DEPARTMENT
OF
THE
TREASURY
ALCOHOL
AND
TOBACCO
TAX
AND
TRADE
BUREAU
(
TTB)

ENVIRONMENTAL
INFORMATION
1.
Name
and
Principal
Business
Address
of
Applicant
2.
Description
of
Activity
in
which
Alcohol
and
Tobacco
Tax
and
Trade
Bureau
has
an
interest
3.
Number
of
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
structutres,
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
activity,
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
smokestacks.

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
(
4/
2004)
OMB
No.
1513­
0023
(
06/
30/
2005)

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
item
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
Street,
Suite
8002,
Cincinnati,
OH
45202.

3.
DISPOSITION.
After
final
action
taken
on
the
related
application
or
other
document,
the
copy
of
this
form
will
be
returned
to
the
applicant.
INSTRUCTIONS
7.
Liquid
Waste
(
Complete
this
item
irrespective
of
any
certification
obtained
as
to
compliance
with
any
environmental
quality
standards
of
any
Federal,
State,
or
local
agency
having
responsibilty
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
utilities.)

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
CONCERNED
FEDERAL,
STATE,
AND
LOCAL
AGENCIES
HAVING
RESPONSIBILITIES
FOR
ENVIRONMENTAL
PROTECTION
AND
THAT
THE
INFORMATION
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
TTB
F
5000.29
(
4/
2004)
PAPERWORK
REDUCTION
ACT
NOTICE
This
request
is
in
accordance
with
Section
3507,
Public
Law
96­
511,
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,
depending
on
individual
circumstances
Comments
concerning
the
accuracy
of
this
burden
estimate
and
suggestions
for
reducing
this
burden
should
be
addressed
to
Reports
Management
Officer,
Regulations
and
Procedures
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
displays
a
currently
valid
OMB
control
number.
