Fillable 6 NYCRR Parts 364/381 Waste Transporter Permit Application (New York State)

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6 NYCRR Parts 364/381 Waste Transporter Permit Application (New York State)

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Rev:March2020,Ver1
Page1of 6
6 NYCRR Parts 364/381
Waste Transporter Permit Application
New York State Department of Environmental Conservation
Division of Materials Management
625 Broadway, 9
th
Floor
Albany, NY 12233-7251
Applicants for a permit, or for modification of an existing permit must use this application form. Forms are
available on the Department’s website or upon request by calling (518) 402-8792. All applications for new
permits must bear original signatures and must be mailed to the above address. Applications for
modification may be mailed, faxed to (518) 402-9034, or e-mailed to transport@dec.ny.gov. Once authorized,
permits will
be mailed to applicants; permits will not be available for pick-up. DO NOT remit payment with your
application; you will be invoiced separately.
TYPE OF APPLICATION: (check one)
□ New Permit Application (Complete Sections A - F)
Once authorized, a permit number will be assigned.
Have you ever had a Part 364 Permit/Registration?
□ No □ Yes, Permit/Registration Number:
□ Modification Application (Complete Sections A and B, and any changes to Sections C - F).
Application Sections Include the Following:
A
Name and Address
B
Certification
C
Waste Descriptions
D
Receiving Facility Information
E
Vehicle Information
F
Insurance
Note: Any of the sections of the application that are not complete will be indicated, and the entire application may
be returned to the applicant. Such returned application will s
erve as the Department's "Incomplete Notification."
Once
corrected,
the
entire
application
must be returned to the Department.
Permit Number: ____________
Check One: Process Modification Upon Receipt____
Process Effective of Upcoming Renewal Date ____
(If no selection, modification request will be processed Upon Receipt)
Page2of 6
SECTION A – NAME and ADDRESS PERMIT NO.
Business Name
Business Physical Address
City
State/Province Zip Code
County
Phone (____) ______________________ E-Mail _____________________________________________
USEPA ID No.
(required for transporters of hazardous waste/waste oil)
Business Mailing Address (if different)
City
State/Province Zip Code
Address vehicles are stored when not in use
Street
City
__________________________________
State/Province Zip Code
____________
SECTION B – CERTIFICATION
I hereby certify that the information contained in this application submitted in support of obtaining a New York State
Regulated Waste Transporter permit contains no information that I know to be false, incomplete, or to have changed prior to
the date of submission without notification to the Department. I also certify that all employees who are or will be involved in
the transportation and handling of hazardous materials or medical waste have been or will be trained (every three years) in
accordance with the requirements set forth in 49 CFR §172.700 subpart H, and 29 CFR §1910.120 and 1910.200 (conducted
annually) before they handle hazardous materials. I also certify that all insurance
coverages referenced herein comply with
6 NYCRR 364-4.7. I am aware that if I have knowingly omitted or falsified any
information required to be disclosed,
processing of the application may be delayed, and the permit sought herein may be
denied or subsequently revoked. I am
aware that false statement or omissions herein are punishable as a Class A
misdemeanor pursuant to Section 210.45 of the
NYS Penal Law, and that failure to pay all outstanding fees, provide proof of
general liability insurance (hazardous, low
level radioactive and medical waste transporters only), evidence of workers’
compensation insurance or submit an annual
report for the previous calendar year, may delay processing or result in
revocation of the permit. Further, The Permittee
affirms that all transfer, storage, treatment and disposal facilities to which waste will
be/are transported are authorized to
accept the waste(s) identified in this permit. Finally, I agree to indemnify and hold The
People of the State of New York, the
Department, their officials, employees and contractors harmless from any claim or
liability arising directly or indirectly out
of this permit application, and the information contained herein, and any permit
issued pursuant thereto.
Title
(required for new applications only)
Date
Print Name
Date of Birth
Signature
Rev:March2020,Ver1
click to sign
signature
click to edit
Rev:March2020,Ver1
Page3of 6
SECTION C – WASTE DESCRIPTIONS PERMIT NO.
NON-INDUSTRIAL/COMMERCIAL WASTES:
“Residential septage” means the contents of a septic tank, cesspool or other individual sewage treatment facility that receives
domestic sewage wastes. It does not include contents of portable toilets.
“Residential raw sewage or portable toilet waste” means any untreated sanitary waste from residential sources or portable
toilets.
INDUSTRIAL/COMMERCIAL WASTES:
“Non-Residential raw sewage or sewage contaminated waste” means any untreated sanitary waste from an industrial/commercial
source.
“Sewage sludge” or “Biosolids” means the accumulated semi-solids or solids resulting from treatment of waste waters from publicly or
privately owned or operated sewage treatment plants.
“Water treatment plant residuals” means the solids resulting from the treatment of raw water at municipal or private water treatment
plants.
“Grease trap waste (brown grease)” means fats, oils, grease and food residues generated from a food establishment that are
captured in a device meant to prevent these materials from entering the sewer or septic system.
“Yellow grease” means vegetable or animal-based oil generated from cooking or frying foods and is a solid at room temperature (68
degrees Fahrenheit). It may contain food particles and water.
“Waste oil” means used engine lubricating oil and any other oil, including but not limited to, fuel oil, motor oil, gear oil, cutting oil,
transmission fluid, hydraulic fluid, dielectric fluid, oil storage tank residue, animal oil, and vegetable oil, which has been contaminated
by physical or chemical impurities, through use or accident, and has not subsequently been re-refined.
“Petroleum contaminated soil” means soil impacted by gasoline, diesel and used oil, but tests below hazardous waste levels.
“Waste tires” means waste tires transported for a fee for the purpose of reuse, recycling, or disposal, except those tires collected and
transported incidental to the collection and transportation of solid waste.
“Friable asbestos-containing waste” means any waste containing greater than one percent asbestos that can be crumbled,
pulverized, or reduced to powder by hand pressure when dry; and any asbestos-containing waste that is collected in a pollution control
device designed to remove asbestos.
“Low-level radioactive waste” or “LLRW” means radioactive material that is not high-level radioactive waste, transuranic waste, spent
nuclear fuel, or the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily
for its source material content; and any waste the United States Nuclear Regulatory Commission classifies as low-level radioactive
waste.
“Hazardous waste” means solid waste that is a RCRA or NYS hazardous waste as defined in Part 371 of this Title.
“Universal waste” means any of the following hazardous wastes that are subject to the universal waste requirement of 40 CFR
273.2 through 273.5: batteries (§273.2); pesticides (§273.3); mercury-containing equipment (§273.4); and lamps (§273.5).
“Industrial-commercial waste” means a waste which originates at, is generated by, or occurs as a result of any industrial or
commercial activity (e.g., including but not limited to pharmaceutical waste, rendering waste, waste from household hazardous waste
collection events, treated medical waste).
“Oil and Gas Well Drilling Cuttings” means wastes from processes utilizing oil-based/polymer-based mud containing mineral oil
lubricant.
“Oil and Gas Well Completion or Production Wastes” means flowback water, production brine, treatment residues, etc.
“Regulated medical waste” means waste generated in diagnosis, treatment or immunization of humans, or animals, in research
pertaining thereto, or in production and testing of biologicals; provided, however, that regulated medical waste must not include
hazardous waste and household medical waste.
“Infectious substance” or “infectious waste” means a Category A or B material known or reasonably expected to contain a
pathogen (see 6 NYCRR 360.2(b)(146) for more details).
PLEASE TAKE NOTICE that transport of regulated waste not identified on your permit, in a vehicle not listed on your
permit, and/or disposal of regulated waste at an unauthorized facility, or at an authorized facility not listed on your permit is a
violation of the provisions of Environmental Conservation Law (ECL) §27-0305 and regulations promulgated pursuant
thereto. ECL §71-2703 provides that any person who violates any of the provisions of, or who fails to perform any duty
imposed by title 3 of article 27 of this chapter or any rule or regulation promulgated pursuant thereto, or any term or condition
of any certificate of permit issued pursuant thereto, or any final determination or order of the commissioner made pursuant to
this title shall be liable for civil and/or criminal penalties.
Rev:March2020,Ver1
Page4of 6
SECTION D – RECEIVING FACILITY INFORMATION PERMIT NO. ____________
Please use the waste types found in Section C and type or print legibly the disposal facility name, address,
phone number and permit or registration number. For permit renewals or modifications, list only the facilities
y
ou want added or deleted. Attach additional
p
a
g
es if necessar
y
.
Waste Type
Receiving Facility Name,
Address, and Phone
Number
Receiving Facility Permit/
Registration Number
Or
Beneficial Use
Determination (BUD) No.
What should be done
with this facility on the
permit?
□ Add □ Delete
□ Add □ Delete
□ Add □ Delete
□ Add □ Delete
□ Add □ Delete
□ Add □ Delete
**BE SURE ALL WASTE TYPES APPEAR WHEN APPLICATION IS
PRINTED BEFORE SUBMITTING.
Rev:March2020,Ver1
Page5of 6
SECTION E – VEHICLE INFORMATION PERMIT NO.
Please type or print legibly the
license plate number(s) of the vehicles proposed to be used to transport
regulated waste and where registered. For permit renewals or modifications, list only the vehicles you want
added or deleted and check the appropriate box. Attach additional pages if needed.
License Plate # State/Province
What should be done
with this plate on the
permit?
Used for Septage and/or
Re
sidential Raw Sewage or
Portable Toilet Waste only?
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
□ Add □ Delete □ Yes □ No
Note: Fees Required to be Paid Annually for each Transport Vehicle
1.
Residential Septage and Residential Raw Sewage or Portable Toilet Waste - $250 for first vehicle; $100
for each additional vehicle of same waste type.
2.
All Other Regulated Waste - $500 for first vehicle; $200 for each additional vehicle of same waste type.
3.
For questions concerning fees, please contact the Regulatory Fee Unit at 518-402-9343.
Rev:March2020Ver1
Page6of 6
SECTION F – INSURANCE
1. LIABILITY INSURANCE – HAZARDOUS AND MEDICAL WASTE ONLY
Proof of insurance as identified below must be submitted with your application or renewal. Proof of
insurance must be submitted in the form of a certificate of insurance, showing NYS Department of
Environmental Conservation as the certificate holder.
Policy or bond limits shall be:
1. $1,000,000 for the transport of waste oil and/or hazardous wastes not requiring a
Hazardous Waste Manifest.
2. $5,000,000 for the transport of hazardous wastes requiring a Hazardous Waste Manifest
or low-level radioactive wastes in any vehicle which exceeds 10,000 pounds maximum
gross weight.
3. $1,000,000 for the transport of hazardous waste or low-level radioactive waste which
does not exceed 10,000 pounds maximum gross weight.
4. $100,000 for the transport of regulated medical waste.
5. Policies of insurance surety bonds must remain in effect throughout the term of the
permit.
6. Only policies which provide a 35-day notice of intent to cancel by the insurer to the
Department fulfill the requirement.
2. NYS WORKERS’ COMPENSATION INSURANCE – ALL TRANSPORTERS
Proof of insurance as identified below must be submitted with your application or renewal. This
proof of insurance must be submitted in the form of a certificated of insurance, showing NYS
Department of Environmental Conservation as the certificate holder. For additional information
contact the Workers’ Compensation Board at (866)298-7830 or at www.wcb.ny.gov
CE-200 Certificate of Attestation of Exemption; or
C-105.2 or NTSIF U-26.3 Certificate of Workers’ Compensation Insurance; or
SI-12 or GSI-10.52 Certificate of Workers’ Compensation Self Insurance
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6 NYCRR Parts 364381 Waste Transporter Permit Application (New York State)

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Completed 22 September 2021

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