Basic Info Department Name Contact Information Name Email Phone Air Quality Is there a valid air permit/registration for the department? Yes No Where are the monitoring records and reports maintained? Emergency Generators What is the size (hp or kW) of the largest emergency generator? Unit - None -hpkW How many emergency generators are located on campus (approximately) that the department is responsible for? Is there an inventory of these available? Yes No Who exercises these units? Name Email Phone Recent Modifications Has the department made any recent modifications to existing air emissions sources? Yes No Are any additions or modifications planned for the next two years? Yes No If yes, describe Air-Related Complaints Have any air-related public complaints been received by the department during the last two years? Yes No Describe the nature of the complaints (odors, visible, emissions, etc.), their dates, and the university's response Does the department own or operate an incinerator? Yes No Does the department own or operate cogeneration or fuel-fired chiller system? Yes No Refrigerants Where does the department use refrigerants (i.e., HVAC, vehicle maintenance garage, Halon systems)? Who is certified to work with refrigerants on campus? Name Email Phone Is there any equipment with > 50 lb of refrigerant? Yes No Where? What refrigerant? Who services these units? Name Email Phone Does the department own a reclaiming unit? Yes No Where does the department store unused refrigerant (this includes new and recovered)? Gasoline Does the department have a gasoline dispensing facility? Yes No If so, how much gasoline was dispensed over each of the past two calendar years? How much so far this year? Does the department have a graphic arts program? Yes No Does the department have any dry cleaning operations? Yes No How many parts washers or degreasers are located within the department? Where are these located and how is the spent solvent disposed? How many spray booths are located within the department? Where are these located? Is traffic paint applied on campus by the department? Yes No How many boilers does the department operate? Asbestos Has the department undertaken any projects involving asbestos over the past 3 years? Yes No Were notifications submitted to Environmental Protection Agency (EPA) or Georgia Environmental Protection Division (EPD) prior to the start of each project? Yes No Are they available? Yes No Are the waste shipment records from the projects available? Yes No Did any exceed the 35-day or 45-day shipment times between date shipped off-site and date received at the final disposal site? Yes No Were the projects performed by licensed asbestos abatement professionals? Yes No Who? Are any containers of asbestos containing material (ACM) currently stored on-site? Yes No Are campus vehicles used to transport asbestos on campus? Yes No Does the department have its own asbestos abatement personnel or team? Yes No EPCRA Does your department have any facilities/research labs/farms/etc... which store extremely hazardous chemicals that are greater than or equal to the threshold planning quantity (TPQ) amount listed on the U.S. Code of Federal Regulations Extremely Hazardous Substances Charts? Yes No Hazardous Substances Release Does the department store any exemptions for hazardous substances (EHS) on-site in excess of the U.S. Government reportable quantity (RQ)? Yes No Does the department store any hazardous substances in quantities great than 10,000 pounds (the term hazardous substance refers to anything that has a Material Safety Data Sheet, including underground storage tanks, above ground storage tanks, oil, sand, road salt, fertilizer, etc.)? Yes No Is there or has there ever been any storage of chemicals, raw materials, fuels, liquids, or wastes by other means, such as surface impoundments, pits, ponds, lagoons or piles of the property? Yes No If yes, please explain Has your department had a release of any hazardous substances? Yes No Was the release reported, and to whom? Lead Paint Is there any pre-1978 residential housing that have separated kitchens? (e.g., student of faculty apartments, RA/RD apartments, President's house, etc.)? Yes No If so, where? Is this housing leased to tenants? Have Environmental Protection Agency (EPA) pamphlets been distributed to any residents? Yes No Does the leasing process include lead-paint disclosures? Yes No Have there been any lead-based paint renovations or abatements performed on target holding or child-occupied facilities? Yes No If so, briefly describe Is there any lead contaminated soil on residential property or on property of a child-occupied facility which exceeds 400 parts per million (ppm) in concentration in child play areas or 1,200 ppm in non-play areas? Yes No Have residential properties been sold by the department which contained lead-based paint? Yes No Pesticides Does the department employ any certified pesticide applicators? Yes No Are they certified for the types of pesticide applications performed? Yes No Are their licenses current? Yes No Does the department apply any restricted use pesticides? Yes No Are restricted use pesticides applied by certified applicators or under their direct supervision? Yes No Are restricted use pesticides applied according to label directions? Yes No Are records of restricted use pesticides maintained for 2 years? Yes No Is there proper signage at primary entry points? Yes No Does the department follow Worker Protection Standards for pesticides covered by WPS rules? Yes No RCRA - leave blank if not sure I. Does the department generate or have the following waste: A. Generate: Wastes listed as hazardous waste under federal and state law (e.g., solvent wastes, old chemical)? Yes No Ignitable wastes (e.g., waste gasoline, paints, thinners, mineral spirits)? Yes No Corrosive wastes (e.g., acids, bases, boiler treatment chemicals)? Yes No Toxic wastes (e.g., photo developer or fixer waste; wastes containing lead, chromium, cadmium, silver or other metals)? Yes No PCB-containing materials (liquids, rags, equipment)? Yes No Waste sludges? Yes No Filter media (i.e., Ethidium Bromide Gels)? Yes No Paper towels used with solvent? Yes No Waste oil or oil spill debris? Yes No Incinerator ash that contains heavy metals? Yes No Process wastes (i.e., a waste product as a result of processes such as: burning, filtration, neutralization etc.)? Yes No Pharmaceutical wastes (e.g., expired medications)? Yes No Debris, soil, and residual from non-hazardous chemical spills? Yes No Inert fill, construction or demolition debris, dredge spoil, or wood wastes? Yes No Household waste products? Yes No Other wastes (i.e., cooking grease)? Yes No B. Generate: Over 1,000 kg of hazardous waste in a calendar month? Yes No Over 100 kg but less than 1,000 kg of hazardous waste in a calendar month? Yes No Less than 100 kg of hazardous waste in a calendar month? Yes No Generate or accumulate in excess of 1 kg of P-waste? Yes No C. Treat or dispose of hazardous waste on-site using the following: Incineration? Yes No Burn in boilers? Yes No Dilution? Yes No Landfill (e.g., placement of materials in landfill)? Yes No Physical/chemical treatment (e.g., neutralization by rendering wastes non-corrosive)? Yes No Biological treatment? Yes No Underground injection? Yes No Wastewater treatment unit? Yes No D. Transport: Does the department transport hazardous or other wastes off-site using State vehicles or employees? Yes No E. Outside Service: Does the department use an outside industrial rag laundering service? Yes No For which campus areas? II. Container Storage Areas: Are hazardous wastes storage areas inspected weekly? Yes No Are ignitable or reactive wastes managed in these areas? Yes No Are incompatible wastes handled? Yes No III. Records/Record Keeping: Was a Resource Conservation and Recovery Act (RCRA) Part A or B application filed? Yes No Are records of hazardous waste characterizations available? Yes No Is a log kept of weekly inspections of the 90-day (if large quantity gen.) or 180-day (if small quantity gen.) storage area? Yes No Is there a Hazardous Waste Contingency Plan? Yes No Is there a hazardous waste training program? Yes No Are employee training records and job descriptions maintained? Yes No IV. Spills and Releases: Have there been any spills or releases of hazardous waste or hazardous substances to the environment? Yes No Have any releases of reportable quantities hazardous substances been reported to the National Response Center under Superfund or Georgia reporting laws? Yes No Other releases of less than reportable quantities that could have impacted the environment? Yes No Have any releases been reported to the local police or fire department or Local Emergency Planning Committees? This is part of the Emergency Planning and Community Right to Know Act (EPCRA). Yes No V. Past Activity and Closed Units: Were any wastes disposed of on-site prior to January 1980? Yes No If any waste was disposed of on-site prior to January 1980 describe the wastes and volumes, and any sampling of wastes or monitoring of groundwater Are any hazardous waste management units (post January 1980) inactive or closed? Yes No Describe closure activities, if applicable VI. Non-hazardous (Solid) Waste Units: Are there now non-hazardous waste management units owned and/or operated by the department? Yes No Landfill? Yes No Waste piles? Yes No Landspreading? Yes No Wastewater treatment facility? Yes No Others? Describe Has the facility monitored groundwater down gradient of any non-hazardous waste management units? Yes No VII. Are hazardous wastes storage areas inspected weekly? Yes No VIII. Does the facility have a license to treat hazardous waste? Yes No Safe Drinking Water Are there any active or inactive wells (production wells, cooling water wells, groundwater monitoring wells, oil or gas wells, injection wells, other) located on this property(s) owned and/or operated by the department? Yes No If yes, what type of well? Describe any reported groundwater problems beneath property or on the surrounding area Does the facility have a groundwater monitoring program? Yes No What parameters are measured? How frequently are groundwater measurements obtained? (i.e. daily, weekly, bi-weekly, monthly, bi-monthly, yearly) Who receives the groundwater analysis results? Name Email Phone Are there available logs of soil borings taken on the property or geotechnical reports from past design or construction work? Yes No Does the property owned by the department have any known or suspected areas of contaminated soil? Yes No Please identify the suspected contaminants How many water supply sources do you have? Are any water recycling processes utilized? Yes No If yes, please describe If there is on-site water treatment, does the department have a licensed well or water treatment works operator? Yes No What treatment of raw water supply is performed? Are there any special restrictions? Please include sludge disposal. SPCC Is there a valid, certified Oil Spill Prevention, Control and Countermeasure (SPCC) Plan for the department? Yes No Stormwater Does the department have a stormwater collection system? Yes No If yes, describe. If no, describe how stormwater discharges from the site? Where does stormwater discharge? To surface water? To a municipal separate storm sewer system? To a combined sewer system? Describe. Does the department hold a permit for stormwater discharges? Yes No Does the department have a Stormwater Pollution Prevention Plan or a Stormwater Management Plan? Yes No Are there known or suspected non-stormwater discharges or connections (e.g., wash waters, floor drains) to the storm drain system or directly to surface waters? Yes No If yes, describe type and location Are there any construction projects currently underway or proposed that will disturb one (1) or more acres of land area? Yes No If so, describe Has coverage been obtained under a General Permit for Stormwater Discharges from Construction Activity? Yes No Has a Stormwater Pollution Prevention Plan been prepared for the construction activity? Yes No Has any stormwater sampling ever been conducted? Yes No TSCA / PCBs Does the department own or work with any equipment which contains any known Polychlorinated Biphenyls (PCBs) (i.e., transformers, capacitors, oil-filled circuit breakers, light ballasts, etc.)? Yes No Is any electrical equipment labeled as containing PCBs? Yes No What fluids from electrical gear owned/operated by the department have been analyzed for PCBs? Yes No What electrical equipment, if any, is owned by the utility which is located on or immediately adjacent to the campus site? Yes No Is there any electrical gear containing PCBs which is being stored on-site? Yes No Has any electrical equipment containing PCBs been disposed of in the past? Yes No How? Where? Are there any pre-1984 hydraulic oil systems on-site (e.g. elevators)? Yes No If so, please list their locations and when they were installed. When was the last full drain and flush of each hydraulic system completed? Has the oil in the hydraulic systems been tested for the presence of PCBs? Yes No Has the department had any spills of materials containing PCBs? Yes No Underground Injection Control Does the department have any Class I, II, III, IV, or V injection wells? Yes No Are the wells properly permitted? Yes No Is the the department in compliance with permit conditions? Yes No Are there any obvious problems with the wells? (i.e., injection of unauthorized waste or structural defeciencies) Yes No Is the department operating any prohibited injection wells? Yes No Does the department have floor drains that discharge to other than sanitary sewer? Yes No Do any floor drains discharge to a well? Yes No Universal Waste 1. Does the department accumulate over 5,000 kg of universal wastes at any one time? Yes No 2. Does the department maintain records of universal waste shipments? Yes No 3. What types of universal wastes are generated (e.g., batteries, pesticides, thermostats, mercury-containing devices, mercury-containing lamps)? Yes No 4. How does the department demonstrate accumulation time? Are universal wastes accumulated longer than one year? 5. Does the department have a universal waste training program? Who is provided with training? 6. How does the department label universal wastes? 7. Does the department have emergency backup systems (e.g., for the phone system, uninterrupted power supply system, computer network, etc.) that are powered by batteries? Yes No If yes, please select the number of backup systems Used Oil 1. Does the department generate used oil? Yes No If so, what type and where? 2. How does the department store used oil? In 55-gallon drums or above ground storage tank(s) (ASTs)? 3. How does the department dispose of used oil and how does the department self-transport? 4. What else is mixed with the used oil prior to disposal? 5. Does the department burn any used oil on-site? Yes No If so, where? 6. Does the department sell any used oil? Yes No UST / ACT 1. Is an inventory (comparison of materials received against material used) on UST's maintained? Yes No 2. Were leak/integrity tests performed on any of the USTs? Yes No If yes, what testing procedures were used? What were the results? 3. If any of the USTs have leaked in the past, what corrective measures were taken by the department? 4. Please describe leak detection, interstitial monitoring, and overfill alarms/protection for all USTs. Who services the tank systems? 5. What type of piping are the USTs equiped with (e.g. single-walled, double-walled, fiberglass, cathodically protected, other, don't know, etc). 6. How many USTs (past and present) in the department? Tank 1 Tank Capacity: Material of Construction: Contents of the container: Date of Installation: Location Address Address 2 City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Tank Registered with Georgia Yes No Tank 2 Tank Capacity: Material of Construction: Contents of the container: Date of Installation: Location Address Address 2 City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Tank Registered with Georgia Yes No Have any USTs been removed in the past? Yes No If so, was Georgia EPD informed prior to the removal/abandonment? Yes No How many ASTs in the Department? Storage Tank 1 Location Address Address 2 City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Type of container in area: Contents of the container: Capacity of containers in area: How often inspected? High level alarms? Yes No Associated underground pipes? Yes No Structural problems? Yes No Secondary containment? Yes No Tanks registered with a regulatory agency? Yes No Are these included in the campus Oil SPCC Plan? Yes No Wastewater / NPDES 1. Does the department have a wastewater discharge permit(s)? Yes No 2. Using the text field box below indicate the type and location of non-sanitary wastewater (e.g., laboratory discharges, boiler blowdown, vehicle wash water, photo processing waste water, seepage discharge, cesspool, and waste sludge) on campus. Be sure to enter where these discharges are routed to and whether discharges are treated or pass through oil/water separators, acid neutralization systems, or silver recovery units. 3. Have there been any changes in department wastewater, wastewater discharges, treatment processes or point of discharge changes in the past three years? Yes No Are any changes planned for the next year? Yes No 4. If the department discharges to a Publicly Owned Treatment Works(POTW), what pretreatment, if any, is required by the treatment facility for the university's discharges? 5. Are wastewater discharges sampled and/or monitored? Yes No Time Period Covered: 6. How many wastewater discharges sampled and/or monitored last year? 1. Are discharge monitoring reports Discharge Monitoring Report (DMRs) submitted? Yes No If so, to whom? Name Email Phone 2. Describe the chain of custody, sampling, and sample handling procedures. 3. Does the department have floor drains? Yes No Describe where they are, where they discharge to, and what they are used for. Leave this field blank
