS
         requirements?
      29 Does the facility make the latest MSDS for each hazardous substance made
         available in the workplace for employees access (40 CFR 370.21)?


                                                                                                                    Please Input




Inventory Form Reporting - Tier I/Tier II
      30 Has the facility prepared for ALL of the following requests from the fire
         department with jurisdiction over the facility:
                 a) An on-site inspection; and                                                                      Please Input
                 b) An information request, on the specific location of hazardous
                 chemicals at the facility?
      31 Has the facility submitted a chemical list, rather than the actual MSDS to the
                                                                                                                    Please Input
         SERC, the LEPC, and the local fire department?
      32 Has the facility ever been penalized for failure to comply with the inventory form
                                                                                                                    Please Input
         reporting requirements?
      33 Was the problem corrected that led to the penalty for violations of the inventory
         form reporting requirements?


Inventory Form Reporting - Tier II
      34 Has the facility submitted a Tier II inventory form (either voluntarily or by
         request)?
                                                                                                                    Please Input



      35 Was the Tier II inventory form submitted by the following deadlines, as
         applicable:
                 a) On March 1 of each year, for submission in place of a Tier I form;
                 and
                 b) Within 30 days of a request by the State Emergency Response
                 Commission, the Local Emergency Planning Committee, or the local fire
                 department?
      36 Did the facility send the Tier II inventory form to ALL of the following authorities:

                 a) The State Emergency Response Commission;
                 b) The appropriate Local Emergency Planning Committee; and
                 c) To the fire department that has jurisdiction over the facility?
      37 Did the Tier II report include ALL of the following data:
                 a) The facility identification (including owner/operator, emergency
                 contacts, and certification);
                 b) The chemical name or common name of all chemicals as provided on
                 the MSDS;
                 c) The chemical properties of all hazardous chemicals listed, including
                 whether the chemical is pure or a mixture, whether it is a solid, a liquid
                 or a gas, and whether it is an extremely hazardous substance;

                  d) The hazard categories for all chemicals;
                  e) The manner in which hazardous chemicals are stored;
                  f) The general location of all hazardous chemicals in each category
                  (which may be claimed confidential and not released to the public); and

                 g) Whether an chemical identity is claimed as a trade secret?
      38 Did the Tier II form include ALL of the following information for the preceding
         calendar year:
                 a) The maximum amounts (in ranges) of all hazardous chemicals in
                 each category;
                 b) The average daily amount (in ranges) of all hazardous chemicals in
                 each category; and
                 c) The number of days the hazardous chemicals in each hazard
                 category were on-site?
Toxic Chemical Release Reporting - Form R
                                                                                      Yes   No   N/A   Comment/Concerns
39 When taking into account the amount of toxic chemicals on-site at the facility,
   did the facility include mixtures containing toxic chemicals or components of
                                                                                                         Please Input
   trade name products which the owner or operator received from another
   person?
40 Did the facility complete a toxic chemical release form for each reportable
   chemical and submit it to the EPA Administrator and designated state official on                      Please Input
   or before July 1, 1988 and by July 1 each year thereafter?
41 If the facility manufactures or processes a toxic chemical, does it provide the
   required information to customers who must file the toxic chemical release form?                      Please Input
                                                                                              Yes   No   N/A   Comment/Concerns
      42 Does the facility provide toxic chemical supplier notification information to
         customers in writing by January 1 of each year, that includes ALL of the
         following information:
                 a) A statement that the mixture or trade name product you supplied
                 contains a toxic chemical(s) subject to the reporting requirements;

               b) The name and CAS registry number of each toxic chemical you sold;
               and
               c) The percent by weight of each toxic chemical in the mixture or trade
               name product?
Form R - Recordkeeping
     43 Do you retain copies of submitted Form Rs for at least three years?
                                                                                                                 Please Input

      44 Do you retain supporting data and documentation of ALL of the following issues
         for at least three years:
                  a) Determination whether a reporting threshold applies;
                  b) Calculations used to determine the quantity of each toxic chemical
                                                                                                                 Please Input
                  released to the environment or transferred to an off-site location; and

                   c) Calculations of use indications and quantities of each toxic chemical
                   (including dates of manufacturing, processing and use)?
      45 Do you retain ALL of the following records for at least three years:
                   a) Receipts or manifest associated with the transfer of toxic chemicals
                   to off-site locations;
                                                                                                                 Please Input
                   b) Documentation of reported waste treatment methods for each toxic
                   chemical; and
                   c) Development of estimates of any release or off-site transfer?
      46 Does the facility retain all supporting material used to determine whether
         supplier notification was required AND a copy of each supplier notice for at least                      Please Input
         three years from the date of submission?
      47 Are all records associated with toxic chemical release reporting kept at the
         facility which submitted the reports AND at the facility to which they apply?                           Please Input

      48 Are records readily available for EPA inspection?
                                                                                                                 Please Input
      49 If the facility ever received a penalty for a recordkeeping violation, was the
         problem that led to the penalty corrected?                                                              Please Input

Toxic Chemical Release Reporting - Reportable Chemicals
      50 Do any of the following conditions apply to the waste stream:
                a) The stream is a product;
                b) The stream is sent to a boiler or industrial furnace, where it is burned
                as fuel;
                c) The stream is a byproduct, intermediate, or a material that is used at
                the facility for the production of a product; or
                                                                                                                 Please Input
                d) The stream leaves the facility, and one or both of the following apply:
                   1) The stream is transferred to another facility for further processing
                   and is returned to the original facility; or
                   2) The stream is transferred to an intracompany facility for further
                   processing in the production of a product or provision of a service?

      51 Do ANY of the following circumstances apply to the chemical waste stream:

                  a) The stream contains one or more reportable chemicals that is
                  released into the environment;
                  b) The stream enters a permitted waste treatment device for treatment;                         Please Input
                  and destruction, biological degradation or chemical conversion of the
                  stream occurs; or
                  c) The stream enters a device where all outputs release or dispose?

Pollution Prevention
      52 Is there a procedure in place at the facility which ensures that Pollution
         Prevention (P2) is a consideration in decision-making?
                                                                                                                 Please Input



Additional Notes:
                                                                                            Yes   No   N/A   Comment/Concerns

Standards Applicable to Generators of Hazardous Waste

Hazardous Waste Determination
       1 Do you have a EPA Hazardous Waste Generator ID number?

                                                                                                               Please Input


        2 Have solid wastes been characterized to determine whether they are
          hazardous?
                                                                                                               Please Input


        3 Does the site determine that wastes are hazardous by any of the following:
                 a) Testing;
                 b) Knowledge of processes; or
                 c) Both testing and knowledge of processes?
        4 Are results of waste tests and waste analyses:
                 a) Kept on file at the site for each waste stream; AND
                 b) Retained for at least three years for ALL wastes tested?
        5 Are waste analyses up to date?
                                                                                                               Please Input

Pollution Prevention
        6 Does the facility's waste minimization program include ALL of the following:

                  a) Demonstrated top management support;
                  b) The tracking of types and amounts of hazardous wastes and
                  hazardous waste constituents, including the rates and dates they are
                  generated;
                  c) A system for determining the true costs associated with hazardous
                                                                                                               Please Input
                  waste management and cleanup, including future liabilities;

                  d) Looking at a process to see where materials can be prevented from
                  becoming a waste minimization opportunities might be;
                  e) A cost allocation system, which identifies those activities which
                  generate hazardous waste; and
                  f) Periodic review?
Manifest - General Requirements
       7 Does the LQG use hazardous waste manifest forms?


                                                                                                               Please Input



        8 Is ALL of the following identifying information provided in the LQG facility's
          manifests:
                  a) The generators name, mailing address, and telephone number;
                  b) The generators EPA Identification Number;
                  c) The transporter's name and EPA Identification Number;
                  d) The TSDF's name, address, and EPA Identification Number; and
                  e) The waste description required by DOT (proper shipping name,
                  hazard class and ID number)?
        9 Is EACH of the following true of the LQG facility's manifest:
                  a) The manifests contain the signed generator's certification; and
                  b) Copies of manifests are retained for at least three years from the
                  date the waste was accepted by the initial transporter?
       10 Did the owner/operator of the LQG facility receive signed copies of ALL
          manifests from transporters and/or TSDFs within 35 days of the shipment?                             Please Input

       11 For any manifest not returned within 35 days, was the transporter and/or TSDFs
          immediately contacted?
       12 If a signed manifest was not received from the transporter and/or TSDF within
          45 days, were BOTH of the following actions taken:
                   a) An Exception Report was sent to EPA that contains a copy of the
                   original manifest and a cover letter describing your efforts
                   to locate the shipment and the results of your efforts; and
                   b) Copies of Exception Reports were retained for at least three years?

       13 The CT Manifest Form is based on the Federal Form 8700-22, has the following
          sections been filled out:
                                                                                                               Please Input
                                                                                                 Yes   No   N/A   Comment/Concerns
                   a) The shaded areas of Form 8700-22 (CGS 22a-449(c)-102(a)(2)(GG)
                                                                                                                    Please Input
                   RCSA); and
                   b) Items A-K on Form 8700-22 (CGS 22a-449(c)-102(a)(2)(HH)
                   RCSA)?
       14 If the waste is being transported to a state that requires use of its own manifest,
          is the generator using that state's manifest (unless the receiving state requires
          otherwise) (CGS 22a-449(c)-102(b)(3) RCSA))?
                                                                                                                    Please Input




       15 When LQG and TSDF owners and operators send hazardous waste off-site for
          treatment, storage, or disposal, do they certify on the manifest that the
          generator, or facility owner or operator, has a waste minimization program in                             Please Input
          place to reduce the quantity and toxicity of the hazardous waste (40 CFR
          262.20 to 40 CFR 262.30)?

       16 Are manifests being kept for three years as well as a signed copy from the
          owner or operator of the designated facility which received the waste?                                    Please Input

Acquisition of Manifests
      17 If the consignment state for the shipment is CT, are you using the Department
          supplied manifest?
                                                                                                                    Please Input


Pre-Transport Requirements - Marking
       18 Has each container of 110 gallons or less used in transportation been marked
          with the following words and information?
                HAZARDOUS WASTE--Federal Law Prohibits Improper Disposal. If
                found, contact the nearest police or public safety authority or the U.S.                            Please Input
                Environmental Protection Agency.
                Generator's Name and Address________________________
                Manifest Document Number___________________________
Use of Manifests
       19 If Connecticut is the state in which the generator is located, or the state to which
          the shipment of hazardous waste is manifested, does the generator send a copy
          of the manifest to DEP within 7 days of the date on which the transporter                                 Please Input
          accepts and signs the manifest (CGS 22a-449(c)-102(b)(3)(B) RCSA)?

       20 Does the owner/operator send a copy of the manifest or shipping paper to both
          the generator state and the consignment state within 30 days of receipt of
          shipment (CGS 22a-449(c)-104(a)(2)(H) to (I) RCSA)?                                                       Please Input



Biennial and Annual Reporting
      21 Has a Biennial Report been prepared, and does it detail the LQG facility's
          hazardous waste activities?                                                                               Please Input

       22 Are ALL of these Biennial Reporting requirements followed:
                 a) One copy of the report is submitted to EPA by March 1 of every even-
                 numbered year;
                 b) Biennial Reports are completed using EPA Form 8700-13A (or
                 required State form); and
                 c) Copies of the Biennial Reports are retained for at least three years?
                                                                                             Yes   No   N/A   Comment/Concerns
       23 Does the Biennial Report include ALL of the following:
                 a) The EPA Identification Number, name, and address of the generator;

                 b) The calendar year covered by the report;
                 c) The name, EPA Identification Number, and address for each off-site
                 TSDF in the U.S. to which HW was shipped during past calendar year;
                 d) The name and EPA Identification Number of each transporter used
                 during the previous calendar year for shipment to TSDFs in the United
                 States;
                 e) A description of the hazardous waste, including the EPA hazardous
                 waste number, the U.S. Department of Transportation (DOT) hazard
                 class, and the quantity of each hazardous waste that was shipped off-
                 site to a TSDF in the U.S.;
                 f) A description of the efforts during the previous year to reduce the
                 volume and toxicity of the waste generated;
                 g) A description of the change in the volume and toxicity of the waste
                 that was achieved during the past calendar year in comparison with
                 previous years, to the extent that such information is available for the
                 years prior to 1984; and
                 h) The certification signed by the generator or authorized
                 representative?
       24 Does the TSDF owner and operator provide any other information which the
          commissioner specifies to the facility's activities to DEP, upon request?

       25 Has an Annual Report been prepared summarizing the types, quantities,
          frequency, and ultimate destination of all hazardous waste exposed during the
          previous calendar year?                                                                               Please Input


       26 Are ALL of these Annual Reporting requirements followed:
                 a) One copy of the report is submitted to EPA by March 1 of every year;
                 and
                 b) Copies of the Annual Reports are retained for at least three years?

       27 Does the Generator's Annual Report include ALL of the following (40 CFR
          262.56):
                 a) The EPA identification number, name, mailing address and site
                 address of the exporter;
                 b) The calendar year covered by the report;
                 c) The name and site address of each consignee;
                 d) By consignee, for each hazardous waste exported, a description of
                 the hazardous waste, the EPA hazardous waste number (from 40 CFR
                 261 subpart C or D), DOT hazard class, the name and US EPA ID
                 number (where applicable) for each transporter used, the total number
                 of waste shipped and number of shipments pursuant to each
                 notification;
                  e) Except for hazardous waste produced by exporters of greater than
                  100 kg but less than 1000 kg in a calendar month, unless provided
                  pursuant to 40 CFR 262.41, in even numbered years:
                     1) A description of the efforts undertaken during the year to reduce
                     the volume and toxicity of waste generated; and
                     2) A description of the changes in volume and toxicity of waste
                     annually achieved during the years in comparison to previous years
                     to the extent such information is available for years prior to 1984;
                   f) A certification signed by the primary exporter?
Off-Site Transport
       28 When offering hazardous waste for off-site transport, does the LQG ensure that
           ALL of the following TSDF and waste hauler conditions are met:

                  a) Manifested hazardous wastes are shipped to properly permitted
                  TSDF;
                  b) Each TSDF to which manifested HW is being shipped has an EPA
                                                                                                                Please Input
                  Identification Number;
                  c) Manifested hazardous wastes are transported only by waste haulers
                  that have EPA Identification Numbers; and
                  d) There are records of the names of each hauler who transported
                  manifested hazardous waste and the waste hauled by each (this
                  information would be included on the facilities manifests)?
       29 Are ALL of the following true for vehicles which are used to transport shipments
          of manifested hazardous wastes:
                  a) The vehicles are placarded according to DOT regulations; and                               Please Input
                                                                                                 Yes   No   N/A     Please Input
                                                                                                                  Comment/Concerns
                b) Outgoing trucks are inspected to verify proper placarding before they
                leave the facility?
Accumulation Time
     30 Does the owner/operator of the LQG facility assure that the following on-site
        HW accumulation time limits are met:
                a) HW is accumulated for no more than 90 days; and/or
                                                                                                                    Please Input
                b) When the 90-day time limit is exceeded, the generator obtains an
                extension from the regulating authority and removes the waste before
                the extension expires?
     31 Does the owner/operator of the SQG facility assure that the following on-site
        HW accumulation time limits are met:
                a) HW is accumulated for no more than 180 days; and/or
                                                                                                                    Please Input
                b) When the 180-day time limit is exceeded, the generator obtains an
                extension from the regulating authority and removes the waste before
                the extension expires?
     32 Has the facility obtained an extension by the EPA of up to 30 days for storage if
        the hazardous waste must remain on-site for more than 90 days because of
        unforeseen, temporary, and uncontrollable circumstances (40 CFR 262.24(b))?                                 Please Input


       33 If generators store hazardous waste on-site without a storage facility permit, are
          all Federal regulatory RCRA accumulation requirements met (40 CFR 262.34)?

                                                                                                                    Please Input




On-Site Accumulation Training
      34 Does the owner/operator of the LQG facility assure that employees, whose work
          may associate them with hazardous waste accumulation areas, receive on-the-
                                                                                                                    Please Input
          job or classroom training about the facility they work in and their job
          responsibilities?
      35 Are ALL of the following training requirements met:
                   a) All facility personnel who handle hazardous waste in any manner,
                   participated in an initial training course related to their management of
                   hazardous waste within six months of beginning employment;

                    b) Each facility employee participated in an annual review of his or her
                    training; and
                    c) The initial training and annual review was directed by a person
                    trained in hazardous waste management?
       36 Are personnel assigned in hazardous waste storage areas generally familiar
          with ALL of the following:
                    a) Facility start up procedures;
                    b) The normal operation of the facility;
                    c) Facility shut down procedures;
                    d) Communications or alarm systems;
                    e) The facility contingency plan;
                    f) Emergency shut down procedures;
                    g) A description of controls; and
                    h) The fail safe features of the systems?
       37 Are personnel assigned in hazardous waste storage areas generally familiar
          with ALL of the following:
                    a) Operating problems;
                    b) Flow controls;
                    c) Monitoring;
                    d) Documentation;
                    e) Site operating procedures;
                    f) Maintenance requirements;
                    g) Equipment safety; and
                    h) Personnel safety?
       38 Are documents containing ALL of the following information maintained at the
          facility:
                    a) Records of each current employees training;
                    b) Records of former employee training, for at least three years after
                    they leave;
                    c) Job title, written job description and name of employee for each
                    position related to hazardous waste management; and
                    d) Written description of type and amount of training (including
                    continual training) that will be given to person filling a hazardous waste
                    management position?
                                                                                             Yes   No   N/A   Comment/Concerns
       39 Did employees with duties and responsibilities including emergency response,
          chemical operations, or hazardous substance processing receive additional
          training in:
                   a) Safety equipment and procedures used in the cleanup and removal
                   of a specific hazardous substance;
                   b) Standard operating procedures, including a detailed review of the
                   hazardous substance material safety data sheets, the safe handling
                                                                                                                Please Input
                   practices for the hazardous substance, and the application of standard
                   operating procedures to actual conditions;
                   c) Emergency procedures regarding fires, leaks, and discharges;
                   d) Equipment familiarization;
                   e) Operating data collection and entry;
                   f) Equipment start-up and shutdown; and
                   g) Control and adjustment of operating conditions?
       40 Did employees receive additional training pertaining to hazardous material
          safety (CGS 22a-449(c)-103 RCSA):
                   a) Safety equipment and uses;
                   b) First aid in the event of accidents with the waste;
                   c) Hazards involved with loading and unloading;
                                                                                                                Please Input
                   d) Equipment familiarization;
                   e) The manifest system and the terms used;
                   f) The physical and chemical properties of the waste being transported;
                   and
                   g) Emergency procedures for the waste being transported?
On-site Accumulation - Preparedness and Prevention
       41 Are ALL employees thoroughly familiar with proper waste handling and
          emergency procedures which are relevant to their responsibilities as follows:
                                                                                                                Please Input
                  a) During normal facility operations; and
                  b) During emergencies?
       42 Does the owner/operator operate and maintain the LQG facility so as to
          minimize the possibility of fire, explosion, and an unplanned release of                              Please Input
          hazardous waste constituents?
       43 Do potential hazards associated with the waste handled in the LQG facility
          require ANY of the following equipment to ensure safety from fire, explosion or
          unplanned releases of waste:
                  a) Internal communications or alarm system;                                                   Please Input
                  b) Telephone or two-way radio to summon outside help;
                  c) Fire extinguishers and other fire control equipment; and/or
                  d) Water at adequate volume and pressure?
       44 Is the necessary safety equipment provided as follows:
                  a) Present and available for use;
                  b) Maintained properly; and
                  c) Tested periodically?
       45 Whenever HW is being handled, is immediate access to communications and
          alarm systems assured as follows:
                  a) All personnel involved have immediate access to an internal alarm or
                  emergency communication device; and
                  b) When only one employee is on the premises working with hazardous
                  waste, the employee has immediate access to a telephone or two-way
                  radio?
       46 Has the fact that no safety equipment is necessary been demonstrated?




       47 Is sufficient aisle space maintained for the unobstructed movement of
          personnel, fire, spill response and other emergency equipment?
                                                                                                                Please Input


       48 Has the owner/operator attempted to make arrangements with local authorities
          to familiarized them with their HW operations that include information about the
          following:
                                                                                                                Please Input
                   a) The facility;
                   b) The hazardous waste handled there; and
                   c) The facility's emergency procedures?
On-site Accumulation - Contingency Plan/Emergency Response
       49 Does the LQG facility have a contingency plan that is designed to minimize
          hazards to health or the environment from fires, explosions, or unplanned                             Please Input
          releases of hazardous waste?
                                                                                          Yes   No   N/A   Comment/Concerns
50 Does the contingency plan include all of the following information, at a minimum
   (40 CFR 264.52, 40 CFR 265.52):
          a) Specific actions that facility personnel must take in response to the
          emergency;
          b) The arrangements for emergency response with local response
          authorities (e.g., fire and police departments, hospitals, local hazmat
          response teams);
          c) Name, address, and home and office telephone numbers of the
          facility's primary emergency coordinator;
          d) Names, addresses, and home and office telephone numbers of all
          other personnel qualified to act as emergency coordinator, listed in the
          order that each will assume responsibility as the emergency
          coordinator;
          e) Up-to-date list and location of all emergency response equipment at
          the facility; including a physical description of each item and an outline
          of its capabilities; and
          d) Personnel evacuation plan?
51 Have copies of the contingency plan been sent to local police and fire
   departments, hospitals, state and local emergency response teams, and DEP
   and maintained at the facility?


52 Is the contingency plan reviewed and immediately amended whenever ANY of
   the following circumstances arise:
            a) The TSDF permit is revised or, for generators and interim TSDFs,
            applicable regulations are revised;
            b) The plan fails in an emergency;
            c) The facility changes its design, construction, operation, or
            maintenance practices, and the change materially increases the chance
            of a fire, explosion, or release of hazardous waste;
            d) The facility changes the response necessary in the event of an
            emergency;
            e) The list of emergency coordinates changes; or
            f) The list of emergency equipment changes?
53 Are ALL of the following emergency coordinator requirements being met:
            a) At all times, an emergency coordinator is on the premises or on call;

           b) Familiarity with the facility's contingency plan;
           c) The operations and activities at the facility;                                                 Please Input
           d) The location of all facility records;
           e) The facility's layout; and
           f) The location and characteristics of hazardous waste managed or
           generated at the facility?
54 Has the on-site accumulation area had an imminent or actual hazardous waste
   emergency situation (i.e. spill, sudden release, leak, explosion, or ignition of any                      Please Input
   hazardous waste)?
55 During the imminent or actual emergency situation, did the emergency
   coordinator (or the designee) immediately complete ALL of the following actions:

           a) Notify all facility personnel with the use of alarms, if available; and
           b) Notify appropriate State and local agencies with designated
           response roles if their help is needed?
56 In response to a release, fire or explosion, did the emergency coordinator take
   ALL of the following action:
           a) Immediately identify the character, amount, and exact source of any
           material released (e.g., by observation, review of facility records,
           manifests, or by chemical analysis);
           b) Assess the possible hazards (direct and indirect) to human health or
           the environment that may result from the release, fire, or explosion;

            c) Take measures to contain the fire, explosion, or release of
            hazardous waste; and
            d) If the facility stops operations in response to the emergency, monitor
            the facility for leaks, pressure buildups, gas generation, and ruptures in
            valves, pipes, and other equipment?
57 If the owner/operator had to implement the contingency plan, was the following
   information recorded and reported:
            a) Notify (verbally or in writing) EPA, the state environmental agency,
            and local emergency response officials that cleanup is complete and the
            facility is ready to resume operations;
                                                                                           Yes   No   N/A   Comment/Concerns
                   b) Report the emergency in the facility's official operating records,
                   including time, date, and details of the incident; and
                   c) Submit a written report within 15 days of the emergency to the EPA
                   and the state environmental agency?
On-site Accumulation - Containers
       58 Is the container storage area inspected weekly?

                                                                                                              Please Input


       59 Are the container storage area inspections:
                  a) Recorded; and
                  b) Maintained for at least three years?
                                                                                              Yes   No   N/A   Comment/Concerns
       60 Does the inspection record for the container storage area include ALL of the
          following:
                  a) The date and time of inspection;
                  b) The name of the inspector;
                  c) The observations of the inspector; and
                  d) The date and nature of remedial actions, if any remedial actions
                  were required?
       61 Are ALL of the following true of containers kept in an on-site accumulation area:

                  a) The containers are in good condition;
                  b) The containers shows no signs of leakage, spillage, rust, bulges, or
                  other damage;
                  c) Each container is labeled or marked clearly with the words,
                  "Hazardous Waste" and with either the chemical name or other words
                  that identify the contents of the container such as "flammable," "acid,"
                  alkaline" "cyanide," "reactive," "explosive," or "halogenated solvent" or
                  the chemical name (CGS 22a-449(c)-104(e) RCSA and 22a-449(c)-
                  105(g) RCSA (interim status));                                                                 Please Input
                  d) Each container is labeled or marked clearly with the waste's
                  identification number;
                  e) The containers are clearly marked with the date accumulation began;

                   f) The containers are kept closed except when waste is added or
                   removed;
                   h) The containers and/or their linings are compatible with the waste
                   stored in them; and
                   i) The containers are handled and stored properly so they won't rupture
                   or leak?
       62 If a container is found to be in poor condition or leaking, are EITHER of the
          following steps taken:
                   a) The entire container is transferred to one in good condition; or                           Please Input
                   b) The contents of the original container are transferred to one in good
                   condition?
       63 Are containers holding ignitable or reactive waste located at least 50 feet from
          the facility's property line?                                                                          Please Input

       64 Are hazardous wastes stored in containers in ANY of the following ways:
                  a) Incompatible wastes, or incompatible wastes and materials are
                  placed in the same container;
                  b) Hazardous wastes are placed in an unwashed container that
                  previously held an incompatible waste or material; or                                          Please Input
                  c) Containers holding compatible hazardous wastes or materials are
                  stored near other containers, piles, open tanks, or surface
                  impoundments that contain wastes with which the container waste may
                  not be compatible?
       65 Where incompatible wastes or materials are stored in the same container, or
          stored in unwashed container that previously held incompatible wastes, are the
          wastes and materials managed as incompatible wastes, or incompatible wastes
          and materials in compliance with 40 CFR 265.17(b)?

On-site Accumulation - Air Emission Standards
       66 Does the facility manage any hazardous waste with organic concentrations of at
          least 10 ppmv that is associated with process vents (40 CFR 265.1032)?
                                                                                                                 Please Input


       67 Does the owner/operator maintain documentation of compliance under the CAA
                                                                                                                 Please Input
          as part of the facility's operating record?
On-site Accumulation - Containment Buildings
       68 For containment buildings, does the LQG maintain EITHER of the following at
          the facility:
                   a) Written procedures to ensure each waste remains in the unit for no
                   more than 90 days, written procedures for waste generation and
                                                                                                                 Please Input
                   management which are consistent with the 90-day storage limit, and
                   documentation that the procedures are implemented; or
                   b) Records which document that containment building is emptied at
                   least once every 90 days?
       69 Does the LQG store hazardous waste on-site for up to 90 days without a permit,
          provided that they comply with the federal accumulation rules and the additional
          Connecticut provisions that require (CGS 22a-449(c)-102(a)(2)(E) RCSA, 22a-
          449(c)-102(a)(2)(F) RCSA, 22a-449(c)-102(a)(2)(K) RCSA, and 22a-449(c)-
          102(a)(2)(M) RCSA)):
                                                                                                                 Please Input
                                                                                            Yes   No   N/A   Comment/Concerns
                  a) Aisle space to be maintained at the facility in accordance with 40
                                                                                                               Please Input
                  CFR 264.35;
                  b) Compliance with the general requirements for ignitable, reactive, or
                  incompatible wastes found at 40 CFR 365.17;
                  c) Secondary containment for containers;
                  d) Waste analysis and trial tests on tanks in accordance with 40 CFR
                  265.200?
On-site Accumulation - Closure of Accumulation Sites
       70 Does the facility comply with the closure performance standards, including
          documentation of the closing when closing a hazardous storage area (CGS 22a-
          449(c)-102(a)(2)(D) RCSA and 22a-449(c)-102(c) RCSA))?                                               Please Input


       71 Was the facility closed in a manner that minimized the need for further
          maintenance?
                                                                                                               Please Input
                                                                                            Yes   No   N/A   Comment/Concerns
      72 Was the facility closed in a manner that minimizes, or eliminates post-closure
          escape of ALL of the following to the ground, surface waters, or to the
          atmosphere:
                 a) Hazardous waste;
                                                                                                               Please Input
                 b) Hazardous constituents;
                 c) Leachate;
                 d) Contaminated runoff; or
                 e) Waste decomposition products?
      73 During closure were ALL of the following properly disposed of or
          decontaminated:
                 a) All contaminated equipment;                                                                Please Input
                 b) All contaminated structures; and
                 c) All contaminated soil?
Universal Waste - Thermostats
      74 Does the facility have any universal waste thermostats?

                                                                                                               Please Input


      75 Have any universal waste thermostats that appeared to be leaking, spilling, or
          damaged been moved to a container that meets all of the following
          requirements:
                 a) The container is closed;
                 b) The container is structurally sound;
                 c) The container is compatible with the battery;
                 d) Containers holding thermostats must be capable of preventing
                 leakage and breakage under all (not just reasonably foreseeable)
                 conditions; and
                 e) The container lacks evidence of leakage, spillage, or damage that
                 could allow for leakage, spillage or damage?
      76 Is EACH universal waste thermostat or container of thermostats labeled or
          marked clearly with ANY of the following phrases:
                 a) "Universal Waste - Mercury Thermostat(s)";
                 b) "Waste Mercury Thermostat(s)"; or
                 c) "Used Mercury Thermostat(s)"?
Universal Waste - Lamps
      77 Does the facility generate universal waste lamps?

                                                                                                               Please Input


       78 Are universal waste lamps contained in packages or containers as follows:
                   a) Containers and packages are structurally sound;
                   b) Containers and packages are compatible with the contents of the
                   lamps;
                                                                                                               Please Input
                   c) Containers and packages holding lamps, whether intact or broken,
                   must be capable of preventing leakage and breakage under all (not just
                   reasonably foreseeable) conditions; and
                   d) Containers and packages show no sign of leakage?
       79 Have any universal waste lamps appeared to be leaking, spilling, or damaged
          so that they might leak?                                                                             Please Input

      80 Was the lamp which was leaking, spilling or damaged moved to a container that
          meets ALL of the following requirements:
                  a) The container is closed;
                  b) The container is structurally sound;
                  c) The container is compatible with the battery; and
                  d) The container lacks evidence of leakage, spillage, or damage that
                  could allow for leakage, spillage or damage?
      81 Is EACH universal waste package or container which holds a lamp labeled or
          marked clearly with AT LEAST ONE of the following:
                  a) The words "Universal Waste Lamp(s)"; or                                                   Please Input
                  b) The words "Waste Lamp(s)"; or
                  c) The words "Used Lamp(s)"?
Universal Waste - Electric Products
      82 Does the facility generate universal waste used electronics (CGS 22a-449(c)-
          113(b) to (f) RCSA))?
                                                                                                               Please Input


       83 Does the facility manage used electronics in a way that prevents the release of
          any universal waste component of a universal waste, or constituent of a
          universal waste, to the environment?
                                                                                                Yes   No   N/A   Comment/Concerns
      84 Are all used electronics stored inside a building with a roof and four walls or in a
          cargo-carrying portion of a truck, such as in a trailer, in a manner that prevents
          them from being exposed to the environment?
      85 Is EACH universal waste package or container which holds a used electronic
          labeled or marked clearly with AT LEAST ONE of the following:
                  a) The words "Universal Waste--Used Electronics"; or
                  b) The words "Waste Used Electronics"; or
                  c) The words "Used Electronics"?
Universal Waste - Batteries
      86 Does the facility have any universal waste batteries (nickel cadmium and small
          sealed lead-acid batteries) (40 CFR 273.9)?
                                                                                                                   Please Input


       87 Are all used universal waste batteries considered waste on the date they are
          discarded?




      88 Does the facility adhere to the Mercury Containing and Rechargeable Battery
          Management Act (Battery Act) that affects the collection, storage, and
          transportation of hazardous waste batteries in the following ways:
                  a) It implements the universal waste rules as the governing authority
                  over the management of batteries subject to Section 104 of the Battery
                  Act;
                  b) It preempts existing state regulations regulating the management of
                  such batteries; and
                  c) It requires states that wish to regulate the management of such
                  batteries to adopt provisions identical to the universal waste rule?
      89 Are ALL universal waste batteries labeled or marked clearly with ANY of the
          following phrases:
                  a) "Universal Waste - Battery(ies)";
                  b) "Waste Battery(ies); or
                  c) "Used Battery(ies)"?
Universal Waste - Accumulation Time Limits
      90 Is universal waste accumulated for longer than one year from the date the
                                                                                                                   Please Input
          universal waste was generated or received from another handler?
      91 If universal waste accumulated longer than one year, did the handler
          demonstrate to the EPA that more time is necessary to properly recycle the
          universal waste?


       92 Is the handler able to prove how long the universal waste has been
          accumulating?                                                                                            Please Input

Universal Waste - Off-site Transport
      93 Does the universal waste handler always send or take universal waste to one of
          the following:
                   a) Another universal waste handler;                                                             Please Input
                   b) A destination facility; or
                   c) A foreign destination?
      94 Where a universal waste handler sends or takes universal waste off-site, have
          they compiled with the regulations for universal waste transporters (40 CFR                              Please Input
          273, Subpart D)?
Universal Waste - Small Handler
      95 Does the small quantity handler provide training which includes a description of
          proper handling and emergency procedures appropriate to the types of                                     Please Input
          universal waste handled at the facility?
                                                                                             Yes   No   N/A   Comment/Concerns
Used Oil - Generation, Collection, Aggregation
      96 Does the facility generate used oil that may have been mixed with hazardous
                                                                                                                Please Input
           waste?
      97 Upon detection of a release, did the generator perform ALL of the following
           cleanup steps:
                  a) Stop the release;
                  b) Contain the released used oil;
                                                                                                                Please Input
                  c) Clean up and manage properly the released used oil and other
                  materials; and
                  d) Repair or replace any leaking used oil storage containers or tanks
                  prior to returning them to service?
      98 Is used oil shipped off-site from the facility?
                                                                                                                Please Input
      99 Does the generator, collection center or aggregation point ship used oil off-site
           exclusively with transporters who have EPA Identification Numbers?
Used Oil - Storage
     100 Is used oil stored only in ANY of the following storage units:
                   a) Tanks; or                                                                                 Please Input
                   b) Containers?
     101 Are all containers, aboveground tanks, and fill pipes which are used to store and
           transfer used oil:
                   a) In good condition, with no severe rusting, no structural defects and                      Please Input
                   no signs of deterioration; and
                   b) Not leaking?
     102 Are all containers and aboveground tanks which are used to store used oil
                                                                                                                Please Input
           labeled or marked clearly with the words "used oil"?
     103 Do you have a Professional Engineer signed Spill Prevention, Countermeasure,
           Control Plan?
                                                                                                                Please Input


Additional Notes
                                                                                                  Yes   No   N/A   Comment/Concerns

Standards Applicable to Transport of Hazardous Materials

General Information
        1 Does the site have any hazardous materials that are shipped under a DOT
                                                                                                                     Please Input
          exemption?
        2 Does the facility meet all of the following requirements of shipping under a DOT
          exemption:
                  a) The packages are shipped in accordance with requirements
                  contained within the written exemption(s);
                  b) The outside of each exempted package is plainly marked "DOT-E"
                  followed by the DOT exemption number;
                  c) Each shipping paper bears the notation "DOT-E" followed by the
                  DOT exemption number; and
                  d) If the exemption contains special carrier requirements, the shipper
                  furnishes a copy of the exemption to the carrier?
Enforcement
        3 Were shipments found to be in compliance with the hazardous materials
          regulations?                                                                                               Please Input

        4 Was a report issued by the inspector?
                                                                                                                     Please Input

        5 Were there any discrepancies noted in the report?



Emergency Response Information
       6 Does the facility provide Emergency Response Information for transported
         hazardous materials?                                                                                        Please Input

        7 Is emergency response information immediately available to all of the following:

                    a) Facility personnel, for use at all times when a hazardous material is
                    present; and                                                                                     Please Input
                    b) Federal, state, or local government agencies that respond to an
                    incident involving a hazardous material, or are conducting an
                    investigation which involves a hazardous material?
        8   Is the emergency response information presented in AT LEAST ONE of the
            following ways:
                    a) On a shipping paper;
                    b) In a document that includes both the technical name and basic
                    description of the hazardous material, and the emergency response
                                                                                                                     Please Input
                    information (such as a MSDS); or
                    c) In a document (such as an emergency response guidance
                    document) that cross-references the description of the hazardous
                    material on the shipping paper with the emergency response
                    information contained in the document?
        9   Does the facility's emergency response information include:
                    a) The basic description and technical name of the hazardous material;
                    b) The immediate hazards of health;
                    c) The risks of fire or explosion;
                    d) The immediate precautions to be taken in the event of an accident or
                                                                                                                     Please Input
                    incident;
                    e) The immediate methods for handling fires;
                    f) The initial methods for handling spills or leaks in the absence of fire;
                    and
                    g) The preliminary first aid measures?
       10   Is the emergency response information:
                    a) Printed legibly in English; and
                                                                                                                     Please Input
                    b) Available for use away from the package containing the hazardous
                    material?
       11   For each shipment of hazardous materials, is an emergency response
            telephone number provided?                                                                               Please Input
                                                                                              Yes   No   N/A   Comment/Concerns
       12 Is the emergency response telephone number entered on shipping papers in
          one of the following locations:
                  a) Immediately following the description of each hazardous material; or

                   b) If the telephone number applies to all the hazardous materials on the
                   shipping paper, in one, clearly visible, and identified location?
       13 Is the phone which receives emergency response telephone calls monitored at
          all times that hazardous material are in transit?


      14 Does the emergency response telephone number provide the required access
          to someone who:
                  a) Is knowledgeable of the hazards and characteristics of the
                  hazardous material being shipped; and
                  b) Has comprehensive emergency response and accident mitigation
                  information for the material?
Administration - Registration
      15 Has the facility submitted a registration statement to the DOT?
                                                                                                                 Please Input

      16 Did the facility meet ALL of the following registration requirements:
                 a) The registration statement was submitted on DOT Form F 5800.2;
                 b) The statement was submitted to the DOT before the registration
                 deadline; and
                 c) The annual fee was paid?
      17 Are ALL of the following documents maintained at the facility's principal place of
         business for a period of three years from the issue date of the Certificate of
         Registration:
                 a) The Certificate of Registration; and
                 b) A copy of the registration statement?
Hazardous Materials Security Plan
      18 Does the facility have a security plan for hazardous materials?
                                                                                                                 Please Input

       19 Does the security plan include an assessment of possible transportation
          security risks for shipments of hazardous materials listed 49 CFR 172.800 and
          appropriate measures to address those risks, including ALL of the following
          elements:                                                                                              Please Input
                  a) Personnel security;
                  b) Unauthorized access; and
                  c) En route security?
       20 Does the security plan meet ALL of the following requirements:
                  a) Is in writing;
                  b) Is revised and updated as necessary;
                                                                                                                 Please Input
                  c) Is retained for as long as it remains in effect; and
                  d) Is made available to employees who are responsible for
                  implementing the plan?
       21 Does the facility adhere to the security plan?
                                                                                                                 Please Input

      22 Is each hazmat employee trained concerning the security plan and its
         implementation, including ALL of the following topics:
                  a) Company security objectives;
                  b) Specific security procedures;                                                               Please Input
                  c) Employee responsibilities;
                  d) Actions to take in the event of a security breach; and
                  e) The organizational security structure?
Highway Transport - Loading/Unloading
      23 Are the following loading and unloading practices implemented at the facility:
                  a) Packages containing hazardous material are secured against
                  movement within the loaded vehicle before it is allowed to leave the
                  shipper's property;
                  b) Smoking is prohibited on or about any vehicle during loading or
                  unloading of any explosive, flammable liquid, flammable solid, oxidizing                       Please Input
                  material, or flammable compressed gas;
                  c) The handbrake or airbrake is triggered on motor vehicles while
                  loading or unloading hazardous materials; and
                  d) Only tools that could not adversely affect packages, containers, or
                  their closures are used?
      24 Is the facility in compliance with the modal segregation requirements?
                                                                                                                 Please Input
       25 Are the following fork-lift requirements met whenever fork lifts are used for
          loading and unloading hazardous materials:
                  a) The rear wheels or motor vehicle are chocked at all times; and                              Please Input
                                                                                                 Yes   No   N/A     Please Input
                                                                                                                  Comment/Concerns
                   b) Only trained and authorized operators are allowed to utilize fork lifts?

Highway Transport - Portable Tanks/Cargo
      26 Is a "qualified" person, who meets all of the following requirements, in
         attendance during the loading and unloading of cargo tanks containing
         hazardous material:
                 a) Is alert and located within 25 feet of the cargo tank and delivery hose
                                                                                                                    Please Input
                 with an unobstructed view;
                 b) Is aware of the nature of the hazardous materials;
                 c) Has been instructed on emergency procedures; and
                 d) Is authorized and has the means to move the cargo tank?
      27 Are tanks containing a residue of a hazardous material handled in the same
         manner as are full tanks?                                                                                  Please Input

Hazardous Materials Table
      28 Is the Hazardous Materials Table reviewed prior to shipping each hazardous
         material to determine:
                 a) If materials originating at the site are hazardous;
                 b) The proper shipping name from column 2;
                 c) The hazard class or division of the material from column 3;                                     Please Input
                 d) The identification number of the material (UN or NA number) from
                 column 4;
                 e) The packing group(s) assigned to a material from column 5; and
                 f) The label(s) to be applied to packages from column 6?
      29 Unless exempted, when a mixture or solution containing a hazardous material is
         not specifically listed in the Table, is it described using the proper shipping
                                                                                                                    Please Input
         name of the hazardous material with the qualifying word "mixture" or "solution"?

       30 When a mixture or solution containing two or more hazardous materials in the
          same hazard class is not identified in the Table by a specific description, is the
                                                                                                                    Please Input
          mixture or solution described using the most appropriate general shipping
          description (e.g., "Flammable liquid, n.o.s.")?
       31 Is the Appendix to the Hazardous Materials Table reviewed for each hazardous
          material to determent if the material is also listed as a hazardous substance?                            Please Input

Shipping Papers
       32 Does the facility use shipping papers for hazardous materials shipped from the
          site?                                                                                                     Please Input

       33 Are hazardous material identified on shipping papers by using at least one of
          the following methods:
                   a) Hazardous materials entered first;
                                                                                                                    Please Input
                   b) Hazardous materials entered in a contrasting color; or
                   c) Hazardous materials identified by the entry of an "X" in a column
                   captioned "HM"?
       34 Do ALL hazardous materials descriptions on the shipping papers have the
          following characteristics:
                   a) Legible;
                                                                                                                    Please Input
                   b) In English;
                   c) Free of any code or abbreviations; and
                   d) Include an emergency response telephone number?
       35 Are ALL of the following elements of the basic shipping description of a
          hazardous material included on shipping papers and entered in the following
          sequence:
                   a) Proper shipping name, as prescribed in 49 CFR 172.101;                                        Please Input
                   b) Hazard class;
                   c) Identification number; and
                   d) Packing group, if any?
       36 Is the total quantity, by weight (or as otherwise appropriate), of each hazardous
          material on a shipping paper entered before and/or after the basic description?                           Please Input

       37 Is all additional information placed AFTER the basic shipping description?

                                                                                                                    Please Input


       38 Are hazardous material shipping descriptions entered on shipping papers
          without abbreviations, except for those specifically authorized by the                                    Please Input
          regulations?
       39 Are ALL shipments of hazardous materials (not including hazardous wastes)
          shipped under ONE of the following conditions:
                  a) In a cargo tank supplied by the carrier;
                                                                                                                    Please Input
                                                                                                  Yes   No   N/A   Comment/Concerns
                  b) By the shipper as a private carrier except for a hazardous material                             Please Input
                  that is to be reshipped or transferred from one carrier to another; or
                  c) For the return of an empty tank car which previously contained a
                  hazardous material and which has not been cleaned or purged?
       40 Is an acceptable, legibly signed, shipper's certification statement shown on each
          shipping paper for shipments of hazardous materials?


       41 Are hazardous wastes offered for highway transportation from the facility?                                 Please Input
       42 Is an acceptable, legibly signed, shipper's certification statements shown on
          each shipping paper for shipments of hazardous wastes?


Shipping Papers - Specific Substances
       43 If the proper shipping name is "n.o.s." or other generic description, is the name
          of the compound or constituent causing a material to be hazardous entered in                               Please Input
          association with the shipping description?
       44 If a hazardous material is a mixture of two or more hazardous materials, are the
          technical names of at least two components most predominately contributing to
                                                                                                                     Please Input
          the hazards of the mixture or solution entered on the shipping paper?

       45 If the proper shipping name of a hazardous substance does not identify the
          hazardous substance by name, is the name of the hazardous substance shown                                  Please Input
          in parentheses in association with the basic description?
       46 Are the shipments containing a hazardous substance described on the shipping
          paper by use of the letters "RQ" either before or after the basic shipping                                 Please Input
          description?
       47 Are shipments of hazardous materials in limited quantities described on the
          shipping paper by use of the words "Limited Quantity" or the abbreviation "LTD                             Please Input
          QTY"?
       48 If empty packages (drums) are shipped by common carrier, are they properly
          described on the shipping papers as a hazardous material or as a RESIDUE?                                  Please Input

       49 Has all hazardous waste, which had been offered, transported, or delivered,
          been accompanied with an EPA hazardous waste manifest, prepared in
          accordance with 40 CFR 262 (EPA regulations for hazardous waste                                            Please Input
          generators), and signed, carried, and given as required in 49 CFR 172.205
          (hazardous waste manifest requirements)?
       50 If a package contains an elevated temperature material and this fact is not
          disclosed in the shipping name (for example, when the words "Molten" or
                                                                                                                     Please Input
          "Elevated temperature" are part of the shipping name), does the shipping paper
          include the word "HOT" immediately preceding the shipping name?
       51 If a package contains a poison, and this fact is not disclosed in the shipping
          name or class entry, does the shipping paper include the word "Poison" or                                  Please Input
          "Toxic"?
Shipping Papers - Poisonous by Inhalation Materials
       52 For materials which are poisonous by inhalation, are the words "Poison-
          Inhalation Hazard" or "Toxic-Inhalation Hazard" and the proper Hazard Zone
                                                                                                                     Please Input
          included on the shipping paper immediately following the shipping description?

Marking
      53 Are packages/containers of hazardous materials marked prior to being offered
         to a carrier for transport?                                                                                 Please Input

       54 Are all non-bulk packages of hazardous materials marked with the proper
                                                                                                                     Please Input
          shipping name and the appropriate UN or NA identification number?
       55 Are combination packages of liquid hazardous materials legibly marked with
          package orientation markings that consist of two arrows pointing upwards with a                            Please Input
          line under them?
       56 Are all non-bulk packages of hazardous material marked with the name and
                                                                                                                     Please Input
          address of the consignee or consignor?
       57 Is the package marked with the proper shipping name without any
                                                                                                                     Please Input
          abbreviations, except for "ORM-D" for "Other Regulated Material"?
       58 Are portable tanks containing hazardous materials shipped from the facility?
                                                                                                                     Please Input
       59 Is the proper shipping name of the material marked on two opposite sides of the
          portable tank?


       60 If the portable tank has a capacity of less than 1,000 gallons, is the identification
          number marked on two opposite sides of the tank in association with the proper
          shipping name?
                                                                                               Yes   No   N/A   Comment/Concerns
      61 If the portable tank has a capacity of 1,000 gallons or more, is the identification
          number marked on each side and each end of the tank?
Marking - Poisonous by Inhalation Materials
      62 Is the facility in compliance with the marking requirements for materials that are
          poisonous by inhalation?
                                                                                                                  Please Input


Labeling
       63 Does the site use warning labels, required by the DOT, for shipments of
          hazardous materials?                                                                                    Please Input

       64 Is column (6) of the Hazardous Materials Table consulted to ensure that the
          proper labels are applied to packages?                                                                  Please Input

       65 Are DOT warning labels placed only on packages that contain the hazard
          represented by the label?                                                                               Please Input

       66 When mixed or consolidated packages of hazardous material are shipped, is a
          label placed on the outside of the package for each hazard class in the mixture
          or consolidation?                                                                                       Please Input


       67 When two or more labels are required on a package, are they displayed or
          affixed next to each other?                                                                             Please Input
                                                                                              Yes   No   N/A   Comment/Concerns
       68 When the package is of a size or shape that does not allow normal labeling, are
          labels displayed on tags affixed to packages?                                                          Please Input

       69 Are additional labeling requirements adhered to, when applicable?
                                                                                                                 Please Input

Placarding
       70 Does the facility use placards required by the DOT to indicate the hazards of the
          material shipped?                                                                                      Please Input

       71 Do the placards meet the DOT size, shape, color, and design specifications?
                                                                                                                 Please Input

       72 Whenever a shipment requires placarding of the vehicle, does the shipper
          provide the required number of the proper placards to the carrier?
                                                                                                                 Please Input

       73 Do placards furnished to carriers represent the hazard of the materials offered
          to, and to be transported by, the carrier?                                                             Please Input

       74 Are placards provided for:
                   a) Any quantity of Table 1 hazardous material; and
                                                                                                                 Please Input
                   b) Table 2 hazardous materials when 1,001 pounds or more are offered
                   to the carrier at one time?
Placarding - Poisonous by Inhalation
       75 Is the facility in compliance with the placarding and hazard communication
          requirements for materials poisonous by inhalation under 49 CFR 172, Subpart
          F (Placarding)?                                                                                        Please Input


Placarding - Mode-specific Requirements
       76 Is the Placard Substitution Table from 49 CFR 171.14(b) being used as a
          guideline for current placarding practices?                                                            Please Input

Packaging
      77 Are materials that have more than one hazard class or division, and that are not
         specifically listed in the Hazardous Materials Table, classed according to the                          Please Input
         highest applicable hazard class?
      78 For each material to be packaged for transportation, is the Hazardous Materials
         Table consulted to determine:
                 a) The packing group in column 5 corresponding to the proper shipping
                 name and hazard class for that material;
                                                                                                                 Please Input
                 b) The applicable packaging specification section of 49 CFR 173 under
                 column 8b or 8c; and
                 c) Any special provisions or exceptions to specific packaging
                 requirements under columns 7 and 8a?
      79 Is the Hazardous Materials Table and 49 CFR 173.21 checked to see if a
         material or packaging for shipment is forbidden by the mode of transport
                                                                                                                 Please Input
         selected?

       80 Are the packaging specifications for each hazardous material obtained from the
          applicable sections of the transportation regulations 49 CFR Part 173?                                 Please Input

       81 Are all hazardous material packagings prescribed or permitted in the specified
          packaging section (Column 8 of the Hazardous Materials Table), OR otherwise
          authorized for hazardous materials shipment?                                                           Please Input


       82 If containers are reused, are they refurbished to meet the requirements of new
          containers?                                                                                            Please Input

       83 Are REUSED paper, plastic, film, or textile packagings utilized for the transport
          of hazardous materials?                                                                                Please Input
                                                                                               Yes   No   N/A   Comment/Concerns
       84 Are packages of hazardous materials prepared so that ALL of the following are
          TRUE for normal transportation conditions:
                  a) There will be no significant release of the hazardous materials to the
                  environment;
                  b) The effectiveness of the packaging will not be substantially reduced;
                                                                                                                  Please Input
                  and
                  c) There will be no mixture of gases or vapors in the package which
                  could, through any credible spontaneous increase of heat or pressure,
                  or through an explosion, significantly reduce the effectiveness of the
                  packaging?
       85 Does the facility ensure that packagings are compatible with their lading
          (contents)?                                                                                             Please Input

       86 Are packaging closures checked to ensure they are closed so that under
          transportation conditions no release to the environment occurs?                                         Please Input

       87 Does this facility ship any packages that require venting?                                              Please Input
       88 For packages that require venting, are the provisions under 49 CFR 273.24(g)
          consulted to ensure that venting is permissible?
      89 Is sufficient head space left in liquid-containing packagings to ensure that
         neither leakage nor permanent distortion of the packaging will occur during                              Please Input
         normal transportation conditions?
Packaging - Non-bulk Packaging
      90 For combination packages containing liquid hazardous materials, are the
         closures on inner packages upright?                                                                      Please Input

       91 Does the facility consider the nature and thickness of the outer packaging to
          ensure that friction occurring during transportation will not generate enough heat                      Please Input
          to dangerously alter the chemical stability of the package?
       92 Is cushioning material within the package:
                    a) Placed so as to prevent breakage and leakage;
                    b) Placed to prevent movement within the package;
                    c) Incapable of reacting dangerously with the contents of the inner                           Please Input
                    packagings; and
                    d) Incapable of having its protective properties weakened in the event
                    of leakage?
       93 Are nails, staples, and other metallic devices secured so that they won't
          protrude from the outer packaging and damage inner packagings or                                        Please Input
          receptacles?
       94 Are filling limitations of non-bulk packages in compliance with the provisions of
          49 CFR 173.24a(b)?                                                                                      Please Input

       95 Do any outer non-bulk packagings contain more than one hazardous material?
                                                                                                                  Please Input
       96 Do the non-bulk packages with more than one hazardous material conform to
          the provisions contained in 49 CFR 173.24(c)(1)?
       97 Does the facility ship hazardous liquids in receptacles?
                                                                                                                  Please Input

Additional Information:
                                                                                                    Yes   No   N/A   Comment/Concerns


Spills

Discharge of Petroleum and Other Hazardous Substances
       1 Does the facility store, transfer, process, or use hazardous substances?
                                                                                                                       Please Input


Construction and Release Detection
      2 Do aboveground storage tanks (AST) meet ALL of the following construction and
          release detection standards:
                                                                    a) Equipped with
                                                                    b) The base underlying
                                                                    any new AST must be
                                                                    made of or surfaced with
                                                                    c) Pipes impermeable
                                                                    a materialthat enter the
                                                                    tank below the liquid level
                                                                    must be equipped with
                                                                    valves that can be                                 Please Input
                                                                    remotely activated or are
                                                                    readily accessible, and
                                                                    d) Mobile or portable
                                                                       ASTs must be protected
                                                                       by secondary
                                                                       containment or diversion
                                                                       structures, and may not
                                                                       e) ASTs with internal
                                                                       heating coils must be
                                                                       designed so that any
                                                                       leakage passing from the
                                                                       tank into the heating coil
                                                                                                             Yes   No   N/A   Comment/Concerns
Spill and Overfill Prevention
        3 Are new and upgraded aboveground storage tanks equipped with a gauge or other
           device that show the level of product in the tank?                                                                   Please Input

        4    Are ASTs equipped with ONE of the following:
                                                                         a) AST systems with a
                                                                         capacity of 660 gallons
                                                                         or less and a vent pipe                                Please Input
                                                                         opening located no more
                                                                         b) All other new ASTs
                                                                         must have a high-level
                                                                         warning system,
Integrity Testing                                                        operating independently
        5 Are integrity and leak testing of buried piping conducted at EACH of the following times:

                                                                               a) Installation;
                                                                                                                                Please Input
                                                                               b) Modification;
                                                                               c) Construction;
                                                                               d) Relocation; and
                                                                               e) Replacement?
        6    Are ASTs with a capacity greater than 2,000 gallons and installed prior to July 22, 1990
             tested for integrity or static head product and periodically inspected internally?                                 Please Input

Release Reporting
       7 Were DEP, National Response Center (NRC), and the state police notified immediately
                                                                                                                                Please Input
          after any discharge from an AST (CGS 22a-608(b))?
       8 Was a written follow-up report submitted as soon as possible after the release is
          reported that includes (CGS 22a-6089(c)):
                                                                          a) Actions taken to                                   Please Input
                                                                          b) Potential health risks;
                                                                          c) Advice on medical
                                                                          attention necessary for
General SPCC Plan Guidelines                                              people exposed to the
       9 Does the facility have a tank with capacity of 660 gallons or more; or total petroleum
          storage capacity of 1,320 gallons or more; or the underground storage capacity exceed                                 Please Input
          42,000 gallons?
      10 Was the facility in operation on or before August 16, 2002?


                                                                                                                                Please Input




       11    Does the SPCC Plan include a prediction of the direction, rate of flow, and total quantity
             of oil that could be discharged from the facility as a result of major equipment failure?                          Please Input

       12    Does the SPCC plan contain a description of the physical layout of the facility that
             includes all of the following:
                                                                           a) A facility diagram with
                                                                           the location and contents
                                                                           of each type of oil in each
                                                                           b) The container                                     Please Input
                                                                           c) Discharge prevention
                                                                           d) Discharge and
                                                                           e) Countermeasures for
                                                                           the discovery, response,
                                                                           f) Disposal of a
                                                                           and cleanup methods for
       13    Does the SPCC plan contain a contact list and phone numbers for:
                                                                           a) The facility response
                                                                           b) The National                                      Please Input
                                                                           c) Cleanup contractors
                                                                           with whom the facility has
                                                                           response agreements;
                                                                           d) All appropriate
       14    Does the SPCC plan include ALL of the following information:
                                                                           a) A clear explanation as
                                                                           to why secondary
                                                                           containment and/or
                                                                           b) An oil spill                                      Please Input
                                                                           contingency plan
                                                                           (following the provisions
                                                                           c) A written commitment
                                                                           of manpower, equipment,
                                                                           and materials required to
       15    Are those portions of the SPCC plan that describe procedures expeditiously control and
                                                                           to be used in the event of
             a discharge in a manner to make them readily usable in an emergency?                                               Please Input

       16    If the facility discharges more than 1,000 gallons of oil in single discharge or
             discharged more than 42 gallons of oil in each of two discharges occurring within any
             12-month period, was ALL of the following information submitted to the EPA Regional
             Administrator and State oil pollution control agency within 60 days:

                                                                          a) Name and location of
                                                                          b) Name of the facility
                                                                                                                                Please Input
                                                                          c) Maximum facility
                                                                          storage capacity or
                                                                          handling capacity and
                                                                          d) Corrective action and
                                                                          e) An adequate
                                                                          f) The cause of the
                                                                          g) Preventative
                                                                          measures taken or
                                                                          contemplated to minimize
                                                                          h) Such other
       17    Is the SPCC plan reviewed and evaluated according to ALL of the following criteria:

                                                                          a) Review occurs every                                Please Input
                                                                          b) Completion of the
                                                                          c) A statement is signed
                                                                          as to whether the SPCC
       18                                                                 plan will be amended?
             Is the SPCC plan amended whenever ANY of the following situations occur:
                                                                          a) If a change in facility
                                                                          design, construction,
                                                                          operation, or                                         Please Input
                                                                          maintenance thatreview
                                                                          b) The five-year
                                                                          indicates that more
                                                                          effective field-proven
                                                                          prevention and control
                                                                          c) The EPA Regional
       19    Does a licensed Professional Engineer (PE) certify any technical amendments to the
                                                                                                                                Please Input
             SPCC plan in accordance with 40 CFR 112.3(d)?
       20    Are all SPCC plan amendments prepared and implemented within the appropriate time
             periods?                                                                                                           Please Input
       21    Where practical, have secondary containment and/or diversionary structures or
             equipment been provided to prevent a discharge as described in 40 CFR 112.1(b)?                                    Please Input

     22 Is the entire containment system capable of containing oil and constructed so that any
          discharge from a primary containment system (such as a tank or pipe) will not escape                                  Please Input
          before cleanup?
SPCC Plan - Minimal Prevention Standards
     23 At a minimum, do the secondary containment and/or diversionary structures or
          equipment consist of at least one of the preventative systems (or its equivalent) listed in
          40 CFR 112.7 (c)(1) (onshore facility) or 40 CFR 112.7 (c)(2) (offshore facility):

                                                                              a) Dikes, berms, or
                                                                              retaining walls
                                                                              sufficiently impervious to
                                                                              b) Curbing;                                       Please Input
                                                                              c) Culverting, gutters,
                                                                              d) Weirs, booms, or
                                                                              e) Spill diversion ponds;
                                                                              f) Retention ponds;
                                                                              g) Sorbent materials;
                                                                              h) Curbing or drip pans
                                                                              i) Sumps and collection
       24    Has the facility determined that the installation of secondary containment and/or
             diversionary structures or equipment is not practical for any part of the facility that might
             be the cause of a discharge as described in 40 CFR 112.1(b)?

       25 When installation of containment or diversionary structures is impractical, has the
          facility submitted the following information to EPA:
                                                                            a) A clear demonstration
                                                                            b) An oil contingency
                                                                            c) A written commitment
                                                                            of personnel, material,
                                                                            and equipment required
     26 If installation of containment or diversionary structures is impractical, is:
                                                                            a) Tank integrity testing
                                                                            b) Valve and piping
SPCC Plan - Onshore Facility Drainage
     27 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable guidelines for onshore non-production facility bulk storage tanks (40                                  Please Input
          CFR 112.7(e)(2))?
     28 Is drainage from diked areas controlled by one of the following methods, unless the
          facility drainage system or the facility effluent treatment system are designed to control
          discharge from diked storage areas:                                                                                   Please Input
                                                                            a) Restrained by
                                                                            b) Emptied by manually
     29 Are drainage systems from undiked areas, with a potential for discharge, designed to
          flow into ponds, lagoons, or catchment basins that are designed to retain oil or return it                            Please Input
          to the facility?
     30 Does facility drainage from diked storage areas drain into a watercourse and not into an
          on-site wastewater treatment plant?
                                                                                                                                Please Input


       31    Is retained stormwater inspected in accordance with 40 CFR 112.8(c)(3)(ii), (iii), and
             (iv) or 40 CFR 112.12(c)(3)(ii), (iii), and (iv), as applicable?
                                                                                                                                Please Input


       32 If drainage waters are treated in more than one treatment unit AND such treatment is
          continuous AND pump transfer is needed, has the facility:                                                             Please Input
                                                                           a) Provided two "lift"
                                                                           b) Permanently installed
     33 If the facility is in a location subject to flooding, does the SPCC Plan provide additional
          protection for events that may occur during the floods?                                                               Please Input
SPCC Plan - Onshore Bulk Storage Tanks
     34 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable requirements for onshore non-production facility bulk storage containers                               Please Input
          (40 CFR 112.8(c) or 40 CFR 112.12)(c))?
     35 Do bulk storage containers used for the storage of oil meet ALL of the following
          conditions:
                                                                           a) Material and
                                                                           construction are
                                                                           compatible with the
                                                                           b) Adequate secondary                                Please Input
                                                                           containment (e.g. dike,
                                                                           containment curb, pit,
                                                                           drainage trench) is
                                                                           c) Corrosion protection
                                                                           is provided for completely
                                                                           buried metallic storage
                                                                           e) Corrosion protection
     36 Are completely buried metallic storage tanks installed on or after January 10, 1974
          subject to leak testing on a regular basis?                                                                           Please Input
     37 Is the drainage of uncontaminated rainwater from diked areas around bulk storage
          containers into storm drains or the discharge of an effluent into an open watercourse,
          lake, or pond not allowed to bypass the facility treatment system unless conditions of 40                             Please Input
          CFR 112.8 (c)(3)(i), (ii), (iii), and (iv) or 40 CFR 112.12 (c)(3)(i), (ii), (iii), and (iv), as
          applicable are met?
     38 Does testing and inspection of aboveground containers meet ALL of the following
          requirements:
                                                                           a) Integrity testing is
                                                                           conducted on a regular
                                                                           schedule as well as when
                                                                           b) The frequency and
                                                                           type of testing take into                            Please Input
                                                                           account container size
                                                                           c) Visual inspection is
                                                                           d) Container supports
                                                                           e) The outside of each
                                                                           container is frequently
                                                                           inspected for signs of
                                                                           deterioration, records
                                                                           f) Comparison
     39 Is leakage through defective heating coils controlled through either of the following
          measures:
                                                                           a) Monitoring the                                    Please Input
                                                                           stream return and
                                                                           exhaust lines forstream
                                                                           b) Passing the
                                                                           return or exhaust lines
                                                                           through a settling tank,
     40 For bulk storage containers that are not provided with secondary containment and/or
          diversionary structures or equipment, are ALL of the following tests conducted:
                                                                                                                                Please Input
                                                                            a) Periodic integrity
                                                                            b) Periodic integrity
                                                                            c) Periodic leak testing
       41    Are containers engineered or updated in accordance with good engineering practice to
             avoid discharges, using at lease one of the following devices:
                                                                            a) High liquid level
                                                                            alarms with audible or
                                                                            visual signal at level
                                                                            b) High liquid a
                                                                            pump cutoff devices set                             Please Input
                                                                            to stop flow at a or
                                                                            c) Direct audible
                                                                            code signal
                                                                            communication between
                                                                            d) A fast response
                                                                            system for determining
                                                                            the liquid level of each
       42    Are liquid level sensing devices tested regularly?             bulk storage container
                                                                                                                                Please Input

       43    Are plant effluent treatment facilities observed frequently enough to detect system
             upsets that could cause a discharge as described in 40 CFR 112.1(b)?                                               Please Input

       44    Does the owner/operator promptly correct visible discharges which result in a loss of oil
             from a container and promptly remove any accumulations of oil in diked areas?                                      Please Input

       45    Are mobile or portable storage containers positioned to prevent a discharge as
             described in 40 CFR 112.1(b) and furnished with secondary containment?                                             Please Input

SPCC Plan - Transfer/Pumping Operations
     46 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable requirements for onshore non-production facility transfer operations,
          pumping, and facility process (40 CFR 112.8(d) or 40 CFR 112.12(d))?                                                  Please Input


       47    Does the site have any buried piping installations?                                                                Please Input
       48    Are ALL of the following measures provided for buried piping installed or replaced on or
             after August 16, 2002:
                                                                                a) Protective wrapping;
                                                                                b) Coating; and
                                                                                c) Cathodic protection
                                                                                (or otherwise satisfaction
       49                                                                       of the corrosion
             If any section of buried line is exposed for any reason, are ALL of the following steps
             taken:
                                                                                a) The line carefully
                                                                                b) If corrosion damage
                                                                                is found, additional
       50                                                                       examination terminal
             If piping is not in service or is in standby service for an extended time, is theand
             connection at the transfer point capped or blank-flanged and marked as to origin?                                  Please Input

       51    Are pipe supports designed to minimize abrasion and corrosion, and allow for
             expansion and contraction?
                                                                                                                                Please Input


       52    Are all aboveground valves, piping, and appurtenances regularly inspected?
                                                                                                                                Please Input

       53 Are the following true for each aboveground piping installation:
                                                                           a) Aboveground valves
                                                                           b) The general condition
                                                                           of flange joints,
                                                                           expansion joints, valve
                                                                           glands and bodies,facility
                                                                           c) In areas where catch
                                                                           drainage is such that a
                                                                           piping failure might
     54 Are all vehicles entering the facility warned to be sure that no vehicle will endanger lead
          aboveground piping or other oil transfer operations?
SPCC Plan - Loading/Unloading
     55 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable guidelines for facility bulk loading and unloading (40 CFR 112.7(e)(4))?                               Please Input

       56    Do the facility's tank car and truck loading and unloading procedures meet the minimum
             requirements established by the Department of Transportation (DOT)?                                                Please Input

       57    Does the drainage from each rack area flow into a catchment basin or treatment facility
             designed to handle spills?                                                                                         Please Input

       58    In these rack areas, is a quick drainage system used, with a containment system
             designed to hold at least the maximum capacity of any single compartment of an tank car
             or truck loaded or unloaded in the area?

       59 Do the tank car and truck loading and unloading procedures incorporate BOTH of the
          following work practices:
                                                                           a) An interlocked
                                                                           warning light, warning                               Please Input
                                                                           signs, or physical barrier
                                                                           system are provided to
                                                                           b) The lowermost drain
                                                                           and all outlets of each
SPCC Plan - Onshore Facility Drainage                                      tank car or truck are
     60 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable requirements for onshore oil production facility drainage (40 CFR                                      Please Input
          112.8(b) or 40 CFR 112.12(b))?
     61 Are facility drainage systems designed to ensure that:
                                                                           a) Dikes (or equivalent)
                                                                           at tank batteries and
                                                                           central treating stations                            Please Input
                                                                           where an accidental
                                                                           discharge of oil would
                                                                           b) Field drainage
                                                                           ditches, and oil traps,
                                                                           c) Accumulated oil are
                                                                           sumps or skimmers is
     62 Are facility drainage systems designed for the following situations:
                                                                           a) Discharged oil is
                                                                           prevented from reaching                              Please Input
                                                                           navigable waters in the to
                                                                           b) In locations subject
                                                                           flooding, provision is
SPCC - Tank Equipment Standards                                            made for additional
     63 Do new ASTs have secondary containment meeting the following requirements:

                                                                          a) Secondary
                                                                          containment must be
                                                                          constructed so that spills
                                                                          b) not permeate
                                                                          willSecondary into the
                                                                          containment must consist                              Please Input
                                                                          of a combination of dikes,
                                                                          liners, pads, ponds,
                                                                          c) The storage capacity
                                                                          of the secondary
                                                                          containment must be able
                                                                          to contain materials must
                                                                          d) Lining the entire
                                                                          be constructed and
                                                                          maintained to meet
     64 Do double-walled tanks meet the following criteria for secondary containment:
                                                                          a) Overfill protection;
                                                                          b) Interstitial monitoring;
                                                                          c) An oil transfer pump                               Please Input
                                                                          with an independent high-
                                                                          level detection system
                                                                          thatAn ability to contain
                                                                          d) will automatically
     65 If a major facility has an AST total storage capacity of 20,000 gallons or more of
          hazardous substance other than petroleum or petroleum products, is an adequate                                        Please Input
          secondary containment system in place?
SPCC Plan - Inspections and Records
     66 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable guidelines for requirements for inspections, tests, and records (40 CFR                                Please Input
          112.7(e))?
     67 Are all inspections and tests required by the Oil Pollution Prevention regulations (40
          CFR 112) conducted in accordance with written procedures developed by the                                             Please Input
          owner/operator or certifying engineer?
     68 Are the written procedures and records of inspections and tests:
                                                                          a) Signed by the                                      Please Input
                                                                          b) Maintained with the
SPCC Plan - Security
     69 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable requirements for security (40 CFR 112.7(g))?                                                           Please Input

       70 Does the facility provide ALL of the following security measures:
                                                                          a) The facility is fully
                                                                          fenced and entrance
                                                                          gates are locked or
                                                                          b) All valves that permit
                                                                          outflow of the container's
                                                                          contents to the surface
                                                                          c) All pump starter
                                                                          controls are accessible                               Please Input
                                                                          only to authorized
                                                                          personnel and are locked
                                                                          d) The
                                                                          loading/unloading
                                                                          connections of piping are
                                                                          capped or blank-flanged
                                                                          e) Facility lighting is
                                                                          adequate for discovery of
SPCC Plan - Personnel, Training and Procedures                            discharges and
     71 Does the SPCC plan include a complete discussion of the facility's conformance with
          the applicable requirements for personnel, training, and discharge prevention                                         Please Input
          procedures (40 CFR 112.7(f))?
     72   At a minimum, are all oil-handling personnel provided with instruction in the following
          subjects:
                                                                          a) Operation and                                      Please Input
                                                                          b) Discharge procedure
                                                                          c) Applicable pollution
                                                                          d) The contents of the
     73 Does the site have a designated person who is accountable for oil spill prevention and
                                                                                                                                Please Input
          reports to facility management?
     74 Are discharge prevention briefings conducted for oil-handling personnel?
                                                                                                                                Please Input

       75    Do the discharge prevention briefings address ALL of the following items:
                                                                           a) Known discharges                                  Please Input
                                                                           b) Malfunctioning
                                                                           c) Any recently
       76    Are the discharge prevention briefing sessions conducted at least once per year to
             assure adequate understanding of the SPCC plan?                                                                    Please Input

       77   Are all personnel involved in oil-handling activities trained in ALL of the following
            subjects:
                                                                              a) Equipment operation                            Please Input
                                                                              b) General facility
                                                                              c) Discharge prevention
                                                                              d) Contents of the
       78 Is training conducted according to the following schedules:
                                                                              a) All employees receive
                                                                              eight hours of training
                                                                              within one year of the                            Please Input
                                                                              effective employees final
                                                                              b) New date of this
                                                                              receive eight hours of
                                                                              training within their first
                                                                              c) All personnel
                                                                              participate in
Spill Prevention - Oil Release                                                unaccounted drills at
       79 Were the number of spills or discharges of oil or other petroleum products documented
                                                                                                                                Please Input
            in the last 12 months?
                                                                                                          Yes   No   N/A   Comment/Concerns
       80   For each spill or discharge, was ALL of the following information provided:
                                                                             a) The date and time of                         Please Input
                                                                             b) The identity of the
                                                                             c) The estimated
       81   For each spill or discharge, did the person in charge, or a person designated to report
            spills, determine whether or not any outside entities (e.g. federal, state and local
                                                                                                                             Please Input
            officials, emergency response teams) needed to be notified?

       82   For each spill or discharge, was the elapsed time between discovery and the notification
            determination documented?
       83   For each spill or discharge, were the appropriate authorities notified immediately after
            the discovery of the spill or discharge?
       84   For each spill or discharge, was the cause of the release documented?                                            Please Input
       85   For any spill or discharge, was any material (regardless of quantity) released to:

                                                                            a) Surface water or                              Please Input
                                                                            b) Groundwater;
                                                                            c) Air; or
                                                                            d) Ground?
Spill Prevention - Reporting
       86 If any spill or discharge caused or contributed to a violation of an NPDES permit, was
            the violation reported in accordance with procedures set forth in the NPDES permit?                              Please Input

       87   If any spill or discharge endangered public health or the environment, was it reported by
            telephone within 24 hours to the EPA (or the state if the state has enforcement authority)                       Please Input
            and by written notice within five days?
       88   If required by the EPA, was a written report for any spill or discharge submitted, and did
            each report include ALL of the following:
                                                                              a) A description of the
                                                                                                                             Please Input
                                                                              b) The period of
                                                                              c) The anticipated
                                                                              d) Steps taken to reduce,
                                                                              eliminate, and prevent
       89   Were any recommended preventive measures implemented? recurrence of the
                                                                                                                             Please Input
       90   If a follow-up written report for any spill or discharge was required by another agency
                                                                                                                             Please Input
            other than the EPA, was the report submitted?
Spill Prevention - Remedial Action
       91 Was remedial action taken for each spill or discharge of oil, and did remedial action(s):

                                                                           a) Control the source of
                                                                           the spill(s) or                                   Please Input
                                                                           discharge(s), prevent
                                                                           further spills or
                                                                           b) Include mechanical or
                                                                           manual methods to
       92                                                                  recover spilled or
            If chemical agents were included in any remedial action, were they used:
                                                                           a) In accordance with                             Please Input
                                                                           b) With the permission
                                                                           of the Federal on-scene
       93   For each spill or discharge did remedial action comply with: coordinator or a state
                                                                           a) Guidelines
                                                                           established in Coast                              Please Input
                                                                           Guard state and local
                                                                           b) All regulations (33
                                                                           requirements for
       94                                                                  recovering oil and
            For each spill or discharge, were the long-term remedial actions taken documented?
                                                                                                                             Please Input
Spill Prevention - Hazardous Substance Release
       95 Were the number of spills or discharges of hazardous substances documented in the
                                                                                                                             Please Input
            last 12 months?
       96 For each spill or release, were ALL of the following documented:
                                                                             a) The date and time of
                                                                                                                             Please Input
                                                                             b) The identity of the
                                                                             c) The estimated
                                                                             d) The location of the
       97 For each spill, was it documented if the spill equaled or exceeded the reportable
                                                                                                                             Please Input
            quantity for that material?
       98 For each spill, did the person in charge of the facility or the person designated to report
                                                                                                                             Please Input
            spills notify the appropriate authorities immediately?
       99 For each spill, was it documented whether any agencies other than the National
            Response Center were notified by the person designated to report spills, and/or by the                           Please Input
            National Response Center?
      100 Were any substance(s) released in a spill defined as hazardous under the Clean Water
                                                                                                                             Please Input
            Act (CWA)?
      101 For ALL substances released during the spill which exceeded a reportable quantity
            under the Clean Water Act, did the person in charge of the facility or the person
            designated to report spills immediately notify ONE of the following entities in
            descending order of priority:
                                                                             a) The National
                                                                             b) The On-scene
                                                                             Coordinator as
                                                                             designated in the
                                                                             c) The Officer-in-
                                                                             d) The Commander of
      102 Were any substance(s) released in a spill defined as hazardous substance(s) under
                                                                                                                             Please Input
            Superfund (CERCLA)?
      103 Did the person in charge or the person designated to report the spill immediately notify
            the National Response Center by telephone?
      104 If an agency required a follow-up written report for any spill or release, was that report
            submitted by the deadline?
      105 For each spill or discharge, was material released:
                                                                             a) Into waters of the
                                                                             b) Into or onto the
                                                                             ground where it could
                                                                             affect either ground
      106 For any spill or discharge, were remedial actions recommended by any regulatory or
                                                                                                                             Please Input
            agency(s)?
      107 Were all recommended remedial actions taken?
Spill Prevention - Reportable Quantity
      108 For each spill or release did the Emergency Coordinator (or his/her designee) do ALL
            of the following:
                                                                             a) Activate facility
                                                                             b) Notify the Community                         Please Input
                                                                             Emergency Coordinator
                                                                             of the Local Emergency
                                                                             c) Notify the State
                                                                             d) Notify the National
      109 For each spill or release did the Emergency Coordinator (or his/her designee)
            determine whether the release:
                                                                             a) Could threaten human
                                                                             health or the environment                       Please Input
                                                                             outside the facility;
                                                                             b) Required immediate
                                                                             notice to the Community
                                                                             Emergency Coordinator
                                                                             c) Triggered the
                                                                             facility's hazardous
Spill Prevention - No Reportable Quantity                                    waste contingency plan,
      110 For any release of one pound or more of a hazardous substance that is not on EPA's list
            of extremely hazardous substances and for which there is no reportable quantity that
            occurred ON or AFTER 4/30/88, did the Emergency Coordinator (or his/her designee)
            notify BOTH of the following:                                                                                    Please Input
                                                                             a) The Community
                                                                             Emergency Coordinator
                                                                             for the Local Emergency
                                                                             b) The State Emergency
      111 Did the notice indicate ALL of the following:
                                                                             a) The chemical name of
                                                                             b) That the substance
                                                                             was not on the EPA list of
                                                                             Extremely Hazardous
                                                                             c) The quantity of the
                                                                             d) The time and duration
                                                                             e) The name and
                                                                             f) The environmental
                                                                             g) Health risks that
                                                                             could be triggered by the
                                                                             release and the
                                                                             h) Proper precautions to
                                                                                                    Yes   No   N/A   Comment/Concerns
Spill Prevention - Extremely Hazardous Substance
      112 For each spill or release was a notice of the release given to ALL of the following
            officials:
                                                                           a) The Community                            Please Input
                                                                           b) State Emergency
                                                                           c) The National
      113 For each spill or release, did the notice of release indicate ALL of the following:

                                                                        a) The chemical name of
                                                                        b) Whether the
                                                                        substance was on the
                                                                        EPA listestimated
                                                                        c) The of Extremely
                                                                                                                       Please Input
                                                                        d) The time and duration
                                                                        e) The name and
                                                                        f) The environmental
                                                                        g) Any known or
                                                                        anticipated health risks
                                                                        h) could be triggered
                                                                        thatRecommendations on
                                                                        precautions to be
Additional Notes:                                                       followed during and after
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