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DANGEROUSWASTE COMPLIANCECHECKLIST/QUESTIONNAIRE, CHAPTER 173-303WAC 

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# ** * PART I: COVER INFORMATION This part of the checklist/questionnaire is applicable to all persons who handle dangerous waste. This cover information includes a review ofthe NotificationFormand confirmation of other general information necessary to maintain accurate files and records.


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### INSPECTOR INFORMATION WDOE Inspector:
Inspector's Signature:

Office (circle one): NW 

### Date ofTHISInspection: DateofLAST Inspection: Other Inspectors Present: SW C 

### E IND 

### Phone

### II:

Name:

_________Agency: Phone #:



### 2. BUSINESS INFORMATION Business Name Address: ______________EPA/State ID

### II:

Zip Code: County: Business Location (If: OtherThan Address) Contact Person: Phone If:\...........

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Business Representatives Present During Inspection: Name:

3. NOTIFICATIONFORM REVIEW NotificationForm Filed: Yes NotificationForm Revisions: Yes Title:

No No Date: Date: Date: Date: Phone 

### 1/:

Is the informationprovided in the most recent NotificationForm still accurate? (rfnot, note any deficiencies in Comments, below.) Comments:



### 4. ADDITIONAL INSPECTION INFORMATION Time InspectorEntered Site: Left Site: Yes No

Were photographs taken during the inspection? Yes No Ifyes, howmany? (Note: Abriefdescription of the pictures should be prepared and included inthe inspection report . ) 

### Were any problems encountered regarding: Permission to enter the site: Permission to have access to any areas on the site: Permission to have access to any records: Other: 

### -2-

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Were samples taken during the inspection? Yes No 

### Ifyes, where and ofwhatwere samples taken:

Were samples splitwith the owner/operator? Yes No 

### Were chain ofcustodyprocedures follows? Yes No



### -3-

### DANGEROUS WASTE COMPLIANCE CHECKLIST/QUESTIONNAIRE, CHAPTER 173-303 WAC 

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# * PART III: TRANSPORTERS This part of the checklist/questionnaire is applicable to any person who transports dangerous waste from a generator to a TSD facility. This part of the checklist/ questionnaire does not apply to persons who only transport dangerous waste on-site, as defined inWAC 

### -040(59). Ifa transporter is also a generator and/orTSD facility owner/ operator, then other applicable parts of 

### this checklist/questionnaire must also be completed.


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# * TransporterName Inspector's Name EPA/State IDlt 

### Date Has this transporter transported dangerous waste since the last time he was inspected (or since he was determined to be a transporter, ifthis is his first-inspection)? (Ifno, explain the evidence onwhich this determination is based under Comments below, and do not complete the remainder ofthis part ofthe checklist/questionnaire.) Comments Yes No

1. 

### APPLICABILITY

### OF GENERATORORFACILITYREQUIREMENTS A. Ifthe answer to eitherofthe following questions is "Yes," then the tr.ansporter is also subject to the**requi~ements** 

### for generators (WAC -240(3)).**~oe~** 

### the transporter ever: a. Transport dangerous waste into Washington State from another country? b. Mixdangerous waste ofdifferentU.S. Department of Transportation shipping descriptions by mixing them into a single container? B. Atransportermaykeep shipments ofdangerous waste for briefperiods (generally ten days or less) under certain conditions. Ifthe answer to any ofthe following conditions is "No," then the transporter is subject to all applicable TSD facility requirements (WAC 

### -240(5)). Yes No2. 

### Does the transporter only keep shipments ofdangerous waste:
a. Which are manifested? b. Which are packaged, labeled, and marked by the generator in accordance withWAC -190(1), (2), and (3)?
c. For ten days or less? Comments



### _._--,---------------- MANIFESTS A. Does this transporter ever transport moderate riskwaste (MRW) using an alternative manifestmechanism, approved by WDOE, as provided inWAC -170(2)(b)(i)? Ifyes, is he complying with the terms and conditions of the alternative manifest for suchMRW (WAC -240(2))? (Ifnot, describe under Comments, below, which aspects of the alternativemanifest system are being violated.) B. Does the transporter ever accept dangerous waste from a generator that is not accompaniedby a manifestprepared and signed by the generator in accordance withWAC -180 (WAC -250(1))? C. Does the transporter deliver the entire quantity of dangerous waste accepted from a generator or t

### ranspo

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### e r to either: the designated facility listed on the manifest; the alternate facility, ifthe dangerous waste cannotbe delivered to the first facility because an emergency prevents'delivery; the next designated transporter; or, the place outside the United States designated by the generator (WAC -250(5))? Ifdangerous waste cannot be delivered to one ofthe places described above, does the transporter contact the generator for further directions, and revise the manifest according to the generator's directions' (WAC -250(6))? Yes No



### D. Complete the following questions. answered "Yes," complete the items H.) below which correspond to eachFor each question (E., F., G., and/or "Yes" answer.
a. Does this transporter ever transport dangerous waste overpublic roads? If "Yes," complete item E., below. 

### -2-b. Does this transporter ever transport dangerous waste by water (bulk shipments)? If "Yes," complete item F., below.
c. Does this transporter ever transport dangerous waste by rail? If "Yes," complete item G., below. d. Does this transporter ever transport dangerous waste out of the United States? If "Yes," complete item H., below.**~.** Transportation by road.
a. Does the transporter keep copies ofmanifests for at least three years after the date the initial transporter accepted waste for transport (WAC -260(1))? b. Before transporting a dangerous waste, does the transporter sign and date the manifest and return a signed copy to the generator before beginning transport (WAC -250(2))?
c. Does the transporter ensure that the manifest accompanies the shipment (WAC -250(3))? d. When delivering the shipment to another transporter or the designated facility, does the transporter: i. Obtain the date of delivery and the handwritten signature on the manifest of the next transporter or facility owner/operator (WAC -250(4)(a))? ii. Retain a copy of the manifest for his records (WAC -250(4)(b))?
Ill. Give the remaining manifest copies to the next transporter or facility owner/operator. (WAC 

### -250(4)(c))?
e. Before accepting dangerous waste from a rail transporter, does the (nonrail) transporter sign and date the manifest and provide a copy to the rail transporter (WAC -250(8)(e))? F. Transportation by water (bulk shipment).
a. Does the water transporter keep for at least three years after the date waste was accepted by the initial transporter copies of shipping papers for all wastes which he transported by water (WAC -260(2)(a))?

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### b. When receiving dangerous waste from a generator, does the water transporter sign and date the manifest and return a signed copy to the generator before beginning transport (WAC -250(2»?
c. Does the watertransporterperform all ofthe following actions'(ifnot, then he must instead perform the actions specified under d. ofthis itemF.): i. Is the dangerous waste deliveredby water to the designated facility (WAC -250(7)(a»? ii. Does a shipping paper containing all information required on a manifest, exceptEPA/ State ID#'s, generator certificationand signatures, accompany the waste shipment (WAC -250(7)(b»? iii. Does the delivering transporter obtain the date ofdelivery and facility owner/operator's handwritten signature on either themanifest or shipping paper (WAC -250(7)(c»? iv. Does the persondelivering the waste to the initial water transporter obtain the date ofdelivery and signature of the water transporter on the manifest and forward it to the designated facility (WAC -250 (7)(d»?
v. Does eachwater transporter keep a copyof the manifest or shipping papers for his records (WAC -250 (7)(e»? d. Ifthe water transporter does notperformthe actions specified in c., above, does he instead: i. Ensure that the manifest accompanies the waste shipment (WAC -250(3»? ii. When delivering the shipment to another transporter or the designated facility: 1. 

### Obtain the date ofdelivery and the handwritten signature on the manifest ofthe next transporter or facility owner/operator (WAC -250(4)(a»? 2. Retain a copy ofthe manifest for his records (WAC -250(4)(b». 3. Give the rema1n1ngmanifest copies to the next transporter or facility owner/ operator (WAC -250(4)(c»?
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### iii. Before accepting dangerous waste from a rail transporter, sign and date the manifest and provide a copy to the rail transporter (WAC -250(8)(e))? G. Transportationby raiL,


### a. Does the rail transporter keep for at least three years after the date waste was acceptedbythe initial transporter copies of shippingpapers for all wastes whichhe transportedby rail (WAC -260(2)(a))? b. Wheneverhe is the initial rail transporter, does he keep copies ofthe manifests and shippingpapers for at least three years after the date the waste was acceptedby the initial transporter (WAC -206 (2)(b)(i))?
c. Wheneverhe is the final rail transporter, does he keep a copy ofthe signedmanifest (or shipping paper ifsignedby the designated facility in lieu ofthe manifest) for at least three years after the date the wastewas acceptedby the initial transporter (WAC -260(2)(b)(ii))? d. When receiving dangerous waste from a generator, does the rail transporter signand date the manifest and return a signed copy to the generator before beginning transport (WAC -250(2))?
e. Asthe initial rail transporter accepting dangerous waste from a nonrail transporter, does the rail transporter: i. Sign and date the manifest and return a signed copy ofthe manifest to the nonrail transporter (WAC**-~50(8)(a)(i)** 

### and (ii))? ii. Retain one copy ofthe manifest and rail shipping paper for his records (WAC -250 (8)(a)(iv))? iii. Forward at least three copies ofthe manifest to either: the next nonrail transporter, ifany; the designated facility, ifthe shipment is delivered to the facility by rail; or, the last rail transporter designated to handle the waste in the United States (WAC -250(8) (a)(iii))?

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### f. Does the rail transporter ensure that a shipping paper containing all the information required on themanifest, exceptEPA/State ID#'s, generator certification and signatures, accompanies the waste at all times (WAC -250(8)(b»? g. When deliveringwaste to a nonrail transporter, does the rail transporter: i. Obtain the date ofdelivery and handwritten signature ofthe next nonrail transport on the manifest (WAC -250(8)(d)(i»? ii. Retain a coy of the manifest for his records (WAC -250(8)(d)(ii»? h. When deliveringwaste to the designated facility, does the rail transporter: i. Obtain the date ofdelivery and handwritten signature ofthe owner/operator on the manifest or shippingpaper (ifthe manifest has notbeen receivedby the facility) (WAC -250(8)(c)(i»? ii. Retain a copy ofthe manifest or shippingpaper for his records (WAC -250(8)(c)(ii»? H. Transportationoutofthe United States.
a. Does the transporter keep copies ofmanifests showing the date the waste left the U.S. for at least three. years after the date the waste was acceptedby the initial transporter (WAC -260(3»? b. Does the transporter indicate on the manifest the date the waste left the U.S. (WAC 

### -250(9)(a»?
c. Does the transporter sign the manifest and retain one copy for his records (WAC -250(9)(b)? d. Does the transporter return a signed·copy ofthe manifest to the generator (WAC -250(9)(c))?

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### Comments

3. SPILLS ORDISCHARGES, DURINGTRANSPORTANDONTHE TRANSPORTER'S OWN PROPERTY. Yes No A. Ifthe transporterhas a discharge ofdangerous waste during transport, does he:
a. Notify the generatorofthe waste that a discharge has occurred (WAC -270(1»? b. Notify the National Response Center (800-424-8802 or 202-426-2675) ifrequired by 49 CFR 171.15 (WAC -270(2»?
c. Forwater shipments, notify as requiredby 33 CFR 153.203 for oil and hazardous substances (WAC -270(4»? d. Report inwriting as requiredby 49 CFR 171.16 to thedirector, Office ofHazardous Materials Regulation, Materials Transportation Bureau, Department of Transportation, Washington, D.C., 20590 (WAC -270(3»? B. Ifthe transporter has any nonpermitted spill ordischarge to ground or to surface or groundwaters, does he:
a. Notify the appropriate regional office ofWDOE (WAC -145(2)(a»)? b. Notify all local authorities in accordance with the local emergency plan (ifnecessary, by checking with the local emergency service coordinatorand fire department to determine notification responsibilities under the plan) (WAC -145(2)(a))? C. Ifthe transporter has any nonpermitted spill or discharge which results in emissions to the air, does he: "a. Notify the local airpollution control authority if

### the spill ordischarge**i~** 

### inwesternWashington (WAC -270(2)(b»?



### -7-

### b. Notify the appropriate regional office ofWDOE if the spill or discharge is in easternWashington (WAC -270(b))?
c. Notify all local authorities in accordance with the local emergency plan (ifnecessary, by checking with the local emergency service coordinator and fire department to determine notification responsibilities under the plan) (WAC -270(2)(b))? D. When the transporterhas any nonpermitted spill or discharge, does he:
a. Take appropriate immediate action to protect human health and the environment (WAC -145(3))? b. Whenever required to by WDOE: i. Cleanup all released wastes or take such other actions as may be required or approved by federal, state, or local officials acting within their responsibilities (WAC -145(3) (a)(i))? ii. Designate and treat, store, ordispose of all soils, waters orothermaterials contaminatedby the spill ordischarge (WAC -145(3)(a)(ii))?
1.11. 

### Restore the'area impactedby the spill or discharge and replenish resources, ifthe' impactedproperty is not owned by the transporter (WAC -145(3)(a)(iii))? Comments

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DANGEROUS WASTE COMPLIANCE CHECKLIST/QUESTIONNAIRE, CHAPTER 173-303WAC 

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# * * PART I I : GENERATORS This part of the checklist/questionnaire is applicable to anypersonwhose actions or processes generate dangerous wastes, and are thus identified as generators under Chapter 173-303 WAC. This part of the checklist/questionnaire mustbe completed for any person who is a generator, including transporters orTSD facilities which generated dangerous waste.


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# * GeneratorName: EPA/State ID#: Inspectors Name: Date: Has this generator generated dangerous waste since the date ofhis last inspection, or since the date he was determined to be a generator ifthis is his first Yes inspection? (If 

### "No," explain howthe generator assures that no dangerous wastes are generated in the Comments No section, below, and do not complete the remainder of this part ofthis checklist/questionnaire.) Comments:

1. 

### DESIGNATION (WAC -170(1)). 

### A. Does the generatorproperly designate his dangerous wastes as DWand/orEHW? 

### B. Does the generator have adequate information to perform these designations? C. Ifdesignation involves performing tests and analyses of his 

### waslps:
a. Does the gener a t.o r have ou-isi

### t.e , or have ready access 

### to, equipment for obtaining and preserving waste samples for tests? Yes No'\.



### 2. b. Dothe waste analyses and test results provide enough information to accurately designate the generator's dangerous wastes (WAC -170(1)(a))?
c. Does the generator retain copies ofall waste analyses used to designate his dangerous wastes for a minimum ofthreeyears (WAC -210(3))? Comments

SHIPPINGDANGEROUS WASTEOFF-SITE A. Does the generator ship any dangerous wastes off-site thatmust have accompanying manifests as required under WAC -180? (If "No," do not complete Section 3. Manifests, Section4. PreparingDangerous Waste for Transport and Section5. Import/Export ofDangerous Waste.) B. Does the generator ever also transporthis ownwastes? (If"YES" be sure to also complete Part III: Transporters ofthis checklist/questionnaire.) C. Listbelow any "outside" transporters the-generator uses to transport his dangerous wastes off-site: Yes No

TransporterName EPA/State ID 

### II

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### 3. Conunents

MANIFESTS (WAC -180). A. Does the generator retain a completed copy ofeachmanifest signedby the initial transporter for at least three years, or until he receives a signed copy from the designated facility indicating receipt of the waste which cppy he keeps for at least three years from the date the initial transporter accepted the waste (WAC 210(1))? B.a Does the generatoruse an alternative manifestmechanism for**moderat~** 

### riskwastes as provided inWAC -170(4)(a)? b. 

### Has this alternative manifestmechanismbeen approved by

### WDOE?
c. Has the generator compliedwith the terms and conditions of, and properly implemented the alternative manifest mechanism? (Ifnot, specifywhat failures occurred underConunents, below.) Yes No

Note: Ifall ofthe dangerous wastes handledby the generator are moderate risk wastes coveredby an alternative manifestmechanism, then complete only items G., H., I" and

### J., below. Ifonly some ofthe generator's dangerous wastes are moderate riskwastes covered by an alternative manifest mechanism, then do complete all remaining items, below. C. Does the generator use the UniformManifest (WAC -180(1)(b))? Does the generator include the additional WDOE infor.- mation required for the UniformManifest:
a. In ItemD - the first transport's telephone number (WAC -180(l)(b)(i))? b. In ItemF - the second transporter's telephone number, ifa second transporter is used (WAC -180(1)(b)(ii))?
c. In ItemH - the designated rece1v1ng facility's telephone number (WAC -180(1)(b)(iii)? d. In Item 1 - the dangerous waste number for each cor.respondingwaste entered and described under Item 11 (WAC -180(1)(b)(iv))?

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D. Is signature of, and date ofacceptance by the transporter obtained prior to tr.ansport (WAC -180(3)(a))7 E. Does the generator retain one copy, signed by the transporter, and give remaining copies to the transporter at ti.me oftransport (WAC -180(3)(a) and (b))? F. Has the generator received copies ofall his manifests, signed, dated, and returned by the receiving TSD facilities? Were all ofthese received within forty-five days after the waste was transported? (If "Yes," do not complete the next item, G., regarding ExceptionReports.) G.a. If the generator does not receive a copy of the manifest with the handwritten signature ofthe designated facility's owner/operatorwithin thirty-five days after the initial transporter accepted the waste, does he contact the transporter(s) and/or facility to determine the status ofthe dangerous waste shipment (WAC -220(2)(a))? b. Has the generator submitted in writing to WDOE an ExceptionReport for each manifest not signed, dated, and returned by the receiving TSD facility within forty-five days oftransport (WAC -220(2))1
c. List the dates during the previous year thatException Reports were submitted:

d. Were the waste shipments described in these Exception Reports finally delivered to a TSD facility? Ifnot, specify which shipments were not delivered or not found:

e. Does the generator retain copies ofall Exception Reports for a minimum of three years (WAC -210(2))? H. If the transporter is unable to deliver the dangerous waste shipment.to either the designated or alternate facility, does the generator either designate another facility for delivery or instruct that the shipment be returned to him when contacted by the transporter for further instructions (WAC -180(3)(c))?


### -4-

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I. When shipping dangerous waste within the United States solely by water (bulk shipment), does the generator send three c0pies ofthe manifest signed and dated by himselfand the initial transporter to either the owner/operator ofthe designated facility, or to the lastwater transporter to handle the waste in the U.S. ifthe waste is exported by water (WAC -180(3)(d))? J. 

### For rail shipments within the United States which originate at the site ofgeneration, does the generator send at least three copies ofthe manifest signed and dated by himselfand the initial transporter to either (WAC -180(3)(e)):
3. 

### The next nonrail transporter, ifany? b. The designated facility if transported solelyby rail?


### c. The last rail transporter to handle the waste in the U.S. ifexported by rail? Comments

4. PREPARINGDANGEROUS WASTEFORTRANSPORT OFF-SITE (WAC -190).
A. Does the generatorpackage his dangerous waste for transport in accordance witn U.S. DOT rules, 49 CFR Parts 173, 178 and 179 (WAC -190(1))? B. Does the generator label arid mark each ofhis packages for shipment in accordance withU.S. DOT rules, 49 CFR Parl 172 

### (WAC -190(2) and (3)(a))? C. Dot's t.hr- gf'I\{'ra t.or mark each package co nt.ainiug 110 gaI I0 IIS ()r I {'Ss 0fda11g('r0 US wasle , illld disP

### Jay i11 

### accordance with 49 CFR 172.304, the following or equivalent words and information (WAC -190(3)(b)): HAZARDOUS WASTE

- State and Federal LawProhibits Improper Disposal. If found, contact the nearest



### -5- Yes No

### 5. police or public safety authority, and the Washington State Department ofEcology or the United States Environmental ProtectionAgency. Generator's Name and Address Manifest Document Number D. Does the generator placard, or offer to the transporter all appropriate**placa~ds,** 

### in accordance with U.S. DOT rules 49 CFR Part 172 SubpartF (WAC -190(4))? Comments

IMPORT/EXPORT OF DANGEROUS WASTE (WAC -230). A. Does the generator import or export any dangerous waste? (I

### f "No, It 

### skip the remainder ofthe questions in this item.) B. Ifthe generator exports dangerous waste to other countries, does he:
a. NotifyEPAinwriting, four weeks before shipping to each country in each calendaryear, ofthe waste's identificationnumber and DOT description, and of the name and address ofthe foreign consignee (40 CFR 262.50 (b)(I))? b. Require the foreign consignee to confirm delivery ofthe waste in the foreign county (40 CFR 262.50(b)(2))?
c. Meet the UniformManifest requirements (including additional WDOE information), except that he uses the name and address of the foreign consignee in place of the designated facility's, and he identifies 

### the point ofdeparture from the United States (40 CFR 262.50(b)(3))? d.. File an Exception Report with EPA ifhe has not received either: i. Acopy ofthe manifest signed by the transporter stating the date and place ofdeparture from the United States within 45 days (40 CFR 262.50(c)(I))? -6- 

### Yes No

### G. ii. 

### Written confirmation from the foreign consignee that the waste was received within 90 days (40 CFR 262.50(c)(2))?
e. Submit copies ofException Reports sent to EPA to WDOE as well (WAC -230(1)(b))? C. Ifthe generator imports waste from foreign countries, does he:
a. Comply with all other requirements for generators (WAC -230(2))? b. Comply with the UniformManifest requirements (including additional WDOE information), except that inplace ofthe generator's name, address, and ID

### #he enters the name and address ofthe foreign generator and the importer and the importer's ID#, and in place ofthe generator's signature on the certification the importeror his agent signs and dates the certification and obtains the transporter's signature (WAC -230(2)(b))? Comments

TRIPLERINSING (WAC'-230(3)! (4) AND 

### -160). A. Does the generator triple rinse all containers which are empty and which held EHW in accordance withWAC -160? B. Does the generator either reuse rinsate from any rinsing operations (including rinsing of tote tanks, truck or railroad tank cars, WAC -230(4)) in a manner consistent with the original product, or else determine ifthe rinsate is designated as dangerous waste and, if so designated, handle it in accordance with Chapter 173-303 WAC and Chapter 90.48 RCW? Comments



### -7- Yes No

### d. Ifthere is everjust one employee present on the premises, does he have immediate access to a device (e.g., telephone, two-way radio) capable of summoning external emergency help (WAC -340(2)(b))?
e. Is adequate aisle space provided to allow for inspections and unobstructed movement ofpersonnel, fire and spill control equipment and decontamination equipment during an emergency (WAC -340(3))? f. Do the hazards posed by the wastes handled by the generator require arrangements with local authorities? (lf 

### "Yes," complete the remaining questions, g. through k, below. If "No," document under Comments, below, why the hazards are not such as to warrant these arrangements.)
. g. Has the generator arranged to familiarize police, fire departments and emergency response teams with: the layout ofhis site; properties ofwastes handled and associated hazards; places where personnel would normally be working; entrances to and roads on the site; and possible evacuation routes (WAC -340(4)(a))? h. Has the generator arranged to familiarize local hospitals with the properties ofdangerous wastes handled and the types of injuries or illnesses which could result from fires, explosions orwaste releases (WAC -340(4)(b))? i. Does the generator have agreements with state emergency response teams, emergency response contractors and equipment suppliers (WAC -340(4)(c))? j. 

### Where more than one party might respond to an emergency, does the generator have agreements designating primary emergency authority and support services to be provided (WAC -340(4)(d))? k. Has the generator documented all instances where state or local authorities have declined to enter into the above arrangements (WAC -340(5))? Comments

-16-

### i. Cleanup all releasedwastes or take such other actions as maybe required or approved by federal, state, or local officials acting within their responsibilities (WAC -145(3)(a)(i))? ii. Designate and treat, store, or dispose of all soils, waters or othermaterials contaminated by the spill or discharge (WAC -145(3)(a)(ii))? iii. Restore the area impacted by the spill or discharge and replenish resources, ifthe impactedproperty is not owned by the generator (WAC -145(3)(a)(iii)? Comments

8. 

### ANNUALREPORTS A. Does the generator retain copies ofAnnual Reports for a minimumofthree years (WAC -210(2))?

.B. Is the generator generating any wastes which.were not reported on his latestAnnual Report and which should have been reported? If "Yes," describe these wastes: Yes No.



### Description/Dangerous Waste

## n

-9- EHW/DW Quantity (Month/Batch)7. 

### NON-PERMITTED SPILLS ANDDISCHARGES (WAC -145). A. Have there been anynonpermitted spills or disctarges on the generator's site whichhave notbeen reported to WDOE? Ifyes, describe whatwastes were spilled and approximatelywhat quantities:

B. Ifthe generatorhas any nonpermitted spill ordischarge to ground or to surface or ground waters, does he:
a. Notify the appropriate regional office ofWDOE (WAC -145(2)(a))? b. Notify all local authorities in"accordance with the local emergencyplan (ifnecessary, by checking with the local emergency service coordinator and fire department to determine notification responsibilities under the plan) (WAC -145(2)(a))? C. Ifthe generatorhas any nonpermitted spill ordischarge which results in emissions to the air, does he:
a. Notify the local airpollution control authority ifthe spill or discharge is inwesternWashington (WAC -270(2)(b))? b. Notify the appropriate regional office ofWDOE if the spill or discharge is in easternWashington (WAC -270(b))?
c. Nolify all local authorities in accordance with the local emergency plan (ifnecessary, by checking with the local emergency service coordinator and fire department to determine notification responsibilities under the plan) (WAC -270(2)(b))? D. Whenthe generatorhas any nonpermitted spill or discharge, does he:
a. Take appropriate immediate action to protect human health and the environment (WAC -145(3))? b. Whenever required by WDOE:

-8- 

### Yes No

### 9. C. Are there any wastes which were reported on his latest Annual Report which the generator is no longer generating? If "yes," provide the waste description and Dangerous Waste 

### #as they appeared on the iatest Annual Report:

Comments



### ADDITIONALREPORTS. Does the department require the generator to submit any additional reports as provided underWAC -220(3)? If "Yes," were these reports accurate and submitted in a timelymanner? (Specifywhat additional reports are required and note any deficiencies under Comments, below.) Comments Yes No

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-10-10. GENERATOR ACCUMULATION (WAC -200). This portion of the generator checklist/questionnaire is only applicable to generators who accumulate dangerous waste on-site as allowed for in WAC -200. To determine whether or not this portion is applicable, first complete itemA. , below. If, after completing item A., it is determined that the generator does accumulate dangerous waste on-site, then complete all of the questions under this Section 10. Generator Accumulation. If, after completing item A., it is determined that the generator does not accumulate dangerous wastes, then do not complete the remaining questions under this section 10. Generator Accumulation. (Note: Under certain circumstances, WAC -200(1)(e)(ii) allows an accumulating generator who keeps his waste less than ten days to be exempt from all or part of sections WAC -330 through -360. If this is the case for this generator, then complete only item A. and the remaining applicable items of this section 10. Generator Accumulation.) 

### A. Determining Whether Or Not The Generator's Accumulation Is Subject To WAC -200.
a. Ifthe answers to both of the following questions are "Yes," then do not complete the remaining generator accumulation questions (they will be asked later under Part IV: Facilities). If either or both questions are answered "No," then continue the remaining questions in this item A. i. Does the generator operate an on-site dangerous waste management facility?
11. Are all of the generator's dangerous wastes placed in and managed (including stored, treated or disposed) at his on-site facility as soon as they become subject to regulation? b. Ifthe answer to any of the following questions is "Yes," then the generator is subject to the generator accumulation standards ofWAC -200, and the remaining items of this section 10. Generator Accumulation must be completed. If the answer to all of the following questions is "No," then the generator is not subject to WAC -200. i. Does the generator ever generate more than 2,200 l b s . (l,000 kg) of dangerous waste in a month or batch, or ever accumulate more than 2,200 lbs. (l,000 kg) on-site at any ti.me?
11. Does the generator ever generate (per month or per batch) or accumulate on-site at anytime more than 2.2 lbs. (1.0 kg) of EHW discarded chemical products (WAC -081)?



### -11- Yes No

### iii. Does the generator ever hold dangerous wastes on-site for more than ten days after the date tile waste quantity fi

### r st 

### exceeds the applicable quantity exclusion limit? iv. Even though the generator removes all wastes in less than ten days, has he been required by WDOE to complywith some or all ofWAC -330 through -360? Conunents



### B. Ninety-Oay* Accumulation Limit. The time limit is one hundred eighty days for moderate riskwastes held in containers or tanks as allowedby WAC -170(4)(b). Yes No



### a.

b.

c. 

### Does the generator ship all wastes off-site to, or place them on-site in, a facility permitted (including interim status orpermit-by-rule) to manage dangerous wastes within ninety days* or less (WAC -200(1)(a))? In those cases where wastes were not sent to a facility within ninety days*, didWDOE grant extensions (maximum thirty days) as allowedby WAC -200(1)(a)? How does the generator determine when theninety-day* accumulation period begins:
1. 

### Whenthe waste is first generated (WAC -200(2)(a))? ii. Ifhe is a small quantity generator, when his aggregated quantity first exceeds the exclusion limit (WAC -200(2)(b))? iii. Wheneach container is full (WAC -200(2)(c))? (Note: This method may not be used ifon-site waste quantity ever exceeds 2,200 pounds before the container is full, or anyon-site wastes are EHW discarded chemical products.)

-12-

### Conunents



### C. Personnel Training (WAC -330).
a. Does the generator have a writtenpersonnel training plan, kept at the generator's site (WAC -330(2))? b. Does the personnel training plan include the following documents and records: i. For eachposition related to the handling of dangerous waste on-site, thejob title, name ofemployee filling eachjob, and thejob description, including requisite skills, education, qualifications and duties for each position (WAC -330(2)(a))? ii. Written description oftype and amount of introductory and continuing training needed for eachposition (WAC -330(2)(b))? iii. Records documenting that employees have received and completed the necessary training (WAC -330(2)(c))?
c. Are training records retained for at least three years after an employee lastworked for the generator, or until the generator closes his site, whichever occurs first (WAC -330(3))? (Note: Records mayhave been transferred within the company to follow an employee. This is permissible, but some record of the employee's transfer and continued employment should be documented.) d. Does the generator provide a training program that teaches personnel to perform their duties inways that ensures the generator's compliance withWAC 173-303 (WAC -330(1))?
e. Does the training program involve: Classroom instruction? On-the-job training? f. Is the training programdirected by a person knowledgeable in dangerous waste handling practices (WAC -330(1)(a))? -13- Yes No

### g. Do the generator's employees participate in an annual review ofthe trainingprovided in the trainingprogram (WAC -330(1)(b))? h. Is the trainingprogram successfully completed by each employee within six months ofbeing employed at the generator's site, or ofbeing assigned to a newposition, whichever is later (WAC**~330(1)(c))?** 

### i. Are newemployees supervised until they complete the trainingprogram (WAC -330(1)(c))? j. Does the training program: i. Include training relevant to the positions in whichpersonnel are employed (WAC -330(1)(a))? ii. Instructpersonnel on contingencyplan implementation (WAC -330(1))? iii. Familiarize personnel with emergency equipment and systems, and emergencyprocedures (WAC -330(1)(d))? k. Where applicable, does the training**prog~am** 

### include the following parameters (WAC -330(1)(d))? i. Procedures for using, inspecting, repairing and replacing emergency andmonitoring equipment. ii. Keyparameters for automatic waste feed cut-off systems. iii. Communications or alarm systems. iv. Response to fires or explosions.
v. Response to ground water contamination. vi. Shutdown ofoperations. Comments:

-14-

### D. Preparedness and Prevention (WAC -340).
a. Is each container and tank used for accumulation labeled or marked with the words "Dangerous Waste" or "Hazardous Waste," and with a label or sign which identifies for employees, emergency response personnel and the public the major risk(s) associated with the waste in the container or tank (WAC -200(1)(e))? b. Unless it can be demonstrated that the equipment is not necessary (specify why not in the Comments, below), or the equipment is not required because wastes are held less than ten days (as allowed by WAC -200(1)(e)), are the following equipment present, tested regularly, and kept in g60d working order: i , Internal communications or alarm system capable of providing immediate emergency instructions (WAC -340(1)(a))? Present? Tested regularly? Good working order? ii. Adevice capable of summoning police or fire departments or emergency response teams (e.g., telephone, two-way radio) (WAC -340(1)(b))? Present? Tested regularly? Good working order?
111. Portable fire extinguishers, fire control equipment, spill control equipment, and decontamination equipment (WAC -340(l)(c))? Present? Tested regularly? Good working order? iv. Water at adequate volwne/pressure to supply hose streams, foam equipment, sprinklers or spray systems (WAC -340(1)(d))?

.Present?

tested regularly? Good working order?
c. Whenever dangerous waste is being handled, do all personnel involved have immediate access to an internal alarm or emergency communication system, either directly or through visual or voice contact with another employee (WAC -340(2)(a))? 

### -15- Yes No

### E. Contingency Plan, Emergency Procedures and Emergencies (WAC -350 and -360). Yes No

a. 

### Does the generator have a contingency plan designed to lessen the potential impacts ofa fire, explosion orunplanned sudden or nonsudden release ofdangerous wastes or dangerous waste constituents to air, soil, surface or ground water (WAC -350(1))7 b. Does the generator have a Spill Prevention Control and Countermeasures (SPCC) plan amended to include a contingencyplan (WAC -350(2))?
c. Are copies ofthe contingency plan and revisions to it: i. Maintained at the generator's site (WAC - 350(4)(a))? 

### ii. Submitted to all local police departments, fire departments, and hospitals, and state and local emergency response teams thatmay provide emergency services (WAC -350(4)(b))? d. Is the contingency plan amended whenever: i. Applicable regulations are revised (WAC -350(5)(i:J))? ii. The plan fails in an emergency (WAC -350(5)(b))? iii. The generator's site changes in a way that increases the potential for fires, explosions, or releases, or that changes the necessary emergency responses (WAC -350(5)(c))? iv. The list ofemergency coordinators changes (WAC -350(5)(d))? v. The list ofemergency equi.pment changes (WAC -350(5)(e))?
e. Does the contingency plan include:

1 . 

### Adescription of the actions personnel must take in the event of an emergency circumstance (WAC -350(3)(a))?

11. 

### Adescription of the arrangements agreed to by local police and fire departments, hospitals, contractors, and state and local response teams to coordinate emergency services (WAC -350(3)(c))?

-17-

### iii. Acurrent list ofemergency coordinators, including names, addresses and twenty-four hourphone numbers (WAC -350(3)(d»? iv. Ifmore than one emergency coordinator is listed, identification ofa primary emergency coordinator, with the others listed in the order that they will assume responsibility as alternates (WAC -350(3)(d»? v. Alist ofall emergency equipment kept on the site, including the location, physical description and briefoutline of the capability of each piece ofequipment (WAC -350(3)(e»? vi. Anevacuationplan (where evacuation could be necessary) forpersonnel, which describes signals to beginevacuation, evacuation routes, and alternate routes (WAC -350(3)(f»? f. Do the information and elements described in the contingencyplan assure that the generatorhas taken adequate precautions for reacting to emergency circumstances? (If "No," specifywhat inadequacies exist in the Comments section, below.) g. Is an emergency coordinatoron the premises at. all times oravailable on-call at all times (WAC - 360(l)

### )? 

### h. Is if i.
ii.

### the emergency coordinator (andhis alternates, any) capable in the following areas (WAC -360(1»: Familiarwith all aspects ofthe contingency plan? Familiarwith all operations and activities on the generator's site? iii. Familiarwith the location and properties ofall wastes handled? iv. Familiarwith the location of all rpcords kept on-sit

### e?


### v. Familiarwith the generator's site layout? vi. Has the authority to commit the resources needed to carry out the contingencyplan? i. Are the following procedures implemented (or, to be implemented) in the event ofan emergency:

-18-

### i. Does the emergency coordinatororhis designee (EC/D) immediately activate internal alarms or communication systems to notify all personnel (WAC -360(2)(a)(i)) and notify appropriate state or local agencies with designated response roles ifhelp is needed (WAC -360(2)(a)(ii))?
11. 

### Does the EC/Dimmediately identify the character, exact source, amount and areal extent ofany releasedmaterials (WAC -360(2)(b))? iii. 

### Concurrently, does the EC/Dassess possible hazards to human health and the environment (including direct, indirect, immediate and long-termeffects) thatmayresult from the emergency (WAC -360(2)(c)}? iv. Ifthe EC/Ddetermines that the emergency could threatenhuman healthorthe environment outside the facility, does he immediately notify andprovide an assessment report (whichmust include the informationdescribed under v., below) to: 1. The appropriate local authorities if evacuation oflocal areas maybe advisable; and remain available to help appropriate officials decide iflocal areas shouldbe evacuated (WAC -360(2)(d)(i))? 2. WDOE and either the government official designated as on-the-scene coordinator, or the NationalResponse Center (WAC -360(2)(d)(ii)? v. Does the assessment report (covered under iv., above) include: 1. Name and telephone number of r.eporter (WAC**-360(2)(~)(i))?** 

### 2. Name and address of the generator's site (WAC -360(2)(e)(ii))? 3. Time and type ofemergency (e.g., fire, release) (WAC -360(2)(e)(iii))? 4. Name and quantity ofmaterials involved (WAC -360(2)(e)(iv))? 5. The extent ofinjuries, ifany (WAC -360(2)(e)(v))?

-19-



### .,.,.

### 6. Possible hazards to human health and the environment offthe site (WAC -360(2)(e) (vi))? 

### vi. During an emergency, does the EC/D take all measures necessary to ensure that fires, explosions, and releases do not occur, recur, or spread to other dangerous wastes (e.g., stopping processes or operations, collecting and containing releases, removing or isolating containers, etc.) (WAC -360(2)(f))? vii. Ifoperations stop in response to an emergency, does the EC/Dmonitor for leaks, pressure buildup, gas generation or ruptures wherever appropriate (WAC -360(2)(g))? viii. Immediately after an emergency, does the EC/D provide for treating, storing or disposing wastes and materials resulting from the emergency (WAC -360(2)(h))? ix. Does the EC/D ensure, in the affected areas on the site, that: 1. Nowaste thatmaybe incompatible with the released material is treated, stored or disposed until cleanup procedures are completed (WAC -360(2)(i)(i))? 2. All emergency equipment listed in the contingencyplan is cleaned and fit for its intendeduse before operations resume (WAC -360(2)(i)(ii))?


### x. Does the generatornotify WDOE, and appropriate local authorities, that his site satisfies the conditions described under ix.I. and 2., above, before operations resume in the affected areas ofhis site (WAC -360(2)(j))? xi. Does the generator note in his operating record the time, date, and details of incidents requiring implementation of the contingency plan (WAC -360(2)(k))? xii. Within fifteen days after the emergency, does the generator submit a written report of the incident to WDOE which includes: 1. 

### Name, address, and telephone number of the generator (WAC -360(2)(k)(i)) and of the site (WAC -360(2)(k)(ii))?

-20-

### 2. Date, time, and type ofemergency (WAC -360(2)(k)(iii))? 3. Name and quantity ofmaterials involved (WAC -360(2)(k)(iv))? 4. The extent ofinjuries, ifany (WAC -360(2)(k)(v))? 5. Anassessment ofactual orpotential hazards to human health or the environment, where this is applicable (WAC -360(2)(k)(vi))? 6. Estimated quantity and disposition of**recove~ed** 

### material that resulted from the incident (WAC -360(2)(k)(vii))? Conunents

11. METHOD OFACCUMULATION How does the generator accumulate his dangerous wastes: A. In containers? (Complete Section 12., below.) B. In;tanks? (Complete Section 13., below.) C. In piles (Note: This option is only available for moderate riskwastes)? (Complete Section 14., below.)
-21-

### 12. ADDITIONALREQUIREMENTS FORGENERATORS ACCUMULATING WASTES INCONTAINERS. A. Are all containers in good condition, and are dangerous wastes transferred to good containers orotherwisemanaged ifthe original container leaks (WAC -630(2))? B. Are all containers marked with the date accumulation began (WAC -200(1)(c))? C. Are all containers made of or lined withmaterials that will not react or are otherwise compatiblewiththe wastes being accumulated (WAC -630(4))? (Ifnecessary, requestand obtain documentation to demonstrate waste/ container compatibility.) D. Are all containers used for accumulating dangerous wastes:
a. Always closed exceptwhen wastes are addedor removed (WAC -630(5)(a))? b. Not opened, handled, or stored (e.g., left in areas ofheavy traffic where collisions could occur, orpersonnel or the public could intentionally or accidentally damage the containers) inways thatwould rupture the containers or cause them to leak (WAC -630(5)(b))? t. 

### Stored in amannerwhich allows the generator to inspect eachcontainer for leaks, ruptures or deterioration? E. Does the generator inspect at leastweekly the areas where containers are used to accumulate wastes, looking for leaking containers and for deterioration from corrosion and other factors (WAC -630(6))? F. 

### Does the generator keep records ofweekly inspections ofhis container storage area which describe (WAC -630(6)):
a. The dates ofinspectionand name(s) of inspector(s)? b. Observations ofany leaks or containerdeterioration detected?
c. Measures taken to correct leaks or deteriorated containers (ifany)?

-22- Yes No

### G. Are containers used for accumulating ignitable or reactive dangerous waste? If

### "Yes":
a. Are containers holding reactive wastes (ifany) capable ofdetonationorexplosion, or that are forbidden explosives orClassAor

### Bexplosives (49 CFR 173.51, 53 or88) stored equivalent to UFC's "American Table ofDistances for Storage ofExplosives," Table 77-201 (WAC -630(8)(a»? b. Are all other ignitable or reactive waste container storage designed, operated andmaintained equivalent to the UniformFire Code, state or local fire codes, orNFPA Pamphlet 1130, 

### "Flammable and Combustible Liquids Code" (WAC -630(8)(b»?
c. Are those areas where ignitable or reactive wastes are accumulated inspected at leastyearlyby a professional person familiarwith the UniformFire Code, orby a federal, state, or local fire marshal (WAC -630(8)(b), -395(1)(d»? d. Does the generator keep records ofthese fire inspections which describe:
1. 

### The dates ofinspection andname(s) of inspector(s)? ii. Observations ofany unsafe or improper ignitable or reactive waste handling? iii. Measures taken to correct any unsafe or improper ignitable or reactive waste handling? 

### H. Are incompatible wastes or incompatible wastes and materials accumulated or held on-site (e.g., corrosives with ignitables, chlorinateds with ignitables)? If 

### "Yes":
a. Describewhichwastes orwastes and materials are incompatible:

-23-

### G. Are containers used for accumulating ignitable or reactive dangerous wasle? If

### "Yes":
a. Are containers holding reactive wastes (ifany) capable ofdetonation or explosion, or that are forbidden explosives or Class Aor

### Bexplosives (49 CFR 173.51, 53 or 88) stored equivalent to UFC's "American Table ofDistances for Storage ofExplosives," Table 77-201 (WAC -630(8)(a))? b. Are all other ignitable or reactive waste container storage designed, operated and maintained equivalent to the UniformFire Code, state or local fire codes, orNFPAPamphlet 1130, 

### "Flammable and Combustible Liquids Code" (WAC -630(8)(b))?
c. Are those areas where ignitable or reactive wastes are accumulated inspected at leastyearlyby a professional person familiar with the UniformFire Code, orby a federal, state, or local fire marshal (WAC -630(8)(b), -395(1)(d))? d. Does the generator keep records ofthese fire inspections which describe: i. The dates ofinspection and name(s) of inspector(s)? ii. Observations ofany unsafe or improper ignitable or reactive waste handling? iii. Measures taken to correct any unsafe or improper ignitable or reactive waste handling? 

### H. Are incompatible wastes or incompatible wastes and materials accumulated orheld on-site (e.g., corrosives with ignitables, chlorinateds with ignitables)? If 

### "Yes":
a. Describewhichwastes orwastes andmaterials are incompatible:

-23-b. Does the generator assure that dangerous wastes are not put in containers which previously held incompatible wastes or materials unless the container has been washed (WAC -630(9)(b))?
c. Are containers holding waste that is incompatible with wastes or materials stored nearby separated or protected from such wastes or materials by a dike, berm, wall or other device, and are containment systems (if any) for incompatible wastes separate (WAC -630(9)(c))? d. Are incompatible wastes, or incompatible wastes and materials put in the same container? Describe which incompatible wastes or wastes and materials are involved:

€. If incompatible wastes or wastes and materials are mixed or commingled, are these activities conducted so as not to (WAC -630(9)(a)): i. Generate extreme heat, pressure, fire, explosion or violent reaction (WAC -395(1)(b)(i))? ii. Produce uncontrolled toxic mists, fumes, dusts or gases in sufficient quantities to threaten human health or the environment (WAC -395(1)(b) (ii))? iii. Produce uncontrolled flammable fumes or gases in sufficient quantities to pose a risk of fire or explosions (WAC -395(1)(b)(iii))? iv. Damage the structural integrity of the facility or containers (WAC -395(1)(b)(iv))?
v. Otherwise threaten human health or the environment (WAC -395(1)(b)(v))? Note: If the generator is treating wastes as they are placed in his.containers (other than simple mixing with an absorbent), he may be operating a dangerous waste treatment facility.

-24-Conunents



### 13. ADDITIONALREQUIREMENTSFORGENERATORSACCUMULATING WASTES INTANKS. A. Does the generator maintain a system of records which assure that no wastes held in his tanks are being**accumu~ated** for more than ninety days (one hundred eighty days for moderate risk wastes only)? B. Are wastes or other materials which are incompatible with the material of construction of the tanks ever placed in the tanks? If "Yes," is the tank protected from corrosion, erosion or abrasion through use of:
a. An inner liner, free of leaks, cracks, holes or other deterioration, which is compatible with the waste or materials (WAC -640(3)(a)(i)? h. Alternative protection (e.g., cathodic protection, corro sion inhibitors) (WAC -640(3)(a)(ii))? C. Doe s the generator use appropriate measures to prevent overfilling and overtopping, including:
a. Controls to prevent overfilling (e.g., waste feed cut-off systems, by-pass to a standby tank) (WAC -640(3)(b)(i))? b. For uncovered tanks, maintenance of at least two feet of freeboard (WAC -200 (l)(b), -640(3)(b)(ii))?



### -25- Yes NoD. Does the generator inspect at least once each operating day:
a. Overfilling control equipment to ensure it is in good working order 

### (WAC -640(4)(a)(i))? b. Data gathered from monitoring equipment where present, to ensure each tank is operated according to its design 

### (WAC -640(4)(a)(ii))?
c. For uncovered tanks, the level ofwaste in each tank to ensure the freeboard is at least two feet 

### (WAC -640(4)(a)(iii))? E. Does the generator inspect at least weekly:
a. The construction materials of the above ground portions of each tank to detect corrosion, erosion or leaking of the tank, fixtures and seams 

### (WAC -640(4) (a)(iv))?
. b. The area immediately surrounding each tank to detect obvious signs of leakage (e.g., wet spots, dead vegetation) 

### WAC -640(4)(a)(v))? 

### F. Does the generator have a written schedule for inspecting his tanks which includes records describing 

### (WAC -640(4)(b)):
a. The dates of inspections and name(s) of inspector(s)? b. Observations ofany conditions which could cause the tank to leak or fail as specified in the written schedule?
c. Measures taken to correct or prevent any hazardous conditions identified during the inspection? G. Does the generator have records describing dates that spills or leaks (if any) from his tanks occurred and measures taken to clean up and decontaminate the spiLls or leaks 

### (WAC -640(4)(c))? (Note: The measures to be taken to respond to spills or leaks should be described in his contingency plan.) 

### H. Does the generator have records showing that at least once each operating day he:
a. Gathered data from monitoring equipment to ensure the tank was uperated according to its design 

### (WAC -640(4)(a)(ii))? b. Checked the level ofwaste in uncovered tanks (if any) to ensure that a m1n1mum freeboard of two feet was maintained 

### (WAC -640(4)(a)(iii), -200(1)(b))?·
-26-

### I. Have any tanks been closed and removed from dangerous waste service since the last inspection? If"Yes":
a. Have all dangerous wastes and residues been removed from the tanks, discharge control equipment, containment systems and bases (where present) and discharge confinement structures (WAC -640(5))? b. Have all tanks, bases, liners and soils containing or contaminated with dangerous wastes or residues been removed or decontaminated (WAC -640(5))? 

### J. Are ignitable or reactive wastes placed in tanks? If "Yes":
a. Is the tank onlyused for emergencies (WAC -640(6)(a)(iii))? b. Is the waste stored in such a way that it is protected from any material or conditions that may cause the waste to ignite or react (WAC -640(6)(a)(ii))?'
c. Is the waste treated, rendered ormixedbefore or immediately afterplacement in the tank so that (WAC -640(6)(a)(i)): i. The resultingmixture in the tank is no longer ignitable or reactive underWAC -090? ii. And, themixing or commingling ofthe waste does not: generate extreme heat, pressure, fire, explosion orviolent reaction; produce uncontrolled toxic mists, fumes, dusts or gases that threaten humanhealth or the environment; produce uncontrolled flammable fumes or gases that pose a risk of fire or explosion; damage the structural integrity ofthe tankor equipment; otherwise threaten humanhealth or the environment (WAC -395(1)(b))? Note: Ifthe generator is treating wastes as they are placed in his tanks, he may be operating a dangerous waste treatment facility. d. Are the tanks located in amanner equivalent to the NFPA's buffer zone requirements for tanks (Tables 2-1 through 2-6 ofthe "Flammable and Combustible Liquids Code - 1981"), or as required by state and local fire codes ifthese are more stringent (WAC -640(6)(b))?


### -27-e. At least yearly, is the tank storage area inspected by a professional person knowledgeable in the Uniform Fire Code, or by a local, state or federal fire marshal (WAC -640(6)(b),

- 395(1)(d))? f. Does the generator keep records of this annual inspection describing: i. The dates of inspection and name(s) of inspector(s)?
11. Observations of any unsafe or improper ignitable or reactive waste handling? iii. Measures taken to correct any unsafe or improper ignitable or reactive waste handling? K. Are incompatible wastes or incompatible wastes and materials placed in the same tank? If "Yes":
a. Describe which wastes or wastes and materials are incompatible:

b. If incompatible wastes or wastes and materials are placed in the same tank, or ifdangerous waste is placed in an unwashed tank which previously held incompatible waste or materials, are these activities conducted so as not to (WAC -640(7)): i. Generate extreme heat, pressure, fire, explosion or violent reaction (WAC -395(1)(b)(i))? ii. Produce uncontrolled toxic mists, fumes, dusts or gases that threaten**h~an** health or the environment (WAC -395(1)(b)(ii))? iii. Produce uncontrolled flammable fumes or gases that pose a risk of fire or explosion (WAC -395(1)(b)(iii)?



### -28-iv. Damage the structural integrity of the tank or equipment (WAC -395(1)(b)(iv))?
v. Otherwise threaten human health or the environment (WAC -395(1)(b)(v))? Note: If the generator is treating incompatible wastes as they are placed in his tanks, he may be operating a dangerous waste treatment facility. Comments

14. ADDITIONALREQUIREMENTS FORGENERATORS ACCUMULATING WASTES IN PILES. Note: This section is applicable to only those moderate risk wastes a generator may be accumulating. A. Does the generator keep records of any leaks of liquids into the leak detection system that have occurred, describing (WAC -660(3)(b)):
a. Dates and times leaks were detected? b. Measures taken to remove accumulated liquids and stop leakage that is occurring?
c. Certification by a qualified engineer that the leak has been stopped? B. Does the generator keep records of any notifications sent to WDOE that there have been leaks into the leak detection system (if any?) C. [Remainder to be added at a later date.

### 1

-29- Yes No

# '-
DANGEROUS WASTE COMPLIANCE CHECKLIST/QUESTIONNAIRE, CHAPTER 173-303WAC


# *

# ** *

# ** * * * *

# ***

# **.'.
" 

# * *

# ** *

# **

# **

# ** 

# ** -!( 

### PART IV: GENERAL TSD FACILITYREQUIREMENTS This partofthe**checklist/que~tionnaire** 

### applies to all facilities which treat, store, ordispose (TSD) dangerous waste, including interim status and final status facilities, andpermit-by-rule and emergency permit facilities (except that in such cases, only some ofthis partofthe checklist/questionnairemaybe applicable). This part ofthe checklist/questionnaire covers those facility requirements which apply to all TSD facilities regardless ofthe specific type ofunit operations (e.g., containers, tanks, incinerators). Otherparts ofthis checklist/questionnaire address the specific unit operating requirements for interim and final status facilities, and shouldbe used in conjunctionwith this more general part. The abbreviation "0/0" is used frequently throughout the TSD facility parts ofthis checklist/questionnaire and stands for the words "owner and/or operator."


# *

# * ** *

# ** *

# **

# * ** *

# ***

# **

# * ** *

# *

# * ***

# *

# ***

# **

# ** ***

# **

# **

# * 1.

2. 

### MODERATE RISKWASTEMANAGEMENT. Does the facility manage any moderate riskwastes (MRW) for whichthe % 

### has sought and obtained fromWDOE reduction in the r.egulatory requirements applicable to such MRW (such reductions must be specified either in the facility permit issued underWAC -806, or else in a notice of interim status modification issued underWAC -805(8))? Ifnot, then all sections of this Part IVofthe checklist/ questionnaire are applicable. Ifyes, then some sections ofthis Part IV maynot be applicable to suchMRWmanagement. Notes shouldbe made in the appropriate Comments area where there may be discrepancies between.the requirements on MRW and on any other dangerous wastes managed at the facility (e.g., fire control equipment maybe checked as present and in good operating condition except for MRW, with a note under comments that suchequipmentwas not present in the MRW management areas because it is not necessary). FACILITY SITING (WAC -420). A. Earthquake Fault Criteria 

### (WAC -420(3)).
a. Is the facility located in anyone of the following counties (WAC -420(3)(c))? (If 

### "No," the facility is automatically in compliance with the earthquake fault criteria and no further questions need to be a sked . ) 

### Yes

Yes No

No

Chelan Clallam Clark Cowlitz Douglas Ferry Grant Grays Har.bor Jefferson King Kitsap Kittitas Lewis Mason Okanogan Pacific Pierce SanJuan Skagit Skamania Snohomish Thurston Wahkiakum Whatcom Yakima

### "

# .. b. Is the facility located within 200 feet ofa fault which has had displacement in Holocene times (WAC -4200)(a))? Note: Existing facilities (i.e., operating prior to November 19, 1980 for EPA wastes andprior to August 9, 1982 for state-only wastes) may be located within 200 feet of such faults. New facilities may not.
c. Ifthe facility manages only moderate riskwastes, and is a new facility located within 200 feet of a fault, is the facility engineered against earthquakes and has WDOE approved the engineering (WAC -4200)(a))? B. Floodplain Criteria (WAC -420(4)).
a. Is the facility located in a one hundred year floodplain (WAC -420(4)(a))? (If "No," then the facility is automatically in compliance with the floodplain criteria and no further questions need to be asked.)· b. Is the facility designed, constructed, operated, and maintained to prevent washout ofany dangerous waste by a one hundred year flood (WAC -420(4)(a) and (b))? (Describe the washout precautions under Comments, below.)
c. Ifthe facility manages DWonly and nevermanages EHW, in lieu ofwashoutprecautions has the facility 0/0 included in his contingencyplanprocedures for safely removing the DW, before floodwaters reach the facility, to another facility that is not vulnerable to floodwaters (WAC -420(4)(a))?**(~f** "Yes," these provisions will be addressed in the Contingency Plan section, below.) C. Shoreline Criteria (WAC -420(5)).
a. Is the facility disposing of dangerous waste in an area defined as a "wetland" under RCW90.58.030 (2)(0. ("Wetlands" or "wetland areas" means those lands extending landward for two hundred feet in all directions as measured on a horizontal plane from the ordinary high water mark; floodways and contiguous floodplain areas landward two hundred feet from such floodways; and all marshes, bogs, swamps, and river deltas associated with the streams, lakes, and tidal waters which are subject to the provisions of this chapter; the same to be designated as to location by the department of ecology.) (WAC -420(5)(a))?
-2-

### 3. b. Is the facility located in an area where the local shoreline management master program permits industrial, navigation, manufacturing, or similar activities (areas classified as natural, conservancy, rural or residential may not be used for dangerous waste management: WAC -420(S)(b))? D. Sole Source Aquifer Criteria (WAC -420(6)). Is this a new facility (constructed and operating after November 19, 1980 for EPAwastes, after August 9, 1982 for state-only wastes) that is disposing of dangerous waste over a sole source aquifer designated pursuant to section 1424(3) of the Safe Drinking Water Act? Comments

SECURITY (WAC -310). A. Can the facility % demonstrate that:
a. Physical contact with wastes or equipment within the active portion will not injure persons or livestock (WAC -310(1)(a))? b. Disturbance ofwastes by persons or livestock will not result in viol.ations of ch. 173-303 WAC (WAC -JIO(I)(b))? B. If the facility % cannot demonstrate both of the above, then does the facility have:
a. Either: i. Abarrier (artificial, natural or both) which completely surrounds the active portion, with a means to control access through gates or other entrances to the active portion at all times (WAC -310(2)(c))?



### -3- Yes No

# ..

4. ii. Or, a twenty-four hour surveillance system to monitor and control entry to the active portion (WAC -310(2)(b))? b. And, signs which (WAC -310(2)(a)): i. Are posted at each entrance to the active portion, and at other locations in sufficient numbers to be seen from any approach? ii. Bear the legend (or an equivalent one), written in English, "Danger-Unauthorized Personnel Keep Out"? iii. Are legible from a distance of twenty-five feet or more? C. If the facility has or is a totally enclosed treatment facility or elementary neutralization or wastewater treatment unit, in lieu of item B., above, does the 0/0 prevent unknowing entry and minimize the possibility of unauthorized entry by persons or livestock onto those portions of his facility (WAC -310(3))? Comments

MANIFESTSYSTEM (WAC -370). A. Does the facility receive any manifested shipments of dangerous waste from off-site? If "No," then do not complete the rest of the questions in this section 4. Manifest System. If "Yes," complete the remaining questions. B. Does the % retain copies of all manifests and shipping papers at the facility for at least three years after shipments are delivered (WAC -370(2)(e) and (3)(e))? C. When a shipment is received accompanied by a manifest, does the % or his agent:

-4- Yes Noa. Sign and date each copy of the manifest to certify receipt (WAC -370(2)(a))? b. Note any significant discrepancies on each copy of the manifest (WAC -370(2)(b))?
c. Immediately give the transporter at least one copy of the signed manifest (WAC -370(2)(c))? d. Within thirty days after delivery, send a copy of the signed manifest to the generator (WAC -370(2)(d))? D. When a shipment accompanied by a manifest or shipping paper (H/SP) is received from a rail or water transporter, does the % or his agent:
a. Sign and date each copy of the M/SP to certify receipt (WAC -370(3)(a))? b. Note any significant discrepancies on each copy of the M/SP (WAC -370(3)(h))?
c. Immediately give the rail or water transporter at least one copy of the M/SP (WAC -370(3)(c))? d. Within thirty days after delivery, send a copy of the signed H/SP to the generator (WAC -370(3)(d))? If the manifest is not received within thirty days after delivery, send a copy of the signed and dated shipping paper to the generator (WAC -370(3)(d))? E. Does the 0/0:
a. Have procedures which he follows to identify significant discrepancies between the shipments he receives and the shipment described on the manifest? b. Detect the following types of significant discrepancies (WAC -370(4)(a)):**~.** Variations in quantities of greater than ten percent for bulk shipments?**~l.** Variations in piece count (e.g., missing containers or packages)? iii. Variations in waste type, discovered by inspection or waste analysis (e.g., acid substituted for solvent)?



### -5-c. Attempt to resolve significant discrepancies (if any) with the transporter or generator (WAC -370(4)(b))? d. If a significant discrepancy is not resolved within fifteen days of its discovery, immediately submit a manifest discrepancy report and a copy of the manifest or shipping paper to WDOE (WAC -370(4)(b))? List any dates since the last inspection (or since .notification if this is the first inspection) that

the % submitted manifest discrepancy reports (if any) to WDOE.

F. Under certain circumstances the % may refuse acceptance of a waste shipment and send it on to another facility.
a. Does the % deny receipt of a shipment only under the following circumstances (WAC -370(5)(a)): i. His facility is not capable of properly managing the waste? ii. There is a significant discrepancy between the shipment and the manifest or shipping paper? iii. The shipment has arrived in a condition which would present an unreasonable hazard to his facility operations or personnel? b. [f the % chooses to deny receipt of the shipment but the containers are damaged or the waste is in a condition that would pose a hazard if transported, does the % implement the provisions of his contingency plan designed to address such situations (WAC -370(5)(c))?
c. When he denies receipt of the shipment, does the 0/0 either send the shipment on to the alternate facility designated on the manifest or shipping paper, or contact the generator to identify another facility and provide for the shipment's delivery to that facility (WAC -370(5)(b))?
.
-6-

### 5. Comments

WASTE ANALYSIS (WAC -300). A. Does the facility % have a waste analysis plan which is kept at the facility (WAC -300(5))? B. Does**~he** waste analysis plan cover the following areas:
a. Howthe % shall obtain detailed chemical, physical, or biological analyses ofwastes adequate to assure safe TSD in accordance with Ch. 173-303 WAC, including where appropriate: data from existing documents or publications; data on wastes generated from similar processes; or, data from actual testing (WAC -300(2))? b. For facilities rece1v1ng waste shipments from off-site, how the % shall confirm that each waste received matches the identity of the waste specified in the manifest or shipping paper (WAC -300(3))?
c. Repeating of analyses to assure accurate information as necessary, including repeat analyses at least when: the % has been notified or has reason to believe that the process generating the waste has significantly changed; and, a waste received from off-site does not match the identity specified on the manifest or shipping paper (WAC -300(4))? C. Does the waste analysis plan assure that the areas descrihed under item B., above, are adequately satisfied by inclusion of at least the following:
a. The parameters for which each waste will be analyzed and rationale for these parameters (WAC -300(5)(a))? b. The methods of obtaining or testing for these parameters (WAC -300(5)(b))?
c. The methods for obtaining representative waste samples (WAC -300(5)(c))?


### -7- Yes Nod. The frequency with which analyses will be reviewed or repeated to assure accurate and current information(WAC -300(5)(d))?
e. The waste analyses which generators have agreed to provide (WAC -300(5)(e))? f. The procedures for quality assurance and quality control, including at least: i. Measures to prevent sample contamination during sampling?
11. Certification/documentation of sampling and testing procedures? iii. Evaluation of personnel performance of sampling/testing? iv. Chain of custody procedures?

v. Inspection, calibration, testing, and maintenance of sampling and analysis equipment? g. For facilities receiving wastes from off-site, the procedures for confirming the waste identity specified on the manifest or shipping paper (WAC -300(5)(g))? Do these procedures include at least: i. Procedures for identifying each waste movement at the facility? ii. Methods for obtaining representative waste samples, if the identification method involves sampling? h. Methods for meeting the additional waste analysis requirements for specific waste management methods as specified for interim and final status TSD under items D. and E., below (WAC -300(5)(£))? D. Interim Status Waste Analysis Requirements for Specific Waste Management Methods. Where appropriate, does the waste analysis plan include procedures for the following interim status management methods:

-8-a. Containers. i. Determining compatibility of a waste to a container (if not determined when containers were first selected)? ii. Determining compatibility of a waste to other wastes or materials stored nearby? iii. Determining compatibility of a waste to wastes previously held in reused containers that were not decontaminated? iv. Analyzing ignitable/reactive containerized wastes?
v. Analyzing liquids that are collected in a storage area? vi. Determining whether or not runoff collected from the active portion would be designated as a dangerous waste? b. Tanks (40 CFR 265.193). i. Determining compatibility of a waste to a tank (ifnot determined when tank was first selected)? ii. Determining compatibility of a waste to any raw materials or other wastes potentially or previously held in the tank by conducting analyses or trial treatment or storage tests (e.g., bench scale, pilot plant) or by obtaining written documented information on similar storage or treatment of similar wastes under similar conditions? iii. Determining the compatibility of a waste to other wastes or materials held or treated nearby? iv. Analyzing ignitable/reactive wastes managed in tanks?
v. Determining whether or not runoff collected from the active portion would be designated as a dangerous waste?
c. Surface Impoundments (40 CFR 265.225). i. Determining compatibility of a waste to the impoundment's materials of construction (if not determined when materials were first selected)?



### -9-ii. Determining the compatibility of a waste to any raw materials or other wastes potentially previously held in the impoundment by conducting analyses or trial treatment or storage tests, or by obtaining written documented information on similar treatment or storage of similar wastes under similar conditions? iii. Determining the compatibility of a waste to other wastes or materials held or treated nearby? \ iv. Procedures for analyzing ignitable/reactive wastes managed in impoundments?
v. Determining whether or not runoff (if any) collected from the active portion would be designated as a dangerous waste? d. Waste Piles (40 CFR265.252). i. Determining the compatibility of a waste to the pile's materials of construction (ifnot determined when materials were first selected)? ii. Determining the compatibility of each waste to be added to the pile (including visual comparison of color and texture) to assure that inadvertent mixing of incompatible wastes does not occur, unless the % can show that either: the only wastes to be added to the pile are compatible; or, the waste received is compatible with the waste in the pile to which it is added? iii. Determining the compatibility of a waste to other wastes or materials potentially held or treated nearby. iv. Determining the compatibility of a waste to wastes previously held on the pile base if it was not decontaminated (unless it can be proven the wastes are the same)?
v. Analyzing ignitable/reactive wastes managed in waste piles? vi. Sampling and analyzing leachate collected beneath the pile, and managing the leachate if hazardous? vii. Determining whether or not runoff collected from the active portion would be designated as a dangerous waste?

-10-e. Land Treatment (40 CFR 264.273).
l
..

11.

iii.

iv.

v.



### vi.

vii.
viii. Determining the concentration in the waste of any substances which exceed the EP toxicity concentration limits of

### WAC -090(8)(c)? For any waste listed in

### WAC -081 or -082, determining the concentrations of any substances which caused the waste to be listed? For any waste mixture designated under

### WAC -084 or the criteria of

### WAC -101 through -103, determining the concentrations of any substances which caused the waste to be designated? If food chain crops are grown, procedures for determining the concentrations of arsenic, cadmium, lead and mercury, unless the 0/0 has written, documented data showing the constituent is not present? Procedures to determine the compatibility of a waste to any raw materials or other wastes potentially applied in a given treatment zone? Determining the compatibility of a waste to other wastes or materials held or treated nearby? Procedures for analyzing ignitable/reactive wastes to be treated? Determining whether or not runoff collected from the active portion would be designated as a dangerous waste? f. Landfills. i. Inspecting containers for free liquids before disposal and for handling any unacceptable free liquids that may appear? ii. Inspecting containers for 90% volume by waste and for handling any containers of waste that are unacceptable by the facility that may appear?
Lll. Determining the compatibility of a waste to landfill liner(s) and leachate collection system materials (if not determined when materials were first selected)? iv. Determining the compatibility of a waste to any other wastes potentially disposed in the landfill?

-11-v.
vi.
vii. Analyzing ignitable/reactive wastes to be disposed? Sampling and analyzing leachate collected and managing the leachate ifdangerous? Determing whether or not runoff collected from the active portion would be designated as a dangerous waste? g. Incinerators (40 CFR

### 265.341). i. Analyzing any waste not previously burned in the incinerator to enable the % to establish steady state operating conditions and to determine the types of pollutants which might be emitted? Do these analyses include determining at least: 1. Heating value of the waste? 2. Halogen and sulfur content of the waste? 3. Concentrations of lead and mercury in the waste, unless the % has written, documented data showing that the element is not present? ii. Determining the compatibility ofwastes to be mixed in the incinerator, and the compatibility ofwastes to be burned with the incinerator's materials of construction? iii. Determing whether or not runoff collected from the active portion would be designated as a dangerous waste? h. Thermal Treatment (40 CFR

### 265.315). i. Analyzing any waste tlOt previously treaLed in the thermal treatment unit to enable the 0/0 to establish steady state operating conditions and to determine the types of pollutants which might be emitted? Do these analyses include determining at least: 1. Heating value of the waste? 2. Halogen and sulfur content of the waste? 3. Concentrations of lead and mercury in the waste, unless the % has written, documented data showing that the element is not present? 

### -12-ii. Determining the compatibility ofwastes to be mixed in the thermal treatment unit, and the compatibility ofwastes to be burned with the unit's materials of construction? iii. If open burning ofwastes is conducted, analyzing the wastes to assure that only explosive wastes with the capability of detonation are being open burned? vi. Determing whether or not runoff collected from the active portion would be designated as a dangerous waste? i. Chemical, Physical and Biological Treatment 

### (40 CFR 265.402).
1. Whenever substantially different wastes are to be treated or substantially different treatment processes are to be used: 1. Procedures for conducting waste analyses and trial treatment tests (e.g., bench scale, pilot plant)? 2. Or else, procedures for obtaining written, documented information on similar treatment of similar wastes under similar conditions? ii. Procedures to determine the compatibility of a waste to process structure (if not determined when structure was first selected)? iii. Procedures to determine the compatibility of a waste to any raw materials or other wastes potentially or previously held in the process structure?
LV. Procedures to determine the compatibility of a waste to other wastes or materials held or treated nearby?
v. Procedures for analyzing ignitable/reactive wastes managed in the process structure? vi. Determing whether or not runoff collected from the active portion would be designated as a dangerous waste?

-13-6. E. Final Status Waste Analysis Requirements for Specific Waste Management Methods. [Reserved] Comments

INSPECTIONS (WAC -320). A. Does the facility % have a written inspection schedule which is kept at the facility (WAC -320(2))? B. Does the facility % keep a written inspection log or summary (WAC -320(2)(d)):
a. Which shows that the inspection schedule is being followed? b. Including at least:
I. The time, date, and nature of the inspection? ii. The printed name and handwritten signature of the inspector?



### -14- Yes Noiii. Notations of observitions made? iv. Date and nature of any repairs or remedial actions?
c. For at least three years from the date of inspection? C. When the facility 

### % discovers any problems during an inspection, does he remedy the problems on a schedule which prevents hazards to the public health and the environment (immediately where a hazard is imminent or has already occurred) (WAC -320(3))? D. Does the inspection schedule identify (WAC -320(2)):
a. The areas of the facility to be inspected? b. The equipment to be inspected, including at least all: i. Monitoring equipment? ii. Safety and emergency equipment? iii. Security devices?

iv. Operating and structural equipment that help prevent,**~etect** or respond to hazards to public health or the environment?
c. Areas subject to spills (to be inspected daily when in use)? d. The frequencies with which these areas and items are to be inspected?
e. The types ofproblems to be looked for during inspections? f. And the additional Inspections to be conducted for specific waste management methods as specified for interim and final status TSD under items 

### E. and F., below? 

### E. Interim Status Inspection Requirements for Specific Waste Management Methods. Where the following types ofmanagement methods are employed, does the inspection schedule specify the additiona1 items to be inspected, inspection frequency and typps of problems to be looked for?
a. Containers (40 CFR 265.174). i. Areas where containers are held, at least weekly, to detect leaks and deterioration caused by corrosion and other factors? 

### -15- Yes Noii. Areas where containers are held to assure that: 1. Maximum storage capacity is not exceeded? -2. Incompatible wastes are not stored together?

3. Ignitable or reactive waste containers are not stored near sources ofheat, ignition or reaction? 4. Proper containers are used for holding wastes? b. Tanks (40 CFR265.194). Wherever present: i. Discharge control equipment (e.g., bypass systems) at least once each operating day? ii. Data**~athered** from monitoring equipment (e.g., pressure gauges) at least once each operating day? iii. The level ofwaste in the tank at least once each operating day? iv. The construction materials of the tank at least weekly to detect corrosion or deterioration?
v. The construction materials of, and the area immediately surrounding, discharge confinement structures (e.g., dikes) for signs of erosion or leakage (e.g., cracks, wet spots) at least weekly?
c. Surface Impoundments (40 CFR265.226). i. The freeboard level at least once each operating day?
11.. The surface impoundment, including dikes and vegetation surrounding the dike for signs of leaks, deterioration or failures at least weekly? d. Waste Piles.
1. Run-on and run-off control systems (if any) for signs of leaks, failure or deterioration? ii. Covers, buildings or other mechanisms (if any) for repelling precipitation and run-on for leaks, deterioration, or failure? iii. Covers or other methods (if any) to prevent wind dispersal? -16-e. Land Treatment. i. Run-on and run-off control systems for signs of leaks, deterioration or failure? ii. Wind dispersal control measures (if any)? iii. The land treatment area, to assure that: 1. Waste and/or material (e.g., water) application rates are not exceeded? 2. Ignitable, reactive and/or incompatible wastes are protected from sources of ignition or reaction? f. Landfills. i. Run-on and run-off control systems for signs of leaks, deterioration or failure? ii. Wind dispersal control measures (if any)? iii. Covers over any closed cells or parts of the landfill to detect signs of erosion, leaks, deterioration or failure of the cap? iv. Active cells to assure that incompatible wastes are not disposed together?
v. Cells in which ignitable wastes in containers are disposed (if any) to assure that they are not being exposed to materials or conditions that could cause them to ignite? g. Incinerators (40 CFR265.347).
L. Existing instrumertts which relate to combustion and emission control at least every 15 minutes (e.g., instruments measuring waste feed, auxiliary fuel feed, air flow, temperature, scrubber flow, scrubber pH and relevant level controls)? ii. The complete incinerator and associated equipment at least daily for leaks, spills, fugitive emissions and deterioration?
L1J. All emergency shutdown controls and alarm systems at least daily to assure proper operation?



### -17-

### F. h. Thermal Treatment (40 CFR265.377). i. Existing instruments which relate to temperature and emission control (e.g., instruments measuring waste feed, auxiliary fuel feed, temperature, and relevant process flow and level controls) at least every 15 minutes? ii. The stack plume (emissions), observed visually at least every hour for normal appearance (color, opacity)? iii. The complete treatment process and associated equipment at least daily for leaks, spills, fugitive emissions and deterioration? iv. All emergency shutdown controls and alarm systems at least daily to assure proper operation?
v. For open burning ofwaste explosives, the area of open burning to assure that it meets the minimum distance to the nearest other property limits? i. Chemical, Physical and Biological Treatment (40 CrR 265.403). i. Discharge control and safety equipment (e.g., cut-off and bypass systems) at least once each operating day? ii. Data gathered from monitoring equipment at least once each operating day? iii. Construction materials of the treatment process or equipment at least weekly for signs of corrosion, leaks, deterioration, or failure? iv
. Construction materials of and areas immediately surrounding discharge confinement structures (e.g., dikes) at least**week~y** for signs of erosion, leakage, deterioration or failure (e.g., cracks, wet spots, dead vegetation)? Final Status Inspection Requirements for Specific Waste Management Methods. Where the following types ofmanagement methods are employed, does the inspection schedule specify the additional items to be inspected, inspection frequency and types of problems to be looked for? [Reserved.]

-18- Yes No

### G. Ignitable or Reactive Waste Storage Inspections. Does the % ever store ignitable or reactive wastes at the facility? If "Yes":
a. Are those areas where ignitable or reactive wastes are stored inspected at least yearly by a professional person familiar with the Uniform Fire Code, or by a federal, state, or local fire marshal (WAC -395(1)(d))? b. Does the % keep records of these fire inspections which describe: i. The dates and times of inspection and name(s) of inspector(s)? ii. Observations of any unsafe or improper ignitable or reactive waste handling? iii. Measures taken to correct any unsafe or improper ignitable or reactive waste handling?
c. Are records of these inspections entered in the inspection log or summary? (If "No," then these records must be entered in the operating record.) Yes No

Comments



### -19-7. PERSONNEL TRAINING (WAC -330). A. Does the facility 

### % have a written training plan, kept at the facility site (WAC -330(2»? B. Does the training plan include the following documents and records:
a. For each position related to the handling of dangerous waste on-site, the job title, name of employee filling eachjob, and the job description, including requisite skills, education, qualifications, and duties for each position (WAC -330(2)(a»? b. Written description of type and amount of introductory and continuing training needed for each position (WAC -330(2)(b»?
c. Records documenting that employees have received and completed the necessary training (WAC -330(2)(c»? C. Are training records retained for at least three years after an employee last worked at the facility, 6r until the facility closes, whichever, occurs first (WAC -330(3»? (Note: Records may have been transferred within the company to follow an employee. This is permissible, but some record of the employee's transfer and continued employment should be**~ocumented.)** D. Does the % provide a training program that teaches personnel to perform their duties in ways that ensures the facility's compliance with WAC 173-303 (WAC -330(1»? E. Does the training program involve: Classroom Instruction? On-the-job training? F. Is the training program directed by a perion knowledgeable in dangerous waste handling practices (WAC -330(1)(a»?

-20- Yes No

### D. Is adequate aisle space**prov~ded** 

### to allow for inspections and unobstructedmovement 0fpersonnel, fire and spill control equipment and decontamination equipment during an emergency (WAC -340(3))? E. Dothe hazards posed by the wastes handled at the facility require arrangements with local authorities? (If "Yes," complete the remaining questions, F. through

### J. below. If "No," document under Conunents, below, whythe hazards are not such as to warrant these arrangements.) F. Has the % 

### arranged to familiarize police, fire departments, and emergency response teams with: the layout ofhis site; properties ofwastes handled and associated hazards; places where personnel would normally be working; entrances to and roads on the site; and possible evacuation routes (WAC -340(4)(a))? G. Has the % 

### arranged to familiarize local hospitals with the properties ofdangerous wastes handled and the types ofinjuries or illnesses which could result from fires, explosions, orwaste releases (WAC -340(4)(b))? H. Does the % 

### have agreements with state emergency response teams, emergency response contractors, and equipment suppliers (WAC -340(4)(c))? I. Where more thanone partymight respond to an emergency, does the % 

### have agreements designating primary emergency authority and support services to be provided (WAC -340 (4)(d))? 

### J. Has the % 

### documented all instances where state or local authorities have declined to enter into the above arrangements (WAC -340(5))? -Comments:

---------._-------------------------------------

---_._----

### - ..--_._----------------------------------------------



### -23-9. CONTINGENCY PLAN, EMERGENCY PROCEDURES AND EMERGENCIES (WAC -350 AND -360). A. Does the % have a contingency plan designed to lessen the potential impacts of a fire, explosion, or unplanned sudden or nonsudden release of dangerous wastes or dangerous waste constituents to air, soil, surface, or ground water (WAC -350(1))? 

### B. Does the % have a Spill Prevention Control and Countermeasures (SPCC) plan amended to include a contingency plan (WAC -350(2))? C. Are copies of the contingency plan and revisions to it:
a. Maintained at the facility (WAC -350(4)(a))? b. Submitted to all local police departments, fire departments and hospitals, and state and local emergency response teams that may provide emergency assistance (WAC -350(4)(b))? D. Is the contingency plan amended whenever:
a. Applicable regulations are revised (WAC -350(S)(a))? b. The plan fails in an emergency (WAC -3S0(5)(b))?
c. The facility changes in a way that increases the potential for fires, explosions or releases, or that changes the necessary emergency responses (WAC -3S0(S)(c))? d. The list of emergency coordinators changes (WAC -3S0(S)(d))?
e. The list of emergency equipment changes (WAC -350 (S)(e))? 

### E. Docs Lhe contingency plan include:
a. Adescription of the actions per sonneI must Lake in the event of an emergency circumstance (WAC -350 (3)(a))? b. 

### Adescription of the arrangements agreed to by local police and fire departments, hospitals, contractors, and state and local response teams to coordinate emergency services (WAC -350(3)(c))?
c. 

### Acurrent list of emergency coordinators, including names, addresses and 24-hour phone numbers (WAC -3S0(3)(d))?

-24- Yes Nod. Ifmore than one emergency coordinator is listed, identification of a primary emergency coordinator, with the others listed in the order that they will assume responsibility as alternates (WAC -350(3)(d))?
e. Alist of all emergency equipment kept on the site, including the location, physical description, and brief outline of the capability of each piece of equipment (WAC -350(3)(e))? f. Anevacuation plan (where evacuation could be necessary) for personnel, which describes signals to begin evacuation, evacuation routes, and alternate routes (WAC -350(3)(f))? g. Provisions for removal of dangerous waste from the facility in the event of a flood if the facility is located in a 100-year floodplain (WAC -420(4)(a))? h. Actions to be taken in the event that a dangerous waste shipment is received which cannot be managed at the facility and is not acceptable to the 0/0, but cannot be transported back to the generator or an alternate facility because it is damaged or would pose a risk to public health or the environment (WAC -350(3)(b))? F. Do the information and elements described in the contingency plan assure that the 

### % has taken adequate precautions for reacting to emergency circumstances? (If "No," specify what inadequacies exist in the Comments section, below.) G. Is an emergency coordinator on the premises at all times or available on-call at all times (WAC -360(1))? II. Is the emergency coordinator (and his alternates, if any) capahl e in the foI.lowing areas (WAC -360(1)):
a. Familiar with all aspects of the contingency plan? b. Familiar with all operations and activities on the facility?
c. Familiar with the location and properties of all wastes handled? d. Familiar with the location of all records kept on-site?
e. Familiar with the facility layout? f. Has the authority to commit the resources needed to carry out the contingency plan? 

### -25-I. Are the following procedures implemented (or, to be implemented) in the event of an emergency:
a. Does the emergency coordinator or his designee (EC/D) immediately activate internal alarms or communication systems to notify all personnel (WAC -360(2)(a)(i)) and notify appropriate state or local agencies with designated response roles ifhelp is needed (WAC -360(2)(a)(ii))? b. Does the EC/D immediately identify the character, exact source, amount and areal extent of any released materials (WAC -360(2)(b))?
c. Concurrently, does the EC/D assess possible hazards to human health and the environment (including direct, indirect, immediate and long-term effects) that may result from the emergency (WAC -360(2)(c))? d. Ifthe EC/D determines that the emergency could threaten human health or the environment outside the facility, does he immediately notify and provide an assessment report (which must include the information described under e., below) to: i. The appropriate local authorities ifevacuation of local areas may be advisable; and remain available to help appropriate officials decide if local areas should be evacuated (WAC -360 (2)(d)(i))?
11. WDOE and either the government offi.cial designated as on-the-scene coordinator, or the National Response Center (WAC -360(2)(d)(ii))?
e. Does the assessment report (covered under d., above) include: i. Name and telephone number of reporter (WAC -360(2)(e)(i))? ii. Name and address of the faci.lity (WAC -360(2)(e)(ii»)?
Ill. Time and type of emergency (e.g., fire, release) (WAC -360(2)(e)(iii))? iv. Name and quantity of materials involved (WAC -360(2)(e)(iv))?
v. The extent of injuries, if any (WAC -360(2)(e)(v))? vi. Possible hazards to human health and the environment off the site (WAC -360(2)(e)(vi))?
-26-f. During an emergency, does the EC/D take all measures necessary to ensure that fires, explosions, and releases do not occur, recur, or spread to other dangerous wastes (e.g., stopping processes or operations, collecting and containing releases, removing or isolating containers, etc.) (WAC -360(2)(f))? g. If**~perations** stop in response to an emergency, does the EC/D monitor for leaks, pressure buildup, gas generation or ruptures wherever appropriate (WAC -360(2)(g))? h. Immediately after an emergency, does the EC/D provide for treating; storing, or disposing wastes and materials resulting from the emergency (WAC -360 (2)(h))? i. Does the EC/D ensure, in the affected areas on the site, that: i. No waste that may be incompatible with the released material is treated, stored, or disposed until cleanup procedures are completed (WAC -360(2)(i)(i))? ii. All emergency equipment listed in the contingency plan is cleaned and fit for its intended use before operations resume (WAC -360(2)(i)(ii))? j. Does the 

### % notify WDOE, and appropriate local authorities, that his site satisfies the conditions described under i. and ii. above, before operations resume in the affected areas of his site (WAC -360(2)(j))? k. Does the 

### % note in his operating record the time, date, and details of incidents requiring implementation of the contingency plan (WAC -360(2)(k))? I. Within 15 days after the emergency, does the 0/0 submit a written report of the incident to WDOE which includes: i. Name, address, and telephone number ofthe 0/0 (WAC -360(2)(k)(i)) and of the facility (WAC -360(2)(k)(ii))?
II. Date, lime, and type of emergency (WAC -360(2)(k)(iii))?
Ill. Name and quantity ofmaterials involved (WAC -360(2)(k)(iv))?



### -27-iv. The extent of injuries, if any (WAC**~360** (2)(k)(v))?
v. An assessment of actual or potential hazards to human health or the environment, where this is applicable (WAC -360(2)(k)(vi))? vi. Estimated quantity and disposition of recovered material that resulted from the incident (WAC -360(2)(k)(vii))? Comments:

10. PRECAUTIONS FORIGNITABLE, REACTIVE OR INCOMPATIBLE WASTES (WAC -395(1)). A. Does the % ever manage ignitable, reactive or incompatible wastes at his facility? (If "No," describe under Comments, below what measures the % takes to assure that no ignitable, reactive, or incompatible wastes are managed. Do not complete the remaining questions in this section.) B. Does the % take precautions to prevent accidental ignition or reaction of ignitable or reactive wastes, including but not limited to (WAC -395(1)(a)):

.1. Scpar a t i ng and p r ot.ectiI1R the wastc fr.om sources of ignition or r.eaction (e.g., open flames, smoking, cutting and welding, hot surfaces, sparks, spontaneous ignition, and radiant heat? 

### -28- Yes Nob. Confining 3moking and open flames to designated areas· where ignitable or reactive waste is handled?
c. Posting "No Smoking" signs in conspicuous places wherever there is a hazard from ignitable or reactive waste? C. [s the management of ignitable or reactive waste, and the mixture or commingling of incompatible wastes or incompatible wastes and materials conducted so that it does not:
a. Generate extreme heat, pressure, fire, explosion, or violent reaction (WAC -395(1)(b)(i))? b. Produce uncontrolled toxic mists, fumes, dusts or gases that threaten human health or the environment (WAC -395(1)(b)(ii))?
c. Produce uncontrolled flammable fumes or gases that pose a risk of fire or explosion (WAC -395(1)(b)(iii))? d. Damage the structural integrity of the tank or equipment (WAC -395(1)(b)(iv))?
e. Otherwise threaten human health or the environment (WAC -395(1)(b)(v))? D. Does the 

### % document these precautions in his operating record (WAC -395(1)(c))? Comments:



### 11. LOADING

### AND UNLOADING

### AREAS (WAC -395(4)). Does the facility receive manifested shipments of liquid dangerous waste for management? 

### -29- Yes NoG. Do the O/O's employees participate in an annual review of the training provided in the training program (WAC -330(1)(b))? H. Is the training program successfully completed by each employee within six months ofbeing employed at the facility, or ofbeing assigned to a new position, whichever is later (WAC -330(1)(c))? I. Are new employees supervised until they complete the training program (WAC -330(1)(c))? J. Does the training program:
a. Include training relevant to the positions in which personnel are employed (WAC -330(1)(a))? b. Instruct personnel on contingency plan implementation (WAC -330(1)(a))?
c. Familiarize personnel with emergency equipment and systems, and emergency procedures (WAC -330(1)(d))? K. Where applicable, does the training program include the following parameters (WAC -330(1)(d))?
a. Procedures for using, inspecting, repairing, and replacing emergency and monitoring equipment. b. Key parameters for automatic waste feed cut-off systems.
c. Communications or alarm systems. d. Response to fires or explosions.
e. Response to ground water contamination. f. Shutdown of operations. Comments:

- ...----------_._--_._---------------------------_._---

-------- .- -

## --_._-_....__._---_.


## __•. 

## _-
-
_ ..

## __._------------------------



### -21-

### 8. PREPAREDNESS AND PREVENTION (WAC -340). A. Unless it can be demonstrated that the equipment is not necessary (specify why not in the Comments, below), are the following equipment present, tested regularly, and kept in good working order:
a. Internal communications or alarm system capable of

.providing immediate emergency instructions (WAC -340

(1)(a))? Present? Tested regularly? Good working order? b. Adevice capable of summoning police or fire departments or emergency response teams (e.g., telephone, two-way radio) (WAC -340(1)(b))? Present? Tested regularly? Good working order?
c. Portable fire extinguishers, fire control equipment, spill control equipment, and decontamination equipment (WAC -340(1)(c))? Present? Tested regularly? Good working order? d. Water at adequate volume/pressure to supply hose streams, foam equipment, sprinklers or spray systems (WAC -340(1)(d))? Present? Tested regularly? Good working order? 

### B. Whenever dangerous waste is being handled, do all personnel involved have immedi.ate access to an i.nternal alarm or emergency communi.cation system, either directly or through vi.sual or voice contact with another employee (WAC -340(2)(a))? C. 

### If there is everjust one employee present on the premises, does he have immediate access to a device (e.g., telephone, two-way radio) capable of summoning external emergency help (WAC -340(2)(b))? -22- Yes NoI I I

If "Yes": A. Has the % provided an area (or areas) for loading and unloading waste shipments? B. Is each loading/unloading area designed, constructed, operated and maintained to:
a. Contain spills and leaks that might occur during loading/unloading (WAC -395(4)(a))? b. Prevent release of wastes or waste constituents to ground or surface waters (WAC -395(4)(b))?
c. Contain washwaters (if any) from the cleaning and decontamination of transport vehicles and load/ unload equipment (WAC -395(4)(c))? d. Allow for removal, as soon as possible, of collected wastes from spills, leaks and equipment washwaters (if any) in a manner to prevent releases to ground or surface waters (WAC -395(4)(d))? Comments:

12. RECORDKEEPING (WAC -380). A. Operating Record.

a. Does the % keep a written operating record at his facility which he maintains until his facility is closed (WAC -380(1))? b. Does the operating record include the following information: i. Records and results of waste analyses (WAC -380(l)(c))?
11. Summar.y reports and details of all incidents that required implementing the contingency plan (WAC -380(1)(d))? iii. Records and results of all inspections (WAC -380(1)(e)) (Note--This information need only be kept for three years)?
-30- Yes Noiv. Monitoring, testing, or analytical data as required under the specific unit requirements for interim and final status (e.g., ground water monitoring data, incinerator stack emission anaiyses, etc.) (WAC -380(1)(f))?
v. All closure and post-closure cost estimates (WAC -380(1)(g))? vi. For off-site facilities, copies of notices to generators informing them the facility has all appropriate permits (WAC -380(1)(h))?
c. Does the % keep in his operating record the following information regarding the types ofwastes he receives or manages on-site (WAC -380(1)(a)): i. Adescription of each waste providing the common name, waste number, and physical form (e.g., liquid, solid) (WAC -380(2)(a) and (b))? ii. Where a waste contains more than one process waste or waste constituent, all applicable waste numbers or else a description of the process which generated the waste (WAC -380 (2)(a))? iii. The weight, or volume and density, for each waste using the units specified in Table 1 (WAC -380(2)(c))? Table 1 Unit ofMeasure
Pounds.
. . . . . . . Short tons (2000 Ibs) Gallons (U.S.). Cubic yar d

### s".
. . Kilograms
. . . . Tonnes (1000 kg). Liters.
. . . Cubic meters... Symbol
P T G Y K H L C Density



### PIG 

### T/Y K/L H/C
iv. The date and method ofmanagement for each waste, using the handling code(s) specified in Table 2 ofWAC -380(2) (WAC -380(2)(d))? d. Does the % include in his operating record the location of each waste within his facility and the quantity at each location, and a cross-reference to specific manifest document numbers for each waste that was accompanied by a manifest (WAC -380(l)(b))? -31-

### e. If this is a 

### disposal facility, does the

### a/a include a mapor diagram ofeach cell or disposal area in his operating record to record the location and quantity ofeachwaste (WAC -380(1)(b))? 

### B. Does the % 

### evermanage ignitable, reactive, or incompatible wastes at his facility? If 

### "Yes":
a. Does the % 

### include in his operating record records ofthe annual inspection by a Fire Marshall or other professional familiar with the UniformFire Code (WAC -395(l)(d))? (If "No," then these records must be entered in his inspection log or summary.) b. Does the operating record include documentation that the % 

### manages his ignitable, reactive, or incompatible wastes in accordance withWAC -395(1)(a) and (l)(b) (e.g., does not cause extreme heat orpressure, toxic mists or fumes, damage facility integrity, etc.) (WAC -395(1)(c))? (Note--This documentation maybebased on references to published scientific or engineering literature, data from trial tests, waste analyses, or the results ofmanaging similarwastes by similarprocesses and operating conditions.) C. Does the % 

### provide copies ofall records, including plans, to

### WDOE upon request and make them available for inspection at all reasonable times (WAC -380(3)(a))7 D. Will the % 

### be sending copies of records ofwaste disposal locations and quantities at the time ofhis facility's closure to

### WDOE, EPA Region

### XAdministrator, and the local land use and planning authority (WAC -380(3)(c))? Comments:

-32-

### 13. REPORTING (WAC -390). A. UnmanifestedWaste Reports. Ifthe % 

### receives from off-site a shipment ofwaste whichwas notmanifested but.should have been, then does he submit a Form 6 - UnmanifestedWaste Report to WDOE within 15 days ofreceiving the shipment (WAC -390(1))? List the dates below that such reports were sent:

B. Annual Reports.
a. Does the % 

### submit a Form 5-TSD FacilityAnnual Dangerous Waste Report to WDOEby March 1 of eachyear reporting the previous calendaryear's waste management activities at the facility (WAC -390(2))? b. Ifthe % ships waste off-site, does he submit a Form4-GeneratorAnnualIDangerous WasteReport toWDOEbyMarch 1 ofeachyear reporting the wastes for whichhe acted as a generator during the previous calendaryear (WAC -390(2))? C. Additional Reports. Does the % 

### provide the following additional reports to WDOE (WAC -390(3)):
a. Reports ofreleases, fires, and explosions as requiredby the emergency procedures ofWAC -360(2)(k)? b. Interim status groundwater monitoring data, as specified in 40 CFR 265.94(a)(2) and (b)(2) (if applicable)?
c. Any other reports required by WDOE (list these reports, ifany, and dates submitted under Comments, below)?



### -33- Yes NoComments:



### -34-DANGEROUS WASTE COMPLIANCE CHECKLIST/QUESTIONNAIRE, CHAPTER 173-303 WAC


## *

# *******

## * *

# * ** * *

# * ** *

# ***

# * **

# * * * *** * * * * *

# * **

# **

# * * PART

### V: INTERIM STATUS TSD FACILITY UNITS This part of the checklist/questionnaire is applicable to all TSD facilities operating under i.nt.e ri.rn status, except for those facilities or portions of facilities 'which are pul)licly owned treatment works (POTW), or are conducting elementary neutralization, t.ota lLy enc l os ed t.rea trneut. or ....-as t.ewacer treatment as these processes are defi.ne d ill WAC 

### -040 [Nole--These processes are provided a permit by rule underWAC 

### -802(4) and (5) if certain conditi.ous are met. These conditions are certain general facility requiremetlts covered under Part 

### IV: General TSD Facility Requirements of this checklist questionnaire. If these conditLons are not met and WDOE has revoked the permit by rule, then saint' or all of thi.s Part Vmay be applicable]. The abbreviation 

### "0/0" is used frequently throughout this part of the checklist/ questionnaire and stands for the words "owner and/or oper.ator."


## * ****

# ***

# **

# * * * **

# **

# * * *

# **

# ** * *

# ***

# ***

# ********

# ** Facilit.y Name Lnspe c t.o r ' s Name EPA/State lOfl Date Check the type(s) ofunit operations that the % conducts at his facility and complete the sections of this Part Vof the checklist/questionnaire identified for each type of unit. Containers (complete section 1.) Tanks (complete section 2.) Surfaco Impoundments (complet.e section 3.) PiI(,s (cumplt'le se ct IOU 4.) 1..lllet TI'l':Illllt'lll (complt'lt' section S,) 1,,'11<11 ills tcoml'l('lt' se-vtion b,) l nciue r ato r s (complele section 7.) The rma l Tr-eatment (complete section 8.) Chemical, Physical, and Biological. Treatment (complete section 9.)r:

1. A. Condition of containers (265.171).
3. Are all containers holding wastes in good condition and free of leaks? If "No," describe the number, quantity, and contents of the bad or. leaking containers, and describe the specific condition of these containers

b. Ifa container is not in good condition or begins to leak, does the % either: i. Transfer the waste from the bad containers to a container in good condition? ii. Or else manage the waste in same otherway that complies withWAC 173-303**(de~cribe** these procedures under Comments, below)? B. Management of containers (265.173).
a. Are all containers holding wastes kept closed during storage except ....-hen adding or removing

....-a st.es? h. Ar« all wasL(' cont.aine r s being:

I. Stored ill a manner thal prevenls leaks or r-uplures?

11. Handled in a manner t.hat, prevents leaks or ruptures? iii. Opened in a manner that prevents leaks or ruptures'?

-2- Yes NoC. Ignitable or reactive wastes (265.176).

a. Ar-e container-s holding r-eactive wastes that ar-e capable ofdetonation or-explosion (designated by WAC -090(7)(a)(vi), (vii) or (viii)) stored with a buffer- zone equivalent to the Unifor-m Fir-e Code's "Amer-ican Table ofDistances for Storage ofExplosives," Table 77-201, 1979 Edition (WAC -440(1)(b))? b. Are container-s holding ignitable wastes and r-eactive wastes (other than those cited in a. above) stored at least fifty feet from the facility's property line? D. Container compatibility (265.172) and incompatible wastes (265.177).
a. Are all container-s made of or lined with materials which will not react with and are other-wise compatible with the waste to be stored, so that the ability to contain the waste is not impaired? b. Are incompatible wastes or incompatible wastes and materials everplaced in the same container, or are wastes ever placed in unwashed containers which previously held incompatible wastes? If "Yes," ar-e these practices conducted in a manner that assures compliance withWAC -395(1)(b)? (Be sure to complete section**10.~of** Part 

### IV: General TSD Facility Requirements of this checklist/questionnaire.)

r. If wastes in container-s are stor-ed near- a ny wastes or-mater-ials that ar-e incompatible, are the waste containers protected fr-omthese incompatible wastes or mater-ials by means of a dike, herm, walI, or other cievice? If "Yes," descr-ibe the device.

-3-Comments:

--_._---_._._--------_._-------------------- 

# _._-_.__._-_._----_._-------------_.



### ------------------------------

-4-2. 

### TANKS (40 CFR PART 265 SUBPART J). A. General operation 

### (265.192).
a. Is each tank:'
1. Tngood operating condition?

11. Free of leaks, cracks, ruptures, seam and fixture weaknesses, and any other prohlems that could lead to loss ofwastes due to structural failures? If "No," describe any problems that were observed.

b. Does the 

### % ever add wastes or treatment reagents to a tankwhich could cause the tank or its inner liner to**rupt~re,** leak, corrode, or otherwise tai

### i hef'o r e the end of its intended life?

c:. • For any uncove r e d tanks, is each tank e-ither :
i. Operated L.U ensure at least two feet (si.xty centimeters) of freeboard? i i . Or else, equipped with a containment structure (e.g., dike or trench), a drainage control system, or a diversion structure (e.g., standby tank), with a capacity that equals or exceeds the volume of the top two feet (60 em) of the tank? (Note for calculation purposes: 1 cubic foot

# =7.48 gaLlons; 1 c-ubic meter

## =264.2 gallons.) d. Ar.e any tanks operated with continuous waste feed? If "Yes":

I. Des c rihe- which tanks and was t.e s are continuous feed systems (if all, just write "I\U").


### -5- Yes NoJ1. Are these tanks equipped with a means to stop the waste inflow? Describe the means (e.g., feed cutoff, bypass to standby tank,etc.).

B. Ignitable or reactive wastes (265.198).
a. Are ignitable or reactive wastes everplaced in tanks? If "Yes," does the % either: i. Use these tanks solely for emergencies? ii. Or else, store or treat the wastes in such a way that they are protected from materials or condiLions which may cause igniLi.on or reaclion? iii. Or plsf', tre-at. , r e nde r , ormix the wastes before 01' immediaLely after placement i.n the tank so that the wastes are not ignitable or reactive (by WAC -090(5) and (7)), and so that treating or mixing complies withWAC -395(1)(b)? (NoLe--If% conducts this "acti.vity , be sure Lo complete section 10. of

Part IV: General TSD Facility Requirements of this checklist/questionnaire.) Describe whir h tanks, ifany, receive ignitable or reaclive wastes,

-6---

### _._-_._..

### _-'---'---
..

### ------------ ------------

b. Are tanks holding reactive wastes that are capable ofdetonation or explosion (designated by WAC -090 (7)(a)(vi), (vii) or (viii)) located with a buffer zone equivalent to the UniformFire Code's "American Table ofDistances for St.ora ge ofExplosives," Table 77-201, 1979 Edition (WAC.-440(l)(b))?
c. Are covered tanks used for holding ignitable or reactive wastes located with a buffer zone equivalent to the National Fire Protection Association's**requirem~nts** for tanks, contained in Tables 2-1 through 2-6 of "The Flammable and Combustible Liquids Code - 1981?" C. Incompatible wastes (265.199). Ifthe 

### % conducts the following activities, are these activities conducted so as to comply withWAC -395(1)(b) (Note--If the 

### % conducts these activities and compliance withWAC -395(1)(b) is required, be sure to complete section 10. ofPart IV: General TSD Facility Requirements of this checklist/questionnaire):
a. Tre<ltment. or storage ofwastes in tanks? h. Pl<lcement. of incompatible wastes, or incompatible wastes and materials in the same tank?
c. Placement ofwastes in an unwashed tank which previously held incompatible wastes or materials? Describe which tanks receive incompatible wastes and what those wastes are.

-----------.----

-7-Comments:

-8-3. SURFACE IMPOUNDMENTS (40 CFR PART265 SUBPARTK). A. Operation and containment (265.222 and 223).
a. Does the % maintain each surface impoundment's freeboard to: i. Be at least two feet (sixty centimeters)? ii. Prevent any overtopping of the dike due to overfilling, wave action or a storm (Note-- This requirement may result in the need for more than two feet of freeboard.)? b. Do all earthen dikes (if any) have a protective cover (e.g., grass, shale, rock) to minimize wind and water erosion and to preserve structural integrity? B. Ignitable or reactive wastes (265.229). Are ignitable or reactive wastes ever placed in the surface impoundment(s)? If "Yes," does the % either:
a. Use the surface**impou~dment(s)** solely for emergencies? b. Or else, treat, r.ender, or. mix the wastes before or immediately after. placement in the surface impoundment(s) so that the wastes are not ignitable or. reactive (by WAC -090(5) and (7)), and so that the treating or mixing complies with WAC -395(1)(b)? (Note--If% conducts this activity, be sure to complete section 10. of Part IV: General TSDfacility Requirements of this checklist/ questionnaire.) Describe which surface impoundments (if any) receive ignitable or reactive wastes.

-------------------------

------------------------------

-9- Yes NoC. Incompatible wastes (265.230) Are incompatible wastes or incompatible wastes and materials ever placed in the same surface impoundment(s)? If "Yes";
3. Does the % do this in a manner that assures compliance with WAC -395(1)(b)? (Note--Be sure to complete section 10. of Part 

### IV: General

### TSD Facility Requirements of this checklist/ questionnaire.) b. Describe which surface impoundments receive incompatible wastes and what those wastes are.

Comments:

-.- _-


## _ 

## _-_._--_.. 

# _-_._.._--------------

-10-

### 4. WASTE PILES (40 CFRPART 265 SUBPARTL). A. Wind protection 

### (265.251). If the wastes in the pile(s) could be subject to wind dispersal, does the % cover or otherwise manage the pile(s) to prevent wind dispersal? 

### B. Containment 

### (265.253). [s leachate or runoff from the pile(s) a dangerous waste? If "Yes," then does the % either:
a. Protect the pile(s) from precipitation and run-on, and prevent the addition of liquids or wastes containing free liquids to the pile(s)? b. Or else, perform all of the following actions: i. Place the pile(s) on an impermeable base that is compatible with the wastes under the conditions of treatment or storage? ii. Design, construct, operate, and maintain a run-on control system capable ofpreventing flow onto the active portion of the pile(s) during peakdischarge from at least a twentyfive year storm? iii. Design, construct, operate, and maintain a run-offmanagement system to collect and control at least the water volume resulting from a twenty-four hour, twenty-five year storm? iv. Empty or otherwise manage run-on and run-off collection and holding facilities (e.g., tanks, basins) as quickly as possible to maLntain**~esign** capacity of the systems? (Note--Collected run-off should be checked to determine if it is dangerous waste and, if so, managed accordingly.) 

### C. 19niLable or reactive wastes 

### (265.256). Are ignitable or reactive wastes ever placed in the pile(s)? If "Yes," does the 

### a/a either:

-11- Yes Noa. Manage the wastes in such a way that they are protected from any materials or conditions which may cause them to ignite or react? b. Or else, treat, render, or mix the wastes before or immediately after placement in the pile(s) so that the wastes are not ignitable or reactive (by WAC -090(5) and (7)), and so that the treating or mixing complies with WAC -395(1)(b)? (Note--If 0/0 conducts this activity, be sure to complete section 10. of Part 

### IV: General TSD Facility Requirements of this checklist/questionnaire.) Describe which pile(s) (if any) receive ignitable or reactive wastes.

D. Incompatible wastes (265.257).
a. Are incompatible wastes, or incompatible wastes and materials ever placed in the same pile(s), or are wastes ever piled on the same area(s) where incompatible wastes or materials were previously piled without the area(s) being decontaminated? If "Yes": i. Does the D/O do this in a manner that assures compliance with WAC -395(1)(b)? (Note--Be sure to complete section 10. of Part IV: General T80 Facility Requirements of this checklist/ 'luestiannai.re . ) ii. Describe which pile(s) receive incompatible wastes and what those wastes are.

-12-b. If a pile ofwaste is incompatible with any**was~e** or other material stored nearby in other containers, piles, open tanks, or surface impoundments, then does the % separate the pile from the other incompatible wastes or materials or otherwise protect them by means of a dike, berm, wall, or other device? Describe the device(s) used to separate and protect the incompatible wastes ormaterials.

Comments:

-13-**~.** LAND

### TREATMENT (40 

### erR PART 265 SUBPART

### M). A. General operation (265.272).
a. Is the land treatment unit effective in making the applied wastes less hazardous or nonhazardous by biological degradation or chemical reaction occurring in or on the soil? If "No," describe the basis for this determination.

b. Has the % designed, constructed, operated, and maintained a run-on control system capable of preventing flow onto active portions during peak discharge from at least a twenty-five year storm?
c. Has the % designed, constructed, operated, and maintained a run-offmanagement system capable of collecting and controlling a water volume at least equivalent to a twenty-four hour, twenty-five year storm? d. Are collection and holding facilities (e.g., tanks, basins) associated with run-on and run-off control systems emptied or otherwise managed expeditiously after storms to maintain design capacity of the systems? (Note--Run-offmay be a dangerous waste and, if designated, must be managed appropriately.)
e. If the treatment zone contains particulate matter which may be subject to wind dispersal, does the 0/0 manage the unit to control wind dispersal? What methodes) does he use?

-14- Yes NoB. Unsaturated zone monitoring (265.278).
a. Does the % have in**w~iting** and does he implement an unsaturated zone**monito~ing** plan? Is the plan designed to: i. Detect the vertical migration ofwasle and waste constituents under the active portions?
11. Provide information on the background concentrations of the waste and waste constituents in similar but untreated soils nearby? b. Does the % keep the monitoring plan and the rationale used in developing the plan at his facility?
c. Does the monitoring plan include, at a minimum: i. Soil monitoring using soil cores? ii. Soil-pore watermonitoring using devices such as lysimeters? d. In order to detect the vertical migration ofwaste and waste constituents below the active portions ofhis facility, does the 

### % demonstrate in his monitoring plan that: i. The depth at which soil and soil-pore water samples are to be taken is below the depth to which waste is incorporated into the soil?
11. The number of soil and soil-pore water samples to be taken is based on the variability of: l. The waste constituents (as identified in the facility waste analysis plan) in the waste and soil? 2. The soil types?

Ill. The fre4uency and timing of soil and soil-pore watf'[ sampling is based on the**f~e4lJency.** time, and rate ofwaste application,**p~oximity** to**g~ound wate~,**  and soil permeability?
e. Does the % analyze the soil and soil-pore water samples**fo~** the waste constituents that**we~e** found in the waste during analysis under his waste analysis plan?



### -15-**~.**C. Ignitable and reactive wastes (265.261). Are ignitable or reactive wastes ever land treated? If "Yes," does the % either: a . Hana ge the waste in s uch a
...·ay that it is pr o t.e c t.r-d from any material or condition which could cause it to ignite or react? b. Or else, treat, render, ormix the wastes before or immediately after placement in the land treatment unites) so that the wastes are not ignitable or reactive (by WAC -090(5) and (7)), and so that the treating ormixing complies withWAC -395(1)(b)? (Note--If% conducts this activity, be sure to complete section 10. of Part IV: General TDS Facility Requirements of this checklist/questionnaire.) Describe which land treatment units (ifany) receive ignitable or reactive wastes.



### D. Incompatible wastes (265.282). Are incompatible wastes or incompatible wastes and materials ever placed in the same land treatment unites)? If "Yes":
a. Does the % do this in a manner that assures compliance with WAC -395(1)(b)? (Note--Be sure to complete section 10. of Part IV: General TSD Facility Requirements of this checklist/ questi.onnaire.) b. Describe which land treatment units receive incompatible wastes and what those wastes are.

-16-E. Food chain crops (265.276). Does the % grow food chain crops on the treated areas of any ofhis land treatment units? If "No," then do not answer the remaining questions under this item. If "Yes," then continue with the remaining questions.
a. Has the % notified WDOE that he is growing food chain crops on his land treated areas? b. Can the % demonstrate, based on field testing, that any arsenic, lead, mercury, or otherwaste constituents identified pursuant to the facility waste analysis plan will either: i. Notbe transferred to the food portion of the crop by plant uptake or direct contact, and will not otherwise be ingested by food chain animals? ii. Or else, not occur in greater concentrations in the crops grown on the land treatment facility than in the same crops grown on untreated soils under similar conditions in the same region?
c. Whe!1 making either of the demonstrations described under b., above, is t.he information us e d to make t.he demonst.ration:

1. Kept at the fa cil Lty?
ll. Based on tests for the specific waste and application rates being used at the facility? iii. Inclusive ofdescriptions of crop and soil characteristics, sample selection criteria, sample size determination, analytical methods, and statistical procedures?



### -17-d. Does the waste applied to treatment areas where food chain crops are grown contain cadmium? If "Yes," does the % satisfy the requirements of either e. or f., below?
e. Does the % perform or assure that all of the following actions oc-cur: i. Unless the waste contains two mg/kg (dry weight) cadmium or less, is the pH of the waste and soil mixture 6.5 or greater at the time of each waste application? ii. If the land treatment area is used for production of tobacco, leafy vegetables or root crops for human consumption, is the annual application of cadmium from waste less than 0.5 kilograms per hectare (kg/ha)? (Note--One hectare equals 10,000 square meters, and equals 2.741 acres.) iii. For any other food chain crops, is the annual application of cadmium from waste less than: 1. 1.25 kg/ha from July 1, 1984 to December 31, 1986? 2. 0.5 kg/ha beginning January 1, 1987? iv. If the background soil pH is greater than 6.5, or if the pH of the waste and soil mixture is adjusted to and maintained at 6.5 (even though the background soil pH is less than 6.5) while crops are grown, then is the cumulative application of cadmium from waste less than the amounts shown in the following table?
Soil Cation Exchange Capacity (meq/lOOg) Less than 5 5 to 15 Greater than 15 Maximum Cumulative**~cation** (kg/ha) 5 10 20

v. If the background soil pH is less than 6.5 (and the waste/soil mixture pH is not adjusted to 6.5 or greater while crops are grown), is the cumulative application of cadmiUm from waste less than 5.0 kg/ha?

-18-f. Or, does the % perform or assure that all of the following actions occur: i. Is animal feed the only food chain crop produced? ii. Is the pHof the waste and soil mixture at the time ofwaste application or at the time the crop is planted, whichever occurs later, at 6.5 or greater? iii. Is a pHof 6.5 or greater in the waste and soil mixture maintained whenever food chain crops are grown? iv. Is there a facility operating plan which demonstrates how the animal feed will be distributed to prevent ingestionby humans?
v. Does the facility operating plan descr.ibe the measures to be taken to safeguard against possible health hazards from cadmium entering the food chain, whichmay result from alternative land uses? vi. Is there a stipulation in the land record or property deed which states that the property has received waste at high cadmium application rates and that food chain crops must notbe grown except in compliance with the actions described in f. i. through vi., above? Comments:



### -------------------------------------------

----------------------------------------------------

-19-6. LANDFILLS (40 CFR PART265 SUBPART N). A. General operation (265.302).
a. Has the % designed, constructed, operated, and maintained a r.un-on control system capable of preventing flow onto active portions during peak discharge from at least a twenty-five year storm? b. Has the 

### % designed, constructed, operated, and maintained a run-off management system capable of collecting and controlling a water volume at least equivalent to a twenty-four hour, twenty-five year storm?
c. Are collection and holding facilities (e.g., tanks, basins) associated with run-on and run-off control systems emptied or otherwise**m~naged** expeditiously after storms to maintain design capacity of the systems? (Note--Run-offmay be a dangerous waste and, if designated, must be managed appropriately.) d. If the landfill contains particulate matter which may be subject to wind dispersal, does the 0/0 manage the unit to control wind dispersal? What methodes) does he use?

e. Does the % assure that wastes which are designated as organic carcinogens or EHW are never disposed of in his landfill (WAC -400(3)(b)(ii))? 

### B. Ignitable or reactive wastes (265.312). Are ignitable or reactive wastes ever placed in the landfill? If "Yes," does the % either:
a. Tr.eat, render, or mix the wastes before or immediately after placement in the landfill so that the wastes are not ignitable or reactive (by
-20- Yes NoWAC -090(5) and (7)), and so that the treating or mixing complies with WAC -395(1)(b)? (Note-- If% conducts this activity, be sure to complete section 10. of Part IV: General TSD Facility Requirements of this checklist/questionnaire.) h. Or else, for ignitable wastes only:
1. Landfill the wastes only in nonleaking containers? ii. Dispose the wastes in such a way that they are protected from materials and conditions (e.g., heat, sparks, rupture) that may cause the wastes to ignite?
111. Cover the wastes daily with soil or other noncombustible material to minimize ignition potential? iv. Prevent disposal of the wastes in cells that contain or will contain other wastes which may generate heat sufficient to cause ignition of the wastes? Describe which landfill cells (if any) receive ignitable or reactive wastes.



### C. Incompatible wastes (265.313). Are incompatible wastes or incompatible wastes and materials ever placed in the same landfill cell? If "Yes":
a. Does the % do this in a manner that assures compliance with WAC -395(1)(b)? (Note--Be sure to complete section 10. of Part IV: General TSD Facility Requirements of this checklist/questionnaire.)

-21-b. Describe which landfill cells (if any) receive incompatible wastes and what those wastes are.

D. Liquid waste (265.314).
a. Does the 

### % ever receive (or generate, if disposing of his own wastes) bulk or noncontainerized liquid wastes for disposal in his landfill? If "Yes," i.s this waste either: i. Solidified or chemically fixed to be a solid prior to disposal? ii. Mixed with absorbent and placed in containers for disposal? b. Does the 

### % ever landfill containers which hold free liquids? If "Yes," are all such containers either:
I. Very small, such as an ampule? ii. Or, designed to hold free liquids for use other than storage (e.g., battery, capacitor)? iii. Or, labpacks (overpacked drums)? be sure to complete the questions below.) (If "Yes," for labpacks,
iv. Or, managed so that all free-standing liquid has been: removed (decanted or drained); mixed with absorbent or solidified; or otherwise eliminated? E. Containers and labpacks (265.315 and 316).
a. Are empty containers crushed flat, shredded, or similarly reduced in volume before burial?



### -22-b. Does the % place overpacked drums (labpacks) in the landfill? If "Yes," does the % observe the following requirements:
1. Are all inside containers sealed tightly, nonlpaking, and made ofmaterials that will not react with or be ignited or**de~omposed** by the wastes they contain?

II.. If DOT regulations (49 CFR Pa rts 173, 178, and 179) specify particular inside containers for the wastes, are these regulations followed? iii. Are the inside containers overpacked in an open head DOT specificationmetal shipping container 

### (49 CFR Parts 

### 178 and 

### 179) ofno more than 

### 110 gallons 

### (416 liters) capacity? iv. Is the overpack container filled with absorbent material sufficient to absorb the liquid contents of all inside containers and to completely fill the overpack container (i.e., no partially full overpack containers maybe landfilled; extra space must be filled with absorbent)?
v. Are the absorbent materials used not capable ofreacting with or being ignited or decomposed by the contents ofthe inner containers? vi. Does the % assure that incompatible wastes are not enclosed in the same overpack container? vii. Are all reactive wastes, other than cyanide or sulfide bearing reactive wastes, treated or rendered nonreactive prior to overpacking? Comments:



### ---------------------------------------------

-23-7. INCINERATORS (40 CFR PART 265 SUBPART0). A. Exemption from incinerator standards (265.340). Does the % burn only the wastes described below, and has he documented, in writing, that the wastes would not reasonably be expected to contain any of the dangerous waste constituents listed in WAC 173-303- 9905, and is this documentation retained at his facility?
a. Wastes listed as dangerous solely because they are ignitable and/or corrosive, or wastes designated as dangerous solely because of the characteristics of ignitability and/or corrosivitYi and b. Wastes listed as dangerous or designated by the characteristics as dangerous solely due to the reactivity characteristics ofWAC 173-303-090 (7)(a)(i), (ii), (iii), (vi), (vii), or (viii), provided that these wastes are not burned when other dangerous wastes are present in the combustion zone. If "Yes," then the % is exempt from all interim status incinerator requirements except 265.351, Closure. Complete only those questions under item C. Closure, below. B. Operation (265.345**~nd** 347(a)).
a. .During startup and shutdown of the incinerator, does the 

### % assure that wastes are not fed to the incinerator unless steady state conditions of operation have been achieved (including steady state operating temperature and air flow)? b. Does the % immediately make appropriate corrections, either automatically or manually, to maintain steady state combustion conditions whenever necessary? C. Closure (265.351). At closure, will (or has) the % remove all wastes and waste residues from the incinerator (including but not limited to ash, scrubber waters, and scrubber sludges) and, ifdesignated as dangerous wastes, manage them accordingly? (Note--This responsibility and measures for accomplishing associated actions must be specified in the O/O's closure plan.)

-24- Yes NoComments:



### -25-8. THERMAL TREATMENT (40 CFR PART265 SUBPART P). A. Operation (265.373 and 377(a)(1) and (2)).
a. Unless his process is a noncontinuous (batch) thermal treatment process which requires a complete thermal cycle to treat discrete quantities, does the % bring his process to steady state (normal) conditions of operation using auxiliary fuel or other means prior to adding dangerous wastes? b. Does the % immediateLy make appropriate corrections, either automatically or manually, to: i. Maintain steady state or other appropriate thermal treatment conditions whenever necessary? ii. Return any visible air emissions to their normal appearance whenever changes in appearance occur? B. Closure (265.381). At closure, will (or has) the % remove all wastes and waste residues from the thermal treatment process and equipment (including but not limited to ash, scrubber waters and scrubber sludges) and, ifdesignated as dangerous wastes, manage them accordingly? (Note-- This responsibility and measures for accomplishing associated actions must be specified in the a/a's closure plan.) C. Open burning ofwaste explosives (265.382).
a. Does the % ever open burn or detonate waste explosives (e.g., military propellants, dynamite, fireworks) which cannot be safely disposed of through other modes of treatment? (Note--Open burning of any other types of dangerous wastes is prohibited.) b. If "Yes," does the a/a conduct such open burning or detonation in a manner that protects public health and the environment, and in accordance with the following table? Yes No

Pounds of waste explosives



## oto 100 101 to 1,000 1,001 to 10,000 10,001 to 30,000 Minimum distance of open burning/detonation to property of others
670 feet (204 m.) 1,250 feet (380 m.) 1,730 feet (530 m.) 2,260 feet (690 ro.) -26-Comments:



### -27-9. CHEMICAL, PHYSICAL, AND BIOLOGICALTREATMENT (40 CFR PART 265 SUBPART Q). A. Operation (265.401).
a. Does the % assure that wastes or treatment reagents are not introduced to the treatment process or equipment if they could cause ruptures, leaks, corrosion, or other failures? Describe howthe % makes these assurances:

b. Where waste is continuously fed into the treatment process or equipment, is the equipment or process equipped with a means to stop the inflow (e.g., waste feed cutoff system, bypass system)?
c. Whentreating wastes, does the % assure that the treatment is conducted so as not to: i. Generate extreme heat orpressure, fire, or explosion orviolent reaction?

11. Produce uncontrolled toxic mists, furnes , dusts, or gases in sufficient quantities to threaten**hl~an** health or the environment? iii. Produce uncontrolled flammable fumes or gases in sufficient quantities to pose a risk of fires or explosions? iv. Damage the structural integrity of the facility or device containing the wastes?
v. Through other like means, threaten human health or the environment? Describe howthe % makes these assurances:



### -28- Yes NoB. Ignitable or reactive wastes (265.405). If ignitable or reactive wastes are placed in a treatment process or equipment, does the % treat, render, or mix the wastes before or immediately after placement in the treatment process or equipment so that the wastes are not ignitable or reactive (by WAC -090(5) and (7)), and so that the treating or mixing complies with WAC -395(1)(b)? (Note--If0/0 conducts this activity, be sure to complete section 10. of Part IV: General

### TSD Facility Requirements of this checklist/questionnaire.) Indicate which treatment units receive ignitable or reactive wastes:



### C. Incompatible waste: (265.406). Are incompatible wastes or incompatible wastes and materials ever placed in the same treatment process or equipment, or are wastes ever placed in unwashed treatment equipment which previously held incompatible wastes or materials? If "Yes":
a. Does the % do this in a manner that assures compliance with WAC -395(l)(b)? (Note--Be sure to complete section 10. of Part IV: General

### TSD Facility Requirements of this checklist/ questionnaire.)

-29-

### b. Describe which treatment processes or equipment receive incompatible wastes and what those wastes are.

D. Closure (265.404). At closure, will (or**ha~)** 

### the % 

### remove**~ll** 

### wastes and waste residues from treatment processes or equipment, discharge control equipment, and discharge confinement structures and, ifdesignated as dangerous wastes, manage them accordingly? (Note--This responsibility and measures for accomplishing associated actions must be specified in the O/O's closure plan.) Comments:

--------------



### -30- 

### •

### DANGEROUS WASTE COMPLIANCECHECKLIST/QCFSTIONNAIRE CHAPTER 173-303 WAC



# * * * * 

# * * * * * * '!: 

## * 

# * *
Part 6: Closure This part of the checklist/questionnaire is applicable to all dangerous waste management facilities operating under interim status. Dangerous waste facilities may include containers, tanks, surface impoundments, waste piles, thermal treatment, chemical, physical and biological treatment, land treatment, incinerators, and landfills. The abbreviation "0/0" is used frequently throughout this checklist/questionnaire and stands for the words "owner and/or operator." The questions in the checklist have been written in a manner such that they can be answered either "Yes" or "No." However, the answers to some questions may require additional explanation. The space provided for comments at the end of each se.ction may be used for explanations. If a question does not apply to a particular facility, simply write 

### "NA" (not applicable) next to the question.

# ~§:~o~~~ KWR\mUS**W~li** DW\S\OK

### CLOSURE PLAN CHECKLIST 6.1. GENERAL FACILITY**I~FOR}~TION** 

### Facility Name: Inspectors Name: EPA/State I.D.: 

### #



# ------- Date:
Checkthe type(s) ofunit operations that the % 

### manages at his facility (refer to 6.3 for Unit Specific Requirements):
Page No.

o

o

o

o

o

o

o

o

o 

### Containers Tanks
... Surface Impoundments
. Piles. • . . . Land Treatment Landfills.
. . Incinerators Thermal Treatment. Chemical, physical and biological treatment. . . .. . ...•.



### - 2 - 13 

### 14 15 

### 16 

### 17 18 19 

### 20 21

### 6.2. GENERALCLOSUREREQUIREMENTS 1. WRITTEN PLAN YES NO



### A. B. Is there aWRITTEN CLOSUREPLANkept at the facility? (40 CFR 261.112(a» Does the closure plan cover all areas and facilities thatwere ACTIVE as of 11/19/80? C. Does the closureplan include general informationabout the facility which wouldbehelpful inreviewing the plan, including (Note: regulations do not presently require the inclusionofthe following information. However, inclusion ofthis informationwill aid in the reviewofthe plan.):

a. facility size(s) b. facility type(s) c. descriptions ofall on-site equipment d. topography e. waste characterization f. soil type g. description of surrounding landuse h. surroundingpopulation i. size offacility (acres) j. 

### volume ofimpoundment k. type(s) oftreatment/processing 1. 

### description of liner m. leachate collection system n. gas collection system o. dredging procedures/schedules, etc. p. incinerator specifications q, other (specify ) Comments:

- 3 -

### 2. MAXIMUMEXTENTOFOPERATION (40 CFR 265.112(a)(1)) A. Does the plan identify the MAXIMUMEXTENTOF OPERATIONwhichwillbe unclosed during the life ofthe facility? B. Is theMAXIMUMEXTENTOFOPERATION estimate exceededby current operations? C. Does theMAXIMUMEXTENT OFOPERATIONestimate include:
a. the maximumarea of landfill or land treatment ever containingwastes? b. inactive areas openbecause of operatingproblems or contingencies? c. maximumareaof land everused for land spreading? d. the most extensive treatment required for land spreading? e. the maximumarea used for storage? Explain each "NO" answer. Comments:

3. PARTIALCLOSURE (40 CFR 265.112(a)) A. Does the plan identify the steps for PARTIAL CLOSURE, at any time during the intended operating life, of YES NO

r ••••••

a. 

### b. c. 

### d. surface impoundments? landfills? tanks? other (specify: )



# ---------- IFNOPARTIAL CLOSUREPLAN, WRITEN/AAND SKIPTO SECTION 5. B. Does the PARTIAL CLOSURE Plan identify
a. the size ofareas partially closed b. procedures for partial closure? c. maintenance program? d. frequency ofpartial closures? e. source ofcovermaterials?


### - 4 -C. Does the plan for PARTIALCLOSURE demonstrate the adequacy of the cap, etc. to meet the closure requirements? OR Are these areas or activities otherwise included in the extent of operations of the closure plan? (Note: If PARTIAL CLOSURE operations would not satisfy closure requirements, the plan must indicate how and when those requirements will be met , )

Does the PARTIAL CLOSURE PLAN describe maintenance activities for partially closed areas, including:
a. visual ipspections? b. groundwater monitoring? c. maintaining cover? d. maintaining diversion structures? e. controlling erosion? f. maintaining vegetation? g. security requirements? h. leachate collection? i. gas collection? YES NO



### D. Does the CLOSURE PLAN describe maintenance frequencies for partially closed areas, including:
a. visual inspections? b. groundwater monitoring? c. maintaining the cover? d. maintaining diversion structures? e. controlling erosion f. maintaining vegetation? g. security requirements? h. leachate collection? i. gas collection? 

### -,i I I i

F. Is there a SCHEDULE FOR PARTIAL CLOSURE? If "NO" SKIP TO SECTION 5. Note: the regulations do not require that plans contain schedules for partial closure, only for final closure.



### - 5 -G. If a schedule is included, does the SCHEDULE FOR PARTIALCLOSURE include:
a. date(s) of partial closure(s)? b. total time required for each partial closure? c. time required for key steps-- YES NO

----) Comments: i. ii. iii.

iv.

v. vi. vii. viii. waste removal? waste stabilization? waste treatment? waste disposal? placement of cover? vegetation? decontamination? other (specify:

4. MAXIMUM INVENTORY (40 CFR265.112(a)(2» 

### A. Is there an estimate of the MAXIMUM INVENTORY ofwastes in storage or treatment at any time during the life of the facility? (Note: write NA for those cases where there is no storage or treatment prior to disposal.) B. Does the MAXIMUM INVENTORY estimate include the maximum amount of on-site wastes?
a. requiring pre-treatment? b. requiring treatment? c. requiring disposal? C. Does the MAXIMUM INVENTORY estimate include the maximum amount of on-site:
a. wastes in surface impoundments? b. wastes in partially-closed nondisposal surface impoundments? c. wastes in tanks? d. wastes in piles? e. wastes in drainage pits? f. wastes in containers? g. standing liquids?



### - 6 -

### C. Does the MAXIMUM INVENTORY estimate include t

### he
i

### maxLmum amount ofon-site': (continued) h. sludge? i. contaminated soil from land treatment fields? j. 

### contaminated soil from around tanks, containers, piles? k. contaminated soil from around tanks, containers, piles? 1. process residues? m. decontamination residues? D. Does the plan discuss the type(s) of TESTINGAND CRITERIAto be used to determine: Note: the regulations do not require closure plans to include information on waste testing and criteria. Write "NA"for situations where soil contamination, decontamination residues, orprocess residues are not relevant.
a. whether soil is contaminated? b. whether decontamination residues are hazardous? c. whether process residues are hazardous? E. Are INCOMPATIBLEWASTES identified and provisions described for keeping them separate during closure (Note: write "NA"only if there are no incompatible wastes being managed at the facility.) Comments:

5. FINAL CLOSURE A. Does the plan clearly identify the STEPS TO CLOSE
a. at any point during the intended operating life? (40 CFR 265.112(a» b. at the end of the intended operating life? (40 CFR 265.112(a))



### - 7 - YES NO**~~~- ---------~-**  -------**-~~~----**

YES NO B. Do the STEPS TOCLOSE in the plan include:
a. removal ofwastes? (40 CFR265.113(a)) b. treatment of wastes? (40 CFR265.113(a)) c. waste disposal? (40 CFR265.113(a)) d. waste containment? e. cover? (40 CFR265.310(b)) f. decontamination of equipment and structures? (40 CFR265.112(a)(3)) g. groundwater monitoring? h. closure certification? (40 CFR265.115) i. maintenance of leachate program? j. maintenance of gas collection program? k. security requirements? C. With respect to the REMOVAL, TREATMENT, ORDISPOSAL of waste, does the plan identify:
a.. the source and type ofmaterials and equipment needed? b. the amount of labor required? c. the capacity. number. and location of trenches or cells needed? d. the area required for landspreading?
D. Does the plan describe the DECONTAMINATION (40 CFR265.112(a)(3); 265.114) of facility equipment and structures, including:
a. a list of equipment, containers, and structures requiring disposal or decontamination? b. decontamination procedures? c. method of treatment or disposal of residues? d. testing program? E. With respect to MONITORING, does the closure plan describe:
a. details of the groundwater monitoring program during closure? b. soil testing and monitoring? c. maintenance ofmonitoring equipment during closure? d. other (specify:



### - 8 -

### F. With respect to CERTIFICATIONofclosure (40 CFR 265.115), does the closure plan describe scheduled or estimated number ofinspections? G. Ifa systemfor COLLECTINGLEACHATE is present, does the closure plan: YES NO

a. b.
c. 

### describe leachate removal, treatment, and disposal during closure? identify the"approximate volume of leachate collected? provide for maintenance of the leachate collection systemduring closure? H. IfaGAS COLLECTION SYSTEM is required during operation, does the closure plan?
a. describe procedures for collecting gas during closure? b. describemonitoring samples and analysis during closure? c. describe maintenance ofgas collection systemduring closure? I. If SECURITY (ex: fencing) is required, does the closure plan:
a. describe the maintenance of security equipment during the closure.period? b. describe the installationofappropriate equipment at closure? c. state the dimensions of the fence and the area to be enclosed? Comments:

6. FINALCLOSURE: SCHEDULE A. Does the plan identify the YEARwhen final closure is expected to occur? (40 CFR 265.112(a)(4))

o 

### What is the expectedyear ofclosure?



### - 9 -B. Is there a SCHEDULE for final closure activities? (40 CFR265.II2(a)(4» IF "NO" SKIP TOCOMMENTS SECTION. C. Does the SCHEDULE for final closure include (Note: regulations require the closure schedules to include, at a minimum, both the total time required to close the facility as well as the time required for intervening activities.):
a. date closure is expected to begin? (40 CFR265.II2(a)(I» b. total time required to close? c. the time for intervening closure activities? (40 CFR265.II2(a)(4» d. time required for key steps: i. waste inventory treatment? (40 CFR265.II2(a)(4» ii. waste inventory disposal? (40 CFR265.II2(a)(4» iii. removal ofwaste inventory and residues? iv. decontamination of facility equipment and structures? v. installation ofcontainment and diversion structures? vi. placement of final cover? (40 CFR265.I12(a)(4» V11. planting vegetation? viii.closure certification? ix. other (specify:
D. Does the SCHEDULE for final closure:
a. encompass more than 90 days for treatment, removal, or disposal of hazardous wastes after receipt of final volume ofwastes? (40 CFR265.1I3(a» b. encompass more than ISO days for completion of closure plan activities after receipt of final volume of wastes? (40 CFR265.II3(b» Comments:

- 10 - YES NO

### 7. GENERALCLOSURECOST ESTIMATE A. Is there a written closure cost estimate? 

### YES NO

B.**~~at** is the amount of the closure cost estimate? 

### $--- C. Is there documentation supporting the cost estimate?
a. work-ups? b. contractor bids? c. operating history? d. other D. Has the cost estimate been adjusted by the 9% inflation factor? 

### (40 CFR

### 265.142(b» E. Does the cost estimate cover all the activities in the closure plan including costs of labor? F. Does the closure cost estimate cover all required closure activities? 

### (40 CFR

### 265.142(a» If 

### "NO" specify in comments below: Comments:



### - 11 -6.3 UNIT SPECIFIC REQUIREMENTS This section addresses requirements which are specific to individual TSDunits. In an effort to simplify the checklist, the requirements in this section have been organized into unit specific modules. This enables the inspector to select only those requirements which are specific to the particular facility under investigation. Please note that with respect to surface impoundments, waste piles and land treatment units, if if

### % either cannot or elects not to remove all waste residues, contaminated soils, structures, and equipment, he must close the facility and perform post-closure care in accordance with the closure and post-closure requirements that apply to landfills.

- 12 -I i I I 

### 1. CONTAINERS A. Does the closure plan describe the following:
a. the procedure for removing hazardous waste containers from the facility; b. inspection ofwaste containers for leaks; c. the procedure for transferring dangerous wastes from leaking containers to non-leaking containers; B. Rave provisions beenmade for the decontamination of equipment and structures? 

## c. Does the plan describe the testing programneeded to judge the success of the decontamination efforts? D. Does the testing program include:
a. sampling methods b. testing parameters c. analytical procedures Comments:



### - 13 - 

### YES NO

### 2. TANKS (40 CFR 265.197) A. Does the closure plan describe procedures for removing hazardous wastes from the tank? B. Does the plan describe procedures for decontaminating the tank, discharge control equipment, and discharge confinement structures? C. Have criteria been established to determine the effectiveness of the decontamination process? D. Have test procedures been included to determine the effectivenss of the decontamination procedures? E. Does the testing procedure include:
a. sampling methods b. testing parameters c. analytical procedures Comments:



### - 14 - 

### YES NO

### 3. SURFACE IMPOUNDMENTS (40 CFR 265.228) A. Upon closure, does the 

### % plan to remove the impoundment:
a. standing liquids b. waste and waste residue c. underlying and surrounding contaminated soil B. Does the closure plan provide a detailed plan for the removal of:
a. all hazardous wastes b. the containment system (if applicable) c. contaminated soil C. Does the closure plan describe a testing program to determine if the site is clean? D. Does the closure plan provide an estimate ofeach quantity ofmaterial to be removed from the site? Comments:

-**1~** - 

### YES NO

### 4. WASTE PILES (40 

### CFR 265.258(a)) A. Does the closure plan provide a detailed plan for the removal of:
a. all hazardous wastes b. the contaminated system (if applicable) c. contaminated soil B. Does the closure plan describe the procedures to be used to decontaminate equipment and structures? 

### YES NO

I I" I I 

### C. Have criteria been established to judge the effectiveness of the decontamination procedures? D. Does the closure plan describe a testing program to determine if the site is clean? Comments:

- 16 -

### 5. LANDTREATMENT (40 CFR265.280) A. Does the closure plan address the following objectives and explain how they will be achieved?
a. control ofmigration of hazardous wastes and constituents into groundwater. b. control of the release of contaminated run-off into surface water. c. control of the release of airborne particulate contaminants caused by wind erosion. d. protection of food chain crops. B. Does the closure plan include at least a narrative statement indicating that the following factors were considered in addressing the closure objectives?
a. type and amount of waste. b. mobility and rate ofmigration c. site location, topography, and surrounding land use. d. climate, including precipitation. e. characteristics of the cover, including material, final surface contour, thickness, porosity, permeability, slope, vegetation. f. geological and soil profiles and surface and subsurface hydrology. g. unsaturated zone monitoring. h. type, concentration, and depth ofhazardous constituent migration as compared to background concentrations.
Comments:



### - 17 - YES NO

### 6. LAND DISPOSAL (40 CFR 265.310) A. Does the closure plan address the following objectives and explain how they will be achieved?
a. control of pollution migration from the facility via groundwater, surface water, and air. b. control of surface water infiltration, including prevention of pooling. c. prevention of erosion. B. Does the closure plan include at least a narrative statement indicating that the following factors were considered in addressing the closure objectives?
a. type and amount ofwaste b. mobility and rate ofmigration c. site location, topography, and surrounding land d. climate, including amount, frequency and pH ofprecipitation e. characteristics of the cover, including material type, final surface contour, thickness, porosity, permeability, slope, and type of vegetation f. geologic characteristics, soil profiles, and surface and subsurface hydrology g. unsaturated zone monitoring h. type, concentration, and depth of hazardous constituent migration as compared to background concentrations Comments:

- 18 - 

### YES NO

### 7. INCINERATORS (40 CFR 265.351) A. Does the closure plan address the removal of:
a. all wastes b. ash c. scrubber waters d. scrubber sludges B. Are procedures for decontaminating the incinerator, ash collection equipment, and emission control equipment, described or referenced in the closure plan? C. Does the closure plan address the disposal of all contaminated equipment, residues, solvents, and contaminated cleaning agents? D. Has the plan included criteria to be used to judge the success of the decontamination efforts? E. Does the closure plan describe a testing program to determine if the standards of decontamination has been met? Comments:



### - 19 - 

### YES NO8. THERMAL TREATMENT (40 CFR 265.381) A. Does the closure plan address the disposal of all wastes and residues? B. Does the closure plan describe the procedure for decontamination of the thermal treatment equipment and surrounding structures? C. Does the closure plan describe a testing program to determine if the standard of decontamination has been met? Comments:

- 20 - YES NO

### 9. CHEMICAL, PHYSICALAND BIOLOGICALTREATMENT (40 CFR 265.404) A. Does the closure plan address the disposal ofall wastes and residues? B. Does the closure plan describe the procedures for decontamination of the thermal treatment equipment and surrounding structur;s? C. Does the closure plan describe a testing program to determine if the standard of decontamination has been met? Comments:



### - 21 - 

### YES NO---**~-------** ._--- -- --- -- --- ..



### 6.4 VERIFICATION OFCLOSURE COST ESTIMATES Sections 1-7 deal with the verification ofcost estimates for various tasks performed during the closure of a dangerous waste management facility. However, some of the informationrequested in the following sections may not be applicable to a particular facility. Ifan item does not apply, mark "NA" (not applicable) on the line located to the left ofthat item. If the requested information is applicable, simply place a ," v" 

### "on the line and enter the estimated figure on the line located to the right of the item. Onthe other hand, if the requested information is applicable and yet'the facility has not provided an estimate for the particular item, enter "NP" (not provided) on the line in the right column. Be sure that all estimates entered below are assigned the appropriate units (i.e., dollars, cubic meters, years, etc.).



### - 22 -1. TREAMENT, DISPOSAL ORREMOVAL OF INVENTORY (40 CFR265.112(a)(2)) Applicable/NA 

### A. On-Site 

# * a. Amount of inventory and residues to be disposed on-site (yd3) i. from cost estimate ii. from closure plan iii. from visual inspection b. Unit cost for on-site treatment or disposal ($/yd3) i. from cost estimate
c. Total cost of on-site treatment disposal ($) i. from cost estimate Amount/NP

B. Off-Site
a. Amount of inventory and residues to be disposed off-site (yd3) i. from cost estimate ii. from closure plan iii. from visual inspection b. Unit cost for off-site treatment or disposal ($/yd3) i. from cost estimate
c. Total cost for off-site disposal excluding transportation i. from cost estimate d. Unit cost for transport of inventory ($/yd3/mile) i. from cost estimate



# *Residues here refer to residues existing at initiation of closure.



### - 23 -Applicable/NA

Comments: e. Transport distance (miles) i. from cost estimate ii. by map reference f. Cost of transport ($) i. from cost estimate g. Cost of off-site treatment or disposal including transport 

### ($) i. from cost estimate ii. inspector calculation C. Total cost of Treating, Disposing or Removing Inventory ($)
a. From cost estimate



### - 24 - Amount/NPApplicable/NA 

### 2. DECONTAHINATION A. Soil Excavation (40 CFR265.280(c)(1))
a. Volume of soil to be removed (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate b. Unit cost for soil excavation ($/yd3) i. from cost estimate
c. Total cost of contaminated soil excavation ($) i. from cost estimate B. Wastewater Removal
a. Volume ofwastewater to be removed (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate b. Unit cost for wastewater removal ($/yd3) i. from cost estimate
c. Total cost of wastewater removal ($) i. from cost estimate C. On-Site Treatment or Disposal of Contaminated Soil, Wastewater and Residues Generated During Decontamination
a. Volume of soil, wastewater and residues to be treated/disposed on-site (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate



### - 25 - Amount/NP

i

- IApplicable/NA b. Unit cost for treatment/disposal ($/yd3) i. from cost estimate Amount/NP

c. Cost of on-site treatment/disposal ($) i. from cost estimate D. Off-Site Treatment or Disposal of Contaminated Soil, Wastewater and Residues Generated During Decontamination
a. Volume of soil, wastewater and residues to be treated/disposal off-site (yd3) i. from cost estimate ii. from closure plan iii. from visual inspection b. Unit cost for off-site treatment/disposal ($/yd3) i. from cost estimate
c. Cost of off-site treatment/ disposal 

### ($) excluding transportation i. from cost estimate d. Unit cost for transport ($/yd3/mile) i. from cost estimate
e. Transport distance (miles) i. from cost estimate ii. by map reference f. Cost of transport 

### ($) i. from cost estimate g. Total cost of off-site treatment or disposal including transport ($) i. from cost estimate



### - 26 -Applicable/NA 

### E. Equipment Decontamination (40 CFR265.112(a)(3))
a. Amount of equipment to be decontaminated (tons) i. from cost estimate ii. from closure plan iii. inspector's estimate b. Unit cost for equipment decontamination ($/ton) i. from cost estimate
c. Cost of equipment decontamination ($) i. from cost estimate Amount/NP

Comments: F. Total Cost ofDecontamination ($)
a. From cost estimate



### - 27 -Applicable/NA 

### 3. CERTIFICATION Amount/NP
Applicable/NA 

### A. Professional Engineer Hours (hrs)

.(40 CFR265.115)
a. from cost estimate b. from closure plan c. inspector's estimate Amount/NP

Comments: B. Unit**Cos~** for Professional Engineer ($/hr.)
a. from cost estimate C. Total Certification Cost ($)
a. from cost estimate



## *Loaded with costs for support personnel.

- 28 -Applicable/NA 4. VERIFICATION OF COST ESTIMATEFOR COVER 

# ** A. Cover Material (40 CFR 265.112(a)(4);

265.280(c)(2))
a. Area to be covered (yd2) i. from cost estimate ii. from closure plan iii. from visual inspection b. Depth of cover material (yd) i. from cost estimate ii. from closure plan iii. inspector's estimate
c. Volume ofmaterial to be obtained on-site (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate d. Volume of material to be obtained off-site (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate
e. Unit cost of excavating material on-site ($/yd3) i. from cost estimate f. Unit cost of purchasing material off-site ($/yd3) i. from cost estimate g. Unit cost of transporting material ($/yd3/mile) i. from cost estimate ii. by map reference Amount/NP



# **Include materials to be used for cover, for example gravel or clay, except for top-soil.



### - 29 -

### Applicable/NA h. Transport distance (miles) i. from cost estimate ii. by map reference Amount/NP

i. 

### Transport cost ($) i. from cost estimate j. Total cost of acquiring material ($) i. from cost estimate k. Unit cost of spreading and compacting material ($/yd3) 

### i. from cost estimate 1. Cost of spreading and compacting material ($) i. from cost estimate
m. Total cost of acquiring and placingmaterial ($) i. from cost estimate B. Top-Soil
a. Area to be covered (yd3) 

### i. from cost estimate ii. from closure plan iii. inspector's estimate b. Depth of top-soil. allowing for appropriate grading (yd) i. from cost estimate ii. from closure plan iii. inspector's estimate
c. Volume of top-soil to be obtained on-site (yd3) 

### i. from cost estimate ii. from closure plan iii. inspector's estimate

- 30 -Applicable/NA d. Volume of top-soil obtained off-site (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate Amount/NP

e. Unit cost of excavating top-soil on site ($/yd3) i. from cost estimate f. Unit cost of purchasing top-soil off-site ($/yd3) i. from cost estimate g. Unit cost of transporting top-soil off-site ($/yd3) i. from cost estimate h. Transport distance (miles) i. from cost estimate ii. by map reference i. Transport cost 

### ($) i. from cost estimate j. Total cost of acquiring top-soil ($) i. from cost estimate k. Unit cost of spreading and compacting top-soil ($/yd3) i. from cost estimate 1. Cost of spreading and compacting top-soil ($) i. from cost estimate
m. Total cost of acquiring and placing top-soil ($) i. from cost estimate



### - 31 -Apflicable/NA 

## c. Synthetic Liner and Buffer Material
a. Area to be covered (yd2) i. fr.om cost estimate ii. from closure plan iii. visual estimate 

# * b. Depth of sand buffer (yd) i. from cost estimate ii. from closure plan iii. inspector's estimate
c. Volume of sand to be obtained on-site (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate d. Volume of sand to be obtained off-site (yd3) i. from cost estimate ii. from closure plan iii. inspector's estimate
e. Unit cost of excavating sand on-site ($/yd3) i. from cost estimate f. Unit cost of purchasing sand off-site ($/yd3) i. from cost estimate g. Unit cost of transporting sand ($/yd3/mile) i. from cost estimate h. Transport distance (miles) i. from cost estimate ii. by map reference Amount/NP



# *Includes other materials (other than clay and top-soil) which may be used along with the snythetic liner.



### - 32 -Applicable/NA i. Total cost of acquiring sand ($) i. from cost estimate Amount/NP

j. Unit cost of spreading and compacting sand ($/yd3) i. from cost estimate k. Cost of spreading and compacting sand ($) i. from cost estimate 1. Total cost of acquiring and placing sand ($) i. from cost estimate
m. Unit cost of acquiring and installing synthetic liner ($) i. from cost estimate
n. Cost of acquiring and installing synthetic liner ($) i. from cost estimate.
o. Unit cost of acquiring and installing synthetic liner and buffer materials ($/yd2) i. from cost estimate p. Total cost of acquiring and installing synthetic liner and buffer materials ($) i. from cost estimate D. Total Cover Cost
a. Unit cost of cover ($/yd2) i. from cost estimate b. Total cost of cover ($)

.i. from cost estimate



### - 33 --------- ----- - ---


### Applicable/NA Comments:

- 34 - 

### Amount/NP

### Applicable/NA 

### 5. REVEGETATION (40CFR 265.280(c)(2)(ii» A. Area in Needofrevegetation (yd2) 

### a. Fromcost estimate b. Fromclosure plan c. Fromvisual inspection Amount/NP

B. Unit Cost for Acquiring and Placing Seed, Fertilizer, etc. 

### ($/yd2) 

### a. Fromcost estimate C. Total Cost ofAcquiring and Placing Seed, Fertilizer, etc. ($)


### a. Fromcost estimate 6. OTHER (fromcost estimate) ($) 

### (specify) (specify) 7. TOTALCLOSURECOSTS ($) 

### A. Fromcost estimate



### - 35 - $----
$----DANGEROUS WASTE COMPLIANCE CHECKLIST/QUESTIONNAIRE CHAPTER 173-303 WAC



## * * * *

# ** **

## ** * * *

## *

# ** * *

## * * * * *

# *

# **

# **

## * *

# * **
Part 7: Post-Closure

This part of the checklist/questionnaire is applicable to all hazardous waste disposal facilities operating under interim status at which dangerous waste will remain after closure. In addition to landfills and land treatment units, post-closure requirements may also apply to surface impoundments and waste piles. The abbreviation "0/0" is used frequently throughout this checklist/questionnaire and stands for the words "Owner and/or operator." The questions in the checklist have been written in a manner such that they can be answered either "Yes" or "No". However, the answers to some questions may require additional explanation. The space provided for comments at the end of each section may be used for explanations. If a question does not apply to a particular facility, simply write "NA" (not applicable) next to the question.

# \5)§~§U~~@:\I] iM\\(

# 8 \.;J;

# ~WR~U'**'l~1i. U\~\~\ott** 

### POST-CLOSURE PLAN CHECKLIST
7.1 GENERAL POST-CLOSURE REQUIREMENTS
1. WRITTEN PLAN A. Is there awritten POST-CLOSURE PLAN at the facility? (40 CFR 265.118(a» If answer is "t\/A" skip to cost estimate checklists. B. Does the post-closure plan cover the MAXINeMAREAEXPECTED TO CONTAIN HAZARDOUS WASTE after closure, including: YES NO

a) b) c) d) 

### Landfills? Disposal surface impoundments? Land treatment facilities where hazardous waste will remain? Other**re~aining** 

### hazardous wastes? C. Does the post-closure plan provide for 30years ofpost-closure care? (40 CFR

### 265.117(a» (NOTE: The postclosure period of 30 years is subject to modification during the post-closure care period. See 40 CFR 265.118(3).) Howmanyyears of post-closure ·care? D. Does the post-closure plan cover all areas where hazardous waste**~ill** 

### remain that**~ere** 

### active as of 11/19/80? Comments:

2. POST-CLOSURE PLA:\ REQUIREMENTS A. Does the plan clearly identify the ACTIVITIES required in post-closure care? (40 CFR 265.118(a» B. Does the plan clearly identify the FREQUENCIES for post-closure activities? (40 CFR 265.118(a»
-2-

### C. no the GROUNDWATER·MONITORING Plans (40 C



### FR :26 5 • 117(a)(l); 2.6.5• 11 8 (a)(l)) 

### inclu

### de: YES NO

a) b) c) d) e) f) 

### Numberofwells? Sample collection activities? Sample collection frequencies? Sample test activities? Sample test frequencies? Replacement offailed wells? 

### D. Is there d 

### copy of the GROUNDWATER**SAMPLI~G** 

### AND ANALYSIS PROGRAM attached to the plan? E. Do theMAINTENANCE PLANS for waste containment structures (40 CFR 265.118(a)(2)) include?

a) Inspection activities? b) Inspection.frequencies? c) Maintaining final cover (erosion damage repair) activities? d)**Maintainin~** 

### final cover (erosion damage repair) frequencies? (40 CFR 265.319(d)(l)) e) Vegetation and fertilizing activities? f) 

### Vegetation and fertilizing frequencies? (40 CFR 265.118(a)(2)(i)) g) Mowingactivities? h) Mowingfrequencies? i) 

### Collection and treatment ofrunoff? j) 

### Frequencies ofrunoff collection and treatment? F. Do MONITORUIC EQUIPMENTMAINTENANCE plans (40 CFR 265.118(a)(2)(ii)) include: a) b) 

### Activities? Frequencies? (40 CFR 265.118(a)(2)(ii)) (40 CFR 265.118(a)(2)(ii) G. Do SECURITY REQCIREMENT plars include: a) Activities? b) Frequencies? H. Does the plan identify the name, address and phone number of the POST-CLOSURE PERIOD CONTACT? (40 CFR 265.118(a)(3)) Comments:

-3-3. OTHER REQUIREMENTS Note: Check the post-closure cost estimate for inclusion of costs for the following activities; such costs are to be included (see 40 CFR265.144 

### (a)) even if the post-closure plan does not discuss these activities.

A. Does the plan address the requirement for notice to the local land authority? (40 CFR265.119) B. Does the plan address the requirement for notice in the dead? (40 CFR265.120) C. Does the plan address the protection and maintenance of surveyed benchmarks? Comments:

4. GENERAL POST-CLOSURE COST ESTIMATE A. Is there a written post-closure cost estimate? (40 CFR

### 265.144(a)) YES NO



### B. What is the amount of the estimate? 

### $------ C. Is there documentation supporting the post-clcsure cost estimate? a) Work-ups? b) Contractor bids? c) Operating history? d)
.Other D. Is the annual estimate multiplied by 30 to cover the entire post-closure care period? (40 CFR 265.144(b)) E. Has the cost estimate been adjusted by the 9% inflation factor? (40 CFR265.144(b)) F. Does the cost estimate cover all the activities in the post-closure plan? (40 CFR265.118)?-- -4-

### G. Including labor costs? Aswell as the requirements ofnotice to local land authorities and in deeds? 

### (40 CFR 265.119, 265.120) Does the post-closure cost estimate cover all required post-closure activities? 

### (40 CfR265.144(a)) If "NO" specify in comments below. YES NO

Comments:

-5-7.2 UNI! SPECIFIC REQUIREMENTS NOTE: Although unit specific requirements apply primarily to landfills and land treatment units, situations may arise where post-closure requirements also apply to surface impoundments and waste piles. For example, if an % of a surface Lmpoun.dment cannot effectively remove all contaminated soils from the unit during closure, some p6st-closure requirements may apply. In this situation, the 

### % would close the impoundment and provide post-closure care as if the unit were a landfill
.. 

### YES NO 1. LANDFILLS (40 CFR265.310) A. Does the post-closure plan address the following objectives and indicate how they will be achieved
a. Control of pollution migration via groundwater, surface water, and air. b. Control of surface water infiltration, including prevention of polling. c. Prevention of erosion. B. Does the post-closure plan include at least a narrative statement indicating that the following factors were considered?
a. Type and amount ofwaste. b. Mobility and rate ofmigration. c. Site location, topography, and surrounding land use. d. Climate, include amount, frequency, and pH of precipitation. e. Characteristics of the cover including material type, final surface contour, thickness, porosity, permeability, slope, and vegetation. f. Geological conditions, soil profiles, and surface and subsurface hydrology. g. Unsaturated zone monitoring. h. Type, concentration, and depth of hazardous constituent, migration as**com~nred** to background concentrations. Comments:



### -6- ._---**~----~**

### C. In addition to the items listed in Section G-2(2)(e), do post-closure maintenance plans include? 

### YES NO

a. b.
c. d. 

### Comments: Procedures for collecting, removing, and treating leachate. The frequencies ofcollecting,**~emoving,** 

### and treating leachate. Gas collection activities. Gas collection frequencies.



### 2. LAND TREATMENT (40 CFR 265.288) A. Does the post-closure plan addr.ess the following objectives and indicate how they will be achieved?
a. 

### b.
c.
d. 

### Comments: Control ofmigration ofhazardous wastes and constituents into the groundwater.. Control of the release ofcontamination runoff in surface water. Control of the release of airborne particulate contaminants caused 

### by wind erosion. Protection of food chain crops.

B. Does the post-closure plan include at least a narrative statement indicating that the following factors were considered in addressing the closure objectives?
a. Type and amount ofwaste. b. Mobility and rate ofmigration



### -7--**~--- -~** **--~--_.** __.**---~--_._- ---~------**  -**---~-** ---.-**~_._--**

c. 

### d.
e.

f.


### g. 

### h.

Comments: Site location, topography, and surrounding land use. Climate, including amount, frequency and pH of precipitation. Characteristics of the cover including material type, final surface contour, thickness, porosity, permeability, slope, and vegatation. Geological characterization, soil profiles,.and surface and subsurface hydrology. Unsaturated zone monitoring. Type, concentration, and depth of hazardous constituent migration as compared to background concentrations.



### -8- 

### YES NO7.3 VERIFICATION OFCOST**ESTI~~TES** Sections 1-10 deal with the verification of cost estimates for required work performed during the post-closure period. However, some of the information requested in the following sections may not be applicable to a particular facility. If an item does not apply, mark "NA" (not appliable) on the line located to the left of that item. If the requested information is applicable, simply place a" "on the line and enter the estimated figure on the line located to the right of the item. On the other hand, if the requested information is applicable and yet the facility has not provided an estimate for the particular item, enter "NP" (not provide.d) on the line in the right column. Be sure that all estiamtes entered below are assigned the appropriate units (i.e., dollars, cubic meters, years, etc.). 1. INSPECTION/FACILITY VISITS
Applicable/NA 

### A. Total hours of professional level personnel (hrs/year) Amount/NP
a. From cost estimate b. From post-closure plan c. Inspector's estimate B. Unit cost1for professional level personnel ($/hr)
a. From cost estimate C. Total inspection/facility visit cost ($/year)
a. From cost estimate 2. REESTABLISHING FINAL COVER AND VEGETATION A. Area involved (yd2)
a. From cost estimate b. From**post-clo~ure** plan c. From visual inspection B. Unit cost for reestablishing cover and**vegeta~ion** ($/yd2)

1Loaded with costs for support personnel.

-9-

### Appli

### cabLe/NA
a. From cost estimate Amount/NP

C. Reest8blishing cover and ve?ptation cost ($/year)
a. From cost estimate 3. FERTILIZING A. Area involved (yd2)
a. 

### From cost estimate b. From post-closure plan c. Fromvisual inspection B. 

### Unit cost for fertilizing ($/yd2) 

### a. From cost estimate C. Total fertilizing cost ($/year)
a. From cost estimate 4. MOWING A. Area involved (yd2) 

### a. From cost estimate b. From post-closure plan c. Fromvisual inspection B. Unit cost for mowing ($/yd2)


### a. From cost estimate C. Mowing cost (S/year)
a. From cost estimate 5. GROUNDWATER**~~ONITORING** 

### AND WELL REPU.CEMENT A. Groundwater**~onitoring** 

### a. Number ofwells i From cost estimate ii. From post-closure plan iii. From visual inspection I 

# \-------
I b. 

### Unit cost for groundwater monitoring ($/well/year) 1. 

### From cost estimate -10-

### Applicable/NA c. Groundwater monitoring cost ($/year) i. Fromcost estimate B. Well Replacement
a. Average annual number ofwell replacements i. From cost estimate ii. From post-closure plan iii. Ip.spector's estimate b. Unit cost for well replacement ($/replacement ) 

### i. From cost estimate
c. Cost for well replacement ($/year) i. From cost estimate C. Total groundwater**monitor~ng** 

### and well replacement cost ($/year)
a. From cost estimate 6. MAINTAINING AND REPLACING FENCES A. Maintaining Fences
a. Length of fence required (yd) Amount/NP

b. 

### i. From cost estimate ii. From post-closure plan iii. From visual inspection Unit cost for maintaining fences ($/yd) i. From cost estimate
c. Cost for maintaining fences ($/year) i. From cost estimate B. Replacing Fences
a. Length

# 05 fence to be replaced annually (y

### d)
2Note in comment; section whether well replacement component is on annual basis ornot. -11-Applicable/NA i. From cost**esti~ate** ii. From post-closure plan iii. Inspector's estimate b. Unit cost for fence replacement ($/yd) i. From cost estimate
c. Cost of fence replacement ($/year) i. From cost estimate 

### C. Total Cost for**~aintaining** and Replacing Fences ($/year) 

### 7. COLLECTION, REMOVAL AND TREATMENT 

### OF LEACHATE A. Amount of leachate collected (gal./year)
a. From cost estimate b. From post-closure plan 

### B. Off Site Disposal
a. Amount of leachate removed to off site disposal facilities (gal./year) i. From cost estimate ii. From post-closure plan b. Unit cost for off site leachate disposal ($/gal.) i. From cost estimate
c. Unit cost for transport of leachate**($/~d.** /mile) i. From cost estimate d. Transport distance (miles) i. From cost estimate Amount/NP



### 3Total length of fence to be replaced over the entire post-closure period divided by 30 to obtain an annual average. 4No t e in comment section whether fence replncement component is on annual basis or not.

-12-**Applicable/~A** Amount/NP ii. From post-closure plan iii. 

### By map reference
e. Cost of transport ($/year) i. From cost estimate f. Total cost of off-site treatment/ disposal of lenchate ($/year) i. From cost estimate C. On Site Disposal
a. Amount of leachate disposed of on-site (gal.) i. From cost estimate ii. From post-closure plan b. Unit cost of on site leachate disposal ($/gal.) i. From cost estimate
c. Cost of on-site leachate disposal ($/year) i. From cost estimate D. Total Cost for Collection, Removal, Treatment, and Disposal of Leachate
a. From cost estimate 8. ADMINISTRATIVE**FU~CTIONS** A. Hours of management time**req~ired** to adminjster the post-closure**r~an** (hrs/year)
a. From cost estimate 

### b. From post-closure plan c. Inspector's estimate 

### B. Unit for management time5 ($/hr) cost
a. From cost estimate C. Total administrative cost ($/year)

5Loaded

### with costs for support personnel. 

### -13-Applicable/NA
a. From cost estimate Amount/NP

9. OTHER (SPECIFY) ($/YEAR) A. Local land authority notice ($/year) 

### (40 CFR265.119) B. Notice in deed ($/year) 

### (40 CFB. 265.120) 

### C. D. 

### E. (Total Other) 10. TOTAL ANNUAL POST-CLOSURE COSTS ($) 

### A. From cost estimate



### -14-

### COHHENTS

-15-.

### PART 8GROUNDWATERMONITORING
This part of the checklist/questionnaire is applicable to any person who owns or operates a surface impoundment, landfill, land treatment or water pile (final status) facility which is used to manage hazardous waste and therefore is required to maintain a ground watermonitoring network. The ground water monitoring checklist/questionnaire consists of five subparts listed as follows: 1. Hydrogeologic Characterization 2. Ground Water Monitoring Network J. Nonitoring w'ell Installation and Construction 4. Field Inspection 5. Water QualitytResu lts All five subparts apply to interim status facilities and detection monitoring programs under final status. The technical information requirements to assess the adequacy of a ground water monitoring program are the same for an interim status facility and detection monitoring program under finai status. Therefore, even though many of the questions in these subparts reference final status regulations, they are also required, on a technical basis, to assess interim status ground water monitoring programs. A ground water assessment checklist (for interim status facilities where ground water contamination has been detected) and additional subparts for final status ground water monitoring requirements will be added later. Note that in many instances more than one of each subpart may be required for a facility inspection. For example, 3 facility may have three different kinds of well constructions, thus, t.hr e-e monitoring well i.nstal l ation and construction checklisl/'ju('slionnaires may hf' app r o p ria t.e . Subpa rt, 4, Fi(·ld lnspectiou is filled out at the facility during the coruplin nc e iuspertio n . Whenever pos sib l e copies of dr awings and figures listed in i.he clll"cklist/'jucstionnaire should be obtained and attached. These may include but ar e not limited to: 1. An as-buill drawi.ng and geologic log (on one figure) for each monitoring wel l . 2. ""ater table and potentiometric maps 3. Hydrogeologic profiles 4. Site maps such as topogr a phic maps, well location maps, surface water and drainage lIIaps, etc. S. Tabulated
.....ate r quality data. Note that the i.nterim status facilities. federal re guLrt tons ar e relerenced facilities and state regulations in Lhe ('hecklist/questionnaire for are referenced for final status' Space for additional remarks is available at the'end of the checkl.ist. 

# **

# * * **

# *

# **

# ** *

# **

# **

# ** *

# *

# ** * * *

# ***

# ** * * * * *

# **

# * **

# **

### .......---, 

### _.'

1. HYDROGEOLOGIC CHARACTERIZATION 

### A. Regional Hydrogeology (WAC 

### -806(4)(xx)(B))
a. Is the regional hydrogeology and its relationship to the facility characterized? If yes, what, data SOilrces have been useo t.o characterize the regional hydrogeology? (i) Puhlished and other technical reports" Specify the reports used:

(ii) Waterwell logs? (iii) Geotechnical horings?



### (iv) Climatic records?

(v) Surface water records? (vi) On-site geologic mapping? (vii) Other (specify)?

b. Is the on-site and off-site ground water ilse chi!racterized? If yes, does the characterization include the following: (i) .A map showing ground water productionwells and other wells (e.g. neighboring monitoring wells) relative to the site? (WAC 

### -806(4)(a) (xviii)(1) ( i i ) WpI 1 I ()gs f()r ;11 I weI Is (if avaiIaI,II')., liii) Use and use rales for all production wells?


### - 2 - Yes No ....**"~"**

(iv) Pumping and static wate r levels'!

(v ) Effect uf on-site and off-site pumping 011 the ground wat.e r flow direction?
c. Does the regional hydrogeologic characterization include the following: (i) Identification of the principal aquifers (i.e. aquifers heingused or which have potential us o ) that may he potentially af fe c t.ed by the site? (WAC -i306(4)(x){B) Remarks:

(ii) Hydrogeologic profiles showing the relationship of the facility to the principle aquifers? Remarks:

(iii) Water tab l e contour and/or pote ntiome-tric maps fur the principle aquifer s? Remarks: ._-----------_.

--------------- 

### B. Site Hydrogeology
a. List the pertinent hydrologic and geologic"**investigat~ons** ongoing or completed at the facility:
Month/Year Description ofWorkOngoing or Completed (ObLain copies of all reports)



### - 3 -»<

----------------------- ------
b. Is a site map (or site maps) available that shows the following: (WAC -R06(4)(a)(xviii) (i) Waste management areas? (ii) Honito ring well locations? (iii) Site topography?

(iv) Surtacr- w.rtr-r ft':ILllr{'S and d r ainagr-?

(v) On-site water supply wells? (vi) Pe rt.ine nt engineered str uc t.u r e s and operational units? (vii) Is the scale of the map appropriate? Scale used: (viii) North arrow? (ix) Legal boundaries?

(x ) Access controls (e.g. roads, fences ) (xi) Su rface 'Inti bu ried utilitie s?

c. Are the following characteristics of tile up pe rmost aquifer (uppermost monitorable saturated zOlle) defined: (WAC 806(4)(x)(B) (i) Aquifer materials (sand, sandy g r a vel , sandstone, etc.) Specify
------------------"

------- (ii) Thickness and lateral extent? Remarks:



### - 4 -(iii) Continuity beneath and adja ce nt to the sit.e? Remarks:

(iv) Water-table contourmaps and potentiometric maps that show ground water flow directions? Remarks:

(v) Seasonal variation of ground water flow directions? Remarks:

(vi) Effect of ground water use on the ground water flow directions? Remarks:

---------_._----------- (vii) Hydraulic conductivity/transmissivity including lateral and vertical variations? Which of the follo
....·ing methods were us ed to determine hydraulic conductivity! transmissivity a) Estimates from grain size aualyses Describe

- 5

-b) Laboratory tests (permeameter tests) Describe

c) Slug tests Describe

d) Pumping tests Describe

e) Other Describe

(viii) Methods used to evaluate slug tests, pumping tests, etc. Remarks:

(ix) Effective porosity?

(x) Storage coefficient including lalerdl and vertical variations? (xi) Interaction with surface water?
e. Has the relationship of the uppermost aquifer to underlying aquifers been characterized? 

### (WAC -806(4)(xx)(B)) 

# •

- - --

### ------------- 

### - 6 ----". .""

### .

If not, l'xplain

Ifyes, does the characterization include the following: (i) Thickness and extent of low permeability layers separating the aquifers? Remarks:

(ii) Hydraulic conductivity of the low permeability layers?

.Remarks:

(iii) Relative hydraulic heads of the uppermost aquifer and the underlying**aquifers~** Remarks:

f. Have the underlying aquifers been**charact~rized?** 

### lWAC -806(4)(xx)(B) Ifyes, does the characterization of the underlying aquifers include the following: (i) Description of aquifer materials (e.g. sandy gravel, fractured s a nd stcne, etc.)? Describe:



### ---_._._- ...

### _-----

- 7 -(ii) Thickness and lateral extent? (iii) Continuity beneath and ad.jacent to the site?

(iv) Water-table contour maps and potentiometric maps that show ground water flow directions? (v) Seasonal variation of ground water flow directions? (vi) Effect of ground water use on ground water flow directions? (vii) Hydraulic conductivity/transmissivity including lateral and vertical variations? Which of the following methods were used to determine the hydraulic conductivity/ transmissivity. a) Estimates from grain size analyses Describe:

b) Laboratory tests (permeameter tests) Describe:

c) Slug tests Describe:

d) Pumptests Describe:

------ ...._.- --- 

### - 8 - 

# •e) Other Describe:

(viii) Methods used to evaluate slug tests, pumping tests, etc.? (ix) Effective porosity?

(x) Storage coefficient or specific yield including lateral and vertical variations? (xi) Interaction with surface water?



### - 9 -.....:.... '-"-'" "-" -----



### 2. 

### GROUNDWATERMONITORINGNETWORK (265.91, WAC -806(4)(xx)E, -645(8) A. Is a site mapavailable that shows the location of the monitoring wells relative to the waste management areas? B. Upgradient/background monitoring wells. (265.91(a)(1), WAC -645(8)(a)(i))
a. Are upgradient/background monitoring wells designated to determine background water quality? How many background wells? b. Are these wells hydraulically upgradient from the facility? If not, howwere the well locations determined?

c. Are the wells screened over the appropriate saturated zone? Describe:

d. Are the wells placed so they are not affected by the active portion? Describe:

e. If ground watermounding is known to oc cu r beneath the facility, could this influence the water quality of upgradient/background hells? Describe: Yes No

f. Are wells downgradient ofother activities (i.e. non DW) that are known to have



### .afTecI:e 

### o'ground-wa't"er-'qua-!-i'ty'?
.. - 10 -

### c. Downgradient monitoring wells. WAC -645(8)(a)(ii» (265.91(a)(2), .:-"",

a. Specify the number of downgradient wells installed at each management unit?

b. Are the downgradient wells screened 1n the same zone as the upgradient wells? Remarks:

c. Are all downgradient monitoring wells screened over the appropriate saturated intervals? (e.g. at the appropriate depth within the uppermost monitorable zone) Describe:

d. Is the well spacing adequate to detect contaminan't, migration? Ifnot, where should additional wells be installed?

e. Is the ground wate r flow dir e ction verifie.l at least annually to ensure that the wells are adequately placed? (265.93(f), wAC -645l9)(e» f. Do the monitoring wells s howwater leveL variations due to seasonal or hydraulic (e.g. tidal) fluctuations? Remarks:



### --_..

### _---------------

- 11 -,--------------------------
-r-.



### .. ' 

# ----,

3, 

### MONXTORINGWELL INSTALLATIONANDCONSTRUCTION (WAC -645(8)(a) and (c), 265,91(c)) A. Are separate as-built drawings and geologic logs available for each monitoring well? Remarks:



### B. Were all monitoring wells installed and constructed similarly? Ifnot, a separate well installation and construction checklist should be filled out for each type of installation and construction method. Remarks:

C. Well installations for wells

__ through

__ a. Circle the drilling method used to install the monitoring wells: 1) hollow-stem auger, 2) cable tool, 

### 3) top-drive air rotary, 

### 4) downhole air rotary, 5) mudrotary, 6) solid-stem auger, 7) jetting, 8) driving, 9) other (specify)

Ifmudrotary was used specify the kind of drilling fluid used.


### If air rotary was used, were in-line filters installed to remove oil from the compressed air? Yes No

-- -
_..-_._--------------- - 12 -

# -.

Remarks:

for other drilling methods, were any fluids added to the hole at any time during drilling or installation? Ifyes, explain.

b. Circle the soil sampling methods used during drilling. 1) grab, 2) split-spoon sampler, 3) shelby tube, 4) D&M sampler, 5) other, explain

c. Describe the soil sampling interval.

d. was the well logged by an experienced geologist, hydrogeologist, or soils engineer? who?

e. Was the drilling equipment decontaminated prior to arriving on-site? Describe the deeon method.

f. 

### Were the drill, drilling equipment, and temporary casing decontaminated between borings?

- 13

-

### Describe**th~** 

### decon method.

g. Was the sampling equipment decontaminated between samples? Describe the decon method.

D. MonitoringWell Construction for Wells through (WAC -400(3)(c)(v), -645(8)(c), 265.91(c))
a. Wasthe well construction supervised by an experienced hydrogeologist, geologist, or soils engineer? Who?

b. Circle the type of completion: 1) single well 2) nests (or clusters) ofwells in separate boreholes, 3) multiple wells in a single borehole, 4) multiport sampler, 5) other (specify)

c. Circle the casing mateiials used: 1) teflon, 2) stainless steel 304, 3) SCH 40 PVC, 4) 

### SCH 80 PVC, 5) ABS, 6) carbon steel, 7) other (specify)

d
.. Circle the type of coupling used: 1) flush-threaded 2) bell, 3) regular pipe, 4) other (specify)

- 14 - -----**--~-------~~~** 

# •e. Circle the screenmaterial used: 1) teflon. 2) stainless steel 304, 3) SCH 40 PVC, 4) SCH 80 PVC, 5) ABS, 6) carbon steel, 7) other (specify)

f. Describe the type ofbottom plug used.
g. Were any glues or solvents used in the well construction? If yes, specify

h. Was a gravel pack installed? Ifyes, (i) Describe the material, its source, and the method of installation.

(ii) Is a grain size distribution of the gravel pack available? (iii) Was the top of the gravel packmeasured before the backfilling or the well sCJls were installed? Remarks:

I. Were well seals installed? Ifyes, describe the type of seal and the method of installation. (For cement g r outs specify the water/cement ratio, bentonite/cement ratio, etc.)

- 15 -

### ·...-....,

.j. Were bentonite pellets placed in the unsaturated zone? Ifyes, were the pellets hydrated (wetted) after they were installed? k. Wasthe well seal installationmethod appropriate? Remarks:

1. Are the wells properly constructed to prevent contamination of the samples, the sampled waterbearing zones, and between aquifers and waterbearing zones? (WAC -400(3)(c)(v), -645(8)(c) Remarks:

m. Were samples taken of all materials used inwell installation (grout, sand pack, bentonite, well material, etc.)? Remarks:



### E. Well Development for Wells through
a. Were the monitoring wells developed? b. Circle the well developmentmethod: 1) Air lift, 2) pllffiping, 3) overpumping, 4) bailing, S) surge block, 6) raw hiding, 7) other (specify)

c. Describe the equipment used for development.

- 16 -

## .'

d. Describe the duration ofdevelopment.

P.**~lat** was the volume ofwater and sediment removerl during development?

f. Was the development continued until the purged water at all wells was sediment free? Ifnot, explain

g. Was the well development adequate? Ifnot, explain h. Were well yields measured? Ifyes, for whichwells

1. Were drawdowns and recovery measured during water yield determinations? Ifyes, specify:

- 17 -4. '.:.



### FIELD INSPECTI

### ON A. Sampling and Analysis Plan (265.92(a), WAC -645(8) (d) and (e))
a. Are all wells to be sampled identified in the plan? Remarks:

b. Are all the appropriate parameters to be sampled and tested identified in the plan? Remarks:

c. Are procedures for purging the wells prior to sample collection specified? Remarks:

d. Dothese procedures adequately identify: (i) The equipment that will be used for evacuation? Remarks:
(ii) Method of decontaminating equipmenl hetweenwells? Yf>S 

### No

Remarks:**-------~--** 

### (iii) Depth(s) in well orborehole from**~hich** 

### waterwill be evacuated? Remarks:
(iv) Pumping rate and duration (or

### amount as appropriate)? Remarks:**~---------------------**

- IH

-**~.**

(v) Special procedures as necessary for evacuation prior to sampling separate phases of in@iscible contaminants? Specify:

e. Are these p r ocedu r e s identified for well evacuation appropriate? Ifnot, what aspects of the specified procedures are not appropriate and require correction?

f. Do the procedures specified for actual collection of ground water samples from the well adequately identify: (i) Equipment that will be used to collect the sample from the well? (ii) Method ofdecontaminating equipment between wells? (iii) Depth(s) ill the well from which the sample will be taken? (iv) Time between well evacuation and sample collection? (v) Special procedures as necessary for collecting samples from separate phases of immiscible contaminants? g. Are appropriate procedures and equipment identified for the collection of samples?



### - 19 -,----------------- -------- ------- ----

If not, what aspects of the identified procedures are not appropriate and require correction?

h. Dothe sampling procedures clearly identify: (i) Sample containers? (ii) Filtering procedures? (iii) Preservation procedures?

(iv) Chain ofCustody?

(v) Transfer and transport blanks? (vi) Other

i. Are these procedures adequate? Ifnot, what aspects of these procedures are not adequate and require correction?

__

j. Dothe sampling and analysis procedures identify analytical procedures? k. Dothese analytical procedures specify analytical methods for each parameter?

- 20 -1. 

### Are these procedures appr op ri

### at

### e? If

### not, what aspect of the procedures are.not adequate and require**correction~**



### m. Are QA and QC procedures described? n. Are these procedures adequate? Ifnot, what aspect ofthe procedures are not adequate and require correction?

B. Field Inspection

- Well Appearance
a. Are the wells adequately protected? Describe:

b. Are the wells locked?
c. Are the wells vented? d. Are the surface seals sloped away from the well?
e. Does the integrity of the surface seal appear adequate? f. Are the wells clearly labeled? Remarks:

---_. - ----- ---_._----

- 21 -

# ---,

c. Field Inspection

- Well Purging
a. Specify the method ofpurging: 1) air lift, 2) centrifugal pump, 3) peristaltic pump, 4) gas-contact positive displacement pumps, 5) non-gas-coniact positive displacement pumps 6) bailer, 7) electric submersible pump, 8) other 

### •

------------



### b. Is this method ofpurging suitable for the parameters to be tested? Remarks:

c. Describe the make and model ofthe purging equipment.

d. Is the depth of the intake measured to verify that it is properly positioned in the well? Remarks:

e. Is the volume ofwater removedmeasured? Specify the volume ofwater removed

- 22 -f
0 I

### s the pumping/removaI 

### r at

### e mea s u r ed? 

### Ifyes, what is the pumping rate?

g. Is the purging equipment adequately decontaminated between wells? (i) 

### Describe decon methods

(ii) Describe deconmethods that require correction

D. Field Inspection-Sampling Procedures (WAC -645(8)(d) and (3))


### a. Are the samples obtained immediately after purging? If 

### "No," specify the time that elapses be twe en purging and sampling Is this elapsed time appropriate for the parameters being tested? Remarks:

_________________ 0

_



### b. Are the samples obtained by the same pers011nel during each sampling episode? Remarks:



### - 23 -c. Circle the samplingmethod used: 1) air lift, 2) centrifugal pump, 3) peristaltic pump, 

### 4) electric submersible pump, 

### 5) gas-contacl positive displacement pump, 

### 6) 1l01l-gas-conlacl positive displacement pump, 7) bailer, 8) other (specify)

d. Describe the make and model of the sampling equipment.

e. Is the sampling procedure consistent with the parameters to be tested? Remarks

f. Is the sampling equipment dedicated to the well? (i) Ifnot, describe the decontamination procedures betweenwells.

(ii) Are the decontamination procedures 3dequate? Remarks:

f. Are water levels measured: 

### (265.92(3), WAC 

### -645(8)(f)) (i) prior to sampling? (ii) during sampling?

Describe the method

- 24 - 

# •

### g. Is the depth ofthe sampling intake measured to verify that it is properly positioned in the well? h. Describe the samplingmaterials that the sample water comes in contact with. (e,g. PVC, teflon, stainless, etc.) (i) Suction tubing/piping

(ii) Discharge tubing/piping

(iii) Pump/baler

Remarks

l. 

### Are special methods used to prevent sample aeration? Remarks

J. 

### Are the samples field filtered for: (i) metals? (ii) others (specify)

Ifyes, what is the filter pore size and which**br~nd** 

### of filters are used?



### - 25 - 

# •

# .---.

k. Are all samples sediment free? Ifnot, specify the wells with sediment

1. Are the types ofbottles used consistenc with the parameters to be tested (see Table I)? Remarks

m. Whatparameters are tested in the field: (i) 

### pH? Specify metermake and model (ii) Specific conductance? Specify metermake and model (iii) Temperature? Specify thermometer make and model (iv) Eh (Redox potential)? Specify meter make andmodel n. Are the field instruments calibrated? Describe the calibration methods.

o. Are the field sampling procedures consislenl with the sampling and analysis plan?



### - 26
... 

## •

### Describe inconsistencies

p. Are the current**~ampling** 

### procedures consistent with past samplingprocedures? q. Are differences significant? Explain

r. Has the same laboratory been used for all sampling episodes? Ifnot, list the laboratories as follows: Sampling Episode (Month/Year)

Remarks Testing Laboratory

- 27 --- - - -------**.~**



### E. Field Inspection

- QA/QC Procedures (WAC -645(8)(d)(iv»)
a. Are the sample bottles properly cleaned prior to samp1ing? Remarks

b. Whatkinds ofQA/QC samples are used: (i) 

### Duplicates? Howmany? (ii) Sample preservative blanks? Howmany? (iii) Transport blanks? Howmany?

.(Lv ) Spikes? Howmany? (v) Transferblanks? Howmany (vi) Other Describe

c. Are the appropriate sample holding times observed? (SeeTable 1) Remarks 

### -_._._------

----------------------------- - 28 -

## .----

d. Are the samples labeled wi

### th the following: (i) 

### Sample number (ii ) 

### Well number (iii ) 

### Data and time sampled

(iv) Name of. sample collector

(v) Preservatives Remarks

e. Is abound field notebookmaintained to record pertinent sampling events and procedures? Remarks f. Does the field notebook record the following: (i) Well number? (ii) Samplenumber? (iii) Namesof sample collectors?

(iv) Signature of sampler?

(v) Samplingmethod? (vi) Presampling purging data (e.g. volume and rate of purging)? (vii) Fieldmeasured parameters (pH, specific conductance, Eh, temperature)? (viii) Water level measurements? g. Is a chain-of-custody record maintained? I f "Yes," does it record the following: (i) 

### We11 number? 

### (ii) Sample number? (iii) Date and time collected?

(iv) Signature of sampler?
- 29 -

### (v) Signature.of**wito~ss?** 

### (vi) Tests to be conducted? (vii) Signatures ofall intermediate handlers and time and date ofhandling? (viii) Signature of receiving laboratory representative and time and date received? 

### h. Are the chain-of-custody procedures adequate to maintain sample integrity? Remarks

- 30 -

### 5. 

### WATERQUALITYRESULTS (INTERIM STATUS) (265.92(b)) A. Does the waterquality dataobtarned to**dat~** 

### include:
a. Drinkingwater**parameters:(T~ble** 

### 1), one year of quarterly samples? Remarks

b. Groundwaterquality parameters (Table I), (i) 

### Oneyear ofquarterly samples? (ii) Annual samples after the first year? Remarks

c. Indicatorparameters (Table 1) (i) Oneyear ofquarterly samples, four replicates each sampling episode? (ii) Semiannual samples thereafter, four replicates for each samplingepisode? Remarks

B. Haveinitial background concentrations been determined for the following parameters (Table I)?
a. Drinking water parameters? b. Waterquality parameters? Remarks

--_.-

### -_.. -_._-------

- 31 - 

### Yes No 

## •------

--- ------------ ---------------

., -_

### .. 

# •

•:;'
. c, ' : '.:'
. . '
.i'.r:j". ;;''-,
. <': '.

.:. .-!"\'.-, 

### C. For upgradient/backgroundwetHr

### nave.t.he:.foll!owing·
. beendetermined for the indicatorparameters:
a. Initial background arithmetic mean? b. Initial background variance? Remarks

D. Have initial background concentrations beendetermined for the following parameters (Table 1).
a. Drinking waterparameters? b. Water quality parameters? Remarks

E. Forupgradient/batkgr6undwells have the following beendetermined for the indicatorparameters:'
a. Initial background arithmetic mean? b. Initial backgroundvariance? Remarks

F. Foreach ofthe downgradientwells'after the first year 'ofquarterly samples were the foltowing determined for the indicatorparameters: a. Arithmetic mean based on at least fOur replicates per sampling episode? b. VAriance based on.at**l~ast** 

### four· replicates per sampling episode? Remarks



### - 32 -

### G. Werethe initial backgroundvalues for the indicator parameters statistically compared to the semiannual samples after**<thefirst·'ye~l1.fp:r::' ",~/** 

### , •.'.:, ':. 

### a. The upgradient/backgroundwells? b. The downgradient wells? Remarks

H. Was the student t-test at the .01 level of**s~gnificance** 

### used for .t

### he statistical**cOlI)pa);~i~on?'** 

### '.-:,,;";:' Remarks

<, •



### I. Havethe comparisons shown a statistical increase'(or decrease ofpH) over initial background for:
a. The upgradientwells? If**yes~** 

### was this information**submitte~.with** 

### the annual reported.dat.a" 

## "'·',',',:.;t'.:**r'~** "'."""'" . ,**:'_.~** '0 } 'J"
. 

### Remarks

-: .•11,"
... -, ••••• :•

• • 'l._**~.** • ..... .-

_•• 

### b. Thedowngradient wells?**I~** 

### yes, were the following**com~leted?** 

### (L) ,Werewells showi

### ngi.i

### nc re.as e (o r..'pH(,1ecrease), ;resampLed**~nQ** 

### ,:tested?,. :**.,.~:_**

... " '. (it) (ii i ) 

### Remarks • - ,"**~:** • .., -. • 'C ,.. 

### Etology was notified within**~ev~ndays** 

### after**-the,inG~~as~.(or** 

### pH 4ecrea&e)**.~aS co~fi~med?'**  • "." "; "1••.••••. 

### Aground water

### assessment~ planwas

### s~bmitted to Eco logy,

### wit..hi-P 15,:9aY5 aft.e.r,the notifi

### cati

### on?

. . - .., • !. I. t •.:' . • ..... : ". -.

.'.
. .i';
.I: .;-.' .';:.,. 

### Additional Remarks: ... --"

, ." "::."':.-"

- t":"···

_ J • II

.

# -

::..

• '.;-1 .'',r.

r: ;.4'
..

...';'-. .:'J!

;,.

### .'
:[1'

_ -"f

.,.--..--..

·s-:'
... ''''.

# -

:.... ..... », ":iJI\.**---._---.~~-** . -.

----**~~_** ..**-----:-:--._-~~~_._~-** ----------.,--:-;--;-:";.'- 34 -.J 

## I

Table' SAMPLINGANDPRESERVATIONPROCEDURES INTERIMSTATUSPARAMETERS

;..'11**,.~**.."

Pro,e (sterilized) MaximumHolding

....Time
.

300ml 200 ml(2)

200 ml 1 gallon 100 ml '000ml '000 ml MinimumVolume

30hours(2)(3) 6..

:months·
. 28 days 6 months

"24--hours'" 24hours

.--_.. ..**_~** .. .. . Fiela.Aci.dified· topH<2with 

### r:HN03 Preservation

FieldAcidified .... t.opH<2wjth.,
.. HN03 FieldAcidified
.,--to·iil·j''<Twitti·- HN03

..,4-&e-' _._._- . FieldAcidifi.ed to pH<2withHN03 ...._.",
...**,..FicJd.Ac.i.d'Lf5.~q** .. topH<2 with HN03

T,P,G' T,e T,Pro

P,G Gp(2)



### , T,P, Container

Coliform

."-'baderia "-Fluoride Parameter

Nitrate

..Endrif:l

Lindane Methoxychlor -Ioxephene 2,4D

.**.~4** !S
..!P.S!Ivex

Radium Gross Alpha

.Cross-Beta DrinkingWater

... 'ArsenicBarium Cadmium ""'''CnrOniium Lead

.....Sel eniurn

Silver Mercury

-- --. . 

### _."_
.._.. T,P 28 days .- ..CroundWater-.OualHy ·Chloride Iron Manganese

..._...**'~od-H:!ffl'** Phenols T,p,e

G "'" '--F'i'eld'Acidi'fied*'

_...-.--·_..6-
..**month~.** ---.

_ topH<2 with

.._ .. J:lNO,3

__.... _.".""_"'."

__...""_"_.'.'

__....... 4°C/H 2S0 4to pH<.2.:
.. __._._._ 50 ml 1000ml
500ml . T,p,e 28 days 50 ml Ground WaterContamination

..·-·-.. pW··· "'Spec'Hic

conductance


### .,..roc._-...

-TOX . ·T,p,e· P,G 

### e, Tef 1on Itrrect cap, no head space G,**Amber~'** ....- Teflonlinedcap, noheedspue-. ,. ..**None~** He.teL DetermineCl

.None-:.Fie.td.

Determined

### Cool--4~CTtl2S0t+(21. topH<2 'Cool'4°C;"add
, ml of0.' M ._s.odium**sulfi~~** None

...-.."28...days.

.._

...

_-......**-r-d~"** ......- .-..-- 25'ml 100ml 40ml(2) 500ml(2)



# _. .e..

__ - Polyethlene C .: Glass'"
... Pro· Polypropylene 

### ·.r....**~._.Teflon** ... *Intheevent·thatHNO cannotbe usedbecauseof s.hippingrestrictionsthe

...'sampleshould-be'

### ref.r~qerat-ed·-to**4-~C,-shippe.d·imneDi.aU!.l)'** and
...

### a.cidi.f.ie~ on receiptatthe laboratory. ThecontainershouldberingedwithHN03•

- .- ..-**-~--~ For'samplesfromnonchlorinated** drinki~g****~a'ter**"suppHes"concfir;t'r=iitecnf,S04

shouldbe addedtolowersamplepHtolessthan2. Analyze samplewitnin 14days. (') 

# nr-**~~~:;"'samPl-E!" ~'e'q;;i;-;;~~nts**  (Rev'.''',

### 2/84', StandardMethods, 16thEd., 1985 .**.~** \..