EPA ID: |__|__|__|__|__|__|__|__|__|__|__|__| 

SEND 

COMPLETED 

FORM TO:

KDHE-BWM 

1000 SW Jackson 

Suite 320 

Topeka, KS 

66612 

Kansas Department of Health and Environment 

Notification of Regulated Waste Activity 

(RCRA SUBTITLE C SITE IDENTIFICATION FORM) 

FORMS 8700-12 and 8700-23 

1. Reason for 

Submittal 

MARK ALL 

BOXES 

THAT 

APPLY 

Reason for Submittal: 

 To provide Initial Notification of Regulated Waste Activity (to obtain an EPA ID Number for hazardous 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 

 Site was a TSD facility and/or generator of >1,000 kg of hazardous waste, >1 kg of acute hazardous waste, or >100 kg of 

acute hazardous waste spill cleanup in one or more months of the report year. 

2. Site EPA ID 

Number EPA ID Number |__|__|__| |__|__|__| |__|__|__| |__|__|__|

3. Site Name Name: 

4. Site Location 

 

Street Address: 

City, Town, or Village: County: 

State: Country: Zip Code: 

5. Site Land 

Type Private County District Federal Tribal Municipal State Other 

6. NAICS 

Code(s) 

(5 or more digits) 

A. B. C. D. 

7. Site Mailing 

Address 

Street or P.O. Box: 

City, Town, or Village: 

State: Country: Zip Code: 

8. Site Contact 

Person 

First Name: MI: Last: 

Title: 

Street or PO Box: 

City, Town or Village: 

State: Country: Zip Code: 

Email: 

Phone: Ext: Fax: 

9. Legal Owner 

and Operator 

of the Site 

A. Name of Site’s Legal Owner: Date Became Owner: 

(mm/dd/yyyy)

Owner Type: Private County District Federal Tribal Municipal State Other 

Street or PO Box: 

City, Town or Village: Phone: 

State: Country: Zip Code: 

B: Name of Site’s Operator: Date Became Operator: 

(mm/dd/yyyy) 

Operator Type: Private County District Federal Tribal Municipal State Other 
EPA ID: |__|__|__|__|__|__|__|__|__|__|__|__| 

10. Type of Regulated Waste Activity 

 Mark “Y” (yes) or “N” (no) for all activities; complete any additional boxes as instructed. (See pages 4 to 7 of instructions.)

A. Hazardous Waste Activities 

 Complete all parts 1 through 10. 

Y N 1. Generator of Hazardous Waste 

 If “Yes”, choose only one of the following: 

 a. LQG: Greater than 1,000 kg/mo (2,200 lbs/mo) of

non-acute hazardous waste; or generates more than 

1 kg (2.2 lbs) of acutely hazardous waste 

 b. SQG: 100 to 1,000 kg/mo (220-2,200 lbs/mo) of 

non-acute hazardous waste; or accumulates less than

1 kg (2.2 lbs) of acutely hazardous waste 

 c. KSQG: 25 to less than 100 kg/mo (55-220 lbs/mo) 

of non-acute hazardous waste; or accumulates less 

than 1 kg (2.2 lbs) of acutely hazardous waste 

 d. CESQG: Less than 25 kg/mo (55lbs/mo) of nonacute hazardous waste 

 In addition, indicate other generator activities. 

Y N 2. Short-Term Generator (generate from a short-term or 

one-time event and not from an on-going processes. 

If Yes, provide info under Comments Section. 

Y N 3. United States Importer of Hazardous Waste

Y N 4. Mixed Waste (hazardous & radioactive) Generator

Y N 5. Transporter of Hazardous Waste. 

 If “Yes”, mark all that apply.

 a. Transporter

 b. Transfer Facility (at your site) 

 

Y N 6. Treater, Storer, or Disposer of Hazardous Waste (at your 

site) 

Note: A hazardous waste permit is required for this activity. 

Y N 7. Recycler of Hazardous Waste (at your site) 

Note: A permit may be required. 

Y N 8. Exempt Boiler and/or industrial Furnace 

 If “Yes”, mark each that applies. 

a. Small Quantity On-site Burner Exemption 

 b. Smelting, Melting, and Refining Furnace Exemption 

Y N 9. Underground Injection Control 

Y N 10. Receives Hazardous Waste from Off-Site 

B. Universal Waste Activities; Complete all parts 1-2: 

 Y N 1. Large Quantity Handler of Universal Waste 

(You accumulate 5,000 kg or more. Refer to Kansas 

regulations to determine what is regulated.) Indicate the 

types of universal waste generated and/or accumulated at 

your site. 

Mark all boxes that apply. 

 a. Batteries 

 b. Pesticides 

 c. Mercury containing equipment 

 d. Lamps 

 e. Others (Describe in Item 12 – Comments) 

Y N 2. Destination Facility for Universal Waste. 

 Note: A hazardous waste permit may be required for

 this activity.

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 Re-refiner 

 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 

 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 ID: |__|__|__|__|__|__|__|__|__|__|__|__| 

11. Description of Hazardous Wastes 

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. 

 

12. Comments 

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 information submitted. Based on my inquiry 

of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information, submitted is, 

to be the best of my knowledge and belief, true accurate, and complete. I am aware that there are significant penalties for submitting false 

information, including the possibility of fine and imprisonment for knowing violations. 

Signature of operator, owner, or an 

authorized representative 

Name and Official Title (type or print) Date Signed

(mm/dd/yyyy) 
Revised 6/14/2013 1 

Instructions for Completing 

Notification of Regulated Waste Activity Form 

(RCRA Subtitle C Site Identification Form) 

Forms KDHE 8700-12 and 8700-23 

INITIAL NOTIFICATIONS

If you do not currently have an EPA (Environmental Protection Agency) Identification (ID) Number and 

you conduct a regulated waste activity at your site, you must submit an initial notification to obtain an 

EPA ID Number. An initial notification must be submitted if you conduct one or more of the following 

activities at your site: 

1. If you generate, transport, treat, store, or dispose of regulated hazardous wastes; 

2. If you recycle hazardous wastes. (Hazardous wastes that are recycled are called recyclable 

materials). The recycling process itself is exempt from regulation, but you must notify the 

Kansas Department of Health And Environment (KDHE) and obtain an EPA ID Number if you 

manage hazardous wastes prior to recycling; 

3. If you are a large quantity handler of universal waste; 

4. If you transport, process, or re-refine used oil; burn off-specification used oil for energy 

recovery; or market used oil; or 

5. If your business moves to another location and you are still conducting regulated waste activities.

If you have questions about any regulated waste activity, please call the KDHE Bureau of Waste 

Management (BWM) at 785-296-1600. Additional information, including this form and its instructions, 

is also available on BWM’s website: http://www.kdheks.gov/waste

SUBSEQUENT NOTIFICATIONS

Even if you have submitted an initial notification and have received an EPA ID Number, you may be 

required to submit a subsequent notification. Kansas Administrative Regulations (K.A.R.) 28-31-4(c) 

requires that anytime there is a change in the information used to obtain the EPA ID Number, the 

generator shall submit these changes to the KDHE, no more than 60 days after the change occurs. 

In general, you should submit a subsequent notification under the following circumstances: 

1. If your business moves to another location; 

2. If your business name changes: 

3. If your generator classification changes; 

4. If the contact person for your site changes; 

5. If the ownership of your site changes; 

6. If an additional owner has been added or replaced since you submitted your initial notification; 

or 

7. If the type of regulated waste activity you conduct changes. 

HOW TO FILL OUT THIS FORM

Please read and follow all instructions. Pay particular attention to information contained in the NOTE

boxes or information that is bolded and/or underlined. If you need assistance, please call the Bureau 

of Waste Management at 785-296-1600. 
Revised 6/14/2013 2 

For subsequent notifications, write your site’s EPA ID Number in Item 2. Use the space for 

Comments in Item 12 to clarify or provide additional information for any item. When entering 

information in the Comments section, please identify the item number and box letter to which the 

comment refers. If you must use additional sheets, please write your site’s EPA ID Number on each 

additional sheet provided. 

ITEM-BY-ITEM INSTRUCTIONS 

Item 1 – Reason for Submittal:

Place an "X" in the appropriate box to indicate whether this form is your Initial Notification to obtain 

an EPA ID Number or a Subsequent Notification to update your site identification information.

• For Initial Notification of Regulated Waste Activity to provide site identification information 

and obtain an EPA ID 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 Kansas regulations enacted pursuant to RCRA, you must submit this form to notify 

the KDHE of your regulated waste activities and obtain an EPA ID 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 ID Number and you need to update your original information (e.g., generator status, new 

owner, new mailing address). 

• As a component of the First RCRA Hazardous Waste Part A Permit Application. If your site is 

planning to treat, store, or dispose of hazardous waste on site in a unit that is not exempt from 

obtaining a hazardous 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 (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 Hazardous 

Waste Report indicating the amount of hazardous waste you generate, treat, ship off-site, or receive 

from off-site, you must fill out this form. 

• Site was a TSD facility and/or generator of ≥1,000 kilograms (kg) of hazardous waste, >1 kg of 

acute hazardous waste, or >100 kg of acute hazardous waste spill cleanup in one or more months of 

the report year (Only a TSD facility and/or Large Quantity Generator should place an “X” in this 

box.) 

Item 2 – Site EPA ID Number: 

NOTE: If this is your initial notification for this site, leave this item blank and proceed to Item 3. 

Write the EPA ID Number assigned to this site location address in Item 2. Be sure to include your 

EPA ID Number on any additional sheets. 
Revised 6/14/2013 3 

Item 3 – Site Name:

Enter the legal name of the facility which is conducting business at this site. 

Item 4 – Site Location Information:

Enter the physical address or location for this site. The address or location must be a physical 

address, not a post office box or route number. This is your 911 system location address.

NOTE: A new EPA ID Number is required if you move to a new location. 

- If your new location does not have an EPA ID Number, a new EPA ID Number will be assigned. 

- If your new location has a previously assigned EPA ID Number, you will use the existing number. 

Item 5 – Site Land Type:

Place an "X" in the box that best describes the land type for your site. Select only one type: Private, 

County, District, Federal, Tribal, Municipal, State, or Other. If Other is selected, explain this in Item 

12 – Comments.

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 

Enter the NAICS code that best describes your site’s primary business production process for 

your products or services. Use the 6-digit code (most specific description) if available for your 

business; if not, use the 5-digit code; do not enter any codes with less than 5 digits.

Boxes B - D 

List other NAICS codes that describe the primary business production processes for your site. Use 

the most specific 6- or 5-digit code available; do not enter any codes with less than 5 digits.

You can obtain information about NAICS Codes from the following sources: 

http://www.census.gov/eos/www/naics/ or http://www.naics.com/search.htm

Item 7 – Site Mailing Address:

Write the site’s mailing address. If the site’s mailing address and the site’s location address are the 

same, you may write “SAME”. 

Item 8 – Site Contact Person:

Enter the name, mailing address, email, business phone number and extension, and fax number of the 

person who should be contacted about information submitted on the form. A Subsequent Notification 

is required when the Site Contact Person changes. 

Item 9 – Legal Owner and Operator of the Site:

Enter the name or names of each legal owner and operator of this site. For the meaning of owner and 

operator, see the definitions provided in these instructions. Use Item 12 – Comments and additional 

sheets, if necessary. 

A. Name of Site’s Legal Owner: Enter the name, mailing address and telephone of each of the 

site’s legal owners. If this is either an Initial or Subsequent Notification, please enter any 

additional owner(s) or any deleted owner(s) since the last notification. Please provide dates 

they became or ceased being an owner. Use Item 12 – Comments to enter information. 

Date Became Owner: Enter the date on which the person or entity became the legal owner of 

site.
Revised 6/14/2013 4 

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, Tribal, Municipal, State, or Other. If Other, 

explain under Item 12 – Comments. 

Owner Mailing Address: Write the mailing address and telephone number of owner. 

B. Legal Operator: Write the name of your site’s operator. If it is the same as the owner, write 

“SAME”. 

Date Became Operator: Write the date on which the person or entity became the operator of 

site.

Operator Type: Same as instructions for Owner Type. 

NOTE: A Subsequent Notification is required when the owner or operator of a site changes. Because 

an EPA ID Number is site-specific, the new owner will use the existing EPA ID Number assigned to 

the site.

Item 10 – Type of Regulated Waste Activity:

A. Hazardous Waste Activities: Place an "X" in the appropriate box to indicate each hazardous 

waste activity being conducted at this site. 

NOTE: Do NOT use the federal generator classifications found in 40 CFR. Use the State of 

Kansas generator classifications described in the following paragraphs to complete this form. 

1. Generator of Hazardous Waste: If you generate a hazardous waste that is listed in 40 CFR 

261.31 through 261.33 or is identified by one or more hazardous waste characteristic(s) 

contained in 40 CFR 261.21 through 261.24, place an "X" in the box corresponding to the total 

quantity of non-acute hazardous waste that is generated in any single calendar month. Do 

NOT average over months; rather enter the highest single monthly total. The definitions for 

the four classifications of hazardous waste generators in Kansas are found in K.A.R. 28-31-

260(c)(2)(E) and K.A.R. 28-31-260a(a)(1), (8), and (9). A brief description of the four classes 

of hazardous waste generators in Kansas follows. 

a. LQG: Large Quantity Generator 

This site is classified as a LQG if the site meets any of the following criteria: 

i Generates, in any single calendar month, 1,000 kg (2,200 lb) or more of hazardous waste; 

or 

ii Generates, in any single calendar month, or accumulates at any time, more than 1 kg (2.2 

lb) of acute hazardous waste; or 

iii Generates, in any single calendar month, or accumulates at any time, more than 100 kg 

(220 lb) of any residue or contaminated soil, waste, or other debris resulting from the 

cleanup of a spill of any acute hazardous waste 

NOTE: If, in addition to being a LQG Generator, you recycle hazardous wastes at your site (without 

storing the wastes before you recycle them), mark both this box and Box A.7.

 
Revised 6/14/2013 5 

b. SQG: Small Quantity Generator

This site is classified as a SQG if the site meets any of the following criteria: 

i Generates, in any single calendar month, more than 100 kg (220 lb) but less than 1,000 kg 

(2,200 lb) of hazardous waste; and

ii Accumulates, at any time, no more than 6,000 kg (13,200 lb) of hazardous waste; and

iii Generates, in any single calendar month, or accumulates at any time, no more than 1 kg 

(2.2 lb) of acute hazardous waste; and

iv Generates, in any single calendar month, or accumulates at any time, more than 100 kg 

(220 lb) of any residue or contaminated soil, waste, or other debris resulting from the 

cleanup of a spill of any acute hazardous waste.

c. KSQG: Kansas Small Quantity Generator

This site is classified as a KSQG if the site meets any of the following conditions: 

i. Generates, in any single calendar month, 25 kg (55 lb) or more but less than 100 kg (220 

pounds) of hazardous waste; and

ii. Accumulates, at any time, no more than 1,000 kg (2,200 lb) of hazardous waste; and

iii Generates, in any single calendar month, or accumulates at any time, no more than 1 kg 

(2.2 lb) of acute hazardous waste; and

iv Generates, in any single calendar month, or accumulates at any time, more than 100 kg 

(220 lb) of any residue or contaminated soil, waste, or other debris resulting from the 

cleanup of a spill of any acute hazardous waste. 

d. CESQG: Conditionally Exempt Small Quantity Generator 

This site is classified as a CESQG if the site meets all of the following conditions: 

i Generates, in any single calendar month, less than 25 kg (55 lb) of hazardous waste; and

ii Accumulates, at any time, no more than 1,000 kg (2,200 lb) of hazardous waste; and

iii Generates, in any single calendar month, or accumulates at any time, no more than 1 kg 

(2.2 lb) of acute hazardous waste, and 

iv Generates, in any single calendar month, or accumulates at any time, more than 100 kg 

(220 lb) of any residue or contaminated soil, waste, or other debris resulting from the 

cleanup of a spill of any acute hazardous waste. 

NOTE: If you generate acute hazardous wastes listed in 40 CFR 261.31, 261.32 or 261.33(e), please 

refer to K.A.R. 28-31-261 and 40 CFR 261.5(e) to determine the circumstances under which you must 

notify the KDHE. 

In addition to indicating the generator class, place an “X” in each appropriate box to indicate other 

generator activities occurring at this site. Please mark all boxes that apply. 

2. Short-Term Generator (generate from a short-term or one-time event and not from on-going 

processes). If “Yes”, provide an explanation in the Comments section. 

3. United States Importer of Hazardous Waste: Place an "X" in the box if you import 

hazardous waste from a foreign country into the United States. Refer to 40 CFR 262.60 for 

additional information. 
Revised 6/14/2013 6 

4. Mixed Waste Generator: Place an "X" in the box if you are a generator of mixed waste. 

Mixed waste is waste that contains both hazardous waste and radioactive waste. Radioactive 

waste includes source, special nuclear, or by-product material subject to the Atomic Energy 

Act (AEA). Refer to RCRA section 1004(41), 42 U.S.C. 6903 (63 FR 17414; April 9, 1998). 

5. Transporter of Hazardous Waste: If you transport hazardous waste within the United States 

and/or own or operate a hazardous waste transfer facility, place an “X” in each appropriate box 

to indicate each hazardous waste management activity. The Kansas regulations for hazardous 

waste transporters are found in K.A.R. 28-31-6, K.A.R. 28-31-263, and K.A.R. 28-31-263a. 

6. Treater, Storer, or Disposer of Hazardous Waste: If you treat, store, or dispose of regulated 

hazardous waste that is subject to a permit or interim status, place an "X" in this box. A 

hazardous waste permit is required for these activities. NOTE: Burning hazardous wastes in 

boilers and industrial furnaces and storing hazardous wastes before recycling fall into this 

category. For permitted activities, please contact KDHE at 785-296-1600 to request a 

Hazardous Waste Part A Permit Application in addition to this notification. 

NOTE: If your site is a destination facility for universal wastes in addition to being a treatment, 

storage, or disposal facility for other hazardous wastes, mark both this box and Box B.2. 

7. Recycler of Hazardous Waste: If you recycle regulated hazardous wastes (recyclable 

materials), place an “X” in this box. The regulations for owners or operators of sites that 

recycle hazardous waste are found in 40 CFR 261.6. A hazardous waste permit may be 

required for this activity. 

NOTE: If your site, in addition to being a recycling site for hazardous waste, treats, stores, or 

disposes of hazardous waste, mark both this box and Box A.6. If your site is a destination 

facility for universal wastes in addition to being a recycling site for other hazardous wastes, 

mark both this box and Box B.2.

8. Exempt Boiler and/or Industrial Furnace: 

a. If you burn small quantities of hazardous waste in an on-site boiler or industrial furnace in 

accordance with the conditions in 40 CFR 266.108, place an “X” in the box to indicate that 

you qualify for the Small Quantity On-Site Burner Exemption. 

b. If you process hazardous wastes in a smelting, melting, or refining furnace solely for 

metals recovery, as described in 40 CFR 266.100(d), or to recover economically significant 

amounts of precious metals, as described in 40 CFR 266.100(g), or if you process 

hazardous 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. 

9. Underground Injection Control: If you generate, treat, store, or dispose of hazardous waste 

and there is an underground injection well located at your site, place an "X" in the box. The 

regulations for owners or operators of underground injection wells are found in 40 CFR Part 

148. 

10. Receives Hazardous Waste From Off-site (at your site): If you received hazardous waste 

from another site, whether this waste was received as a commercial transaction or waste 

received from a restricted group of off-site generators, place an “X”. 
Revised 6/14/2013 7 

B. Universal Waste Activities: Refer to K.A.R. 28-31-273, 40 CFR 261.9, and 40 CFR Part 273 for 

the regulations covering universal waste.

1. Large Quantity Handler of Universal Waste (LQHUW): You are an LQHUW if you 

accumulate a total of 5,000 kg (11,000 pounds) or more of any universal wastes (calculated 

collectively) at any time. Place an “X” in the appropriate box to indicate the type of universal 

wastes you generate and/or accumulate at your site.

2. Destination Facility: Place an "X" in the box if you treat, dispose of, or recycle universal 

wastes on site. A hazardous 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 hazardous wastes, mark both this box and box A.6. In addition, if your 

site recycles hazardous wastes, mark both this box and box A.7.

C. Used Oil Activities: Place an “X” in each appropriate box to indicate each used oil management 

activity taking place at this site. The Kansas regulations for used oil management are found in 

K.A.R. 28-31-6, K.A.R. 28-31-279 and K.A.R. 28-31-279(a). 

1. Used Oil Transporter: If you transport used oil and/or own or operate a used oil transfer 

facility, place an "X" in each appropriate box to indicate each used oil management activity. 

2. Used Oil Processor/Re-Refiner: If you process and/or re-refine used oil, place an "X" in each 

appropriate box to indicate each used oil management activity. 

3. Off-Specification Used Oil Burner: If you burn off-specification used oil fuel, place an "X" 

in this box to indicate this used oil management activity. 

4. Used Oil Fuel Marketer: If you market off-specification 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 

listed in 40 CFR 279.11, place an "X" in Box 4.b. If either of these boxes is marked, you also 

must notify (or must have previously notified) as a used oil transporter, used oil processor/rerefiner, or off-specification used oil fuel burner. If you are only a used oil generator, you are 

not required to notify unless you conduct any of the previously described used oil activities. 

Item 11 – Description of Hazardous Wastes:

You will need to refer to K.A.R. 28-31-261, K.A.R. 28-31-261a, and 40 CFR 261 to complete this 

item. Part 261 identifies those solid wastes which are defined as hazardous and regulated under the 

hazardous waste regulations. You may obtain information regarding the types of regulated hazardous 

waste by contacting the Bureau of Waste Management at 785-296-1600. This information is also 

available on BWM’s website: www.kdheks.gov/waste Please click on the link Hazardous Waste 

Generators Program and then scroll down and click on Hazardous Waste Generator Handbook. The 

handbook may be printed. 

Regulated Hazardous Waste Codes: If you manage hazardous wastes that are described in 40 CFR 

Part 261, write each appropriate 4-digit code in the boxes provided. 

NOTE: If you need to list more than will fit under Item 11, please continue listing the 

hazardous waste codes either under Item 12 – Comments or on an extra sheet. If you use an extra 

sheet, include your EPA ID number on the top of the sheet and attach it to the form. 

 
Revised 6/14/2013 8 

Item 12 – Comments:

Use this section as needed to provide additional information for Items 1 through 11. You may attach 

additional sheets if necessary. Please enter your EPA ID Number on any additional sheets.

Item 13 – Certification: 

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

NOTE: All notification forms must include this signed and dated certification to be considered 

complete. 

Return the Completed Notification Form To: 

Sarah Fulton 

KDHE-BWM 

1000 SW Jackson, Suite 320 

Topeka, KS 66612-1366 

ADDITIONAL INFORMATION 

Transporters: 

Hazardous Waste and Used Oil Transporters must also complete a Transporter Registration form. The 

forms can be found on the BWM website or by using the following link: 

http://www.kdheks.gov/waste/forms_hazwaste.html#hwgen

Fee Payment: 

KAR 28-31-10 sets the monitoring fees for hazardous waste activities. A listing of the fees can be 

found on the BWM website or by using the following link: 

http://www.kdheks.gov/waste/p_hwfees.html

Transporters will submit the fee with the Transporter Registration form. Generators will receive an 

invoice for the fee. 

 
Revised 6/14/2013 9 

DEFINITIONS

The following definitions are included to help you to understand and complete the form: 

Act or RCRA means the Solid Waste Disposal Act, as amended by the Resource Conservation and 

Recovery Act of 1976, as amended by the Hazardous and Solid Waste Amendments of 1984, 

42 U.S.C. Section 6901 et seq. 

Acutely Hazardous Waste means wastes that are highly toxic commercial chemical products, offspecification chemicals, or container residues and residues from the spillage of these chemicals 

that are discarded or intended to be discarded. These highly toxic chemicals have been 

identified by EPA as always being acutely hazardous wastes when disposed. EPA has 

developed a list of these chemicals, called the P-list, which is contained in 40 CFR 261.33(e). 

These P-listed chemicals include commercially pure grades of the chemicals, any technical 

grades of these chemicals that are produced or marketed, and all formulations in which only 

one of the P-listed chemicals is the sole active ingredient. An example of an acutely hazardous 

waste would be a P-listed pesticide such as parathion (P089) that must be disposed. Examples 

of generators that generate acutely hazardous wastes are pesticide applicators, laboratories, and 

chemical formulators. 

Authorized Representative means the person responsible for the overall operation of the RCRA site 

or an operational unit (i.e., part of an RCRA site), e.g., superintendent or plant manager, or 

person of equivalent responsibility. 

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 feed water pumps); or 

5. The unit is one which the KDHE has determined, on a case-by-case basis, to be a boiler, 

after considering the standards in 40 CFR 260.32. 

Disposal means the discharge, deposit, injection, dumping, spilling, leaking, or placing of any solid 

waste or hazardous waste into or on any land or water so that such solid waste or hazardous 

waste or any constituent thereof may enter the environment or be emitted into the air or 

discharged into any waters, including ground waters. 

EPA Identification (ID) Number means the number assigned by KDHE to each hazardous waste 

generator, hazardous waste transporter, and treatment, storage, or disposal RCRA site; large 

quantity handler of universal wastes; used oil transporter, used oil processor/re-refiner, offspecification used oil fuel burner, and used oil fuel marketer. 
Revised 6/14/2013 10 

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

Hazardous Waste Generator means any person, by site, whose act or process produces hazardous 

waste identified or listed in 40 CFR Part 261 or whose act first causes a hazardous waste to 

become subject to regulation. 

Hazardous Waste Storage means the holding of hazardous waste for a temporary period, at the end 

of which the hazardous waste is treated, disposed of, or stored elsewhere. 

Hazardous Waste Transporter means a person engaged in the off-site transportation of hazardous 

waste by air, rail, highway, or water. 

Hazardous Waste Transfer Facility means a site that holds manifested hazardous wastes at their site 

for a period of ten (10) days or less while the waste is in transit. The Federal regulations for 

hazardous waste transfer facilities are found in 40 CFR Part 263.12. 

Hazardous Waste Treatment means any method, technique, or process, including neutralization, 

designed to change the physical, chemical, or biological character or composition of any 

hazardous waste so as to neutralize such hazardous waste, or so as to recover energy or 

material resources from the hazardous waste, or so as to render such hazardous waste 

nonhazardous, or less hazardous; 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 hazardous waste so as to 

render it nonhazardous. 

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 KDHE may add to this list. 

Large Quantity Handler of Universal Waste means a universal waste handler (as defined in 40 CFR 

273.6) who accumulates 5,000 kilograms (11,000 pounds) 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. 

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. 

Off-Specification Used Oil Burner means an site where used oil not meeting the specification 

requirements in 40 CFR 279.11 (off-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. 
Revised 6/14/2013 11 

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

CFR 279.11. 

Operator means the person responsible for the overall operation of a site. See Person. 

Owner means a person who owns a site or part of a site, including the property owner. 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. 

RCRA Subtitle C Site (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 hazardous wastes; recycling of hazardous wastes; the accumulation of 5,000 kg 

(11,000 pounds) or more of universal wastes; and the transportation (and temporary storage 

during transportation), processing/re-refining, burning, or marketing of used oil. A site may 

consist of several treatment, storage, or disposal operational units. A site also may consist of 

an area undergoing corrective action. (For entities that only transport regulated wastes, the 

term site refers to the headquarters of that entity=s operations.) 

Small Quantity On-Site Burner Exemption means that persons who burn small quantities of 

hazardous waste in an on-site boiler or industrial furnace, in accordance with 40 CFR 266.108, 

are conditionally 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 hazardous 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 hazardous 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 hazardous 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). 

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). 

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 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. 
Revised 6/14/2013 12 

Used Oil Activities, for the purposes of EPA Form 8700-12, include used oil transporter and transfer 

facility; used oil processing and re-refining; off-specification used oil burner; and used oil fuel 

marketing. 

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 an site that processes on- or off-specification used oil. 

Used Oil Re-Refiner means an site that produces lubricating oils and greases, industrial fuel, asphalt 

extender, gasoline, and other products from on- or off-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. 


Page 1 of 6

EPA ID Number 

Kansas Department of Health and Environment 

HARDOUS WASTE PERMIT INFORMATION FORM

1. Facility Permit 

Contact First Name: MI: Last Name:

Contact Title:

Phone: Ext.: Email:

2. Facility Permit 

Contact Mailing 

Address

Street or P.O. Box:

City, Town, or Village:

State:

Country: Zip Code:

3. Operator Mailing 

Address and 

Telephone Number

Street or P.O. Box:

City, Town, or Village:

State: Phone:

Country: Zip Code:

4. Facility Existence 

Date Facility Existence Date (mm/dd/yyyy):

5. Other Environmental Permits

A. Facility Type

(Enter code) B. Permit Number C. Description

6. Nature of Business:
EPA ID Number 

7. Process Codes and Design Capacities – Enter information in the Section on Form Page 3

A. PROCESS CODE – Enter the code from the list of process codes below that best describes each process to be used at the facility. If more lines 

are needed, attach a separate sheet of paper with the additional information. For “other” processes (i.e., D99, S99, T04 and X99), describe the 

process (including its design capacity) in the space provided in Item 8.

B. PROCESS DESIGN CAPACITY – For each code entered in Item 7.A; enter the capacity of the process.

1. AMOUNT – Enter the amount. In a case where design capacity is not applicable (such as in a closure/post-closure or enforcement action)

enter the total amount of waste for that process.

2. UNIT OF MEASURE – For each amount entered in Item 7.B(1), enter the code in Item 7.B(2) from the list of unit of measure codes below that

describes the unit of measure used. Select only from the units of measure in this list.

C. PROCESS TOTAL NUMBER OF UNITS – Enter the total number of units for each corresponding process code.

Process Appropriate Unit of Measure for Process Process Appropriate Unit of Measure for

Code Process Design Capacity

Disposal Treatment (Continued) (for T81 – T94)

D79 Underground Injection Gallons; Liters; Gallons Per Day; or

Well Disposal Liters Per Day 

D80 Landfill Acre-feet; Hectares-meter; Acres;

Cubic Meters; Hectares; Cubic

Yards 

D81 Land Treatment Acres or Hectares 

D82 Ocean Disposal Gallons Per Day or Liters Per Day

D83 Surface Impoundment Gallons; Liters; Cubic Meters; or 

Disposal Cubic Yards 

D99 Other Disposal Any Unit of Measure Listed Below

T81 Cement Kiln Gallons Per Day; Liters Per Day; Pounds

Per Hour; Short Tons Per Hour;

Kilograms Per Hour; Metric Tons Per 

T82 Lime Kiln Day; Metric Tons Per Hour; Short Tons

Per Day; BTU Per Hour; Liters Per Hour; 

T83 Aggregate Kiln Kilograms Per Hour; or Million BTU Per

T84 Phosphate Kiln 

T85 Coke Oven 

T86 Blast Furnace 

T87 Smelting, Melting, or Refining Furnace 

T88 Titanium Dioxide Chloride Oxidation Reactor 

T89 Methane Reforming Furnace 

T90 Pulping Liquor Recovery Furnace 

T91 Combustion Device Used in the Recovery of Sulfur Values from Spent

Sulfuric Acid 

T92 Halogen Acid Furnaces 

T93 Other Industrial Furnaces Listed in 40 CFR 260.10 

T94 Containment Building Cubic Yards; Cubic Meters; Short Tons

Treatment Per Hour; Gallons Per Hour; Liters Per

Hour; BTU Per Hour; Pounds Per Hour; 

Short Tons Per Day; Kilograms Per

Hour; Metric Tons Per Day; Gallons Per

Day; Liters Per Day; Metric Tons Per

Hour; or Million BTU Per Hour 

Storage

S01 Container Gallons; Liters; Cubic Meters; or

Cubic Yards 

S02 Tank Storage Gallons; Liters; Cubic Meters; or 

Cubic Yards 

S03 Waste Pile Cubic Yards or Cubic Meters

S04 Surface Impoundment Gallons; Liters; Cubic Meters; or 

Cubic Yards 

S05 Drip Pad Gallons; Liters; Cubic Meters;

Hectares; or Cubic Yards 

S06 Containment Building Cubic Yards or Cubic Meters 

Storage 

S99 Other Storage Any Unit of Measure Listed Below 

Treatment

T01 Tank Treatment Gallons Per Day; Liters Per Day

T02 Surface Impoundment Gallons Per Day; Liters Per Day 

T03 Incinerator Short Tons Per Hour; Metric Tons

Per Hour; Gallons Per Hour; Liters

Per Hour; BTUs Per Hour; Pounds

Per Hour; Short Tons Per Day;

Kilograms Per Hour; Gallons Per

Day; Metric Tons Per Hour; or

Million BTU Per Hour 

T04 Other Treatment Gallons Per Day; Liters Per Day; 

Pounds Per Hour; Short Tons Per

Hour; Kilograms Per Hour; Metric 

Tons Per Day; Short Tons Per Day;

BTUs Per Hour; Gallons Per Day;

Liters Per Hour; or Million BTU Per 

Hour 

T80 Boiler Gallons; Liters; Gallons Per Hour;

Liters Per Hour; BTUs Per Hour; or

Million BTU Per Hour 

Miscellaneous (Subpart X)

X01 Open Burning/Open Any Unit of Measure Listed Below

Detonation 

X02 Mechanical Processing Short Tons Per Hour; Metric Tons Per 

Hour; Short Tons Per Day; Metric Tons

Per Day; Pounds Per Hour; Kilograms 

Per Hour; Gallons Per Hour; Liters Per

Hour; or Gallons Per Day 

X03 Thermal Unit Gallons Per Day; Liters Per Day; Pounds

Per Hour; Short Tons Per Hour;

Kilograms Per Hour; Metric Tons Per

Day; Metric Tons Per Hour; Short Tons

Per Day; BTU Per Hour; or Million BTU

Per Hour 

X04 Geologic Repository Cubic Yards; Cubic Meters; Acre-feet; 

Hectare-meter; Gallons; or Liters

X99 Other Subpart X Any Unit of Measure Listed Below 

Unit of Measure Unit of Measure Code Unit of Measure Unit of Measure Code Unit of Measure Unit of Measure Code

Gallons.................................................G Short Tons Per Hour................................D Cubic Yards..............................................Y

Gallons Per Hour..................................E Short Tons Per Day..................................N Cubic Meters ............................................C

Gallons Per Day ...................................U Metric Tons Per Hour..............................W Acres ......................................................... B

Liters.....................................................L Metric Tons Per Day.................................S Acre-feet...................................................A

Liters Per Hour.....................................H Pounds Per Hour...................................... J Hectares.................................................... Q

Liters Per Day.......................................V Kilograms Per Hour .................................X Hectare-meter............................................F

Million BTU Per Hour...............................X BTU Per Hour.............................................I

Page 2 of 6 
Page 3 of 6

EPA ID Number 

7. Process Codes and Design Capacities (Continued)

EXAMPLE FOR COMPLETING Item 7 (shown in line number X-1 below): A facility has a storage tank, which can hold 533.788 gallons.

Line

Number

A. Process

Code

(From list above) 

B. PROCESS DESIGN CAPACITY C. Process Total For Official Use Only

(1) Amount (Specify) (2) Unit of Measure Number of Units

X 1 S 0 2 533.788 G 001

1

2

3

4

5

6

7

8

9

1 0

1 1

1 2

1 3

Note: If you need to list more than 13 process codes, attach an additional sheet(s) with the information in the same format as above. 

Number the line sequentially, taking into account any lines that will be used for “other” process (i.e., D99, S99, T04, and X99) in Item 8.

8. Other Processes (Follow instructions from Item 7 for D99, S99, T04, and X99 process codes)

Line

Number

(Enter #s in 

sequence 

with Item 7) 

A. Process Code

(From list above) 

B. PROCESS DESIGN CAPACITY

(1) Amount (Specify) (2) Unit of

Measure

C. Process Total For Official Use Only

Number of Units

X 2 T 0 4 100.00 U 001
Page 4 of 6

ENGLISH UNIT OF MEASURE CODE METRIC UNIT OF 

MEASURE 

CODE 

POUNDS 

TONS 

P 

T 

KILOGRAMS 

METRIC TONS 

K 

M 

EPA ID Number 

9. Description of Hazardous Wastes - Enter Information in the Sections on Form Page 5

A. EPA HAZARDOUS WASTE NUMBER – Enter the four-digit number from 40 CFR, Part 261 Subpart D of each listed hazardous waste you will

handle. For hazardous wastes which are not listed in 40 CFR, Part 261 Subpart D, enter the four-digit number(s) from 40 CFR Part 261, Subpart 

C that describes the characteristics and/or the toxic contaminants of those hazardous wastes.

B. ESTIMATED ANNUAL QUANTITY – For each listed waste entered in Item 9.A, estimate the quantity of that waste that will be 

handled on an annual basis. For each characteristic or toxic contaminant entered in Item 9.A, estimate the total annual 

quantity of all the non-listed waste(s) that will be handled which possess that characteristic or contaminant.

C. UNIT OF MEASURE – For each quantity entered in Item 9.B, enter the unit of measure code. Units of measure which must be 

used and the appropriate codes are:

If facility records use any other unit of measure for quantity, the units of measure must be converted into one of the required 

units of measure, taking into account the appropriate density or specific gravity of the waste.

D. PROCESSES

1. PROCESS CODES:

For listed hazardous waste: For each listed hazardous waste entered in Item 9.A, select the code(s) from the list of 

process codes contained in Items 7.A and 8.A on page 3 to indicate all the processes that will be used to store, treat, 

and/or dispose of all listed hazardous wastes.

For non-listed waste: For each characteristic or toxic contaminant entered in Item 9.A, select the code(s) from the list of 

process codes contained in Items 7.A and 8.A on page 3 to indicate all the processes that will be used to store, treat, 

and/or dispose of all the non-listed hazardous wastes that possess that characteristic or toxic contaminant.

NOTE: THREE SPACES ARE PROVIDED FOR ENTERING PROCESS CODES. IF MORE ARE NEEDED:

1. Enter the first two as described above.

2. Enter “000” in the extreme right box of Item 9.D(1).

3. Use additional sheet, enter line number from previous sheet, and enter additional code(s) in Item 9.E.

2. PROCESS DESCRIPTION: If code is not listed for a process that will be used, describe the process in Item 9.D(2) or in 

Item 9.E(2).

NOTE: HAZARDOUS WASTES DESCRIBED BY MORE THAN ONE EPA HAZARDOUS WASTE NUMBER – Hazardous

wastes that can be described by more than one EPA Hazardous Waste Number shall be described on the form as follows:

1. Select one of the EPA Hazardous Waste Numbers and enter it in Item 9.A. On the same line complete Items 9.B, 9.C, 

and 9.D by estimating the total annual quantity of the waste and describing all the processes to be used to store, 

treat, and/or dispose of the waste.

2. In Item 9.A of the next line enter the other EPA Hazardous Waste Number that can be used to describe the waste. In 

Item 9.D.2 on that line enter “included with above” and make no other entries on that line.

3. Repeat step 2 for each EPA Hazardous Waste Number that can be used to describe the hazardous waste.

EXAMPLE FOR COMPLETING Item 9 (shown in line numbers X-1, X-2, X-3, and X-4 below) – A facility will treat and dispose of an 

estimated 900 pounds per year of chrome shavings from leather tanning and finishing operations. In addition, the facility will treat 

and dispose of three non-listed wastes. Two wastes are corrosive only and there will be an estimated 200 pounds per year of each 

waste. The other waste is corrosive and ignitable and there will be an estimated 100 pounds per year of that waste. Treatment will 

be in an incinerator and disposal will be in a landfill.

Line

Number

A. EPA Hazardous

Waste No.

(Enter code)

B. Estimated

Annual

Qty of

Waste

C. Unit of

Measure

(Enter code)

D. PROCESSES

(1) PROCESS CODES (Enter Code) (2) PROCESS DESCRIPTION

(If code is not entered in 9.D(1))

X 1 K 0 5 4 900 P T 0 3 D 8 0 

X 2 D 0 0 2 400 P T 0 3 D 8 0 

X 3 D 0 0 1 100 P T 0 3 D 8 0 

X 4 D 0 0 2 Included With Above 
EPA ID Number

9. Description of Hazardous Wastes (Continued. Use additional sheet(s) as necessary; number pages as 5a, etc.)

Line Number

A. EPA Hazardous

Waste No.

(Enter code)

B. Estimated

Annual

Qty of

Waste

C. Unit of

Measure

(Enter code)

D. PROCESSES

(1) PROCESS CODES (Enter Code) (2) PROCESS DESCRIPTION

(If code is not entered in 9.D(1))

1

2

3

4

5

6

7

8

9

1 0

1 1

1 2

1 3

1 4

1 5

1 6

1 7

1 8

1 9

2 0

2 1

2 2

2 3

2 4

2 5

2 6

2 7

2 8

2 9

3 0

3 1

3 2

3 3

3 4

3 5

3 6

Page 5 of 6 
EPA ID Number 

9. Description of Hazardous Wastes (Continued. Use additional sheet(s) as necessary; number pages as 5a, etc.)

Line Number

A. EPA Hazardous

Waste No.

(Enter code)

B. Estimated

Annual

Qty of

Waste

C. Unit of

Measure

(Enter code)

D. PROCESSES

(1) PROCESS CODES (Enter Code) (2) PROCESS DESCRIPTION

(If code is not entered in 9.D.1)

Page 5 of 
EPA ID Number

10. Map

Attach to this application a topographical map, or other equivalent map, of the area extending to at least one mile beyond property 

boundaries. The map must show the outline of the facility, the location of each of its existing intake and discharge structures, each of its 

hazardous waste treatment, storage, or disposal facilities, and each well where it injects fluids underground. Include all spring, rivers, and 

other surface water bodies in this map area. See instructions for precise requirements. 

11. Facility Drawing

All existing facilities must include a scale drawing of the facility (see instructions for more detail). 

12. Photographs

All existing facilities must include photographs (aerial or ground-level) that clearly delineate all existing structures; existing storage, 

treatment, and disposal areas; and sites of future storage, treatment, or disposal areas (see instructions for more detail). 

13. Comments

Page 6 of 6
Instructions for Filling Out the 

Hazardous Waste Permit Information Form

General 

Instructions

Please type or print, leaving only one blank box between words. Abbreviate, if necessary, to stay within

the number of boxes allowed for each item. Some items in the form require narrative explanation. If

more space is necessary to answer a question, use the space provided in Item 13 and reference the item

number to which the additional information applies or attach a separate sheet entitled “Additional

Information”. Remember to include your EPA Identification Number and site name in the upper lefthand corner of each attached page. 

Unless otherwise specified in the instructions to the form, each item must be answered. To indicate that

each item has been considered, enter “NA” for not applicable, if a particular item does not fit the

circumstances or characteristics of your facility or activity. 

For a Revised Part A Permit Application, circle the item numbers with new information or changes. 

In addition to this form, the facility must also submit a Notification of Regulated Waste 

Activity/Subtitle C Site Identification Form. 
Hazardous Waste Permit Information Form

(continued)

Instructions page 2 

Item-By-Item Instructions

Item 1 – Facility Permit Contact

Give the name, title, work telephone number, and e-mail of a person who is thoroughly familiar with the

activities at the facility that require a hazardous waste permit and with the facts reported in the Hazardous

Waste Permit Information Form. This person must be available to be contacted by offices reviewing the

permit application, if necessary. If the Facility Permit Contact person is the same as the Site Contact

Person identified in Item 8 of the RCRA Subtitle C Site Identification Form (Site ID Form), you may

print “Same as Site Contact” in this box. 

Item 2 – Facility Permit Contact Mailing Address

Enter the mailing address for the facility permit contact. If the mailing address is the same as the Site

Mailing Address (Item 7) on the Site ID Form, you may print “Same as Site Mailing Address” in this box. 

Item 3 – Operator Mailing Address and Telephone Number

Enter the mailing address and telephone number of the facility operator identified in Item 9.B of the Site

ID Form. 

Item 4 – Facility Existence Date

Enter the appropriate date that applies to your facility from among the following: 

• the date that hazardous waste operations at the facility commenced; 

• the date construction on the facility commenced; or

• the date operation is expected to begin. 

Item 5 – Other Environmental Permits

A. Permit Type: Using the codes listed below, enter a letter on the form for all other environmental

permits the facility has received, or for which the facility has filed an application, even if the

permit has not yet been received. 

N = NPDES (National Pollutant Discharge Elimination System) Clean Water Act 

P = PSD (Prevention of Significant Deterioration) Clean Air Act

R = RCRA (Resource Conservation and Recovery Act)

U = UIC (Underground Injection Control) Safe Drinking Water Act

F = EPA 404 (Dredge or Fill Permits under Section 404 of the Clean Water Act)

E = Other relevant environmental permits. List any other relevant Federal (e.g.,

permits under the Ocean Dumping Act), State (e.g., State permits for new air

emission sources in nonattainment areas under Part D of the Clean Air Act or

State permits under Section 404 of the Clean Water Act), or local environmental

permits or applications.

B. Permit Number: Give the number of each presently effective permit issued to the facility for

each program, or if you have previously filed an application, but have not yet received a permit,

give the number of the application and note this in the description. You may list additional

permit numbers on a separate sheet of paper if you have more than one currently effective permit 
Hazardous Waste Permit Information Form

(continued)

Instructions page 3 

for your facility under a particular permit program. Remember to include your EPA

Identification Number and site name in the upper left-hand corner of each attached page. 

C. Description: Use the space provided for any additional information identifying or describing the

permits. 

Item 6 – Nature of Business

Briefly describe the nature of your business (e.g., products produced or services provided). If more space

is needed, please attach additional sheets. Remember to include your EPA Identification Number and site

name in the upper left-hand corner of each attached page. 

Item 7 – Process Codes and Design Capacities

The information in Item 7 describes all the processes that will be used to treat, store, or dispose of

hazardous waste at the facility. The process code and design capacity of each process must be provided

as part of the description. The design capacity of injection wells and landfills at existing facilities should

be measured as the remaining, unused capacity. Tank storage should refer to each tank, not each tank

farm. Please indicate the location of each process listed in Item 7 on either the map provided for Item 10

or the photographs provided for Item 12. Use the line number from Item 7 to indicate where the

process(es) are located. See the form for detailed instructions on Item 7. 

 NOTE

Submission of a Revised Part A Permit Application is required before processes for

treating, storing, or disposing of hazardous wastes are changed; before new processes are

added; and/or before the design capacities of these processes are increased. 

Item 8 – Other Processes

Use this space to describe other processes that did not have a specific process code listed in Item 7.A of

the form. Follow the instructions for Item 7.A on the form for other process codes (i.e., D99, S99, T04,

and X99 process codes). Describe the other processes in Item 13 - Comments. 

Item 9 – Description of Hazardous Wastes

This information describes all the hazardous wastes, using their hazardous waste codes, that will be

treated, stored, or disposed at the facility. In addition, the processes that will be used to treat, store, or

dispose of each hazardous waste and the estimated annual quantity of each hazardous waste must be

provided. The form contains three pages to capture the information for Item 9: Page 4 of 6, which has

detailed instructions; Page 5 of 6, which is to be filled out; and Page 5_ of _, which is used if additional

pages are needed. If additional pages are needed, the pages should be numbered as follows: Page 5a of 6,

Page 5b of 6, Page 5c of 6, etc. See the form for detailed instructions on Item 9. 
Hazardous Waste Permit Information Form

(continued)

Instructions page 4 

NOTE

Submission of a Revised Part A Permit Application is required before a facility 

begins treating, storing, or disposing of new hazardous wastes not previously 

identified in the facility’s Part A Permit Application. Changes in the quantity of 

hazardous waste previously specified in the Part A Permit Application can be made 

without submitting a Revised Part A Permit Application, provided the quantity does 

not exceed the process design capacities specified in the first Part A submission. 

Item 10 – Map

Provide a topographic map or maps of the area extending to at least one mile beyond the property

boundaries of the facility. The map must clearly show the following: 

• The legal boundaries of the facility; 

• The location and serial number of each of your existing and proposed intake and discharge

structures; 

• All hazardous waste management facilities; 

• Location of all processes listed in Items 7 and 8 identified by process code; 

• Each well where you inject fluids underground; and 

• All springs and surface water bodies in the area, plus all drinking water wells within 1⁄4 mile of the

facility which are identified in the public record or otherwise known to you. 

If an intake or discharge structure, hazardous waste disposal site, or injection well associated with the

facility is located more than one mile from the plant, include it on the map, if possible. If not, attach

additional sheets describing the location of the structure, disposal site, or well, and identify the U.S.

Geological Survey (or other) maps corresponding to the location. Remember to include your EPA

Identification Number and site name in the upper left-hand corner of each attached page. 

On each map, include the map scale, a meridian arrow showing north, and latitude and longitude at the

nearest whole second. On all maps of rivers, show the direction of the current, and in tidal waters, show

the directions of the ebb and flow tides. Use a 7-1/2 minute series map published by the U.S. Geological

Survey. If a 7-1/2 minute series map has not been published for your facility site, then you may use a 15-

minute series map from the U.S. Geological Survey. If neither a 7-1/2 nor 15-minute series map has been

published for your facility site, use a plant map or other appropriate map, and include all the requested

information; in this case, briefly describe land uses in the map area (e.g., residential, commercial).

For information about obtaining maps, contact the U.S. Geological Survey at (888) 275-8747 or see the

USGS web site at http://www.usgs.gov/pubprod. 

You may trace your map from a geological survey chart, or other map meeting the above specifications.

If you do, your map should bear a note showing the number or title of the map or chart from which it was

traced. Include the names of nearby towns, water bodies, and other prominent points. 
Hazardous Waste Permit Information Form

(continued)

Instructions page 5 

Item 11 – Facility Drawing

All existing facilities must include a drawing showing the general layout of the facility. This drawing

should be approximately to scale and fit on an 8 1⁄2” x 11” sheet of paper. The drawing should show the

following: 

• The property boundaries of the facility; 

• The areas occupied by all storage, treatment, or disposal operations that will be used during

interim status; 

• The name of each operation (e.g., multiple hearth incinerator, drum storage area, etc.); 

• Areas of past storage, treatment, or disposal operations; 

• Areas of future storage, treatment, or disposal operations; and 

• The approximate dimensions of the property boundaries and all storage, treatment, and disposal

areas. (Where applicable, use the process codes listed in Items 7 and 8 to indicate the location of 

all storage, treatment, and disposal areas.) 

NOTE New facilities do not have to complete Item 11. 

Item 12 – Photographs

All existing facilities must include photographs that clearly delineate all existing structures; all existing

areas for storing, treating, or disposing of hazardous waste; and all known sites of future storage,

treatment, or disposal operations. Photographs may be color or black and white, ground-level or aerial.

Indicate the date the photograph was taken on the back of each photograph. Use the process codes listed

in Items 7 and 8 to indicate the location of all storage, treatment, and disposal areas. 

NOTE New facilities do not have to complete Item 12. 

Item 13 – Comments

Use this space for any additional comments and attach additional sheets if necessary. Remember to

include your EPA Identification Number and site name in the upper left-hand corner of each attached

page.