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Fairfield General Facility Registration Form

Fairfield General Facility Registration Form

Fairfield General Facility Registration Form

  • This form is to be used for providing general information about a facility being registered under the Source Water Protection Program (SWPP). Regulated Substance use must be registered on separate forms. Any person owning and/or operating more than one facility subject to regulation under the SWPP must register each facility separately.
  • I. Contact Information

  • Other Contacts

    if different from general facility contact listed above
  • name
  • for renters/leasers only
  • II. General Business Information

  • Include your Ohio EPA Hazardous Waste Generator Number if applicable.
  • III. General Site Information

  • Approx: Acres or Sq. ft
  • Well No.General LocationDepth (ft)Diameter of well (inches)Parameters Monitored ForFrequency (per) 
    Add a new row
    If yes, please provide the following information. If this information is already available in a report or other documentation, you may attach that information to this form in lieu of completing the following table.
  • IV. Commercial Landfill Operations

    The following section should be completed only if you operate a commercial landfill. Regulated substance storage must be reported on the Regulated Substance Storage Inventory Form.
  • What types of waste products are currently being disposed of at the facility? What types have been disposed of at the facility in the past?
  • V. Commercial Junk Yards

    The following section should be completed only if you operate a commercial junk yard, metal recycling yard, scrap yard, or salvage yard. Regulated Substance storage must be reported on the Regulated Substance Storage Inventory Form.
  • VI. Certification

    I hereby certify that I have reviewed this document and to the best of my knowledge and belief, the information in this document is true, complete, and accurate. I also certify that inspection of regulated substance storage units, as applicable, is and will continue to be conducted in accordance with Section 1192.05 of the Source Water Protection Ordinance No. 153.98; and, as applicable, a Spill Control plan will be completed and kept up to date in accordance with Section 1192.05(g) of the Source Water Protection Ordinance No. 153-98.
  • print
  • Questions

    If you have any questions about this form or the Source Water Protection Program, please do not hesitate to contact the Groundwater Consortium Manager at: Ph: (513) 383-3162 Email: tim.mclelland@hamilton-oh.gov
  • Date received
  • gallons
  • pounds

Fairfield General Facility Registration Form


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Signature Certificate
Document name: Fairfield General Facility Registration Form
lock iconUnique Document ID: e0759c7ec58795a1b7257d754cb818da59e4f39c
Timestamp Audit
September 1, 2022 11:17 am ESTFairfield General Facility Registration Form Uploaded by Tim McLelland - tim.mclelland@hamilton-oh.gov IP 216.48.130.130

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