FACILITY INFORMATION for ROAD APPLICATION
of WASTE and WASTEWATER

1. This application is being made for oil and gas associated facilities*: (check one)

A.       drilling fluids, i.e., mud and cuttings as appropriate
B.       produced water and produced water contaminated soils
C.       waste crude oil and sludges, i.e., tank bottoms, PCS, pit oils

*If the facility is conducting , or plans to conduct, cleanup of a site under the Voluntary Remediation Program (VRP), a Road Application Permit will not be issued by WQD for management of waste or contaminated soil that is or may be generated from site cleanup activities.  Please do not submit this application.  Contact the VRP for waste or contaminated soil management options. 

2. Land ownership of disposal site (road) -

Name:       
Address:       ;       ,                
Telephone:       

Signature of Landowner: _________________________________________

3. Attach a contour map delineating the roadways of the intended road application site. Indicate the location of the source in relation to the application site. If appropriate, show locations of any waterways or drainages within 1/4 mile and slope of roadway. Show location of any surface or groundwater domestic water supply within a 1/4 mile of the application site. Indicate the location in:

Section                

Township                

Range                

County of the application site.       

4. Attach several color photos.

A. The road on which application is to be made. The photos will aid in determining if a site visit is necessary.
B. Application equipment to be used.

5. Volume of waste to be applied:       

6. Proposed application rate:       

7. Describe method of application and incorporating waste into the road bed:
      

8. List all known previous waste applications to this site.

9. The Road Application Permit Package shall consist of the following:

A. Application for Permit to Construct
B. Facility information for Road Application
C. Color Photos
D. Site Map
E. Waste Analysis
F. Roadbed analysis if previously used as an application site.

10. Waste sampling. Attach the appropriate waste analysis as required in the appendix. Samples extracted from a pit should be area and depth-integrated by dividing the pit surface area into quadrants (four sample points), the total depth into three foot layers (e.g., nine foot depth = three sample points) to the top of the sludge layer for a total of x subsamples which should be composited in a large container. Sample volume, number of containers, type of containers, preservatives and shipping instructions should be obtained from the lab.

APPENDIX - WASTE ANALYSES

A. Drilling fluids (mud and cuttings as appropriate)

pH
Total dissolved solids or specific conductance
Metals and TOX using Toxicity Characteristic Leaching Procedures (TCLP)
Other constituents or hazardous waste criteria determined to be appropriate by WOGCC

B. Waste crude oil sludges and PCS

pH
Benzene
Metals and TOX using TCLP
Other constituents or hazardous waste criteria determined to be appropriate by WOGCC

C. Produced water and produced water contaminated soils

Radium 226
Total dissolved solids or specific conductance
Metals and TOX using TCLP
Other constituents or hazardous waste criteria determined to be appropriate by WOGCC

D. Roadbed analysis (if previously used as application site)

Metals and TOX using TCLP
Other constituents or hazardous waste criteria determined to be appropriate by WOGCC

Note: The WOGCC will allow a total constituent analysis (TOX) to be substituted for the halogenated organics listed in the TCLP constituents provided the following conditions are met:

1. The TOX test has a detection level of 0.1 mg/l;
2. The TOX test is run on a fluid extracted in accordance with the TCLP procedure;
3. If the TOX concentration exceeds any one of the appropriate individual constituent regulatory levels an analysis will be required for all individual TCLP constituents; and
4. The analysis of non-halogenated constituents may be required by the WOGCC, as necessary.