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	12/2007	292K
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.

NOx SIP Call
Form Name (pdf format)	Form	Date	Size
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	08/2007	182K

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) (Word Format)	---	04/2006	280K
General Permit Applications
Sample Permit (PDF Format)	---	12/2005	169K
Concrete Permit Instructions (PDF Format)	---	06/2006	266K
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
Miscellaneous Forms
SC Department of Health & Environmental Control Insignificant Activities List (PDF)	---	04/2008	78K
Regulated Pollutant List (Word Format- Fillable)	---	04/2006	533K
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

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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	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	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	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	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	--- <