Form Ttb F 5000.29 - Environmental Information Template - Alcohol And Tobacco Tax And Trade Bureau (Ttb) Page 2

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7. Liquid Waste (Complete this item irrespective of any certification obtained as to compliance with any environmental quality standards of an y Federal, State,

or local agency having

for environmental protection including any certification under the Federal Water Pollution Control Act.)

A. Describe amount and content of any liquid waste to be generated.

B. Describe proposed method of disposal ( sewer, flaming, recycling, etc). Describe any proposed means to monitor quality and characteristics, and any

proposed equipment or facilities for treatment or control of liquid wastes.

8. Noise (Describe operational noise sources other than those normally associated with office operations, building maintenance, or uti lities.)

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THE INFORMATION SHOWN ON THIS FORM AND, TO THE BEST OF MY

KNOWLEDGE AND BELIEF, IT IS TRUE, CORRECT, AND COMPLETE. I AGREE THAT COPIES OF THIS FORM MAY BE FURNISHED TO CON-

CERNED FEDERAL, STATE, AND LOCAL AGENCIES HAVING RESPONSIBILITIES FOR ENVIRONMENTAL PROTECTION AND THAT THE INFORMA-

TION HEREON MAY BE USED IN THE PREPARATION OF AN ENVIRONMENTAL STATEMENT PURSUANT TO THE REQUIREMENTS OF THE

NATIONAL ENVIRONMENTAL POLICY ACT, 42 U.S.C. 4332.

9. Date

10. Applicant

11. By (Signature and Title)

Alcohol and Tobacco Tax and Trade Bureau Determination of Effect. After consideration of all available environmental information relevant to the proposed

activity, it is determined that:

The conduct of the activity described in item 2, pursuant to issuance or approval of the

(Specify whether application, bond, formula, permit, license, etc.)

will

will not significantly affect the environment.

Signature of Director, National Revenue Center

Date

PAPERWORK REDUCTION ACT NOTICE

This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by TTB to determine if any environmental impact

statement or environmental permit is necessary for the proposed operation. The information is required to obtain a benefit.

The estimated average burden associated with this collection of information is 30 minutes per respondent or recordkeeper, depen ding on individual circum-

stances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management

Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it display s a current, valid OMB control

number.

TTB F 5000.29 (10/2008)