DSHW-2025-000444

PART I - GENERAL INFORMATION APPLICANT: PLEASE COMPLETE ALL SECTIONS
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:
.
II. 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:
III. Facility Owner(s) Information
Name of Facility Owner
Mailing Address
City
State
Zip Code
Telephone
IV. Facility Operator(s) Information
Name of Facility Operator
Mailing Address
Click or tap here to enter text.
City
State
Zip Code
Telephone
V. Property Owner(s) Information
Name of Property Owner
Mailing Address
City
State
Zip Code
Telephone
VI. 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)
VII. Waste Types (check all that apply)
VIII. Facility Area
Exploration and Production wastes that are exempt from hazardous waste rules (R315-261-4(b)(5))
Hydro excavation wastewater
Industrial wastewater
Restaurant waste liquids and greases
Sludge
Other: Click or tap here to enter text.
Hazardous waste from very small quantity generator (R315-260-10(c)(172))
Facility Area: acres
Disposal Area:Click or tap here to enter text. acres
Design Capacity: Years Cubic Yards Tons
PART 2 – APPLICATION CHECKLIST (ALL PERMIT APPLICATIONS)
Permit Requirements for Solid Waste Facilities (R315-310)
General Contents of a Permit Application for a New Facility or a Facility Seeking Expansion (R315-310-3)
Description of Item
Rule(s) Cited
Included in Submission
Comments / Explanation / Location in Document
Complete Part I - General Information.
R315-310-3(1)(a)
YesNo, explain
General facility description, plans, and drawings signed and sealed by a professional engineer registered in Utah
R315-310-3(1)(b)
R315-310-3(1)(b)(i)(B)
R315-310-3(1)(b)(i)(C)
YesNo, explain
Legal description of the property, proof of ownership, lease agreement, or other mechanism
R315-310-3(1)(c)
YesNo, explain
Maps of the proposed facility site, including land use and zoning of the surrounding area
R315-310-3(1)(c)
YesNo, explain
Description of waste types to be handled and area served by facility
R315-310-3(1)(d)
YesNo, explain
Plan of Operation
(See detailed requirements in Section 3.2.1 of this document)
R315-310-3(1)(e)
R315-302-2(2)
(See detailed requirements in Section 3.2.1 of this document)
Form used to record weights or volumes of waste received
R315-310-3(1)(f)
R315-302-2(3)(a)(i)
YesNo, explain
Inspection schedule and inspection log
R315-310-3(1)(g)
R315-302-2(5)(a)
YesNo, explain
Closure and post-closure care plans required by R315-302-3.
(See detailed requirements in Section 3.6 of this document.)
R315-310-3(1)(h)
R315-302-3

YesNo, explain
Financial Assurance Cost Estimates
(See detailed requirements in Section 3.6.3 of this document)
R315-310-3(1)(j)
R315-309-2
YesNo, explain
Historical and archaeological identification efforts
(See detailed requirements in Section 3.1.6 of this document.)
R315-310-3(1)(k)
YesNo, 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)
YesNo, explain
Name and address of all owners of the property within 1,000 feet of the proposed facility
R315-310-3(2)(a)(i)
YesNo, 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 above.
R315-310-3(2)(a)(ii)
YesNo, 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)
YesNo, explain
Contents of a Permit Application for a New or Expanded Solid Waste Surface Impoundment (R315-310-4, R315-310-5)
Description of Item
Rule(s) Cited
Included in Submission
Comments / Explanation / Location in Document
Topographic map of the facility and waste management units drawn to a scale of 200 feet to the inch containing:
Five foot contour intervals where the relief exceeds 20 feet and two foot contour intervals where the relief is less than 20 feet;
Boundaries of the facility and waste management units; and
Ground water monitoring wells if used.
R315-310-4(2)(a)(i)
YesNo, explain
The most recent full size U.S. Geological Survey topographic map, 7-1/2 minute series, if printed, or other recent topographic survey of equivalent detail of the area, showing:
The waste facility boundary;
The property boundary;
Surface drainage channels;
Existing utilities and structures within one-fourth mile of the facility site; and
The direction of the prevailing winds
R315-310-4(2)(a)(ii)
YesNo, explain
If accepting small quantity generator hazardous waste, a geohydrological assessment of the facility that addresses:
Local and regional geology and hydrology, including faults, unstable slopes and subsidence areas on site;
Evaluation of bedrock and soil types and properties, including permeability rates;
Depths to ground water or aquifers;
Direction and flow rate of ground water;
Quantity, location, and construction of any private and public wells on the site and within 2,000 feet of the facility boundary;
Tabulation of all water rights for ground water and surface water on the site and within 2,000 feet of the facility boundary;
Identification and description of all surface waters on the site and within one mile of the facility boundary;
Background ground and surface water quality assessment and identification of impacts of the existing facility upon ground and surface waters from discharges;
Calculation of a site water balance; and
Conceptual design of a ground water 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)
YesNo, explain
If accepting small quantity generator hazardous waste, an engineering report, plans, specifications, and calculations that address:
Location standards of R315-302-1 (see location standards in Section 3.1 of this document);
The basis for calculating the facility's life;
Cell design to include liner design, cover design, fill methods, elevation of final cover and bottom liner, and equipment requirements and availability;
Identification of borrow sources for daily and final cover, and for soil liners;
Interim and final leachate collection, treatment, and disposal;

Ground water monitoring plan (if applicable);
Facility gas monitoring and control (if applicable);
Design and location of run-on and run-off control systems;
Closure and post-closure design, construction, maintenance, and land use; and
Quality control and quality assurance for the construction of any engineered structure or feature
How the facility will meet the requirements of Rule R315-322 for a solid waste surface impoundment. (see requirements in Part 3 of this document)
R315-310-4(2)(c)
R315-310-5(2)(e)
YesNo, explain
A Closure Plan addressing schedule, capacity, a final inspection, and closure costs.
(See detailed requirements in Section 3.6.1 of this document)
R315-310-4(2)(d)
YesNo, explain
A Post-Closure Plan addressing, as appropriate: site monitoring of facility gas, groundwater, and surface water; inspections by facility owner or operator; maintenance activities to
maintain cover and run-on and run-off systems; identification of post-closure costs; changes to record of title; and contact information.
(See detailed requirements in Section 3.6.2 of this document)
R315-310-4(2)(e)
YesNo, explain
PART 3 – APPLICATION CHECKLIST, SOLID WASTE SURFACE IMPOUNDMENT
Solid Waste Surface Impoundment Requirements (R315-322)
Description of Item
Rule(s) Cited
Included in Submission
Comments / Explanation / Location in Document
Location Standards (R315-322-2)
Land Use Compatibility
Documentation that the facility is not located within 1,000 feet of monuments, wilderness areas, or specified water bodies:
R315-322-2(1)
R315-302-1(2)(a)(i)
YesNo, explain
Documentation that the facility is not located within ecologically and scientifically significant natural areas.
R315-322-2(1)-(2)
R315-302-1(2)(a)(ii)
YesNo, explain
Documentation that the facility is not located within ¼ mile of:
Dwellings, Schools, or Churches; and
Historic Properties
R315-322-2(1)
R315-302-1(2)(a)(iii)
YesNo, explain
Documentation that the facility is not located within 5,000 fet of any airport runway.
R315-322-2(1)
R315-302-1(2)(a)(iv)
YesNo, explain
Documentation that the facility is not located within qualifying archaeological sites.
R315-322-2(1)
R315-302-1(2)(a)(v)
YesNo, explain
Geology
Documentation that the facility is not located on any geologically unstable area, fault areas, or seismic impact zones.
R315-322-2(1)
R315-302-1(2)(b)
YesNo, explain
Surface Water
Documentation that the facility is not located on land used for drinking water purposes.
R315-322-2(1)
R315-302-1(2)(c)(i)
YesNo, explain
Documentation that the facility is not located within a floodplain unless a demonstration can be made that it will not restrict flow, reduce temporary storage, or result in a washout.
R315-322-2(1)-(2)

R315-302-1(2)(c)(ii)
YesNo, explain
Wetlands
Documentation that the facility is not located within a wetland unless a demonstration of sufficient information reasonably determines:
There is no practicable alternative;
It will not violate State or Federal law;
It will not jeopardize threatened and endangered species and associated critical habitat;
There will be no significant degradation of wetlands; and
Appropriate steps have been taken for no net loss of wetlands.
R315-322-2(1)-(2)
R315-302-1(2)(d)
YesNo, explain
Groundwater
Documentation that the facility is not located:
Within 5 feet of high groundwater (lined);
Within 10 feet of high groundwater (unlined);
Within 5 feet of high groundwater if specific criteria are met;
Over a sole source aquifer;
Over groundwater classified as IB; or
In a designated drinking water source protection area.
R315-322-2(1)
R315-302-1(2)(e)
YesNo, explain
Historic Preservation Survey Requirement
Documentation of notice of concurrence, or lack thereof, or joint analysis from State Historic Preservation Office of no adverse effect on any historic properties.
R315-322-2(1)
R315-302-1(2)(f)
YesNo, explain
Traffic Impact Study Requirement
Documentation of a traffic impact study approved by the jurisdictional authority of the roads to include:
Safety, operation, and condition of roadways serving the facility and forecasted needs; and
Any improvement and maintenance agreements with the road authority.
R315-322-2(1)
R315-302-1(2)(g)
YesNo, explain
Location Exemption
Documentation of any exemptions from location standards.
R315-322-2(1)
R315-302-2(3)b)(i)
YesNo, explain
Solid Waste Surface Impoundment General Requirements (R315-322-3)
Plan of Operation
An intended schedule of construction
R315-322-3(1)(a)
R315-302-2(2)(a)
YesNo, explain
Solid Waste Handling Procedures
R315-322-3(1)(a)
R315-302-2(2)(b)
YesNo, explain
Inspection and Monitoring Schedule
R315-322-3(1)(a)
R315-302-2(2)(c)
YesNo, explain
Fire or Explosion Contingency Plan
R315-322-3(1)(a)
R315-302-2(2)(d)
YesNo, explain
Corrective Action Program for Groundwater Contamination
R315-322-3(1)(a)

R315-302-2(2)(e)
YesNo, explain
Contingency plans for other releases
R315-322-3(1)(a)
R315-302-2(2)(f)
YesNo, explain
Fugitive Dust Control Plan
R315-322-3(1)(a)
R315-302-2(2)(g)
YesNo, explain
Description of maintenance of installed equipment including leachate and gas collection systems, and groundwater monitoring systems
R315-322-3(1)(a)
R315-302-2(2)(i)
YesNo, explain
Procedures for excluding the receipt of prohibited hazardous waste or prohibited waste containing PCBs
R315-322-3(1)(a)
R315-302-2(2)(j)
YesNo, 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
R315-322-3(1)(a)
R315-302-2(2)(l)
YesNo, explain
Closure and Post-Closure Care Plans
(See detailed requirements in Section 3.6 of this document)
R315-322-3(1)(a)
R315-302-2(2)(m)
YesNo, explain
Cost estimates and financial assurance. (See detailed requirements in Section 3.6 of this document)
R315-322-3(1)(a)
R315-302-2(2)(n)
YesNo, explain
Facility operations training plan for site operators
R315-322-3(1)(a)
R315-302-2(2)(o)
YesNo, explain
If managing high liquid wastes, then a High Liquid Waste Management Plan must be included in the Plan of Operations
R315-303-3(2)
YesNo, explain
For surface impoundments that use enhanced evaporation systems, a plan to control overspray and corrective actions for overspray cleanup.
R315-322-3(1)(b)
YesNo, explain
Recordkeeping (to be kept onsite or at an approved location)
Daily operating records documentation containing:
Weights or volumes of solid waste received daily.
Documentation of deviations from the approved plan of operation.
Training and notification procedures
Results from groundwater and gas monitoring that may be required.
An inspection log or summary.
R315-322-3(1)(c)
R315-302-2(3)(a)
YesNo, explain
Documentation of any demonstration made with respect to any location standard or exemption.
R315-322-3(1)(c)
R315-302-2(3)(b)(i)
YesNo, explain
Closure and post-closure plans
(See detailed requirements in Section 3.6 of this document)
R315-322-3(1)(c)
R315-302-2(3)(b)(iii)

YesNo, explain
Cost estimate and financial assurance documentation.
(See detailed requirements in Section 3.6 of this document)
R315-322-3(1)(c)
R315-302-2(3)(b)(iv)
YesNo, explain
Other information pertaining to operation, maintenance, monitoring, or inspections as may be required by the director.
R315-322-3(1)(c)
R315-302-2(3)(b)(vi)
YesNo, explain
Reporting
Annual and Quarterly reporting requirements.
R315-322-3(1)(d)
R315-315-302-2(4)
YesNo, explain
Inspections
Owner or Operator Inspections
R315-322-3(1)(e)
R315-315-302-2(5)
YesNo, explain
Solid Waste Surface Impoundment Standards for Performance (R315-322-4)
Meet the standards for performance as described in R315-303-2.
R315-322-4(1)
R315-303-2
YesNo, explain
Documentation of flagging, netting, or other appropriate measures to protect waterfowl and other wildlife receptors which may reasonably be expected to come into contact with E&P wastes
managed in Class VII solid waste surface impoundments.
R315-322-4(2)-(3)
YesNo, explain
Documentation of facility fencing used to deter access of livestock and wildlife.
R315-322-4(3)
YesNo, explain
Standards for Design, R315-322-5
Documentation that impoundment is 55 acre-feet of water or less, unless otherwise approved by the director.
R315-322-5(2)
YesNo, explain
Documentation of levee design that meets the following standards:
Inside grade is no steeper than 3:1 and outside grade no steeper than 2:1;
The top of the levee shall have a 2% cross slope toward the pond and be of sufficient width to allow for adequate anchoring of liner components and compaction; and
Vertical height of the levees shall not exceed 25 percent of the total vertical depth of the surface impoundment.
R315-322-5(3)
YesNo, explain
Diagrams of unloading structures and applicable explanations that contain:
Construction and installation details;
Explanation of methods that control flow and prevent undesired waste from entering the surface impoundment, including hydrocarbons; and
Leak detection system, unless determined unnecessary by the director.
R315-322-5(4)
YesNo, explain
Demonstration that design, construction, and operation of any dewatering, stabilization, or treatment used complies with containment system and leachate management requirements of R315-303-3(2)(b).
R315-322-5(5)
R315-303-3(2)(b)
YesNo, explain
Detailed control features of enhanced evaporation systems, including location (must be at least 100 t from facility exterior boundary)
R315-322-5(6)
YesNo, explain
If applicable, documentation of container and tank storage areas used to manage waste containing free liquids shall have a secondary containment that:
Is sufficiently impervious to contain leaks, spills, and accumulated precipitation;
Is designed to drain and remove liquids from leaks, spills, or precipitation;
Must contain 10% of the cumulative volume of the containers, or the volume of the largest container, whichever is greater;
Is designed to prevent run-on into the containment system; and/or

Is designed to remove spilled or leaked waste and accumulated precipitation from the sump or collection area.
R315-322-5(7)
YesNo, explain
Documentation of facility stormwater run-on controls
R315-322-5(8)
R315-303-3(1)(c)
YesNo, explain
Documentation of facility stormwater run-off collection and treatment.
R315-322-5(8)
R315-303-3(1)(d)
YesNo, explain
Demonstrate that the facility will meet the requirements of R315-303-3(8) including:
Fencing at the property or unit boundary.
A lockable gate.
Weighing or estimating tonnage of all incoming waste and recording in operation record.
Erecting a sign at the facility entrance with specific information. (for facilities located in Duchesne or Uintah County, the sign must include location using the Public Land Survey
System)
Other requirements, as specified by Director.
R315-322-5(9)
R315-303-3(8)
YesNo, explain
Detailed design drawings and as built drawings of surface impoundments and other associated structures signed and sealed by a professional engineer.
R315-322-5(10)
R315-303-3(7)
YesNo, explain
For new or laterally expanding surface impoundments, documentation demonstrating the facility either:
Meets the requirements for groundwater alternative or waiver of R315-302-1(2)(e)(vi);
Monitor the groundwater beneath the impoundment according to R315-308; or
Install and maintain leak detection equipment and conduct monitoring according to R315-322-5(13).
R315-322-5(11)(b)
R315-302-1(2)(e)(vi)
R315-308
R315-322-5(13)
YesNo, explain
For existing surface impoundments, documentation of existing groundwater monitoring wells or leak detection equipment and associated monitoring programs.
R315-322-5(11)(d)
YesNo, explain
The following documentation regarding synthetic liners being used:
Evidence that liner is appropriate for containing E&P waste;
Material used and installation methods are included in the quality control and quality assurance portion of the engineering report;
Procedures for liner repair, should leakage occur; and
Meet liner design requirements of R315-303-3(4), or dual liner design standards of R315-322-5(12)(f).
R315-322-5(12)
R315-310-4(2)(c)(x)
R315-303-3(4)
R315-322-5(12)(f)
YesNo, explain
Detailed construction and installation diagrams of leak detection system to include:
Drainage and collection area between the liners;
Vertical riser for visual inspection of the sump area; and
Monitoring schedule.
R315-322-5(13)
YesNo, explain
Standards for Operation (R315-322-6)
Evidence demonstrating that the facility will operate according to requirements of R315-303-4.
R315-322-6(1)
R315-303-4
YesNo, explain
Evidence demonstrating that the facility will operate according to operational standards including:
Operating will a minimum of three feet of freeboard.

Separating oil from produced water before discharge into impoundment.
Preventing hydrocarbon accumulation on impoundment.
Preventing overspray.
R315-322-6(2) thru
R315-322-6(5)
YesNo, explain
Closure, Post-Closure, and Financial Assurance (R315-322-7)
Closure Plan Requirements
Closure schedule.
R315-310-4-2(d)(i)
YesNo, explain
Capacity of solid waste facility in volume and tonnage.
R315-310-4-2(d)(ii)
YesNo, explain
Final inspection by regulatory agencies
R315-310-4-2(d)(iii)
Identification of closure costs including cost calculations and the funding mechanism.
R315-310-4-2(d)(iv)
YesNo, explain
Demonstrate that Closure Performance Standard will be met (minimizes need for further maintenance, minimizes threats to human health and environment, and prepares for post-closure)
R315-302-3(2)
YesNo, explain
Inclusion of any applicable covering, grading, seeding, landscaping, contouring, and screening information.
R315-302-3(3)(a)
YesNo, explain
Projections of time intervals for sequential partial closure, if applicable.
R315-302-3(3)(c)
YesNo, explain
Projected fund withdrawal intervals for the associated closure costs from the financial assurance instrument.
R315-302-3(3)(c)
YesNo, explain
Plan to either:
excavate, remove, and dispose of any liners, sludges, soils, wastes, then place soil and seed according to R315-303-3(5)(a)(ii).
Get a permit from the director to dispose of residual waste on-site in compliance with R315-303-3(5).
Or a combination of the two options above.
R315-322-7(2)
R315-303-3(5)(a)(ii)
R315-303-3(5)
YesNo, explain
Post-Closure Plan Requirements
Plan that addresses site monitoring
R315-310-4(2)(e)(i)
YesNo, explain
Plan that addresses inspections of facility by owner or operator.
R315-310-4(2)(e)(ii)
YesNo, explain
Plan that addresses maintenance activities to maintain cover and run-on and run-off systems
R315-310-4(2)(e)(iii)
YesNo, explain
Identification of post-closure costs, including calculations and the funding mechanism.
R315-310-4(2)(e)(iv)
YesNo, explain
Name, address, and telephone number of person or office to contact about facility during post-closure period.
R315-310-4(2)(e)(vi)
YesNo, explain
Plan that lasts for five years
R315-322-7(3)
YesNo, explain
Plan that includes maintenance of any monitoring equipment and sampling and testing schedules
R315-322-7(3)(i)

YesNo, explain
Plan that includes inspection and maintenance of any cover material, including repair or erosion channels and reseeding.
R315-322-7(3)(ii)
YesNo, explain
Financial Assurance
Closure Costs
Third party cost estimate for all materials and activities pertaining to closure including cost of:
Obtaining, moving, and placing cover material;
Final grading of cover material;
Obtaining, moving, and placing topsoil;
Fertilizing, seeding, mulching; and
Removal of stored materials, buildings, and equipment.
R315-309-2(3)(a)
YesNo, explain
Post-Closure Costs
Third party cost estimate for all materials and applicable activities pertaining to closure including:
Any required groundwater monitoring;
Leachate monitoring and treatment;
Gas monitoring; and
Cover, stabilization, repair, erosion control, and reseeding as necessary.
R315-309-2(3)(b)
YesNo, explain