new hauler application checklist
TRANSCRIPT
NEW HAULER APPLICATION CHECKLIST
To begin the Liquid Waste Hauler Discharge Permit process, please gather and submit the following information to Monterey One Water, ATTN: Sarah Stevens via:
Email: [email protected] Fax: (831) 883-0516 Hard Copy Mail: Monterey One Water
ATTN: Sarah Stevens 5 Harris Court, Building D Monterey, CA 93940
Completed New Hauler Permit Application, Signed and Certified
Certificates of insurance meeting below-specified coverage limits:
✓ Certificate of Worker's Compensation Insurance- Minimum $1,000,000 per occurrence and combined single limit coverage for bodily injury or disease;
✓ Certificate of Automobile Insurance- Minimum $1,000,000 per occurrence and combined single limit coverage for bodily injury and property damage; and,
✓ Certificate of General Liability Insurance- Minimum $1,000,000 per occurrence and combined single limit coverage for bodily injury, personal injury and property damage.
Completed M1W Liquid Waste Truck/Fleet Registration Form, Signed and Certified
Valid Monterey County Department of Environmental Health Non-Hazardous Liquid Waste Permit Inspection Form and/or Permit
Safety Data Sheets (SDS) for all Chemical Deodorants Used in Chemical Toilets. Note: Per a change in Federal Regulations, Material Safety Data Sheets (MSDS) are no Longer Acceptable
Liquid Waste Hauler Application (Revised 3/9/2018) Page 1
NEW LIQUID WASTE HAULER PERMIT APPLICATION
PART A – BUSINESS CONTACT INFORMATION A1. Company Business Name: _______________________________________________________________ A2. Business Address:
a. Street Address: __________________________________________________________________
City, State, & Zip Code: ____________________________________________________________
b. Mailing Address: _________________________________________________________________
City, State, & Zip Code: ____________________________________________________________
c. Website Address: ________________________________________________________________
A3. Chief Executive Officer:
a. Name: _________________________________________________________________________
b. Title: __________________________________________________________________________
c. Mailing Address: _________________________________________________________________
A4. Company’s contact person:
a. Name: _________________________________ Email:_________________________________
b. Phone: _________________________________ Fax: __________________________________
A5. Person to be contacted in case of emergency:
a. Name: _________________________________________________________________________
b. Title: __________________________________________________________________________
c. Phone: (Daytime) ____________________________ (Evening) ____________________________
A6. Name of Automobile Insurance Company: __________________________________________________
A7. Name of Workers Compensation Insurance Company: _________________________________________
A8. Name of General Liability Insurance Company: _______________________________________________
a. M1W must be listed as Additional Insured on Automobile and General Liability Insurance Policies.
b. Copy of Monterey County Health Department Non-Hazardous Liquid Waste Vehicle Inspection Form must be provided to M1W annually.
Liquid Waste Hauler Application (Revised 3/9/2018) Page 2
PART B – WASTE HAULING INFORMATION
B1. Fleet List: Please submit a completed fleet list in Microsoft Excel format as follows: Hauler Permit # Make Model Vin# Lic. Plate # Gal Wastewater Capacity Tare Weight
B2. List all Counties served: __________________________________________________________________
B3. Average number of Haulings conducted per week: ____________________________________________
B4. Anticipated Gallons Per Hauling: ___________________________________________________________
B5. Does your company haul liquid waste with Chemical Deodorants? Yes No
If yes, a Safety Data Sheet (SDS) must be provided for all deodorants used.
B6. Do your truck(s) discharge at facilities other than those that are controlled by M1W?
Yes No
If yes, where? __________________________________________________________________________
B7. WASTES HAULED / DISCHARGE FACILITIES / TRUCKS USED
• Select all types of waste hauled *
• List the discharge facility used for each type of waste (i.e., M1W) *Multiple waste types may require multiple accounts, please disclose all types of wastes hauled.
Types of Waste
Discharge Facility Truck(s)
Used
Chemical Toilet
Septic Tank
Restaurant Grease
Car Wash Sumps (dilute oily waste)
Stormwater Interceptors (dilute oily waste)
Industrial Wastes
Salt Brine
Used Motor Oil**
Chemical Waste**
Agricultural Sumps
Drilling Water
Storm Drain Pumpouts
Other:
** Trucks used to periodically haul non-acceptable wastes will not be allowed to discharge at the M1W Treatment Plant.
Liquid Waste Hauler Application (Revised 3/9/2018) Page 3
PART C – CERTIFICATION
I certify that the information contained herein is true and correct to the best of my knowledge.
Executed this _____ day of _____________________, 20___, at ____________________, California. (date) (month) (city) _______________________________________ ____________________________________ Print Name Title _______________________________________ ____________________________________ Signature Date
Liquid Waste Hauler Application (Revised 3/9/2018) Page 4
ATTENTION PERMITTED GREASE HAULERS
Inedible Kitchen Grease Manifest Protocol
The State of California Department of Food and Agriculture (CDFA) passed legislation regarding Inedible
Kitchen Grease Manifest requirements (Article 42, Subchapter 2, Chapter 4, Division 2 of Title 3 of the
California Code of Relations,
Section 1180.24) which became
effective April 1, 2013. This
legislation requires commercial
transporters of Inedible Kitchen
Grease (IKG) in California to
create and maintain a manifest
for each collection, transport, and
delivery of IKG. IKG Manifests
may be maintained on forms
provided by the Department of
Food and Agriculture (see
Example 1.1), or on forms of your
own creation which document the
same information.
Example 1.1 CDFA Inedible Kitchen Grease Manifest
As of April 1, 2013, all grease discharges brought to the M1W Regional Treatment Plant must have the
accompanying IKG documentation attached to the M1W Liquid Waste Hauler Manifest. All trucks used to
haul grease must be permitted with the CDFA and the authorized sticker displayed in a visible location on the
truck.
I certify that I have read and understand the information contained herein. I agree to provide IKG manifest documentation with each grease discharge at the time of discharge.
Executed this _______ day of _____________________, 20____, at ____________________, California. (date) (month) (city) _______________________________________ ____________________________________ Print Name Signature _______________________________________ ____________________________________ Company Name Title
____________________________________ Date
M1W LIQUID WASTE FLEET REGISTRATION FORM
Please electronically complete, sign, and certify this document and submit to M1W via email at [email protected]. This information will be used for full-load billing, which commenced in October 2019.
New/ Existing? Make Model Vin # License # Gallon Wastewater Capacity
I hereby certify that the above information is true and correct to the best of my knowledge. I certify that I understand that this information will be used for the purposes of billing for liquid waste discharges conducted by my company at Monterey One Water’s (M1W) Regional Treatment Plant, and that in order to modify this information I must complete, sign, certify and resubmit to M1W. Executed on ______________ __________, 20_____ at ______________________ (Month) (Day) (City) Name (Print) ________________________________________ Signature ________________________________________________ Company ___________________________________________ Title ___________________________________________________