Industrial Stormwater Permitting Questionnaire
Automobile Salvage (Sector M) and
Recycling (Sector N)
The mission of the Arizona Department of Environmental Quality (ADEQ) is to protect and enhance public health and the environment. To fulfill this mission, ADEQ conducts ongoing outreach activities to inform regulated facilities about potential permitting responsibilities and assist them with regulatory compliance. Stormwater discharges associated with industrial activities need coverage under a Clean Water Act permit. Facility operator(s) who do not have an appropriate industrial stormwater discharge permit are subject to potential enforcement actions, including fines and penalties, by ADEQ and /or the United States Environmental Protection Agency (EPA). To assess permitting needs, please complete the following questionnaire and return it to ADEQ within 14 days at the following address:
Arizona Department of Environmental Quality; Stormwater Program
1110 West Washington, 5415A-1; Phoenix, Arizona 85007
Part A. GENERAL INFORMATION
Facility Name ______Owner Name ______
Address ______Owner Address ______
City ______State ___ Zip Code______City ______State ____ Zip Code______
Does this facility currently have stormwater coverage under Arizona Multi-Sector General permit (MSGP) or No Exposure Certification?
Yes Permit Authorization # ______(Skip Parts B-D. Fill out Part E)
No (Please fill out the remaining parts of the survey)
Part B. FACILITY CONTACT INFORMATION
Contact Person ______Affiliation/Title______
Telephone ______E-Mail ______
Part C. STANDARD INDUSTRIAL CLASSIFICATION (SIC)
SIC codes (check all that apply):
M - 5015 - Automobile Salvage Yards:
Activities related to dismantling of used motor vehicles for the purpose of selling parts
Wholesale or retail distribution of used motor vehicle parts
N1 - 5093 - Scrap Recycling and Waste Recycling:
Scrap and waste recycling facilities (non-source separated, Non-liquid recyclable materials) engaged in processing.
Reclaiming, and wholesale distribution of scrap and waste materials such as ferrous and nonferrous metals, paper, plastic, cardboard, glass, and animal hides.
Waste recycling facilities (liquid recyclable materials) engaged in reclaiming and recycling liquid wastes such as used oil, antifreeze, mineral spirits, and industrial solvents.
N2 – 5093 – Source Separated Recycling facilities:
Recycling facilities that only receive source-separated recyclable materials primarily from non-industrial and residential sources (i.e., common consumer products including paper, newspaper, glass, cardboard, plastic containers, aluminum and tin cans); including recycling facilities commonly referred to as material recovery facilities (MRF).
Other:______
Part D. SURVEY FOLLOW-UP DIRECTIONS
If your facility is subject to industrial stormwater permitting, but does not currently have permit coverage, please check the applicable boxes:
Facility Notice of Intent (NOI) is attached
NOI will be submitted on the following date ______
Facility elects not to obtain permit coverage (please be aware, both state and federal rules specify civil and/or criminal fines, penalties, and imprisonment for industrial stormwater discharges without permit coverage)
PART E. CERTIFICATION STATEMENT
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly 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 that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
Printed Name: ______Title ______
Signature ______Date ______
If you have any questions regarding this questionnaire or need additional information, please contact Spencer York, Project Manager, Stormwater and General Permit Unit at (602) 771-4509 or email at .
MSGP Sectors M and N QuestionnairePage 1
November 5, 2014