CONTINUED FROM THE FRONT VII. SIC CODES (4-digit, in order of non A. FIRST B. SECOND t N/A (sPecr 49 7N/A (way) 7 713 1 IB 17 15 16 19 C. THIRD D. FOURTH c N/A Wear) 7N/A (2PecifY) 7 is 16 17 15 16 19 VIII. OPERATOR INFORMATION A. NAME B. Is the name listed in Item C Arran McGinnis VIII-A also the owner? 8 ❑ YES 123 NO IS 19 65 C. STATUS OF OPERATOR (Enter the appropriate letter into the answer box; al 'Other, specify.) D. PHONE area code & no.) F= FEDERAL M= PUBLIC (other than federal a state) I p I (specify) S • STATE O = OTHER (specify) c 340 1690 1 1487 P • PRIVATE fl16 16 IS 19 21 12 ZS E. STREET OR PO BOX 6100 Red Hook Quarters B-3 26 55 F. CITY OR TOWN G. STATE H. ZIP CODE IX. INDIAN LAND c St. Thomas VI 00802 Is the facility loca ed on Indian lands? B❑ YES 8 NO15 16 40 42 42 47 51 X. EXISTING ENVIRONMENTAL PERMITS A. NPDES (Discharges to Surface Wafer) D. PSDemir Emissions from Proposed Sources) C7 IN /A9 N 9 P It5 16 57 15 18 17 l 18 30 B. UIC (Underground Injection of Fluids E. OTHER (specify) (Specify) C T IN/A G T s 9 U 9 15 03 17 IS 30 15 18 I? 18 30 C. RCRA (Hazardous Wastes) E. OTHER (specW) (Specify) T I N/A c 9 R 9 15 16 17 18 30 15 18 12 18 30 XI. MAP Attach to this application a topographic map of the area extending to at least one mile beyond properly show the outline of the facility, the location of each of its existing and proposed intake and discharge hazardous waste treatment, storage, or disposal facilities, and each well where it injects fluids underground. boundaries. The map must structures, each of its Include all springs, rivers and other surface water bodies in the map area. See instructions for ,recise re. uirements. XII. NATURE OF BUSINESS (provide a brief description) Private Residence, Domestic Use, Irrigation use. XIII. CERTIFICATION (see instructions) I certify under penally of law that I have personally examined and am familiar with the information submitted all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the the application, I believe that the information is true, accurate and complete. I am aware that there are submitting false information, including the possibilit of fine and imprisonment. in this application and information contained in significant penalties for A. NAME & OFFICIAL TITLE (type or print) B. SIGNATURE - Island Manager C. DATE SIGNED COMMENTS FOR OFFICIAL USE ONLY c C is 16 55 EPA FORM 3510.1 (8-90) EFTA01221868 PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY. You may report some or all of this information on separate sheets (use the same format) instead of completing these pages. SEE INSTRUCTIONS. EPA E NUMBER (copy from Item 1 of Form I) VI 0040525 V. INTAKE AND EFFLUENT PART A - You must provide CHARACTERISTICS (continued from page 3 of Form 2-C) the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional details. 1. POLLUTANT 2. EFFLUENT 3. UNITS (specify if blank) 4. INTAKE (optional) a. MAXIMUM DAILY VALUE 0. MAXIMUM 30 DAY VALVE oraix(orie) e. LONG TERM AVRG. VALUE Of ImNitible) d. NO. OF a. LONG TERM AVERAGE VALUE b. NO. OF iii coratimun ON in MASS in eateENTRAll ON (2) MASS in nonce/man ON Ca MASS ANALYSIS a. CONCEN. TRANON b MASS in eoNcEmitAn ON MP KASS ANALYSES a. Biochemical Oxygen Demand (8OD) N/A b. Chemical Oxygen Demand (COD) N/A C. Total Organic Carbon (TOC) N/A d. Total Suspended Solids (TSS) N/A e. Ammonia (as N) N/A f. Flow Value 300 000 Value 9,000,000 Value 6,000,000 30 Day Value g. Temperature (winter) Value Y9cValue 29c Value 29c Daily `C Value h. Temperature (summer) Value 29c Value 29c Value 29c Daily .0 Value i. pH Minimum 7.6 Maximum 7.8 Minimum Maximum 7.6 7.8 30 Day STANDARD UNITS PART B - Mark "X' in column 2-a for each pollutant you know or have reason to believe is present. Mark "r in column 2-b for each pollutant you believe to be absent. mark column 2a for any pollutant which is limited either directly, or indirectly but expressly in an effluent limitation guideline, you must provide the results one analysis for that pollutant. For other pollutants for which you mat* column 2a, you must provide quantitative data or an explanation of their presence discharge. Complete one table for each outfall. See the instructions for additional details and requirements. If you of at least in your 1. POLLUT- ANT AND CAS NO. (if available) 2. MARK le 3. EFFLUENT 4. UNITS (specify if blank) 5. INTAKE (optional) Livia& D err B. M. star a. MAXIMUM DAILY VALUE b MAXIMUM 30 DAY VALUE Of ava2eON) C. LONG TERM AVRG. VALUE (if avagablo) d. NO. OF a. LONG TERM AVERAGE VALUE b. NO. OF 0( OONCEIMA MN (2) MASS oi catepiattao N CI %MSS oi coNcENTRATIO NCZ MASS ANALYSIS a. CONGER. TRAT1ONb MASS PIANALYSES CONaPaltATION .ova: a. Bromide (24959-67-9) • s a Chrima Total Residual ❑ 02 c. Color 0 ei d. Fecal Coliform 0 r a. Fluoride (16984-48-8) O f. Nitrate- Nitrite (as N) 0 0 EPA FORM 3510-2C (Rev. 8-90) Page V-1 CONTINUE ON REVERSE EFTA01221869