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Hazardous Waste Facility Permit Fee Transmittal 47214 - Indiana
| Hazardous Waste Facility Permit Fee Transmittal Form. This is a Indiana form and can be used in Land Department Of Enviromental Management Statewide . |
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HAZARDOUS WASTE FACILITY PERMIT FEE TRANSMITTAL State Form 47214 (R6 / 11-12) Approved by State Board of Accounts, 2012 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT INSTRUCTIONS: This form shall be used to transmit fees for all hazardous waste facility permits, applications, and modifications (NEW permits, RENEWALS of permits, Class 2 & 3 MODIFICATIONS of permits) pursuant to IC 13-16, and is to accompany all payments. Make check or money order payable to the Indiana Department of Environmental Management. For payment by Master Card or Visa please visit the IDEM Cashier's office or contact the office by telephone at 317-232-8705 Monday through Friday between the hours of 9:00am to 3:00pm. Upon completion, return this form and appropriate fees to the following address: Glynda Oakes (N1154) Indiana Department of Environmental Management Office of Land Quality Permits Mail Code 66-20 100 North Senate Avenue Indianapolis, IN 46204-2251 A COPY of your check, money order or IDEM issued credit card receipt and a COPY of this fee transmittal form must be attached to your permit application. Submit application and modification materials to: Mr. Victor P. Windle Indiana Department of Environmental Management Office of Land Quality Permits Mail Code 66-20 100 North Senate Avenue Indianapolis, IN 46204-2251 SECTION A. APPLICANT(S) INFORMATION Name: Mailing address: (number and street) City State ZIP code Telephone number: Name and County of Facility: Type of Application Amount of Fee ACC. #2830-412300-100800 American LegalNet, Inc. www.FormsWorkFlow.com SECTION B. HAZARDOUS WASTE PERMIT FEE SCHEDULE The following fees are to accompany applications and modifications. A person or facility that is described in more than one (1) category must pay all applicable fees in accordance with 329 IAC 3.1-1-14.1(b). Please circle all fee(s) you are paying. Type of Facility Hazardous Waste Landfill Hazardous Waste Incinerator Hazardous Waste Storage Facility Hazardous Waste Treatment Facility Part B for Existing Storage Facility* Part B for Existing Treatment Facility* New Permit Application $40,600 Permit Renewal $34,000 Class 3 Modification $34,000 Class 2 Modification $2,250 $21,700 (per unit) $21,700 (per unit) $21,700 (per unit) $2,250 $23,800 $17,200 $17,200 $2,250 $23,800 $17,200 $17,200 $2,250 $23,800 N/A N/A N/A $23,800 N/A N/A N/A *Applies to interim status facility seeking first permit. American LegalNet, Inc. www.FormsWorkFlow.com
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