DWQ-2024-007026

DWQ USE ONLY
Date received:
Filing Date (application complete):
Application for Sales and/or Use Tax Exemption Certification Read
before completing this form.
1.To be certifiable, the PCF/FPCP(s) must be
designed, constructed, installed, or be used primarily
(its primary function is) to control, remove, reduce or
prevent water pollution by the disposal or elimination ofwaste and the use of treatment works for industrialwaste. Basic to any consideration for exemption is that(1)there needs to be water pollution in the stream
entering PCF/FPCP(s) and (2) there needs to
be a demonstrated reduction, control, or preventionof pollution by the method mentioned above.2.An application may be submitted after contract has been
let for the PCF/FPCP(s).3.Complete the application and send to the Division of
Water Quality. The Director of the Division has
authority to issue the certifications in compliance withTitle 19-12.
4.The application can only be processed if the
information is complete. The Division may request
additional information before the application can be
considered complete. Once the application is
complete, the filing date is fixed and the 120 days
processing period begins. The certification will
consist of a letter signed by the Director ordesignated staff and will list what pollution control
facilities or components are being certified. The
certification is for the PCF/FPCP, not the costs
submitted.
5.Before a certification is given, DWQ will consult with
the Utah State Tax Commission.6.Ultimately Regardless of any guidance the PCF/FPCPmust comply with Utah Title 19-12 in order to Qualify
Name of requesting Trade or Business
Name of Owner Individual Partnership Corporation Lessee
Trade or Business Mailing Address Contact person’s name and telephone number
Street Address City County State ZIP Code
Location of PCF/FPCP (if different from mailing address)
Street Address City County State
UT
ZIP Code
The following information must be provided before a certification will be processed.
1.Water Quality permit or approval order (date and number, if applicable), rule or State that applies to this PCF/FPCP
Date PCF/FPCP construction or installation started Date contract was awarded 2.Check one and provide date.
3.Estimated PCF/FPCP(s) completion date
4.Please provide a brief description of the PCF/FPCP(s) and the process or operational procedure associated with it.
Attach additional pages if needed.
Pollution Control Facility (PCF)/Freestanding Pollution Control Property (FPCP)
Certification Application Division of Water Quality (DWQ)
5. Please give a statement of expected or realized reduction of pollutant discharges or emission levels, which
can be demonstrated. Attach additional pages if needed.
6. Describe recoverable by-products resulting from the PCF/FPCP(s).
7.Check one and provide information. If PCF/FPCP(s) is/(are) part of a larger project(s) include only thosecosts chargeable to the PCF/FPCP(s).
Total estimated costs for the PCF/FPCP(s) Total actual costs for the PCF/FPCP(s)
8. Please list the major components of the pollution control facility(ies). Include materials, equipment, land
(or parts thereof) purchased, leased, or otherwise procured and services with the estimated or actual costschargeable to the PCF/FPCP(s). Attach additional pages as needed.
9. List the PCF/FPCP(s) contractors constructing or installing. Attach additional pages as needed.
Send application: Division of Water Quality 288 North 1460 West P.O. Box 144870 Salt Lake City, UT 84114-4870
https://deq.utah.gov/water-quality/water-quality-electronic-submissions
or Via the Water Quality Electronic Submissions Portal via URL below:
I hereby Certify that to the best of my knowledge and understanding that the Facility/Property meets the definition of a Pollution Control Facility or Freestanding Pollution Control Property as Required in Utah Title 19-12:
Applicant Signature_________________________ Name/Title________________________________________
PCF or Date________________________ Type of Property FPCP