Form Ttb F 5000.29 - Environmental Information Template - Alcohol And Tobacco Tax And Trade Bureau (Ttb)

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OMB No. 1513-0023 (08/31/2011)

DEPARTMENT OF THE TREASURY

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

ENVIRONMENTAL INFORMATION

INSTRUCTIONS

1. COMPLETION. Answer all items in sufficient detail or as not applicable to your activity. The information on all items should relate to the activity in which

the Bureau has an interest. If additional space is required for any item, please attach a separate sheet identified by the ite m number of this form. Your

answers are evaluated by the Bureau to determine whether the activity will have a significant effect on the environment. If TTB F 5000.30, Supplemental

Information on Water Quality Considerations - Under 33 U.S.C. 1341(a), is also being submitted for your activity, you may make reference to any relevant

information given on TTB F 5000.30 for items 6 and 7 of this form.

2. FILING. Submit an original and one copy of this form to the Director, National Revenue Center, 550 Main St, Ste 8002, Cincinnati, OH 45202-5215.

3. DISPOSITION. After final action taken on the related application or other document, the copy of this form will be returned to the applican t.

1. Name and Principal Business Address of Applicant

2. Description of Activity in which Alcohol and Tobacco Tax and

3. Number of

Trade Bureau has an interest

Employees

4. Location Where Activity is to be Conducted (Be specific, Number, Street, City, State, ZIP Code; describe locations of buildings and outside equipment and

their situation relative to surrounding environment including other structures, land use, lakes, streams, roads, railroad facilities, etc. Maps, photos, or

drawings may be provided.)

5. Heat and Power:

A. Describe types of heat and power to be used and their sources. If they are to be produced in connection with the proposed ac tivity, estimate type and

quantity of fuel to be used for each purpose. (Example: 40 tons/yr. anthracite coal for heat, 20 million cu.-ft./yr. natural for power generating.)

B. Describe any air pollution control equipment proposed for use in connection with fuel burning equipment, boilers, or smokesta cks.

6. Solid Waste:

A. Describe amount and composition of all solid waste to be generated.

B. Discuss proposed methods of disposal (Incineration, open burning, landfill, government or commercial garbage collection, etc.)

Specify whether on-site or off-site.

C. Describe any air pollution control equipment proposed for use in connection with any incinerators.

TTB F 5000.29 (10/2008)