DEPARTMENT OF ENVIRONMENTAL QUALITY
Solid Waste
Certification of Compliance
Form 7336 (revised 6/29/17)
The solid waste regulations (LAC 33:VII.525) requires permit holders to submit an annual certification of compliance (CoC) the LDEQ by October 1st for the previous state fiscal year (i.e., reporting period July 1st to June 30th). General instructions for completion can be found on the LDEQ website at. Send the completed original and 2 copies of the form to:
U.S. MAIL / OR / COURIER or HAND DELIVERY
OES – Waste Permits Division
P.O. Box 4313
Baton Rouge, LA, 70821-4313 / OES – Waste Permits Division
LDEQ’s Headquarters at the Galvez Building
602 North Fifth Street
Baton Rouge, LA, 70802
For questions, contact Mike Hahn of the OES – Waste Permits Division at 225-219-3464 or .
- General Permit Information
Name of Permitted Facility / Reporting Period: July 1, thru June 30,
Physical Address of Permitted Facility
Permit # / Permit Issuance Date / Solid Waste Site ID # / Agency Interest (AI) #
- Certification of Responsible Official (See LAC 33:VII.115 for definition of responsible official)
Signature of Responsible Official / Date
Printed Name of Responsible Official / Title
Company Name / E-Mail Address
Mailing Address – Line 1 / Mailing Address – Line 2
City / State / Zip / Telephone Number
- GeneralSW Contact Person
Name of General SW Contact / Title
Company Name / E-Mail Address
Mailing Address – Line 1 / Mailing Address – Line 2
City / State / Zip / Telephone Number
- SW Billing Information
Check if SW billing info is same as general SW Contact
Billing Company Federal Tax ID #
Name of SW Billing Contact / Title
Company Name / E-Mail Address
Mailing Address – Line 1 / Mailing Address – Line 2
City / State / Zip / Telephone Number
5.List of Permitted Facility(ies) (i.e., processing/disposal units)
# / Facility/Unit Name
(as named by the permittee
and referenced in permit ) / Facility/UnitCategory(ies)
(Check all that apply for each facility/unit) / Processing/Disposal Classification
(MUST USE ONE OF THE FOLLOWING:
Air Curtain Destructor, Autoclave, Compost Facility, C&D Debris Landfill, Incinerator, Landfarm, Landfill , Processing Transfer Station, Refuse-Derived Fuel, Resource Recovery/Recycling, Separation Facility, Shredder/Compactor Baler, Surface Impoundment, Woodwaste Landfill) / STATUS
TYPE I / TYPE II / TYPE I-A / TYPE II-A / TYPE III / Operating/ Inactive / Post-Closure
1
2
3
4
5
6
7
8
9
0
6.Site-Wide Solid Waste Management
A.Wasindustrialsolid waste generated at the site that was sent off-site for disposal?
YesIf “yes,” complete Attachment 1. Provide the types and quantities, in wet tons, of industrial solid waste generated that was sent off-site for disposal.
No
B.Is there a solid waste processing facility/unit permitted at the site?
YesIf “yes,” complete Attachment 2. Provide the types and quantities, in wet tons, of solid waste processed, including waste generated on-site and off-site, indicating percentage of each. For waste generated off-site, indicate whether the waste was generated in-state or out-of-state.
No
C.Is there a solid waste disposal facility/unit permitted at the site?
YesIf “yes,” complete Item 6.B.1 below andAttachment 2. Provide the types and quantities, in wet tons, of solid waste disposed, including waste generated on-site and off-site, indicating percentage of each. For waste generated off-site, indicate whether the waste was generated in-state or out-of-state.
NoIf “no,” go to Item 7.
1.Didany permitted landfill at the site dispose of construction/demolition (C&D) debris?
YesIf “yes,” complete “3.B – Type III (Construction/Demolition Debris) Facility”of Attachment 3.
No
7.Solid Waste Operator Certification and Training Program
A.Is the facility/unitrequired to have certified solid waste operators under the Solid Waste Operator Certification and Training Program of LAC 46:XXIII? (This applies to Type II, II-A and III facilities/units that manage residential waste, commercial waste, C&D debris and/or woodwaste; or, are composting facilities or separation facilities. This does NOT apply to Type I or I-A facilities/units that only manage industrial solid waste. The program requires: 1) having the required number of certified operators; 2) timely recertification; and 3) notifying both the Waste Permits Division and the governing board within 30 days of any changes in the employment status of certified operators as required by LAC 33:VII.711.C.3.b, 713.C.3.b, 715,C.3.b, 717.F.3.b and 721.B.3.b.)
YesIf “yes,” provide the number of certified solid waste operators required by LAC 46:XXIII. (NOTE: It is possible that operators may have dual certifications.)
Level A - / Level B - / Level C -
No
8.Groundwater Monitoring
A.Is the permittee required to have a groundwater monitoring system in accordance with LAC 33:VII.805 of the SW regulations?
YesIf “yes,” complete Items 8.A.1 and 8.A.2 below.
NoIf “no,” go to Item 9.
1.Is the facility in:
Detection Monitoring Assessment Corrective Action
2.Have any changes been made to the groundwater monitoring network or groundwater monitoring program at the site? (e.g., Were any monitoring wells replaced, added, or plugged and abandoned?Has the facility changed the monitoring program from detection to assessment, or assessment to corrective action?)
YesIf “yes,” briefly explain below.
No
EXPLAIN:
9.Landfill Requirements
A.Are any of the permitted units landfills? (This includes operating and/or post-closure portions.)
YesIf “yes,” complete Attachment 4 for each landfill.
No
10.Cost Estimates and Financial Assurance for Closure and/or Post-Closure
A.Provide the EDMS Document ID # and date of the latest ITEMIZED cost estimates for closure/post-closure approved by the Waste Permits Division as required by LAC 33:VII.1303 and 1305. (These are the itemized [i.e., detailed] costs to perform closure/post-closure at the facility.)
Date of Detailed Cost EstimatesEDMS Document ID #
B.Provide the date(s) and EDMS Document ID #(s) of both theadjusted cost estimates for closure/post-closureand theadjusted financial assurance mechanismthat were submitted to the Waste Permits Division as required by LAC 33:VII.1303. (Cost estimates and financial assurance must be adjusted for inflation annually and for any changes made to the closure/post-closure plan. The deadlines for providing adjusted cost estimatesand financial assurance are not necessarily the same and may be different from the CoC deadline[i.e., October 1st]. Cost estimates and financial assurance mechanisms must be submitted under separate cover letter to the Waste Permits Division.)
Date of Adjusted Cost EstimatesEDMS Document ID #
Date of Adjusted Financial AssuranceEDMS Document ID #
N/AAll permittees are required to provide adjusted cost estimates. If adjusted financial assurance is not required, check “N/A” and briefly explain below (i.e., facility not yet accepting waste, financial assuranceexceeds the value of the adjusted cost estimates; exempted federal or state permittee; local government financial test or guarantee utilized).
EXPLAIN:
11.Certifying Compliance for Specific Permit Conditions
A.Has the permitteecomplied with the site specific conditions that require annual compliance certification in accordance with LAC 33:VII.525.D.12, if applicable? (These conditions in the permit begin with “Annual certification per LAC 33:VII.525.A required.”)
Yes
NoIf “no,”briefly explain below. State which site specific condition(s) was not met; the circumstances for not meeting the condition, steps taken by the permittee to return to permit conditions; steps taken by the permittee to ensure similar issues are prevented in the future; and the current status as of the date of this certification. (Compliance with each condition must be addressed separately; however, a site specific condition addressed elsewhere in the CoC may be referenced rather than repeating the response.)
N/A“N/A” should only be checked if there are no site specific conditions listed in the permit that require annual compliance certification.
EXPLAIN:
12.Certification of Compliance - Attachment List / Checklist
Each attachment listed below should have a “Yes” or “No” checked indicating whether the attachment is required and included in the certification of compliance. If additional attachments are needed to further explain certain information, create an attachment and fill in the description at the bottom of this list. The corresponding attachment number listed in the first column should be used regardless of whether any of the precedingattachments are not required.
# / Attachment Description / Template / Required & Included
Yes / No
1 / Industrial SW Generated and Sent Off-Site for Disposal / Yes
2 / Types and Quantities of Solid Waste Processed / Yes
3 / Types and Quantities of Solid Waste Disposed / Yes
4 / Requirements for Landfills / Yes
5 / No
6 / No
7 / No
form_7336_r08Certification of Compliance
6/29/17Page 1 of 4
Attachment 1
Industrial Solid Waste Generated
and Sent Off-Site for Disposal
For each industrial solid waste generated at the site that was sent off-site for disposal, enter the waste code number (assignedby the Office of Environmental Services, Public Participation and Permit Support Division), the totalamount of waste generated (in wet tons ONLY), and thecollector’s/transporter’s and the disposer's identification number (assigned by the OES, Public Participation and Permit Support Division). Add up the amounts generated and enter in the GRAND TOTAL box. Copy this attachmentand add additional pages as necessary (add up the amounts reported on all pages and put in the TOTAL box on the FIRST PAGE ONLY). Enterthe amount of waste generated that remained on-site and sent off-site. All calculations used to compute the quantity (expressed in wet tons) of solid waste generated atthe site must be documented by the permittee and kept as part of the operating record.
INDUSTRIALSOLID WASTE
WASTE CODE # / QUANTITY OF WASTE GENERATED
(WET TONS) / COLLECTOR/
TRANSPORTER ID # / DISPOSER ID #
GRAND TOTAL:
Quantity of Waste Generated that Remained On-Site:
Quantity of Waste Generated that was Transported Off-Site:
form_7336_r08Certification of Compliance
6/29/17Attachment 1
Attachment 2
Types and Quantities of Solid Waste Processed
2.A – Type II-A (Non-Industrial Solid Waste) Facility
For each non-industrial solid waste, enter the amount of waste processed from on-site (in wet tons ONLY), the amount of off-site waste processed from in-state sources (in wet tons ONLY), and the amount of off-site waste processed from out-of-state sources (in wet tons ONLY). Enter the transporter’s and disposer's identification numbers assigned by the Department of Environmental Quality. Add up the amounts reported and enter in the TOTAL box. Enter the percentage of waste processed that was generated on-site and off-site. Enter the amount of waste processed that remained on-site and sent off-site. Copy this form and add additional pages as necessary. If additional pages are used, add up the amounts reported on all pages and put the totals on the FIRST PAGE ONLY. All calculations used to compute the quantity (expressed in wet tons) of solid waste generated at the site must be documented by the permittee and kept as part of the operating record.
Method of Processing:Transfer Station Incinerator/Waste Handling Facility Autoclave Shredder
Baler Compactor Refuse Derived Fuel Facilities
NON-INDUSTRIALWASTE / QUANTITY OF WASTE PROCESSED FROM ON-SITE
(WET TONS) / QUANTITY OF OFF-SITE WASTE PROCESSED FROM IN-STATE
(WET TONS) / QUANTITY OF OFF-SITE WASTE PROCESSED FROM OUT-OF-STATE
(WET TONS) / TRANSPORTER ID# / DISPOSER ID #
01-Residential
02-Commercial
03-Trash
04-Woodwastes
05-Const/Demolition Debris
06-Incinerator
07-Domestic Sewage Sludge
08-UST Corrective Action Waste
09-Agricultural Waste
10-Stable
11-Infectious Waste
12-Friable Asbestos
13-
TOTAL:
% of Waste Processed from On-State: / % of Waste Processed from Off-Site:
Quantity of Waste Processed that Remained On-Site:
Quantity of Waste Processed that was Transported Off-Site:
form_7336_r08Certification of Compliance
3/7/17Attachment 2
Attachment 2 (Continued)
Types and Quantities of Solid Waste Processed
2.B - Type I-A (Industrial Solid Waste) Facility
For each industrial solid waste received for processing, enter the industrial waste code number(the number assigned to the waste by the Office of Environmental Services, Waste Permits Division), the amount of waste processed from on-site (in wet tons ONLY), the amount of off-site waste processed from in-state sources (in wet tons ONLY), and the amount of off-site waste processed from out-of-state sources (in wet tons ONLY). Enter transporter’s and disposer's identification numbers assigned by the Department of Environmental Quality. Add up the amounts reported and enter in the TOTAL box. Enter the percentage of waste processed that was generated on-site and off-site. Enter the amount of waste processed that remained on-site and sent off-site. Copy this form and add additional pages as necessary. If additional pages are used, add up the amounts reported on all pages and put the totals on the FIRST PAGE ONLY. All calculations used to compute the quantity (expressed in wet tons) of solid waste generated at the site must be documented by the permittee and kept as part of the operating record.
Method of Processing:Transfer Station Incinerator/Waste Handling Facility Autoclave Shredder
Baler Compactor Refuse Derived Fuel Facilities
INDUSTRIAL WASTE CODE # / QUANTITY OF WASTE PROCESSED FROM ON-SITE(WET TONS) / QUANTITY OF OFF-SITE WASTE PROCESSED FROM IN-STATE
(WET TONS) / QUANTITY OF OFF-SITE WASTE PROCESSED FROM OUT-OF-STATE
(WET TONS) / TRANSPORTER ID # / DISPOSER ID#
TOTAL:
% of Waste Processed from On-Site: / % of Waste Processed from Off-Site:
Quantity of Waste Processed that Remained On-Site:
Quantity of Waste Processed that was Transported Off-Site:
Attachment 2 (Continued)
Types and Quantities of Solid Waste Processed
2.C - Type III Separation and Composting Facility
For each solid waste, enter the amount of waste received (in wet tons ONLY), enter the amount of waste re-used or recycled (in wet tons ONLY), the amount of waste sent off-site for processing or disposal (in wet tons ONLY), and the processor’s/disposer's and transporter’s identification numbers assigned by the Department of Environmental Quality. Add up the amounts reported and enter in the TOTAL box. Enter the amount of waste received from in-state sources and from out-of-state sources (in wet tons ONLY). Copy this form and add additional pages as necessary. If additional pages are used, add up the amounts reported on all pages and put the totals on the FIRST PAGE ONLY. All calculations used to compute the quantity (expressed in wet tons) of solid waste generated at the site must be documented by the permittee and kept as part of the operating record.
WASTE / QUANTITY OF WASTE RECEIVED(WET TONS) / QUANTITY OF WASTE RE-USED OR RECYCLED (WET TONS) / QUANTITY SHIPPED OFF-SITE FOR PROCESSING/
DISPOSAL
(WET TONS) / DISPOSER/
PROCESSOR ID # / TRANSPORTER ID #
03-Trash
04-Woodwastes
05-Construction/
Demolition Debris
09-Agricultural Waste
10-Stable
13-
TOTAL:
Quantity of Waste Received from In-State: / Quantity of Waste Received from Out-Of-State:
Quantity of Waste Processed that Remained On-Site:
Quantity of Waste Processed that was Transported Off-Site:
Attachment 2 (Continued)
Types and Quantities of Solid Waste Processed
2.D - Type III Separation and Composting Facility
Provide a summary of product use. Enter the code that applies from the table below or the name of the material shipped off-site for recycling/re-use (in wet tons ONLY). Enter the name of the person receiving the material for reuse, recycling, or resale. Also, enter the mailing address, the name of a contact person, and the telephone number. All calculations used to compute the quantity (expressed in wet tons) of solid waste generated at the site must be documented by the permittee and kept as part of the operating record.
Separation Facilities Only: What percentage of the total waste stream received by the facility has been reduced?
Quantity of Material Shipped Off-Site(Wet Tons) / Persons Receiving Material Shipped Off-Site for Reuse/Recycling
Code/Name / Quantity Recycled / Quantity
Re-used / Name:
Mailing Address:
Contact Person:
Telephone:
Received for: Reuse Recycling
Quantity of Material Shipped Off-Site
(Wet Tons) / Persons Receiving Material Shipped Off-Site for Reuse/Recycling
Code/Name / Quantity Recycled / Quantity
Re-used / Name:
Mailing Address:
Contact Person:
Telephone:
Received for: Reuse Recycling
Quantity of Material Shipped Off-Site
(Wet Tons) / Persons Receiving Material Shipped Off-Site for Reuse/Recycling
Code/Name / Quantity Recycled / Quantity
Re-used / Name:
Mailing Address:
Contact Person:
Telephone:
Received for: Reuse Recycling
MATERIAL CODES
SEPARATION FACILITIES / COMPOSTING FACILITIES01-A / Glass / M1 / Class M1 Compost
01-B / Metals / M2 / Class MC Compost
01-C / Paper / S1 / Class S1 Compost
01-D / Plastic / S2 / Class S2 Compost
01-E / White Goods / YW / Class YW Compost
01-F / Batteries
01-G / Waste Oil
01-H / Other, Specify
form_7336_r08Certification of Compliance
6/29/17Attachment 2
Attachment 3
Types and Quantities of Solid Waste Disposed
3.A –Type II (Non-Industrial Solid Waste) Facility
For each non-industrial solid waste, enter the amount of waste disposed from on-site (in wet tons ONLY), the amount of off-site waste disposed from in-state sources (in wet tons ONLY), and the amount of off-site waste disposed from out-of-state sources (in wet tons ONLY). If no tonnage wasgenerated, mark “0”. Do not leave any section blank. Add up the amounts reported and enter in theTOTAL box. Enter the percentage of waste disposed that was generated on-site and off-site. Copy this form and add additional pages as necessary. If additional pages are used, add up the amounts reported on all pages and put the totals on the FIRST PAGE ONLY. All calculations used to compute the quantity (expressed in wet tons) of solid waste generated atthe site must be documented by the permittee and kept as part of the operating record.