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### FOR REFERENCE WHEN REVIEWING **THE INFORMATION COLLECTION REQUEST**

**This version is an update for the Notification of Regulated Waste Activity.**  **There are some minor changes from the March 2005 version in the reporting requirements, instructions, and form.**  

# Notification of Regulated Waste Activity

Instructions and Form

EPA Form 8700-12 (OMB# 2050-0028; Expires - date as approved from OMB)

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# Notification of Regulated Waste Activity Instructions and Form

Section 3010 of Sub title C of Resource Conservation and Recovery Act (RCRA) requir es any person who generates, transports, or recycles regulated wastes or who owns or operates a facility for the treatment, storage, or disposal of regulated wastes to notify EPA of their activities, including the location and gene ral description of the activities and the regulated wastes handled. Respondents must submit the information required in the Notification of Regulated Waste Activity Instructions and Form booklet by completing the RCRA Subtitle C Site Identification Form [EPA Form 8700-12]. As required by statute, EPA promulgated regulations to implement these notification requirements at 40 CFR Parts 262,263, 264, 265, 266, 270, 273, and 279. EPA needs this information to determine the universe of persons who generate, handle, and manage these regulated wastes; assign EPA Identification Numbers; and ensure that these regulated wastes are managed in a way that protect s human health and the environment as required by RCRA. This is mandatory reporting by the respondents. EPA enters notification information submitted by respondents into RCRAInfo, the EPA national database, and assigns EPA Identification Numbers. EPA uses this information to identify the universe of regulated waste generators, handlers, and managers and their specific regulated waste activities. EPA also uses the information for tracking and for a variety of enforcement and inspection purposes. Finally, EPA uses this information to ensure that regulated waste is managed properly, that statutory provisions are upheld, and that regul ations are adhered to by facility owners or operators. Section 3007(b) of RCRA and 40 CFR Part 2, Subpart B, which define s EPA's general policy on public disclosure of information, both contain provisions fo r confidentiality. However, the Agency does not anticipate that businesses will assert a claim of confidentiality covering a ll or part of the Notification of Regulated Waste Activity. If such a claim were asserted, EPA must and will treat the information in acco rdance with the regulations cited above. EPA also will assure that this information collection complies with the Privacy Act of 1974 and OMB Circular 108. Estimated Burden: The reporting burden for information collection requirem ents associated with initial notification requirements is estimated to be approximately 2 hours. The burden estimate includes time for reading the regulations and preparing and submitting the initial notification. The reporting burden for information collection requirements associated with subsequent notification is estimated to be approximately 1 hour. The burden estimate includes time for reading the regulations, preparing and submitting a subsequent notification. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB Control Number 2050-0028 in any correspondence. Do not send the completed form to this address. Also, you can send comments to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk Office for EPA. Please include the OMB Control Number 2050-0028 in any correspondence.

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# Notification of Regulated Waste Activity Instructions and Form

This booklet is designed to help you determine if you are subject to requirements under the Resource Conservation and Recovery Act (RCRA) for notifying the U.S. Environmental Protection Agency (EPA) of your regulated waste activities. Regulated wastes are hazardous wastes as defined by 40 CFR Part 261, universal wastes as defined by 40 CFR Part 273, and used oil as defined by 40 CFR Part 279. The instructions contained in this booklet w ill assist you in obtaining an EPA Identification Number by completing and submitting the RCRA Subtitle C Site Identification Form (Site Identification Form or Site ID Form) [EPA Form 8700-12] for Initial Notifications or in revising your Site Identification Form if you are required to submit a Subsequent Notification. RCRA is a Federal law. If you are regulated but do not comply with the RCRA notification requirements, you may be subject to civil penalties. Large Quantity Handlers of Universal Waste and Used Oil Handlers have the option of submitting either the Site Identification Form or a letter to notify EPA of their regulated waste activities, including both initial and subsequent notifications. As noted above, the instructions in this booklet refer only to completing and submitting the RCRA Subtitle C Site Identification Form. However, the circumstances under which these handlers must notify EPA of their regulated waste activities, the data they must provide, and the procedures they must follow, as described in this booklet, apply to submitting the Site Identification Form or a letter.

Note: Although this booklet contains inform ation and instructions for completing a Notification of Regulated Waste Activity, it should not be considered a substitute for the regulations in Title 40 of the Code of Fede ral Regulations (40 CFR). Rather , this booklet serves as a supplement to the regulations and provides additional information not contained in 40 CFR. As a handler of regulated wastes, you are responsible for learning and complying with all the requirements that apply to you and your regulated waste activities. In addition, remember that this booklet an d the regulations in 40 CFR address only the Federal hazardous waste program. Many States may have notification requirements that differ from the Federal requirements; those States may use Site Identification Form or they may use a similar State form that requires information not requested in the EPA form. Again, it is your responsibility to make sure that you have completed and submitted all forms required under the Federal or your State program.

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Not for use 2 We realize that the regulations are complex. Although we are not providing reprints of the 40 CFR regulations in this booklet, copies of the Federal regulations are available from EPA (see below). We have listed the addresses and phone numbers of the contacts in each State who can

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3 answer your questions and help you understand the Federal and State requirements that apply to you; these are in the contact list found on the Internet at: http://www.epa.gov/epaoswer/hazwaste/data/form8700/forms.htm#links

Click on the document under the section: Where can I obtain assistance with the Notification of Regulated Waste Activity requirements and the RCRA Subtitle C Site Identification Form? Where should I send my completed form?

In addition to those contacts, there are several other sources available to help with your questions and provide information on EPA regulations:

· RCRA Frequently Asked Questions Internet Page . This allows users to find answers to commonly asked questions that cover a wide range of RCRA issues and topics. Find at:

http://waste.custhelp.com/cgi-bin/waste.cfg/php/enduser/entry.php

· RCRA Online . The RCRA Online database is designed to enable users to locate documents, including publications and other outreach materials, that cover a wide range of RCRA issues and topics. Find at:

http://www.epa.gov/rcraonline/

· EPA Internet page for RCRA regulations at:

http://www.epa.gov/docs/epacfr40/chapt-I.info/

· Compliance Assistance Centers . The Environmental Protection Agency (EPA) has sponsored partnerships with industry, academic institutions, environmental groups, and other agencies to launch sector-specific Compliance Assistance Centers (Centers). Each Center addresses real world issues in understandable language for you to understand Federal environmental requirements and how to save money through pollution prevention techniques. Visit the Compliance Assistance Centers at: http://www.assistancecenters.net

There are several Centers listed; you may find one for your business. If not, you may want to review “Do I Need a Hazardous Waste Generator Identification Number?” and other questions at: http://www.transource.org/hazmatz.htm

· EPA National Compliance Assistance Clearinghouse . The Clearinghouse is a comprehensive source of compliance assistance information and resources. Use Internet links to Federal, State, local, and other compliance assistance providers to find the tools you need. Visit the Clearinghouse at: http://www.epa.gov/clearinghouse

· EPA Small Business Ombudsman Office -- 1-800-368-5888

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4 · Your Trade Association

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## Initial Notifications

If you do not currently have an EPA Identification Number and you handle regulated waste, you must submit an initial notification. Please refer to information contained in Sections 1 through 3 of this booklet to help you determine whether you handle a regulated waste, whether any exemptions or exclusions apply to you, and how you should file Notification of Regulated Waste Activity. Circumstances under which you should submit an initial notification include:

1. If you generate, transport, treat, store, or dispose of hazardous wastes. Refer to Section 1 for further information and a description of exclusions or exemptions; or

2. If you recycle hazardous wastes. (Recyclable materials are defined as hazardous wastes that are recycled.) The recycling process itself is exempt from regulation, but you must notify EPA and obtain an EPA Identification Number prior to recycling recyclable materials. Refer to Section 1 for further information and a description of exemptions; or

3. If you are a large quantity handler of universal waste. Refer to Section 2 for further information and a description of exemptions. (Notification is required for people who have not previously notified EPA of their hazardous waste activities or who have not already sent a notification to EPA as required by 40 CFR Part 273.32); or

4. If you transport, process, or re-refine used oil; burn off-specification used oil for energy recovery; or market used oil. Refer to Section 3 for further information and for a description of exemptions. (Notification is required for people who have not previously notified EPA of their hazardous waste activities or have not notified under 40 CFR Part 279 or under 40 CFR Part 266, Subpart E, which was replaced by 40 CFR Part 279.)



## Subsequent Notifications

Even if you have submitted an initial notification and have received an EPA Identification Number, you may be required to submit a subsequent notification. Please refer to Sections 1 through 3 and 5 of this booklet for information on when and how to complete a subsequent notification. In general, you should submit a subsequent notification under the following circumstances:

1. If your business moves to another location; or 2. If the contact for your site changes; or 3. If the ownership of your site changes; or 4. If an additional owner has been added or replaced since you submitted your initial notification; or 5. If the type of regulated waste activity you conduct changes.

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## Contents of This Booklet

Following is a list of the sections contained in this booklet and the information covered in those sections:

Section 1. How to Determine if You Must Notify EPA of Your Hazardous Waste Activities

Section 2. How to Determine if You Must Notify EPA of Your Universal Waste Handling Activities

Section 3. How to Determine if You Must Notify EPA of Your Used Oil Management Activities

Section 4. How to File Notification of Regulated Waste Activity (Information on how and where to file your form and where you can get additional information.)

Section 5. Item-by-item Instructions for Notification of Regulated Waste Activity Using the RCRA Subtitle C Site Identification Form (The blank form is provided at the end of this booklet.)

Section 6. Definitions (These are provided to help you understand and complete your Notification of Regulated Waste Activity.)

Section 7. EPA Hazardous Waste Numbers for Waste Streams Commonly Generated by Small Quantity Generators

Appendix 1- Typical Hazardous Waste Streams Produced by Small Quantity Generators

Appendix 2- Typical Hazardous Waste Streams and EPA Hazardous Waste Numbers

RCRA Subtitle C Site Identification Form (Site ID Form) - a copy of the blank form for f iling a Notification of Regulated Waste Activity

After your completed Site ID Form for a notification is received and processed, you w ill be sent a written acknowledgment that will include your EPA Identification Number. You must use this number on all communications with EPA regarding your regulated waste activities.

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# 1. How to Determine if You Must Notify EPA of Your Hazardous Waste Activities

All persons who generate, transport, recycle, treat, store, or dispose of hazardous waste are required to notify EPA (or their State agency if the State is authorized to operate its own hazardous waste program) of their hazardous waste activities. These persons must obtain an EPA Identification Number unless their solid waste has been excluded from regulation or their hazardous waste has been exempted as outlined below. These respective notification requirements are found in 40 CFR Parts 261, 262, 263, 264, 265, and 266. In addition to the discussion below, you will need to refer to 40 CFR Part 261 to help you determine if the waste you handle is both a solid waste and a hazardous waste that is regulated under RCRA. If you need help making this determination after reading these instructions, contact the agency listed for your State in Section 4 of these instructions. To determine if you handle a solid waste that is also a hazardous waste and regulated under RCRA, ask yourself the following questions.



## A. Do I Handle a Solid Waste?

40 CFR 261.2 defines "solid waste" as any discarded material that is not excluded under Part 261.4(a) or that is not excluded by variance granted under Part 260.30 and 260.31. A discarded material is any material which is:

1. Abandoned, as explained in Part 261.2(b); or

2. Recycled, as explained in Part 261.2(c); or

3. Considered inherently waste-like as explained in Part 261.2(d); or

4. A military munition identified as a solid waste in Part 266.202.

If you do not handle a solid waste, you do not need to notify EPA.


## B. Has My Solid Waste Been Excluded from the Regulations under Part 261.4?

The list of general exclusions can be found in 40 CFR 261.4. If the solid waste that you handle has been excluded, either by rule or special variance, then you do not need to notify EPA for that solid waste. If your solid waste was not excluded from regulation, you need to determine

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8 if it is a hazardous waste that EPA regulates. EPA regulates a solid waste as hazardous waste in two ways:

1. By specifically listing the solid waste as a hazardous waste and assigning it a unique EPA Hazardous Waste Code Number; or 2. By regulating it because it possesses any of four hazardous waste characteristics and assigning it a generic EPA Hazardous Waste Code Number.



## C. Is My Solid Waste Specifically Listed as a Hazardous Waste?

Parts 261.30 through 261.33 identify certain solid wastes that EPA has specifically listed as hazardous. Persons who handle listed hazardous waste are subject to regulation and must notify EPA of their hazardous waste activities unless they are exempted as discussed below. Refer to these regulations to see if your solid waste is in cluded as a "listed hazardous waste." If you are handling a newly regulated hazardous waste and have already notified EPA prior to that hazardous waste being regulated and already have an EPA Identification Number, you do not need to submit a subsequent notification for that newly regulated hazardous waste.



## D. Does My Solid Waste Possess a Hazardous Characteristic?

Even if your solid waste is not specifically listed as a hazardous waste, it may st ill be hazardous because it exhibits certain hazardous characteristics. These characteristics are:

1. Ignitability; 2. Corrosivity; 3. Reactivity; and 4. Toxicity.

Parts 261.20 through 261.24 explain each of the characteristics and outline the testing procedures you should use to determine if your solid waste meets these characteristics. Persons who handle characteristic hazardous waste that is regulated must notify EPA of their activities unless they are exempted, as discussed below. If you are handling a newly regulated hazardous waste and have already notified EPA prior to that hazardous waste being regulated and already have an EPA Identification Number, you do not need to submit a subsequent notification for that newly regulated hazardous waste.



## E. Has My Hazardous Waste Been Exempted from the Regulations under Parts 261.5 and 261.6(a)(3)?

Parts 261.5 and 261.6(a)(3) list certain hazardous wastes that are not subject to RCRA regulation. If the hazardous waste that you handle has been exempted, then you do not need to notify EPA for that hazardous waste.

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# 2. How to Determine if You Must Notify EPA of Your Universal Waste Handling Activities

Under 40 CFR Part 273, Subpart C, Large Quantity Handlers of Universal Waste who accumulate a total of 5,000 kilograms or more of universal wastes at any time are required to notify EPA (or their State agency if the State is authorized to operate its own universal waste program) of their universal waste activities and obtain an EPA Identification Number, unless they have previously notified EPA of their hazardous waste activities. Large Quantity Handlers of Universal Waste must notify EPA of their universal waste activities and obtain an EPA Identification Number before meeting or exceeding the 5,000 kilogram storage limit. Small Quantity Handlers of Universal Waste are exempt from these notification requirements.

Note: Please refer to the regulations in 40 CFR Part 273 to ensure that you are aware of all the requirements that apply to your universal waste handling activities.

3. How to Determine if You Must Notify EPA of Your Used Oil Management Activities

Under 40 CFR Part 279, Subparts E, F, G, and H, respectively, persons who transport used oil; process or re-refine used oil; burn off-specification used oil for energy recovery; or market used oil fuel, are required to notify EPA (or their State agency if the State is authorized to operate its own used oil program) and obtain an EPA Identification Number, unless they are exempt as outlined below. Off-specification used oil may be burned for energy recovery in an industrial furnace, boiler, or hazardous waste incinerator subject to regulation under Subpart O of 40 CFR Part 264 or 265. Used oil transporters; used oil processors/re-re finers; off-specification used oil burners; and used oil fuel marketers who have not previously notified EPA of their hazardous waste activities or notified under 40 CFR Part 266, Subpart E (replaced by Part 279) must notify EPA to identify their used oil management activities.

Note: Please refer to the regulations in 40 CFR Part 279 to ensure that you are aware of all the requirements that apply to your used oil management activities.

Who is exempt from used oil notification requirements?

A. Persons who burn on-specification used oil fuel: Used oil that is to be burned for energy recovery and that meets the specification provided under Part 279.11 is exempt from the regulations. However, the person who first claims that the used oil meets the specification is subject to notification as a used oil fuel marketer and certain other

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10 requirements (see Part 279, Subpart H) . The burner of fuel that meets the specification in Part 279.11 is not required to notify.

B. Used oil generators are not required to notify EPA.

C. Used oil generators operating used oil-fired space heaters: Persons who burn only used oil that they generate (or used oil received fr om household do-it-yourself used oil changers) in used oil-fired space heaters are exempt from the notification requirement provided that the device is vented to the outdoors and the device is not designed to have a capacity greater than 0.5 million BTU/hour. 

# 4. How to File Notification of Regulated Waste Activity

Initial Notifications

If you do not currently have an EPA Identification Number and you handle a regulated waste, you must submit an initial notification for your regulated waste activities. Please refer to Sections 1 through 3 of this booklet for more information on whether you must notify EPA of these regulated waste activities. You can satisfy this initial notification requirement by completing and signing the enclosed RCRA Subtitle C Site Identification Form (Site Identification Form) [EPA Form 8700-12] and submitting it to the appropriate address (see Section C below). Under the Hazardous Waste Import Regulations, 40 CFR Part 262.60, foreign generators should not apply for an EPA Identification Number . These regulations state that when filling out a U.S. manifest, you must include the name and address of the foreign generator, and the name, address, and EPA Identification Number of the importer. Please contact the U.S. firms involved with your shipments and determine which firm will serve as the U. S. Importer.



## Subsequent Notifications

Even if you have submitted an initial notification and have received an EPA Identification Number, you may be required to submit a subsequent notification. Please refer to information contained in Sections 1 through 3 and Section 5 of this booklet for instructions on when and how to complete a subsequent notification.



## A. How Many Forms Should I File?

A person who is subject to the hazardous waste, universal waste, or used oil management regulations under RCRA should submit one notification (Site Identification Form) per RCRA site. If you conduct any regulated waste activity - hazardous waste, universal waste, or used oil

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11 management activities - at more than one RCRA site, you must submit a separate notification using the Site Identification Form for each RCRA site. If you only transport regulated wastes and do not generate, treat, store, or dispose of hazardous wastes; qualify as a large quantity handler of universal wastes; or process/re-refine used oil, burn off-specification used oil fuel, or market used oil fuel, you may submit one notification that covers all transportation activities your company conducts. This notification should be sent to the appropriate address (see subsection C below) that serves the State where your company has its headquarters or principal place of business. However, if you are a transporter who also engages in one or more of the regulated waste activities listed above, you must complete and submit a separate notification using the Site Identification Form to cover each RCRA site.



## B. Can I Request that this Information Be Kept Confidential?

All information you submit in an initial or subsequent notification can be released to the public, according to the Freedom of Information Act, unless it is determined to be confidential by EPA pursuant to 40 CFR Part 2. Since notification information is very general, EPA believes it is unlikely that any information in your notification could qualify to be protected from release. However, you may make a claim of confidentiality by printing the word "CONFIDENTIAL" on both sides of RCRA Subtitle C Site Identification Form and on any attachments. EPA w ill take action on the confidentiality claims in accordance with 40 CFR Part 2.



## C. Where Should I Send My Completed Form?

We have provided an up to date list of the address for your State Office where you should send your completed RCRA Subtitle C Site Identification Form. Also listed is the phone number you can call for additional information; in some cases there also is an e-mail address. This contact list can be found on the Internet at:

http://www.epa.gov/epaoswer/hazwaste/data/form8700/forms.htm#links

Click on the document under the section: Where can I obtain assistance with the Notification of Regulated Waste Activity requirements and the RCRA Subtitle C Site Identification Form? Where Should I Send My Completed Form?

Many States use the form included at the end of this booklet; some also require additional information. The other States require that you complete and submit a state specific form. The Contact List notes which form to use; even if you use the included form, you should check with your state to determine if you need to submit additional information. Also, contact your State if you have any questions about your submission.

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# 5. Item-by-item Instructions for Notification of Regulated Waste Activity Using the RCRA Subtitle C Site Identification Form

Please be sure to review the instructions carefully and complete all items on the form. After you have submitted the Site Identification Form once, your State may allow you to attach a copy of your most recently submitted form. If so, circle items numbers for which any information has changed. Then enter the new information (also circle the item numbers) on the Site Identification Form included in this booklet and provide the required signatures in Item 13 - Certification. Note: Be sure to use your most recently submitted form; it may have been submitted for a Subsequent Notification of Regulated Waste Activity, the Hazardous Waste Report, or a previous RCRA Hazardous Waste Part A Permit Application.

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# Instructions for Filling Out the **RCRA Subtitle C Site Identification (Site ID) Form**

WHO MUST SUBMIT THIS FORM

All sites required to submit any of the following must submit the RCRA Subtitle C Site Identification (Site ID) Form:

Initial Notification of Regulated Waste Activity Subsequent Notification of Regulated Waste Activity First RCRA Hazar dous Waste Part A Permit Application Revised RCRA Hazar dous Waste Part A Permit Application Hazar dous Waste Report

You must complete all the items on the Site ID Form.



## PURPOSE OF THIS FORM

For purposes of the Notification of Regulated Waste Activity, the Site ID Form provides site-specific information about a facility for obtaining an EPA Identification Number and submitting Initial Notification of Regulated Waste Activity. For purposes of a Subsequent Notification of Regulated Waste Activity, the Site ID Form provides updated site-specific information for those items that have changed at your site and verifies the information for those items that remain unchanged. For the purposes of the RCRA Hazar dous Waste Part A Permit Application and the Hazar dous Waste Report, you must also complete the Site ID Form to update your site information.



## HOW TO FILL OUT THIS FORM

Complete all of the Site ID Form items.

Item 1 - your reason for submitting the form
Item 2 - your site’s EPA Identification Number
Item 3 - the name of your site
Item 4 - the physical location of your site
Item 5 - the land type of your site
Item 6 - the North American Industry Classification System (NAICS) code(s) for your site
Item 7 - the mailing address for your site
Item 8 - name and phone number of a contact person at your site

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### 14 Item 9 - names of the operator and the legal owner(s) of your site
Item 10 - your site’s regulated waste activities (enter all that apply)
Item 11 - the description of hazar dous waste if you handle any
Item 12 - additional comments on Items 1 through 11
Item 13 - certification that the information you provided throughout the form is truthful, accurate and complete
Type or print in black ink all items except the Signature box in Item 13. Enter your site’s EPA ID Number in the top left-hand corner on the second and third pages of the form; for Initial Notification for this site, leave the EPA Identification Number blank. Use Item 12 - Comments to clarify or provide additional information for any entry. When entering information in the comments section, enter the item number and box letter to which the comment refers. If you must use additional sheets for comments, enter your site’s EPA ID Number in the top left-hand corner of each sheet.

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## ITEM-BY-ITEM INSTRUCTIONS

Item 1 -- Reason for Submittal:

Reason for Submittal : Place an “X” in the appropriate box to indicate whether this form is your Initial Notification of Regulated Waste Activity (to obtain an EPA Identification Number); a Subsequent Notification of Regulated Waste Activity (to update your site identification information); a component of a First or a Revised Hazar dous Waste Part A Permit Application; or a component of the Hazar dous Waste Report.

For Initial Notification of Regulated Waste Activity to provide site identification information and obtain an EPA Identification Number for hazardous waste, universal waste, or used oil activities. If your waste activity is regulated under Subtitle C of the Resource Conservation and Recovery Act (RCRA) and the rules promulgated pursuant to the Act (specifically 40 CFR Parts 260–299), you must submit this form to notify the appropriate State or EPA Regional Office of your regulated waste activities and obtain an EPA Identification Number.

For Subsequent Notification of Regulated Waste Activity to update site identification information. You must use this form to submit a subsequent notification if your site already has an EPA Identification Number and you wish to change information (e.g., generator status, new site contact person, new owner, new mailing address, new regulated waste activity, etc.).

As a component of a First RCRA Hazardous Waste Part A Permit Application. If your site is planning to treat, store, or dispose of hazar dous waste on site in a unit that is not exempt from obtaining a hazar dous waste permit, you must submit this form as part of the Part A Permit Application. Also, if the activity at this site (treatment, storage, or disposal) became newly regulated under RCRA Subtitle C and the rules promulgated pursuant to the Act (specifically 40 CFR Parts 260-299), you must submit this form as part of the Part A Permit Application.

As a component of a Revised RCRA Hazardous Waste Part A Permit Application. If you must submit a revised Part A Permit Application to reflect changes that have occurred at your site, you must submit this form as part of your revised Part A Permit Application. Examples of site changes requiring a revised Part A Permit Application include managing new wastes not identified in the first submission of the form or changes to existing waste treatment processes. When submitting a revised Part A Permit Application, please include the Amendment number in the appropriate space.

As a component of the Hazardous Waste Report. If you are required to submit a Hazar dous Waste Report indicating the amount of h azar dous waste you generate, treat, recycle, dispose, ship off site, or receive from off site, you must f ill out this form.



## NOTE You will report your current Hazar dous Waste Generator status as of the date of submitting the Site Identification Form in Item 10.A.1 - Generator of Hazar dous Waste. Your status may have changed since your last submission (unless this is an Initial Notification of Regulated Waste Activity).

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### 16 Item 2 -- Site EPA ID Number:

Provide your EPA Identification Number in Item 2 for this site. Also, be sure to include your EPA Identification Number at the top of pages 2 and 3 of the form (as well as on any attachments to the Site ID Form).



## NOTE If this is your Initial Notification for this site, leave the EPA Identification Number blank and proceed to Item 3.

Items 3 and 4 -- Site Name and Location:

Provide the legal name of your site and a complete location address. Please note that the address you give for Item 4, Site Location, must be a physical address, not a post office box or route number.



## NOTE A new EPA Identification Number is required if you change the location of your site.

Item 5 -- Site Land Type:

Place an “ X ” in the box that best describes the land type of your site. Select only one type: Private, County, District, Federal, Indian (see Indian Country below), Municipal, State, or Other. If your site’s Land Type could be described as Municipal and as County, as District, or as Indian, do not mark Municipal. Instead choose the other appropriate code; you may explain this in Item 12 - Comments

.
Indian Country - Land governed by an entity on the list of Federally recognized American Indian tribes and Alaskan Native entities at: http://www.epa.gov/edr/fdetribal.pdf

Item 6 -- North American Industry Classification System (NAICS) Code(s):

Box A must be completed. Completing Boxes B-D is recommended, if applicable.

Box A Provide the North American Industry Classification System (NAICS) code that bestdescribes your site’s primary business production process for your products or services. Use the six (6) digit code (most specific description) if available for your business; if not, use the five (5) digit code; do not enter any four (4) or less digit code.

Boxes B - D List other NAICS codes that describe the primary business production processes for your site. Use the 6 or 5 digit codes that apply to your site.

Check with your accounting or business staff to determine your NAICS code(s); the NAICS code is used in tax reporting and other business reports. A list of the acceptable codes is on the Internet
at - http://www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm You can obtain additional information about NAICS codes from the Internet at - http://www.census.gov/epcd/naics02/

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### 17 Item 7 -- Site Mailing Address:

Please enter the Site Mailing Address. If the mailing address and the Location of Site (Item 4) are the same, you can enter “ Same as Item 4 ” in the box for Item 7.

Item 8 -- Site Contact Person:

Enter the name, business telephone number, and extension of the individual who should be contacted regarding the information submitted in the Site ID Form. You may also enter an email address; if you want to be contacted by fax, enter that number in Item 12 - Comments. A Subsequent Notification is recommended when the Site Contact Person changes. Do not enter other contact persons here; if there are other persons who may be contacted about this submission, list them and their other contact information in Item 12. An example would be a contact specifically for the Hazardous Waste Report. Note that the Facility Permit Contact information for the RCRA Hazardous Waste Part A Permit Application is entered in Items 1 and 2 of the Hazardous Waste Permit Information Form.



## NOTE It is assumed that the Site Contact Person will r eceive mail at the Site Ma iling Address provided in Item 7. If this is not the case, please provide the mailing address for the Site Contact Person in Item 12 - Comments.

Item 9 -- Operator and Legal Owner of the Site:

This section should be used to indicate all the operators and owners of this site. Please review these definitions:

Operator - The person responsible for the overall operation of a RCRA site. Note: This is the legal entity which controls the RCRA site operation rather than the plant or site manager. This is usually a company or business name, not an individual. See Person

.

Owner - The person who owns a RCRA site or part of a RCRA site. Note: This includes the property owner. This may be an individual, company, or business name. See Person

.

Person - An individual, trust, firm, joint stock company, Federal Agency, corporation (including a government corporation), partnership, association, State, municipality, commission, political subdivision of a State, or any interstate body.

A. Name of Site’s Operator: Provide the name of your site’s operator.

Date Became an Operator: Indicate the date on which the above entity became the operator of your site. Enter dates as in this example: For April 22, 2005, enter 04/22/2005.

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### 18 Operator Type: Place an “ X ” in the box that best describes the operator type of your site. Select only one type: Private, County, District, Federal, Indian (see below), Municipal, State, or Other. If your site’s Operator Type could be described as Municipal and as County, as District, or as Indian, do not mark Municipal. Instead choose the other appropriate code; you may explain this in Item 12 - Comments.

Indian - A member of an entity on the list of Federally recognized American Indian tribes and Alaskan Native entities at: http://www.epa.gov/edr/fdetribal.pdf

Use the Comments section in Item 12 to list any additional operators, their names, the dates they became operators, operator type, and mailing address. If necessary, attach a separate sheet of paper.

B. Name of Site’s Legal Owner : Provide the name of your site’s legal owner(s). This includes owner(s) of the building(s) and land.

Date Became an Owner: Indicate the date on which the above entity became the owner of your site. Enter dates as in this example: For April 22, 2005, enter 04/22/2005.

Owner Type: Place an “ X ” in the box that best describes the owner type of your site. Select only one type: Private, County, District, Federal, Indian (see below), Municipal, State, or Other. If your site’s Owner Type could be described as Municipal and as County, as District, or as Indian, do not mark Municipal. Instead choose the other appropriate code; you may explain this in Item 12 - Comments.

Indian - A member of an entity on the list of Federally recognized American Indian tribes and Alaskan Native entities at: http://www.epa.gov/edr/fdetribal.pdf

Use the Comments section in Item 12 to list any additional owners, their names, the dates they became owners, owner type, mailing address, and which owner(s), if any, are no longer owners since your last submission of this form. If necessary, attach a separate sheet of paper.

Legal Owner Address: Please enter this information if your State requires it; see your State’s specific instructions if any. If the address and the Location of Site (Item 4) are the same, you can enter “Same as Item 4” in the box for Item 9.



## NOTE A subsequent notification is recommended when the operator or owner of a site changes. Because an EPA Identification Number is site-specific, the new owner will keep the existing EPA Identification Number for that location. If your business moves to another location, the operator or owner must notify the State or EPA Regional Office of this change. Since your business has changed locations, a new EPA Identification Number will be assigned.

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### 19 Item 10 -- Type of Regulated Waste Activity

Place an “X” in box “Yes” or in box “No” as appropriate for activities at this site; complete any additional boxes as instructed.

A. Hazardous Waste Activities: Complete all parts 1 through 6.



## NOTE Listed below are the Federal generator status definitions. If, however, the State where your site is located has definitions different from the Federal definitions, you must use the State definitions.

1. Generator of Hazardous Waste: If you generate a hazar dous waste that is listed in 40 CFR 261.31 thr ough 261.33 or identified by one or more h azar dous waste characteristic(s) contained in 40 CFR 261.21 thr ough 261.24, place an “X” in the appropriate box for the quantity of nonacutely hazar dous waste that is generated per calendar month. The regulations for h azar dous waste generators are found in 40 CFR Part 262. Consult these regulations and your State for details about how the regulations apply to your situation. Below is a brief description of the three types of hazar dous waste generators.

If “Yes”, mark only one of the following - a, b, or c.

a. LQG: Large Quantity Generator

This site is a Large Quantity Generator if the site meets any of the following criteria: i) Generates, in any calendar month, 1,000 kg (2,200 lbs.) or more of RCRA hazar dous waste; or ii) Generates, in any calendar month, or accumulates at any time, more than 1 kg (2.2 lbs.) of RCRA acute hazar dous waste; or iii) Generates, in any calendar month, or accumulates at any time, more than 100 kg (220 lbs.) of spill cleanup material contaminated with RCRA acute hazar dous waste.



## NOTE If, in addition to being an LQG, you recycle hazar dous wastes at your site, mark both this box and Box A.4 below.

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### 20 b. SQG: Small Quantity Generator

This site is a Small Quantity Generator if the site meets all of the following criteria: i) Generates, in any calendar month, more than 100 kg (220 lbs.) but less than 1,000 kg (2,200 lbs.) of RCRA hazar dous waste; and ii) Generates, in any calendar month, or accumulates at any time, no more than 1 kg (2.2 lbs.) of acute hazar dous waste and no more than 100 kg (220 lbs.) of material from the cleanup of a spill of acute h azar dous waste.

OR , the site is a Small Quantity Generator if the site:

i) Meets all other criteria for a Conditionally Exempt Small Quantity Generator (see below), but ii) Accumulates, at any time, more than 1,000 kg (2,200 lbs.) of RCRA hazar dous waste.

c. CESQG: Conditionally Exempt Small Quantity Generator

This site is a CESQG if the site does all of the following: i) Generates no more than 100 kg (220 lbs.) of RCRA hazar dous waste in any calendar month; and ii) Accumulates, at any time, no more than 1,000 kg (2,200 lbs.) of RCRA hazar dous waste; and iii) Generates, in any calendar month, or accumulates at any time, no more than 1 kg (2.2 lbs.) of acute hazar dous waste, and no more than 100 kg (220 lbs.) of material from the cleanup of a spill of acute h azar dous waste.



## NOTE If you generate acutely hazar dous wastes listed in 40 CFR 261.31, 261.32 or 261.33(e), please refer to 40 CFR 261.5(e) to determine the circumstances under which you must notify the EPA.

In addition to the above, mark “Yes” or “No” for the other hazar dous waste activities listed below that may occur at this site. Complete 1.d and e, and 2 through 6.

d. United States Importer of Hazardous Waste

Mark “Yes” if you import hazar dous waste from a foreign country into the United States. Refer to 40 CFR 262.60 for additional information.

e. Mixed Waste Generator

Mark “Yes” if you are a generator of mixed waste (waste that is both hazar dous and radioactive). RCRA defines “mixed waste” as waste that contains both hazar dous waste and source, special nuclear, or by-product material subject to the Atomic Energy Act (AEA), RCRA section 1004(41), 42 U.S.C. 6903 (63 FR 17414; April 9, 1998). See the definitions on pages 39, 42, and 43.

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### 21 2. Transporter of Hazardous Waste: Mark “Yes” if you transport hazar dous waste within the United States. The Federal regulations for hazar dous waste transporters are found in 40 CFR Part 263.

3. Treater, Storer, or Disposer of Hazardous Waste: If you treat, store, or dispose of hazar dous waste, mark “Yes”. A RCRA Hazar dous Waste Permit is required for this activity. Contact the appropriate office for your State for more information. The Federal regulations for operators and owners of permitted treatment, storage, and disposal facilities (TSDFs) are found in 40 CFR Parts 264, 265, 266, and 270.



## NOTE If your site is a destination facility for universal wastes in addition to being a treatment, storage, or disposal facility for other RCRA hazar dous wastes, mark both this box and Box B.2 below.

4. Recycler of Hazardous Waste: If you recycle regulated hazar dous wastes (recyclable materials), mark “Yes”. The Federal regulations for operators and owners of sites that recycle hazar dous waste are found in 40 CFR 261.6. You also may be subject to other Federal and State regulations; in some cases a permit is required.



## NOTE If your site, in addition to being a recycling site for hazar dous waste, is a treater, storer, or disposer of hazar dous waste, mark both this box and Box A.3 above. If your site is a destination facility for universal wastes in addition to being a recycling site for other RCRA hazar dous wastes, mark both this box and Box B.2 below.

5. Exempt Boiler and/or Industrial Furnace: If you mark “Yes”, mark each that applies.

a. If you burn small quantities of hazar dous waste in an on-site boiler or industrial furnace in accordance with the conditions in 40 CFR 266.108, mark “Yes” to indicate that you qualify for the Small Quantity On-Site Burner Exemption.

b. If you process hazar dous wastes in a smelting, melting, or refining furnace solely for metals recovery, as described in 40 CFR 266.100(d), or to recover ec onomically significant amounts of precious metals, as described in 40 CFR 266.100(g), or if you process h azar dous wastes in a lead recovery furnace to recover lead, as described in 40 CFR 266.100(h), place an “X” in the box to indicate that you qualify for the Smelting, Melting, and Refining Furnace Exemption.

6. Underground Injection Control: If you generate, treat, store, or dispose of hazar dous waste and there is an underground injection well located at your site, mark “Yes”. The Federal regulations for operators or owners of underground injection wells are found in 40 CFR Part 148.

In addition to the above, mark “Yes” or “No” for the other regulated waste activities listed below that may occur at this site. Complete Items B and C.

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### 22 B. Universal Waste Activities: Refer to your State-specific requirements and definitions for universal
waste. Also, refer to 40 CFR 261.9 and 40 CFR Part 273 for the Federal regulations covering universal waste. Complete 1 and 2.

1. Large Quantity Handler of Universal Waste (LQHUW): You are an LQHUW if you accumulate a total of 5,000 kg or more of any universal wastes (calculated collectively) at any time. If “Yes”, place an “X” in the appropriate box(es) to indicate the type(s) of universal wastes you generate at your site. If your State has additional universal wastes, indicate what they are and place an “X” in the corresponding box(es).

2. Destination Facility: Mark “Yes” if you treat, dispose of, or recycle universal wastes on site. A hazar dous waste permit is required if you treat or dispose of universal wastes; a permit may be required if you recycle universal wastes.



## NOTE If your site, in addition to being a destination facility for universal wastes, is also a treatment, storage, or disposal facility for RCRA hazar dous wastes, mark both this box and Box A.3 above. In addition, if your site recycles RCRA hazar dous wastes, mark both this box and Box A.4 above.

C. Used Oil Activities: Mark the appropriate box(es) to indicate which used oil management activities are taking place at this site. The Federal regulations for used oil management are found in 40 CFR Part 279. Complete 1 through 4.

1. Used Oil Transporter: If you transport used oil and/or own or operate a used oil transfer facility, mark “Yes” and place an “X” in the appropriate box(es) to indicate this used oil management activity. 2. Used Oil Processor/Re-Refiner: If you process and/or re-refine used oil, mark “Yes” and place an “X” in the appropriate box(es) to indicate this used oil management activity.

3. Off-Specification Used Oil Burner: If you burn off-specification used oil fuel, mark “Yes” to indicate this used oil management activity.

4. Used Oil Fuel Marketer: Mark “Yes” if you market used oil fuel. If you market offspecification used oil directly to a burner, place an “X” in Box 4.a. If you are the first to claim the used oil meets the used oil specification established in 40 CFR 279.11, place an “X” in Box 4.b. If either of these boxes is marked, you also must notify (or have previously notified) as a used oil transporter, used oil processor/re-refiner, or off-specification used oil fuel burner, unless you are a used oil generator. (Used oil generators are not required to notify.)

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### 23 Item 11 -- Description of Hazardous Wastes:

Complete this item if you marked “Yes” for any activity in Item 10. A . and if your State requires it. You will need to refer to 40 CFR Part 261 to complete this item. Part 261 identifies those solid wastes which the EPA defines as hazar dous and regulates under RCRA. If you need help completing this section, please contact your State Office.

A. Federally Regulated Hazardous Wastes: If you handle hazar dous wastes that are described in 40 CFR Part 261, enter the appropriate 4-digit code(s) in the box(es) provided.



## NOTE EPA Hazar dous Waste Codes. If you handle more h azar dous wastes than will fit under Item 11.A., please continue listing the hazar dous waste codes on an extra sheet. If you handle a large number of codes, you may copy the list in this booklet and mark the ones that you handle. Attach any additional sheets to the Site Identification Form.

B. State-Regulated Hazardous Wastes: If you manage State-regulated hazar dous wastes that have a state waste code, enter the appropriate code(s) in the box(es) provided.

Item 12 -- Comments:

Use this section as needed to provide additional information for Items 1 through 11. Include the item number and box letter (if any) for each comment you make. You may attach additional sheets if needed.

Item 13 -- Certification:

This certification must be signed by operator(s), owner(s), or authorized representative(s) of the site. An

“ authorized representative ” is a person responsible for the overall operation of the site (i.e., a plant manager or superintendent, or a person of equal responsibility). For the RCRA Hazardous Waste Part A Permit Application, all operator(s) and owner(s) of the site must sign (see 40 CFR 270. 10 (b) and 270.11)

.



## NOTE All Site ID Form submissions must include this certification to be complete.

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# 6. Definitions

The following definitions are included to help you to understand and complete the RCRA Subtitle C Site Identification Form:

Accumulation: See 40 CFR 262.34. A site that does not hold RCRA Interim Status or a RCRA permit may accumulate hazar dous waste for a short period of time before shipping it off site. The waste must be accumulated in either tanks or containers; it may not be accumulated in surface impoundments. Generators of more than 1,000 kg (2,200 lbs) of h azar dous waste per month may accumulate their waste for up to 90 days before shipping it off site. Generators of 100 kg (220 lbs) to 1,000 kg (2,200 lbs) of h azar dous waste per month may accumulate their waste for up to 180 days before shipping it off site. If the nearest treatment, storage, disposal, or recycling facility to which they can send their waste is more than 200 miles away, they may accumulate their waste for 270 days.

Act or RCRA means the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act of 1976, as amended by the H azar dous and Solid Waste Amendments of 1984, 42 U.S.C. Section 6901 et seq.

Acute Hazardous Waste means any hazar dous waste with an EPA h azar dous waste code beginning with the letter “P” (40 CFR 261.33(e)) or any of the following “F” codes: F020, F021, F022, F023, F026, and F027 (40 CFR 261.31). These wastes are subject to stringent quantity standards for accumulation and generation (40 CFR 261.5(e)).

Authorized Representative means the person responsible for the overall operation of the RCRA site or an operational unit (i.e., part of a RCRA site), e.g., superintendent or plant manager, or person of equivalent responsibility.

Authorized State means a State that has obtained authorization from the EPA to direct its own RCRA
program.

Boiler means an enclosed device using controlled flame combustion and having the following characteristics:

1. The unit has physical provisions for recovering and exporting energy in the form of steam, heated fluids, or heated gases;

2. The unit's combustion chamber and primary energy recovery section(s) are of integral design (i.e., they are physically formed into one manufactured or assembled unit);

3. The unit continuously maintains an energy recovery efficiency of at least 60 percent, calculated in terms of the recovered energy compared with the thermal value of the fuel;

4. The unit exports and utilizes at least 75 percent of the recovered energy, calculated on an annual basis (excluding recovered heat used internally in the same unit, for example, to preheat fuel or combustion air or drive fans or feedwater pumps); or

5. The unit is one which the Regional Administrator has determined, on a case-by-case basis, to be a boiler, after considering the standards in 40 CFR 260.32.

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25 By-product Material means material that is a by-product material is (1) any radioactive material (except special nuclear material) yielded in or made radioactive by exposure to the radiation incident to the process of producing or utilizing special nuclear material; and (2) the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its source material content (defined in the Atomic Energy Act of 1954).

Code of Federal Regulations (CFR) means the codification of the general and permanent rules published in the Federal Register by the Executive departments and agencies of the Federal Government. The Code is divided into 50 titles which represent broad areas subject to Federal regulation. Each title is divided into chapters that usually bear the name of the issuing agency. Each chapter is further subdivided into parts covering specific regulatory areas. The CFR title applicable for the Hazar dous Waste Report is

“ 40, ” as in “ 40 CFR 262.34. ”

Conditionally Exempt Small Quantity Generator (CESQG) of Hazardous Waste means a generator that meets the following criteria:

In every month during the year, the site did all of the following:

1. Generated no more than 100 kg (220 lbs.) of RCRA hazardous waste in a calendar month; and

2. Generated, in a calendar month, or accumulated at any time, no more than 1 kg (2.2 lbs.) of acute hazardous waste, and no more than 100 kg (220 lbs.) of material from the cleanup of a spill of acute hazardous waste; and

3. Accumulated, at any time, no more than 1,000 kg (2,200 lbs.) of hazardous waste.

Confidential Business Information (CBI) means information a site does not wish to make available to the general public for competitive business reasons. Confidential Business Information (CBI) may be claimed for certain information in your report. A claim may be made in accordance with 40 CFR Part 2, Subpart B.

Delisted Wastes means a site-specific wastes excluded from regulation under 40 CFR 260.20 and 260.22. A waste at a particular generating site may be excluded by petitioning the EPA Administrator for a regulatory amendment. These wastes are listed in Appendix IX of 40 CFR Part 261.

Disposal means the discharge, deposit, injection, dumping, spilling, leaking, or placing of any solid waste or hazar dous waste into or on any land or water so that such solid waste or h azar dous waste or any constituent thereof may enter the environment or be emitted into the air or discharged into any waters, including ground waters.

Environmental Protection Agency (EPA), also called U.S. EPA, means the United States Environmental Protection Agency. Some State environmental authorities may be called the EPA also, as in “ Illinois EPA.”

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26 EPA Identification (ID) Number means the number assigned by the EPA to each hazardous waste generator, hazar dous waste transporter, and treatment, storage, or disposal facility; United States importer of hazar dous waste; mixed waste (h azar dous and radioactive) generator; recycler of hazar dous waste; exempt boiler and/or industrial furnace burning or processing h azar dous waste; large quantity handler of or destination facility for universal wastes; disposer of h azar dous waste with an underground injection permit; used oil transporter, used oil processor/re-refiner, o ff-specification used oil fuel burner, used oil fuel marketer; or site undergoing corrective action.

Excluded Wastes means wastes excluded from the definition of solid or hazardous waste under 40 CFR 261.3 and 261.4.

Hazardous Waste means a hazar dous waste as defined in 40 CFR 261.3.

Hazardous Waste Generator means any person, by site, whose act or process produces hazar dous waste identified or listed in 40 CFR Part 261.

Hazardous Waste Number or Code, EPA, means the number (or code) assigned by the EPA to each hazardous waste listed in 40 CFR Part 261, Subpart D and to each characteristic identified in 40 CFR Part 261, Subpart C. The codes consist of one letter (D, F, P, U, or K) and three numbers.

Hazardous Waste Storage means the holding of hazar dous waste for a temporary period, at the end of which the hazar dous waste is treated, disposed of, or stored elsewhere.

Hazardous Waste Transporter means a person engaged in the off-site transportation of hazar dous waste by air, rail, highway, or water.

Hazardous Waste Treatment means any method, technique, or process, including neutralization, designed to change the physical, chemical, or biological character or composition of any hazar dous waste so as to neutralize such hazar dous waste, or so as to recover energy or material resources from the hazar dous waste, or so as to render such h azar dous waste nonh azar dous, or less h azar dous; safer to transport, store or dispose of; or amenable for recovery, amenable for storage, or reduced in volume. Such term includes any activity or processing designed to change the physical form or composition of hazar dous waste so as to render it nonh azar dous.

Incineration means the burning of certain types of solid, liquid, or gaseous materials; or a treatment technology involving destruction of waste by controlled burning at high temperatures (e.g., burning sludge to remove the water and reduce the remaining residues to a safe, non-burnable ash that can be disposed safely on land, in some waters, or in underground locations).

Industrial Furnace means any of the following enclosed devices that are integral components of manufacturing processes and that use thermal treatment to accomplish recovery of materials or energy: cement kilns; lime kilns; aggregate kilns; phosphate kilns; coke ovens; blast furnaces; smelting, melting and refining furnaces; titanium dioxide chloride process oxidation reactors; methane reforming furnaces; pulping liquor recovery furnaces; combustion devices used in the recovery of sulfur values from spent sulfuric acid; halogen acid furnaces, as defined under industrial furnace in 40 CFR 260.10; and such other devices as the Administrator may add to this list.

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27 Interim (Permit) Status means the period during which the operator/owner of an existing TSD facility is treated as having been issued a RCRA permit even though he/she has not yet received a final determination. An existing facility should have automatically qualified for interim status if the operator/owner filed both timely “ notification” and the first part (Part A) of the RCRA permit application. Interim status continues until a final determination is made to issue or deny the permit. Operator/owner of new facilities cannot by definition qualify for interim status; rather, they need a RCRA permit prior to beginning construction of a hazardous waste management facility.

Large Quantity Generator (LQG) of Hazardous Waste means a generator that meets any of the following criteria:

1. Generates, in a calendar month, 1,000 kg (2,200 lbs.) or more of RCRA hazardous waste, during one or more months in a year; or 2. Generates, in a calendar month, or accumulates at any time, more than 1 kg (2.2 lbs.) of RCRA acute hazardous waste; or 3. Generates, in a calendar month, or accumulates at any time, more than 100 kg (220 lbs.) of spill cleanup material contaminated with RCRA acute hazardous waste.

Large Quantity Handler of Universal Waste means a universal waste handler (as defined in 40 CFR 273.6) who accumulates 5,000 kilograms or more total of universal waste (batteries, pesticides, or thermostats, collectively) at any time. This designation is retained through the end of the calendar year in which 5,000 kilograms or more of universal wastes are accumulated.

Management or Hazardous Waste Management means the systematic control of the collection, source separation, storage, transportation, processing, treatment, recovery, or disposal of hazardous waste (40 CFR 260.10).

Manifest, Uniform Hazardous Waste, means the shipping document EPA form 8700-22 and, if necessary, Form 8700-22A, originated and signed by a generator in accordance with the instructions included in the appendix to 40 CFR Part 262. The “ cradle-to-grave” paperwork must accompany a shipment of hazardous waste as it moves from the generator to the transporter and eventually to the hazardous waste management facility.

Mixed Waste means a waste that contains both hazardous and source, special nuclear, or byproduct material subject to the Atomic Energy Act (AEA), RCRA section 1004(41), 42 U.S.C. 6903 (63 FR 17414; April 9, 1998).

Municipality means a city, village, town, borough, county, parish, district, association, Indian tribe or authorized Indian tribal organization, designated and approved management agency under Section 208 of the Clean Water Act, or any other public body created by or under State law and having jurisdiction over disposal of sewage, industrial wastes, or other wastes.

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28 Off-Specification Used Oil Burner means a RCRA site where used oil not meeting the specification requirements in 40 CFR 279.11 (o ff-specification used oil) is burned for energy recovery in devices identified in Section 279.61(a).

Off-Specification Used Oil Fuel means used oil fuel that does not meet the specification provided under 40 CFR 279.11.

On-Specification Used Oil Fuel means used oil fuel that meets the specification provided under 40 CFR 279.11.

Off-site Facility means a hazardous waste treatment, storage, disposal, or recycling area located at a place away from the generating site.

On-site Facility means a hazardous waste treatment, storage, disposal, or recycling area located on the generating site.

Operator means the person responsible for the overall operation of a RCRA site. Note: This is the legal entity which controls the RCRA site operation rather than the plant or site manager. This is usually a company or business name, not an individual. See Person

.

Owner means a person who owns a RCRA site or part of a site. Note: This includes the property owner. This may be an individual, company, or business name. See Person

.

Person means an individual, trust, firm, joint stock company, Federal Agency, corporation (including a government corporation), partnership, association, State, municipality, commission, political subdivision of a State, or any interstate body.

Resource Conservation and Recovery Act (RCRA) means the Solid Waste Disposal Act as amended by the Resource Conservation and Recovery Act (RCRA) (40 CFR 270.2). It is the Federal statute that regulates the generation, treatment, storage, disposal, recycling, and/or transportation of solid and hazardous waste.

RCRA Interim (Permit) Status - Refer to “ Interim (Permit) Status.”

RCRA Permit means a complete RCRA permit is comprised of an operating permit for hazardous waste treatment, storage, and disposal, and a corrective action permit addressing releases from solid waste management unit (SWMUs). To apply for a permit, a site must file a two-part application (Part A and Part B). A facility is not considered to have a complete RCRA permit until both parts have been issued.

RCRA Subtitle C Site (RCRA Site or Site) means the physical plant or location at which one or more of the following regulated waste activities occurs: the generation, transportation, treatment, storage, or disposal of hazar dous wastes; recycling of h azar dous wastes; United States importer of h azar dous waste; mixed waste (hazar dous and radioactive) generator; exempt boiler and/or industrial furnace burning or processing hazar dous waste; large quantity handler of or destination facility for universal wastes; disposing hazar dous waste with an underground injection permit; the transportation (and temporary storage during transportation), processing/re-refining, burning, or marketing of used oil; or undergoing corrective action. A site may consist of several treatment, storage, or disposal operational units. For entities that only transport regulated wastes, the term site refers to the headquarters of that entity’s operations.

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29 Recycling means the use, reuse, or reclamation of a material (40 CFR 261.1(c)(7)).

“ Reclamation” is the processing or regeneration of a material to recover a usable product (e.g., recovery of lead values from spent batteries, regeneration of spent solvents) (40 CFR 261.1(c)(4)). A material is “used or reused” if it is either: (1) employed as an ingredient (including use as an intermediate) in an industrial process to make a product (e.g., distillation bottoms from one process used as feedstock in another process) (40 CFR 261.1(c)(5)). However, a material will not satisfy this condition if distinct components of the material are recovered as separate end products (as when metals are recovered from metal-containing secondary materials); or (2) employed in a particular function or application as an effective substitute for a commercial product (e.g., spent pickle liquor used as phosphorous precipitant and sludge conditioner in wastewater treatment).

Small Quantity Generator (SQG) of Hazardous Waste means a generator that meets all the following criteria:

1. Generates, in a calendar month, more than 100 kg (220 lbs.) but less than 1,000 kg (2,200 lbs.) of RCRA hazardous waste, during one or more months in a year; and

2. Generates, in a calendar month, or accumulates at any time, no more than 1 kg (2.2 lbs.) of acute hazardous waste and no more than 100 kg (220 lbs.) of material from the cleanup of a spill of acute hazardous waste.

OR , your site is a Small Quantity Generator if the site:

1. Meets all other criteria for a Conditionally Exempt Small Quantity Generator, but

2. Accumulates, at any time, more than 1,000 kg (2,200 lbs.) of hazardous waste.

Small Quantity On-Site Burner Exemption means that persons who burn small quantities of hazar dous waste in an on-site boiler or industrial furnace, in accordance with 40 CFR 266.108, are c onditionally exempt from regulation for that activity.

Smelting, Melting, and Refining Furnace Exemption means that: owners or operators of smelting, melting, and refining furnaces that process hazar dous waste solely for metal recovery are conditionally exempt from regulation, except for 40 CFR 266.101 and 266.112, provided they comply with the requirements in Section 266.100(d); owners or operators of smelting, melting and refining furnaces that process hazar dous waste for recovery of precious metals are conditionally exempt from regulation, except for 40 CFR 266.112, provided they comply with the requirements in Section 266.100(g); and owners or operators of lead recovery furnaces that process h azar dous waste for recovery of lead and that are subject to regulation under the Secondary Lead Smelting NESHAP are conditionally exempt from regulation, except for 40 CFR 266.101, provided they comply with the requirements in Section 266.100(h).

Solid Waste means any garbage, refuse, or sludge, or other materials not excluded under 40 CFR 261.4(a). Exclusions include, for example, domestic sewage and any mixture of other wastes that pass through a sewer system to a publicly owned treatment works (POTWs); industrial wastewater discharges that are point source discharges subject to regulation under the Clean Water Act; irrigation return flows; nuclear materials defined by the Atomic Energy Act; and in situ mining materials (see also page 33). Wastewaters being collected, stored, or treated before discharge and sludges generated by wastewater treatment are not

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31 Source Material that material as defined by the Atomic Energy Act of 1954: (1) Uranium, thorium, or any other material determined by the Commission pursuant to the provisions of Section 2091 of this title to be source material; or (2) ores containing one or more of the foregoing materials in such concentration as the Commission may by regulation determine from time to time.

Special Nuclear Material means that materia as defined by the Atomic Energy Act of 1954: (1) plutonium, uranium enriched in the isotope 233 or in the isotope 235, and any other material which the Commission, pursuant to the provisions of Section 2071 of this title, determines to be special nuclear material, but does not include source material; or (2) any material artificially enriched by any of the foregoing, but does not include source material.

Transfer Facility means any transportation-related facility including loading docks, parking areas, storage areas, and other similar areas where shipments of hazardous waste are held during the normal course of transportation (40 CFR 260.10).

Underground Injection Control means the subsurface emplacement of fluids through a bored, drilled or driven well; or through a dug well, where the depth of the dug well is greater than the largest surface dimension. Underground injection wells are regulated under both the Safe Drinking Water Act and the Resource Conservation and Recovery Act (see 40 CFR Part 148).

United States Importer means any person who imports hazardous waste from a foreign country into the United States. This does not include hazardous waste shipped from a foreign Department of Defense site, Maquiladora, United States territory or protectorate

.
Universal Waste means any of the following hazardous wastes that are managed under the universal waste requirements of 40 CFR Part 273: batteries, pesticides, thermostats, and lamps.

Used Oil means any oil that has been refined from crude oil, or any synthetic oil, that has been used, and as a result of such use, is contaminated by physical or chemical impurities.

Used Oil Fuel Marketer means any person who conducts either of the following activities:

1. Directs a shipment of off-specification used oil from their RCRA site to an off-specification used oil burner; or

2. First claims that used oil that is to be burned for energy recovery meets the used oil fuel specifications set forth in 40 CFR 279.11.

Used Oil Management Activities , for the purposes of the Site Identification Form, include used oil transportation; used oil processing and re-refining; burning off-specification used oil fuel; and used oil fuel marketing.

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32 Used Oil Processing means chemical or physical operations designed to produce from used oil, or to make used oil more amenable for production of, fuel oils, lubricants, or other used oil-derived products. Processing includes, but is not limited to: blending used oil with virgin petroleum products, blending used oils to meet the fuel specification, filtration, simple distillation, chemical or physical separation, and re-refining.

Used Oil Processor means a RCRA site that processes on- or off-specification used oil.

Used Oil Re-Refiner means a RCRA site that pr oduces lubricating oils and greases, industrial fuel, asphalt extender, gasoline, and other products from on- or o ff-specification used oil.

Used Oil Transfer Facility means any transportation-related facility, including loading docks, parking areas, storage areas, and other areas where shipments of used oil are held for more than 24 hours during the normal course of transportation and not longer than 35 days. Transfer facilities that store used oil for more than 35 days are subject to regulation under 40 CFR Part 279, Subpart F.

Used Oil Transporter means any person who transports used oil, any person who collects used oil from more than one generator and transports the collected oil, and owners and operators of used oil transfer facilities. Used oil transporters may consolidate or aggregate loads of used oil for purposes of transportation but, with the following exception, may not process used oil. Used oil transporters may conduct incidental processing operations that occur in the normal course of used oil transportation (e.g., settling and water separation), but that are not designed to produce (or make more amenable for production of) used oil-derived products or used oil fuel.

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# 7. EPA Hazardous Waste Numbers for Waste Streams Commonly Generated by Small Quantity Generators

EPA recognizes that generators of small quantities of h azar dous waste, many of which are small businesses, may not be familiar with the manner in which h azar dous waste materials are identified in the Code of Federal Regulations. In order to aid small quantity generators in determining the EPA Hazar dous Waste Numbers for their hazar dous wastes that are needed to complete EPA Form 8700-12, two appendices are enclosed. Appendix 1 lists 18 general industry categories that contain small quantity generators. For each of these categories, commonly generated hazar dous wastes are identified. Appendix 2 lists EPA H azar dous Waste Numbers for each hazar dous waste stream identified in Appendix 1.

To use these appendices:

1. Locate your industry in Appendix 1 to identify the h azar dous waste streams common to your activities.

2. Find each of your hazar dous waste streams in Appendix 2, and review the more detailed descriptions of typical hazar dous wastes to determine which h azar dous waste streams actually result from your activities.

3. If you determine that a hazar dous waste stream does apply to you, report the 4-digit EPA H azar dous Waste Number in Item 11 of EPA Form 8700-12.

The industries and h azar dous waste streams described here do not provide a comprehensive list but rather serve as a guide to potential small quantity generators in determining which of their solid wastes, if any, are hazar dous. Except for the pesticide category, this insert does not include EPA H azar dous Waste Numbers for commercial chemical products that are h azar dous when discarded unused. These chemicals and their EPA Hazar dous Waste Numbers are listed in 40 CFR 261.33. If the specific Hazar dous Waste Number that should be applied to your h azar dous waste stream is unclear, please refer to 40 CFR Part 261. Copies of Part 261 and other EPA regulations in 40 CFR are available at most libraries and on EPA’s Internet page at:



### http://www.epa.gov/docs/epacfr40/chapt-I.info/

In those cases where more than one Hazar dous Waste Number is applicable, all should be used. If you have any questions, or if you are unable to determine the proper EPA Hazar dous Waste Numbers for your hazar dous wastes, contact your State Office (see page 2).

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## Appendix 1

Typical Hazardous Waste Streams Prod uced by Small Quantity Generators

LABORATORIES Acids/Bases, Heavy Metals/Inorganics, Ignitable Wastes, Reactives, Solvents

PRINTING AND ALLIED INDUSTRIES Acids/Bases, Heavy Metals/Inorganics, Ink Sludges, Spent Plating Wastes, Solvents

PESTICIDE END USERS AND APPLICATION Heavy Metals/Inorganics, Services, Pesticides, Solvents

CONSTRUCTION Acids/Bases, Ignitable Wastes, Solvents

EQUIPMENT REPAIR Acids/Bases, Ignitable Wastes, Lead Acid Batteries, Solvents

FURNITURE/WOOD MANUFACTURING & REFINISHING Ignitable Wastes, Solvents

OTHER MANUFACTURING (textiles, plastics, leather) Heavy Metals/Inorganics, Solvents

LAUNDRIES AND DRY CLEANERS Dry Cleaning Filtration Residues, Solvents

EDUCATIONAL AND VOCATIONAL SHOPS Acids/Bases, Ignitable Wastes, Pesticides, Reactives, Solvents

BUILDING CLEANING AND MAINTENANCE Acids/Bases, Solvents VEHICLE MAINTENANCE Acids/Bases, Heavy Metals/Inorganics, Ignitable Wastes, Lead Ac id Batteries, Solvents

WOOD PRESERVING Preserving Agents

MOTOR FREIGHT TERMINALS AND RAILROAD Acids/Bases, Transportation, Heavy Metals/Inorganics, Ignitable Wastes, Lead Acid Batteries, Solvents

FUNERAL SERVICES Solvents (formaldehyde)

METAL MANUFACTURING Acids/Bases, Cyanide Wastes, Heavy Metals/Inorganics, Ignitable Wastes, Reactives, Solvents, Spent Plating Wastes

CHEMICAL MANUFACTURERS Acids/Bases, Cyanide Wastes, Heavy Metals/Inorganics, Ignitable Wastes, Reactives, Solvents

CLEANING AGENTS AND COSMETICS Acids/Bases, Heavy Metals/Inorganics, Ignitable Wastes, Pesticides, Solvents

FORMULATORS Acids/Bases, Cyanide Wastes, Heavy Metals/Inorganics, Ignitable Wastes, Pesticides, Reactives, Solvents

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## Appendix 2

Typical Hazardous Waste Streams and EPA Hazardous Waste Numbers

ACIDS/BASES:

Acids, bases or mixtures having a pH less than or equal to 2 or greater than or equal to 12.5, and liquids that corrode steel at a rate greater than 0.25 inches per year are considered to be corrosive (for a complete description of corrosive wastes, see 40 CFR 261.22, Characteristic of Corrosivity). All corrosive materials and solutions have the EPA Hazardous Waste Number D 002. The following are some examples of the more commonly used corrosives:

Examples of Corrosive Waste Streams

Acetic Acid Ammonium Hydroxide Chromic Acid Hydrobromic Acid Hydrochloric Acid Hydrofluoric Acid Nitric Acid Oleum Perchloric Acid Phosphoric Acid Potassium Hydroxide Sodium Hydroxide Sulfuric Acid

DRY CLEANING FILTRATION RESIDUES:

Cooked powder residue (perchloroethylene plants only), still residues, and spent cartridge filters containing perchloroethylene or valclene are hazardous a nd have an EPA Hazardous Waste Number of F 002. S till residues containing petroleum solvents w ith a flash point less than 140 ° F are also considered hazardous and have an EPA Hazardous Waste Number of D 001.

HEAVY METALS/INORGANICS:
Heavy Metals and other inorganic waste materials exhibit the characteristic of TCLP Toxicity and are considered hazardous if the extract from a representa tive sample of the waste has any of th e specific constituent concentrations as shown in 40 CFR 261.24, Table 1. This may include dusts, solutions, wastewater treatment sl udges, paint wastes, waste inks, and other such materials which contain heavy metals/inorganics (note that wastewater treatment sludges from electroplating operations containing nickel and cyanide are identified as F006). The following are TCLP Toxic:

Waste Stream EPA Hazardous Waste Number

Arsenic Barium Cadmium Chromium Lead Mercury Selenium Silver D004 D005 D006 D007 D008 D009 D010 D011

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36 IGNITABLE WASTES:

Ignitable wastes include any flammable liquids, non-liquids, and contained gases that have a flashpoint less than 140 ° F (for a complete description of ignitable wastes see 40 CFR 261.21, Characteristic of Ignitab ility). Examples are spent solvents (see also so lvents), solvent still bottoms, i gnitable paint wastes (paint removers, brush cleaners, and stripping agents), epoxy resins, and adhesives (epoxies, rubber cements, and marine glues), and waste inks containing flammable solvents. Unless otherwise sp ecified, all ignitable wastes have an EPA Hazardous Waste Number of D001.

Some commonly used ignitable compounds are:

Waste Stream EPA Hazardous Waste Number

Acetone Benzene n-Butyl Alcohol Chlorobenzene Cychlohexanone Ethyl Acetate Ethylbenzene Ethyl Ether Ethylene Dichloride Methanol Methyl Isobutyl-Ketone Petroleum Distillates Xylene F003 D001 F003 F002 F003 F003 F003 F003 D001 F003 F003 D001 F003

INK SLUDGES CONTAINING CHROMIUM AND LEAD:

This includes solvent washes and sludges, caustic washes and sludges, and water washes and sludges from cleaning tubs, and equipment used in the formulation of ink from pigments, driers, soaps, and stabilizers containing chromium and lead. All ink sludges have an EPA Hazardous Waste Number of K 086.

LEAD ACID BATTERIES:

Used lead acid batteries should be reported on the notification form only if they are not recycled. Used lead acid batteries that are recycled do not need to be counted in determining the quantity of waste that you generate per month, nor do they require a hazardous waste manifest when shipped o ff your premises. (Note: Special requirements do apply if you recycle your batteries on your own premises -- see 40 CFR 266.80.)

Waste Stream EPA Hazardous Waste Number

Lead Dross Spent Acids Lead Acid Batteries D008 D002 D008, D002

ORGANIC WASTES:

See 40 CFR 261.24, Table 1 - Maximum Concentration of Contaminants for the Toxicity Characteristic for a list of constituents and regulatory levels.

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37 PESTICIDES:

Pesticides, pesticide residues, washing and rinsing solutions , and dips which contain cons tituent concentrations at or above Toxicity Characteristic regulatory levels (see 40 CFR 261.24) are h azardous waste. Pesticides that have an oral LD50 toxicity (rat) < 50 mg/kg, inhalation LC50 toxicity (rat) < 2 mg/L, or a dermal LD 50 toxicity (rabbit) < 200 mg/kg are hazardous materials. The following pesticides woul d be hazardous waste if they are technical grade, unused, and disposed. For a more complete listing, see 40 CFR 261.32-33 for specific listed pesticides, discarded commercial chemical products, and other wastes, wastewaters, sludges, and by-products from pesticide production. (Note that while many of these pesticides are no longer in common use, they are included here for those cases where they may be found in storage.)

Waste Stream EPA Hazardous Waste Number

Aldicarb Aldrin Amitrole Arsenic Pentoxide Arsenic Trioxide Cacodylic Acid Carbamic Acid, Methylnitroso-Ethyl Ester Chlordane Copper Cyanides 1,2-Dibromo-3-Chloropropane 1,2-Dichloropropane 1,3-Dichloropropene 2,4-Dichlorophenoxy Acetic Acid DDT Dieldrin Dimethoate Dimethylcarbamoyl Chloride Dinitrocresol Dinoseb Disodium Monmomethane arsonate Disulfoton Endosulfan Endrin Ethylmercuric Chloride Famphur Nepthachlor Hexachlorobenzene Kepone Lindane 2-Methoxy Mercuric Chloride Methoxychlor Methyl Parathion Monosodium Methanearsonate Nicotine Parathion Pentachloronitrobenzene Pentachlorophenol Phenylmercuir Acetate Phorate Strychnine Thallium Sulfate Thiram P070 P004 U011 P011 P012 U136 U178 U036 P029 U066 U083 U084 U240 U061 P037 P044 U097 P047 P020 D004 P039 P050 P051 D009 P097 P059 U127 U142 U129 D009 D014 P071 D004 P075 P089 U185 U242 D009 P094 P108 P115 U244

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38 Toxaphene Warfarin P123 U248

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39 REACTIVES:

Reactive wastes include reactive materials or mixtures which are unstable, react violently with or form explosive mixtures with water, generate toxic gases or vapors when mixed with water (or when exposed to pH conditions between 2 and 12.5 in the case of cyanide- or sulfide-bearing wastes), or are capable of detonation or explosive reaction when irritated or heated (for a complete description of reactive wastes, see 40 CFR 261.23, Characteristic of Reactivity). Unless otherwise specified, all reactive wastes have an EPA Hazardous Waste Number of D 003. The following materials are commonly considered to be reactive:

Waste Stream EPA Hazardous Waste Number
Acetyl Chloride Chromic Acid Cyanides Organic Peroxides Perchlorates Permanganates Hypochlorites Sulfides D003 D003 D003 D003 D003 D003 D003 D003

SOLVENTS:

Spent solvents, solvent still bottoms, and mixtures containing solvents are often hazardous. This includes solvents used in degreasing and paint-brush cleaning and the distillati on residues from reclamation. The following are some commonly used hazardous solvents (s ee also Ignitable Wastes for other hazardous solvents and 40 CFR 261.31 for most listed hazardous waste solvents):

Waste Stream EPA Hazardous Waste Number

Benzene Carbon Disulfide Carbon Tetrachloride Chlorobenzene Cresols Cresylic Acid O-Dichlorobenzene Ethanol Ethylene Dichloride Isobutanol Isopropanol Kerosene Methyl Ethyl Ketone Methylene Chloride Naphtha Nitrobenzene Petroleum Solvents (Flash-point less than 140 ° F) Pyridine 1, 1, 1-Trichloroethane Tetrachloroethylene Toluene Trichloroethylene Trichlorofluoromethane D001 F005 F001 F002 F004 F004 F002 D001 D001 F005 D001 D001 F005 F001 (Sl udges), F 002 (S till Bottoms) D001 F004

D001 F005 F001 (Sl udges), F 002 (S till Bottoms) F001 (Sl udges), F 002 (S till Bottoms) F005 F001 (Sl udges), F 002 (S till Bottoms) F002

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40 Waste Stream EPA Hazardous Waste Number

Trichlorotrifluoroethane White Spirits F002 D001

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41 SPENT PLATING AND CYANIDE WASTES:

Spent plating wastes contain cleaning solutions and plati ng solutions with caustics, solvents, heavy metals, and cyanides. Cyanide wastes may also be generated from heat treatment operations, pigment production, or manufacturing of anti-caking agents. Plating wastes are generally Hazardous Waste Numbers F 006-F009. Heat treatment wastes are generally Hazardous Waste Numbers F 010-F012. See 40 CFR 261.31 for a more complete description of plating
wastes.

WOOD PRESERVING AGENTS:

Compounds or mixtures used in wood preserving, including the wastewater treatment sludge from wastewater treatment operations, are considered hazardous wastes. Bo ttom sediment sludges from the treatment of wastewater from wood preserving processes that use creosote or pe ntachlorophenol are hazardous and have an EPA Hazardous Waste Number of K001. In add ition, wastewaters, process residuals, preservative drippage, and spent formulations from certain wood preserving processes are also hazardous wastes and carry EPA Hazardous Waste Numbers F032, F034, or F035, depending on the contaminants they contain. Unless otherwise indicated, specific w ood preserving components are as follows:

Waste Stream EPA Hazardous Waste Number(s)

Chromated Copper Arsenate Creosote Pentachlorophenol D004, F035 K001, F034 K001, F032

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# RCRA Subtitle C Site Identification Form

**Read all instructions before completing the form.**

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### United States Environmental Protection Agency



## RCRA SUBTITLE C SITE
IDENTIFICATION FORM

1. Reason for
Submittal (See instructions on page 13.)

MARK ALL BOX(ES)
THAT APPLY Reason for Submittal:

To provide Initial Notification of Regulated Waste Activity (to obtain an EPA ID Number for hazardous waste, universal waste, or used oil activities)

To provide Subsequent Notification of Regulated Waste Activity (to update site identification information)

As a component of a First RCRA Hazardous Waste Part A Permit Application

As a component of a Revised RCRA Hazardous Waste Part A Permit Application

(Amendment #______)

As a component of the Hazardous Waste Report

2. Site EPA ID Number (page 14) EPA ID Number I___I___I___I I___I___I___I I___I___I___I I___I___I___I

**3. Site Name (page 14)**  **Name:**

**Street Address:**

**City, Town, or Village: State:**  **4. Site Location**
**Information (page 14)** 

**County Name: Zip Code:** 

**5. Site Land Type (page 14)**  **Site Land Type:** Private County District Federal Indian Municipal
State Other

**A. I___I___I___I___I___I___I**  **B. I___I___I___I___I___I___** 
**I 6. North American**  **Industry**
**Classification System (NAICS)**  **Code(s) for the Site (page 14)**  **C. I___I___I___I___I___I___I**  **D. I___I___I___I___I___I___** 
**I**

**Street or P. O. Box:**

**City, Town, or Village:**

**State: 7. Site Mailing** 
**Address (page 15)** 

**Country: Zip Code:** 

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**Person (page 15)**  **Phone Number: Extension:** Email address:

A. Name of Site's Operator: Date Became Operator (mm/dd/yyyy):

Operator Type: Private County District Federal Indian Municipal State Other

B. Name of Site's Legal Owner: Date Became
Owner (mm/dd/yyyy): 9. Operator and Legal Owner
of the Site (pages 15 and 16)

Owner Type: Private County District Federal Indian Municipal State Other

EPA Form 8700-12 (Revised XX/XXXX) Page 1 of 3

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Street or P. O. Box:

City, Town, or Village:

State: **9. Legal Owner (Continued)** 
**Address**

Country: Zip Code:

**10. Type of Regulated Waste Activity Mark “Yes” or “No” for all activities; complete any additional boxes as instructed. (See instructions on pages 17 to 20.)** 

A. Hazardous Waste Activities Complete all parts for 1 through 6.

Y N 1. Generator of Hazardous Waste If “Yes”, choose only one of the following - a, b, or c.

a. LQG: Greater than 1,000 kg/mo (2,200 lbs./mo.) of non-acute hazardous waste; or

b. SQG: 100 to 1,000 kg/mo (220 - 2,200 lbs./mo.) of non-acute hazardous waste; or

c. CESQG: Less than 100 kg/mo (220 lbs./mo.)
of non-acute hazardous waste

In addition, indicate other generator activities.

Y N d. United States Importer of Hazardous Waste

Y N e. Mixed Waste (hazardous and radioactive) Generator Y N 2. Transporter of Hazardous Waste

Y N 3. Treater, Storer, or Disposer of Hazardous Waste (at your site) Note: A hazardous waste permit is required for this activity.

Y N 4. Recycler of Hazardous Waste (at your site)

Y N 5. Exempt Boiler and/or Industrial

Furnace If “Yes”, mark each that applies.

a. Small Quantity On-site Burner Exemption b. Smelting, Melting, and Refining

Y N **6. Underground Injection Control**

B. Universal Waste Activities

Y N 1. Large Quantity Handler of Universal Waste (accumulate 5,000 kg or more) [refer to your State regulations to determine what is regulated]. Indicate types of universal waste generated and/or accumulated at your site. If “Yes”, mark all boxes that apply:
Generate

a. Batteries

b. Pesticides

c. Mercury containing equipment

d. Lamps

e. Other (specify) ________________ C. Used Oil Activities Mark all boxes that apply.

Y N 1. Used Oil Transporter If “Yes”, mark each that applies. a. Transporter b. Transfer Facility

Y N 2. Used Oil Processor and/or Rerefiner If “Yes”, mark each that applies.
a. Processor
b. Re-refiner

Y N 3. Off-Specification Used Oil Burner

Y N 4. Used Oil Fuel Marketer

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g. Other (specify) ________________

Y N **2. Destination Facility for Universal Waste**
**Note:** A hazardous waste permit may be required for this activity. If “Yes”, mark each that applies. a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used Oil Burner
b. Marketer Who First Claims the Used Oil Meets the Specifications

EPA Form 8700-12 (Revised XX/XXXX) Page 2 of 3

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11. Description of Hazardous Wastes (See instructions on page 21.)

A. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes handled at your site. List them in the order they are presented in the regulations (e.g., D001, D003, F007, U112). Use an additional page if more spaces are needed.

B. Waste Codes for State-Regulated (i.e., non-Federal) Hazardous Wastes. Please list the waste codes of the Stateregulated hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if more spaces are needed for waste codes.

12. Comments (See instructions on page 21.)

13. Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the informatio n submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gather ing the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware tha t there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violatio ns. For the RCRA Hazardous Waste Part A Permit Application, all operator(s) and owner(s) must sign (see 40 CFR 270.10 (b) and 270.1 1). (See instructions on page 21.)

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EPA Form 8700-12 (Revised XX/XXXX) Page 3 of 3

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