Application for Amendment of Permit to Transportprescribed Industrial Waste

Application for amendment of permit to transportprescribed industrial waste

Environment Protection Act 1970

Form F1008.1April 2018

*This replaces form F1008 issued December 2017

Read Permit to transport prescribed industrial waste (EPA Publication IWRG811)and Vehicle guidance: Non-tanker vehicles/trailers (EPA Publication IWRG814) or Vehicle guidance: Tanker/tanker trailer (EPA Publication IWRG816) before completing this application.

Please email complete application as a PDF or Word document to the Permitting team at

Note: EPA will amend, or refuse to amend, a permit within 21 days after receiving a complete application and the relevant fee, or 21 days after receiving any additional information requested by us, whichever is the later.

PART 1: Applicant details
Permit holder name
Is the applicant a lessee? / Yes
If yes, enter registered vehicle owner’s full name here:
No
ABN(if applicable) / ACN (if applicable)
Full name of person authorised to make statements on behalf of the applicant
Phone / Mobile
Email
Registered address (as per ASIC register)
Physical address (operating business in VIC)
Postal address (for correspondence)
PART 2: Relevant offence declaration (to be completed by all applicants, including corporations):
Has the applicant been found guilty of a ‘relevant offence’(as defined in Section 20C of the Environment Protection Act) in the past 10 years?
Yes
If yes, please attach a statutory declaration to this permit application, setting out the specific circumstances and why those circumstances should not prevent this application from being approved.
No
Relevant offences are defined in Section 20C of the EP Act. They include any indictable offences and certain summary offences. Relevant offences are considered by EPA in determining whether an applicant is a fit and proper person to hold the amended permit. Please refer to the guidelinePermit to transport prescribed industrial waste(EPA Publication IWRG811) for more information.
PART 3: Corporation relevant offence declaration (to be completed only if the Applicant is a corporation):
If the applicant is a corporation, has any director or person concerned in the management of the corporation been found guilty of a ‘relevant offence’ as defined in Section 20C of the Environment Protection Act in the past 10 years?
Yes
If yes, please attach a statutory declaration from that person (or each of those persons) to this permit application, setting out the specific circumstances and why those circumstances should not prevent this application from being approved.
No
Relevant offences are defined in Section 20C of the EP Act. They include any indictable offences and certain summary offences. Relevant offences are considered by EPA in determining whether persons are fit and proper to be involved in a corporation holding the amended permit. Please refer to the guideline Permit to transport prescribed industrial waste(EPA Publication IWRG811) for more information.
PART 4: Permit and vehicle details
Permit number / Registration number
Reason for amendment (please select) / Number plate change (if interstate registered vehicle – attach a copy of the vehicle registration certificate)
Variation of waste types (select the waste to be transported from the list attached in Part 7 of this application)
Company name change (no application fee required)
Amendment details
(provide any additional relevantinformation)
List all methods of assembly, oralternative designs, not mentioned in EPA guidance IWRG816 or IWRG814 (if applicable).
An assessment will be made by EPA as to whether these give equivalent results in terms ofmeeting the vehicle requirements.
PART 5: Declaration of applicant – your application will not be accepted unless the declaration is completed and signed
Environmental Protection (Industrial Waste Resource) Regulations 2009
I hereby declare that I have made all necessary enquiries and the information provided in this application (including any attachments) is true and correct. I understand that it is an offence to intentionally or negligently provide incorrect or misleading information to the Environment Protection Authority or to conceal information from the Authority.
I also declare that the vehicle, detailed in Part 4, is fit for the purpose of transporting the prescribed industrial waste specified in the permit and conforms to the relevant vehicle requirements set out in Vehicle guidance: Non-tanker vehicles/trailers (EPA Publication IWRG814) or Vehicle guidance: Tanker/tanker trailer (EPA Publication IWRG816) and Permit to transport prescribed industrial waste (EPA Publication IWRG811).

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Family name / Given name/s
Position
(applicable to companies)

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Signature (1) / Date / / /
Signature (2) / Date / / /

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A digital copy of the applicant’s signature is acceptable, in lieu of a wet signature.
If a company, a person of authority must complete.
Second signature only required if the applicant is a partnership.

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The personal information on this form and any correspondence, notice or other document issued after processing of this information will be stored and used by EPA for the purpose of administering the Environment Protection Act 1970 and Environment Protection (Industrial Waste Resource) Regulations 2009. You may access this information by contacting the EPA Privacy Information Officer. This information may be disclosed to another Government organisation, tribunal or court, where required for administering or enforcing the above Act and Regulations or any other relevant laws.

PART 6: Checklist – to be completed by the applicant
Industrial Waste Resource Guideline IWRG811 (applicable to all vehicle types), IWRG814 (applicable to non-tanker vehicles/trailers) and IWRG816 (applicable to tanker/tanker trailer) read and understood.
A self-assessment, against the requirements in IWRG814 (applicable to non-tanker vehicles/trailers) or IWRG816 (applicable to tankers/tanker trailers), has been conducted for the vehicle that is the subject of this application and the vehicle meets the relevant requirements to transport the waste code(s) selected from the Table 1 list attached below.
Relevant offence declaration completed (Parts 2 and 3). Documentation attached (if you selected yes).
Copy of vehicle registration certificate attached (for vehicles registered with an interstate authority OR with VicRoads within the last 4 weeks).
Declaration (Part 5) read and signed.
Types of waste to be transported from Table 1 (Part 7) list attached (if applicable).
Do not send any fees with this application – EPA will advise you of the correct fee to be paid once assessment of the application is complete.
PART 7: Waste description and codes
The list in Table 1 is described in the Industrial Waste Resource Guideline Waste codes (EPA Publication IWRG822). Only select the waste code(s)to be transported, and that are appropriate for the vehicle.Refer to IWRG814 (applicable to non-tanker vehicles/trailers) and IWRG816 (applicable to tanker/tanker trailer) for further guidance on how to select waste codes suitable for the vehicle body type.

Table 1: Waste description and codes

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Waste description / Waste code / Select
Cyanide-containing wastes / A100
Acids in a solid form or acidic solutions with pH value of 4 or less / B100
Alkaline solids or alkaline solutions with pH value of 9 or more, including caustic soda, alkaline cleaners and waste lime / C100
Metal carbonyls / D100
Inorganic fluorine compounds, excluding calcium fluoride / D110
Mercury and mercury compounds / D120
Equipment and articles containing mercury / D121
Arsenic and arsenic compounds / D130
Chromium compounds
(hexavalent and trivalent) / D140
Tannery wastes containing chromium / D141
Cadmium and cadmium compounds / D150
Beryllium and beryllium compounds / D160
Antimony and antimony compounds / D170
Thallium and thallium compounds / D180
Copper compounds / D190
Cobalt and cobalt compounds / D200
Nickel compounds / D210
Lead and lead compounds / D220
Zinc compounds / D230
Selenium and selenium compounds / D240
Waste containing silver from the production, formulation and use of photographic chemicals and processing materials / D261
Barium compounds / D290
Non-toxic salts including sodium chloride, calcium chloride / D300
Boron compounds / D310
Inorganic sulfur containing compounds / D330
Phosphorus compounds, excluding mineral phosphates. / D360
Inorganic chemicals not otherwise specified in this item / D390
Smelter waste containing prescribed industrial waste / D400
Oxidising agents (including peroxides) not otherwise specified in this item / E100
Waste of an explosive nature not subject to other Victorian legislation, including azides / E120
Highly reactive chemicals not otherwise specified in this item / E130
Aqueous-based wastes from the production, formulation and use of paints, lacquers, varnish, inks, dyes and pigments / F100
Aqueous-based wastes from the production, formulation and use of resins, latex, plasticisers, glues and adhesives / F110
Solvent-based wastes from the production, formulation and use of paints, lacquers, varnish, inks, dyes and pigments / F120
Solvent-based wastes from the production, formulation and use of resins, latex, plasticisers, glues and adhesives / F130
Ethers and highly flammable hydrocarbons, including petrol and jet fuel / G100
Non-halogenated organic solvents / G110
Dry-cleaning wastes containing organic solvents, including perchloroethylene / G130
Halogenated organic solvents / G150
Wastes from the production, formulation and use of organic solvents, not otherwise specified in this item / G160
Waste from the production, formulation and use of biocides and phytopharmaceuticals, not otherwise specified in this item / H100
Organophosphorus pesticides / H110
Mixed pesticide residue / H160
Copper-chrome-arsenic (CCA) / H170
Waste oils unfit for their original intended use
Examples: lubricating and hydraulic waste oils / J100
Waste hydrocarbons / J110
Waste oils and water mixtures or emulsions, and hydrocarbon and water mixtures or emulsions / J120
Triple interceptor waste and stormwater contaminated with oil or hydrocarbons / J130
Transformer fluids excluding polychlorinated biphenyls / J140
Other oils, hydrocarbons or emulsions not otherwise specified in this item including cutting oils and soluble oils / J150
Tarry residues arising from refining, distillation and any pyrolytic treatment / J160
Used oil filters
Note: this waste must be reused or recycled and is prohibited from disposal to landfill. For more information refer to the Oil filters – Classification for reuse / J170
Animal effluent and residues including abattoir wastes and other wastes from animal processing
Examples: poultry wastes, fish and shellfish wastes / K100
Grease interceptor trap effluent
Note: this waste must be reused or recycled and is prohibited from disposal to landfill. For more information refer to the Grease interceptor trap effluent – Classification for reuse / K120
Tannery wastes (not containing chromium) and wool scouring wastes / K140
Food and beverage processing wastes
Note: For unprocessed used cooking fats and oils, the Industrial Waste – Classification for unprocessed used cooking fats and oils may apply / K200
Car and truck washwaters / L100
Industrial washwaters from cleaning, rinsing or washing operations not otherwise specified in this item
Examples: textile cleaning/processing effluent NOS, industrial plant and machinery washwaters and cooling tower washwaters / L150
Polychlorinated biphenyls (PCB) in concentrations over 50mg per kg / M100
Waste substances and articles containing or contaminated with polychlorinated biphenyls in concentrations over 50mg per kg / M110
Solvents, oils and materials contaminated with polychlorinated biphenyls in concentrations over 2 mg per kg but less than 50mg per kg / M120
Non-halogenated, non-solvent organic chemicals, not otherwise specified in this item, including glycol coolant, radiator fluid and brake fluid / M130
Phenol and phenol compounds including halogenated phenols / M150
Halogenated organic chemicals, not otherwise specified in this item / M160
Organic isocyanate compounds / M220
Amines and other nitrogen compounds / M230
Detergents and surface active agents (surfactants) / M250
Highly odorous organic chemicals including mercaptans and acrylates / M260
Prescribed industrial waste residues in rigid steel or plastic containers with an original volume less than 200 litres
Note: Any contaminants (List 3) must be specified / N100
Prescribed industrial waste residues in rigid steel or plastic containers with an original volume greater than or equal to 200 litres
Note: Any contaminants (List 3) must be specified
This waste must be reused or recycled and is prohibited from disposal to landfill. For more information refer to the Large containers ( ≥200L) contaminated with PIW – Classification for reuse / N105
Prescribed industrial waste residues in bags or containers not covered by waste codes N100 or N105
Note: Any contaminants (List 3) must be specified / N110
Category A contaminated soil
Note: Any contaminants (List 3) must be specified.
Refer to EPA guidance material for details on identifying hazard category
These wastes must not be disposed directly to landfill without prior treatment. / N119
Category B contaminated soil
Note: Any contaminants (List 3) must be specified.
Refer to EPA guidance material for details on identifying hazard category / N120
Category C contaminated soil
Note: Any contaminants (List 3) must be specified.
Refer to EPA guidance material for details on identifying hazard category / N121
Spent catalysts
Note: Any contaminants (List 3) must be specified / N130
Fire debris and fire wash-waters that are contaminated with chemicals
Note: Any contaminants (List 3) must be specified / N140
Fly ash / N150
Prescribed industrial wastes that are immobilised in accordance with a classification issued by EPA Victoria / N160
Prescribed industrial wastes that are chemically fixed and/or encapsulated / N170
Prescribed industrial waste that are solidified or polymerised / N180
Filter cake / N190
Ion-exchange column residues / N200
Residues from pollution control operations, not otherwise specified in this item (including activated carbon, baghouse dust, residues from industrial waste disposal operations and leachate) / N210
Asbestos including asbestos in fill material soil
Note: If soil containing asbestos is category A, B or C contaminated soil the description of waste for that category applies and asbestos needs to be specified as a contaminant / N220
Ceramic-based fibres with physico-chemical characteristics similar to those of asbestos / N230
Absorbents contaminated with prescribed industrial waste residues
Examples: rags contaminated with oils, hydrocarbons and organic solvents
Note Any contaminants (List 3) must be specified.
Refer to EPA guidance material for details on identifying hazard category.
This description of waste does not apply if there is a more specific description of waste (e.g. Used oil filters) / N250
Schedule 1 industrial wastes contaminated with prescribed industrial waste residues, not otherwise specified in this item
Note: Any contaminants (List 3) must be specified / N260
Clinical and related wastes, including biomedical waste, not otherwise specified in this item / R100
Pathogenic substances and quarantine wastes / R110
Waste from the use of pharmaceutical products, not otherwise specified in this item / R120
Cytotoxic substances / R130
Waste from the production of pharmaceutical products and cosmetics, not otherwise specified in this item / R140
Waste chemical substances arising from laboratories, research and development, or teaching activities / T100
Waste from the production, formulation and use of photographic chemicals and processing materials not containing silver / T120
Inert sludges or slurries
Note: For drilling muds, the Industrial Waste – Classification for drilling mud may apply / T130
Foundry sands / T160
Waste chemicals in small quantities, not otherwise specified in this item
Example: collected household chemicals / T170

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