SCDHEC: EQC Administration Forms

Environmental Quality Control (EQC)

	Environmental Application, Registration, and Reporting Forms

	Air Quality (Asbestos, Compliance, Emissions Inventory, Modeling, Permitting, Source Evaluation)
	Land and Waste Management (Emergency Response, Hazardous Waste Management, Mining, Radioactive Waste Management, Recycling, Solid Waste Management)
	Ocean and Coastal Resource Management
	Water (Drinking Water, Wastewater, Groundwater, Agricultural Facilities, Storm Water, Dams and Reservoirs Safety, Wetlands, Recreational Waters)

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Bureau of Air Quality

Asbestos
Form Name (pdf format)	Form	Date	Size
Demolition License Application	DHEC	07/2004	200K
Asbestos Abatement Project License Application	DHEC 3430	07/2004	173K
Abatement Project Quarterly Report	DHEC 3575	06/1998	354K
Waste Shipment Record	DHEC 3688	09/2000	31K
Notification of Non-Friable Asbestos Abatement Project	DHEC 3654	05/2004	35K
Notification of Residential Non-Friable Asbestos Abatement Project	DHEC 3653	05/2004	34K
Abatement License Application	DHEC 2925	07/2004	144K
Application for Group License	DHEC 3422	08/1996	196K
Temporary Asbestos Storage Containment Area License Application	DHEC 3423	04/2003	32K
For more detailed information about Asbestos Forms, visit the Asbestos Contacts and Forms web page or contact Robin Mack at 803-898-4270.

Emergency Planning & Community Right to Know Act (EPCRA)
Form Name (pdf format)	Form	Date	Size
Tier II Form	Federal Form	11/2008	28K
Tier II Form Instructions	Federal Form	11/2008	57K

Emissions Inventory
Form Name (pdf format)	Form	Date	Size
Point Source Data Report	DHEC 1904	11/2009	337K
Electronic Signature Agreement	DHEC 1040	12/2009	168K
Electronic Registration Agreement	DHEC 1041	12/2009	160K
For more detailed information about performing an emissons inventory or HAP Emission Summary, visit the Emissions Inventory website or contact Lynn Barnes at 803-898-4298.

Reporting Requirements for Ground Level Ozone Non-Attainment Areas
Form Name (pdf format)	Form	Date	Size
Emissions Statement Reporting Form	DHEC 1216	12/2009	167K
For more detailed information about Emissions Statement Reporting Form, please visit the Reporting Requirements for Ground Level Ozone Non-Attainment Areas website or contact Lynn Barnes at 803-898-4298.

SC CAIR Programs / NOx SIP Call
Form Name (pdf format)	Form	Date	Size
CAIR Permit Application	DHEC 2069	02/2009	233K
CAIR Permit Application Instructions	DHEC 2069i	02/2009	204K
NOx Budget Permit Application	DHEC 2929	06/2002	102K
NOx Budget Program New Source Allocations (Set-Aside) Application	DHEC 2932	11/2004	126K
NOx Budget Early Reduction Credit Request For Sources Utilizing NOx Averaging	DHEC 2933	10/2003	84K
NOx Budget Early Reduction Credit Request For Sources Not Utilizing NOx Averaging	DHEC 2934	10/2003	97K

Maximum Achievable Control Technology (MACT)
Form Name (pdf format)	Form	Date	Size
Annual Solvent Emission Report, Subpart T	DHEC 2922	02/2002	343K
Exceedance Report, Subpart T	DHEC 2921	02/2002	124K
Ongoing Compliance Report, Subpart N	DHEC 2909	11/2009	183K

Permitting
Form Name (pdf format)	Form	Date	Size
Applications
Expedited Review Program SOP - Air Quality Construction Permits - PDF	DHEC 2212	06/2007	82K
Expedited Review Request Form - Air Quality Construction Permits - PDF	DHEC 2212	06/2007	82K
Modeling - Air Dispersion Modeling Questionnaire - PDF	DHEC 3555	12/1997	50K
Construction Application - Part I and applicable forms for each emission sources (PartIIA thru IIGa)
Part I - Instructions (PDF Format)	DHEC 1924	06/2007	80K
Part I (PDF Format - Fillable)	DHEC 1924	06/2007	714K
Part I (Word Format -Fillable)	DHEC 1924	06/2007	431K
Part IIA - Fuel Burning Permit Application - Instructions (PDF Format)	DHEC 1924a	06/2007	58K
Part IIA - Fuel Burning Permit Application (PDF Format - Fillable)	DHEC 1924a	06/2007	728K
Part IIA - Fuel Burning Permit Application (Word Format - Fillable)	DHEC 1924a	06/2007	414K
Part IIB - Process Permit Application - Instructions (PDF Format)	DHEC 1924b	06/2007	54K
Part IIB - Process Permit Application (PDF Format - Fillable)	DHEC 1924b	06/2007	676K
Part IIB - Process Permit Application (Word Format - Fillable)	DHEC 1924b	06/2007	378K
Part IIC - Incinerator Permit Application (PDF Format)	DHEC 1924c	07/1997	2M
Part IIC - Incinerator Permit Application (Word Format - Fillable)	DHEC 1924c	07/1997	111K
Part IID - Asphalt Plant Permit Application (PDF Format)	DHEC 1924d	07/1997	2M
Part IID - Asphalt Plant Permit Application (Word Format -Fillable)	DHEC 1924d	07/1997	144K
Part IIE - Dry Cleaner Permit Application (PDF Format)	DHEC 1924e	07/1997	2M
Part IIE - Dry Cleaner Permit Application (Word Format - Fillable)	DHEC 1924e	07/1997	65K
Part IIF - Concrete Batch Plant Permit Application (PDF Format)	DHEC 1924f	07/1997	59K
Part IIF - Concrete Batch Plant Permit Application (Word Format - Fillable)	DHEC 1924f	07/1997	85K
Part IIG - Storage Vessel Permit Application (PDF Format)	DHEC 3409	07/1997	2M
Part IIG - Storage Vessel Permit Application (Word Format - Fillable)	DHEC 3409	07/1997	100K
Part IIGa - Supplemental Storage Vessel Permit Application (PDF Format)	DHEC 3410	07/1997	2M
Part IIGa - Supplemental Storage Vessel Permit Application (Word Format - Fillable)	DHEC 3410	07/1997	79K
Fees for New Sources
Permit Fees for New Sources	DHEC 3628	01/1999	111K
Note: This is NOT for permit applications. The Department charges no fees for air permit applications, renewals, or revisions. Please read the following memorandum for an explanation of new source permit fees.
Air Permit Fees for New Sources -Memorandum	---	---	---
Explanation of new Source Permit Fees as they relate to Annual Permit Fees and Application Fees
General Conditional Major Operating Permits
Asphalt Plants (GCMP-03) (PDF Format)	---	02/2007	338K
Concrete Plants (GCMP-04) (PDF Format)	---	06/2006	169K
Fuel Combustion Operations (GCMP-02) (PDF Format)	---	04/2006	275K
Textile Greige Operations (GCMP-01) (PDF Format)	---	04/2006	280K
General Permit Applications
Sample Permit (PDF Format)	---	12/2005	169K
Concrete and/or Block Plants Application (Word Format - Fillable)	---	11/2008	415K
Fuel Burning Permit Instructions (PDF Format)	---	12/2005	76K
Fuel Burning (Word Format - Fillable)	---	12/2005	186K
Fuel Burning Calculation Worksheet (Excel Format)	---	12/2005	525K
Hot Mix Asphalt Plants Instructions (PDF Format)	---	04/2006	82K
Hot Mix Asphalt Plants (Word Format)	---	04/2006	223K
Textile Greige Operations Instructions (PDF Format)	---	12/2005	183K
Textile Greige Operations (Word Format - Fillable)	---	12/2005	208K
Low NOx Burner Replacement Notification
Instructions for Low NOx Burner Replacement Notification Form (PDF Format)	---	09/2004	80K
Low NOx Burner Replacement Notification Form (Word Format- Fillable)	DHEC 2935	09/2004	97K
Title V Permit Applications
Title V Permit Application	---	---	---
Title V Modification Forms
Form A - Facility Profile (Word Format- Fillable)	DHEC 2937	06/2008	133K
Form AA - Administrative Amendment Modification Form (Word Format- Fillable)	DHEC 2938	05/2005	70K
Form MM - Minor Modification Form (Word Format- Fillable)	DHEC 2949	06/2008	222K
Form OF - Operational Flexibility (Word Format- Fillable)	DHEC 2950	10/2005	175K
Form OF - Operational Flexibility Intructions (Word Format- Fillable)	---	04/2007	80K
Form RO - Responsible Official (RO) Notification Form (Word Format- Fillable)	DHEC 2951	05/2005	102K
Form RO - Responsible Official (RO) Notification Form Instructions (Word Format- Fillable)	---	05/2005	61K
Form SM - Significant Modification Form (Word Format- Fillable)	DHEC 2936	05/2005	64K
Operating Permits
Facility Profile Update & Ownership Transfer Form	DHEC 2954	08/2009	308K
State Operating Permit and Conditional Major Operating Permit Renewal Request Form	DHEC 2955	08/2009	279K
State Operating Permit and Conditional Major Operating Permit Renewal Request Form Instructions	DHEC 2955	08/2009	61K
Miscellaneous Forms
SC Department of Health & Environmental Control Insignificant Activities List (PDF)	---	04/2008	78K
Confidentiality Information (Word Format- Fillable)	---	04/2007	32K
Compliance Assurance Monitoring (CAM) Plan Form (Word Format- Fillable)	---	01/2006	128K
Monitoring Range Submittal Form and Instructions (Word Format- Fillable)	---	05/2005	125K
Monitoring Range Instructions (Word Format- Fillable)	---	05/2005	67K

Source Evaluation
Form Name (pdf format)	Form	Date	Size
Site-Specific Test Plan/Final Report Checklist	---	1/1998	335K
For more information about source evaluation, contact Michael Shroup at 803-898-4051.

Technical Management
Form Name (pdf format)	Form	Date	Size
Title V Annual Compliance Certification	DHEC 3650	Rev. 06/03	102K
For more information or questions about our forms, please visit the Technical Management web site or contact Dawn Jordan at 803-898-4075

Bureau of Land and Waste Management

Dry Cleaning
Form Name (pdf format)	Form	Date	Size
Instructions for Drycleaner Eligibility Application	DHEC 3469	04/2005	156K
Drycleaner Eligibility Application	DHEC 3469	04/2005	131K
Drycleaner Notice of Property Transfer or Name Change	DHEC 2057	08/2005	104K
Drycleaner Containment Structure Certification Form	DHEC 3879	05/2005	115K
Due Diligence Form	DHEC 3471	03/1997	125K
Field Inspection Form	DHEC 3470	03/1997	116K
Application for Certification of Environmental Contractor	DHEC 3464	02/1997	845K
For more information or questions about our Dry Cleaning Forms, please contact Lisa Appel at 803-896-4060.

Hazardous Waste

Form Name (pdf format)

Form

Date

Size

RCRA Part A Permit Application - Instructions and Forms

EPA 8700-23

03/2005

251K

Hazardous Waste Reporting Forms Workbook

Instructions & Codes	- 355K	DHEC Form 1963	- 382K
DHEC Form 2701	- 8642K	DHEC Form 1964	- 997K
DHEC Form 1962	- 1001K	DHEC Form 1965	- 1479K

3428

11/2001

22K

Standards Applicable to Transporters of Hazardous Waste

---

Hazardous Waste Transporter Permit Application

---

06/2001

643K

Waste Minimization Report

3446

12/2007

232K

For more information or questions about Hazardous Waste Reporting Forms, please contact Teresa Hayes at 803-896-4139 or Hazardous Waste Transporters, please contact Carroll Burley at 803-896-4141.

Infectious Waste
Form Name (pdf format)	Form	Date	Size
Infectious Waste Generator Registration	DHEC 1999	03/2001	2091K
Instructions for Generator Registration	DHEC 1999	03/2001	64K
Infectious Waste Transporter Registration	DHEC 3408	02/2001	210K
Instructions for Transporter Registration	---	---	7K
Infectious Waste Transporter Certificate of Insurance	DHEC 3407	04/1996	65K
Checklist for Infectious Waste Management Plan Review	---	---	105K
Infectious Waste Generator Inspection Report	---	---	71K
Infectious Waste Transporter Inspection Report	---	---	67K
Infectious Waste Manifest The Program recommends that the Infectious Waste Manifest be printed as a four page carbonless form. It is also recommended that the four pages be printed on different color paper. The colors that have been used in the past are: Copy 1: White Copy 2: Yellow Copy 3: Pink Copy 4: Goldenrod There is no requirement that these colors be used, or that they be used in this order.	DHEC 2116	09/1992	212K
For more information or questions about our Infectious Waste Generator Forms, please contact Leslie Yasinsac at 803-896-4192 or Infectious Waste Transporter Forms, please contact Margie Davis at 803-896-4193.

Mining
Form Name (pdf format)	Form	Date	Size
Application for an Exploration Certificate ($300.00 fee)	Mining MR-200 DHEC 3100	08/1997	127K
Reclamation Plan for Exploration	Mining MR-300 DHEC 3101	08/1997	159K
Application for an Individual Mine Operating Permit ($600 fee )	Mining MR-400 DHEC 3102	08/1997	255K
Reclamation Plan for an Individual Mine Operating Permit	Mining MR-500 DHEC 3103	01/1999	24K
Application for a General Mine Operating Permit ($375.00 fee) Click here for GP1 reclamation Plan	Mining MR-400GP1 DHEC 3114	10/2004	673K
Land Entry Agreement for Land Owned by Mine Operator	Mining MR-600 DHEC 3104	08/1997	26K
Land Entry Agreement for Land Leased by Mine Operator	Mining MR-700 DHEC 3105	08/1997	24K
Reclamation Bond Form to Post a Surety Bond	Mining MR-800 DHEC 3106	08/1997	23K
Reclamation Bond Form to Post a Bond Other than a Surety Bond	Mining MR-900 DHEC 3107	08/1997	23K
Assignment	Mining MR-1000 DHEC 3108	03/1994	24K
Irrevocable Letter of Credit	Mining MR-1050 DHEC 3109	08/1997	26K
Annual Reclamation Report to be submitted with $375.00 annual fee	Mining MR-1100 DHEC 3110	06/2006	70K
Application for Modifying a Mine Operating Permit and/or Reclamation Plan	Mining MR-1300 DHEC 3111	08/1997	87K
Mine Operating Permit Transfer Agreement	Mining MR-1400 DHEC 3112	03/1994	46K
For more information or questions about our Mining Forms, please contact Wendy Hamilton at 803-896-4267.

Radioactive Waste
Form Name (pdf format)	Form	Date	Size
Radioactive Waste Shipment Prior Notification and Manifest Form	DHEC 0802	10/1984	162K
Radioactive Waste Shipment Certification	DHEC 0803	05/1980	52K
Application for Radioactive Waste Transport Permit	DHEC 0800	09/2003	314K
For more information or questions about our Radioactive Waste Forms, please contact Arlene Wilkes at 803-896-4247 or Kim Clyburn at 803-896-4240.

Solid Waste
Form Name (pdf format)	Form	Date	Size
Application for Permit to Construct a Solid Waste Management System	DHEC 1932	07/1997	66K
Registration for Wood Chipping, Shredding and/or Composting	DHEC 1988	07/1997	66K
Application for Registration or Permit to Land Apply	DHEC 3568	03/1998	62K
Notice of Intent to Operate a Land-Clearing Debris and Yard Trash Landfill	DHEC 3569	03/1998	108K
Application of Registration for Structural Fill	DHEC 3570	09/2008	112K
Application for Permit to Construct a Solid Waste Tire Facility	DHEC 3571	03/1998	92K
Lead Acid Battery Facilities Registration Form	---	---	50K
Used Oil Collection Center and Aggregation Point	---	---	52K
S.C. Waste Tire Hauler Registration Form	---	11/1999	182K
S.C. Waste Tire Hauler Annual Report Form	---	11/1999	184K
Used Oil Transporter Registration Instructions	---	3/20/2000	264K
Used Oil Transporter and Transfer Facility Registration	DHEC 2716	04/2002	117K
Used Oil Transporter Certificate of Insurance	DHEC 2717	04/2002	166K
For more information or questions about our Waste Tires, Lead Acid Battery, or Used Oil Forms, please contact Marty Lindler at 803-896-4205.

Underground Storage Tanks - Assessment and Corrective Action Section
Form Name (pdf format)	Form	Date	Size
Risk-Based Corrective Action		---	650K
Site Rehabilitation Contractor Certification Application	DHEC 3499	12/2007	3170K
Well Installation or Boring Invoice	DHEC3667	10/2003	15K
Initial Ground Water Assessment	---	---	62K
Initial Groundwater Assessment Invoice	DHEC3666	05/01	35K
Tier I Assessment	---	---	98K
Tier I Assessment Invoice	DHEC 3665	05/2004	169K
Tier II Assessment	---	---	86K
Tier II Assessment Plan	DHEC 3527	07/1999	152K
Appendix A - Standard Field Cleaning (Decontamination) Procedures	---	09/2008	90K
Appendix B - Design And Installation of Monitoring Wells	---	09/2008	68K
Slug Test	DHEC 3531	07/1999	42K
Assessment Component Invoice and Instructions	DHEC 3664	12/2005	371K
Assessment Component Cost Agreement	---	---	33K
Corrective Action	---	---	254K
Corrective Action Invoice	DHEC 3687	05/01	147K
Analytical Methodology	---	---	101K
SUPERB Allowable Costs	---	---	35K
Request for Review	DHEC 3668	11/99	32K
For more information or questions about our UST Assessment and Correction Action Forms, please contact Katina Brown at (803) 896-6274.

Underground Storage Tanks - Regulatory Compliance Section
Form Name (pdf format)	Form	Date	Size
Underground Storage Tank - Application for Permit to Install	DHEC 2101	05/2009	735K
Underground Storage Tank - Application for Permit to Operate	DHEC 1959	05/2009	5173K
Assessment Guidelines for Permanent Closure and Change in Service	---	02/2006	368K
Certificate of Financial Responsibility	DHEC 3472	01/2007	164K
List of Insurance Agencies	---	---	3.38K
Frequently Asked Questions About Financial Responsibility	---	---	8.29K
Underground Storage Tank Transfer of Ownership	DHEC 3871	08/2008	224K
72-Hour Release Report	---	---	---
Notification of USTs No Longer in Operation	DHEC3856	06/2002	41K
Notification of USTs Currently in Operation	DHEC1917	06/2002	42K
Alternate Fuel Installation Application	DHEC 3885	06/2006	277K
Tank and Sludge Disposal Form	DHEC 2233	05/2009	87k
Monthly Statistical Inventory Reconciliation (SIR) Report	DHEC 3574	06/2002	35K
State of South Carolina Impressed Current Cathodic Protection System Evaluation	DHEC 2551	7/2002	5650K
State of South Carolina Galvanic (Sacrificial Anode) Cathodic Protection System Evaluation	DHEC 2550	7/2002	3140K
Seasonal Tanks		4/2009	123K
Site Check Fact Sheet		5/2009	305k
Class A/B Operator Log.	DHEC 2213	9/2009	269k
For more information or questions about our UST Regulatory Compliance Forms, please contact 803-896-7957.

Waste Assessment
Form Name (pdf format)	Form	Date	Size
Industrial Volatile TCLP/R.61-58.5 - (Note: Microsoft Excel needed to open spreadsheets)	DHEC 3661	06/2009	---
Industrial RCRA - TCLP Metals - (Note: Microsoft Excel needed to open spreadsheets)	DHEC 3657	06/2009	61K
Industrial Inorganic TCLP/R.61-58.5 - (Note: Microsoft Excel needed to open spreadsheets)	DHEC 3660	06/2009
Industrial RCRA - TCLP Volatiles - (File Format: Microsoft Excel spreadsheet)	DHEC 3658	06/2009
Industrial Semi-Volatile TCLP/R.61-58.5 - (File Format: Microsoft Excel spreadsheet)	DHEC 3662	06/2009
Industrial RCRA - TCLP Semi-Volatiles - (File Format: Microsoft Excel spreadsheet)	DHEC 3659	06/2009
Land Application -(File Format: Microsoft Excel spreadsheet)	DHEC 3734
Analyte Batch Report and Concentrations - (File Format: Microsoft Excel spreadsheet)	DHEC 3732	04/2002	211K
Cross Reference Report for QA and Analyte - (File Format: Microsoft Excel spreadsheet)	DHEC 3733	10/2000	41K
Frequently Asked Questions	DHEC 3660, 3661, 3662, 3657, 3658, 3659	---	3.38K
Instructions	---	---	36.1K
TCLP Variable Detection Levels Memo	---	---	8.29K
Generator's Knowledge Certification	DHEC 3574	06/2002	35K
Instructions for Statistical Analyses for Random Simple and Stratified Sampling	DHEC 3782, 3783	04/1999	34.3K
Simple Random Sampling Method for Hazardous Waste	DHEC 3782	---	---
Stratified Random Sampling Method	DHEC 3783	---	---
For more information or questions about our Waste Assessment Forms, please contact Steve Burdick at 803-896-4120.

Ocean and Coastal Resource Management

Please click for OCRM Forms

Bureau of Water

Agricultural Facilities
Form Name (pdf format)	Form	Date	Size
Request for a Preliminary Site Inspection	DHEC 2623	10/2008	197K
Notice of Intent to Construct an Agricultural Facility	DHEC 3579	08/2002	37K
Agricultural Animal Facilities (Other than Swine)	DHEC 3580	08/2002	58K
New or Expanding Small Swine Facilities (500,000 lbs or less)	DHEC 3577	08/2002	58K
New or Expanding Large Swine Facilities (500,001 lbs or more)	DHEC 3578	08/2002	61K
Stacking Shed and/or Composter	DHEC 2512	08/2002	41K
Agricultural Manure Brokers	DHEC 2514	08/2002	50K
Agricultural Manure Applicators	DHEC 2510	08/2002	52K
Modifications (for existing facilities)	DHEC 2511	08/2002	37K
Agricultural Permit Transfer of Ownership or Operation	DHEC 2513	08/2002	48K
Integrator Registration Form	DHEC 2516	10/2002	39K
Manure Balance Sheet	---	---	04K
Manure Transfer Agreement	---	---	19K

Dams
Form Name (pdf format)	Form	Date	Size
Application to Construct or Alter a Dam	DHEC 2602	02/2002	210K

Drinking Water
Form Name (pdf format)	Form	Date	Size
Construction Permit Application - Drinking Water and/or Wastewater Facilities	DHEC 1970	03/2008	470K
Small Business Water System Construction Permit Application	DHEC 1206	06/2004	46K
Water Line Extensions - General Construction Permit Application for Public Water Supply Systems	DHEC 2507	08/2000	216K
Application for Transfer of Operating Permit for A Public Water System	DHEC 1329	10/2003	122K
Bacteriological Analysis Input Form	DHEC 1974	07/2004	75K
Optimum Corrosion Control Treatment (OCCT) Recommendation - Desktop Evaluation Short Form for Small and Medium Public Water Systems	DHEC 2134	08/2002	84K
Optimum Corrosion Control Treatment Documentation Flushing Records	DHEC 2515	09/2002	179K
Controlled Fluoridation Monthly Report	DHEC 2613	08/2003	43K
Controlled Fluoridation Monthly Report (Excel Version)	DHEC 2613	08/2003	60K

Groundwater Monitoring
Form Name (pdf format)	Form	Date	Size
Monitoring Well Application	DHEC 3736	09/2007	73K
Groundwater Monitoring Report	DHEC 2110	11/2002	111K
Guidance Document - General Objectives and Components of Contamination Assessments and Remedial Actions, DHEC. May, 1994	---	05/1994	2.0 MB

Groundwater Use
Form Name (pdf format)	Form	Date	Size
Groundwater Withdrawal Permit Application	DHEC 2504	8/2002	497K
Underground Injection Control Permit Application	DHEC2502	11/2001	43k
(Guidance Document for Underground Injection Control Permit)	---	---	---

Navigable Waters
Form Name (pdf format)	Form	Date	Size
Permit Application for Construction in Navigable Waters (Individual Permit)	---	07/1994	189K
Permit Application for Construction in Navigable Waters (Lake Greenwood Permit)	--	09/1995	187K
Permit Application for Construction in Navigable Water (Public Utilities General Permit)	---	---	200K

Recreational Waters
Form Name (pdf format)	Form	Date	Size
Swimming Pool Application to Construct a Recreational Water Facility	DHEC 2501	01/2006	320K
Swimming Pool Final Inspection Checklist	DHEC 1931	10/2002	53K
Swimming Pool Change Order Request Form	DHEC 3627	02/2002	283K
Swimming Pool Facility Information Sheet	DHEC 3441	11/1997	112K
Swimming Pool Incident Report	DHEC 3785	07/2001	116K
Natural Recreational Facility Application for Initial Certification	DHEC 3821	12/2001	86K
Natural Recreational Facility Application for Annual Permit to Operate	DHEC 1926	02/1999	46K
Bacteriological Analysis Input Form	DHEC 3631	03/1999	193K

Residential Well Program Forms
Form Name (pdf format)	Form	Date	Size
Notice of Intent	DHEC 3647	09/2007	175K
Water Well Record Form	DHEC 1903	07/2003	351K

State Revolving Fund (Guidance Packages)
Form Name (pdf format)	Form	Date	Size
Drinking Water Project Questionnaire	DHEC 3463	07/2008	192K
Wastewater Project Questionnaire	DHEC 3561	07/2008	155K
Monthly Estimated Draw Request Schedule	DHEC 3584	09/1988	26K
Draw Request Form	DHEC 3585	09/1988	43K
Official Designation and Signature Form	DHEC 3586	09/1988	26K
Monthly Construction Inspection Report	DHEC 3587	09/1988	43K
Schedule for Construction	DHEC 3588	09/1988	26K
Project Construction Summary	DHEC 3589	09/1988	24K
Certification Regarding Debarment, Suspension and Other Responsibility Matters	DHEC 3590	09/1988	28K
Prime Contractor's Subagreement Certification	DHEC 3591	09/1988	584K
Certification by Proposed Prime or Subcontractor Regarding Equal Employment Opportunity	DHEC 3592	09/1988	36K
Clean Water SRF - Certification Regarding Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970	DHEC 3593	09/1988	25K
Drinking Water SRF - Certification Regarding Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970	DHEC 3594	09/1988	100K
Preaward Compliance Review Report for All Applicants Requesting Federal Financial Assistance	EPA 4700-4	01/1990	22K
MBE/WBE Utilization Under Federal Grants, Cooperative Agreements, and Interagency Agreements	EPA 5700-52A	05/1996	377K
Please Click for SRF Forms, Reports, and Guidance Documents

Untitled Document

Storm Water - NPDES
Form Name (pdf format)	Form	Date	Size
Storm Water Notice of Intent For Coverage Under the Storm Water NPDES General Permit for Discharges Associated with Industrial Activity Except Construction	DHEC 2611	01/1997	166K
Storm Water Notice of Termination For Terminating Coverage Under the Storm Water NPDES General Permit for Discharges Associated with Industrial Activity.	DHEC 2609	05/2007	133K
Storm Water Notice of Termination For Terminating Coverage Under the Storm Water NPDES General Permit for Discharges Associated with Construction Activity.	DHEC 2610	09/2004	108K
Notice of Intent (NOI) for Stormwater Discharges from Large and Small Construction Activities, NPDES General Permit SCR100000 - (Replaces DHEC forms 3306 and 2612 for coverage under the new CGP) As of 9/1/07, see the MS4 Transition Document for information about where to submit the NOI.	DHEC 2617	09/2007	949K
Consolidated Permits Program - Application Form 1 General Information This is EPA's Application Form 1. It contains general information about the applicant and facility. This form must accompany the individual NPDES permit application - Form 2f.	EPA 3510	08/1990	2.5M
Form 2f	EPA 3510-2f	11/1990	1M
No Exposure Certification for Exclusions from NPDES Stormwater Permitting	DHEC 2616	04/2006	419K
Erosion Prevention and Sediment Control Monthly Report	DHEC 1356	03/2008	285KB

Wastewater - Compliance
Form Name (pdf format)	Form	Date	Size
Sewer System Overflow or Pump Station Failure Report Form	DHEC 3685	02/2002	137K
Satellite Sewer System Owner Notification Form	DHEC 2614	08/2003	321K

Wastewater - Construction
Form Name (pdf format)	Form	Date	Size
Construction Permit Application - Water and/or Wastewater Facilities	DHEC 1970	03/2008	470K
Industrial Wastewater Facility Closure Form	DHEC 1795	11/2009

Wastewater - ND Permits
Form Name (pdf format)	Form	Date	Size
No Discharge or ND Permit Application The ND Permit Application is used as part of a Preliminary Engineering Report (PER) submittal for New, Expanding, and Renewals of Wastewater Treatment Plants with Land Disposal of Wastewater or Sludge.	---	---	143K
Location Supplement for NPDES and ND Permit Applications	---	---	51K
Sludge Disposal Supplement for NPDES and ND Permit Applications Sludge Supplement must accompany NPDES and ND Forms: Standard Form 2D and Form 2E.	---	07/1998	62K

Wastewater - NPDES
Form Name (pdf format)	Form	Date	Size
Notice of Intent (NOI) - NPDES General Permit for Bulk Petroleum Facility Discharges SCG340000	DHEC 2624	4/2009	698K
Notice of Intent (NOI) - Discharges Associated with Nonmetallic Mineral Mining Facilities - NPDES General Permit #SCG730000	DHEC 3559	12/2006	218K
Notice of Intent (NOI) - Hydrostatic Test Water: Discharges From New and Used Oil and Gas Lines and Tanks - NPDES General Permit #SCG670000	DHEC 3729	07/2002	50K
Notice of Intent (NOI) - Utility Water Discharges - NPDES General Permit #SCG250000	DHEC 3632	01/2005	100K
Notice of Intent (NOI) - Vehicle Wash Water: Discharges From Vehicle Wash Water Discharges - NPDES General Permit #SCG750000	DHEC 3756	07/2002	222K
Consolidated Permits Program - Application Form 1 - General Information This is EPA's Application Form 1. It contains general information about the applicant and facility. This form must accompany the NPDES permit application.	EPA 3510	08/1990	2.5M
Consolidated Permits Program - Application Form 2C - Wastewater Discharge Information EPA Form 2C is used by existing industrial facilities when reapplying for an NPDES permit. Instructions are included. This form must be accompanied by EPA Form 1, the Location Supplement, and the Sludge Supplement.	EPA 3510-2C	10/1990	3.1M
Application Form 2D - New Dischargers and New Sources: Application to Discharge Process Wastewater EPA Form 2D is used by industrial facilities when applying for new discharges or new sources. Instructions are included. This form must be accompanied by EPA Form 1, the Antidegradation Supplement, the Location Supplement, and the Sludge Supplement.	EPA 3510-2D	10/1990	1.3M
Application Form 2E - Facilities Which Do Not Discharge Process Wastewater EPA Form 2E is used by facilities which do not discharge process wastewater. Instructions are included.This form must be accompanied by EPA Form 1, the Location Supplement, and the Sludge Supplement.	EPA 3510-2E	10/1990	1M
Antidegradation Supplement for NPDES Permit Applications The Antidegradation Supplement must be filed when an NPDES application is for a new or expanding discharge (including new/increased loadings).	DHEC 3590	09/1998	5K
Location Supplement for NPDES and ND Permit Applications	---	---	51K
Sludge Disposal Supplement for NPDES and ND Permit Applications Sludge Supplement must accompany NPDES Forms: Standard Form 2D and Form 2E.	---	07/1998	---
EPA Form 2A is used by municipal facilities when applying for new discharges or new sources. Instructions are included. This form must be accompanied by the Antidegradation Supplement, the Location Supplement, and EPA Form 2S.	EPA 3510-2A	01/1999	1,628K
EPA Form 2S is used by municipal facilities when applying for new discharges or new sources. Instructions are included. This form must be accompanied by the Form 2A and the Location Supplement.	EPA 3510-2S	01/1999	93K
Mixing Zone Supplement	---	05/2009	759K

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South Carolina Department of Health and Environmental Control