~..L,U~ 7L V r r~, r.- ~
TEXAS NATURAL RESOURCE CONSERVATION COMMISSION ®L~L~cts~~
INDUSTRIAL WASTEWATER PERMIT APPLICATION
SUBMISSION CHECKLIST -SUBMIT THIS WITH THE APPLICATION
DO NOT SUBMIT THE INSTRUCTIONS WITH THE APPLICATION
INDICATE IF THE FOLLOWING ARE INCLUDED IN THE APPLICATION.
WORKSHEET	Y	N	WORKSHEET	y	N
ADMII~IISTRATIVE REPORT 1.0	t,..		WORKSHEET 6.0		~
ADMINISTRATIVE REPORT 1.1			WORKSHEET 7.0		~
SPIF			WORKSHEET 9.0		/
TECHNICAL REPORT 1.0	~		USGS MAP		
WORKSHEET 1.0	+!~		AFFECTED LANDOWNER MAP	,,,	
WORKSHEET 2.0	~./		FLOW DIAGRAM	t/	
WORKSHEET 3.0	/		SITE DRAWING	;/	
WORKSHEET 4.0			ORIGINAL PHOTOGRAPHS	t/'	
WORKSHEET 4.1		1,/	SOLIDS MANAGEMENT PLAN	/	
WORKSHEET 5.0	/		WATER BALANCE		/~
Please indicate by a check mark the amount submitted for the application fee:
		Major		Minor
EPA Classification	New	Amend.	Renewal	Amend./Mod.
Minor facility not subject to categorical				
standards promulgated by the EPA (40 CFR	$350	/$350	$315	$150
Part 400-471)				
Minor facility subject to categorical				
standards promulgated by the EPA (40 CFR	$1,250	$1,250	$1,215	$150
Part 400-471)				
Major facility	N/A *	$2,050	$2,015	$450
* All facilities are designated as minors until formerly classified as a major by EPA.
A COPY OF THE CHECK MUST BE SUBMITTED AS PART OF THE APPLICATION
For Commission Use Only:
Segment Number
Expiration Date
Proposed/Current Permit Number
County,
Region
Page 1
ADMINISTRATIVE REPORT 1.0 -INDUSTRIAL
THE FOLLOWING IS REQUIRED FOR ALL APPLICATIONS RENEWAL NEW AND AMENDMENT
The instructions MUST BE FOLLOWED while completing the application Failure to do so will result in
significant delays in the processing of the application.
Type of application: (check all that apply)
New TPDES
Major amendment to existing permit
Renewal of existing permit
Storm water only discharges
New TLAP
_ Minor modification to permit
- Minor amendment to permit
ii a 1 in for an amendlment/modification to a ermit, briefl describe the reason for the ro osed amendment.
~Q./J .Ga't7'D iTCt>il ~.- l ~C.i L~ " C "~ / tJ-> Q~ N ~ ~I ~~ IZ-~ Co~pG`R7 ®~ D ~ i N P-
~1~A't'vf'~ WG ~aUe, /+. -~c'~.Eal ®~ ~/$clp ~~y `'`Jio s-u~~+~_~ i7TSAC~~tc~~~.
~~~ c sz ~ ~~ -E-(,,.a-r +~~c~r n~.z ~ -F : ec d1 a iz e,o. b~ L cs-~ed1- o~ g~z~ ~ t- a ~v
¢wtc~ t>S -~v DDS ~~ ~oalct-A-Lto,.~s(D•~-l~ ~vrLLL AtJC2A~~C. ~a./i~~ tcn.-rte.`
his E K e~CL7~ v ??_QX~ __ ~cA.C ~y ~ ~aL T~4ti ~ u ~fMC,T ~-~ ~su-~.m-~JrPC_I. ~B r~ ~'~~ )
1. APPLICANTrrI__NFORMATION (Instructions, Page 13)
a. Facility owner*: ~RV~rt~ - (~ji'o,lruc,. IL
Charter Number (issued by the Texas Secretary of State): t~ -[ 3`7`~ ~jOD
Mailing address for use on the permit and permit correspondence:
Street N~ Z Street name: ~'rTi:~.) U~`~ L N • Street typ
P.O. Box City: 14.~cz~ c C(~ State: 1 `F Zip code:_
Telephone number: ~~30~ "ZS7- ~s
Tax Identification Number issued by the State Comptroller: 7 `F'a'6 ~~ ~ ~ ~
e_ L~
~ Q"'OZ~
Charter Number (issued by the Texas Secretary of State): / ~ `f /~5~8~ 30 0
'~` Owner of the facility must apply f~ the permit
Check one; 1/ The TNRCC has issued this Customer Reference Number to the owner. CN: ~®g'O/ ~~
The owner has not yet received a Customer Reference Number. A completed Core Data Form (TNRCC-
10400)listing the owner as a customer and this facility as the regulated entity is attached to this application.
b. Co-Permittee information (complete only if the operator must be a co-permittee)
Facility operator: ~ ~~&
Mailing address for use on the permit and permit correspondence:
Street No. Street name: Street type
P.O. Box City: State: Zip code:
Telephone number: Date of Birth:
Tax Identification Number issued by the State Comptroller:
Charter Number (issued by the Texas Secretary of State):
Check one: The TNRCC has issued this Customer Reference Number to the co-permittee. CN:
The co-permittee has not yet received a Customer Reference Number. A completed Core Data Form
(TNRCC-10400) listing the co-permittee as a customer and this facility as the regulated entity is attached
to this application.
Industrial Administrative Report, TNRCC-10411 (Revised 3/02) Page 2
Provide a brief description as to the need for a co-permittee.
c. Individual information (complete only if the facility owner or co-permittee is an individual)
Name: Check one: Male Female
State Identification Number:
Date of Birth:
Assumed business or professional name:
Home address:
Street No. Street name: Street type
P.O. Box City: State: Zip code:
Telephone number:
Business name:
Check one: The TNRCC has issued this Customer Reference Number to this person. CN:
This person has not yet received a Customer Reference Number. A completed Core Data Form (TNRCC-
10400) listing this person as a customer and this facility as the regulated entity is attached to this
application.
2. CONfTACT INFORMA /T_ION (Instructions, Pages 14)
Name: ~-Jli c~-E ~ ~ • ~~~5 trc~ l Company: l=qu i . ~ -lam ~ O ~ ~r~c
Telephone number: ~~ "ZS-'7"D4~ Fax number: \~3°~ Zs~7-oooS E-Mail: l)~her.~s~c.-{ ~ ~trec~._ ~'o, i ~c
Street No.= j 1 Z Street name: ~t TfO ~ GF r~ Street type: (. r~ .
P.O. Box City: ~!2LZU i l te~ State: ~1~ Zip code: -1 ~OZ-~
Check one or more:
/ Administrative contact
technical contact
Name:
Telephone number:
Company:
Fax number:
)rMail:
Street No. Street name: Street type:~
P.O. Box City: State: Zip code:-
Check one or more: Administrative contact Technical contact
3. NOTICE INFORMATION (Instructions, Page 14)
a. Individual publishing the otices
Name: _~` ~ ~~ ~nY-., (,~~{ Telephone number:~~ ~~ ZS 7 -OOfl S~
r ~
Company: ~ ~ i~.ck ~ ° ~~b I ~+3 c-- - Fax number: ~~ ~~ Z~' "1- ®~® ~
Street No. 5 l Z- Street name: L'®TT'®~ ~T' ~ Street type: (~ rJ .
P.O. Box City: ~.z>/y i ~~,~. State~Zip code: -1cb~Z~
Industrial Administrative Report, TNRCC-10411 (Revised 3/02) Page 3
b. Method of receiving Notice of Receipt and Intent to Obtain a Water Quality Permit Package and Instructions
(Check pne)
/ E-mail: E-mail address: M,~nee~~~~~a,r~i -~~® co ~-t
Fax: Fax number: t~ 30~ Z ~~° ®Oo ~,
Overnight/Priority mail: (self addressed, prepaid envelope required)
Regular Mail: Street No. S l Z- Street name: C o-tTor-1 U i.
Street type: (~ a P.O. Box City: ~ ~~r~y i. l~t Stater Zip: -7 g0 Z~
c. Contact in the notice
Name: ~~`~^ ~ ~ ~ - ~~~ ~ Telephone number: C~ i~~ z S 7-0®o s
~- -
Company: E4~ c't~c~-. -~C a ~tJG, _ Fax number ~~o~ Zs ? - oo ~ ,6
Street No. S CZ Street name: C~~ c~ ~J Pte- t a Street type: (~~
P.O. Box City: ~•e.cz>:zu ~ l t t State: T~ Zip code: ~ F5o Z~
d. Public place information
Location of public building: ~ 2tz~ eo u r~^cL~
Public building name: ~~etz Comma Z-y~u ~e~c»s-~
Name: «¢-2 ~U ~,-~-~, _ Telephone number:
Street No. -Za o Street name: ~"~A•-~ t~ ~ Street type: Ayerg~ vim.
City: ~.~~.~ i l~~ County: (L~zz.2. State~`C~ Zip code: -Z~~~S
4. FACILITY INFORMATION (Instructions, Pages 1415)
a. State/TPDES Permit No.~ Etap~Z3~ - Eo o Expiration date: Z 1 O S
NPDES Permit No. Expiration date:
Check one: The TNRCC has issued this Regulated Entity Reference Number for this facility. RN:
No Regulatory Entity Reference Number has been received for this facility. One or more completed Core
Data Forms TNRCC-10400) listing this facility as the regulated entity is attached to this application.
b. Plant Name: ~Ru ~ - 1~0 ~~~ L.
County in which the facility is located: ~C{ e- ~-
County in which the outfall is located:_ <<~CZ (Z
c. Owner of the facility: ~t~?u~'r'er~+. ~~b ~ J ~ L.
d. Owner of land where the facility is/will be: ~~ ~ ie~c~ °' ~` o ~.S~J~'e-•
If not the same as the facility owner, there must be a long teem lease agreement in effect for at least six years. In some cases, a lease may not suffice -see instmctions
Street No. ~ lZ Street name: ~ TAO ~ b- i vJ Street type: L ry
City: tC~.tZlzu ~ ~ ~~- State: ~~-Zip code: ego zg
Industrial Administrative Report, TNi2CC-10411 (Revised 3102) Page 4
e. Ownership of effluent disposal site: GC~U i.-~e~ - ~L~ ~~ ~,
If not the sazne as the facility owner, there must be a long team lease agreement u~ effect for at least six years
Street No. ~.~ Z. Street name: ~® `~®~ C~ t~
Street type: L-h~
City: ~~~~ ~~ ~ ~-~ State: ~'~. .Zip code: ~ ~~
f. Owner of sewage sludge disposal site: 6J
only regnired if authorisation is being sought in the permit for sludge disposal on property owned/controlled bythe applicant
Street No. Street name: Street type:
City State: Zip code:
5., LOCATION INFORMATION (Instructions, Pages 16-17)
a. Is the location of the facility used in the existing permit correct: Yes No
If no, or a new permit application, please give an accurate description:
~t,ctdZc acl ~s ~.v sr~w~~ t ®c~--r~o-~
Sc2Com~a 6-r a ~.ra
~ZesZ.rrui It e 1 T`F 'Z`~zSS
b. Is the point of discharge and discharge route in the existing permit correct: Yes No
If no, or a new or amendment permit application, please give an accurate description:
~Sa.7.wA4~~C ~~'~ '~C~A[ZCt.L tZeJ'C"~- IN "tom L1C~~`+Ti~ ~,e~Z,If~i'~ ARC
GDR Ttu'C~ ~ l-~ ArS I-s C~ ~.e..t N Gh. i~r~P~-~ ~ o s-L ~L m n i F t +e?D,
c. If a TLAP, is the location of the effluent disposal in the existing permit accurate: ~` Yes c/ No
If no, or a new or amendment permit application, please give an accurate description:
~Ir•~!~ b'~i7t'T1'O YJJ~ 2l l Z.pf~~ ~-~ t~~ .~,~U~ t7`ZAT~ Ft is-+~AS NOT
~e~>=~e-P o e~ m Z,..t 1~. ~ ~e~u~.: ~-~ ®u ~ -~.crtw<i -t"ZC, u ce.tz~r~Tt..t~ iZ~ F(Q~CS
d. If a TLAP, provide the flow of effluent from the treatment facility to the effluent disposal site
1kS wa--rem c+u~a/<cz.S Y; (~ov ~s>rl .4,u~ ir~-~ 2,--c~ l,a-OQ 9a-l s~p-c,•e. -~i4N
~z~ ~k-C..e-a t.tirr-u I~ooo e~Arllo..~ ~st...rti e~+.~tae~/pu.~pT',~.t~.E~lves<r~ is ua~ r~
iA Z'~5t.~..UD ~uG -E-e C-o~,s.~~y~c.~tze r~sc~ucl ~'ie-1~~' ~ ADD Z Cep i4-Trasct+eb~
tza~.w tlx~
e. For TLAP applications, please identify the nearest watercourse to the disposal site to which rainfall runoffmight
flaw if not contained: ®~,-f- ~ ~,
Industrial Administrative Report, TNRCC-1U411 (Revised 3/02) Page 5
`EQ v ~ ~~ ~ ~ ~ ~
~ ~~
~~~ ~ L~~ ~ l~ ~ ~~
r
} ~.
h~
°~'/f~
~~ .
LPD Fi~'ryr
6o'x17 pct
3060 sgit
Bixk B
	~ w~
a
	m
	a
	
r	g
	
~	~
sv	
q'~	N
	r
a.
G
~I
B' wh 1~0 P1C
0
Lot 1
Int9
3' ach. 4L0 PVC
~~ ~
D Field
'x 18 pcs
BO sgft
Intl
1000 gal primary trentm~ tank -' .
X1000 gaL aecondry t.remeat teak
1000 gat 8caiag ~,.am~-r/ pu :sg tank
''
t ~--`"nx vim` ~~za~
A
n
4
t
s Qoa ~' ,~
1~RC~srR~ iD~
f. Is the location of the sewage sludge disposal site in the existing permit accurate: Yes No '~N/A
If no, or a new permit application, please give an accurate description:
g. Provide a USGS Map with all required information. Indicate by a check mark that the information is provided.
'~ Applicant's property boundary Treatment plant boundaries
Point of discharge and highlighted discharge route / Effluent disposal site boundaries
- All ponds Sewage sludge disposal site
1 mile radius and 1 mile downstream information New and future construction
h. Is the facility located in Bexar, Comal, Hays, Kinney, Medina, Travis, Uvalde, or Williamson County?
Yes ~ No
If yes, additional information concerning protection of the Edwards Aquifer may be required.
i. Identify the name and distance to the nearest city from the facility: ~r.¢¢-v ~ (~~
j. Is/will the treated wastewater discharge to a city, county, or state highway right-of--way, or a flood control district
drainage ditch? ~ Yes r/_ No
Ifyes, indicate by a check mark if: Authorization granted Authorization pending
For new and amendment permit applications, provide copies of letters that show proof of contact and upon receipt,
the approval letter.
k. Is the facility located on or does the treated effluent cross Indian Land? Yes ~/ No
6. MISCELLANEOUS INFORMATION (Instructions, Page 17-18)
a. Provide two names of individuals that can be contacted during the permit term.
Name: _1N~rcQ~..o-Gl E. ~+oS~~= `1 Telephone number~~63a~ 2s ~ - oc~ O 5
Company: ~o ~T~ _ ~Cm ~ 1-,~ c_. Fax number: ~~ 3b~ '2.:5~- ®e~e~ E,
Street No. S lZ Street name: eo-R D+~1 Cry ~ Street type: ~-~
City: ~ce>'.~~ Lt.~ State:~X Zip code: -7~oZ.~s
Name:~ED C - W ~ ~~~'~ Telephone number: ~g 30~ Z S' ~- o oa s
Company: ~Q,~i-tec~ -~~ ~ =~.sc.. Fax number: ($~~~ Z~?-ooo ~
Street No. S'~2 Street name: c~ro~J ~iµ Street type: l~ N ,
City: ~iz~v << ll~ State: T`F Zip code: ~~ z~
Industrial Administrative Report, TidRCC-10417 (Revised 3/02) Page 6
b. List each person formerly employed by the TNRCC who represented your company and was paid for service
regarding the application. ~ ~/~-
c. For all applications involving an average daily discharge of 5 million gallons per day or more, provide the names
of all counties located within 100 statute miles downstream of the point(s) of discharge.
d. Please provide the address for receiving self-reporting/DMR forms:
Company: Env ; t'c~- _ ~ i`o I S'~~. Department: ~'~~ C~ ~ C-s
Name: l~-c., c l.. ~. E ~ E - ~E--~ ~~ ~-(
Street No. S LZ Street Name: L' oTi ou~1 ~- ~ ~ Street Type:
P.O. Box City: 1~ ~Z y < < ~`e-
Please provide the address for receiving Annual Billing Invoices:
La
State: ~~ Zip code: ~ ~~ Z4S
Company:~C,? v ~ ~ c~ - ~ ~ c~ ~1-+-' c~ Deparhnent: ~c.ou ~S -Sao-y,n,~ ~.L
Name: ~ ~ ~. v~ ~ ~"~- ~ 1 ~ N~e.,J
Street No. S l2 Street Name: CoaTo .J Cs-~.'+~ Street Type: (.- N
P.a Box city: ~Ce~-e ~: ~ l.-~
State: 1C Zip code: -l ~ o Z
Industrial Administrative Report, TNRCC-10411 (Revised 3/02) Page 7
7. SIGNATURE PAGE (Instructions, Page 18)
Typed or printed name Title
certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for known violations.
~~
Signature: ~ ~> ~~~--%~"'~~ / Date: ~ '7'~
-~ ,Ji
~~,
Subscribed and Sworn to before me by the said ~~ ~c..~~.C~.'c-~.C~/.1.~ on this
(~ day ~ 20 Q
My commission expires on the ~_~ day of 20 C~_~
~~~ ' Ce~:sCe~/
Notary Public
~y~:~?/
County, Texas
[SEALJ
~~'~ P.' ~•. SHERRiE STADlER
;~. `~,:.
*: *= MY COiv1h11SSlON EXPIRES
;~;,~;;~ June 5, 2005
NOTE: If co-permittees are necessary, both entities must submit separate Signature Pages.
Industrial Administrative Report, 71dRCC-10411 (Revised 3102) Page 8
Equitech-Bio Inc.
512 Cotton Gin Lane
Kerrville, Texas 78028
Tel: 830-257-0005
Fax: 830-257-0006
E-mail: info(u?ecluitech-bio.com
November 15,2004
To Whom it may concern,
This letter authorizes Mr. Michael Hensley, Facilities Manager, to sign for
Equitech-Bio Inc in the matter of Equitech-Bio's 2004 Application for Renewal of
permit
#WQ0004237000, related to the disposal of our waste water.
Richard S. Phillips, Vice President
~s~o ~p
Equ tech-Bio Inc.
TNRCC USE ONLY:
Application type: _
County:
Agency Receiving SPIF:
Renewal Major Amendment _
Admin Complete Date:
_ Texas Historical Commission
Texas Parks and Wildlife
Minor Amendment New
U.S. Fish and Wildlife
Army Corps of Engineers
8. SUPPLEMENTAL PERMIT INFORMATION FORM (SPIF) (Instructions, Page 18)
This form applies to TPDES ermit applications only. The SPIF must be completed as a separate document. The
TNRCC will mail a copy of the SPIF to each agency as required by the TNRCC agreement with EPA. If any of the
items are not completely addressed and/or further information is needed, you will be contacted to provide the
information before the permit is issued. Each item must be completely addressed. DO NOT REFER TO A
RESPONSE OFANYTI'EMINTHEPERMTTAPPLICATIONFORM. Eachattachmentmustbeprovidedwiththis
form, separately from the administrative report of the application. The application will not be declared
administratively complete without this form being completed in its entirety including all attachments
The following applies to all applications:
1. Permittee: ,~g, ~ i rcc~ - ~ ~`o I ..L ~ L
2. Permit No_ O ~{ ~L ~j ~- (NPDES Permit No./EPA ID No.)
3. Address of the project (location description that includes street/highway, city/vicinity, county:
~ l Z C~ >T~ Gr a r,.N. , k~c~+zy:~ lC..~.~ ~,~-~-_-~ Te~.r~
4. Provide the name, address, telephone and fax number of an individual who can be contacted to answer specific
questions about the property: I
Name: '~'~~ ~ ~E ~ ~ - ~-{ Er`t S~ t~ Telephone number:~~ 3 d~ 2. S""l. - Oo o S-
Company: ~Q ~ ~ Tc~G. l3: o i ~.- dJL . Fax number: ~'~ 3 ~~ ZS Z - o o O S'
Street No. ~i (Z- Street name: ~' o'CroV~1 C~-~ ~ Street type:
(,.-~1
City: ~ezy ~ ~ ~-t- State: ~~ Zip code:
-Z So Z~6
5. List the county in which the facility is located: ~2- ~Z..
6. If the property is publicly owned and the owner is different than the permittee/applicant, please identify the owner
of the property: ~~
Industrial Administrative Report, TNRCC-10411 (Revised 3!021 Page 9
7. Identify the name ofthe water body (receiving waters) or TNRCC segment number that will receive the discharge:

8. Please provide a separate 7.5 minute USGS quadrangle map with the project boundaries plotted and a general
location map showing the project area. (This map is required in addition to the map in the administrative report)
9. Please provide original photographs of any structures 50 years or older on the property.
10. Does your project involve any of the following? If yes, circle the appropriate letter.
a. Proposed access roads, utility lines, construction easements
b. Visual effects that could damage or detract from a historic property's integrity
c. Vibration effects during construction, or as a result of project design
d. Additional phases of development that are planned for the future
e. Sealing caves, fractures, sinkholes, other karst features
f. Disturbance of vegetation or wetlands
11. List proposed construction impact (surface acres to be impacted, depth of excavation, sealing of caves or other
karst features): U
12. Describe existing disturbances, vegetation & land use: W
The following applies only to applications for New TPDES permits and Major Amendments to TPDES Permits
13. List construction dates of any buildings or structures on the property: r i,,,.t.~~e.~eos-e..
Prt~Dt~ 7.©O Z , u a t~-~1? ~Tl O w7 A.~ u-s r+-5'CG C', e.~•t e.~Rr~2.D
u
14. Provide a brief history of the property, and name of the architect/builder, if known:
tu-~
W ~-
~G
s~
s ~c L~Z.w a~s
w csc N ~e~
A ~{-
~p
v p e y ~QzA~ ~ ~~ 1~~~ 1--u
~a ~a.l (o,~ r p~~ vcs~c~~~ as o->z~~ N +~-( pe,z
j.~j ~ : c~
R~tq~v e-S~ C ra ~ ~-~~T fL ~~ ~ -~ ~-~ luJ( C"ji.5c.l..~~.l~G /~~-t' V-+~~
s~v~t-e.~+p.~p -~'oe ~-aev~,4( ~~~~~C.~a.i ion 1~~~ C~e.~S~u4~
tzc~~a ~.~sr~l(~p
E'a-Tf ~-~ S ~g-c-:emu-~ _
Administrative Report, TNRCC-10411 (Revised 3/02) Page 10
ADMINISTRATIVE REPORT 1.1-INDUSTRIAL
THE FOLLOWING IS REQUIRED FOR NEW AND MAJOR AMENDMENT APPLICATIONS
1. AFFECTED LANDOWNER INFORMATION (Instructions, Pages 19-20)
a. Indicate by a check mark that the landowners map or drawing, with scale, includes the following, as applicable.
T'he applicant's property boundaries
'/~ The plant site boundaries within the applicant's property boundaries
/ The property boundaries of all landowners surrounding the applicant's property
The point(s) of discharge and highlighted discharge route clearly shown for one mile downstream OR if the point
of discharge is into a lake, bay estuary or effected by tidal, delineate the approximate properly boundaries of the
landowners along the watercourse '/Z mile in all directions of the outfall(s).
The boundaries of the effluent disposal site, all evaporation/holding ponds within the applicant's property
/ The properly boundaries of all landowners surrounding the property boundaries where the effluent disposal site
is located
The boundaries ofthe sludge use/disposaUincinerationsfte and the property boundaries oflandowners surrounding
the applicant's property boundaries where the sewage sludge beneficial site is located
The property boundaries of landowners within'/2 mile in all directions from the applicant's property boundaries
where the sewage sludge disposal site and/or incineration site are located
b. Indicate by a check mark which format the landowners list is submitted: /Disk d~ 4 sets of labels in the required
format
c. Indicate by a check mark that the list of landowners is cross-referenced to the landowners map: ~
Provide the source ofthe landowners' names and mailing addresses: ke~tz. ~oy,~rn~ p~e~;gp.( 'p~~;~
d. As required by Texas Water Code 5.115, is any permanent school fund land affected by this application?
Yes ./ No
If yes, provide the location and foreseeable impacts and effects this application has on the land(s):
2. ORIGINAL PHOTOGRAPHS (Instructions, Page 21)
Provide original ground Ievel photographs. Indicate by checking that the following information is provided:
At least one original photograph of the new and/or expanded treatment unit location.
At least one original photograph showing the proposed/existing point of discharge and as much area downstream
as can be captured on film. If the discharge is to an open waterbody, show as much area on both sides of the point
of discharge as can be captured on film.
At least one photograph of the existing/proposed effluent disposal site.
Administrative Repprt, TIdRCC-10411 (Revised 3102) Page 11

TECHNICAL REPORT 1.Q -INDUSTRIAL
TIIE FOLLOWING IS REQUIRED FOR ALL APPLICATIONS, RENEWAL, NE W, AND AMENDMENT
1. FACILITY/SITE INFORMATION (Instructions, page 22)
a. Describe the type of activity and general nature of your business.
~gvit"F~G-(.~.-~O~uG. ~5~. ~v~~ifZo~s4nk`~(SctzJd~$A•~'~Sez~wt P-ACR•O~~°E-CaaTiS
Dec~~veo E~ w6~o(c. a.,sc~,.~,11bCpcD -(-Cw.T:scotlecr~'a~F~o~voNOa.lnte~ e.sceyr~~s
Se ene.~-re:Q ~n~•t ~(~.c. b taop b~' ~ Cozc~~ t~-fl b lr~o n ce.f CS (~F. •IC.s3~~~ c.c~it'Q.t Fuj ~ ~,,g -kt.,e.. l(ectt
5{,~UyK~e..1p '~Cw9AL~~-1 S'~GC~il~c..-C~~'~ctzilJG ~ S~TLU V.1 ~o ~'WC_. C ~JgT~YsI~Q~, S ~Gi~l TIO~LIs
r'gvete t?i~o~Z,,~ `P'°'ek-~~S s2~e~1 S4:p ~¢ozen~ ~-lt~v~~L.~~ U. ~. ar~.,e Yk~Orce p
b. SIC Code(s) Z ~ ~ , ~ ,
c. Describe the wastewater generating processes.
W~ S.~LMRATe. A.wL-~~ g.e~v~ -~SZaw~ u~(,.o~2 ~~,oc~~ ~K ~oRa~iY~e( a. ~~a't' o-E '~. ~
~; G~~.5 S G.~v wl ~ s '!?~-w ~.1 ~•..~~ ~ s ce-~TK~ Fc1 ~j 61~ ~'< <-~e.e~~ <s N a ~ oit ~-e..D ~ *~ ~tZ~ t~e..
(alsctc_ ~-crlsg~ R.C., ,~izc. -Ea~~-~ -~a 't~,~, L~4NV'~:1~ weed-~~ T4.~ RC..B -(-L-a-t-
i rJ ups A-S ~, v-3 ~-T2-~. ~'.CZe.Sv (-~ a -~ 'DES ~ P ~l~ ~~2.-C~ i ~.1 Geu]-~z ~ ~ c.~ 2~© -E
A~S~~Nu~~, C.C~ess ~~.N , oozs`)° o ~-E-1,~.~. aQ~ ~iNn~.(J,o (~~..c~ o ~sez~ ~
Due nnS~u w. ~ g ~c.~- ,a-r ~°L ~-~v '~.e~ -~eoae.~S ~ -.~ v sTO Q.C-D ~ N d .1 ~ F
~ ~t-'¢CEZ~Lz ~ .~' C
S. m~.lG ~ oa~T~. ~tZocGSS W,cL-rem l~ ~~ ` ~~~SGb
-~.a~4 ~ .a~a "~, o . s ~sz~w~ ~a~v •E-~,.,c-~ +~~xes w ~-l~ ~D,-~. ~.e.¢~.T® ~ i ~
~5 ~ ~ A.~,°~+y w !aTr~, -ts o ~. 1~~+.~5~ °~j o ~ Q.. ~ L~.c~ ctSS ~ ~, Ass c~ va~-e. .4N D
C~u~~ ++~et~ i hel ~o ec. A-~~ ~~AV~ ~-l.L ~ ~~~,~~~'t~-~rzsc~ ~ ~ ~. ~-~.-~~ w• -~,,2
A av w las~iq u spa ~- fez aot?G-C e.-a--t ,
Y~~
awt~~r~-c s G.a ~ (,~, kx. N~ ~~~~ `~(~.~.1 s'©o ~ ~-~l~.as / na.H _
d. Provide a list of raw materials, major intermediates, and products handled at your facility.
Raw Materials	Intermediate Products	Final Products
A+NiuUI.Pa.~ V9~~,~, ~lsa7	~.G•Z?js	1z~s
Z
~
-"~tK.a~ ~ ~ ~		~i ~'CtQ. Are
/
,
~.~ ~ r4r ~~o		EL
~bV iM.tZJ ~7A~1~
~J~
~++~m ~f i U ~ SU ~~Tt.		l
Lk C ~pU ~~ ~ i~ l~
		
		
		
		
		
iecnmCal Report 1.0, TNRCC-10055 (Revised 12101) Page 1
e. Indicate by a check mark that an attached facility map with the following information was provided with the
application:
Production areas, maintenance areas, materials handling areas, and waste disposal areas.
/ The location of each unit of the wastewater treatment plant including the Iocation of wastewater
collection sumps and impoundments.
Attachment: d~l.~
f. Is this a new permit application for an existing facility? Yes ~ No
If yes, provide background discussion below.
g. I the treatment facility/disposal site located above the 100-year frequency flood level?
Yes No
List source(s) used to determine 100 year frequency flood plain: IM.d'P ~ ~'-t.~:Z ~~4iSti4 ~'L~~Sz~
If no, provide the elevation of the 100-year frequency flood plain and describe what protective measures aze in use
or planned to be used to prevent flooding of the treatment facility/disposal area.
h. For new or amendment permit applications, will there be dischaz a offill material into a water in the state for
construction of the proposed outfall structure? Yes ~No
If no, proceed to Item No. 2. If yes, has the applicant applied for a U.S. Corps of Engineers 404 Dredge and
Fill permit? Yes No
If yes, provide the permit number:
If no, provide the approximate date you anticipate submitting your application to the Corps.
Technical Report 1.0, TNRCC-10055 (Revised 12/01) Page 2
a
v
~~a ,~~naaxl
,§~•o3a~ e
i ia'1
.~,~„~,
an
1
d'a'l 3~s:3 fs_~~ga ±^raF i°~ CCCT
~p3 3uamasl S.[puoaaa Tab Oo01
J
~[avl iaao~varl S.iv~d Tn8 CCC
aa~d'
ana oro~ -use .e
~~

6io'I
9 ~I~ig
.t
o	
x
	o
~,
1	
a	
~.	
*	~
a
i	
	
	
	~
	a
N	
~d	
~	
N	
~~ Z	
oed arl ~ F
~~bs flgQ£
yid ~,jx~og
~i~ rtd'I
~~bs 09
sod 9I x~
Plaid Q

~' ~" ' •r
i~/,~d°
/~ ~
~ ~V
p
~i~
2. TREATMENT SYSTEM (Instructions, page 23)
a. List any physical, chemical, and/or biological treatment process that you use for the treatment of wastewater
at your facility. Include a description of each treatment process starting with initial treatment and finishing with
the discharge point.
~~
b. _~ Indicate by a check mark that an attached flow schematic with a water balance was provided with the
application showing each treatment unit and all sources of wastewater flow into the treatment plant and to each
outfalUpoint of disposal. Attachment: ~ ~
3. IMPOUNDMENTS (Instructions, page 23)
Do you use or plan to use any wastewater lagoons, ponds, or impoundments? Yes / No
If yes, complete item 3(a) for existing impoundments and items 3(a}3(f) for new or proposed impoundments.
If no, proceed to Item No. 4.
a. Provide the following information in the table provided:
Designation: Indicate the appropriate use designation for each pond [Treatment (T'), Disposal (D), Containment
(C), or Evaporation (E)]
Discharge Point: If a discharge occurs from the impoundments, designate the outfall associated with the
impoundment.
Liner Information: Ifthe impoundments are lined to comply with specifications outlined for 1) a compacted clay
liner (C), 2) an in-situ clay liner (n, or 3) a synthetic/plastic/rubber liner (S), indicate the liner type with the
appropriate letter designation (see instructions for further detail on liner specifications). If not, provide a
reference to the attachment that provides a description ofthe alternate liner and any additional technical information
necessary for an evaluation.
Dimensions: Provide the dimensions(s), freeboard, surface area, and storage volume capacity of the
impoundments. For impoundments with irregular shapes, submit surface area (instead of length and width), the
average depth, and the maximum depth below natural ground level.
Technical Report 1.0, TIdRCC-10055 (Revised 12/01) Pag@ 3
Impoundment Information Table
	Pond #	Pond #	Pond #	Pond #	Pond #
Designation	
(T) (D) (C) or (E)					
Discharge Point	
Outfall Number					
Liner Information	
Liner Type (C) (I) or (S)					
Alt. Liner Attachment Reference					
Dimensions	
Length (feet)	ft	ft	ft	ft	ft
Width (feet)	ft	ft	ft	ft	ft
Depth from Water Surface	ft	ft	ft	ft	ft
Depth from Nat. Ground Level	avg _max	avg _max	_avg _max	avg _max	avg max
Freeboard (feet)	ft	ft	ft	ft	ft
Surface Area (acres)	acres	acres	acres	acres	acres
Storage Capacity (gallons)	gal.	gal.	gal.	gal.	gal.
	Pond #	Pond #	Pond #	Pond #	Pond #
Designation	
(T) (D) (C) or (E)					
Discharge Point	
Outfali Number					
Liner Information	
Liner Type (C) (I) or (S)					
Alt. Liner Attachment Reference					
Dimensions	
Length (feet)	ft	ft	ft	ft	ft
Width (feet)	ft	ft	ft	ft	ft
Depth from Water Surface	$	ft	ft	ft	ft
Depth from Nat. Ground Level	_avg max	_avg max	avg max	avg _max	_avg max
Freeboard (feet)	ft	ft	ft	ft	ft
Surface Area (acres)	acres	acres	acres	acres	acres
Storage Capacity (gallons)	gal.	gal.	gal.	gal.	gal.
Technical Report 1.0, TNRCC-10055 (Revised 121011 Page 4
TIIF, FOLLOWING ITEMS ARE REQUIRED ONLY FOR NEW OR PROPOSED IMPOUNDMENTS.
b. Indicate by a check mark if any of the following data was provided with the application:
(1) Synthetic/plastic/rubber liner data
(2) In-situ clay liner data
Attachment:
c. Are there any leak detection systems or ground water monitoring wells in place or planned? Yes /No
Ifyes, indicate by a check mark that a separate attachment was provided with the leak detection system
information for each pond and/or ground water monitoring well data.
Attachment:
d. Is the bottom of the pond above the seasonal high water table in the most shallow water bearing zone?
Yes No
If no, indicate by a check mark that additional information was provided describing the depth of the
seasonal high water table in the most shallow water bearing zone in relation to the depth of the bottom of the
new or proposed impoundment and how this may or may not impact groundwater.
e. Indicate by a check mark that the following information was provided:
A USGS quadrangle map or a color copy of original quality and scale which accurately Iocates and
identifies water supply wells and/or monitor wells within % mile radius of the impoundments.
Copies of State Water Well Reports (driller's logs, completion data), and data on depths to ground
water for water supply wells including a description of how the depths to ground water were obtained.
For TLAP permit applications: '~ Indicate by a check mark that the new or proposed impoundments)
and the land application disposal area are located in the same general area and the information for this item is
provided in Worksheet 3.0 (item 8).
f. Indicate by a check mark if any data was provided with the application pertaining to the ground water,
soils, geology, etc. used to assess the potential for migration of wastes from the impoundments and/or the
potential for contamination of ground water or surface water.
4. OUTFALL/DISPOSAL METHOD INFORMATION (Instructions, page 25)
Complete the following tables to describe the location and wastewater discharge or disposal operations for each
outfall for discharge operations and for each point of disposal for TLAP operations.
For TLAP permit applications: Indicate the disposal method and each individual irrigation area (1), evaporation
pond (E), or subsurface drainage system (S) by providing the appropriate letter designation for the disposal
method followed by a numerical designation for each disposal area (e.g. evaporation pond, application area) in the
space provided for "Outfall" designation (e.g. "E 1" for evaporation pond 1, "I2" for irrigation area No. 2, etc.).
Technical Report 1.0, TNRCC-10055 (Revised 12101) Page 5
©UTFALL:
l ev. t'2 3 ~-~
Latitude	Longitude	Location Description
c.JR2° «.	n4%	~i~~° ~~.	6~7	~treeC~. -i3~~,.iae- ~	c.~Ly~sJ~~1~ir~c
,	.	$'l2. ~~~ C=~ ~	
Permitted Flow MGD
( )	Pro osed Flow GD
P (M )	IGe~z~zisi l({, TIC. -z~zS	
Dly Avg	Dly Max	Dly Avg	Dly Max	Discharge Duration
a{ o~'y	'~°~ r«((a~	'S~ ~l !or)	a-L~or~	~_ (his./day) ~ (days/mo.) ~'_y (mo./year)
~! Pumped _ Gravity	Measurement Device: K rlg. McTztz-	'Intermittent	Seasonal -Continuous
Contributing Wastestreams:		Volume (MGD)		% of Total Flow
e~-c ..s~ a.-r-tee:
~.b. .+~,c~T~e Tac '		~ v		Z~ ~
l
~j i ~~ i /~ s4~vrDG (~L u.s M~^ tern wt		~ ~		Z ~'
~ ,.~ u i wee.~3C eC.es•,.~ ~eer~.		~ Da		~3~
~~ G~~~ t1i c~ ~ w~a-c~ti=		~		1
~
Zc~
~l'L~ ~wAQ2r rj ~'~J fG		20		t~
j
~ Cc
				
				
				
OUTFACE:
Latitude	Longitude	Location Description
						
		
Permitted Flow (MGD)	Proposed Flow (MGD)	
Dly Avg	Dly Max	Dly Avg	Dly Max	Discharge Duration
				(hrs./day) (days/mo.) (mo.tyearj
_ Pumped _ Gravity	Measurement Device:		Intermittent Seasonal Continuous
Contributing Wastestreams:		Volume {MGD)	% of Total Flow
				
				
				
				
				
				
				
				

Technical Report 1.0, TNRCC-10055 (Revised 12101) Page 6
OUTFACE:
Latitude	Longitude	Location Description
						
		
Permitted Flow (MGD)	Proposed Flow (MGD)	
Dly Avg	Dly Max	Diy Avg	Dly Max	Discharge Duration
				(hrs./day) (days/mo.) (mo./year)
_ Pumped _ Gravity	Measurement Device:		Intermittent Seasonal Continuous
Contributing Wastestreams:		Volume (MGD)	% of Total Flow
				
				
				
				
				
				
				
				
OUTFACE:
Latitude	Longitude	Location Description
						
		
Permitted Flow (MGD)	Proposed Flow (MGD)	
Dly Avg	Dly Max	Dly Avg	Dly Max	Discharge Duration
				(hrsJday) (days/mo.) (mo./year)
Pumped _ Gravity	Measurement Device:		Intermittent Seasonal Continuous
Contributing Wastestreams:		Volume (MGD)	% of Total Flow
				
				
				
				
				
				
				
				
Technical Report 1.0, TNRCC-10055 (Revised 12101) Page 7
S. BLOWDOWN AND ONCE-THROUGH COOLING WATER DISCHARGES (Instructions, page 26)
a. Does your facility use any cooling towers or boilers that discharge blowdown or other wastestreams to the
outfall(s)? _Yes ,+/ No
b. Does your facility discharge once-through cooling water to the outfall(s)? Yes +/ No
c. If yes to either item a or b, indicate with a check mark that the appropriate MSDS with the following
information for each chemical additive was submitted with the application.
Manufacturers Product Identification Number.
Product use. (e.g., biocide, fungicide, corrosion inhibitor, etc.)
Chemical Composition including Chemical Abstracts System (CAS) number for each ingredient.
Classify product as non-persistent, persistent, or bioaccumulative.
Product or active ingredient half-life. '
Frequency of product use (e.g., 2 hr/day once every two weeks).
Product toxicity data specific to fish and aquatic invertebrate organisms.
Concentration of whole product in wastestream (if above item is for whole product)
Concentration of active ingredient in wastestream (if above item is for active ingredient)
Please provide a summary of this information in addition to the submittal of the MSDS for each specific
wastestream and the associated chemical additives and specify which outfalls are affected.
Attachment•
d. Cooling Towers and Boilers
	Number of Units	Daily Avg_ Blowdown	Daily Maa Blowdown
Cooling Towers	cooling towers	Daily Avg: gallons/day	Daily Max: gallons/day
Boilers	boilers	Daily Avg: gallons/day	Daily Max: gallons/day
6. STORM WATER MANAGEMENT (Instructions, page: 26)
Are there any existing or proposed outfalls which discharge storm water runoff commingled with other
wastestreams? Yes ''~ No. If yes, provide the following information. If no, proceed to Item No. 7.
a. Provide a brief narrative description of the industrial processes and activities that occur outdoors or in some
manner that may result in exposure of the materials to precipitation or runoffin areas where runoff is generated.
Technical Report 1.0, TNRCC-10055 (Revised 12!01) hags $
7. DOMESTIC SEWAGE, SEWAGE SLUDGE, AND/OR 5EPTAGE MANAGEMENT AND DISPOSAL
(Instructions, page 27}
a. Please check the appropriate method(s) of domestic sewage and domestic sewage sludgetreatment/disposal and
complete Attachment F if directed.
Domestic sewage is not generated on-site. PROCEED TO ITEM N0.8.
Both domestic and industrial treatment sludge ARE commingled prior to use or disposal. PROCEED TO
ITEM N0.8.
Industrial wastewater and domestic sewage are treated separately and the respective sludge IS NOT
commingled prior to sludge use or disposal. COMPLETE WORKSHEET 5.0 OF THIS
APPLICATION.
If your facility is a POTW, COMPLETE WORKSHEET 5.0 OF THIS APPLICATION.
Facility is connected to a wastewater treatment plant permitted to receive domestic sewage, or the domestic
sewage is transported off-site to a permitted facility for treatment and/or disposal. COMPLETE ITEM
NO. 7.B.
`~ Domestic sewage is disposed of by an on-site septic tank. COMPLETE ITEM 7.B.
Other. Please provide a detailed description below.
b. Provide the name and TNRCC, NPDES, and/or TPDES Permit No. ofthe waste disposal facility which receives
the domestic sewage/septage. If hauled by motorized vehicle, provide the name and TNRCC Registration No.
of the hauler.
P
la
nt/Hauler Name	Permit/Registration No.
,,
((
C~.¢.2~(4~ •L est..	GE ~ (fib
~ zZ -c~t,~e,~.~. ~ sr. «~.e ~~ ~C~ -c- . z~	.
8. IMPROVEMENTS OR COMPLIANCE/ENFORCEMENT REQUIREMENTS (Instructions, page 27)
Is the permittee currently required to meet any implementation schedule for compliance or enforcement?
Yes ~ No
If yes, provide a brief summary of the requirements and a status update.
Technical Report 1.0, TNRCC-10055 (Revised 12/01) Page 9
5~. TOXICITY TESTING (Instructions, page 27)
Have any biological tests for acute or chronic toxicity been made on any of your discharges or on a receiving water
in relation to your discharge within the last three (3) years?
Yes `/ No
If yes, identify the tests and describe their purposes below. PIease attach a copy of aII tests performed that have
not been previously sent to the TNRCC and/or EPA.
10. OFF-SITE/THIRD PARTY WASTES (Instructions, page 28)
Do you receive wastes from off-site sources for treatment in your facility, disposal on-site via land application,
and/or discharge via a permitted outfall? Yes `~ No
If no, proceed to Item No. 11. If yes, proceed as directed.
a. Indicate with a check mark that a detailed attachment with the following information was provided with the
application: Attachment:
List of wastes received
Characterization of wastes received
Volumes of each waste received
Info. on compatibility with on-site wastes
Identified sources of wastes received
Name and addresses of generators
Description of the relationship of waste
source(s) with your facility's activities.
b. Is wastewater from a TNRCC, NPDES, and/or TPDES permitted facility commingled with your wastewater
afteryour final treatment andpriorto discharge viayour final outfall/point of disposal?~_ Yes ~_ No
If yes, provide the name, address, and TNRCC, NPDES, and/or TPDES permit number of the contributing facility
and a copy of any agreements and/or contracts relating to this activity.
c. Is your facility a Publicly Owned Treatment Works (POTW) that accepts process wastewater from any
Significant Industrial User (SIU) and has or is required to have an approved pretreatment program under the
NPDES/'TPDES program? Yes `~No If yes, complete Worksheet 6.0 of this application.
11. RADIOACTIVE MATERIALS (Instructions, page 28)
Are radioactive materials mined, used, stored, or processed at this facility? Yes ~ No
Ifyes, Provide a list ofthe materials and the results of one analysis ofyour effluent in picocuries per liter (pCi/L)
for all radioactive parameters which may be present.
I Radioactive Materials I Conc. (pCi/L)
Technical Report 1.0, TNRCC-10055 (Revised 12/01) Page 10
THE FOLLOWING ITEMS ARE ONLY REQUIRED FOR EXISTING PERMITTED FACILITIES
12. MAJOR AMENDMENT REQUESTS (Instructions, page 28)
Are you requesting a maj or amendment of an existing permit? / Yes No
If yes, list each specific request and provide discussion on the scope of any requested permit changes.
(~vC~ ~e~veg~ is ~o i-~c~eise. lsPq .~czow~ "3ab 'f'o scp Cz'Ptj~.4~avtrez~,ve+~l
3~7450~{2 w,~ ~~tua¢ lisz~o ~ r.~ o>/~~i~ta( ~Pp(~cd+T~,J~`C-o~uY C~ewsl~+a••aSt~r'«
Dcsrgr~ i a~9iu~-tEp -4-d w~a ~ar -~-("e-~ w as a. r~up {-o ~t~.~~... s~~.~ ope~a°rt'oe
V1.~~ -~o TNTI,LG. ~~J~ItL~ ~-v ,e.~iu ~ jJ>~Dc~Ti o~ gc.(~.A~(e-! ~T ~.'S ~-t'wt~JL~p,
©~~~ 3p ~o ~~2 lna.l~ ~e~~ Go~-p Ce~d~- ~~v ,~.~-1 'P¢o~.~j s (,~~.,r~,~ ,~ ~e
~-~.G ~piTlo>JA~~ 3~-1~b~E'-~Z 5~~ svie~ ~tz.~.iu~ie~ ~Q. ~d,,.~~C~zc~ ~t.,~D
zc~~ae-v, ~ v ~ - -~.~ s=. ~ ~ -~ e.~,.,~~ w ~s w ~' -~ ~lo~ e.c ~-~zo ~~ .
(,~.~ sysr~ ~J-~1G-R'pU.~S we.l~, F4• -.~a -~olr~~ ~ ruo ooo~ ~ beQ.~~va
q~~S utou.~er~ ~- uv Rakep w e.e. (~ ~ ~ . go~lc -~.: w~c~ ,,,, Ias v ~~ecoN ns.~x.y
~elk[M4u,7r -~+W ~S t~~~ -pJ e~'12tb Eve.tZa.` ~o W.o ~~ ~t,l C~.l.l2'~2C~ ~ S~L'i~
~vmg. ~RC~tt(.e. ,Ti~-
If necessary, provide supplemental information or additional data that will support the request.
13. MINOR MODIFICATION REQUESTS (Instructions, page 29)
Are you requesting any minor modifications to the permit? Yes `~ No Note: seethe instructions for an
exclusive list of changes considered as minor modifications.
If yes, list and discuss the requested changes.
14. MINOR AMENDMENT REQUESTS (Instructions, page 29)
Are you requesting any minor amendments to the permit? Yes / No
If yes, list and discuss the requested changes.
Technical Report 1.0, TMRCC-10055 (Revised 12/01) Page 11
WORKSHEETS
TO THE INDUSTRIAL WASTEWATER PERMIT APPLICATION TECHNICAL REPORT
Please review the worksheet requirements in the instructions and indicate by checking either yes or no which
worksheets are required, completed, and submitted with the technical report. Worksheets that are not applicable
do not need to be submitted with the technical report.
WORKSHEET	COMPLETED AND SUBMITTED
WITH THE TECHNICAL REPORT:
	YES	NO
1.0: EPA EFFLUENT CATEGORICAL GUIDELINES	~'	
2.0: POLLUTANT ANALYSES REQUIREMENTS		
3.0: LAND DISPOSAL OF EFFLUENT	~/	
4.0: RECEIVING WATERS		L/~
4.1: STREAM PHYSICAL CHARACTERISTICS WORKSHEET		~~
5.0: SEWAGE SLUDGE MANAGEMENT AND DISPOSAL		
6.0: INDUSTRIAL WASTE CONTRIBUTION		:./
7.0: STORM WATER RUNOFF		t/'
8.0: AQUACULTURE (Reserved)	N/A	N/A
9.0: CLASS V INJECTION WELL		t/
Technica9 Report 1A, TNRCC-1x055 (Revised 1zro1D Page 12
WORKSHEET 1.0 -EPA EFFLUENT CATEGORICAL GUIDELINES
REQUIRED FORALL APPLICATIONS FORTPDES PERMITS FORDISCHARGES OF WASTEWATERS
SUBJECT TO EPA EFFLUENT LIMITATION GUIDELINES.
1. CATEGORICAL INDUSTRIES (Instructions, page 31)
Is your facility subject to any of the 40 CFR effluent guidelines outlined in Table 1? Yes / No
If yes, provide the appropriate information in the table below. If no, this worksheet is not required.
Industry CFR
2. PRODUCTION/PROCESS DATA (Instructions, page 32)
a. Production data: Provide the appropriate data for effluent guidelines with production based effluent limitations.
Subcategory ~ Actual Quantity/Day ~ Design QuantitylDay ~ -Units
b. Organic Chemicals, Plastics, and Synthetic Fibers Manufacturing Data (40 CFR Part 414): Provide
each appropriate subpart and the percent of total production. Also provide the appropriate data for metal
bearing wastestreams as required in 40 CFR Part 414, Appendices A and B.
Subcategory % of total Appendiz A and B
production
Metal Process
Worksheet 1.0, TNRCC-10055 (Revised 12101) Page 1-1
c. Refineries (40 CFR Part 419): Provide the applicable subcategory and a brief justification for each.
3. PROCESS/NON-PROCESS WASTEWATER FLOWS: Provide a breakdown of process wastewater
flow(s) and non-process wastewater flow(s) as directed. (Instructions, page 32)
4. NEW SOURCE DETERMINATION: Provide a list of wastewater generating processes subj ect to effluent
guidelines and the appropriate information. (Instructions, page 32)
Process EPA Guideline Date Process/Construction
Commenced
Part Subpart
Worksheet 1.0,'~NRCC-10055 (Revised 12!01) Page 1-2
WORKSHEET 3.0 -LAND DISPOSAL OF EFFLUENT
REQUIRED FOR ALL RENEWAL, AMENDMENT, AND NEW APPLICATIONS FOR A PERMIT TO
DISPOSE OF WASTEWATER BY LAND DISPOSAL.
1. TYPE OF DISPOSAL SYSTEM (Instructions, Page 42)
Irrigation Subsurface Application
~_ Evaporation V Subsurface soils absorption
Evapotranspiration beds Surface Application
Other (describe below in detail)
FOR ITEMS 2-6, COMPLETE THE ITEM FOR THE APPLICABLE METHOD OF DISPOSAL
2. IRRIGATION (Instructions, Page 42)
a. Land application area:
Effluent Application
in GPD	Irrigation Acreage
in Acres	Describe land use & indicate type(s) of crop(s)	Public
Access Y/N
			
			
			
b. Irrigation Information:
Area under irrigation:	acres	Design application rate:	acre-feet/acre/year
Design application frequency:	hours/day	Design Total Nitrogen	
	days week	loading rate:	ibs N/acre/day
Land grade: average:	percent (%)	Irrigation efficiency:	percent (%)
maximum:	percent (%)	Effluent Conductivity:	mmhos/cm
Method of Application:			
Indicate by a check mark that a detailed attachment is provided with the application including an engineering
report with water balance and storage volume calculations and nitrogen balance. Attachment:
c. Annual cropping plan:
Provide the required cropping plan. Indicate by a check mark that each of the following is provided.
Types of crops
Crop growing season
Harvesting method/number of harvests
Crop yield goals
Break down of acreage and percent of total
acreage for each crop.
Nitrogen loading requirements per crop.
Additional fertilizer requirements
Supplemental watering requirements
Crop salt tolerances
Worksheet 3.0, TNRCC-10055 (Revised 12101) Page 3-1
3. EVAPORATION PONDS (Instructions, Page 43)
Daily average effluent flow into ponds: gallons per day
Indicate by a check mark that a separate engineering report with water balance and storage. volume
calculations was provided with the application.
4. EVAPOTRANSPIRATION BEDS (Instructions, Page 43)
Number of beds:
Area of bed(s): acres
Depth of bed(s): feet
Void ratio of soil in the beds:
Storage volume within the beds:
Indicate by a check mark that a separate engineering report with water balance and storage volume
calculations, and description of the lining was provided with the application.
5. SUBSURFACE APPLICATION (Instructions, Page 43): Check the type of system:
Conventional Drainf~eld, Beds, or Trenches
Graveless Pipe
~-Pressure Dosing
Mound System
Drip/Trickle Irrigation
Other
Application area:
Application rate:
Area of trench:
Number of beds:
Infiltration Rate:
Area of bed(s):
Soil Classification:
2
6, ~/~~ acres
1 O gaUsquaze feet/day
foL4 b F'~ square feet
inches/hour
square feet
~'
Area of drainfield:
Depth to groundwater:
Dosing duration per azea:
Dosing amount per area:
Storage volume:
~,sYo~ square feet
feet
K hours
inches/day
'3,a~ gallons
Indicate by a check mark that a sepazate engineering report with all necessary information and a description
of the schedule of dosing basin rotation was provided with the application.
Indicate by a check mazk that the Class V Injection Well Inventory/Authorization Form (Worksheet 9.0)
for this type of disposal system has been submitted to the TNRCC Waste Permits Section as directed.
6. OVERLAND. FLOW (Instr
Area used for application:
Slopes for application area:
Design application rate:
Slope length:
Design BODS Loading rate:
Design application frequency:
fictions, Page 43)
acres
percent (%)
gpm/foot of slope width
feet
lbs BODS/acre/day
hours/day and days/week
Indicate by a check mark that the necessary information is provided Provide a separate engineering report
with the method of application and design requirements according to 30 TAC Section 317.10.
Worksheet 3.0, TNRCC-10055 (Revised 121011 Page 3-2
?. STORM WATER MANAGEMENT (Instructions, Page 43)
a. Is storm water runoff a component of the effluent disposed of via land application? Yes '~ No
b. If yes, Provide the following information:
Disposal Area Contributing Primary Soil Cover Type (i.e. pasture, row crop land, concrete
Area Runoff (acres) Type slab, etc.)
c. If no, Provide a description of tailwater controls and storm water runon controls used for the disposal area.
8. WELL AND MAP INFORMATION (Instructions, Page 44)
Indicate by a check mark that the following information is shown and labeled on the USGS map:
The boundaries of the Land application site(s) / Effluent storage and tailwater control facilities
On-site buildings ~/ Buffer zones
_~ Waste disposal or treatment facilities
All water wells within 'h mile radius of the disposal site or property boundaries
Do you plan to install ground water monitoring wells or lysirneters around the land application site?
Yes No
4. SOIL MAP AND SOIL INFORMATION (Instructions, Page 44)
Indicate by a check mark that the following information was provided:
USDA Soil Survey map that indicates the area to be used for effluent disposal with the locations
identified by fields and crops.
Break down of acreage and percent of total acreage for each soil type.
Results from soil analyses.
For each texture class in the disposal site, the engineering properties (No. 200 sieve, liquid limit, plasticity)
must be submitted.
10. EDWARDS AQUIFER RECHARGE AREA (Instructions, Page 45)
Is the facility subject to 30 TAC Chapter 213, Edwards Aquifer Rules? Yes `~ No
If yes, indicate by a check mark that a report concerning the recharge area was provided with the
application.
Worksheet 3.0, TNRCC-10055 (Revised 12/01) Page 3-3
11. EFFLUENT MONITORING DATA (Instructions, Page 45)	
Date Daily Avg. BOD TS5 Nitrogen Conductivity Tota acres Hydraulic
(mo/yr) Flow (GPD) (mg/L) (mg/L) (mg/L) (mmhos/cm) i
i
	rr
gated Application rate
~~'
~ O Z
~
'	s(.~'a. - (acre-feet/month)
~~9 S
3 ~
3 `d
/ 7, 7 / ~ 7	3r~-~~,
'	
9 o Z 3-z9o 3 g7 2~ z 3
~. 9	~ ~5-
!o oZ .Z67.7~ (S~a Lam- "~lO -?, ~	f ~'S'
/iaz ~3.s5~ -
o, 0 2 -rya	
____
	
~1n3	
	
~ 03 --- '-- ~-	
7-	
s 43 - -	
G o3 - .- .~	
0.3 - - .-	
S D3 -- --- - ~ ~~-	_
9.0,3 -	
/0/03 r- _
-	
---
// 03 - -.-
_ `.	
tz o3 - aµs~4-os~; ~. •~
=~ u
J
two	s~ .4-
-
,
e~
o ~ -- -- ~ ~ ~	Pal L .
---~
1
z o~ 2(0-x" c 5
~4~v <~. c~a '1.3 Z	3 7
~/°~ g( -~ ~ gi 7
/ ~Z ~.3~	
465-
~ o~ g~ ~ ~~ l`f~ G l.o 't, ~ ~	!~a
	
Provide a discussion of all persistent excursion fo pernutted parameters and corrective actions taken.
~.~~. 20 ~~ .:L- c~ v~sT-i bel~-t-c mN Z~aZ fS 4~ ~ A. i~ ~ e~5 eD	~s~rti~v ~ N S Z-, ~+,.
1Z
e~o~zt,~56- G PQ o ~ ~% ~~ ~c erJT-~ (n ~-J e- -4-.9, fie n~ a oiz.~eCT r' v ~ a4 c-
r
r'~ n~ g ,
.t
I~~7)~2~-r`7(ilJ~ 6'"[T~L~'~'~cz''/beta-~ ~ nr4`C//7~~~.~.c.V ~ oi.1 SU~w~
~~ ~ ~LIZ~-OlLµn o4. ~GC, ®Ue.
17~SG p.1LTC ~ QG ~-l~ V~ ~~~~~`f	1
t
~c~ wa.p ~ o loc rN.11r/A,~'['ie~~
D C D e~ .~ D t~ ~~ ~
~
get-ete-~ -~M,uGjn ~o e~ p~-~e~ Da(o (~ ~~,(~~B	
Worksheet 3.0, TMfdCC-10055 (Revised 12/01)
Page 3-4
12. POLLUTANT ANALYSIS: Complete table required for all permit applications for the authorization of
land application of effluent. (Instructions, Page 45)
~.u~~~weets.u, enrccC-10055 (Reeised 12/01)
Page 3-5
WORKSIIEET 5.0 -SEWAGE SLUDGE MANAGEMENT AND DISPOSAL
THE FOLLOWING IS REQUIRED FOR ALL TPDES PERMIT APPLICATIONS THAT MEET THE
CONDITIONS AS OUTLINED IN TECHNICAL REPORT 1.0, ITEM N0.7.
SEWAGE SLUDGE SOLIDS MANAGEMENT PLAN (Instructions, Page 50)
a. Is this a new permit application or an amendment permit application? !/ Yes No
b. Does the facility discharge in the Lake Houston watershed? Yes ~ No
If yes to either item a or b, indicate by a check mark that a solids management plan was provided with the
application.
2. SEWAGE SLUDGE MANAGEMENT AND DISPOSAL (Instruction, Page 50)
a. Please check the current sludge disposal method(s). More than one method can be checked.
Permitted landfill Marketing and distribution by the permittee
Registered land application site Composted by the permittee
Surface disposal site (sludge monofill)
'~ Transported to another WWTP (written statement or contractual agreement required)
Beneficial land application as authorized in the existing permit
b. Disposal site name, TNRCC Permit/Registration Number and County where disposal site is located:
IGcrzlz Ga vuy ~'~-1 Te~/~~ trs w i ~7~" 1 o s ~ ~ o ~
c. Me od of Transportation (truck, train, pipe, other) and hauler Registration Number:
a Le.~ C~,.~c-~~.. S~ 'CGr~~ 2oc~ss
Transported in; ci li uid
q semi-liquid semi-solid solid state
Land application for : Reclamation .. Soil Conditioning
d. If the existing permit contains authorization for sludge land application, composting, marketing and
distribution of sludge, and/or sludge lagoons and authorization to renew the activity is being sought in the
application, the appropriate sections of the Slud a Technical Re ort must be provided.
3. PERMIT ATTI'HORIZATION FOR SEWAGE SLUDGE DISPOSAL (Instructions, Page 51)
Are you requesting new authorization to beneficially land apply sewage sludge at this site or a site under your direct
control? Yes '~ No
Are you requesting new authorization to market and distribute sewage sludge at this facility or a facility under your
direct control? Yes `~ No
Are you requesting new authorization to compost sewage sludge? Yes v No
Are you requesting new authorization to surface dispose sewage sludge at this site or site under your direct control?
Yes ~ No
Are you requesting new authorization to incinerate sewage sludge at this site or site under your direct control?
Yes _ ,/ No
If yes to any of the above items, provide the information required in the SLUDGE TECHNICAL REPORT
New authorization for beneficial land application, incineration, and sludge lagoons in the TPDES or TLAP permits
re uires a major amendment to the permit. New authorization for composting may require a major amendment to the
permit. See the instructions for an explanation whether a major amendment is required or if authorization for
composting can be added through the renewal process.
Worksheet 5.0, TtdRCC-10055 (Revised 12101) Page 5-1