DSHW-2025-000443

PART I - GENERAL INFORMATION APPLICANT: PLEASE COMPLETE ALL SECTIONS
I. Facility Type Small Incinerator Large Incinerator Small Incinerator, Commercial Large Incinerator, Commercial
II. Application Type New Application Major Modification (see R315-311-2(1)(c)) Renewal Application Minor Modification (see R315-311-2(1)(a))
For Renewal Applications, Facility Expansion Applications, and Modifications Applications, enter current permit number:
III. Facility Name and Location
Legal Name of Facility
Facility Address (Street or Directions to Facility)
County
City
Zip Code
Telephone
Township
Range
Section
Quarter Section
Quarter/Quarter SectionMain GateLatitude:Longitude:Click or tap here to enter text.
IV. Facility Owner(s) Information
Name of Facility Owner
Mailing Address
City
State
Zip Code
Telephone
V. Facility Operator(s) Information
Name of Facility Operator
Mailing Address
City
State
Zip Code
Telephone
VI. Property Owner(s) Information
Name of Property Owner
Mailing Address
City
.
State
Zip Code
Telephone
VII. Designated Contact Information
Facility Owner Designated Contact (if different than above)
Title
Mailing Address
City
State
Zip Code
Telephone
Email Address
Alternative Telephone (cell phone or other)
Facility Operator Designated Contact (if different than above)
Title
Mailing Address
City
State
Zip Code
Telephone
Email Address
Alternative Telephone (cell phone or other)
Property Owner Contact (if different than above)
Title

Mailing Address
City
State
Zip Code
Telephone
Email Address
Alternative Telephone (cell phone or other)
VIII. Waste Types (check all that apply)
IX. Design Capacity
All non-hazardous solid waste (see R315-315-7(3) for PCB special
requirements) OR facility accepts only the following wastes:
Asbestos
Construction and Demolition
Dead Animals
Industrial
Incinerator Ash
PCB’s (R315-315-7(3) only)
Petroleum Contaminated Soils
Other:
Tons per Day:
(or)
Pound per Hour:
PART II - APPLICATION CHECKLIST
Description of Item
Rule(s) Cited
Included in Submission
Location in the Document/Comments
Ia. General Requirements for All Facilities
Complete Part I - General Information
R315-310-3(1)(a)
Yes No, explain
General facility descriptions including maps, plans, and drawings
R315-310-3(1)(b)
Yes No, explain
Legal description of the property, proof of ownership, lease agreement, or other mechanism
R315-310-3(1)(c)
Yes No, explain
Types of waste to be handled at the facility and area served by the facility
R315-310-3(1)(d)
Yes No, explain
The Plan of Operation as required by R315-302-2(2)
R315-310-3(1)(e)
Yes No, explain
Form used to record weights or volumes of wastes received required by R315-302-2(3)(a)(i)
R315-310-3(1)(f)
Yes No, explain
Inspection schedule and inspection log as required by R315-302-2(5)(a)
R315-310-3(1)(g)
Yes No, explain
Closure and post-closure care plans
R315-310-3(1)(h)
Yes No, explain
Documentation to show that any wastewater treatment facility, such as run-off or a leachate treatment system is being reviewed by the Division of Water Quality
R315-310-3(1)(i)
Yes No, explain
Proposed financial assurance plan that meets the requirements of R315-309
R315-310-3(1)(j)
Yes No, explain
Historical and archeological identification efforts
R315-310-3(1)(k)

R315-302-1(2)(f)
Yes No, explain
For a new facility owned or operated by a local government, financial information that discloses the costs of establishing and operating the facility
R315-310-3(1)(l)
Yes No, explain
Documentation that the facility is not a commercial facility for facilities claiming non-commercial status
UCA 19-6-102(3)
Yes No, explain
Ib. Public Participation Requirements
Name and address of all owners of the property within 1,000 feet of the proposed facility
R315-310-3(2)(a)(i)
Yes No, explain
Documentation that a notice of intent to apply for a permit for a solid waste facility has been sent to all property owners identified in R315-310-3(2)(a)(i)
R315-310-3(2)(a)(ii)
Yes No, explain
Name of the local government with jurisdiction over the site and the mailing address of that local government office
R315-310-3(2)(a)(iii)
Yes No, explain
Ic. Location Standards for All Facilities
Documentation showing the facility will not be located within 1,000 feet of a nation, state, county, or city park, monument, recreation area, designated wilderness or wilderness study
area, wild and scenic river area, or stream, lake, or reservoir
R315-302-1(2)(a)(i)
Yes No, explain
Documentation showing the facility is not located within an ecologically and scientifically significant natural area, including wildlife management areas and habitat for threatened or
endangered species as designated pursuant to the Endangered Species Act of 1982
R315-302-1(2)(a)(ii)
Yes No, explain
Documentation showing the facility is not located within ¼ mile of existing permanent dwellings, residential areas, and other incompatible structures such as schools or churches and
historic structures or properties listed or eligible to be listed in the State or National Register of Historic Places
R315-302-1(2)(a)(iii)
Yes No, explain
Documentation showing the facility is not located in a subsidence area, a dam failure flood area, above underground mine, above a salt dome, about a salt bed, or on or adjacent to geologic
features that could compromise the structural integrity of the facility
R315-302-1(2)(b)(i)
Yes No, explain
Documentation showing the facility is not located within 200’ of a Holocene fault unless the owner or operator demonstrates to the Director that an alternative setback distance of less
than 200’ will prevent damage to the structural integrity of the unit
R315-302-1(2)(b)(ii)
Yes No, explain
Documentation showing the facility is not located in a seismic impact zone unless the owner or operator demonstrates to the Director that any containment structures, including liners,
leachate collection systems, and surface water control systems, are designed to resist the maximum horizontal acceleration in lithified earth material for the site
R315-302-1(2)(b)(iii)
Yes No, explain
If the facility is located in an unstable area, documentation that demonstrates to the Director that engineering measures have been incorporated into the facility design to ensure the
integrity of the structural components of the facility will not be disrupted
R315-302-1(2)(b)(iv)
Yes No, explain
Documentation showing the facility is not located on any public land that is being used by a public water system for water shed control for municipal drinking water purposes
R315-302-1(2)(c)(i)
Yes No, explain
Documentation showing the facility is not located in a flood plain unless the owner or operator demonstrates to the Director that the unit will not restrict the flow of the 100-year
flood, reduce the temporary water storage capacity of the floodplain, or result in a washout of solid waste
R315-302-1(2)(c)(ii)
Yes No, explain
Documentation showing the facility is not located in wetlands unless the owner or operator demonstrates to the Director the facility meets the requirements of R315-302-1(2)(d)(i) through
(vi)
R315-302-1(2)(d)
Yes No, explain
Documentation the applicant has paid the costs for review of a traffic impact study, any costs required by the road authority for improvements, and submit a traffic impact study as specified
in R315-302-1(2)(g)(i)

R315-302-1(2)(g)
Yes No, explain
Documentation demonstrating the facility will not incinerate infectious waste and chemotherapeutic agent waste within a two-mile radius of an area zoned as residential after January
1, 2014
R315-306-2(2)(b)
R315-306-3(2)(a)
Yes No, explain
Id. Special Requirements for a Commercial (For-Profit) Solid Waste Treatment Facility
Is this a commercial facility? ☐ Yes, complete Section Id. ☐ No, skip Section Id.
Information required by 19-6-108(10), including evidence of:
A proven market, including waste sources, quantity, pricing, waste generation trends, and competing facilities;
Public benefits, including meeting a capacity need, recovery of energy and resources, and reduction of less suitable waste management methods; and
An acceptable compliance history;
And, information to demonstrate that the requirements of 19-6-108(11) are satisfied, including evidence that:
The probable environmental effect outweighs the probable adverse environmental effect; and
The facility serves an industry need in the state.
R315-310-3(3)(a)
Yes No, explain
IIa.Plan of Operation Requirements for All Facilities
An intended schedule of construction
R315-302-2(2)(a)
Yes No, explain
Description of on-site solid waste handling procedures
R315-302-2(2)(b)
Yes No, explain
Schedule for conducting inspections and monitoring
R315-302-2(2)(c)
Yes No, explain
Contingency plans in the event of a fire or explosion
R315-302-2(2)(d)
Yes No, explain
Corrective action programs to be initiated if groundwater is contaminated
R315-302-2(2)(e)
Yes No, explain
Contingency plans for other releases, for example, release of explosive gases or failure of run-off containment system
R315-302-2(2)(f)
Yes No, explain
Plan to control fugitive dust
R315-302-2(2)(g)
Yes No, explain
Plan to control wind-blown litter
R315-302-2(2)(h)
Yes No, explain
Description of maintenance of installed equipment including leachate and gas collection systems, and groundwater monitoring systems
R315-302-2(2)(i)
Yes No, explain
Procedures for excluding the receipt of prohibited hazardous waste or prohibited waste containing PCBs
R315-302-2(2)(j)
Yes No, explain
Procedures for controlling disease vectors
R315-302-2(2)(k)
Yes No, explain
Plan for an alternative waste handling or disposal system during periods when the solid waste facility is not able to dispose of solid waste, including procedures to be followed in case
of equipment breakdown
R315-302-2(2)(l)
Yes No, explain
Closure and post-closure care plans
R315-302-2(2)(m)
Yes No, explain
Cost estimates and financial assurance information as required by R315-309-2(3)

R315-302-2(2)(n)
Yes No, explain
Training plan for site operations
R315-302-2(2)(o)
R315-306-2(12)
R315-306-3(2)(h)
Yes No, explain
IIb. Other Site-Specific Information Pertaining to the Plan of Operation as Required by the Director
Address alternative storage or disposal plans for any breakdown that would result in overfilling the storage facility
R315-306-2(3)
R315-306-3(2)(c)(i)
Yes No, explain
Written waste identification plan that includes the identification of the specific waste streams to be handled, generator waste analysis requirements and procedures, waste verification
procedures, generator certification of wastes shipped as being nonhazardous, and record keeping procedures, including a detailed operating record
R315-306-2(4)
R315-306-3(2)(c)(i) through (vi)
Yes No, explain
Demonstrate the facility is surrounded by a fence, trees, shrubbery, or natural features so as to control access and be screed from the view of immediate neighbors (unless the topping
floor is fully enclosed in a building; adequate buffer zone of at least 50 feet from the operating area to the nearest property line in areas zoned residential to minimize noise and
dust nuisances
(Large Incinerators Only)
R315-306-2(5)
Yes No, explain
Solid waste storage requirements
R315-306-2(6)
R315-306-3(2)(d)
Yes No, explain
Approved sampling plan for the composite sample ash and residues
R315-306-2(7)
R315-306-3(2)(e)
Yes No, explain
Demonstrate the facility is located, designed, constructed, and operated in a manner that complies with state and local air pollution control authority emission and operating requirements
R315-306-2(8)
R315-306-3(2)(g)
Yes No, explain
Documentation to show that air pollution and water pollution control systems are being reviewed or have been reviewed by the Division of Air Quality and the Division of Water Quality
R315-310-7(2)(c)
Yes No, explain
Procedures for the collection and treatment of any run-off from the active areas of the site that may result from a 25-year storm event, and divert any run-on for the maximum flow of
a 25-year storm around the site
(Large Incinerators Only)
R315-306-2(9)
Yes No, explain
The use of all-weather roads from the disposal site
(Large Incinerators Only)
R315-306-2(10)
Yes No, explain
Procedures for controlled access
(Large Incinerators Only)
R315-306-2(11)
Yes No, explain
Procedures for providing recycling facilities in a manner equivalent to those specified for landfills in R315-303-4(6)
(Large Incinerators Only)
R315-306-2(14)
Yes No, explain
Procedures to prevent the disposal of prohibited hazardous waste or prohibited waste containing PCBs
R315-306-2(15)
R315-306-3(2)(f)
Yes No, explain
Procedures for handling special wastes as required by R315-315

R315-315-1(1)
Yes No, explain
Cleaning procedures for storage areas
R315-310-7(2)(b)(i)
Yes No, explain
Inspections to ensure compliance with state and local air pollution laws
R315-310-7(2)(b)(iii)
Yes No, explain
Disposal procedures describing how and where fly ash, bottom ash, and other solid waste will be disposed
R315-310-7(2)(b)(iv)
Yes No, explain
Other site-specific information required by the Director
R315-302-2(2)(p)
Yes No, explain
IIIa. Geohydrological Assessment
Local and regional geology and hydrology, including faults, unstable slopes, and subsidence areas on site
R315-310-4(2)(b)(i)
Yes No, explain
Evaluation of bedrock and soil types and properties, including permeability rates
R315-310-4(2)(b)(ii)
Yes No, explain
Depths to groundwater or aquifers
R315-310-4(2)(b)(iii)
Yes No, explain
Direction and flow rate of groundwater
R315-310-4(2)(b)(iv)
Yes No, explain
Quantity, location, and construction of any private and public wells on the site and within 2,000 feet of the facility boundary
R315-310-4(2)(b)(v)
Yes No, explain
Tabulation of all water rights for groundwater and surface water on the site and within 2,000 feet of the facility boundary
R315-310-4(2)(b)(vi)
Yes No, explain
Identification and description of all surface waters on the site and within one mile of the facility boundary
R315-310-4(2)(b)(vii)
Yes No, explain
Background and surface water quality assessment and identification of impacts of the existing facility upon ground and surface waters from landfill leachate discharges
R315-310-4(2)(b)(viii)
Yes No, explain
Calculation of a site water balance
R315-310-4(2)(b)(xi)
Yes No, explain
Conceptual design of a groundwater and surface water monitoring system, including proposed installation methods for these devices and where applicable, a vadose zone monitoring plan
R315-310-4(2)(b)(x)
Yes No, explain
IIIb. Engineering – Designs, Plans, and Specifications
Topographic map of the facility unit drawn to a scale of 200 feet to the inch containing five foot contour intervals
R315-310-4(2)(a)(i)
Yes No, explain
Most recent full size U.S.G.S. topographic map, 7-1/2 minute series showing the waste facility boundary, the property boundary, surface drainage channels, existing utilities, and structures
within 1/4-mile of the facility site, and the direction of the prevailing winds
R315-310-4(2)(a)(ii)
Yes No, explain
Engineering report, plans, specifications, and calculations of how the facility will meet location standards in R315-302-1
R315-310-4(2)(c)(i)
Yes No, explain
Design and location of run-on and run-off control systems
R315-310-4(2)(c)(viii)
Yes No, explain
Quality control and quality assurance for the construction of any engineered structure of feature, excluding buildings at the landfills, at the solid waste disposal facility and for

any applicable activity such as groundwater monitoring
R315-310-4(2)(c)(x)
Yes No, explain
Documentation the facility meets the Performance Standards
R315-303-2
Yes No, explain
Engineering report, plans, specifications, and calculations
R315-310-7(2)(a)
Yes No, explain
Other design requirements
R315-303-3(8)
Yes No, explain
IV. Closure and Post Closure Care Requirements for Incinerators
Closure plan as required by R315-302-3
R315-310-7(2)(d)
Yes No, explain
Closure plan to include the removal of any ash, solid waste, or other residues to a permitted facility
R315-306-2(16)
R315-306-3(2)(i)
Yes No, explain
V. Financial Assurance Requirements for Incinerators
Financial assurance to cover the costs for closure of the facility that meets the requirements of R315-309
R315-306-2(17)
R315-306-3(2)(j)
Yes No, explain