Permit Application Page 24
d. A duly authorized representative of the individual designated in paragraph (a), (b), or (c) of this
section if:
(i) the authorization is made in writing by the individual described in paragraph (a), (b), or (c);
(ii) the authorization specifies either an individual or position having responsibility for the
overall operation of the facility from which the Industrial Discharge originates, such as the
position of plant manager, operator of a well, or well field superintendent, or a position of
equivalent responsibility, or having overall responsibility for environmental matters for the
company; and
(iii) the written authorization is submitted to the City.
e. If an authorization under paragraph (d) of this section is no longer accurate because a different
individual or position has responsibility for the overall operation of the facility, or overall
responsibility for environmental matters for the company, a new authorization satisfying the
requirements of paragraph (d) of this section must be submitted to the City prior to or together
with any reports to be signed by an authorized representative.
5. Provide the name of a person who is thoroughly familiar with the facts reported on this form and who
can be contacted by the Control Authority (e.g., the plant manager).
6. [Note: This question might not be applicable to all pretreatment programs. The following question
is only applicable to those programs implementing this optional streamlining provision.]
Indicate if the facility would like to be considered for regulation under a general permit.
SECTION B – INSTRUCTIONS (BUSINESS OPERATIONS)
1. Check off all operations that occur or will occur at your facility. If you have any questions regarding
how to categorize your business activity, contact the Control Authority for technical guidance.
2. Provide a brief narrative description of all operations at this facility.
3. For all processes found on the premises, indicate the NAICS (North America Industry Classification
System) code which replaces the Standard Industrial Classification (SIC) system. To determine the
NAICS code for a facility see North American Industry Classification System--United States, 2002
which includes definitions for each industry, tables showing correspondence between 2002 NAICS
and 1997 NAICS for codes that changed, and a comprehensive index--features also available on this
web site. To order the 1400-page 2002 Manual, in print, call NTIS at (800) 553-6847 or (703) 605-
6000, or check the NTIS web site. The 1250-page 1997 Manual, showing correspondence between
1997 NAICS and 1987 SIC, is also available. The 2002 and 1997 versions of NAICS are available on
CD-ROMs, which can be ordered at NTIS. See http://www.census.gov/epcd/www/naics.html which
lists NAICS codes and definitions for each industry.
4. List the types of products, giving the common or brand name and the proper or scientific name. Enter
from your records the average and maximum amounts produced daily for each operation for the
previous calendar year, and the estimated total daily production for this calendar year. Be sure to
specify the daily units of production. Attach additional pages as necessary.
5. Provide the facility’s long-term average production value for the past 5 years.