FORMS: Bureau of Land and Waste Management

Drycleaners

Form Name DHEC Form #
Drycleaner Eligibility Application - Drycleaner Eligibility Application D-3469
Drycleaner Notice of Property Transfer or Name Change - Drycleaner Notice of Property Transfer or Name Change D-2057
Drycleaner Containment Structure Certification Form - Drycleaner Containment Structure Certification Form D-3879

For more information or questions about our Dry Cleaning Forms, please contact Robert Hodges at (803) 898-0919.

Electronic Manufacturers

Form Name DHEC Form #
Covered Electronic Devices Manufacturer Registration (D-2425) D-2425

Groundwater Monitoring Wells

Form Name DHEC Form #
Monitoring Well Application - Use to request approval from DHEC to install groundwater monitoring wells at a site D-3736

Robert Cole - (803) 898-0802

Hazardous Waste

Form Name DHEC Form #
Hazardous Waste Transporter Permit Application - Hazardous Waste Transporter Permit Application ------
Introduction to the South Carolina Notifications of Regulated Waste Activity Form - Introduction and basic generators information for the Notification of Regulated Waste Activity ------
Notification of Regulated Waste Activity Form - The Notification and Reporting Form is used by companies that are required under the South Carolina Hazardous Waste Management Regulations, 6I-79.262.13, 263.13, 264.5 and 265.5 to notify the South Carolina Department of Health and Environmental Control (SCDHEC) that they are involved in hazardous waste activities. SCDHEC is responsible for assigning the Environmental Protection Agency Identification Number (EPA ID #). EPA 8700‐12, 8700‐13 A/B, 8700‐23
Introduction to Hazardous Waste Reports - Introduction and basic generators information for the Notification and the Hazardous Waste Reports ------
Quarterly Hazardous Waste Report Codes - Form Codes, Management Method Codes, Source Codes, and Waste Minimization Codes ------
Quarterly Hazardous Waste Report - Generation and On-Site Treatment, Storage, Disposal and Recovery (Instructions) - "Generation and On-Site T,S,D,R" - This form is used to report the amount IN POUNDS of hazardous waste generated during a quarter. Any waste generated on-site and then treated, stored, (accumulated), disposed of (on-site) or recovered should be reported on this form. The treatment, disposal and recovery activities mentioned here may require either currently having Interim Status or obtaining a Hazardous Waste Permit from S.C. DHEC. Large Quantity Generators are allowed to store (accumulate) hazardous waste under 90 days without a permit. The EPA ID # and name of all initial transporters who hauled hazardous waste for you during this quarter. D-1962
Quarterly Hazardous Waste Report - Waste Shipped Off-Site for Treatment, Storage, Disposal and Recovery (Instructions) - "Waste Shipped Off-Site for T,S,D,R" - This form is a log of manifested hazardous waste shipments transported off-site for a quarter. D-1963
Quarterly Hazardous Waste Report - Off-Site Facility Report (Instructions) - "Off-Site Facility Report" - This form is to be completed only by those companies who accept hazardous waste that was generated by other companies for the purpose of treatment, storage, disposal and/or recovery. The treatment, storage, disposal and recovery activities mentioned here require either currently having Interim Status or obtaining a Hazardous Waste Permit from S.C. DHEC. D-1964
Hazardous Waste Index (Instructions) - "Hazardous Waste Index" - This form is used to create an index of all the hazardous waste streams a company generates. When a new waste stream is generated, this form is to be completed and submitted with the rest of the quarterly report forms. Please do not repeat old waste stream information. This form is never required to be completed by those companies who submit an Annual Declaration. D-1965
RCRA Part A Permit Application - Instructions and Forms - RCRA Part A Permit Application - Instructions and Forms EPA 8700-23
Waste Minimization Report - Waste Minimization Report - Large Quantity Generators are Required to Submit D-3446

For more information or questions about Regulated Waste Activity, Hazardous Waste Transporters, and Hazardous Waste Reporting Forms, please contact Shamille Rice at (803) 898-0495.

Infectious Waste

Form Name DHEC Form # e-Permissions
Checklist for Infectious Waste Management Plan Review - Checklist for Infectious Waste Management Plan Review ------ -
Infectious Waste Generator Registration - Infectious Waste Generator Registration D-1999 Infectious Waste Generator Registration
Infectious Waste Transporter Registration - Infectious Waste Transporter Registration D-3408 Infectious Waste Transporter Registration
Infectious Waste Transporter Certificate of Insurance - Infectious Waste Transporter Certificate of Insurance D-3407 -
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. D-2116 -

For more information or questions about Infectious Waste Reporting Forms, please contact Kim Clyburn at (803) 898-0239.

Mining

Form Name DHEC Form #
MR-200: Application for an Exploration Certificate ($300.00 fee) - Application for an Exploration Certificate ($300.00 fee) D-3100
MR-300: Reclamation Plan for Exploration - Reclamation Plan for Exploration D-3101
MR-400GP1: Notice of Intent for Coverage Under a General Mine Operating Permit (with instructions) ($600 fee) - Click here if site is located in Beaufort, Berkeley, Charleston, Colleton, Dorchester, Georgetown, Horry, or Jasper counties.
Click here for GP1 Permit/Reclamation Plan.
A NPDES permit is required for all mine sites.
D-3114
MR-400: Application for a Mine Operating Permit ($600 fee ) - Click here if site is located in Beaufort, Berkeley, Charleston, Colleton, Dorchester, Georgetown, Horry, or Jasper counties.
Click here for Information to Mine in Water Bodies
D-3102
MR-500: Reclamation Plan for an Individual Mine Operating Permit - Reclamation Plan for an Individual Mine Operating Permit D-3103
MR-600: Land Entry Agreement for Land Owned by Mine Operator - Land Entry Agreement for Land Owned by Mine Operator D-3104
MR-700: Land Entry Agreement for Land Leased by Mine Operator - Land Entry Agreement for Land Leased by Mine Operator D-3105
MR-800: Reclamation Bond Form to Post a Surety Bond - Reclamation Bond Form to Post a Surety Bond D-3106
MR-900: Reclamation Bond Form to Post a Bond Other than a Surety Bond - Reclamation Bond Form to Post a Bond Other than a Surety Bond D-3107
MR-1000: Assignment - Assignment of Reclamation Bind D-3108
MR-1050: Irrevocable Letter of Credit - Irrevocable Letter of Credit D-3109
MR-1100 : Annual Reclamation Report to be submitted with $375.00 annual fee - Mining Annual Operating Fee per mine D-3110
MR-1300: Application for Modifying a Mine Operating Permit and/or Reclamation Plan - Application for Modifying a Mine Operating Permit and/or Reclamation Plan D-3111
MR-1400: Mine Operating Permit Transfer Agreement ($600 fee) - Mine Operating Permit Transfer Agreement D-3112

For more information or questions about Mining Forms, please contact Joe Koon at (803) 898-1371.

Radioactive Waste

Form Name DHEC Form #
Application for Radioactive Waste Transport Permit - Application for Radioactive Waste Transport Permit D-0800
Radioactive Waste Shipment Prior Notification and Manifest Form - Radioactive Waste Shipment Prior Notification and Manifest Form D-0802
Radioactive Waste Shipment Certification - Radioactive Waste Shipment Certification D-0803

For more information or questions about Radioactive Waste Forms, please contact Kim Clyburn at (803) 898-0239.

Solid Waste Compliance

Form Name DHEC Form #
Annual Report SW Mgt WT Collection, Processing & Disposal Facilities D-2718

South Carolina Solid Waste Transfer Stations Annual Report (07/2014)

Instructions

D-1350

Class -1 Landfill Annual Report Form

Instructions

D-1342

Class -2 Landfill Annual Report Form

Instructions

D-1321

Class-3 Landfill Annual Report Form

Instructions

D-3122

Composting / Wood Chipping Facility Annual Report Form

Instructions

D-1343
Lead Acid Battery Facilities Registration Form - Lead Acid Battery Facilities Registration Form D-2733

SW Incineration and Pyrolysis Annual Report Form

Instructions

D-1272

SW Processing Facility Annual Report Form

Instructions

D-1331

SW Used Oil Transporters - Transfer Station Annual Report Form (and instructions)

D-1317
Used Oil Collection Center and Aggregation Point - Used Oil Collection Center and Aggregation Point ------
Used Oil Transporter Registration Instructions - Used Oil Transporter Registration Instructions ------
Used Oil Transporter and Transfer Facility Registration - Used Oil Transporter and Transfer Facility Registration D-2716
Used Oil Transporter Certificate of Insurance - Used Oil Transporter Certificate of Insurance D-2717
Waste Tire Hauler Annual Report Form - S.C. Waste Tire Hauler Annual Report Form ------
Waste Tire Hauler Registration - WTP D-2735
Waste Tire Hauler Manifest - WTP D-2738
Waste Tire Hauler - Irrevocable Letter of Credit ------
Waste Tire Hauler - Assignment of Certificate of Deposit ------
Waste Tire Hauler - Financial Guarantee Bond ------
Electronic Recovery Facility - Financial Guarantee Bond ------
SW Management Facility - Financial Guarantee Bond ------
SW Management Facility - Irrevocable Letter of Credit ------
SW Management Facility - Performance Bond ------
SW Management Facility - Assignment of Certificate of Deposit - ------
SW Management Facility - Trust Fund Agreement ------
SW Management Facility - Standby Trust Fund Agreement ------

For more information or questions about Waste Tires, Lead Acid Battery, or Used Oil Forms, please contact Chris Carney at (803) 898-0727.

Solid Waste Permitting

Form Name DHEC Form #
Application for Permit to Construct a Solid Waste Management System - Application for Permit to Construct a Solid Waste Management System D-1932
Application for Registration or Permit to Land Apply - Application for Registration or Permit to Land Apply D-3568
Application of Registration for Structural Fill - Application of Registration for Structural Fill D-3570
Application of Registration of Construction & Demolition Debris Recycling Facility - Application of Registration for Construction & Demolition Debris Recycling Facility D-3328
Application for Permit to Construct a Solid Waste Tire Facility - Application for Permit to Construct a Solid Waste Tire Facility D-3571
Local Government Full Cost Disclosure Report D-1409
Registration for Wood Chipping, Shredding and/or Composting - Registration for Wood Chipping, Shredding and/or Composting D-1988
Notice of Intent to Operate a Land-Clearing Debris and Yard Trash Landfill - Notice of Intent to Operate a Land-Clearing Debris and Yard Trash Landfill D-3569

For more information or questions about Solid Waste Permitting, please contact Justin Koon at (803) 898-1339.

Underground Storage Tanks - Assessment and Corrective Action Section

Form Name DHEC Form #
Analytical Methodology - Analytical Methodology ------
Appendix A - Standard Field Cleaning (Decontamination) Procedures - Appendix A - Standard Field Cleaning (Decontamination) Procedures ------
Assessment Component Cost Agreement 6/15/17 D-2795
Assessment Component Invoice and Instructions 6/15/17 D-0728A
Certified Contractors ------
Active Correction Action (ACA) pre - 8/1/2012 ------
Active Correction Action (ACA) Invoice Free Product Only D-0426
Dissolve Clean-Up (CA) Invoice - Dissolve Clean-Up (CA) Invoice D-3728
Field Data Sheet - Gauging D-0424
Field Data Sheet - Sampling D-2540
Free Product Dissolve Clean-UP (CA) Invoice - Free Product Dissolve Clean-UP (CA) Invoice D-3868
Initial Groundwater Assessment Invoice - Initial Groundwater Assessment Invoice D-3666
Owner/Operator Contractor Selection Form D-3244
Quality Assurance Program Plan - Quality Assurance Program Plan ------
Contractor's Addendum, Quality Assurance Program Plan - Contractor's Addendum, Quality Assurance Program Plan ------
Request for Review - Request for Review D-3668
Site Rehabilitation Contractor Certification Application - Site Rehabilitation Contractor Certification Application D-3499
Site-Specific Work Plan D-0653
Slug Test - Slug Test D-3531
SUPERB Allowable costs June 15, 2017 ------
Tier I Assessment Invoice - Tier I Assessment Invoice D-3665
Well Development Data Verfication Form Underground Storage Tank Management Division D-2099
Well Installation or Boring Invoice 8/16/16 D-0725A

For more information or questions about our UST Assessment and Correction Action Forms please call (803) 898-2544

Underground Storage Tanks - Regulatory Compliance Section

Form Name DHEC Form #
Alternate Fuel Installation Application - Alternate Fuel Installation Application D-3885
Application for Permit to Operate Field Constructed Systems D-3179
Application for Permit to Install Airport Hydrant Systems D-3180
Application for Permit to Install Field Constructed Systems D-3181
Application for Permit to Operate Airport Hydrant Systems D-3178
Assessment Guidelines for Permanent Closure and Change in Service - Assessment Guidelines for Permanent Closure and Change in Service D-3182
Certificate of Financial Responsibility - Certificate of Financial Responsibility D-3472
Class A/B Operator Log - Class A/B Operator Log D-2213
Financial Responsibility Mechanisms Information Sheet - Financial Responsibility Mechanisms Information Sheet ------
List of Insurance Agencies - List of Insurance Agencies ------
Monthly Statistical Inventory Reconciliation (SIR) Report - Monthly Statistical Inventory Reconciliation (SIR) Report D-3574
Notification of USTs No Longer in Operation - Notification of USTs No Longer in Operation D-3856
Notification of USTs Currently in Operation - Notification of USTs Currently in Operation D-1917
Overfill Prevention Equipment Operability Check D-3187
Rectifier Log - Rectifier Log D-0648
Release Detection Equipment Testing D-3188
Site Check Fact Sheet - Site Check Fact Sheet ------
Spill Bucket Integrity Testing - Spill Bucket Integrity Testing D-2562
State of South Carolina Galvanic (Sacrificial Anode) Cathodic Protection System Evaluation - State of South Carolina Galvanic (Sacrificial Anode) Cathodic Protection System Evaluation D-2550
State of South Carolina Impressed Current Cathodic Protection System Evaluation - State of South Carolina Impressed Current Cathodic Protection System Evaluation D-2551
Containment Sump Integrity Testing Form - Containment Sump Integrity Testing Form D-3183
Tank and Sludge Disposal Form - Tank and Sludge Disposal Form D-2233
Underground Storage Tank - Application for Permit to Install - Underground Storage Tank - Application for Permit to Install D-2101
Underground Storage Tank - Application for Permit to Operate - Underground Storage Tank - Application for Permit to Operate D-1959
Underground Storage Tank Transfer of Ownership - Underground Storage Tank Transfer of Ownership D-3871
Walkthrough Inspection Checklist D-3184
Walkthrough Inspection Checklist/Operator Log D-3185
24-Hour Release Report - 24-Hour Release Report D-3177
Line Tightness Testing D-3315
Automatic Line Leak Detector Function Check D-3316
Sump Sensor Function Check D-3318
Tank Tightness Testing D-3317

For more information or questions about our UST Regulatory Compliance Forms, please call (803) 898-0589.

Waste Assessment

Form Name DHEC Form #
Frequently Asked Questions - DHEC 3660, 3661, 3662, 3657, 3658, 3659 ------
Generator's Knowledge Certification - Generator's Knowledge Certification ------
RCRA & SW - TCLP Metals - Microsoft Excel needed to open spreadsheets D-3657
Industrial RCRA - TCLP Volatiles - Microsoft Excel needed to open spreadsheets D-3658
Industrial RCRA & SW - TCLP Semi-Volatiles - Microsoft Excel needed to open spreadsheets D-3659
Industrial Inorganic TCLP/R.61-58.5 - Microsoft Excel needed to open spreadsheets D-3660
Industrial Volatile TCLP/R.61-58.5 - Microsoft Excel needed to open spreadsheets D-3661
Industrial Semi-Volatile TCLP/R.61-58.5 - Microsoft Excel needed to open spreadsheets D-3662
Industrial RCRA - TCLP Metals - Microsoft Excel needed to open spreadsheets D-3667
Analyte Batch Report and Concentrations - Microsoft Excel needed to open spreadsheets D-3732
Cross Reference Report for QA and Analyte - Microsoft Excel needed to open spreadsheets D-3733
Land Application - Microsoft Excel needed to open spreadsheets D-3734
Simple Random Sampling Method for Hazardous Waste - Microsoft Excel needed to open spreadsheets D-3782
Instructions for Simple Random Sampling Method for Hazardous Waste D-3782
Stratified Random Sampling Method - Microsoft Excel needed to open spreadsheets D-3783
Instructions for Statistical Analyses for Random Simple and Stratified Sampling - Instructions for Statistical Analyses for Random Simple and Stratified Sampling D-3782, 3783
TCLP Variable Detection Levels Memo (rev. 6/9/2017) - TCLP Variable Detection Levels Memo ------

For more information or questions about Waste Assessment Forms, please contact Steve Burdick at (803) 898-1317.

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Bureau of Land & Waste Management Forms & Worksheets