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Page 1: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

521

Appendix D: TRI Form R

5

Page 2: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

522522

TAKING STOCK: North American Pollutant Releases and Transfers

Page 3: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

523

Appendix D: TRI Form R

Page 4: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

524524

TAKING STOCK: North American Pollutant Releases and Transfers

Page 5: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

525

Appendix D: TRI Form R

Page 6: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL
Page 7: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

527

Appendix E: NPRI Reporting Form

Page 8: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

528528

TAKING STOCK: North American Pollutant Releases and Transfers

Page 9: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

529

Appendix E: NPRI Reporting Form

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530530

TAKING STOCK: North American Pollutant Releases and Transfers

Page 11: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

531

Appendix E: NPRI Reporting Form

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532532

TAKING STOCK: North American Pollutant Releases and Transfers

Page 13: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

533

Appendix E: NPRI Reporting Form

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534534

TAKING STOCK: North American Pollutant Releases and Transfers

Page 15: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

535

Appendix E: NPRI Reporting Form

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536536

TAKING STOCK: North American Pollutant Releases and Transfers

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537

Appendix E: NPRI Reporting Form

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538538

TAKING STOCK: North American Pollutant Releases and Transfers

Page 19: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

539

Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual)

1

TO

BE

CO

MP

LE

TE

D B

Y I

NE

-SE

MA

RN

AP

1) A

PP

LIC

AT

ION

NU

MB

ER

:2)

EN

VIR

ON

ME

NT

AL

RE

GIS

TR

AT

ION

NU

MB

ER

:

3) R

EC

EIV

ED

BY

:

Nam

e an

d si

gnat

ure

(Sig

natu

re w

ith d

ate

rece

ived

)

In c

ompl

ian

ce w

ith

Art

icle

s 5,

sec

tion

s V

I, X

II a

nd

XV

II,

109

BIS

, 10

9 B

IS 1

an

d 11

1, o

f th

e G

ener

al L

aw o

f E

colo

gica

lE

quil

ibri

um a

nd

En

viro

nm

enta

l P

rote

ctio

n (

LG

EE

PA

); A

rtic

les

86,

88,

89,

90 a

nd

91 o

f th

e L

aw o

n N

atio

nal

Wat

ers;

an

dpu

rsua

nt t

o th

e A

gree

men

t th

roug

h w

hich

the

Nat

iona

l Eco

logi

cal I

nsti

tute

(IN

E),

sha

ll is

sue

a Si

ngle

Env

iron

men

tal L

icen

se a

ndre

ques

t an

Ann

ual O

pera

tion

Cer

tifi

cate

, the

com

pany

I r

epre

sent

her

eby

prov

ides

the

follo

win

g in

form

atio

n to

IN

E r

egar

ding

the

annu

al fa

cilit

y op

erat

ions

cov

ered

by

Env

iron

men

tal R

egis

trat

ion

Num

ber:

___

____

____

____

____

_

TO

BE

CO

MP

LE

TE

D B

Y T

HE

IN

DU

STR

IAL

FA

CIL

ITY

5) P

LA

CE

AN

D D

AT

E O

F C

ER

TIF

ICA

TE

CO

MP

LE

TIO

N:

Day

:

M

onth

:

Y

ear:

Nam

e an

d si

gnat

ure

of th

e le

gal r

epre

sent

ativ

e

I de

clar

e th

at t

he in

form

atio

n co

ntai

ned

in t

his

requ

est

and

the

appe

ndic

es t

here

to is

tru

e. I

n ca

se o

f an

y om

issi

ons

or f

alse

decl

arat

ions

,SE

MA

RN

AP

may

can

cel t

his

appl

icat

ion

or a

pply

appr

opri

ate

adm

inis

trat

ive

sanc

tion

s.N

ame

and

signa

ture

of t

he te

chni

cal o

ffice

r

FORM

COA

CE

RT

IFIC

AT

E F

OR

TH

E O

PE

RA

TIO

N O

F IN

DU

STR

IAL

FAC

ILIT

IES

UN

DE

R F

ED

ER

AL

JU

RIS

DIC

TIO

NFO

R T

HE

YE

AR

___

___

Page 20: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

540540

TAKING STOCK: North American Pollutant Releases and Transfers

2

WH

O S

HO

UL

D M

AK

E T

HIS

AP

PL

ICA

TIO

N?

Thi

s fo

rm s

hall

be s

ubm

itted

by

indu

stri

al fa

cilit

ies

havi

ng a

Sin

gle

Env

iron

men

tal L

icen

se o

r an

Ope

ratin

gLi

cens

e.

INST

RU

CT

ION

S FO

R T

HE

CO

MP

LE

TIO

N O

F T

HIS

FO

RM

:

The

dat

a in

the

tab

les

prov

ided

in t

he G

ener

al C

atal

ogue

of I

nstr

ucti

ons

shal

l be

used

to

com

plet

e th

is fo

rm.

The

follo

win

g in

stru

ctio

ns m

ust a

lso

be fo

llow

ed:

O

ne c

ertif

icat

e fo

rm s

hall

be c

ompl

eted

for

each

faci

lity.

2) T

his

form

sha

ll be

com

plet

ed in

type

scri

pt o

r in

cle

arly

pri

nted

lett

ers

in b

lue

or b

lack

ink.

3) T

hose

spa

ces

whe

re f

acili

ty d

ata

are

iden

tica

l to

thos

e re

port

ed i

n th

e LA

U

(Sin

gle

Env

iron

men

tal

Lice

nse)

or

to t

hose

rep

orte

d pr

evio

usly

wit

h th

is s

ame

form

for

the

last

Ope

rati

on C

erti

ficat

e sh

all n

otbe

com

plet

ed. I

f an

ele

ctro

nic

vers

ion

of t

he f

orm

is b

eing

use

d, e

nsur

e th

at t

he p

revi

ousl

y re

port

edda

ta w

hich

the

form

incl

uded

hav

e no

t bee

n al

tere

d.

4) T

he O

pera

tion

Cer

tific

ate

Form

sha

ll b

e pr

epar

ed i

n on

e or

igin

al a

nd o

ne c

opy

and

/or

in e

lect

roni

c f

orm

(flo

ppy

disk

), w

ith a

prin

ted

cove

r pag

e du

ly si

gned

by

the

lega

l rep

rese

ntat

ive

and

the

tech

nica

l offi

cer.

5) I

f th

e re

ques

ted

info

rmat

ion

is n

ot a

vaila

ble,

thi

s sh

ould

be

indi

cate

d by

ND

(N

ot A

vaila

ble)

; if

the

info

rmat

ion

is n

il, t

his

shou

ld b

e in

dica

ted

by 0

(ze

ro).

If t

he in

form

atio

n is

not

app

licab

le, t

his

shou

ldbe

indi

cate

d by

NA

(N

ot A

pplic

able

).

6) I

f th

e sp

ace

prov

ided

on

the

prin

ted

form

is n

ot la

rge

enou

gh t

o co

ntai

n th

e re

ques

ted

info

rmat

ion,

addi

tiona

l pag

es s

houl

d be

app

ende

d fo

llow

ing

the

mod

el o

f tha

t hea

ding

.

7) T

he G

ener

al O

pera

tion

al D

iagr

am r

eque

sted

sha

ll be

pre

pare

d ac

cord

ing

to t

he e

xam

ple

incl

uded

in

App

endi

x 3

of t

he G

ener

al I

nstr

ucti

ons.

8) S

ecti

on V

of

the

Ope

rati

on C

erti

fica

te s

hall

be c

ompl

eted

onl

y fo

r su

bsta

nces

or

chem

ical

cat

egor

ies

liste

d in

Tab

le 1

8 of

the

Gen

eral

Cat

alog

ue o

f Ins

truc

tion

s.

9) F

acili

ties

usi

ng t

his

Ope

rati

on C

erti

ficat

e fo

rm fo

r th

e fir

st t

ime

shal

l als

o co

mpl

ete

as a

n ap

pend

ix, o

na

one-

tim

e ba

sis,

the

Reg

istr

atio

n D

ata

on t

he a

pplic

atio

n fo

rm f

or t

he S

ingl

e E

nvir

onm

enta

l Lic

ense

,pa

ges

3 an

d 4.

Page 21: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

541

Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual)

3

I.G

EN

ER

AL

TE

CH

NIC

AL

INFO

RM

AT

ION

If t

he f

acili

ty is

usi

ng t

his

repo

rtin

g fo

rm f

or t

he f

irst

tim

e, it

sha

ll co

mpl

ete

the

gene

ral t

echn

ical

info

rmat

ion

requ

este

d in

thi

sse

ctio

n of

the

Cer

tific

ate.

If t

he fa

cilit

y ha

s a

Sing

le E

nvir

onm

enta

l Lic

ense

or

has

used

this

rep

orti

ng fo

rm p

revi

ousl

y, it

sha

ll en

ter

only

the

cha

nges

mad

e fo

r th

e re

port

ed y

ear.

We

rem

ind

you

that

cha

nges

of

Nam

e, C

ompa

ny N

ame,

pro

cess

or

redu

ctio

ns o

rin

crea

ses

in p

rodu

ctio

n sh

ould

hav

e be

en r

epor

ted

whe

n th

ey to

ok p

lace

at t

he A

pplic

atio

ns O

ffic

e. I

f the

re w

as a

cha

nge

of a

ddre

ssor

tra

nsfe

r of

the

fac

ility

, the

com

pany

wou

ld h

ave

appl

ied

for

a ne

w L

icen

se a

nd w

ould

the

refo

re h

ave

a ne

w E

nvir

onm

enta

lR

egis

trat

ion

Num

ber.

Ann

ual d

ata

on r

aw m

ater

ial a

nd fu

el c

onsu

mpt

ion

and

prod

ucti

on s

hall

also

be

repo

rted

in t

his

sect

ion.

1.1

CH

AN

GE

OF

NA

ME

OR

CO

MP

AN

Y N

AM

ED

ate

of n

otic

e :

Day

Mon

thYe

ar

1.2

CH

AN

GE

OF

LE

GA

L R

EP

RE

SEN

TA

TIV

ED

ate

of n

otic

e :

Day

Mon

thYe

ar

1.3

CO

MP

AN

Y R

EP

RE

SEN

TA

TIV

E1

Nam

e or

com

pany

nam

e:R

FC

:

Add

ress

.

S

tree

t: __

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

__

Bui

ldin

g an

d Fl

oor

Num

bers

:___

____

____

____

___

Nei

ghbo

urho

od:_

____

____

____

____

____

____

____

____

____

____

____

Loca

lity

(exc

ept

Mex

ico

Cit

y.):

___

____

____

____

____

____

____

____

____

____

____

____

____

____

_ Po

stal

Cod

e:__

____

___

Mun

icip

alit

y or

Del

egat

ion:

____

____

____

____

____

____

____

__ F

eder

al B

ody:

____

____

____

____

____

____

____

____

____

_

Tel

epho

nes:

____

____

____

____

____

____

Fax

:___

____

____

____

__ E

lect

roni

c M

ail:_

____

____

____

____

____

____

____

___

1.4

EQ

UIV

AL

EN

T N

UM

BE

R O

F E

MP

LO

YE

ES

2 :

1.5

RIS

KS

AN

D C

ON

TIN

GE

NC

IES

1.5.

1D

ate

of s

ubm

issi

on o

f the

last

Ris

k A

sses

smen

t:D

ayM

onth

Year

1.5.

2D

ate

of th

e la

st u

pdat

e of

the

Acc

iden

t Pre

vent

ion

Prog

ram

:D

ayM

onth

Year

1.5.

3If

app

licab

le, d

ate

of u

pdat

e of

the

Con

tinge

ncy

Prog

ram

:D

ayM

onth

Year

1.5.

4If

loca

ted

in th

e M

etro

polit

an A

rea

of M

exic

o C

ity,

or

in a

n ar

ea h

avin

g an

Env

iron

men

tal C

onti

ngen

cy P

rogr

am, g

ive

the

date

you

r Pa

rtic

ipat

ion

Plan

for

the

Prog

ram

was

sub

mit

ted:

Day

Mon

thYe

ar

1 I

nfor

mat

ion

on t

he fa

cilit

y re

pres

enta

tive

aut

hori

zed

to d

eal w

ith

the

publ

ic a

nd c

lari

fy a

ny in

form

atio

n su

pplie

d in

thi

s C

erti

fica

te.

2 D

ivid

e th

e to

tal n

umbe

r of

man

hou

rs (

tota

l fac

ility

sta

ff)

by 2

000

hour

s.

Page 22: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

542542

TAKING STOCK: North American Pollutant Releases and Transfers

4

1.6

PR

OC

ESS

DE

SCR

IPT

ION

If n

eces

sary

due

to c

hang

es in

the

faci

lity

or if

usi

ng th

is fo

rm fo

r th

e fir

st ti

me,

pre

pare

the

Gen

eral

Ope

rati

ng D

iagr

am a

nd t

heT

able

of c

onsu

mpt

ion,

gen

erat

ion

and/

or r

elea

se p

oint

s, fo

llow

ing

the

exam

ple

incl

uded

in

the

Gen

eral

Ins

truc

tion

s. T

hedi

agra

m s

hall

incl

ude

all a

reas

(pr

oduc

tion

, was

tew

ater

trea

tmen

t, w

aste

man

agem

ent,

serv

ices

, etc

.) w

here

ther

e ar

e co

nsum

ptio

npo

ints

of r

aw m

ater

ials

, wat

er o

r en

ergy

, or

whe

re p

ollu

tant

s ar

e ge

nera

ted,

sto

red

or r

elea

sed.

1.7

RA

W M

AT

ER

IAL

S (

not a

pplic

able

to h

azar

dous

was

te tr

eatm

ent f

acili

ties)

Nam

e3C

onsu

mpt

ion

Phys

ical

Typ

e of

Ann

ual c

onsu

mpt

ion

Com

mer

cial

Che

mic

alC

AS

Num

ber

poin

t4st

ate5

stor

age6

Am

ount

7U

nit8

1.8

PR

OD

UC

TS

(no

t app

licab

le to

haz

ardo

us w

aste

trea

tmen

t fac

ilitie

s)

Prod

uct n

ame

Typ

e of

Inst

alle

d pr

oduc

tion

cap

acit

yA

nnua

l pro

duct

ion

stor

age

6A

mou

nt 7

Uni

t 8A

mou

nt 7

Uni

t 8

1.9

EN

ER

GY

CO

NSU

MP

TIO

N

Con

sum

ptio

nE

nerg

yA

nnua

l con

sum

ptio

npo

ints

9ty

pe10

Am

ount

7U

nit 8

3 I

ndic

ate

both

nam

es w

hen

poss

ible

and

if a

vaila

ble

the

Che

mic

al A

bstr

acts

Ser

vice

iden

tifi

cati

on n

umbe

r (C

AS

num

ber)

.4 C

onsu

mpt

ion

poin

t. N

umbe

r ap

pear

ing

in t

he G

ener

al O

pera

ting

Dia

gram

.5 P

hysi

cal s

tate

. Ph

ysic

al S

tate

Cod

es m

ay b

e co

nsul

ted

in T

able

1 o

f the

Gen

eral

Cat

alog

ue.

6 T

ype

of s

tora

ge.

Acc

ordi

ng t

o T

able

2 o

f th

e G

ener

al C

atal

ogue

.7 A

mou

nt.

Acc

ordi

ng t

o th

e T

able

in w

hich

it a

ppea

rs, r

efer

ring

to

valu

e of

, con

sum

ptio

n, r

elea

se, t

rans

fer,

sto

rage

, etc

.8 U

nit.

Any

uni

t cu

stom

arily

use

d in

the

faci

lity

may

be

used

; we

reco

mm

end

use

of t

he D

ecim

al M

etri

c Sy

stem

or

by d

efau

lt t

he I

mpe

rial

Sys

tem

.9 W

hen

ener

gy c

onsu

mpt

ion

per

proc

ess

is u

nkno

wn,

con

sum

ptio

n po

int

coul

d re

fer

to t

he fa

cilit

yÕs

inpu

t po

int(

s).

10 I

ndic

ate

whe

ther

the

ene

rgy

com

es f

rom

an

elec

tric

al c

urre

nt in

put

(EE

) or

if it

is in

tern

ally

gen

erat

ed in

the

fac

ility

thr

ough

fos

sil f

uel c

ombu

stio

n (C

F), u

seof

com

bust

ible

was

te (

RC

) or

thr

ough

ano

ther

gen

erat

ion

met

hod

(OM

).

Page 23: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

543

Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual)

5

1.10

FU

EL

(S)

USE

D

Com

bust

ion

Cap

acit

yB

urne

rFu

elC

onsu

mp-

Is it

pre

-A

nn

ual

cons

umpt

ion

equi

pmen

tA

mou

ntU

nit

type

type

tion

poi

nt11

heat

ed?

12A

mou

ntU

nit

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

II. A

TM

OSP

HE

RIC

PO

LL

UT

ION

Purs

uant

to

Art

icle

19

of t

he L

GE

EPA

Reg

ulat

ions

on

Atm

osph

eric

Pol

luti

on P

reve

ntio

n an

d C

ontr

ol, t

he fo

llow

ing

data

sha

ll be

prov

ided

the

fir

st t

ime

this

rep

orti

ng f

orm

is

used

or

whe

n th

e fa

cili

ty d

ata

are

diff

eren

t fr

om t

hose

re

port

ed i

n th

e Si

ngle

Env

iron

men

tal L

icen

se, t

he R

elea

se I

nven

tory

or

the

last

Ope

ratin

g C

ertif

icat

e:

2.1

PO

LL

UT

AN

T R

EL

EA

SE P

OIN

TS

Nam

e of

mac

hine

,eq

uipm

ent

Rel

ease

poin

t13R

elea

seex

pens

eE

stim

atio

nC

ontr

ol e

quip

men

tE

stim

ated

effic

ienc

y of

or a

ctiv

ity

Am

ount

Uni

tm

etho

d14or

met

hod

cont

rol e

quip

men

t15

11 W

hen

ener

gy c

onsu

mpt

ion

per

proc

ess

is u

nkno

wn,

con

sum

ptio

n po

int

coul

d re

fer

to t

he fa

cilit

yÕs

inpu

t po

int(

s).

12 S

tate

Yes

or

No.

13 R

elea

se p

oint

. N

umbe

r ap

pear

ing

in t

he G

ener

al O

pera

ting

Dia

gram

.14

Est

imat

ion

met

hod.

Acc

ordi

ng t

o T

able

3 o

f th

e G

ener

al C

atal

ogue

, whe

n no

sta

ndar

d ap

plie

s.15

Eff

icie

ncy

of t

he p

ollu

tant

red

ucti

on c

ontr

ol e

quip

men

t, in

per

cent

.

Page 24: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

544544

TAKING STOCK: North American Pollutant Releases and Transfers

6

2.2

RE

LE

ASE

DU

CT

S

2.2.

1 If

any

em

issi

ons

are

not d

ucte

d, g

ive

the

tech

nica

l rea

sons

for

this

sit

uati

on (

appe

nd d

ocum

ent)

.

2.2.

2 If

ther

e ar

e re

leas

e du

cts

indi

cate

:

Duc

t or

chim

ney

num

ber16

Rel

ease

poin

t 17

Hei

ght

(m)18

Inne

rdi

amet

er (

m)

Gas

flow

spee

d (

m/s

ec)

Out

put

tem

pera

ture

(¼C

)Sa

mpl

ing

plat

form

19

2.3

RE

LE

ASE

S IN

TO

TH

E A

TM

OSP

HE

RE

BY

CO

MB

UST

ION

EQ

UIP

ME

NT

20

2.3.

1 C

ombu

stio

n ga

ses

21

Rel

ease

NO

xSO

2C

OH

C22

poi

nt

Am

ount

Uni

tE

stim

atio

nm

etho

d23A

mou

ntU

nit

Est

imat

ion

met

hod

Am

ount

Uni

tE

stim

atio

nm

etho

dA

mou

ntU

nit

Est

imat

ion

met

hod

2.3.

2 Pa

rtic

les

and

exce

ss a

ir20

Rel

ease

Part

icle

s24Sm

oke

Exc

ess

air

poin

tA

mou

ntU

nit

Est

imat

ion

met

hod

dens

ity

% v

ol

III.

WA

TE

R U

SE A

ND

DIS

CH

AR

GE

OF

WA

STE

WA

TE

RS

16 E

num

erat

e in

pro

gres

sive

ord

er.

17 R

elea

se p

oint

. Num

ber

appe

arin

g in

the

Gen

eral

Ope

rati

ng D

iagr

am.

18 H

eigh

t in

met

ers

of t

he s

mok

esta

ck o

r re

leas

e du

ct m

easu

red

from

the

gro

und

up.

19 I

ndic

ate

whe

ther

the

re is

one

or

not.

20 R

epor

ted

valu

es m

ust

com

ply

wit

h N

OM

-085

-EC

OL-

1994

.21

If

NO

M-0

85-E

CO

L-1

994

is a

pplic

able

, the

fac

ility

sha

ll re

port

her

e th

e av

erag

e va

lue

of c

once

ntra

tion

s of

com

bust

ion

gase

s m

easu

red,

in p

pm, o

r us

e pp

mto

cal

cula

te t

he a

nnua

l tot

al r

elea

sed.

If t

his

is n

ot t

he c

ase,

an

esti

mat

e sh

all b

e m

ade

of t

he r

elea

ses,

indi

cati

ng t

he m

etho

d us

ed.

22 I

f th

e fa

cilit

y ha

s to

tal h

ydro

carb

on m

easu

rem

ents

the

ave

rage

val

ue i

n pp

m o

r to

tal a

nnua

l rel

ease

s sh

all b

e re

port

ed h

ere.

If

this

is

not

the

case

, it

shal

lre

port

the

est

imat

ed r

elea

ses

of s

peci

fic

hydr

ocar

bons

in S

ecti

on F

ive

of t

his

Cer

tifi

cate

.23

Whe

n t

he N

OM

-085

-EC

OL

-199

4 st

anda

rd i

s ap

plic

able

, on

ly d

irec

t m

easu

rem

ent

may

be

used

. If

thi

s is

not

the

cas

e, s

peci

fy t

he e

stim

atio

n m

etho

dac

cord

ing

to T

able

3 o

f th

e G

ener

al C

atal

ogue

.24

If

NO

M-0

85-E

CO

L-1

994,

is a

pplic

able

, the

fac

ility

sha

ll re

port

her

e th

e av

erag

e va

lue

of c

once

ntra

tion

s of

com

bust

ion

gase

s m

easu

red,

in

µg/m

3 o

r us

eth

em t

o ca

lcul

ate

the

annu

al t

otal

rel

ease

d. I

f thi

s is

not

the

cas

e, a

n es

tim

ate

shal

l be

mad

e of

the

rel

ease

s, in

dica

ting

the

met

hod

used

.

Page 25: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

545

Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual)

7

If t

his

form

is b

eing

use

d fo

r th

e fir

st t

ime

or if

the

dat

a re

ques

ted

are

diff

eren

t fr

om t

hose

cal

led

for

in t

he A

pplic

atio

n fo

r a

Sing

leE

nvir

onm

enta

l Lic

ense

or

in th

e la

st O

pera

tion

Cer

tific

ate,

the

follo

win

g da

ta s

hall

be p

rovi

ded

for

purp

oses

of i

nfor

mat

ion.

3.1

AN

NU

AL

WA

TE

R U

SE

Con

cess

ion

or a

ssig

nmen

t lic

ense

num

ber

25

Wat

er e

xtra

ctio

n so

urce

: A

mou

nt 7

Uni

t 8

Dri

nkin

g w

ater

net

wor

k

Surfa

ce

Und

ergr

ound

Salt

wat

er

Tre

ated

(reu

se)

Oth

er (s

peci

fy)

3.2

DIS

CH

AR

GE

OF

WA

STE

WA

TE

RS

3.2.

1 C

hang

es t

o th

e pe

rmit

or

auth

oriz

ed d

isch

arge

reg

istr

atio

n

Dis

char

ge p

erm

it or

reg

istr

atio

n nu

mbe

r

Cer

tific

ate

of c

hang

e nu

mbe

r is

sued

by

the

Publ

ic R

egis

try

of W

ater

Rig

hts

(RE

PDA

)

3.2.

2 G

ener

al d

isch

arge

dat

a

Disc

harg

eR

elea

seD

ischa

rge

Hyd

rolo

gica

lD

ischa

rge

Cro

pT

reat

men

t in

sit

u

type

26po

int27

num

ber28

regi

on29

frequ

ency

30Ir

riga

tion

31C

ode32

Am

ount

Uni

t

25 I

f the

re is

no

gran

t of

con

cess

ion

or a

ssig

nmen

t, a

ppen

d a

copy

of t

he c

onfi

rmat

ion

of c

onne

ctio

n to

the

dri

nkin

g w

ater

sys

tem

.26

Dis

char

ge t

ype.

Acc

ordi

ng t

o T

able

4 o

f th

e G

ener

al C

atal

ogue

.27

Rel

ease

poi

nt.

Num

ber

appe

arin

g in

the

Gen

eral

Ope

rati

ng D

iagr

am28

Whe

n pe

rtin

ent,

sta

te t

he r

elat

ions

hip

betw

een

the

rele

ase

poin

ts id

enti

fied

in t

he d

iagr

am o

f t

he f

acili

tyÕ

s co

nsum

ptio

n an

d re

leas

e po

ints

and

the

dis

char

genu

mbe

rs a

ppea

ring

in t

he a

pplic

atio

n m

ade

to t

he N

atio

nal W

ater

Com

mis

sion

.29

Acc

ordi

ng t

o T

able

17

of t

he G

ener

al C

atal

ogue

.30

Ind

icat

e if

con

tinu

ous

(C),

inte

rmit

tent

(I)

or

occa

sion

al (

F).

31 I

ndic

ate

whe

ther

res

tric

ted

(R

) or

not

res

tric

ted

(N).

32 T

reat

men

t m

etho

ds.

See

Tab

les

5, 6

and

7 o

f th

e G

ener

al C

atal

ogue

.

Page 26: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

546546

TAKING STOCK: North American Pollutant Releases and Transfers

8

3.2.

3 W

aste

wat

er d

isch

arge

qua

lity

desc

ript

ion

33

Para

met

erD

ischa

rge

num

ber34

Ann

ual v

olum

e [l

iter

s]

Hyd

roge

n po

tent

ial (

pH)

Tem

pera

ture

[¼C

]

Fats

and

oils

[m

g/l]

Floa

ting

mat

ter

(pre

sent

or

abse

nt)

Sedi

men

tabl

e so

lids

[ml/

l]

Tot

al s

uspe

nded

sol

ids

[mg/

l]

Bio

chem

ical

oxy

gen

dem

and

(DB

O5)

[m

g/l]

Tot

al n

itro

gen

[mg/

l]

Tot

al p

hosp

horu

s [m

g/l]

Feca

l col

iform

bac

teri

a [N

MP/

100

ml]

Hel

min

th e

ggs

[org

anis

ms/

l]

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

####

IV. H

AZ

AR

DO

US

WA

STE

GE

NE

RA

TIO

N, T

RE

AT

ME

NT

AN

D T

RA

NSF

ER

Pur

suan

t to

NO

M-0

52-E

CO

L-9

3, N

OM

-053

-EC

OL

-93

or w

hen

prov

idin

g ha

zard

ous

was

te t

reat

men

t se

rvic

es, i

ndus

tria

lfa

cilit

ies

shal

l pro

vide

the

fol

low

ing

info

rmat

ion

whe

n th

is f

orm

is u

sed

for

the

firs

t ti

me

or w

hen

the

data

req

uest

ed a

redi

ffer

ent f

rom

thos

e re

port

ed in

the

Sing

le E

nvir

onm

enta

l Lic

ense

or

the

last

Cer

tific

ate

of O

pera

tion:

4.1

HA

ZA

RD

OU

S W

AST

E G

EN

ER

AT

ION

AN

D T

RE

AT

ME

NT

WIT

HIN

TH

E F

AC

ILIT

Y

Gen

erat

ion

Was

te id

enti

ficat

ion

Ann

ual g

ener

atio

nT

reat

men

t or

dis

posa

l met

hod

poin

t35N

OM

-052

-C

ode36

Am

ount

Uni

tC

ode37

Tre

atm

ent c

apac

ity

EC

OL-

9338

Am

ount

Uni

t

33 A

nnua

l ave

rage

as

a fu

ncti

on o

f th

e vo

lum

e. V

alue

est

imat

ed b

ased

on

the

data

pre

sent

ed d

urin

g th

e re

port

ed y

ear

to t

he a

utho

riti

es (

if t

he C

NA

, use

the

figu

res

give

n in

the

qua

rter

ly d

ecla

rati

ons

for

the

righ

t to

rel

ease

).34

Ent

er d

isch

arge

num

bers

app

eari

ng in

the

app

licat

ion

mad

e to

the

Nat

iona

l Wat

er C

omm

issi

on.

35 G

ener

atio

n po

int.

Num

ber

appe

arin

g in

the

Gen

eral

Ope

rati

ng D

iagr

am.

36 H

azar

dous

was

te c

ode

acco

rdin

g t

o T

able

8 o

f th

e G

ener

al C

atal

ogue

.37

Tre

atm

ent

or d

ispo

sal m

etho

ds. S

ee T

able

s 5,

6, 7

, 9, 1

0, 1

1, 1

2 13

and

14

of t

he G

ener

al C

atal

ogue

.38

Was

te i

dent

ific

atio

n nu

mbe

r ac

cord

ing

to N

OM

-052

-EC

OL

-93,

ind

icat

ing

Tab

le n

umbe

r an

d ap

pend

ix w

here

list

ed o

r C

RE

TIB

cod

e. I

f th

e w

aste

is

not

liste

d, t

he c

orre

spon

ding

CR

ET

IB a

naly

sis

shou

ld b

e at

tach

ed.

Page 27: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

547

Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual)

9

4.2

HA

ZA

RD

OU

S W

AST

E S

TO

RA

GE

WIT

HIN

TH

E F

AC

ILIT

Y

Gen

e-W

aste

iden

tific

atio

nSt

orag

e39

rati

onN

OM

-052

-C

ode40

Typ

e41St

orag

e de

scri

ptio

n42

Cap

acit

yT

ime

poin

tE

CO

L-93

43Si

teM

ater

ial

Ven

tila

tion

Ligh

ting

Am

ount

Uni

t(d

ays)

4.3

HA

ZA

RD

OU

S W

AST

E T

RA

NSF

ER

S44

Gen

erat

ion

Was

te id

enti

ficat

ion

Han

dlin

g co

mpa

ny45

Tot

al tr

ansf

erre

d

poin

tN

OM

-052

-EC

OL

-93

Cod

eA

mou

ntU

nit

4.4

HA

ZA

RD

OU

S W

AST

E T

RE

AT

ME

NT

CO

MP

AN

IES

46

Was

te id

enti

ficat

ion

Tre

atm

ent o

r di

spos

alA

nnua

l tot

al h

andl

ed

NO

M-0

52-E

CO

L-93

Cod

em

etho

d 47

Am

ount

Uni

t

39 P

ursu

ant

to A

rtic

les

14 t

o 21

of

the

LG

EE

PA

Haz

ardo

us W

aste

s R

egul

atio

ns, a

ppen

d a

deta

iled

desc

ript

ion

of h

ow t

he w

aste

is s

tore

d an

d th

e si

te o

r si

tes

wit

hin

the

faci

lity,

indi

cati

ng d

rain

age

and

wat

er n

etw

orks

wit

hin

the

stor

age

area

as

wel

l as

the

safe

ty m

easu

res

take

n.40

Haz

ardo

us w

aste

cod

e a

ccor

ding

to

Tab

le 8

of

the

Gen

eral

Cat

alog

ue.

41 T

ype

of s

tora

ge.

See

Tab

le 2

of

the

Gen

eral

Cat

alog

ue.

42 S

tora

ge f

eatu

res

. See

Tab

le 1

5 of

the

Gen

eral

Cat

alog

ue.

43 W

aste

ide

ntif

icat

ion

num

ber

acco

rdin

g to

NO

M-0

52-E

CO

L-9

3, i

ndic

atin

g T

able

num

ber

and

appe

ndix

whe

re li

sted

or

CR

ET

IB c

ode.

If

the

was

te i

s no

tlis

ted,

the

cor

resp

ondi

ng C

RE

TIB

ana

lysi

s sh

ould

be

atta

ched

.44

The

haz

ardo

us w

aste

s ge

nera

tor

shal

l con

trac

t on

ly t

he s

ervi

ces

of c

ompa

nies

aut

hori

zed

to h

andl

e su

ch w

aste

s by

the

IN

E (

Art

icle

s 15

1 B

IS o

f th

e L

GE

EP

Aan

d 10

of

the

Haz

ardo

us W

aste

s R

egul

atio

ns).

45 E

nter

the

Haz

ardo

us W

aste

s T

reat

men

t Pe

rmit

Num

ber

issu

ed b

y th

e I

NE

.46

Thi

s se

ctio

n is

to

be c

ompl

eted

onl

y by

com

pani

es p

rovi

ding

haz

ardo

us w

aste

tre

atm

ent

serv

ices

.47

Tre

atm

ent

met

hod

code

. Se

e T

able

s 5,

6 7

, 10,

11,

12,

13

and

14 o

f the

Gen

eral

Cat

alog

ue.

Page 28: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

548548

TAKING STOCK: North American Pollutant Releases and Transfers

10

V.

ANN

UA

L R

ELEA

SES

AN

D T

RA

NSF

ER O

FLI

STED

PO

LLU

TA

NT

S

Thi

s se

ctio

n is

to

be c

ompl

eted

by

indu

stri

al fa

cilit

ies

rele

asin

g or

tra

nsfe

rrin

g an

y su

bsta

nce

or t

ype

of c

hem

ical

list

ed in

Tab

le 1

8of

the

Gen

eral

Cat

alog

ue.

5.1

ID

EN

TIF

ICA

TIO

N A

ND

USE

S

Pollu

tant

iden

tific

atio

nC

onsu

mpt

ion

orA

mou

ntU

nit

Est

imat

ion

Nam

e48K

ey49

Use

50re

leas

e po

int51

met

hod52

5.1.

1 In

form

atio

n re

quir

ed o

nly

for

haza

rdou

s was

te tr

eatm

ent a

nd w

aste

wat

er tr

eatm

ent f

acili

ties:

Pollu

tant

iden

tific

atio

nG

ener

ator

Am

ount

rec

eive

d

Nam

eK

eyid

entif

icat

ion

53A

mou

ntU

nit

48 S

ubst

ance

s. C

hem

ical

nam

e ac

cord

ing

to T

able

18

of t

he G

ener

al C

atal

ogue

.49

Cod

e ac

cord

ing

to T

able

18

of t

he G

ener

al C

atal

ogue

.50

Ind

icat

e if

use

d as

a d

irec

t in

put

(ID

), in

dire

ct in

put

(II)

, kep

t in

sto

rage

(IA

) or

gen

erat

ed in

-pla

nt (

EG

) by

a p

rodu

ctio

n, t

reat

men

t or

ser

vice

pro

cess

.51

Con

sum

ptio

n or

rel

ease

poi

nt.

Num

ber

appe

arin

g in

the

Gen

eral

Ope

rati

ng D

iagr

am.

52 E

stim

atio

n m

etho

d. S

ee T

able

3 o

f th

e G

ener

al C

atal

ogue

.53

Haz

ardo

us W

aste

s G

ener

ator

Reg

istr

atio

n N

umbe

r is

sued

by

the

INE

.

Page 29: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

549

Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual)

11

5.2

PO

LL

UT

AN

T R

EL

EA

SES

Pollu

tant

Into

air

Into

wat

erIn

to g

roun

d

code

54R

elea

sepo

int

Am

ount

Uni

tE

stim

atio

nm

etho

d55D

isch

arge

num

ber56

Am

ount

Uni

tE

stim

atio

nm

etho

dD

epos

itpo

int57

Am

ount

Uni

tE

stim

atio

nm

etho

d

5.2.

1 Po

lluta

nt r

elea

ses

to a

ny m

ediu

m d

ue t

o ac

cide

nts

and/

or c

onti

ngen

cies

:

Pollu

tant

cod

eE

vent

cod

e58A

mou

ntU

nit

Est

imat

ion

met

hod

54 C

ode

acco

rdin

g to

Tab

le 1

8 of

the

Gen

eral

Cat

alog

ue.

55 E

stim

atio

n m

etho

d. S

ee T

able

3 o

f th

e G

ener

al C

atal

ogue

.56

Ent

er d

isch

arge

num

bers

app

eari

ng in

the

app

licat

ion

mad

e to

the

Nat

iona

l Wat

er C

omm

issi

on.

57 P

oint

wit

hin

the

faci

lity

whe

re t

he p

ollu

tant

is d

epos

ited

for

trea

tmen

t or

fina

l dis

posa

l.58

Eve

nts.

Ent

er t

he e

vent

Cod

e ac

cord

ing

to T

able

16

of t

he G

ener

al C

atal

ogue

.

Page 30: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

550550

TAKING STOCK: North American Pollutant Releases and Transfers

12

5.3

PO

LL

UT

AN

T T

RA

NSF

ER

S

5.3.

1 T

rans

fer

to a

haz

ardo

us w

aste

s tr

eatm

ent f

acili

ty o

r to

was

tew

ater

trea

tmen

t fac

ilitie

s

Pollu

tant

cod

e59

Phys

ical

stat

e60H

andl

ing

com

pany

61T

reat

men

t or

disp

osal

met

hod

code

62A

mou

ntU

nit

Est

imat

ion

met

hod63

5.3.

2 T

rans

fer

to th

e pu

blic

sew

age

syst

em

Pollu

tant

cod

eR

elea

se p

oint

Am

ount

Uni

tE

stim

atio

n m

etho

d

59 C

ode

acco

rdin

g to

Tab

le 1

8 of

the

Gen

eral

Cat

alog

ue.

60 P

hysi

cal s

tate

. Se

e T

able

1 o

f th

e G

ener

al C

atal

ogue

.61

Env

iron

men

tal R

egis

trat

ion

Num

ber

of t

he fa

cilit

y au

thor

ized

to

hand

le h

azar

dous

was

tes.

62 T

reat

men

t or

dis

posa

l met

hods

. Se

e T

able

s 5,

6, 7

, 9, 1

0, 1

1, 1

2, 1

3 an

d 14

of t

he G

ener

al C

atal

ogue

.63

Est

imat

ion

met

hod.

See

Tab

le 3

of

the

Gen

eral

Cat

alog

ue.

Page 31: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL

551

Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual)

13

5.4

PO

LL

UT

ION

PR

EV

EN

TIO

N A

ND

CO

NT

RO

L

5.4.

1 T

otal

rel

ease

s an

d ac

tivi

ty in

dica

tors

Tot

al r

elea

ses

(ai

r +

wat

er +

soi

l)A

ctiv

ity

Pollu

tant

code

Prev

ious

yea

rR

epor

ted

year

Est

imat

e fo

r ne

xtye

arin

dica

tors

64

Am

ount

Uni

tA

mou

ntU

nit

Am

ount

Uni

tPr

evio

usye

arR

epor

ted

year

5.4.

2 P

ollu

tion

pre

vent

ion

and

cont

rol a

ctiv

itie

s

Tre

atm

ent

in si

tu

Pollu

tant

Con

trol

Stor

age

Tre

atm

ent

Phys

ical

Est

imat

ion

code

acti

vity

65Fo

rm66

Leng

th

(day

s)

Met

hod

code

67

Est

imat

ed

effi

cien

cyst

ate68

Am

ount

Uni

t m

etho

d69

64 T

he r

epor

ted

acti

vity

inde

x m

ay b

e ca

lcul

ated

bas

ed o

n th

e am

ount

of

chem

ical

use

d as

raw

mat

eria

l or

prod

uced

.65

Ind

icat

e if

the

re h

ave

been

: Cha

nges

in

oper

atin

g pr

acti

ces

(CP

O),

Tre

atm

ent

in si

tu (

TS)

, In

ven

tory

con

trol

(C

I),

Spil

l an

d le

akag

e pr

even

tion

(P

DF

),C

hang

es t

o in

puts

(C

MP)

, Pro

duct

cha

nges

(C

P), C

hang

es in

the

pro

duct

ion

proc

ess

(MPP

), C

hang

es in

cle

anin

g pr

acti

ces

(CPL

), O

ther

s (O

).66

Typ

e of

sto

rage

. Se

e T

able

2 o

f th

e G

ener

al C

atal

ogue

.67

Tre

atm

ent

met

hods

. Se

e T

able

s 5,

6 a

nd 7

of

the

Gen

eral

Cat

alog

ue.

68 P

hysi

cal s

tate

. Se

e T

able

1 o

f th

e G

ener

al C

atal

ogue

69 E

stim

atio

n m

etho

d. S

ee T

able

3 o

f th

e G

ener

al C

atal

ogue

Page 32: Appendix D: TRI Form R - cwm.unitar.org · Appendix F: Certificate for the Operation of Industrial Facilities under Federal Jurisdiction (Cédula de Operación Anual) I. GENERAL TECHNICAL