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0210-PM-PIO0001 Rev. 9/2020 Instructions Page 1 of 14 COMMONWEALTH OF DEPARTMENT OF ENVIRONMENTAL PROTECTION GENERAL INFORMATION FORM AUTHORIZATION APPLICATION INSTRUCTIONS GENERAL INFORMATION General Instructions. This package is designed to assist the applicant in completing the General Information Form (GIF) and in determining which environmental permits or approvals are needed for the project. Please type or print clearly when completing the form. If information needed is more than space allows, attach additional sheets as necessary. If a question is not applicable to you or your project, write NA in the appropriate box. For example application is in reference to the Act 537 Program. Many GIF questions may not apply to this type of applicant; but program-specific forms for that particular program will need more information from the applicant. This GIF assists the Department of Environmental Protection to identify permits and authorizations needed for an activity and may facilitate program coordination. A full application for a particular Department of Environmental Protection (DEP) permit or other authorization will generally consist of forms related to the particular permit or other authorization. Individual applications may require more detailed information, such as site drawings and more detailed applicant information. Moreover, an applicant may need to provide proof of financial responsibility (such as performance bonds, insurance policies, or both) in order to qualify for some DEP permits or authorizations. These requirements vary by program. Be sure to ask each program whether you must supply financial responsibility documents in order to obtain your permit or other authorization. If multiple applications are necessary for a facility or activities, only one GIF need be submitted for a facility or activities in addition to the various program-specific applications. If the applications are submitted at different times, the applicant may photocopy the most up-to-date version of the GIF or refer to the Application Processing System (APS) coordination number assigned by DEP (if known) when submitting forms. To Obtain DEP Application Packages. DEP asks that you use the most up-to-date application package available. The most recent version of this General Information Form (GIF) package can be obtained by contacting the appropriate DEP office, or through our website noted below. This package, as well as other Department-wide and/or Program- Specific Permit Application Form Packages are available in Microsoft Word format at this same web location. Applicants can download the appropriate form to a personal computer, complete the form electronically, and print the document for submittal to DEP. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 2 of 14 Access: www.dep.pa.gov Select: Data and Tools Select: eLibrary Select: Permit and Authorization Packages Select: Department-Wide General Information Select: General Information Form (GIF) 0210-PM-PIO0001 DEFINITIONS eFACTS (Environment, Facility, Application, Compliance Tracking System). The DEP’s electronic application system to document and maintain client, site and facility data for purposes of authorizing regulated activities and tracking compliance. DEP’s eFACTS on the web can be used to locate DEP ID#s referenced throughout this document (eg. Site ID#, Client ID#) eNotice. (Electronic notification system) allows users to track permit applications, check the status of environmental regulations and notify users to technical guidance document postings. This system is available by logging on to the DEP website, selecting TOOLS and then selecting eNOTICE. Please note: some programs, due to safety and security concerns, do not participate in permit application tracking. Client (Responsible Party). A client (also referred to as Applicant) is a person or organization that requests approval from DEP to perform a regulated activity. Client information is documented and assigned an internal DEP Client ID# for tracking purposes. Site (Place). A site is a physical location of importance to DEP. A site may include locations where a regulated facility is physically located or where a regulated activity occurs that has the potential to impact the health and safety of the citizens and/or the natural resources of the Commonwealth. A site is not solely defined by geographical location (can span several municipalities and even counties in some cases) but rather by the client/applicant’s purpose of doing business. All DEP programs involvement at a physical location of importance to DEP is grouped under one ‘entity’ – site. This holistic view of site will promote an understanding of the interrelationships of facilities to support pollution prevention; multi-media inspections; a Department-wide view of compliance; and public understanding and access of information. Site information is documented and assigned an internal DEP Site ID# for tracking purposes. Site-to-Client Relationships. DEP will create internal records to relate (link) each site with all clients associated with the site and/or its facilities. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 3 of 14 Facility. A facility (also referred to as Primary Facility (PF)) is a logical bridge between sites and sub-facilities that allows DEP to provide a framework for a facility’s or an activity’s regulation. Primary facility is a way to group a program’s involvement at a site (what it regulates) under one heading. For example: The Coal Mining program groups all of their involvement (regulated entities) under the Primary Facility type of ‘Coal Mining Operations’. Facility information is documented and assigned an internal DEP Facility ID# for tracking purposes. Other examples of PFs are: Water Pollution Control Facility Radiation Facility Oil & Gas Entity Water Resource Air Emissions Plant Encroachment Location Sub-Facility. A sub-facility (SF) is program-specific. A sub-facility is what DEP regulates. For example: A Deep Mine is a sub-facility of a Coal Mining Operation primary facility. Other examples of PFs and associated SFs are: Primary Facility (PF) Sub-Facility (SF) Water Pollution Control Facility * Treatment Plant * Discharge Point Radiation Facility * X-ray Machine * Radioactive Materials Oil & Gas Entity * Impoundment * Temporary Storage Structure Water Resource * Surface Water Withdrawal * Groundwater Withdrawal Air Emissions Plant * Incinerator * Process Encroachment Location * Bridge * Dock Project. A project includes all the construction, installation, and/or renovation needed to achieve the applicant’s goal. An applicant must obtain all required permits/approvals from DEP before beginning regulated activities or the construction or expansion of a regulated facility. Project information is documented and assigned an internal DEP application processing system number (APS ID#) for tracking purposes. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 4 of 14 Authorization. Any DEP approval given to a client, site or facility such as permits, plans, licenses, registrations, certifications, etc. Authorization information is documented and assigned an internal DEP Auth ID# for tracking purposes. Permit Coordination. Projects requiring multiple DEP permits are coordinated to ensure a timely, comprehensive staff review within DEP and with the Permit Applicant on all technical and environmental matters related to the project. Potential project issues can be identified early so that timely and appropriate public outreach measures can be taken and technical/coordination issues can be considered and resolved appropriately. CLIENT INFORMATION DEP Client ID#. Department-wide unique identification number assigned by DEP to the client after client information is entered into DEP’s computer system. This one number identifies the client regardless of the program with which the client is working. This identification number will be identified on future correspondence from DEP as well as on client information available on our DEP website. When replying to DEP, inclusion of this number will make it easier to process your request in a timely manner. If you know your Client ID#, enter it. If you are a new client to DEP, skip to the next request for information. Client Type Code. Enter the code that represents the type of client acting as the responsible authority for the permitted activity. The list of Client Type Codes can be found on the list of Type Codes included at the end of this instruction document. Dun & Bradstreet ID#. If known, supply the applicant’s Dun & Bradstreet Identification Number. This information is optional. Organization Name or Registered Fictitious Name. Clients other than individuals must provide the name under which they conduct the activity or business in which the permit or other authorization will be issued. Individuals or sole proprietorships should complete the “Organization Name” if they conduct their business or activity under a name other than their own (for example, “Jones Construction Company”, rather than “Mary Jones”). For partnerships, be sure to list the business name of the partnership as it appears on legal partnership papers. If the applicant is an individual(s) or partnership, be sure to also provide the appropriate information on the individual name lines. Employer ID# (EIN). Also referred to as “Federal Tax ID#”. The EIN aids DEP in identifying the organization, coordinating permitting, and effective recordkeeping. This information is required. If you are an Individual or Sole Proprietorship you may not have an EIN and may need to supply your Social Security Number (SSN). Be sure to check the box Yes if your EIN is your SSN. DEP encourages sole proprietorships to obtain an EIN. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 5 of 14 Individual Last Name, First Name, MI, Suffix. This information must be provided for applicants who are individuals or partnerships. Additional Individual Last Name, First Name, MI, Suffix. This information must be provided for additional applicants who are individuals or partnerships. Mailing Address. The mailing address of the client identified above (this should not include locational data that is not appropriate for a mail piece). In addition to the street number and name, PO Box#, RR# Box#, or Highway Contract# designations, use any appropriate designation and number to further define the mailing address of the applicant. e.g., APT (Apartment) DEPT (Department) RM (Room) BLDG (Building) FL (Floor) STE (Suite) City, State, ZIP+4, Country. Enter an appropriate city, borough, or town designation (do not enter a township designation in this area). Do not use abbreviations for the city name. Use the two-character abbreviation for the state. Include the four-digit extension to the ZIP code. If other than USA, provide country. Client Contact Information. Clients that are organizations must provide the name of a person representing the client (organization). This client contact must be an employee of the organization and must be located at the mailing address of the client and may receive correspondence on behalf of the client. Include the individual’s name, title, daytime phone number, and email address. The Department will use this contact information for maintaining client data. This individual should be a high-level employee such as CEO, VPs, Operations Manager, or someone capable of answering informational questions regarding the organization such as EIN, fictitious name ownership, address data, related organizations, corporate changes, or similar information related to the business. Project contact information should be entered in the Site Contact found in the Site Information section. SITE INFORMATION DEP Site ID#. Department-wide unique identification number assigned to the site after site information is entered into DEP’s computer system. This one number identifies the site regardless of the program with which the applicant is working. This identification number will be identified on future correspondence from DEP as well as on site information available on our DEP website. When replying to DEP, inclusion of this number will make it easier to process your application in a timely manner. If you know your Site ID#, enter it. If you are identifying a new site to DEP, skip to the next request for information. Site Name. The name of the site at the specific physical location. Do not use abbreviations, acronyms, etc. EPA ID#. If known, supply the EPA ID# for the site (this number is also referred to as a FINDS ID#). ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 6 of 14 Estimated Number of Employees to be Present at Site. To assist with future Pollution Prevention and Compliance Assistance initiatives, please include the estimated number of employees to be present at the site once it is active. Description of Site. Provide a written description of how the proposed site will be used (such as, water treatment plant, sewage treatment plant, toy factory, coal mine). County, Municipality, State. Indicate the county(ies) and municipality(ies) in which the site is located. Check the appropriate box to identify the type of municipality entered (city, borough, township). Include the two-character abbreviation for the state. Site Location. Provide the physical address of the location where the permitted activities will occur. No PO Box Numbers will be accepted for site location information. Provide the City (or municipality), State, and the ZIP+4, if known. Detailed Written Directions to Site. When providing written directions, do not use PO Box address data. Include landmarks and approximate distances from the nearest highway. Site Contact Information. Provide the name of the person having overall responsibility for environmental matters at the site. Include the individual’s name, title, firm, mailing address, daytime phone number, and email address (optional). NAICS Codes. Clients applying for an authorization from DEP need to provide the appropriate North American Industry Classification System (NAICS pronounced nākes) code(s) at the Sector level (at a minimum). Enter all NAICS codes that pertain to the activity for which the application is being completed. More than one two-digit or three- digit NAICS code may be entered in the box provided. If you know your six-digit NAICS code, enter it in the optional box provided. The most up-to-date list of NAICS sector and subsector codes can be found on the NAICS website (part of the US Census Bureau) at http://www.census.gov/eos/www/naics/ or by contacting a DEP office identified at the end of this instructions document. Site-to-Client Relationship. Enter the relationship code that best describes how the client is related to the activity or operation at the site for which the permit or other authorization is being sought. The list of Site-to-Client Relationship Codes can be found on the list of Type Codes included at the end of this instructions document. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 7 of 14 FACILITY INFORMATION Modification of Existing Facility. If this project is to modify an existing facility, system, or activity, indicate the facility type and its DEP facility identification number. Latitude / Longitude. Latitude and longitude measures aid in providing the physical location of the facility. If known, indicate appropriate degrees, minutes, and seconds for the project. The Latitude/Longitude Point of Origin is the place or location where the reading was actually taken. Additional Locational Data Information. This information is being requested in order to determine the method, accuracy and description of the latitude and longitude information that is being provided with the application. If known, please provide this information for your locational data. The list of locational data codes and descriptions can be found by referencing ‘GIF Locational Data Codes’. This document can be found on the DEP website with this GIF package or by contacting a DEP office identified at the end of this instructions document. PROJECT INFORMATION Project Name. Provide the name by which this proposed activity or project is, or will be, known XYZ Sub-Division, ABC Plant Expansion). Project Description. Provide a detailed description of the project. If applying for a part of a larger project, broadly describe the entire project a pipe crossing to serve the XYZ Sub-Division). Project Consultant Information. Provide the name of the consultant for this project, if applicable. Include the individual’s name, title, firm, mailing address, daytime phone number, and email address (optional). Time Schedules / Project Milestones. Provide the proposed schedule of project milestones, if any 09-15-2002 Proposed Construction Start Date). Environmental Justice. The answer provided to Question 1 in the Project Information section will determine whether this project is subject to the Environmental Justice Public Participation Policy (Document ID: 012-0501-002). An Environmental Justice Area is any census tract with a 30 percent or greater minority population or 20 percent or greater at or below the poverty level as defined by the most recent census data provided by the US Census Bureau (American Community Survey). To determine if the project is located in or within a 0.5 mile radius of an Environmental Justice Area, please use the Environmental Justice Areas Viewer. For detailed information on how this is integrated with the permit application process, please see the Environmental Justice Public Participation Policy. Answers to questions 1 through 3 are not mandatory but are used by DEP for outreach purposes. The answers provided will not impede the permit review process or permit review timeframes. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 8 of 14 Project’s Land Use. The answer provided to Question 4 in the Project Information section will determine whether this project is subject to the Land Use Policy. Authorization/application types that are affected by DEP’s Land Use Policy are attached to these instructions as Appendix A. For detailed instructions on how to complete this section, see the Department's Policy for Consideration of Local Comprehensive Plans and Zoning Ordinances in DEP Review of Authorizations for Facilities and Infrastructure - Document ID: 012-0200-001. If you are not sure if your authorization/application type is affected by the Land Use Policy, please contact the appropriate DEP office. LAND USE INFORMATION Applicants can choose an early opt-out option by attaching documentation indicating they have received zoning approval from the municipal governing bodies where the project is being proposed. For more information, see the Department's Policy for Consideration of Local Comprehensive Plans and Zoning Ordinances in DEP Review of Authorizations for Facilities and Infrastructure. If the applicant chooses the early-opt out option and zoning approval documentation is attached, the Land Use Information section does not need to be completed. If the applicant does not choose the early opt-out option and the authorization/ application type is listed in Appendix A, the applicant must complete the Land Use Information section. For detailed instructions on how to complete this section, see the Department's Policy for Consideration of Local Comprehensive Plans and Zoning Ordinances in DEP Review of Authorizations for Facilities and Infrastructure COORDINATION INFORMATION Multiple authorizations are often required for residential, commercial, or industrial land development. This section is vital in determining if any other environmental permits or approvals are needed for your project. Special Note: By completing this section, you will assist DEP and County Conservation Districts in coordinating all authorizations that may be required for your project. County Conservation District approval does not automatically guarantee the issuance of other permits for your project, nor does it relieve you of the responsibility of making timely application for other necessary permits. Note that local municipal approvals may also be required before the project can be initiated. If your proposal will generate sewage, the local municipality will need to review its sewage plan and receive approval from DEP prior to your submission. In addition, please note that even though you may soon receive a General Permit authorization, other permit requirements may preclude site development or other activities until all permits are issued. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 9 of 14 What Your “Yes” Answers Mean. If you answer “Yes” to any of the questions in this section, you will probably need a specific permit or approval from DEP. Refer to the information provided at the end of these instructions that identifies specific regional, central, and district offices. Contact the appropriate DEP office to further discuss the need for an authorization. If additional applications are necessary, they will be mailed to you. If “Yes” to Question, Contact: 1.0 District Mining Permitting Section 1.1 to 1.3 Regional Air Quality Program 1.4 Regional Clean Water Permitting Section 1.5 Central Office Dam Safety Division 1.6 District Oil & Gas Program (located only in NC, SW & NW Regional Offices) 2.0 District Mining Permitting Section 2.1 to 2.3 Regional Air Quality Program 2.4 Regional Clean Water Permitting Section 2.5 Central Office Dam Safety Division 3.0 to 3.3 District Oil & Gas Program (located only in NC, SW & NW Regional Offices) 4.0 to 5.3 Local County Conservation District - or - Regional Soils & Waterways Section 5.4 to 5.7 Regional Permit Coordination Office 6.0 to 8.0 Regional Clean Water Permitting Section 9.0 Regional/District Clean Water Planning Section 10.0 Regional Clean Water Operations Section 11.0 to 12.0 Central Office Dam Safety Division 13.0 Regional Air Quality Program (Except if the answer to 13.0.1 is “Yes”, then you do not need to contact the Regional Air Quality Program) 14.0 to 17.0 Regional Safe Drinking Water Program - and - Planning and Conservation Program 18.0 Regional Waste Management Program 19.0 District Mining Permitting Section 20.0 to 23.0 Central Office Storage Tanks Division 24.0 Regional Radiation Protection Program (located only in SE, SC, SW Regional Offices) CERTIFICATION A legally responsible agent of the client should complete and sign the certification. APPLICANT’S CHECKLIST To assure your application is complete, we are providing a convenient checklist of what may need to be attached to the application as well as who to contact for additional information. This checklist is optional and need not be returned with the completed application. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 10 of 14 TYPE CODES The following list of codes is to identify specific types of requested information. CLIENT INFORMATION. Client Type / Codes Government Non-Government Individual AUTH Authority ASSOR Association/Organization INDIV Individual CNTY County LLC Ltd Liability Company FED Federal Agency LLP Ltd Liability Partnership MUNI Municipality NPACO Corporation NONPG Non-PA Govt OTHER Other (Non-Govt) OTHG Other (Govt) PACOR Corporation SCHDI School District PARTG Partnership-General STATE State Agency PARTL Partnership-Limited SOLEP Sole Proprietorship Note: If two individuals’ names are listed as the application’s clients, the Client Type Code of “Partnership/General” should be used. SITE INFORMATION. Site-to-Client Relationship Codes Code Type Code Type OWN Owner LESOP Lessee / Operator OPR Operator CONTR Contractor for Owner or Operator OWNOP Owner/Operator AGENT Agent for Owner or Operator LESSE Lessee OTHER Other (Explain) ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 11 of 14 DEP OFFICES The following information is to assist the client with appropriate contact information when addressing the Department. Listed below is information for regional, central, district mining offices and district oil & gas offices and the counties they serve. REGIONAL OFFICES PA Dept of Environmental Protection SE Regional Office 2 E. Main Street Norristown PA 19401-4915 (484) 250-5900 SERO Counties: Bucks, Chester, Delaware, Montgomery, and Philadelphia. Oil & Gas issues should be addressed to Eastern District Oil & Gas Operations Office for these counties. Note: Air Quality in the City of Philadelphia is regulated by the Philadelphia Health Department, Division of Air Management Services (AMS). Information on AMS permitting requirements can be obtained by calling [PHONE REDACTED]. PA Dept of Environmental Protection NE Regional Office 2 Public Square Wilkes Barre PA 18701-1915 (570) 826-2511 NERO Counties: Carbon, Lackawanna, Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming. Oil & Gas issues should be addressed to Eastern District Oil & Gas Operations Office for these counties. PA Dept of Environmental Protection SC Regional Office 909 Elmerton Ave Harrisburg PA 17110-8200 (717) 705-4700 SCRO Counties: Adams, Bedford, Berks, Blair, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, and York. Oil & Gas issues should be addressed to Eastern Oil & Gas Operations Office for these counties. PA Dept of Environmental Protection NC Regional Office 208 W Third St Ste 101 Williamsport PA 17701 (570) 327-3636 NCRO Counties: Bradford, Cameron, Clearfield, Centre, Clinton, Columbia, Lycoming, Montour, Northumberland, Potter, Snyder, Sullivan, Tioga, and Union. Oil & Gas issues should be addressed to Eastern District Oil & Gas Operations Office for these counties. PA Dept of Environmental Protection SW Regional Office 400 Waterfront Dr Pittsburgh PA 15222-4745 (412) 442-4000 SWRO Counties: Allegheny, Beaver, Cambria, Fayette, Greene, Somerset, Washington, and Westmoreland. PA Dept of Environmental Protection NW Regional Office 230 Chestnut St Meadville PA 16335-3481 (814) 332-6945 NWRO Counties: Butler, Clarion, Crawford, Elk, Erie, Forest, Indiana, Jefferson, Lawrence, McKean, Mercer, Venango, and Warren. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 12 of 14 CENTRAL OFFICES PA Dept. of Environmental Protection Dam Safety Division PO Box 8460 Harrisburg PA 17105-8460 (717) 787-8568 PA Dept. of Environmental Protection Storage Tanks Division PO Box 8762 Harrisburg PA 17105-8762 1-800-42TANKS (toll free within PA) (717) 772-5599 (local & outside PA) PA Dept. of Environmental Protection Bureau of Clean Water Operations Monitoring & Training Division PO Box 8774 Harrisburg PA 17105-8774 (717) 772-4018 (activities outside PA) Appropriate Regional Office (activities in PA) PA Dept. of Environmental Protection Bureau of Clean Water Planning & Permits Division PO Box 8774 Harrisburg PA 17105-8774 (717) 787-8184 (activities outside PA) Appropriate Regional Office (activities in PA) PA Dept. of Environmental Protection Hazardous Waste Mgmt Division PO Box 69170 Harrisburg PA 17105-9170 (717) 787-6239 PA Dept. of Environmental Protection Municipal & Residual Waste Mgmt Division PO Box 69170 Harrisburg PA 17105-9170 (717) 787-7381 PA Dept. of Environmental Protection Bureau of Radiation Protection PO Box 8469 Harrisburg PA 17105-8469 (717) 787-2480 PA Dept. of Environmental Protection Certification & Licensing Section PO Box 8455 Harrisburg PA 17105-8455 (717) 772-4497 (X-Ray Equipment Renewal) PA Dept. of Environmental Protection Bureau of Oil & Gas Management PO Box 8765 Harrisburg PA 17105-8765 (717) 772-2199 PA Dept. of Environmental Protection Bureau of Safe Drinking Water Permits Division PO Box 8467 Harrisburg PA 17105-8467 (717) 787-9633 PA Dept. of Environmental Protection Certification & Licensing Section PO Box 8454 Harrisburg PA 17105-8454 (717) 787-5236 (Water/Wastewater Certification) (717) 787-6045 (Sewage Enforcement Office Certification & Laboratory Certification) (717) 787-8059 (Blaster License, Storage Magazine License, Sales Permit, Explosives Purchase Permit) ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 13 of 14 DISTRICT MINING OFFICES PA Dept of Environmental Protection New Stanton District Office 131 Broadview Road New Stanton, PA 15672 Mailing Address: PO Box 133 New Stanton, PA 15672 (724) 925-5500 New Stanton DO Counties: Allegheny, Fayette, Greene, Washington, and Westmoreland. PA Dept of Environmental Protection Cambria District Office 286 Industrial Park Rd Ebensburg PA 15931-4119 (814) 472-1900 Cambria DO Counties: Adams, Bedford, Blair, Cambria, Cumberland, Franklin, Fulton, Huntingdon, Indiana, Juniata, Mifflin, Perry and Somerset. PA Dept of Environmental Protection Pottsville District Office 5 West Laurel Blvd Pottsville PA 17901-2522 (570) 621-3118 Pottsville DO Counties: Berks, Bucks, Carbon, Chester, Columbia, Dauphin, Delaware, Lancaster, Lackawanna, Lebanon, Lehigh, Luzerne, Monroe, Montour, Montgomery, Northampton, Northumberland, Philadelphia, Pike, Schuylkill, Susquehanna, Wayne, Wyoming, and York. PA Dept of Environmental Protection Moshannon District Office 186 Enterprise Drive Philipsburg PA 16866 (814) 342-8200 Moshannon DO Counties: Bradford, Cameron, Centre, Clearfield, Clinton, Lycoming, Potter, Snyder, Sullivan, Tioga and Union. PA Dept of Environmental Protection California District Office* California Tech Park 25 Technology Drive Coal Center PA 15423 (724) 769-1100 California DO Counties: All counties where mining and subsidence occur. *Underground mining permits issued PA Dept of Environmental Protection Knox District Office White Memorial Bldg 310 Best Avenue Knox, PA 16232 Mailing Address: PO Box 669 Knox, PA 16232-0669 (814) 797-1191 Knox DO Counties: Beaver, Butler, Clarion, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, McKean, Mercer, and Venango, and Warren. ---PAGE BREAK--- 0210-PM-PIO0001 Rev. 9/2020 Instructions Page 14 of 14 DISTRICT OIL & GAS OPERATIONS OFFICES PA Dept. of Environmental Protection Northwest District Oil & Gas Office 230 Chestnut Street Meadville, PA 16335-3481 (814) 332-6860 NW District Office Counties: Clarion, Crawford, Elk, Erie, Forest, Indiana, Jefferson, Lawrence, McKean, Mercer, Venango, Warren. PA Dept. of Environmental Protection Southwest District Oil & Gas Office 400 Waterfront Drive Pittsburgh, PA 15222-4745 (412) 442-4024 SW District Office Counties: Allegheny, Beaver, Cambria, Fayette, Greene, Somerset, Washington, Westmoreland. PA Dept. of Environmental Protection Eastern District Oil & Gas Office 208 West Third St Williamsport, PA 17701-6448 (570) 321-6550 Eastern District Office Counties: Adams, Bedford, Berks, Blair, Bucks, Bradford, Cameron, Carbon, Centre, Chester, Clearfield, Clinton, Columbia, Cumberland, Dauphin, Delaware, Franklin, Fulton, Huntingdon, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Montgomery, Montour, Monroe, Northampton, Northumberland, Perry, Philadelphia, Potter, Pike, Schuylkill, Sullivan, Snyder, Susquehanna, Tioga, Union, Wayne, Wyoming, York.