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Significant Indirect User (SIU)
Application Forms and Checklists

*Download forms to the right of your discharge category.

Discharge Category Description Form Title
L - Individual Permit for Discharge to POTW
blue arrow Application for Completeness Checklist/NJPDES Significant Industrial User Permit (52 kb) pdf
blue arrow NJPDES Form 1 (173 kb) pdf
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blue arrow Form R - Industrial Generator pdf

Miscellaneous SIU Checklists and Forms

Administrative Updates
blue arrow Administrative Update Form (41 kb) pdf
Permit Inactivation
blue arrow Inactivation of NJPDES Permit Monitoring and Reporting Requirements pdf
  Inactivation” means that a permittee still possesses a valid NJPDES permit except that the permitted discharge has ceased, been temporarily discontinued or has not yet commenced.  The submission of Monitoring Report Forms is not required unless the outfall(s) is reactivated.  

Permit Revocation
blue arrow Request for Permit Revocation/Certification of Closure pdf

Revocation” means that a permittee no longer possesses a valid NJPDES permit, for consolidated permits this means all discharge categories have ceased.  The submission of Monitoring Report Forms is no longer required.

Statement of Consents
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WQM 003 Form - Statements of Consent (108 kb) pdf
Transfer of Permit
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Application for Transfer of a Permit (49 kb) pdf
Applicability Determinations/Supplements
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Baseline Report (15 kb) pdf
Agreement to Do Business Electronically
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Agreement to do Business Electronically (32kb) pdf
NJPDES EDI Agreement Form
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NJPDES EDI Agreement Form (66kb) pdf

Helpful Links
Significant Industrial User Permit Application Deficiencies

Program Contacts
Bureau of Pretreatment and Residuals, (609)984-4428
Permit Administration Section, (609)984-4428



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Last Update: October 7, 2016