U n it e d St a t e s

En v ir on me n t a l Pr o t e cti o n

Ag e n cy



### FINAL Draft

- March 2 9 , 2016



# R C R A H a z a r d o us

W a s t e P a rt A

P erm i t

A pp lica t i o n

Ins t ru ct i o ns and F o r m

E P A F o rm 8700

- 23

( O M B # 20 50

- 0 0 2 4 ; E x p i r es ?? / ?? / ??? )O ff ic e o f R e s ou rc e C on s e r va t i o n an d R e c o v e r y ( O R C R )

( 5 3 0 3 P)

Wa s h i n g t on

, D C 2 0 4 60

R C R A H a z a r dou s Wa s te P a r t A P e r m i t A ppl ic a t i o n

I n s t r u c t i on s an d Fo r m

Th e R e s our c e C on s e rv a t i o n a n d R ec ov e r y A c t (RCR A ) S e c t i o n 3005 r e qu i r e s t h e U

. S

. Env i ron m e n t al P ro tect i o n A ge n c y ( E P A ) to e s t a b lish

p e r mi t t i n g r e qu i r e m e n t s a pp li c a b le t o h a z a rdou s w as t e t r e a t m e n t

, s t or a ge

, o r d is po sal fa c il i t i e s ( T S D F s). Th e own e r a n d op e r a t o r o f a T S D F

m u st ob t a i n a p e r mit as r e qu i r e d und e r 4 0 C F R Pa r t 270. R e s pond e n t s m u st s ub m i t t h e i n f or ma t i o n r e qu i r e d in t h e RCRA H a z a rdo u s W as t e

Pa r t A P e r mit App li c a t i o n [ E PA F o r m 8700

- 23] (Pa r t A P e r m i t App li c a t i on ) f o r a fi r st p e r mit a pp li c a t i o n o r f o r a r e v is e d p e r mit a pp li c a t i on

.

O w n e r s a n d op e r a t or s o f f ou r t yp e s o f T S D F s a r e s ub j ec t t o th e r e qu i r e m e n t s: n e w f a c il i t i e s no t y e t c on s t r u cte d ; n ew ly r eg u l a te d e x is t i n g

fa c il i t i e s s ub j e c t t o RC R A p e r mi tt i n g r e qu i r e m e n t s f o r t h e fi r st t im e ; p e r m i t t e d fa c il i t i e s w i th n ew ly r eg u la te d un i t s; a n d i n te r im s t a t u s fa c il i t i e s.

Th e E PA nee d s i n f or ma t i o n c on t ai n e d in t h e a pp li c a t i o n t o i d e n t ify t h e p e r s on (s) l eg ally r e s pon si b le f o r h a z a r d o u s w as t e a c t i v i t y

, t o

d ete r mi n e w h i c h fa c ili t i e s r e qu i r e p e r mi t s und e r m or e t h an o n e pro g r am, to ass e ss po te n t ial f o r t h e fa c ili t y t o p o ll u t e n e a rb y g r o un d

a n d s u r fa c e w a te r s, t o i d e n t ify t h e t im e f r ame a v aila b le f o r th e E PA t o pro ce ss p e r mit a pp li c a t i on s, a n d t o d ete r mi n e t h e s p e c if i c w a s te s a

fa c i li t y is l eg ally all o we d t o h a nd le f o r d iff e r e n t p u rp o s e s. Th e E PA m u st e n s u r e t h at h a z a r d o u s w as te s a r e ma n a ge d in a w ay t ha t pro tect s

hu man h e al t h a n d t h e e nv i ron m e n t as r e qu i r e d b y RCR A

. Th is is ma n d a t or y r ep or t i n g b y t h e r e s po n d e n t s.

Th e E PA e n te r s Pa r t A P e r m i t App li c a t i o n i n f or ma t i o n s ub mi tte d b y r e s pond e n t s i n t o RC R A I n f o

, t h e E PA n a t i on al d a t a b as e

, a n d iss u e s

p e r mi t s. Th e E PA u s e s t h is i n f or ma t i o n t o i d e n t ify t h e un i v e r se o f r eg u la te d w as t e T S D F s a n d t h e ir s p ec ific r e g u la te d h a z a rd o u s w as t e

a ct i v i t i e s. T h e E PA also u s e s t h e i n f or ma t i o n f o r t r a c ki n g a n d p l a nn i n g a n d f o r a v a r i et y o f e n f or ce m e n t a n d i n s p ect i o n p u rpo s e s.

F i n all y

, t h e E PA u s e s t h is i n f or ma t i o n t o e n s u r e t h a t : h a z a rd o u s w a s te s a r e ma n a ge d p rop e r l y ; T S D F s a r e op e r a te d a n d mai n t ai n e d as

r e qu i r e d ; s t a t u t or y pr o v isi on s a r e uph e l d ; a n d t h at r eg u la t i on s a r e a dh e r e d t o b y fa c ili t y o w n e r s a nd op e r a t or s.

Se c t i o n 3007( b ) o f RCRA a n d 4 0 C F R Pa r t 2, S u b p a r t B, w h i c h d e fi n e s t h e E P A’ s ge n e r al po l i c y o n p u b lic d is c l o s ur e o f i n f o r ma t i on

, bo t h

c on t ain p r ov isi on s f o r c on fi d e n t iali t y

. H o we v e r

, t h e A ge n c y do e s n o t a n t i c i p a t e th at bu s i n e ss e s w ill ass e r t a c laim o f c on fi d e n ti ali t y c ov e r i n g

all o r p a r t o f t h e P a r t A P e r mit A pp li c a t i on

. If s u c h a c laim we r e ass e r te d

, t h e E PA m u st a n d w ill t r e at t h e i n f or ma t i o n in a cc ord a n c e w i t h

t h e r eg u la t i on s c i te d a bov e

. T h e E PA also w ill ass u r e t h at th e i n f or ma t i o n c o ll ect i o n c o m p li e s w i t h t h e P r i v a c y A c t o f 1974 a n d O M B Ci r c u lar

10 8.

Es tim a t e d B u r d e n : Th e r e por t i n g b u rd e n as s o c ia te d w i t h t h e Pa r t A P e r mit A p p li c a t i o n r e qu i r e m e n t s is e s t i ma te d t o a v e r a g e 12 hour s

f o r a fa c ili t y t o pr e p a r e a n d s ub mit a n e w o r r e v is e d Pa r t A Pe r mit App li c a t i o n a n d as s o c ia te d do c u m e n t a t i on

. Th e r ec ord k ee p i n g bu r d e n is

e s t i m a te d t o a v e r a g e 4 hour s f o r a f a c ili t y t o r e ad t h e r eg u l a t i on s.

To comment on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested method s for

minimizing respondent burden, inclu ding the use of automated collection techniques, the EPA has established a public docket for the Information

Collection Request (ICR) under Docket ID Number EPA

- HQ

- OLEM

– 2016

– 0182 , which is available for public viewing at the RCRA Docket in the EPA

Docket C enter (EPA/DC), EPA West, Room 3334, 1301 Constitution Ave., NW, Washington , D.C. The EPA Docket Center Public Reading Room is

open from 8:30 a.m. to 4:30 p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading Room is (202) 566

- 1744 and the telephone number for the RCRA Docket is (202) 566

- 0 270. An electronic version of the public docket is available through EPA

Dockets (EDOCKET) at http://www.epa.gov/dockets/r egulations.htm

. Use EDOCKET to submit or view public comments, access the index listing

of the contents of the public docket, and to access those documents in the public docket that are available electronically. Once in the system,

select “search,” then key in the docket ID number identified above. Also, you can send comments to the Office of Information and Regulatory

Affairs, Office of Management and Budget, 725 17 th Street, NW, Washington, D.C. 20503, Attention: Desk Office for EPA. Please include t he EPA

Docket ID Number EPA

- HQ

- OLEM

– 2016

– 0182 and OMB Control Number 2050

- 0024 in any correspondence.iii

3 

## T AB L E O F C O N TE N T S

T h e R C R A H aza rdou s Waste P a r t A P erm i t A pp li c at i o n

.............................. . ......... ............ . .......................... 1

I n tr odu cti o n

............................... . ............................... . ............................... . ............................... . ........ ...... . 1

W ha t ’ s N e w

............................... . ............................... . ...................... ......... . ............................... . ........ ...... . 2

W h e re to G e t H e l p

............................... . ............................... . ............................... . ....................... ............. . 2

E xi s ti n g F a cilit i e s

....................... ........ . ............................... . ............................... . ............................... . . ...... . 3

N e w F a ci l iti e s

............................... . ............................... . ............................... . ............................. .. . .. .......... . 4

Fir s t P a rt A S ub m i s s i o n

............................... . ............................... . ............................... . .......................... ... . 4

R ev i s e d P a rt A S ub m i s s i o n

............................... . ........................... .... . ............................... . . .............. . ........ . 5

D e t erm i n i n g i f Y o u Mu st F i l e

............................... . ............................... . .................. .... . ............................... . . 6

W h o M u s t File a R C RA Haza r dou s W a s te P e r m it A pp lic a ti o n ?

............................... . .............. . . ................ . 6

Ho w Do I K no w if I Hand le a R e g u l a t e d Ha z a r dou s W a s t e ?

............................... . ............................. ........ . 6

O f f

- s i t e F a cilit i e s

..................... .......... . ............................................... . ............................... . .............. . ..... . 6

O n

- s i t e

F a cilit i e s

............................... . .................. ........... . ............................... . ............................. .. . .................... . 6

H o w To F il e A R C R A H aza rdou s Waste P erm i t A pp li c a t i o n

............................... . ..................... . ..................... 8

Ho w M an y P e r m it A pp lic a ti o n s S hou ld I Fil e ?

............................... . ..................... ......... ................. . .......... . 8

C a n I R e qu es t t ha t t h is I n f o r m a ti o n b e K e p t C on f i d e n ti a l?

............................... . ............................... . .. .... . 8

W h e re S h o u ld I S e n d My C o m p l e t e d P e r m it A pp lic a ti on ?

.............................. . . ........................... ............ . 9

W h e n S h o u ld I File My P e r m it A pp lic a ti on ?

............................... . ............................... . ............. .. . ............. . 9

W h e n S h o u ld My P e r m it A pp lic a ti o n b e R ev i se d ?

.......................... ..... . .... .......................... ................. . . . 10

F a ciliti e s O p e r a ti n g U nd e r I n t e rim St a t u s

............................... . .......................... ...................... . .......... . 10

F a ciliti e s O p e r a ti n g U nd e r a R C RA Haza r dou s W a s te P e r m it

. .............................. . ................. ............. . 11

I n st ruc t i on s f o r F illi n g O u t t h e R C R A S ub t i t l e C Si te I den t i f ic at i o n ( Si te I D ) F or m

....................... .. ............ 12

W h o M u s t S ub m it t h is F o r m

............................... . ...... ......................... . ............................... . ... .... . ........ . ... . 12

P u r po s e o f t h is F o r m

............................... . ............................... . ............................... . ...... .......... . .............. . 12

Ho w to Fill O u t t h is Form

............................... . ............................... . ............................... . ................. ........ . 12iii

4 It em

- B y

- It e m I n s tr u cti o n s

............................... . ............................... . ............................... . ... ........... .. . ....... . 13

It e m 1

– R e a s o n f o r S ub m itt a l

............................... . ............................... . ............................... . . ........... . 13

It e m 2

– Site E PA ID Nu m b e r

............................... . ........................... .... . .......................... .................... . 15

It e m 3 an d 4

– Site N a m e an d L o c a ti o n

............................... . ............................... . ............ ... . .............. . 15

It e m 5

– Site L an d T yp e ...............................

. ....... ........................ . .................... ........................... . ...... . 16

It e m 6

– No rth A m e ric a n I ndu s try C l as s i f i c a ti o n S y s t e m ( N A I C S) C od e ( s )

.......................... ................ . 16

It e m 7

– Site M a ili n g A dd r e s s

........................ ....... . ............................... . ........................... ................... . 17

It e m 8

– Site C on t a ct P e r s o n

............................... . ............................... . ......................... ...................... . 17

It e m 9

– L e g a l O w n e r an d O p e r a t o r o f t h e

. Sit e

............................... . ........................... .................... . .. . 17

It e m 10

– T yp e o f R e g u l a t e d W a s te Act i v it y

............................................. . ........................ . ..... . .. . . ....... . 19

. It e m 11

– D e s cri p ti o n o f Haz a r dou s W a s t e s

............................................. . .......................... . .. . ... . . ...... . 27

It e m 12

– No ti f ic a ti o n o f Haza r dou s S e c onda ry M a t e ri a l ( H S M) Act i v ity

.............. . ................... . ... . .... . 28

It e m 13

– C o m me n t s

............................... . .............................................. . ............................... . ...... . .... . 28

It e m 14

– Ce rt i f ic a ti o n

............................. ...... ........... . ............................... . .................. ............. . ... . ..... . 28

A ddendu m t o t h e Si te I den t ifi c at i o n F orm : No t ifi c at i o n o f H aza rdou s S econd a r y M at er i al A c t i vi ty

.... ..... . 29

Y o u M u s t Fill O u t t h is S e cti o n

............................... . .... ....... ........ . ............................... . .. ............. . .............. . 29

It e m 1

– I nd ic a te R e a s o n f o r No ti f ic a ti o n (i n cl ud e da t e s w h e re r e qu e s t e d )

............... . ......... . ............. . 30

It e m 2

– De s cri p ti o n o f E xcl ud e d Haza r dou s S e c onda ry M a t e ri a l ( H S M ) Ac t i v it y

........ . ....... . ............. . . 31

It e m 3

– F a cility ha s Fi nan ci a l A ss u r an c e P u r s uan t to 40 C FR 261.4( a ) (24 ) ( v i )

............. . .... ... .............. . 34

I n st ruc t i on s f o r F illi n g O u t t h e H aza rdou s Waste P erm i t i n f orm at i o n F or m

................... . ....... . ... .. ............... 36

Ge n e r a l I n s tr u cti on s

............................... . ............... . ............................... . .............................. .. . . ............... . 36

It em

- B y

- It e m

I n s tr u cti o n s

................ ...... ............... . ............................... . ............ ................... . ............................. .. .. . ....... . 36

It e m 1

– F a cility P e r m it C on t a ct

............................... . .............. . ............................... . ............ .. ............. . 36

It e m 2

– F a cility P e r m it C on t a ct M a ili n g A dd r e s s

.............................................. . ................. .. .............. . 36

It e m 3

– O p e r a t o r M a ili n g A d d r es s an d T e l e ph o n e Nu m b e r

........................................... . .... . ............. . 36iii

5 It e m 4

– F a cility E xi s t e n c e D a t e

.............. ................. . ............................... . ............... . .......................... . 37

It e m 5

– Ot h e r En v ir on m e n t a l P e r m i t s

............................... . .................... . .......................... . ............... . 37

It e m 6

– Na t u re o f B u s i n e s s

............................. . ................................................. . ............................... . . 38

It e m 7

– Pr o c e s s C o d e s an d D es ign C apa ci t i e s

............................... . ............................................... . ... . 38

It e m 8

– Ot h e r Pr o c e s s e s

............................... . ......................... . ..................... . ............................... . .... . 38

It e m 9

– De s cri p ti o n o f Haza r dou s W a s t es

............................... . ............... . ........................ ....... . ......... . 38

It e m 10

- M a p

............................... . ............... . ............................... . ............................... . ..................... . 39

It e m 11

– F a cility Dr a w i n g

............... . ............................... . ....... ........................ . ............................... . .. . 40

It e m 12

– P ho t o gr aph s

............... . ............................... . ............................... . ............................... . ....... . 40

It e m 13

- C o m me n t s

.. .............. . .......... ..................... . ............................... . ............................... . ........... . 40

Ot he r Re f erenc e I n f o rm at i o n a n d C od e L i sts

............ ....... .. . ..................... . .......... . ............................... . ....... 42

E xcl ud e d W a s t e s

................. . ............................... . ............................... . ............................... . ..................... . 43

D ef i n iti o n s

................. . ............................... . ............................... . ................ ............... . ............................... . 45

E PA Haza r dou s W a s te C od e s

. ................ . ............................... . ............................... . ............................... . .. . 55

Haza r dou s S e c onda ry M a t e ri a l ( H SM) F a c i lity C od e s

. ...... .......... . ............................... . ............................. . 55

Haza r dou s S e c onda ry M a t e ri a l ( H SM) L and

- B a se d U n it C o d e s

................. . ............................... . .............. . 53

Management Method C od e s

. ................ . . .......... .................... . ............................... . ............................... . .. . 58

# T h is p age i n t en t i on ally l e f t b l a n k1



## T H E R C R A HA Z A R D O U S W A S T E P A R T A P E R M I T A P P L I C A T I O N

I N T R O D U C T I O N

T h e R e s o u r c e C o n s e r v at i o n a n d R e c o ve r y A ct (RCR A ) r e qu ir e s a n yo n e w h o o w n s o r o p e ra t e s a facil i t y

w h e re h a z ar d o u s w a ste is t r e at e d

, s t o r e d

, o r d is p o s e d t o h a v e a RCRA h a z ar d o u s waste p e r m it iss u e d b y

t h e U .S

. E n v i r o n m e n tal P r o tect i o n Ag e n c y ( E P A ). T h is b o o klet i s d esi gn ed t o h e l p yo u d e t e r m i n e if y o u are

subject to RCRA hazardous waste permitting r e qu ir e m e n ts. T h e i n str u c ti o n s c o n tai n e d in t h i s b oo k l e t

will a s sist yo u in star t i n g t h e p e r m i t ti n g p r o c e ss b y c o m p l e ti n g a n d s ub m itti n g a RCRA H a z ar d o u s

Was t e P art A Pe r m it App licat i o n [ E P A F o rm 8 7 0 0

- 2 3 ] ( P art A Pe r m it App licat i o n ) o r in mo d i f y i n g y o u r

h a z ar d o u s waste p e r m it b y s ub m i tti n g a r e v is e d a pp licat i o n

.

T h e re are t wo p ar t s to a R CRA Ha z ar d o u s Was t e Pe r m it App licat i o n

– P art A a n d P art B. P art A o f t h e

RCRA Hazardous Wa s te Permit App licat i o n c o n sists o f E P A F o r m 8 7 0 0

- 2 3 ( i n cl ud e s both t h e RC R A

Sub title C S ite I d e n tificat i o n F o r m a n d t h e H a z ar d o u s Waste Pe r m it I n f o r m at i o n F o r m ), a l o n g with m a p s

, d ra w i ng s, a n d ph o t o g ra p h s, as r e qu ir e d b y 4 0 C F R 2 70

. 1 3

. P a r t B o f t h e RCRA h a z ar d o u s wa s te p er m i t

a pp licati o n c o n tai n s d e ta i le d

, sit e

- s p e cif i c i n f o r m at i o n

. T h e re is n o f o rm f o r t h e P art B P e r m i t App licati o n ;

r a t h e r, t h e P a rt B Pe r m it App lic a ti o n m u st b e s u b m it t e d in n arra t i v e f o r m a n d c o n t ain t h e i n f o r m a ti o n

d e scri b e d in a pp lica b le s e ct i o n s o f 4 0 C F R 2 70

. 1 4 t h r o ug h 27 0

. 27.

N OTE A lt h o ug h t h is bo ok l e t c o n tai n s i n f o r m at i o n a n d i n s t r u cti o n s f o r c o m p leti n g a P art A Pe r m it

App licati o n

, i t s h o u ld n o t b e c o n si d e r e d a s ub stit u t e f o r t h e r e gu lat i o n s in Tit l e 4 0 o f t h e C o d e

o f F e d e ral R e gu lat i o n s ( 4 0 C F R). Rat h er, t h is bo o kl e t ser v es as a s upp l e m e n t to t h e r e gu lati o n s

a n d p r o v i d e s a dd iti o n al i n f o r m ati o n n o t c o n tai n e d i n 4 0 C F R. A s an o w n e r o r o p e ra t o r o f a

h a z ar d o u s waste tr e a t m e n t, st o ra g e

, o r d is po sal faci l i t y

, y o u are r e s p o n si b le f o r lear n i n g a n d

c o m p l y i n g w i th all t h e r e q u ir e m e n ts t h a t a pp ly to y o u a n d t h e o p e ra t i o n s at y o u r facilit y

.

In a dd iti o n

, r e m e m b e r t h at t h is b o o kl e t a n d t h e r e gu lati o n s in 4 0 C F R a dd r e ss on ly t h e F e d e r a l

h a z ar d o u s was t e p r o g r a m

. M a n y S ta t e s m ay h a v e h a z ar d o u s was t e p e r m itti n g re qu ire m e n ts

t h at d iffer fr o m t h e F e d e r al re qu ire m e n ts; t h o s e S t a tes m ay u se E P A F o r m 8 7 00

- 2 3 f o r t h e

P art A Pe r m it App licati o n s ub m iss i o n o r t h e y m a y u se a si m ilar S t a te f o r m t h at r e qu ir e s

i n f o r m a ti o n no t r e qu ested in t h e E P A f o r m

. Ag ai n

, i t is y o u r r e s p o n si b ili t y to m a k e s u r e t h at

yo u h a v e c o m p let e d a n d s ub m itt e d all f o r m s r e q u ir e d und e r t h e F e d e ral o r y o u r S ta t e

p r o g ra m

.2 T h e R C RA Haza r dou s W a s te P a rt A P e r m it A pp lic a ti on

(c on ti nu e d)

W H A T ’ S N E W

B e l o w a r e a list o f c h a ng e s t o t h e R CRA H a z ar d o u s Waste P art A Pe r m it App licati o n I n str u ct i o n s a n d

F o r m s.

C L A R IFI E D T H E D E F I N I T I O N OF L A R G E QU A N T I T Y G E N ER A T O R ( L Q G )

A lt h o ug h c u rr e n t RCRA r e gu lati o n s d o n o t s p e cif i cally d e fi n e t h e t e r m “ lar g e qu a n tity g e n e r a t o r ” ( L QG )

,

t h e y d o d e fi n e t h e t e r m s “ c o nd iti o n al l y e x e m p t s m all qu a n tity g e n e ra t o r ” ( C E S QG) a n d “ s m all qu a n ti t y

g e n e ra t o r “ ( S QG). T hu s, a L QG i s a g e n e ra t o r t h a t is n o t a CE S QG o r S QG. F o r pu r p o s e s o f clarit y

, t he

d e fi n iti o n o f L QG h as b ee n r ev i s e d t o d e scri b e all t h o s e sit u at i o n s w h e re a g e n e r at o r w o u ld b e a L QG.

C L A R IFI E D T H E D E F I N I T I O N O F S M A L L Q U A N T I T Y G E N ER A T O R ( S Q G )

A S QG is d e fi n e d at 4 0 C F R 260

. 1 0 as a si t e t h at g e n e rates less t h an 1

, 0 0 0 ki l o g r a m s (k g ; 2

, 2 0 0 p o und s

[ l b s ] ) o f h a z ar d o u s w a ste i n a c al e nd ar m o n t h

. Ho w eve r

, t h ere are o t h er sit u a ti o n s w h e r e a g e n era t o r

c o u ld g e n e ra t e s m all a moun ts o f ac u t e h a z ar d o u s w aste list e d in s e ct i o n s 2 6 1

. 3 1 o r 26 1

. 3 3 (e ) ; a n d a n y

r e si du e s o r c o n t a m i n at e d s o il, was t e

, o r o t h e r d e b ris r e s u lti n g f r o m t h e c l e a nu p o f a s p ill, i n to o r o n a n y

la n d o r w at e r, o f a n y ac u te h a z ar d o u s w a st e s list e d in s e ct i o n s 2 6 1

. 3 1 o r 2 6 1

. 3 3 ( e ) a n d still m ai n tain i t s

r e gu lat o r y s tat u s as a S QG. T h e r e f o r e

, f o r pu r p o s e s o f clari t y

, t h e d e fi n iti o n o f S QG h as b ee n r e v is e d t o

d escri b e all t h o se sit u a ti o n s w h e r e a g e n era t o r w o u ld c o n ti nu e t o b e a S Q G. T h e E P A p la n s t o m a ke t h e

a pp r o p riate c o n f o r m i n g c h a ng e to t h e o u t d a t e d d e fi n i ti o n o f S QG at 4 0 C F R 2 6 0

. 1 0 in t h e f u t u r e

.

C L A R IFI E D T H E D E F I N I T I O N O F C O N D I T I O N A L L Y E X E M P T S M A L L Q U A N T I T Y G E N ER A T O R

( C E S Q G )

A CE S QG is d e fi n e d at 4 0 C F R 2 6 1

. 5( a ) as a site t h at g e n erates l ess t h an o r e q u al to 1 0 0 k g ( 2 2 0 l b s) o f

h a z ar d o u s wa s te in a ca l e nd ar m o n t h

. H o w e v e r, as f o un d in 4 0 C F R 2 6 1

. 5 ( e )

, a g e n e r a t o r al s o m a y

g e n e ra t e s m all a m o un ts o f acute h a z ar d o u s was t e list e d in s e ct i o n s 2 61

. 3 1 o r 2 6 1

. 3 3 ( e ) ; a n d a n y

r e si du e s o r c o n t a m i n at e d s o il, was t e

, o r o t h e r d e b ris r e s u lti n g f r o m t h e c l e a nu p o f a s p ill, i n to o r o n a n y

la n d o r w a t e r, o f a n y a c u te h a z ar d o u s wa s t e s lis t e d in s e c ti o n s 26 1

. 3 1

, o r 2 61

. 3 3 ( e ) a n d still m ai n tain i ts

r e gu lat o r y s tat u s as a CE S QG. T h e r e f o r e

, f o r pu r p o s e s o f clarit y

, t h e d e fi n it i o n o f C E S QG h a s b e e n

r ev i s e d t o d e scri b e all t h o s e sit u at i o n s w h e re a g e n e r at o r w o u ld c o n ti nu e t o b e a CE S QG.

UPDATED TO REFLECT 2 015 DEFINITION OF SO LID WASTE FINAL RULE

On January 13, 2015, EPA published the Definition of Solid Waste (DSW) final rule (80 FR 1694), which revised

the regulations related to certain exclusions from s olid and hazardous waste regulation. Changes have been

made to the Site ID form, particularly to the Addendum to the Site ID Form, to reflect this final rule.

OTHER CHANGES

1) Changes were made to the list of Excluded Wastes, and Hazardous Secondary Materi al (HSM) Facility

Codes;

2) New fields added to Site ID:

Owner: Added telephone number, extension, and notes field and

Operator: Added address, telephone number, extension, and notes field;3 T h e R C RA Haza r dou s W a s te P a rt A P e r m it A pp lic a ti on

(c on ti nu e d)

3) HSM Addendum: removed Financial Assurance question.

W H E R E T O G E T H EL P

We r e ali z e t h at t h e r e gu lati o n s a r e c om p l ex. A lt h o ug h we a r e n o t p r o v i d i n g re p ri n ts o f t h e 4 0 C F R

r e gu lati o n s in t h is bo o kl e t, c o p ies o f t h e F e d e ral r e g u lati o n s are a v aila b le f r o m t h e E P A (s e e b e l o w). A

list o f S t a te a n d E P A R e g i o n al Off i c e a dd r e ss e s

, c o n ta c t n a me s

, t e le p h o n e nu m b e rs, a n d e

- m a il

a dd r e ss e s a r e l o ca t e d a t : https://www.epa.gov/sites/production/files/2016

- 03/documents/conta ct02172016.pdf

.

In a dd iti o n to t h o se c o n ta c ts, t h e re are s e ve r al o t h e r s o u rc e s a v aila b le t o h e lp with yo u r qu e st i o n s a n d

p r ov i d e i n f o r m at i o n o n E P A r e gu lati o n s :

R C R A F REQ U E N T L Y A S K E D Q U E S T I O N S

T h is all o w s u s e rs to fi n d a n sw e rs t o c om mo n l y as ke d qu e sti o n s t h a t c o v e r a w i d e ra ng e o f RCRA iss u e s

a n d t o p ics. F i n d at: h tt p : // waste.s up p o rt p o r tal. c o m / i cs / s u p p o r t / d e f a u lt.as p ? d e p tI D = 2 3 0 2 3

.

R C R A O N L I N E

T h e RCRA O n li n e d ata b a s e is d e si gn e d t o e n a b l e u s e r s to l o c a te d o c u me n ts, i n c l ud i n g pub licati o n s a n d

o t h e r o u tr e ach m at e ria l s t h at c o v e r a wi d e r a ng e o f R C RA iss u e s a n d t o p ics. F i n d a t :

h tt p : / / w ww

. e p a. g o v / rcr a on li n e

.

R C R A R E G U L A T I O N S

T h e F e d e ral r e gu lat i o n s c a n b e f o un d a t : h tt p : / / w ww

. gp o

. g o v / f d s y s /

.

C O M P L I A N C E A S S IS T A N C E C E N T ER S

T h e E P A h as s p o n s o r e d p art n e rs h i p s with i ndu s t r y , aca d em i c i n stit u t i o n s, e n v i r o nm e n tal g r o up s, a n d o t h e r

a g e n c i e s t o l a u n c h s e c t o r

- s p e cific C o m p l i a n c e A s s i s t a n c e C e n t e r s ( C e n t e rs). E ach

C e n t e r a dd r e ss e s r e al w o rld iss u e s in und e r s ta nd a b le l a ngu a g e f o r y o u t o und e rsta n d F e d e ral

e n v ir o n me n tal r e qu i r e m e n ts a n d ho w to sa v e m o n e y t h r o ug h p o ll u ti o n p r e ve n t i o n t e c hn i qu e s. V isit

t h e C o m p lia n c e A ssista n ce C e n t e rs a t : h t t p : / / w ww.assi s ta n ce c e n te r s. n e t

.

E P A N A T I O N A L C O M P L I A N C E A S S I S T A N C E C L E A R I N G H O U S E

T h e C o m p lia n ce A ssi s ta n ce Cleari ngh o u s e is a c om p r e h e n si v e s o u r ce o f c o m p lia n ce assis t a n ce i n f o r m a ti o n

a n d r e s o u r c e s. U se li n k s to F e d e ral, S t at e

, l o cal, a n d o t h e r c o m p lia n ce a s sista n c e p r ov i d e rs to fi n d t h e

t o o ls y o u n e e d

. V is i t t h e C o m p lia n ce A ssis t a n c e Cleari ng h o u se at:

h tt p : / / w ww

. e p a. g o v / c o m p lia n ce / ass i sta n c e / i nd ex. h t ml

.

E P A S M A L L B U S I N E S S O M B U D S M A N O F F I C E

1

- 8 00

- 3 6 8

- 5 8 8 8

.4 T h e R C RA Haza r dou s W a s te P a rt A P e r m it A pp lic a ti on

(c on ti nu e d)

Y O U R T R A D E A S S O C I A T I O N

E X I S TI N G F A C I L I T I E S

Existi n g h a z ar d o u s w a ste m a n a g e me n t f a cilities a r e t h o se h a z ar d o u s wa s te t r e a t me n t, s t o ra g e

, o r d is p o sal

facil i ties (T S D F s) w h ich w e re in o p e rat i o n o r f o r w h ich c o n str u c ti o n h ad c om me n c e d o n o r b e f o re

N o v e m b e r 19

, 1 9 80

, o r w h ich we r e in ex i ste n ce o n t h e eff e cti v e d ate o f t h e s tat u t o ry o r r e gu lat o r y

a m e ndm e n ts t h at r e nd e r t h e facili t y s ub j e ct t o t h e r e qu ir e m e n t t o o b tain a RCRA p e r m it. RCRA

e s ta b lis h e d a p r o c e d u re f o r o b tai n i n g i n t e rim s t at u s t h at al l o w s t h e se e xis t i n g facilities t o c o n ti n u e

o p e ra t i n g un til a fi n al h a z a r d o u s wa s te p e r m i t is i s s u e d

.

Y o u m u st s u b m it a P art A P e r m it App licat i o n c o m p let i n g all f o r m s i n cl ud e d in t h i s bo ok l e t. If y o u d o n o t

file a No tificat i o n o f R CR A Sub title C A cti v i ty a n d c o m p l e t e t h e P art A P e r m it App lic a ti o n b y t h e

d e a d li n e s s p e cif i e d in t h e “ W H E N S HOULD I F I L E M Y PER M I T A PP L I C A TI O N? ” se c ti o n o f t h ese i n str u cti o n s,

yo u will b e r e qu ir e d b y law t o h alt yo u r o p e ra t i o n s un til a RC RA h a z ar d o u s w aste p e r m it is iss u e d

.

F acility o w n e rs o r o p e r a t o r s with i n t e r i m stat u s are t r e at e d as h a v i n g b ee n iss u e d a p e r m it un til t h e E P A

r ev i e ws t h e P a r t B Pe r m it App licati o n a n d iss u e s a R C RA h a z ar d o u s wa s te p e r m i t. Y o u m ay s ub m i t yo u r

P art B Pe r m it App licat i o n v o l un taril y ; h o w e v e r, y o u a r e n o t r e qu ir e d t o s ub m i t it un til it is r e qu e st e d b y

t h e E P A

. Y o u will t h e n h a v e u p t o six m o n t h s to s ubm it t h e P art B Pe r m it App lic a ti o n

.

N E W F A C I L ITI E S

N e w h a z ar d o u s was t e m a n a g eme n t facilit i e s are t h o se h a z ar d o u s w a ste T SDF s w h ich w e re n o t in

o p e rat i o n o r f o r w h ich c o n str u cti o n h ad no t c o mm e n c e d o n o r b e f o r e No v e m b e r 19

, 1 9 80

. O w n e rs o r

o p e ra t o rs o f n e w h a z ar dou s waste m a n a g e me n t fac i lities m u s t s ub m it b o th P a r t s A a n d B o f t h e RC R A

H a z ar d o u s Was t e P e r m it App licati o n at l e ast 1 8 0 d a y s b e f o re ph y s i cal c o n st r u cti o n o f t h e facil i ty i s

ex p ec t ed to c om m e n c e. In a dd iti o n

, t h ese o w n ers o r o p er a t o rs a r e n o t al l o w ed to b e g in ph y sic a l

c o n str u c ti o n o f t h e n e w f a cility o r t o t r e at, s t o r e

, o r d is p o se o f h a z ar d o u s was t e s un til r e c e i v i n g a RCRA

h a z ar d o u s wa s te p e r m it. A s s u c h

, n e w faciliti e s d o n o t r e c e i v e i n t e r i m st a t u s. I n a dd iti o n

, n e w facilit i e s

are t h o s e facilit i e s t h at are n e wly s ub j e c t t o t h e r e qu i r e m e n t t o o b tain a R C RA h a z ar d o u s was t e p e r m i t

( e .g

., t h r o ug h t h e E P A’s p r om u l g at i o n o f a n e w h a z a r d o u s w a ste listi ng ). A n a pp licati o n f o r a p e r m it

m ay b e s u b m it t e d a n y t i m e af t e r p r o m u l g at i o n o f t h o se sta nd ar d s in 4 0 C F R s ub j e cti n g t h e facili t y t o

h a z ar d o u s wa s te p e r m i tti n g r e qu ir e m e n ts.

Mo s t S t a te go v er n m e n ts are a u t h o ri z ed b y t h e E P A to a d m i n ist e r h a z ar d o u s wa s te m a n a g e m e n t p r o g ra m s

in l i e u o f t h e F e d e ral RCRA p r o g ra m

. Y o u s h o u ld c o n ta c t y o u r S tate h a z ar d o u s was t e m a n a g e me n t a g e n cy

t o d e t e r m i n e a n y a dd it i o n al S ta t e r e qu ir e me n ts. Y o u will n ee d to c o m p ly w ith t h e s p e cific p e r m it

a pp licat i o n re qu ire m e n ts o f t h a t S ta t e.

T h e f o ll o wi n g i n str u ct i o n s p r ov i d e s p e cific i n f o r m at i o n f o r c o m p leti n g a n d s u b m itti n g a P art A Pe r m it

App licati o n u si n g t h e f o r m s i n cl ud e d in t h is b oo k l e t. T h e i n str u ct i o n s al s o p r ov i d e g e n e r al i n f o r m at i o n

f o r c o m p leti n g a P art B Pe r m it App licat i o n

. If, aft e r r e a d i n g t h e i n str u ct i o n s, yo u h a v e a n y qu e st i o n s

r e g ar d i n g t h e R C RA h a z ar d o u s w a ste p e r m it a pp licat i o n p r o c e ss, c o n tact y o u r S t ate R e p r e s e n tat i v e w h o

can a n sw e r y o u r qu e st i o n s a n d h e lp y o u und e rsta n d t h e F e d e ral a n d S ta t e re qu i r e m e n ts t h a t a pp ly to

yo u

. A list o f S t a te c o n t ac t s is a v aila b le a t : https://www.epa.gov/sites/production/files/2016

-5 T h e R C RA Haza r dou s W a s te P a rt A P e r m it A pp lic a ti on

(c on ti nu e d)

0 3/documents/contact02172016.pdf

.

F I R S T P A R T A S U B M I S S I O N

B o th n e w a n d e xisti n g fac i lities t h at tr e a t, st o r e

, o r d is p o se o f r e gu lat e d h a z ar d o u s was t e a r e r e qu ir e d

to s u b m it a P a r t A Pe r m it A pp licati o n in a c c o r d a n c e w i th t h e d e a d li n e s s e t f o r t h i n t h e “ W H E N S HOULD I

F I LE M Y P E R MI T A P P L I C A TI O N? ” se c ti o n o f t h e se i n str u cti o n s. Ow n e rs o r o p e ra t o rs o f facilit i e s t h a t

h a v e n o t p r e v i o u s l y s ub m i tt e d a P art A P e r m i t App li c ati o n will n ee d t o s u b m it a p e r m it a pp licat i o n f o r

t h e first t i me

. Ex a m p les o f facilities m aki n g t h e ir fi r st P a r t A s ub m iss i o n are n e w facilit i e s o r e xi s ti n g

f acilities t h at b e c o m e n e w ly s ub ject t o t h e r e qu ire m e n t to h a v e a RCRA h a z ar d o u s was t e p e r m it. Y o u

s h o u ld m a r k t h e b o x in It e m 1 o f t h e RCRA Sub tit l e C S ite Id e n tificat i o n F o r m ( S ite ID F o r m ) t o i nd ica t e

as a c o m p o n e n t o f a fi r st RCRA H a z ar d o u s Was t e P art A P e r m i t App lic a ti o n

. T h is bo ok l e t c o n t ai n s

i n f o r m a ti o n a n d i te m

- b y

- i t e m i n str u ct i o n s f o r c o m p l e ti n g b o th t h e S ite ID F o rm a n d t h e H a z ar d o u s

Waste P er m i t I n f o r m a ti o n F o r m.

R E V I S E D P A R T A S U B M I SS I O N

T h e re a r e s e ve ral c o nd it i o n s und e r w h ich a f acili t y t h at h as p r ev i o u sly s ub m it t e d a P art A Pe r m i t

App licati o n m u s t r ev i se t h at first s ub m iss i o n t o r e fl e ct c h a ng e s t h at h a v e o cc u r r e d at t h e facili t y

. B o th

f aciliti e s o p e ra t i n g und e r i n t e rim s t at u s a n d facil i ties o p e ra t i n g und e r a RCRA h a z ar d o u s was t e p e r m i t m ay

fi n d it n e c e ssa r y to r e v ise t h e ir P art A Pe r m it A p p licati o n

. Y o u s h o u ld m ark t h e b o x in It e m 1 o f t h e S ite

ID F o r m t o i nd ic a te a s a c o m p o n e n t o f a r e v i sed R C RA H a z ar d o u s Was t e P art A Pe r m it App licati o n

.

If t h e o w n e r o r o p e ra t o r o f t h is facili t y h as c h a ng e d si n ce t h e f a cility last s u b m itt e d t h e P a r t A Pe r m it

App licati o n

, b e s u re t o s ub m it a R e v is e d P art A P e r m i t App licati o n

. T h e c o nd it i on s r e qu iri n g s ub m issi o n

o f a R e v i s e d P art A Pe r m i t App licat i o n are s u m m ar i z e d in t h e “ HOW T O F I LE A R C RA H A Z A RD O US

W A S TE PER M IT A PP L IC A T I O N ” s ect i o n o f t h is bo o k let. T h ere is al s o i t e m

- b y

- it e m i n str u ct i o n s f o r

c o m p l e ti n g bo th t h e S i t e I D F o r m a n d t h e H a z ar d o u s Waste P e r m i t I n f o r m at i o n F o rm c o n tai n e d in t h is

b oo k l et.D e t e r m i n i n g if Y o u M u s t Fi l e

(c on ti nu e d)

6 

## D E T E R M I N I N G I F Y O U M U S T F I L E

W H O M U S T F I L E A R C R A H A Z A R D O U S W A S T E P E R M I T A P P L I C A TI O N ?

T h e R e s o u r c e C o n s e r v at i o n a n d R e c o v e ry A ct o f 1 9 7 6 (RCR A ), a s a me nd e d

, r e qu ir e s e a ch p e r s o n o w n i n g

o r o p e ra t i n g a facil i ty f o r t h e t r e a t me n t, s t o ra g e

, o r d is p o sal o f r e gu la t e d h a z ar d o u s waste t o h a v e a

RCRA h a z ar d o u s w a ste p e r m it. T h is i n cl ud e s i nd i v i du als, tr u st s

, fi r m s, j o i n t s t o ck c om p a n i es, F e d e r al

a g e n cies, c o r p o r a ti o n s ( i n cl ud i n g g o v e r nm e n t c o r p o ra t i o n s), p ar t n e rs h i p s, as s o ciat i o n s, S ta t e s

,

m un ici p alities, c om m iss i o n s, i n t e rst a te b o d i e s, o t h e r p o litical s ubd i v is i o n s o f a S tat e

, o r I nd ian tri b e s ( o r

an a u t h o ri z e d I nd ian tri b e o r g a n i z ati o n ). If y o u t r e a t, st o r e

, o r d is p o s e o f r e gu lat e d h a z ar d o u s wa s te

wit h o u t o b tai n i n g a p e r m i t

, y o u m ay b e s ub j e c t t o a c i v il o r cr i m i n al p e n al t y

.

B o th n e w a n d e xisti n g fac i lities t h at tr e a t, st o r e

, o r d is p o se o f r e gu lat e d h a z ar d o u s was t e a r e r e qu ir e d

to s ub m it a R C RA H a z ar d o u s Was t e P art A P e r m it App li cati o n [ E P A F o r m 8 7 0 0

- 2 3 ] ( P art A P e r m it

App licati o n ) a s d e s cri b e d i n 4 0 C F R P a r t 2 7 0

. F o u r t y p e s o f faciliti e s a r e r e qu ir e d t o s u b m it t h e P a r t A

Pe r m it App licati o n : n e w f a cilities n o t y e t c o n s tr u ct e d ; n e w l y r e gu lat e d e xi s ti n g f a cilities s ub j e ct t o RCRA

p e r m i t ti n g r e qu ir e m e n ts f o r t h e fir s t t i m e ; p e r m it te d facilities w i th n e w l y r e g u lat e d un its; a n d i n t e r i m

stat u s facil i ties.

In an i n sta n ce w h e r e t h e S tate m ay h a v e a n ew l y re g u lated un it, a P a r t A P er m i t App licati o n is r e qu ire d

. Add i n g n e w un its f o r tr e a t i ng

, st o ri ng

, a n d d is p o si n g o f w a ste cr e a t e s a c h a ng e to t h e facili t y ( b e it an

e xisti n g facili t y o r i n t e rim stat u s facil i t y ) w h ich w o u l d r e qu ire a R ev i s e d P a r t A Pe r m it App lic a ti o n

, a s

doe s a m a j o r pe r m i t m od i f ic a t i on.

C o n ta c t y o u r S t a te if y o u h a v e qu e s ti o n s a b o u t t h e a pp lica b ility o f t h e P a r t A Pe r m it App licat i o n f o r m t o

yo u r f a cilit y

. A list o f P a r t A Pe r m it App licati o n c o n t a cts can b e f o un d at:

https://www. epa.gov/sites/production/files/2016

- 03/documents/contact02172016.pdf

.

H O W D O I K N O W I F I H A N D L E A R E G U L A T E D H A Z A R D O U S W A S T E ?

O F F

- S I T E F A C I L I T I E S

Ow n e rs o r o p e r a t o r s o f o ff

- site faciliti e s t h at tr e at, st o r e

, o r d is p o s e o f s o lid wast e s, as d e fi n e d b y

40 C F R 2 6 1

. 2

, are e n c o u ra g e d to o b tain i n f o r m at i o n o n t h e s o lid was t e s t h e y r e c e i v e f r o m g e n e ra t o rs. If

t h e g e n e r a t o rs will no t s u pp ly t h is i n f o r m at i o n

, y o u are still r e s p o n si b le f o r d e t e r m i n i n g if t h e s o lid wast e s

yo u h a nd le are al s o h a z ar d o u s was t e s t h at a re r e gu lat e d b y RCR A

. To d o s o

, y o u s h o u ld f o l l o w t h e

p r o c e du r e s f o r o n

- si t e faciliti e s t h at a r e d es c ri b ed b el o w.

O N

- SI T E F A C I L I T I E S

G e n e ra t o rs w h o tr e a t, s t o r e

, o r d is p o s e

, o n

- s i t e

, t h e ir o wn s o lid w a st e s ( a s d e fi n e d b y 40 C F R 2 61

. 2 ),

s h o u ld em p l o y t h e f o l l o w i n g p r o c e du r e s in d e t e r m i n i n g if t h e ir s o lid was t e s a r e h a z ar d o u s was t e s t h a t are

r e gu la t e d b y RCR A

. T h is d e t e r m i n at i o n is m a d e as f o l l o w s :• F irst, y o u n ee d t o d e t e r m i n e if t h e s o lid waste h a nd l e d is e xcl ud e d f r o m r e gu l a ti o n und e r RCR A

.

T h e li s t o f e x cl u si o n s can b e f o un d in t h e r e gu lat i o n e n titled “ I d e n tificat i o n a n d L isti n g o f

H a z ar d o u s Was t e

, ” 40 C F R 2 6 1

. 4

. If t h e s o lid was t e s h a nd led are e xcl ud e d

, a R CRA h a z ar d o u s

waste p e r m it is n o t n ee d e d to trea t

, st o r e, o r d is p o s e o f t h e s e s o lid wa s tes. If t h e s o lid was t e

h a nd l e d is n o t e xcl ud e d b y 4 0 C F R 2 61

. 4

, y o u n e ed to d e t er m i n e if t h e s o lid wa s te h a nd led is a

h a z ar d o u s w a ste t h at is r e gu lat e d und e r RCR A

. A s d e scri b e d b e l o w, t h e E P A r e gu lat e s a s o lid

waste a s a h a z ar d o u s wa s te b y s p e cif i cally listi n g i t as a h a z ar d o u s was t e o r b y assi gn i n g it a

g e n e ric h a z ar d o u s wa s te c o d e b e ca u s e it p o s se ss e s a n y o f t h e f o u r h a z ar d o u s wa s te

c h aract e ri s tics.

• If t h e s o lid wa s te h a nd l e d is n o t e xcl ud e d b y 4 0 C F R 2 61

. 4

, y o u n e e d t o d e t e r m i n e if i t is a

h a z ar d o u s was t e t h at is l i s t e d in 4 0 C F R P a r t 2 61

, Su b p art D

, “L i s ts o f H a z ar d o u s Wast e s

. ” If yo u

o wn o r o p e r a te a facili t y w h e re l i st e d h a z ar d o u s w a ste is tr e a t e d

, s t o r e d

, o r d i s p o s e d

, y o u a r e

s ub j e ct t o r e gu lat i o n a n d m u st file a R CRA H a z ar dou s Waste Pe r m it App licat i o n

, un less t h e

h a z ar d o u s wa s te h as b ee n e x e m p t e d as d e s cri b e d b e l o w.

• If t h e s o lid was t e h a nd led i s no t l i st e d in 4 0 C F R P art 2 6 1

, Subp art D

, t h e s o lid w aste m ay still b e

a h a z ar d o u s waste i f it po s s e ss e s c e r t ain c h ara c t e rist i cs o r c o n tai n s c e r t ain c o n t a m i n a n ts. T h e s e

c h aract e ri s tics a n d c o n t a m i n a n ts are d e scri b e d in 4 0 C F R P a r t 2 6 1

, Subp art C

, “ C h aract e rist i cs o f

H a z ar d o u s W a s t e

. ” A d e t e r m i n a ti o n t h at a s o lid waste po ss e s s e s t h e se c h aract e ri s tics o r

c o n t a m i n a n ts m a y b e m a d e b as e d o n e i t h e r:

1

. Y o u r k n o w l e dg e o f t h e h a z ard c h aract e ri s tic o f t h e s o lid w aste in li gh t o f t h e

m a t e rials o r p r o c e s s e s u se d ; o r

2

. T h e r es u lts o f t esti n g t h e s o lid waste a c c o r d i n g to t h e m et h o d s in 4 0 C F R P a r t 2 6 1

, Subp art C.

If y o u o wn o r o p e r a te a facility w h e r e c h ar a ct e ri s t i c h a z ar d o u s was t e is tr e a t e d

, s t o r e d

, o r

d is p o s e d

, yo u a re s ub j ec t to r e gu lat i o n a n d m u s t file a RCRA H a z a r d o u s Was t e P e r m it App licati o n

,

un l e ss t h e h a z ar d o u s w a ste h as b ee n e xe m p t e d a s d e s cri b e d b e l o w.

• If t h e h a z ar d o u s waste t h at y o u h a nd le h as b e e n e x em p t e d und e r 4 0 C F R 2 61 .5 o r 4 0 C F R

2 6 1

. 6 (a ) ( 3 )

, y o u a r e n o t s u b j e ct t o r e gu lati o n a n d d o n o t n e e d t o file a R CRA H a z ar d o us Wa s te

Pe r m it App lic a ti o n

.

In a dd iti o n

, c e r t ain o t h e r p e rs o n s w h o h a nd le h a z a r d o u s w a ste are n o t r e q u ir e d to o b tain a R CRA

h a z ar d o u s wa s te p e r m i t. T h e y a r e :

• G e n e ra t o rs w h o a cc u m u l ate t h e ir o wn h a z ar d o u s waste o n

- si t e f o r less t h an 9 0 d a y s as

p r ov i d e d in 40 C F R 2 6 2

. 3 4 ;

• F ar me rs w h o d is p o s e o f h a z ar d o u s wa s te p e stici d e s fr o m t h e ir o wn u se as p r o v i d e d in 4 0 C F R

2 6 2

. 7 0 ; a n d

• Ow n e rs a n d o p e ra t o rs o f t o tally e n c l o s e d tr e a t m e n t facilities as d e fi n e d in 40 CFR 2 6 0

. 1 0

.

7Ho w to File a R C RA Haza r dou s W a s te P e r m it A pp lic a ti on

(c on ti nu e d)

8 

## H O W T O F I L E A R C R A H A Z A R D O U S W A S T E PE R M I T A P P L I C A T ION

A s n o t e d a bo v e

, t h e re a r e two p ar t s to t h e RCRA H a z ar d o u s Was t e P e r m i t A pp licati o n

– P art A a n d

P art B. A s r e qu ir e d b y 40 C F R 2 7 0

. 1 3

, t h e P a r t A P e r m it App licati o n d efi n es t h e p r o ce s ses to b e u sed f o r

tr e a t me n t

, s t o ra g e

, a n d d i s p o sal o f h a z ar d o u s wast e s; t h e d e si g n ca p aci t y o f s u ch p r o c e s s e s; a n d t h e

s p e cific h a z ar d o u s w ast e s to b e h a nd led at a faci l it y

. T h e R C RA H a z ar d o u s Waste P art A Pe r m it App licati o n

[ E P A F o r m 8 7 0 0

- 2 3 ] ( P a r t A P e r m i t App li cati o n ) is s u b m it t ed b y c o m p leti n g t h e t w o f o r m s i n cl ud e d in t h is

b oo kl e t: t h e RCRA Sub title C S ite I d e n tificati o n F o rm ( S i t e ID F o r m ) a n d t h e H a z ar d o u s Waste P e r m i t

I n f o r m a ti o n F o r m

.

T h e P art A P e r m it App lic a ti o n s e r v e s as a v e h icle t h r o ug h w h ich an o w n e r o r o p e r a t o r m ay s u b m it

facilit y

- s p e cific i n f o r m at i o n to t h e r e gu lat o r y a u t h o r i t y a n d k ee p t h is i n f o r m a ti o n c u rr e n t. A s s p e cified

b y 4 0 C F R 2 70

. 14 t h r o u g h 2 7 0

. 2 7

, t h e P art B P e r m it App licat i o n r e qu ir e s d e tai l e d s i t e

- s p e cific

i n f o r m a ti o n s u ch as g e o l o g ic, h y d r o l o g ic, a n d e ng i n ee ri n g d ata. T h e P a r t B Pe r m it App licat i o n is s ub m it t e d

in n arra t i v e f o r m

.

H O W M A N Y P E R M I T A P P L I C A T I O N S S H O U L D I F I LE ?

Y o u n e e d s ub m i t o n ly o n e RCRA H a z ar d o u s Wa s te P e r m it App licat i o n ( P art A a n d P art B) p e r facili t y

,

p r ov i d e d t h at y o u d e s cr i b e all o f t h e act i v it i e s at t h at facili t y

. If you conduct hazardous waste

acti v i t y (i e s) a t m o re t h an o n e facili t y

, y o u m u st s u b m it a s e p ar a te RCRA H a z ar d o u s W a ste P e r m i t

App licati o n ( P art A a n d P art B) f o r e ach facili t y l o c ati o n

. Y o u al s o m u st h a v e an E P A I d e n tific a ti o n Nu m b e r

f o r e a ch o f t h e fa c ilities.

N OTE O n ly o n e RCRA H a z ar d o u s Waste P e r m it App licat i o n i s r e qu ir e d p e r facili t y

. A t s o m e p o i n t, y o u

m ay b e r e qu ir e d t o s ub m it r ev i s e d a pp licat i o n s to upd ate y o u r fi r st P art A Pe r m it App lic a ti o n

s ub m issi o n

. A t a n y g i ve n ti m e

, t h e fir s t s ub m i s si o n a n d a n y s ub s e qu e n t r e v is e d s ub m issi o n s

r e p r e s e n t t h e P art A Pe r m i t App licati o n f o r y o u r facili t y

.

C A N I R E Q U E S T T H A T T H I S I N F O R M A TI O N B E K E P T C O N F I D E N T I A L ?

A ll i n f o r m at i o n s ub m i tt e d i n t h is f o rm will b e s ub j e c t to pub lic d iscl o s u r e

, t o t h e e xt e n t p r ov i d e d b y t h e

F r ee do m o f I n f o r m at i o n A ct, 5 U .S. C. S e ct i o n 5 52

, a n d t h e E P A ’s B u si n e ss C o n fi d e n tiality R e gu lati o n s

,

40 C F R P art 2 a n d 40 C F R 2 70

. 12

. Cla i m s o f c o n fi d e n tiality f o r t h e n a m e a n d a dd r e ss o f a n y p e r m i t

a pp lica n t o r p e r m itt e e will b e d e n ie d

. P e r s o n s fili n g t h is f o rm m ay m a k e cla i m s o f c o n fi d e n tial i ty f o r

c e r t ain i n f o r m a ti o n

. Su ch clai m s m u st b e cle a rly i n d icat e d b y s u b m itti n g an attac h me n t li s ti n g t h e s p e cific

i n f o r m ati o n f o r w h ich c o n fi d e n tial t r e a t me n t is r e qu e s t e d at t h e t i m e o f fili ng

. T h is a t tac h me n t m u st

i n cl ud e a wr i tt e n s ub sta n tiati o n o f t h e cla i m f o r c o n fi d e n tiali t y t h a t a n s w e rs t h e f o l l o wi n g qu e sti o n s :9

• W h ich s e c ti o n s o f t h e P a rt A P e r m it App licat i o n f o rm c o n tain t h e i n f o r m at i o n y o u cla i m is

e n titled to c o n fi d e n tial t r e at m e n t?

• F o r ho w l o n g is c o n fi d e n ti a l tr e a t me n t d e si r e d f o r t h e i n f o r m a ti o n ?

• W h at me as u r e s h a v e yo u tak e n to gu ard a g ai n st u nd e sir e d d i sc l o s u re o f t h e i n f o r m at i o n t o

o t h er s ?

• To w h at ex t e n t h as t h e i n f o r m ati o n b een d isc l o s ed t o o t h ers, a n d w h at p reca u ti o n s h a v e b een

tak e n in c o nn e c ti o n with t h at d iscl o s u r e ?

• H as t h e E P A o r a n y o t h e r F e d e ral a g e n c y m a d e a p e r t i n e n t c o n fi d e n tiality d e t e r m i n at i o n ? If s o

,

i n cl ud e a c o p y o f s u ch d e t e r m i n at i o n o r r e f e r e n ce t o i t

, if a v aila b l e

.

• Will d iscl o s u re o f t h e information b e li k e ly t o r es u lt in s ub sta n tial h a r m f u l e ff e c ts o n yo u r

c o m p e tit i v e p o s i ti o n ? If s o

, w h at w o u ld t h o s e h a r m f u l e f f e cts b e a n d w h y s h o u ld t h e y b e

v ie w e d as s ub sta n tial? E x p lain t h e ca u sal r e lat i o n s h ip b e t w ee n d i s cl o s u r e a n d t h e h a r m f u l effects.

I n f o r m a ti o n c o v e r e d b y c on fi d e n tiality cla i m a n d t h e a b o v e s ub sta n tiat i o n will b e d iscl o s e d b y t h e E P A

o n ly to t h e ex t e n t a n d b y m ea n s o f t h e p r o ce du r e s s et f o rth in 4 0 C F R P art 2 a n d 4 0 C F R 27 0

. 12

.

If n o claim o f c o n fi d e n tiali t y o r n o s ub s t a n tiat i o n ac c o m p a n ies t h e i n f o r m ati o n w h e n it is s ub m itt e d

, t h e

E P A m ay m ake t h e i n f o r m a ti o n a v aila b le to t h e pub lic wit h o u t f u r t h e r n o ti c e t o t h e s ub m i t t e r.

W H E R E S H O U L D I S E N D M Y C O M P L E T E D P E R M I T A PPL I C A T I O N ?

Y o u s h o u ld s ub m it t h e RC R A H a z ar d o u s W a ste P e r m i t App licati o n t o yo u r S tate o r E P A R e g i o n al c o n tact.

A list o f S ta t e C o n ta c ts can b e f o un d a t : https://www.epa.gov/sites/production/files/2016

- 03/documents/contact02172016.pdf

.

M a n y S tat e s u se t h e f o r m i n cl ud e d at t h e e n d o f t h is b oo k l e t ; s o m e al s o r e qu ire a dd iti o n al i n f o r m at i o n

.

Ot h e r S ta t e s r e qu ire t h at yo u c o m p le t e a n d s ub m it a S tat e

- s p e cific f o r m

. T h e C o n t a ct list i nd ic a t e s

w h ich f o r m to u s e

. E v e n if yo u u se t h e i n cl ud e d f o r m

, y o u s h o u ld c h e ck with you r S tate to d e t e r m i n e if

yo u n e e d t o s ub m i t a dd it i o n al i n f o r m at i o n

. A l s o

, c on tact y o u r S t a te if yo u h a v e a n y qu e st i o n s a b o u t

yo u r s u b m iss i o n

.

W H E N S H O U L D I F I L E M Y PE R M I T A PPL I C A T I O N ?

A s r e qu ir e d b y 4 0 C F R 2 70

. 10

, t h e d e a d li n e s f o r fili n g RCRA H a z ar d o u s Was t e Pe r m it App licat i o n s a r e :

E X IS T I N G F A C I L I T I E S

U nd e r 4 0 C F R 2 7 0

. 1 0 ( e ), e xisti n g facilit i e s m u st s ub m it a P a r t A Pe r m it App l i cati o n n o la t e r t h an s i x mo n t h s

f o l l o wi n g t h e pub l icati o n o f r e gu lat i o n s t h at s ub j e ct t h e facil i ty t o t h e r e qu ir e m e n t t o h a v e a RCRA

h a z ar d o u s was t e p e r m it.10

N E W F A C I L I T I E S

U nd e r 4 0 C F R 2 70

. 1 0 (f), n e w facilit i e s m u st s u b m it b o th P art A a n d P art B Pe r m it App licat i o n s at l e a s t

1 8 0 d a y s b e f o re c om me n c i n g ph y sical c o n str u ct i o n o f t h e fa cil i t y

. A p e r m it mu st b e r e c e i ve d b e f o re

c o n str u c ti o n b e g i n s.

W H E N S H O U L D M Y P E R M I T A P P L I C A TI O N B E R E V I S E D ?

F A C I L I T I E S O P E R A T I N G U N D E R I N T ER I M S T A T U S

In ac c o r d a n ce with 4 0 C F R 2 70

. 72 ( a )

, t h e o w n e r o r op e ra to r o f a facil i ty o p e ra t i n g und e r i n t e r i m st a t u s

m u st s u b m it a R e v is e d P a r t A P e r m i t App licat i o n at t h e f o l l o wi n g ti m e s:

• P ri o r t o tr e ati ng

, s t o ri ng

, o r d is p o si n g o f n e w h a z ar d o u s was t e s n o t p r ev i o u sly i d e n tified in t h e

facilit y ’s P art A P e r m it Ap p licati o n

. S i m ilar l y

, w h e n t h e E P A ( o r a S ta t e with an a u t h o ri z e d RCRA

p r o g ra m ) p r o m u l g at e s a r u le listi n g o r i d e n tif y i n g n e w h a z ar d o u s w ast e s, fac i lities m a n a g i n g t h ese

was t es m u st r e v i s e t h eir P a r t A P e r m it App lic a t i o n t o ref l ect t h is a c ti v i t y

.

• P ri o r t o i n c r e asi n g t h e d e s i g n ca p acity o f t h e p r o c e s s e s u s e d at t h e facili t y

. T h e E P A R e g i o n a l

Ad m i n istra t o r ( o r t h e S t a te D i r e c t o r, f o r an a u t h o ri z e d S tat e ) m u st a pp r o v e c h a ng e s in c a p aci t y

b e f o re t h e y t a ke e ffe c t at t h e facili t y

.

• P ri o r to c h a ng i n g e xisti n g p r o c e s s e s o r a dd i n g n e w p r o c e s s e s f o r t r e ati ng

, s t o ri n g

, a n d d is p o si n g

o f h a z ar d o u s wa s t e s at t h e facilit y

. C h a ng e s in tr e a t me n t, s t o ra g e

, a n d d is p o s a l p ractic e s m u st

b e a pp r o v e d b y t h e R e g i o n al Ad m i n istra t o r ( o r S ta t e D ir e c t o r) b e f o r e t h e y are i m p l e me n t e d b y a

facilit y

.

• P ri o r t o und e r g o i n g a c h a n g e in o w n e rs h ip o r o p e ra t i o n al c o n t r o l o f a facil i t y

.

• W h e n e v e r facili t y c h a ng e s o cc u r in a c c o r d a n c e with an i n t e rim s tat u s c o r r e ct i v e a c ti o n o r d e r

iss u e d b y t h e E P A

, an a u t h o ri z e d S ta t e

, o r b y a c o u rt in a j ud icial acti o n b r o ugh t b y t h e E P A o r

t h e S ta t e.

• W h e n a facili t y a dd s un its f o r t h e tr e a t m e n t, s t o ra g e

, a n d d is p o sal o f h a z ar d o u s was t e t h at a r e

n ewly r e gu lated b y t h e E P A o r a St a t e

. A R e v i s ed P a rt A P e r m it App licat i o n m u st b e s u b m it t ed

o n o r b e f o re t h e d a t e o n w h ich t h e un it b e c o m e s s ub j e ct t o t h e n e w r e qu ir e m e n ts.

C h a ng e s in t h e qu a n ti t y o f h a z ar d o u s wa s te c u rr e n t l y s p e cified in t h e first P art A Pe r m it App licati o n c a n

b e m a d e wit h o u t s ub m i t ti n g a Re v i s ed P art A P e r m it A pp licati o n

, p r o v i d ed t h e q u a n tity do es no t e x ce e d

t h e d e si g n ca p acit i e s o f t h e p r o c e s s e s s p e cified in t h e first P art A Pe r m it App licati o n o r a s ub s e qu e n t

P art A P e r m i t App licat i o n

.

F ail u re to f u r n ish all i n f o r m a t i o n r e qu ir e d to p r o c e s s a RCRA H a z ar d o u s W a s t e P e r m i t App licat i o n is

g r o und s f o r t e r m i n at i o n o f i n t e rim stat u s.11 Determining if You Must Notify

(continued)

F A C I L I T I E S O P E R A T I N G U N D E R A R C R A H A Z A R D O U S W A S T E P ER M I T

Ow n e rs o r o p e ra t o rs o f f a cilities o p e ra t i n g und e r a RCRA H a z ar d o u s Wa s te P e r m it m a y m o d ify t h e i r

p e r m it at a n y ti m e

, in ac c o r d a n ce w i th t h e s p e cif i c r e qu ir eme n ts in 40 C F R 2 7 0

. 42

. App e nd ix I to 4 0

C F R

2 7 0

. 4 2 d i v i d e s t h e v ar i o u s t y p e s o f p e r m it m o d if i cati o n s i n to Class e s 1

, 2

, a n d 3

, b a s e d o n t h e

c o m p lexi t y o f facili t y c h a ng e s n e c e ss i tati n g a p e r m it m o d ificat i o n

. Class 1 mo d ifi c ati o n s are m i n o r

c h a ng e s t h a t k ee p t h e p e r m it c u rr e n t with c h a ng e s t h at o cc u r t o t h e facili t y o r i ts o p e ra t i o n

. Cl a ss 2

a n d

3 mo d ific a ti o n s i nv o l v e m o re si gn ifica n t c h a ng e s in f a cility

o p e ra t i o n s.

In all cas e s w h e n a facility o w n e r o r o p e ra t o r r e qu e s t s a p e r m it mo d ific a ti o n

, h o w ev e r, h e o r s h e m u s t

s ub m it t h e i n f o r m a ti o n r e qu ir e d in t h e P a r t A Pe r m i t App licat i o n (in 40 C F R 2 7 0

. 1 3 ) as p art o f t h e

mo d ifi c ati o n s ub m i t tal.

F i n all y

, und e r 4 0 C F R 2 70

. 10 ( h )

, f acilities with a R C RA Ha z ar d o u s Wa s te P e r m it m u st s u b m it a n ew

a pp licati o n ( P art A a n d P a r t B) a t lea s t 1 8 0 d a y s p ri o r to t h e e x p irat i o n d ate o f t h e p e r m it.12 Site ID Form

(continued)



## INSTRUCTIONS FOR FILLING OUT THE

RCRA SUBTITLE C SITE IDENTIFICATION FORM (SITE ID FORM)

WHO MUST SUBMIT THIS FORM

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

(Site ID Form):

 Initial Notification of Regulated Waste Activity;

 Subsequent Notification of Regulated Waste Act ivity;

 First RCRA Hazardous Waste Part A Permit Application;

 Revised RCRA Hazardous Waste Part A Permit Application;

 Hazardous Waste Report;

 Notification for eligible academic entities opting into or withdrawing from managing laboratory

hazardous wastes pu rsuant to 40 CFR Part 262 Subpart K (if in an eligible State); and

 Notification for facilities managing hazardous secondary material pursuant to 40 CFR 260.42

(if in an eligible State).

Some States have requirements in addition to, or that are different fr om the Federal requirements. To

obtain the appropriate forms or ask questions, refer to a list of contacts at:

https://www.epa.gov/sites/production/files/2016

- 03/documents/contact02172016.pdf

.

The list will tell you whether the Federal form or a State form is used, who to contact, and w here to mail

the completed form.

PURPOSE OF THIS FORM

The Site ID Form provides site

- specific information about your facil ity and is used to obtain an EPA

Identification Number under the RCRA Program. The Site ID Form also provides updated information for

items that have changed at your site and verifies the information for those items that remain unchanged.

HOW TO FILL OUT THIS FORM

Complete the following Site ID Form items, as applicable to your facility:

 Item 1

- your reason for submitting the form

 Item 2

- your site’s EPA Identification Number

 Item 3

- the name of your site

 Item 4

- the physical location of you r site

 Item 5

- the land type of your site

 Item 6

- the North American Industry Classification System (NAICS) code(s) for your site

 Item 7

- the mailing address for your site

 Item 8

- name, title, address, e

- mail, telephone number, extension , and fax of a contact person

at your site13 Site ID Form

(continued)

 Item 9

- name, address of the legal owner(s), address, e

- mail, telephone number,

extension, and fax number of the operator(s) of your site

 Item 10

- your site’s regulated waste activities (enter all that apply)

 Ite m 11

- the description of hazardous waste

 Item 12

- your site’s hazardous secondary material activity, if you manage any

 Item 13

- additional comments on Items 1

– 12

 Item 14

- certification that the information you provided throughout the form is trut hful,

accurate, and complete

 Addendum to the Site Identification Form

– notification of hazardous secondary material activity

Type or print, in black ink, all items except the Signature box in Item 14. In Item 14, provide the

required ink signatures. Si gnatures must be original. Stamped or photocopied signatures are not

acceptable. Enter your site’s EPA Identification Number in the top left

- hand corner on all pages of the

form; for an Initial Notification for this site, leave the EPA identification Num ber blank. Use

Item 13

– Comments to clarify or provide additional information for any entry. When entering

information in the comments section, enter the item number and box letter to which the comment

refers. If you must use additional sheets for comm ents, enter your site’s EPA Identification Number

in the top left

- hand corner of each sheet.

ITEM

- BY

- ITEM INSTRUCTIONS



### I T E M 1

– REASON FOR SUBMITTAL

Place an “X” in the appropriate box(es) to indicate whether this form is your Initial Notificatio n (i.e., this

is your first time submitting site identification information / to obtain an EPA Identification Number for

this location); a Subsequent Notification (to update your site identification information); a component of

a First or a Revised Hazardo us Waste Part A Permit Application; or a component of the Hazardous Waste

Report.

TO PROVIDE AN INITIA L NOTIFICATION (FIRS T TIME SUBMITTING SI TE IDENTIFICATION

INFORMATION / TO OBT AIN AN EPA IDENTIFIC ATION NUMBER FOR THI S LOCATION)

 If your waste activity i s regulated under Subtitle C of the Resource Conservation and Recovery Act

(RCRA) and the rules promulgated pursuant to the Act (specifically 40 CFR Parts 260

- 299), you

must submit this form to notify the appropriate State or EPA Regional Office of your re gulated

waste activities and obtain an EPA Identification Number.

 If you are an eligible academic entity opting into 40 CFR Part 262, Subpart K for managing

laboratory hazardous wastes AND you have never before submitted site identification

information, y ou must submit this form to notify the appropriate State or EPA Regional Office of

your activities. Note: You must check with your State to determine if you are eligible to manage

laboratory hazardous waste pursuant to 40 CFR Part 262, Subpart K in order for you to notify.

 If you will begin managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii) 260.30

,

40 CFR 261.4(a)(23), (24), or (25) (27) AND you have never before submitted site identification

information, you must submit this form, pursu ant to 40 CFR 260.42, to notify the appropriate14 Site ID Form

(continued)

State or EPA Regional Office of your activities. Note: You must check with your State to determine

if you are eligible to manage hazardous secondary material under these exclusions in order for

you to notif

y.

TO PROVIDE A SUBSEQU ENT NOTIFICATION (TO UPDATE SITE IDENTIFI CATION

INFORMATION FOR THIS LOCATION)

 You must use this form to submit a subsequent notification if your site already has an EPA

Identification Number and you wish to change information (e.g. , generator status, new site

contact person, new owner, new mailing address, new regulated waste activity, etc.).

 If you have previously submitted site identification information and are an eligible academic entity

opting into or withdrawing from 40 CFR P art 262, Subpart K for managing laboratory hazardous

wastes, you must use this form. Note: You must check with your State to determine if you are

eligible to manage laboratory hazardous waste pursuant to 40 CFR Part 262, Subpart K in order

for you to not ify.

 If you have previously submitted site identification information and are notifying (or re

- notifying)

that you will begin managing, are managing, or have stopped managing hazardous secondary

material under 40 CFR 261.2(a)(2)(ii) 260.30 , 40 CFR 261.4( a)(23), (24), or (25) (27) , you must

submit this form, pursuant to 40 CFR 260.42, to notify the appropriate State or Regional Office of

your activities. Note: You must check with your State to determine if you are eligible to manage

hazardous secondary m aterial under these exclusions in order for you to notify.

AS A COMPONENT OF A FIRST RCRA HAZARDOUS WASTE PART A PERMIT APPLICATION

If your site is planning to treat, store, or dispose of hazardous waste on

- site in a unit that is not exempt

from obtaining a hazardous waste permit, you must submit this form as part of the Part A Permit

Application. Also, if the activity at this site (treatment, storage, or disposal) became newly regulated

under RCRA Subtitle C and the rules promulgated pursuant to the Act (specifically 40 CFR Parts 260

- 299),

you must submit this form as part of the Part A Permit Application.

AS A COMPONENT OF A REVISED RCRA HAZARDO US WASTE PART A PERM IT APPLICATION

If you must submit a Revised Part A Permit Application to reflect changes th at have occurred at your site,

you must submit this form as part of your Revised Part A Permit Application. Examples of site changes

requiring a Revised Part A Permit Application include managing new wastes not identified in the first

submission of the fo rm or changes to existing waste treatment processes. When submitting a Revised

Part A Permit Application, please include the Amendment Number in the appropriate space.15 Site ID Form

(continued)

AS A COMPONENT OF TH E HAZARDOUS WASTE RE PORT (IF MARKED, SEE SUB

- BULLET

BELOW)

If you are required to submit a Hazardous Waste Report indicating the amount of hazardous waste you

generate, treat, recycle, dispose, ship off

- site, or receive from off

- site, you must fill out this form. A Site

ID Form submitted with a Hazardous Waste Report i s equivalent to a Subsequent Notification.

SITE WAS A TSD FACILITY AND/OR GENERATOR OF ≥ 1,000 KG OF HAZARDOUS WASTE, > 1

KG OF ACUTE HAZARDOUS WASTE, OR > 100 KG OF ACUTE HAZARDOUS WASTE SPILL

CLEANUP IN ONE OR MORE MONTHS OF THE REPORT YEAR (OR STATE EQUIVALENT LQG

REGULATIONS)

The purpose of th is check box is to distinguish between sites that meet the criteria and are

required to file a report versus those who file voluntarily or by State

- only requirement but were

not a treatment, storage, and disposal facility (TSDF) or a Large Quantity Generat or (LQG) during

the report year. Sites required to file the report should place an “X” in this box, while non

LQG/TSD sites should not. For more information about who must file a report, refer to “WHO

MUST FILE THE 201 5 7 HAZARDOUS WASTE REPORT” section o f the 201 5 7 Hazardous Waste

Report Instructions and Form booklet.

I T E M 2

– SITE EPA ID NUMBER

Provide your EPA Identification Number in Item 2 for this site . The first two characters of the EPA

Identification Number must be a valid State postal code . Be sure to include your EPA Identification

number at the top of all pages of the form (as well as on any attachments to the Site ID Form).

NOTE If this is your Initial Notification for this site, leave the EPA Identification Number blank and

proceed to Item 3.

I T E M 3 AND 4

– SITE NAME AND LOCATION

Provide the legal name of your site and a complete location address. Please note that the address you

give for Item 4, Site Location, must be a physical address, not a post office box or route num ber. Only

foreign hazardous waste transporters, with their headquarters located outside the U.S., may provide a

Site Location Country outside of the U.S.

NOTE A new EPA Identification Number is required if you change the location of your site.16 Site ID Form

(continued)

I T E M 5

– SITE LAND TYPE



### Place an “X’ in the box that best describes the land type of your site. Select only one type:

Private, County, District, Federal, Tribal (see below), Municipal, State, or Other. If your

site’s Land Type could be described as M unicipal and another Land Type, such as County,

District, or Tribal, do not place an “X” in Municipal. Instead, choose the other appropriate

Land Type. (For example, if your site’s Land Type is both Municipal and County, you would

place an “X” in the box for County.) You may explain this in Item 13

– Comments.

Tribal

- A member of The l L and which your site is on land belongs to one of the tribes/entities on the list

of Federally recognized American Indian tribes and Alaskan Native entities located at:

http://www.epa.gov/tribal/whereyoulive/tribes

- a

- z.htm

.

I T E M 6

– NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM (NAICS) CODE(S)

Box A must be completed. Completing Boxes B

- D is reco mmended, if applicable.

Box A

Provide the North American Industry Classification System (NAICS) code that best describes your site’s

primary business production process for your products or services. Referencing the latest version of

NAICS codes, use th e 6

- digit code (most specific description) if available for your business; if not, use the

5

- digit code; do not enter any four (4) or less digit codes.

Box es B

- D

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

the latest version of NAICS codes, use the 6

- digit code (most specific description) if available for your

business; if not, use the 5

- digit code; do not enter any four (4) or less digit codes.

Check with your accounting or business staff to determine your NAICS code(s); the NAICS code is used in

tax reporting and other business reports. You can obtain additional information about NAICS codes at

http://www.census.gov/eos/www/naics

.

NOTE Changes will be made to the NAICS codes in 2017 . All sites should confirm their NAICS codes

in the new 2017 NAICS code table prior to completing Item 6

– NAICS Codes. You can obtain

additional information about the 2017 NAICS codes at

http://www.census.gov/eos/www/naics

.17 Site ID Form

(continued)

I T E M 7

– SITE MAILING ADDRESS

Please enter the Site Mailing Address. If the Mailing Address and the Location of Site (Item 4) are the

same, you can enter “Same as Item 4” i n the box for Ite m 7.

I T E M 8

– SITE CONTACT PERSON

Enter the name, title, business address, telephone number, extension, fax number, and e

- mail address of

the individual who should be contacted regarding the information submitted in the Site ID Form. A

Subsequent Notification is recommended when the Site Contact Person changes. Do not enter other

contact persons here; if there are other persons, who may be contacted about this submission, list them

and their other contact information in Item 13

– Co mments. If the person completing the Hazardous

Waste Report this form is not the primary site RCRA hazardous waste contact, enter the primary site RCRA

hazardous waste contact here and add the contact information for the person completing the Hazardous

Wa ste Report form in Item 13

– Comments.

NOTE This is NOT the Facility Permit Contact information. The Facility Permit Contact information

should be entered on the RCRA Hazardous Waste Part A Permit Application.

I T E M 9

– LEGAL OWNER AND OPERATOR O F THE SITE

This section should be used to indicate all owners and operators of this site.

A. NAME OF SITE’S LEGAL OWNER

Provide the name of your site’s legal owner(s). This includes owner(s) of the building(s) and land. Please

review these definitions:

Owner

– The person who owns a RCRA site or part of a RCRA site. Note: This includes the owner(s) of the

building(s) and/or land. This may be an individual, company, or business name. See Person

.

Person

– An individual, trust, firm, joint stock company , Federal Agency, corporation (including a

government corporation), partnership, association, State, municipality, commission, political subdivision

of a State, or any interstate body.

DATE BECAME AN OWNER

Indicate the date on which the above entity becam e the owner of your site. Enter dates as in this example:

For April 22, 2015, enter 04/22/2015. This is a required field and a date must be reported.

OWNER TYPE

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

County, District, Federal, Tribal (see below), Municipal, State, or Other. If your site’s Owner Type could

be described as Municipal and another Owner Type, such as County, District, or Tribal, do not place an

“X” in Municipal. Instead, c hoose the other appropriate Owner Type. (For example, if your site’s Owner18 Site ID Form

(continued)

Type is both Municipal and County, you would place an “X” in the box for County.) You may explain this

in Item 13

– Comments.

Tribal

- A member of one of the tribes/entities on t he list of Federally recognized American Indian tribes

and Alaskan Native entities located at: http://www.epa.gov/tribal/whereyoulive/tribes

- a

- z.htm

.

LEGAL OWNER ADDRESS

Enter the addr ess, e

- mail

, telephone number, extension, and fax number of the legal owner. If the address

and the Location of Site (Item 4) are the same, you can enter “Same as Item 4” in the box for Item 9 A

.

Use the Comments section in Item 13 to list any additional o wners, their names, the dates they became

owners, owner type, mailing address, and which owner(s), if any, are no longer owners since your last

submission of this form. If necessary, attach a separate sheet of paper. Remember to enter your site’s

EPA Ide ntification Number in the top left

- hand corner of each sheet.

B. NAME OF SITE’S OPERATOR

Provide the name of your site’s operator. Please review these definitions:

Operator

– The person responsible for the overall operation of a RCRA site. Note: This is t he legal entity

which controls the RCRA site operation rather than the plant or site manager. This is usually a company

or business name, but may be an individual. See Person

.

Person

– An individual, trust, firm, joint stock company, Federal Agency, corp oration (including a

government corporation), partnership, association, State, municipality, commission, political subdivision

of a State, or any interstate body.

DATE BECAME AN OPERATOR

Indicate the date on which the above entity became the operator of y our site. Enter dates as in this

example: For April 22, 2015, enter 04/22/2015. This is a required field and a date must be reported.

OPERATOR TYPE

Place an “X’ in the box that best describes the operator type for your site. Select only one type: Pri vate,

County, District, Federal, Tribal (see below), Municipal, State, or Other. If your site’s Operator Type could

be described as Municipal and another Operator Type, such as County, District, or Tribal, do not place an

“X” in Municipal. Instead, choos e the other appropriate Operator Type. (For example, if your site’s

Operator Type is both Municipal and County, you would place an “X” in the box for County.) You may

explain this in Item 13

– Comments.

Tribal

- A member of one of the tribes/entities on the list of Federally recognized American Indian tribes

and Alaskan Native entities located at: http://www.epa.gov/tribal/whereyoulive/tribes

- a

- z.htm

.

Use the Comments section in Item 1 3 to list any additional operators, their names, the dates they became

operators, operator type, mailing address, and which operator(s), if any, are no longer operators since

your last submission of this form. If necessary, attach a separate sheet of pape r. Remember to enter your

site’s EPA Identification Number in the top left

- hand corner of each sheet.19 Site ID Form

(continued)

OPERATOR ADDRESS

Enter the address, e

- mail

, telephone number, extension, and fax number of the operator. If the address

and the Location of Site (Item 4) are the same, you can enter “Same as Item 4 9A ” in the box for Item 9 B

.

Use the Comments section in Item 13 to list any additional operators, their names, the dates they became

operators, operator type, mailing address, and which operator(s), if any, a re no longer operators since

your last submission of this form. If necessary, attach a separate sheet of paper. Remember to enter your

site’s EPA Identification Number in the top left

- hand corner of each sheet.

NOTE A subsequent notification is recom mended when the owner or operator of a site changes.

Because an EPA Identification Number is site

- specific, the new owner will keep the existing

EPA Identification Number for that location. If your business moves to another location, the

owner or operato r must notify the State or EPA Regional Office of this change. Since your

business has changed locations, a new EPA Identification Number will be assigned.

I T E M 10

– TYPE OF REGULATED WASTE ACTIVITY

Mark box “Yes” or box “No” as appropriate for all current activities (as of the date submitting the

form) at this site; complete any additional boxes as instructed. Current activities mean activities that

are in effect when the form is submitted or those that the site plans to begin after EPA Identif ication

Number assignment. The information you provide in Item 10 will be considered current as of the date

you certify the form. If the site is no longer a generator as of the date you certify the form, you should

mark the “No” (not a generator) box for Generator of Hazardous Waste.

NOTE You must report your current regulated waste activities as of the date of submitting the

Site ID Form

.

A. HAZARDOUS WASTE ACTIVITIES (COMPLETE ALL PARTS 1 THROUGH 10)

NOTE Listed below are the Federal generat or status definitions. If, however, the State where your

site is locat ed has definitions different from the Federal definitions, you must use the State

definitions.20 Site ID Form

(continued)

1. GENERATOR OF HAZARDOUS WASTE (AT YOUR SITE):

If you generate a hazardous waste that is listed in 40 CFR 261.31 through 261.33 or identified by one or

more hazardous waste characteristic(s) contained in 40 CFR 261.21 through 261.24, place an “X” in the

appropriate box for the quantity of hazardous waste that is generated per calendar month. The

regulations for hazardous waste generators are found in 40 CFR 261.5 for conditionally exempt small

quantity generators (CESQGs) and in 40 CFR Part 262 for both small quantity generators (SQGs) and

large quantity generators (LQGs). Consult these regulations and your State for details about how the

regulations apply to your situation. Below is a brief description of the three typ es of hazardous waste

generators.

If “Yes”, place an “X” in only one of the following

– a, b, or c.

a. LQG: Large Quantity Generator

For purposes of providing information in this form, the site is a n LQG if the site generates any of the

following amounts in a calendar month :

(i) Greater than or equal to 1,000 kilograms (kg; 2,200 pounds [lbs]) of non

- acute RCRA hazardous

waste; or

(ii) Greater than 1 kg (2.2 lbs) of any RCRA acute hazardous waste listed in sections 261.31 or

261.33(e) ; or

(iii) Greater than 100 kg (220 lbs ) of any residue or contaminated soil, waste, or other debris

resulting from the cleanup of a spill, into or on any land or water, of any acute hazardous wastes

listed in sections 261.31 or 261.33(e).

NOTE As discussed earlier, a RCRA LQG is a site th at is neither a CESQG nor a SQG. For purposes of

clarity, we describe above the situations when a site would be a n LQG.

If, in addition to being a n LQG, you recycle hazardous wastes at your site, mark both this box

and Item 10.A.4 10.A.7

.

Hazardous sec ondary material managed under 40 CFR 261.2(a)(2)(ii) 260.30 , 40 CFR

261.4(a)(23), (24), or (25) (27) DOES NOT count towards your generator status. However,

you must check with your State to determine if you are eligible to manage hazardous

secondary mater ial under these exclusions.

b. SQG: Small Quantity Generator

This site is a SQG if the site meets all of the following criteria:

(i) Generates, in any calendar month, more than 100 kg (220 lbs) but less than 1,000 kg (2,200 lbs)

of RCRA hazardous waste; and

(ii) D oes not generate, in any calendar month, more than 1 kg (2.2 lbs.) of acute hazardous waste

listed in sections 261.31 or 261.33(e) ; and

(iii) Does not generate more than 100 kg (220 lbs) of material from the cleanup of any residue or

contaminated soil, waste, or other debris resulting from the cleanup of a spill, into or on any land

or water, of any acute hazardous wastes listed in sections 261.31 or 261.33(e).21 Site ID Form

(continued)

NOTE The definition of a n SQG found at 40 CFR 260.10 is outdated. The EPA plans to make the

approp riate conforming change in the future. Moreover, here in this document, for

purposes of clarity, we include those situations where a n SQG also may have generated

amounts of acute hazardous wastes and still maintain its regulatory status as a n SQG.

c. CESQ G: Conditionally Exempt Small Quantity Generator

This site is a CESQG if the site generates less than or equal to the following amounts in a calendar

month:

(i) 100 kg (220 lbs) of hazardous waste; and

(ii) 1 kg (2.2 lbs) of acute hazardous wastes listed in sections 261.31, or 261.33(e); and

(iii) 100 kg (220 lbs) of any residue or contaminated soil, waste, or other debris resulting from the

cleanup of a spill, into or on any land or water, of any acute hazardous wastes listed in sections

261.31, or 261.33 (e).

NOTE A CESQG is defined at 40 CFR 261.5(a) as a site that generates less than or equal to 100 kg

(220 lbs) of hazardous waste. However, the regulations at 40 CFR 261.5(e) discuss situations

where a CESQG could be subject to full regulation. For purposes of clarity, we describe all

those situations where a site continues to be a CESQG.

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

refer to 40 CFR 261.5(e) to determine the circumstances under which y ou must notify the

EPA.

If you marked “Yes” above ”Y” for item 10.A.1 Generator of Hazardous Waste , indicate your other

generator activities size in 10.A.1a , 10.A.1b, or through item 10.A.1 c . Mark “Yes” or “No” ”Y” or “N” for

the other hazardous waste act ivities listed below in item 10.A.2 through item 10.A.10 that may occur at

this site. Complete all parts 2

- 10.22 Site ID Form

(continued)

2. SHORT

- TERM GENERATORS

Mark “Yes” if the site is currently generating hazardous waste only as the result of a one

- time, non

recurring, temporary event that is not related to normal production processes. In other words, short

term generators produce hazardous waste from a particular activity for a limited time and then cease

conducting that activity. Short

- term generators would not be considered episodic generators because

episodic generators have the potential to generate on a regular basis (for example, a facility that fluctuates

from SQG to LQG in one month is not a short

- term generator). Examples of short

- term generators include:

(1) one

- tim e highway bridge waste generation; (2) underground storage tank removals; (3) generation of

off

- spec or out

- of

- date chemicals at a site that normally doesn’t generate hazardous waste; (4)

remediation or spill clean

- up at sites with no previous RCRA EPA Ide ntification Number; and (5) site or

production process decommissions by a new operator. If you mark “Yes”, you must provide an

explanation of your short

- term generation event in Item 13

– Comments.

3. U.S. IMPORTER OF HAZARDOUS WASTE

Mark “Yes” if you impo rt hazardous waste from a foreign country a site located in a foreign country into

the U.S. Refer to 40 CFR 262.10(e) and 40 CFR 262.60(a) for additional information.

4. MIXED WASTE GENERATOR

Mark “Yes” if you are a generator of mixed waste (waste that is b oth hazardous and radioactive). RCRA

defines “mixed waste” as waste that contains both hazardous waste and source, special nuclear, or by

product material subject to the Atomic Energy Act (AEA), RCRA Section 1004(41), 42 U.S.C. 6903 (63 FR

17414; April 9, 1998). See the “ DEFINITIONS ” section.

5. TRANSPORTER OF HAZARDOUS WASTE

a. Transporter

You transport hazardous waste within the U.S. The Federal regulations for hazardous waste

transporters are found in 40 CFR Part 263

.

b. Transfer Facility (at your site)

You are a hazardous waste transfer facility, at your site, if you hold manifested hazardous waste(s) at

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

hazardous waste transfer facilities are found in 40 CFR 263.12

.

6. TREATER, STORER, OR DISPOSER OF HAZARDOUS WASTE (AT YOUR SITE)

If you treat, sto re, or dispose of hazardous waste, mark “Yes.” A RCRA Hazardous Waste Part B Permit is

required for this activity. Contact the appropriate office for your State for more information. The Federal

regulations for owners and operators of permitted treatmen t, storage, and disposal facilities (TSDFs) are

found in 40 CFR Parts 264, 265, 266, and 270

.

Mark “No” if any of the following conditions are true for your facility:23 Site ID Form

(continued)

 This facility does not rec eive hazardous waste from other generators and ships all waste off

- site

for management within the regulatory timeframe.

 This facility is only involved with on

- going post

- closure activities, corrective actions under the

Hazardous and Solid Waste Amendments of 1984 (HSWA), or a consent order under a non

traditional permit or without a RCRA permit being required.

 Receives waste from off

- site but does not store greater than 10 days before re

- shipping

(i.e., transfer facility).

NOTE If your site is a destin ation facility for universal wastes in addition to being a TSDF for other

RCRA hazardous wastes, mark “Yes” for both this box and Item 10.B.2.

7. RECYCLER OF HAZARDOUS WASTE (AT YOUR SITE)

If you recycle regulated hazardous wastes (recyclable materials) at your site, mark “Yes”. The Federal

regulations for owners and operators of sites that recycle hazardous waste are found in 40 CFR 261.6

. You also may be subject to other Federal and State reg ulations; in some cases a permit is required.

NOTE If your site, in addition to being a recycling site for hazardous waste, is a treater, storer, or

disposer treats, stores, or disposes of hazardous waste, mark “Yes” for both this box and

Item 10.A.6. If your site is a destination facility for universal wastes in addition to being a

recycling site for other RCRA hazardous wastes, mark “Yes” for both this box and Item 10.B.2.

8. EXEMPT BOILER AND/OR INDUSTRIAL FURNACE (AT YOUR SITE)

If “Yes”, place an “X ” in all that apply.

a. Small Quantity On

- Site Burner Exemption

You burn small quantities of hazardous waste in an on

- site boiler or industrial furnace in accordance

with the conditions in 40 CFR 26 6.108 , place an “X” in the box to indicate that you qualify for the Small

Quantity On

- Site Burner Exemption.

b. Smelting, Melting, and Refining Furnace Exemption

You process hazardous wastes in a smelting, melting, or refining furnace solely for metals rec overy,

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

as described in 40 CFR 2 66.100(g) , or if you process hazardous wastes in a lead recovery furnace to

recover lead, as described in 40 CFR 266.100(h) , place an “X’ in the box to indicate that you qualify for

the Smeltin g, Melting, and Refining Furnace Exemption.

9. UNDERGROUND INJECTION CONTROL (AT YOUR SITE)

If you generate, treat, store, or dispose of hazardous waste and place the waste or its residuals into an

underground injection well (e.g., a Class I well) located at your site, mark “Yes.” The Federal regulations24 Site ID Form

(continued)

for owners and operators of underground injection wells are found in 40 CFR Part 148

.

10. RECEIVES HAZARDOUS WASTE FROM OFF

- SITE (AT YOUR SITE)

If y ou received hazardous waste from another site, whether this waste was received as a commercial

transaction or waste received from a restricted group of off

- site generators, mark “Yes.”

In addition to the above, mark “Yes” or “No” for the other regulated wa ste activities listed below that

may occur at this site. Complete Items B, C, and D as appropriate.

B. UNIVERSAL WASTE ACTIVITIES (AT YOUR SITE)

Refer to your State

- specific requirements and definitions for universal waste. Also, refer to 40 CFR 261.9

and 40 CFR Part 273 for the Federal regulations covering universal waste. Complete parts 1 and 2.

1. LARGE QUANTITY HANDLER OF UN IVERSAL WASTE (LQHUW)

You are an LQHUW if you accumulate a total of 5,000 kg or more total of universal wastes (batteries,

pesticides, mercury

- containing equipment, or lamps

– calculated collectively) at any time. This

designation is retained through the end of the calendar year in which the 5,000 kg limit is met or exceeded.

If “Yes,” place an “X” in the appropriate box(es) to indicate the type(s) of universal wastes managed at

your site. If your State has other additional universal wastes, indicate wh at they are by placing an “X” in

the corresponding box(es) (10.B.1.e, f, or g).

2. DESTINATION FACILITY FOR UNIVERSAL WASTE

Mark “Yes” if you treat, dispose, or recycle universal wastes on

- site. A hazardous waste permit is required

if you treat or disp ose of universal wastes; a permit may be required if you recycle universal wastes.

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

RCRA hazardous wastes, mark “Yes” for both this box and Item 10.A. 6. In addition, if your

site recycles RCRA hazardous wastes, mark “Yes” for both this box and Item 10.A.7.

C. USED OIL ACTIVITIES

Mark the appropriate box(es) to indicate which used oil management activities are taking place at this

site. The Federal regu lations for used oil management are found in 40 CFR Part 279

. Complete all parts

1 through 4.

1. USED OIL TRANSPORTER

If “Yes,” place an “X” in all that apply.

a. Transporter

You transport use d oil within the U.S. The Federal regulations for used oil transporters are found in

40 CFR 279.40

- 47.25 Site ID Form

(continued)

b. Transfer Facility (at your site)

You own or operate a used oil transfer facility. The Federal regulations for used oil transfer facilities

are found i n 40 CFR 279.40

- 47.

2. USED OIL PROCESSOR AND/OR RE

- REFINER (AT YOUR SITE)

If “Yes,” place an “X” in all that apply.

a. Processor

You process used oil. The Federal regulations for processors of used oil are found in 40 CFR 279.50

- 59.

b. Re

- refiner

You ref ine used oil. The Federal regulations for re

- refiner s of used oil are found in 40 CFR 279.50

- 59.

3. OFF

- SPECIFICATION USED OIL BURNER (AT YOUR SITE)

You burn off

- specification used oil fuel. Mark “Yes” to indicate this used oil management activity.

3

. USED OIL FUEL MARKETER (AT YOUR SITE)

If “Yes,” place an “X” in all that apply.

a. Marketer Who Directs Shipment of Off

- Specification Used Oil to Off

- Specification Used Oil Burners

You are a marketer who directs shipment of off

- specification used oil t o off

- specification used oil

burners. The Federal regulations for off

- specification used oil used oil fuel marketers are found in 40

CFR 279.70

- 75.

b. Marketer Who First Claims the Used Oil Meets the Specification

You are the first to claim that used oil me ets the used oil specification s established in 40 CFR 279.11.

NOTE If either of these boxes is marked, you must also notify (or have previously notified) as a used

oil transporter (10.C.1), used oil processor/re

- refiner (10.C.2), or off

- specification us ed oil

fuel burner (10.C.3), unless you are a used oil generator. (Used oil generators are not

required to notify.)

D. Eligible Academic Entities with Laboratories

– Notification for opting into or withdrawing from

managing laboratory hazardous wastes purs uant to 40 CFR Part 262, Subpart K

Note: Fill out Box D ONLY if you are at least one of the following: a college or university; a teaching

hospital that is owned by or has a formal written affiliation agreement with a college or university; or a

non

- pro fit research institute that is owned by or has a formal written affiliation agreement with a

college or university; AND you have checked with your State to determine if 40 CFR Part 262, Subpart K26 Site ID Form

(continued)

is effective in your State and for any State

- specific requir ements. See EPA’s website for more

information about these regulations :

http://www.epa.gov/wastes/hazard/generation/labwaste/implementation.htm

http://www2.epa.gov/hwgenerators/regulations

- hazardous

- waste

- generated

- academic

- laboratories

Subpart K is an optional alternative set of requirements for eligible academ ic entities with laboratories.

Certain generators (i.e., eligible academic entities defined under (1) below) are eligible to operate under

Subpart K for management of their hazardous wastes in laboratories in lieu of 40 CFR 262.34(c) (or 40 CFR

261.5 for CESQGs). Eligible academic entities with laboratories that generate hazardous waste that elect

to opt into Subpart K, are currently operating under Subpart K, or subsequently withdraw from Subpart K

must complete this section to meet the notification requ irements of this Subpart. Refer to 40 CFR 262.203

and 40 CFR 262.204

.

NOTE Eligible academic entities with laboratories must com plete a separate Site ID Form for each

site (i.e., EPA Identification Number) that is managing hazardous waste under Subpart K. All

laboratories with the same EPA Identification Number will be regulated under this Subpart.

If eligible academic entities w ith laboratories withdraw from Subpart K, all laboratories with

the same EPA Identification Number associated with the withdrawal from Subpart K will be

regulated under 40 CFR 262.34(c) requirements (or 40 CFR 261.5 for CESQGs).

1. OPTING INTO OR CUR RENTLY OPERATING UNDER 40 CFR PART 262, SUBPART K FOR THE

MANAGEMENT OF HAZARDOUS WASTES IN LABORATORIES

Mark “Yes” for this box if you are an eligible academic entity and you elect to opt into or are currently

operating under 40 CFR Part 262, Subpart K f or the hazardous wastes generated in your laboratories. If

you mark “Yes” for this box, you must place an “X” in at least one of the following to indicate your type of

eligible academic entity. Place an “X” in all that apply:

a. College or University

You ar e an eligible college or university if you are a private or public, post

- secondary, degree

- granting,

academic institution, that is accredited by an accrediting agency listed annually by the U.S.

Department of Education.

b. Teaching Hospital that is owned by or has a formal written affiliation agreement with a college or

university

You are an eligible teaching hospital if you are a hospital that trains students to become physicians,

nurses, or other health personnel and is either: (1) owned by a college or un iversity, or (2) has a

master affiliation agreement and program letter of agreement, as defined by the Accreditation

Council for Graduate Medical Education, with an accredited medical program or medical school.

c. Non

- profit Institute that is owned by or has a formal written affiliation agreement with a college or

university27 Site ID Form

(continued)

You are an eligible non

- profit institute if you are an organization that conducts research as its primary

function and files as a non

- profit organization under the tax code of 26 U.S.C. 5 01(c)(3) and is either:

(1) owned by a college or university, or (2) has a formal written affiliation agreement with a college

or university that establishes a relationship between institutions for the purposes of research and/or

education and is signed b y authorized representatives from each institution. A relationship on a

project

- by

- project or grant

- by

- grant basis is not considered a formal written affiliation agreement.

2. WITHDRAWING FROM 40 CFR PART 262, SUBPART K FOR THE MANAGEMENT OF HAZARDOUS

WASTES IN LABORATORIES

Mark “Yes” for this box if you have previously elected to opt into 40 CFR Part 262, Subpart K and are now

withdrawing from participation in this optional set of alternative requirements for hazardous waste

generation in laboratorie s. Withdrawing generators will automatically revert to regulation under 40 CFR

262.34(c) requirements (or 40 CFR 261.5 for CESQGs). If marking “Yes” for this box, please include

comments in Item 13

– Comments that explain your reasons for withdrawing fro m Subpart K.

I T E M 11

– DESCRIPTION OF HAZARDOUS WASTES

Complete this item if you marked “Yes” for any activity 1 (a

- c), 6, 7, or 8 in Item 10.A

. You will need to

refer to 40 CFR Part 26 1 to complete this item. Part 261 identifies those solid wastes which the EPA

defines as hazardous and regulates under RCRA. If you need help completing this section, please contact

your State Office.

A. WASTE CODES FOR FEDERALLY REGULATED HAZARDOUS WASTES

Please list the waste codes of the Federal hazardous wastes (described in 40 CFR Part 261) handled at

your site. List them in the order they are presented in the regulations using the appropriate 4

- digit code(s)

(e.g., D001, D003, F007, U112).

N OTE If you handle more hazardous wastes than will fit under Item 11.A, please continue under

Item 13

– Comments or on an extra sheet. Remember to include your EPA Identification

Number on the top of each page. If you handle a large number of codes, you may copy the

list in this booklet and mark the ones that you handle. Attach any additional sheets to the

Site ID Form. Remember to include your EPA Identification Number on the top of each page.

B. WASTE CODES FOR STATE

- REGULATED (I.E., NON

- FEDERAL ) HAZARDOUS WASTES

If you manage State

- regulated hazardous wastes that have a State waste code, enter the appropriate

code(s) in the box(es) provided. Please list the waste codes of the State

- regulated hazardous wastes

handled at your site in the order th ey are presented in the regulations.28 Site ID Form

(continued)

NOTE If you handle more hazardous wastes than will fit under Item 11.B, please continue under

Item 13

– Comments or on an extra sheet. Remember to include your EPA Identification

Number on the top of each page.

I T E M 12

– NOTIFICATION OF HAZARDOUS SECONDARY MATERIAL (HSM) ACTIVIITY

A. Mark “Yes” if you are notifying under 40 CFR 260.42 that you will begin managing, are still managing,

or will stop managing hazardous secondary material under 40 CFR 261.2(a)( 2)(ii) 260.30 , 40 CFR

261.4(a)(23), (24), or (25) (27) . Mark “No” if you are not notifying under 40 CFR 260.42. Note: You

must check with your State to determine if you are eligible to manage hazardous secondary material

under these regulations.

NOTE If you mark “Yes,” you must fill out the Addendum to the Site ID Form: Notification of

Hazardous Secondary Material Activity. See instructions for this Addendum after Item 14.

B. Mark “Yes ” if you are submitting a legitimate recycling notification under 40 CFR 260.43(a)(4)(iii).

Recycling of hazardous secondary materials for the purpose of the exclusions or exemptions from

hazardous waste regulations must be legitimate. You must notify EPA if the product of your

recycling process has levels of haza rdous constituents that are not comparable to a legitimate

product or intermediate, but the recycling is still legitimate. The recycling can be shown to be

legitimate based on lack of exposure from toxics in the product, lack of the bioavailability of the

toxics in the product, or other relevant considerations which show that the recycled product does

not contain levels of hazardous constituents that pose a significant human health or environmental

risk. Documentation of legitimacy must be maintained onsite for three years. If you’d like to submit

additional information regarding your recycling, use the Comments Box in Item 13.

Mark “No” if you are not notifying under this provision. Notification is not required if the product of

the recycling process is c omparable to a legitimate product or intermediate per 40 CFR

260.43(a)(4)(i) or (ii).

I T E M 1 3

– COMMENTS

Use this section as needed to provide additional information for Items 1 through 12. Include the item

number and box letter (if any) for each com ment you make. You may attach additional sheets if needed.

Remember to include your EPA Identification Number on the top of each page.

I T E M 14

– CERTIFICATION

This certification must be signed and dated by the owner(s), operator(s), responsible of ficial(s), or29 Site ID Form

(continued)

authorized representative(s) of the site. See 40 CFR 270.11 for more information on signatories in

general. See also 40 CFR 270.10(b) for additional Hazardous Waste Part A Permit Application signatory

specifics. An “authorized representative” is a person responsible for the overall operation of the site

(i.e., a plant manager or superintendent, or a person of equal res ponsibility).

NOTE All Site ID Form submissions must include this certification to be complete.30 

## Addendum to the Site Identification Form:

Notification of Hazardous Secondary Material Activity

YOU MUST FILL OUT THIS SECTION IF:

 You are located in a State that allows you to manage excluded hazardous secondary material under 40

CFR 261.2(a)(2)(ii) 260.30 , 261.4(a)(23), (24), or (25) (27) . See

http://www.epa.gov/epawaste/hazard/dsw/s tatespf.htm for a list of eligible States; AND

 You will begin managing, are still managing, or will stop managing excluded hazardous

secondary material under 40 CFR 261.2(a)(2)(ii) 260.30 , 40 CFR 261.4(a)(23), (24), or (25) (27)

and must notify the appr opriate State or Regional Office of your activities, pursuant to 40 CFR

260.42. These regulations exclude certain hazardous secondary material being reclaimed from

the RCRA Subtitle C definition of solid waste provided certain requirements and conditions are

met. See EPA’s website for more information about these regulations:

http://www.epa.gov/osw/hazard/dsw/rulemaking.htm

.

Complete all parts 1

– 3 1 and 2

.

NOTE You must be managing ex cluded hazardous secondary material in compliance with

40 CFR 261.2(a)(2)(ii) 260.30 , 261.4(a)(23), (24), and/or (25) (27) (or State equivalent). Do

not include any information regarding your hazardous wastes in this section. See 73 FR

64668 or http://www.epa.gov/epawaste/hazard/dsw/impresource.htm for more

information on these exclusions.

You must submit a completed Site ID Form, including this Addendum, prior to operating

under the exclusion(s) and by March 1 of each even

- numbered year thereafter to your

regulatory authority using the Site ID Form as pursuant to 40 CFR 260.42. Persons who must

satisfy this notification requirement can submit this information at the same time as thei r

Hazardous Waste Report (which is also due by March 1 of each even

- numbered year).

If you stop managing hazardous secondary material in accordance with the exclusion(s) and

do not expect to manage any amount of hazardous secondary material under the excl usion(s)

for at least one year, you must also submit a completed Site ID Form, including this

Addendum, within thirty (30) days pursuant to 40 CFR 260.42.

Remember to include your EPA Identification Number on the top of each page.31

I T E M 1

– INDICAT E REASON FOR NOTIFICATION (INCLUDE DATES WHERE REQUESTED)



### Place an “X” in the box for the reason that applies to you:

FACILITY WILL BEGIN MANAGING EXCLUDED HAZARDOUS S ECONDARY MATERIAL AS OF

(MM/DD/YYYY)

Place an “X” in this box if you are notifying tha t you will begin managing hazardous secondary material under

the exclusion(s).

 Facilities must notify prior to operating under the exclusion(s).

 If placing an “X” in this box, list the date (mm/dd/yyyy) when you will begin managing hazardous

secondary mat erial under 40 CFR 261.2(a)(2)(ii) 260.30 , 40 CFR 261.4(a)(23), (24), or (25) (27) . Note:

If the facility had previously notified that it will stop managing hazardous secondary material in the

past but will now begin anew, list the next planned start dat e.

FACILITY IS STILL MANAGING EXCLUDED HAZARDOUS S ECONDARY MATERIAL/RE

- NOTIFYING

AS REQUIRED BY MARCH 1 OF EACH EVEN

- NUMBERED YEAR

Place an “X” in this box if you are re

- notifying that you are still managing hazardous secondary material under

the exclusi on(s). Note: You must have previously notified that you began managing hazardous secondary

material in order to check this box.

 Facilities must re

- notify by March 1 st of each even

- numbered year.

 If placing an “X” in this box, you do not have to list a d ate.

FACILITY HAS STOPPED MANAGING EXCLUDED HA ZARDOUS SECONDARY MA TERIAL AS OF

(MM/DD/YYYY) AND IS NOTIFYING AS REQUIRE D

Place an “X” in this box, if you are notifying that you have stopped managing hazardous secondary material

under the exclusion(s) and do not expect to manage any amount of hazardous secondary material for at least

one year (pursuant to 40 CFR 260.42(b)). List the date when you stopped managing hazardous secondary

material. Enter the date in “mm/dd/yyyy” format.

 Facilities must notify w ithin 30 days of when they stopped managing hazardous secondary material.

You are considered to have stopped managing hazardous secondary material if: (1) you stop

managing hazardous secondary material completely (e.g., you cease operations); (2) you cho ose to

manage the hazardous secondary material as hazardous waste; (3) you undergo closure and request

release from financial assurance per 40 CFR 261.143(h) or 40 CFR 264.143 ; or (4) you temporarily

suspend management of hazardous secondary material for a t least one year.

 Only place an “X” in this box if you have stopped managing all hazardous secondary material under

the exclusion(s). For example, if your facility only stopped managing one hazardous secondary32

material, but continued to manage another h azardous secondary material, you would leave this box

blank since your facility continues to manage some amount of hazardous secondary material.

 If you submit a notification that you have stopped managing hazardous secondary material, you do

not need to r e

- notify (unless you choose to manage hazardous secondary material again, in which

case you would have to submit a notification prior to managing). After submitting a stop notification,

you can leave the Addendum blank for subsequent submissions, includin g any subsequent Hazardous

Waste Report submissions.

I T E M 2

– DESCRIPTION OF EXCLUDED HAZARDOUS SECONDARY MATERIAL (HSM) ACTIVITY

In the table provided on the Addendum to the Site Identification Form, list your appropriate facility code,

each waste c ode for the hazardous secondary material you manage, the estimated and actual quantities in

short tons for each hazardous secondary material, and the appropriate land

- based code for how you manage

the hazardous secondary material. Do not include any infor mation regarding your hazardous wastes in this

section. See examples below on how to answer this question.

a. Facility Code

Using the facility codes, found in the “ HAZARDOUS SECONDARY MATERIAL (HSM) FACILITY CO DES ”

section of this booklet, enter the appropriate 2

- digit code(s) that correctly describes your facility. If more

than one code applies to your facility, enter each 2

- digit code on a separate row. Each hazardous

secondary material should be reported b y facility code.

b. Waste Code(s) for HSM

Use the box provided to enter the appropriate 4

- digit hazardous waste code(s) that would apply to your

hazardous secondary material if you managed it as hazardous waste (i.e., the waste code(s) that would

apply if yo u did not manage your material in accordance with 40 CFR 261.2(a)(2)(ii) 260.30 , 40 CFR

261.4(a)(23), (24), or (25) (27) ).

NOTE If you list more codes or manage more hazardous secondary material than will fit in the table

under Item 2, please continue u nder Item 13

– Comments, or on an extra sheet. Remember to

include your EPA Identification Number on the top of each page.

c. Estimate Short Tons of Excluded HSM to be Managed Annually

In the box provided, enter your estimated tonnage (using short tons) o f hazardous secondary material

you expect to manage annually. Convert all physical quantities (e.g., gallons, cubic yards, kilograms,

metric tons, etc.) to short tons (1 short ton = 2,000 pounds) and round to the nearest ton (no decimals).

Note: Your es timated tonnage should be for the entire amount of hazardous secondary material to be

reclaimed NOT just the quantity of constituent or product reclaimed.

d. Actual Short Tons of Excluded HSM Managed During the Most Recent Odd

- Numbered Year

Report the tonnag e (using short tons) of each hazardous secondary material you actually managed during

the most recent odd

- numbered year. For example, if you are submitting this notification on February 20,

2016, enter the amount you actually managed during 2015 (i.e., th e tonnage you managed from January

1, 2015 to December 31, 2015). Convert all physical quantities (e.g., gallons, cubic yards, kilograms,33

metric tons, etc.) to short tons (1 short ton = 2,000 pounds) and round to the nearest ton (no decimals).

Note: You r actual tonnage should be for the entire amount of hazardous secondary material that was

sent for reclamation NOT just the quantity of constituent or product reclaimed. If this is your initial

notification, enter “0.”

e. Land

- based Unit Code

Using the land

- based unit codes, found in the “ HAZARDOUS SECONDARY MATERIAL (HSM) LAND BASED

UNIT CODES ” section of this booklet, enter in the 2

- digit code that best describes the land

- based unit

you use or will use to manage the hazardous secondary material. If you do not use any land

- based units,

enter “NA.” If you use the code “OT” (Other), please describe your land

- based unit in Item 13

–

Comments. If more than one land

- based unit code applies to a hazardous secon dary material, list it

separately using another row.

EXAMPLES FOR REPORTI NG HAZARDOUS SECONDA RY MATERIAL ACTIVITY

Example 1

A pharmaceutical manufacturer generates spent solvents that are characteristic for ignitability (D001). The

manufacturer plans to manage spent solvents under 40 CFR 261.2(a)(2)(ii) 40 CFR 261.4(a)(23) and

261.4(a)(24) by sending some amount to a reclaimer within its own company and the rest off

- site to a

reclamation recycling facility within the U.S. The manufacturer will not manage any spent solvents in a land

based unit. Following the regulations, the manufacturer submits an initial notification prior to managing its

spent solvents under the exclusions. The facility would report its hazardous secondary material activity as

follow s:

a. Facility code (answer

using codes listed in

the Code List section of

the instructions) b. Waste Code(s) for

hazardous secondary

material (HSM) c. Estimated short tons

of HSM to be

managed annually d. Actual short tons of

HSM that was

managed during the

most r ecent odd

numbered year e. Land

- based unit code

(answer using codes

listed in the Code List

section of the

instructions)

02 D001 15 0 NA

06 D001 40 0 NA

Example 2

A steel manufacturer generates electric arc furnace dust and spent pickle liquor from one of its steel

operations. The manufacturer sends electric arc furnace dust (K061) off

- site to a reclamation recycling facility

within the U.S. and reclaims spent pickle liquor (K062) on

- site. Neither hazardous secondary material is

managed in a land

- based unit. The steel manufacturer has managed both hazardous secondary material

under 40 CFR 261.2(a)(2)(ii) 40 CFR 261.4(a)(23) and 261.4(a)(24) for a number of years and it is now time to

re

- notify . The facility would report its hazardous secondary material activity as follows:

a. Facility code (answer

using codes listed in

the Code List section of

the instructions) b. Waste Code(s) for

hazardous secondary

material (HSM) c. Estimated short tons

of HSM to be

managed annually d. Actual short tons of

HSM that was

manag ed during the

most recent odd

numbered year e. Land

- based unit code

(answer using codes

listed in the Code List

section of the

instructions)

01 K062 60 52 NA

06 K061 20,000 22,468 NA

Example 3

A reclamation A RCRA

- permitted recycling facility has been rece iving and reclaiming spent solvents under 40

CFR 261.2(a) (2) ( ii ) 40 CFR 261.4(a)(23) and 261.4(a)(24) for a number of years. The facility receives and34

reclaims spent solvents from multiple hazardous secondary material generators, some of which are within

the same company. No spent solvents are managed in a land

- based unit. It is now time to re

- notify. The

facility would report its hazardous secondary material activity as follows:

a. Facility code (answer

using codes listed in

the Code List section of

the instructions) b. Waste Code(s) for

hazardous secondary

material (HSM) c. Estimated short tons

of HSM to be

managed annually d. Actual short tons of

HSM that was

managed during the

most recent odd

numbered year e. Land

- based unit code

(answer using codes

listed in th e Code List

section of the

instructions)

03 D001; F002; F003; F005 6,000 7,533 NA

03 D001; D035; F002; F003 1,500 918 NA

07 D001; F002; F003; F005 3,000 3,509 NA

07 D001; D038; F002; F003 1,000 523 NA

Example 4

A smelting operation generates furnace bricks that are characteristic for chromium (D007) and sends them

off

- site for reclamation recycling . Before shipping the bricks off

- site, the facility manages some of the bricks

in a containment building and the rest in a pile on the land. The facility has been managing the bricks under

40 CFR 261.4(a)(24) for a number of years and must now re

- notify. The facility would report its activity as

follows:

a. Facility code (answer

using codes listed in

the Code List section of

the instructions) b. Waste Code(s) f or

hazardous secondary

material (HSM) c. Estimated short tons

of HSM to be

managed annually d. Actual short tons of

HSM that was

managed during the

most recent odd

numbered year e. Land

- based unit code

(answer using codes

listed in the Code List

section of the

in structions)

06 D007 200 235 NA

06 D007 115 126 PL

Example 5 1

An A RCRA

- permitted intermediate facility has been managing wastewater treatment sludges from

electroplating operations (F006) for the past seven years but, due to company consolidation, it w ill soon shut

down. In accordance with 40 CFR 260.42, the facility notifies that it will stop managing hazardous secondary

material. The facility would report its activity as follows:

a. Facility code (answer

using codes listed in

the Code List section of

the instructions) b. Waste Code(s) for

hazardous secondary

material (HSM) c. Estimated short tons

of HSM to be

managed annually d. Actual short tons of

HSM that was

managed during the

most recent odd

numbered year e. Land

- based unit code

(answer using codes

listed in the Code List

section of the

instructions)

08 F005 0 5,034 NA



### Item 3

– Facility has Financial Assurance Pursuant to 40 CFR 261.4(a)(24)(vi)

Financial assurance is required for reclaimers (07, 11) and intermediate (08) facilities managing hazardous

se condary material under 40 CFR 261.4(a)(24) and (25). See EPA’s website for more information about these

regulations: http://www.epa.gov/epawaste/hazard/dsw/impresource.htm

.

 Mark “Yes, ” if you have financial assurance pursuant to 40 CFR 261.4(a)(24)(vi) AND you use at least

one facility code that is 07, 08, or 11 in Item 2.a above. For example, the facilities in Examples 3 and

5 above are required to have financial assurance because th e facility codes are 07 and 08,

respectively.35

 Mark “No,” if you do NOT have financial assurance pursuant to 40 CFR 261.4(a)(24)(vi). Note:

Reclaimers (07, 11) and intermediate (08) facilities must have financial assurance in order to manage

hazardous s econdary material under 40 CFR 261.4(a)(24) and (25). Answering “No” to this question

may mean you are in violation of these regulations if you report facility codes 07, 08, or 11. For

example, the facilities in Examples 1, 2, and 4 above are not require d to have financial assurance

because these facilities did not report facility codes of 07, 08, or 11.36 

## I N S T R U C T IO N S FO R F I L L I N G O U T TH E

HA Z A R D O U S W A S T E PE R M I T I N FO R M A T IO N FO R M

G E N E R A L I N S T R U C TI O N S

P lea s e t y p e o r p ri n t, l e a v i n g o n ly o n e b l a n k b o x b e tw ee n w o r d s. Abb r e v ia t e

, if n e c e ssa r y

, t o s tay wit h in

t h e nu m b e r o f b o x e s al l o w e d f o r e a ch it e m

. So m e it e m s in t h e f o r m r e qu ire n arra t i v e e x p la n at i o n

. I f

mo r e s p a c e is n ece s sary to a n swer a qu est i o n

, u se t h e s p ace p r o v i d ed in It e m 1 3 a n d refer e n c e t h e it e m

nu m b e r t o w h ich t h e a dd iti o n al i n f o r m at i o n a pp lies o r at t ach a s e p ar a te s h e e t e n tit l e d “ Add it i o n a l

I n f o r m a ti o n

. ” R e m e m b e r to i n cl ud e yo u r E P A I d e n t i ficati o n Nu m b e r a n d S i t e N a m e in t h e upp e r l e f t

h a n d c o r n e r o f e ach a t tac h e d p a g e

.

U n less o t h e r wise s p e cified in t h e i n str u c ti o n s t o t h e f o r m

, e a ch i t em m u st b e a n swere d

. To i nd ica t e

t h at e ach i t e m h as b e e n c on si d e r e d

, e n t e r “ N A ” f o r “n o t a pp lica b le

, ” if a p a r tic u lar it e m do e s no t fit t h e

circ u m s ta n c e s o r c h arac t e r istics o f y o u r f a cility o r act i v it y

.

F o r a R ev i s e d P art A P e r m i t App licati o n

, circle t h e i te m nu m b e rs with n e w i n f o r m ati o n o r c h a ng e s.

IT E M

- B Y

- IT E M I N S T R U C TI O N S

I T E M 1

– F A C I L I T Y P E R M I T C O N T A C T

Gi v e t h e n a me

, tit l e

, w o rk t e l e ph o n e nu m b e r, a n d e

- m ail o f a p e r s o n w h o is t h o r ough ly f a m iliar with t h e

acti v it i e s at t h e facil i ty t h a t r e qu ire a R C RA Ha z ar d o u s Was t e P e r m i t a n d with t h e facts r e p o r t e d in t h e

H a z ar d o u s W aste Pe r m it I n f o r m a ti o n F o r m

. T h is p e rs o n m u st b e a v aila b le t o b e c o n ta c t e d b y o ffi c e s

r ev i e wi n g t h e p e r m it a pp licati o n

, if n e c e ssa r y

. If t h e F acility P e r m it C o n ta c t p e rs o n is t h e s a m e a s t h e

S ite C o n tact P e r s o n i d e n ti f ied in It e m 8 o f t h e R C RA Sub title C S i t e I d e n tifi c ati o n F o r m ( S i t e ID F o r m )

,

yo u m a y p ri n t “ S a m e as S i t e C o n tac t ” in t h is b o x.

I T E M 2

– F A C I L I T Y P E R M I T C O N T A C T M A I L I N G A D D R E S S

E n t e r t h e m aili n g a dd r e ss f o r t h e f a cility p e r m it c o n t act. If t h e m aili n g a dd r e ss is t h e s a m e a s t h e S i t e

M aili n g Add r e ss ( I t e m 7 ) o n t h e S ite ID F o r m

, yo u m a y p r i n t “ S a m e as S ite M aili n g Add r e ss” in t h is bo x.

I T E M 3

– O P E R A T O R M A I L I N G A D D RE S S A N D T E L E P H O N E N U M B E R

E n t e r t h e m aili n g a dd r e ss a n d t e le p h o n e nu m b e r o f t h e facil i ty o p e ra t o r i d e n tifi e d in I t e m 9

. B o f t h e S i t e

ID F o r m

.37 Haza r dou s W a s te P e r m it I n f o r m a ti o n F o rm

(c on ti nu e d)

I T E M 4

– F A C I L I T Y E X I S T E N C E D A T E

E n t e r t h e a pp r o p ri a te d a t e t h at a pp lies to y o u r facili t y fr o m t h e f o l l o wi ng :

• T h e d ate t h at h a z ar d o u s w aste o p erat i o n s a t t h e facil i ty c om m e n ce d ;

• T h e d ate c o n str u ct i o n o n t h e facili t y c o mm e n c e d ; o r

• T h e d ate o p erat i o n is e x p e cted t o b e g i n

.

I T E M 5

– O T H E R E N V I R O N M E N T A L P ER M I T S

A

. P ERM I T T Y P E

Usi n g t h e c o d e s lis t e d b e l o w, e n t e r a l e tt e r o n t h e f o rm f o r all o t h e r e n v i r o nm e n tal p e r m i ts t h e f a cility h as

r e c e i ve d

, o r f o r w h i c h t h e facility h as filed an a pp licati o n

, e ve n if t h e p e r m it h a s n o t y e t b een rece i v e d

.

N = N PD ES ( N ati o n al P o ll u ta n t D isc h ar g e Eli m i n a ti o n S y s t em ) Clean Wa t e r A ct

P = P S D ( P r e v e n ti o n o f S i gn ifi c a n t D e t e r i o ra t i o n ) C l e an A i r A ct

R = RCRA ( R e s o u r ce C o n s e r v at i o n a n d R e c o ve r y A c t)

U = UIC (U nd e r g r o un d I n j e ct i o n C o n t r o l) S a f e D ri n ki n g W at e r A c t

F = E P A 4 0 4 ( D re dg e o r F ill P e r m its und er S ect i o n 4 0 4 o f t h e Clean Water A ct)

E = Ot h e r r e l ev a n t e n v ir o n m e n tal p e r m i ts. L i st a n y o t h e r r e l e v a n t F e d e ral ( e .g.

, p e r m i t s

und er t h e O c ean D u m p i n g A ct), S tate ( e. g.

, S ta t e p e r m its f o r n e w a i r em i s si o n s o u rc e s in

n o n attai n m e n t a r eas un d er P a r t D o f t h e C l ean A ir A ct o r S ta t e p e r m its und er

S ecti o n 4 0 4 o f t h e C l e an W at e r A c t), o r l o cal e n v i r o nm e n tal p e r m its o r a pp licati on s.

B

. P ERM I T N UMBE R

Gi v e t h e nu m b er o f e a ch p rese n t l y eff e cti v e p e r m it i s s u ed to t h e facili t y f o r e ach p r o g ra m

, o r if y o u h a v e

p r ev i o u s l y filed an a pp lica t i o n

, bu t h a v e n o t y e t r e c e i ve d a p e r m i t, g i v e t h e n u m b e r o f t h e a pp lic a ti o n

a n d n o te t h is in t h e d e scr i p ti o n

. Y o u m a y list a dd it i on al p e r m it n u m b e rs o n a s e p arate s h e e t o f p a p e r if

yo u h a v e mo r e t h an o n e c u rr e n tly e ffe c ti v e p e r m it f o r yo u r facili t y und e r a p a r t ic u lar p e r m it p r o g r a m

.

R e m e m b e r t o i n cl ud e yo u r E P A I d e n tificat i o n N u m b e r a n d S i t e N a m e in t h e u p p e r l e f t

- h a n d c o r n e r o f e ach

at t ac h e d p a g e

.

C

. D E SC R I P T I ON

Use t h e s p ace p r o v i d e d f o r a n y a dd iti o n al i n f o r m at i o n i d e n tif y i n g o r d e scri b i n g t h e p e r m its.38 Haza r dou s W a s te P e r m it I n f o r m a ti o n F o rm

(c on ti nu e d)

I T E M 6

– N A T U R E O F B U S I N E S S

Bri e fly d e s cri b e t h e n a t u r e o f yo u r bu si n e ss ( e .g

., p r o du cts p r o du c e d o r s e r v i c e s p r o v i d e d ). If mo r e

s p ace is n ee d e d

, p l e a s e a t t ach a dd iti o n al s h e e ts. R e m e m b e r t o i n cl ud e y o u r E P A I d e n tifi c ati o n Nu m b e r

a n d S ite N a m e in t h e upp e r l e f t

- h a n d c o r n e r o f e ach a t tac h e d p a g e

.

I T E M 7

– P RO C E S S C O D E S A N D D E SI G N C A P A C I T I E S

T h e i n f o r m at i o n in I t e m 7 d escri b es all t h e p r o ces s es t h at will b e u s ed to t r eat, s t o r e, o r d is p o s e o f

h a z ar d o u s w a ste at t h e fa c ilit y

. T h e p r o c e ss c o d e a n d d e si g n c a p acity o f e ach p r o c e s s m u st b e p r o v i d e d

as p art o f t h e d e s cri p ti o n

. T h e d e si g n c a p acity o f i n j e cti o n w e lls a n d la nd fills at e xisti n g facil i ties s h o u ld

b e me a s u r e d as t h e r e m a i n i ng

, unu s e d ca p acit y

. T a n k st o ra g e s h o u ld r e f e r t o e ach ta n k, n o t e ach ta n k

far m

. P l e ase i nd ic a te t h e l o c a ti o n o f e ach p r o c e ss list e d in I t e m 7 o n e it h e r t h e m ap p r ov i d e d f o r

Item 1 0 o r t h e p h o t o g ra ph s p r o v i d e d f o r It e m 1 2

. U se t h e li n e nu m b e r f r o m I t e m 7 t o i nd ica t e w h e r e

t h e p r o cess ( es) are l o ca t e d

. S ee t h e f o r m f o r d etai l ed i n str u cti o n s o n I te m 7

.

N OTE Sub m issi o n o f a R e v i s e d P art A Pe r m i t App licati o n is r e qu ir e d b e f o r e p r o c e s se s f o r t r e ati ng

,

st o ri ng

, o r d is p o si n g o f h a z ar d o u s w ast e s a r e c h a n g e d ; b e f o re n e w p r o c e ss e s a r e a dd e d ;

a nd /o r b e f o r e t h e d e si g n c a p acities o f t h e se p r o c e ss e s a re i n c r e as e d

.

I T E M 8

– O T H E R P RO C E S S E S

Use t h is s p ace t o d e s cri b e o t h er p r o ce s ses t h at d id n o t h a v e a s p e cific p r o c e s s c o d e list e d in It e m 7

. A o f

t h e f o r m

. F o ll o w t h e i n st r u cti o n s f o r I t e m 7

. A o n t h e f o r m f o r o t h er p r o c e ss c o d es (i

. e., D 9 9

, S 99

, T 0 4 , a n d

X 9 9 p r o cess c o d es). D escri b e t h e o t h er p r o c ess e s in It e m 1 3

– C o m m e n ts.

I T E M 9

– D E S C R I P T I O N O F HA Z A R D O U S W A S T E S

T h is i n f o r m at i o n d e s cri b e s all t h e h a z ar d o u s was t e s, u si n g t h e ir h a z ar d o u s w a ste c o d e s

, t h a t will b e

tr e at e d

, s t o r e d

, o r d is p o se d at t h e facili t y

. In a dd iti on

, t h e p r o c e sses t h at will b e u sed to tr e at, s t o re, o r

d is p o se o f e ach h a z ar d o u s wa s te a n d t h e e s ti m a t e d a nnu al qu a n tity o f e ach h a z ar d o u s w a ste m u st b e

p r ov i d e d

. T h e f o r m c o n t ai n s t h r e e p a g e s t o ca p t u re t h e i n f o r m a ti o n f o r It e m 9 : P a g e 4 o f 6

, w h i ch h as

d e tail e d i n s t r u ct i o n s; P a g e 5 o f 6 , w h ich is to b e fill e d o u t ; a n d P a g e 5

_ o f _, w h ich is u s e d if a dd it i o n al

p a g e s are n e e d e d

. If a dd it i o n al p a g e s a r e n ee d e d

, t h e p a g e s s h o u ld b e n u m b e r e d as f o l l o w s : P a g e 5 a o f

6

, P a g e 5 b o f 6

, P a g e 5 c o f 6

, e tc. S ee t h e f o rm f o r d e tail e d i n str u ct i o n s o n I t e m 9

.39 Haza r dou s W a s te P e r m it I n f o r m a ti o n F o rm

(c on ti nu e d)

N OTE Sub m issi o n o f a R ev i s e d P art A Pe r m it App licat i o n is r e qu ir e d b e f o re a f a cility b e g i n s tr e a ti ng

,

st o ri ng

, o r d is p o si n g o f n e w h a z ar d o u s wa s t e s n o t p r ev i o u sly i d e n tif i e d in t h e facilit y ’s P art A

Pe r m it App licati o n

. C h a n g e s in t h e qu a n ti t y o f h a z ar d o u s waste p r e v i o u s l y s p e cifi e d in t h e

P art A P e r m it App licat i o n c an b e m a d e wit h o u t s u b m i tti n g a R ev i s e d P art A Pe r m it App licati o n

,

p r ov i d e d t h e qu a n ti t y do e s n o t e x c ee d t h e p r o c e s s d e si g n ca p aciti e s s p e cif i e d in t h e first P a r t A

s ub m issi o n

.

I T E M 1 0

- M A P

P r o v i d e a t o p o g ra ph ic m a p o r m a p s o f t h e ar e a e x t e nd i n g to a l e ast o n e m i l e b e yo n d t h e p r o p e r t y

b o und ari e s o f t h e fac ili t y

. T h e m ap m u st c l e arly s ho w t h e f o ll o wi ng :

• T h e le g al b o und ari e s o f t h e facilit y ;

• T h e l o c a ti o n a n d s e rial n u m b e r o f e ach o f y o u r e x i sti n g a n d p r o p o s e d i n ta k e a n d d isc h ar g e

str u ct u re s ;

• A ll h a z ar d o u s wa s te m a n a g e m e n t facilit i e s;

• Lo c a ti o n o f all p r o c e s s e s li s t e d in It e m s 7 a n d 8 i d e n tif i e d b y p r o c e s s c o d e ;

• Each w e ll w h e r e yo u i n j e ct fl u i d s un d e r g r o und ; a n d

• A ll s p ri ng s a n d s u rface wa t e r b o d ies in t h e ar e a, p l u s all d ri n ki n g wat e r w e lls w i t h in 1⁄4 m ile o f t h e

facility w h ich are i d e n tified in t h e p ub lic r e c o rd o r o t h e r w ise k no wn t o yo u

.

If an i n ta k e o r d i s c h ar g e s t r u ct u r e

, h a z ar d o u s waste d is p o sal s it e

, o r i n j e ct i o n w e ll as s o cia t e d with t h e

facility is l o ca t e d m o re t h a n o n e m i l e fr o m t h e p la n t, i n cl ud e it o n t h e m a p

, if p o ssi b le. If n o t, a ttach

a d d iti o n al s h ee ts d e s cri b i n g t h e l o c ati o n o f t h e s tr u c t u r e

, d is p o sal sit e

, o r w e l l

, a n d i d e n ti f y t h e U. S

.

G eo l o g ical Su r v e y ( o r o t h e r) m a p s c o r r e s p o nd i n g t o t h e l o cat i o n

. R e m e m b e r to i n cl ud e yo u r E P A

I d e n tificati o n Nu m b e r a n d S ite N a m e in t h e upp e r l e f t

- h a n d c o r n e r o f e ach a t ta c h e d p a g e

.

On e a ch m a p

, i n cl ud e t h e m ap scale, a me ri d ian arr o w s h o wi n g n o r t h

, a n d lati t ud e a n d l o ng it ud e at t h e

n e ar e st w h o l e s e c o nd

. On all m a p s o f r i ve rs, s ho w t h e d ir e ct i o n o f t h e c u rr e n t, a n d in ti d al wat e rs, s h o w

t h e d ir e ct i o n s o f t h e e b b a n d fl o w ti d e s. U s e a 7

- 1 / 2 m i nu te s e r i e s m ap pub lis h e d b y t h e U .S . G e o l o g ic a l

Su r vey

. If a 7

- 1 / 2 m i nu t e s e ri e s m ap h as n o t b ee n pub lis h e d f o r y o u r facil i ty s i t e

, t h e n yo u m a y u s e a

15

- m i nu te s e ri e s m ap fr o m t h e U. S

. G e o l o g ical Su r v ey

. If n e it h e r a 7

- 1 / 2 n o r 15

- m i nu te s e ri e s m ap h a s

b ee n pub lis h e d f o r y o u r f acility sit e

, u s e a p la n t m ap o r o t h e r a pp r o p ri a te m a p

, a n d i n cl ud e all t h e

r e qu e st e d i n f o r m at i o n ; in t h is cas e

, b ri e fly d e scri b e la n d u s e s in t h e m ap ar e a ( e .g.

, r e si d e n tial,

c o m m e rcial).

F o r i n f o r m at i o n a b o u t o b t ai n i n g m a p s, c o n ta c t t h e U .S

. G eo l o g ical Su r v e y at (8 88 ) 2 7 5

- 8 7 4 7 o r s ee t h e

U .S . G eo l o g ical Su r ve y w eb site a t h tt p : / / w ww. u s g s. g o v/ pubp r o d

.

Y o u m a y trace y o u r m ap f r o m a g eo l o g ica l s u r v e y c h a r t

, o r o t h e r m ap m e e ti n g t h e a bo v e s p e cif i cat i o n s.

If yo u do

, y o u r m ap s h o u l d b e ar a n o t e s ho wi n g t h e nu m b e r o r title o f t h e m a p o r c h art f r o m w h ich it

was tr a c e d

. I n cl ud e t h e n a me s o f n e ar b y t o w n s, wa te r b o d i e s, a n d o t h e r p r om i n e n t p o i n t s.40 Haza r dou s W a s te P e r m it I n f o r m a ti o n F o rm

(c on ti nu e d)

I T E M 1 1

– F A C I L I T Y D R A W I N G

A ll e xisti n g f a cilities m u s t i n cl ud e a d ra w i n g s h o wi n g t h e g e n e ral la y o u t o f t h e facili t y

. T h is d ra w i n g

s h o u ld b e a pp r o x i m a t e ly t o s cale a n d fit o n an 8 1⁄2 ” x 1 1 ” s h e e t o f p a p e r. T h e d rawi n g s h o u ld s ho w t h e

f o ll o w i ng :

• T h e p r o p e r t y b o und ari e s o f t h e facil i t y ;

• T h e ar e as o cc up ied b y all st o ra g e

, tr e a t m e n t, o r d i s p o sal o p e ra t i o n s t h at will b e u s e d du ri n g

i n t e rim stat u s ;

• T h e n a m e o f each o p erat i o n (e. g.

, m u l ti p le h ea r th i n c i n erat o r, d r u m s t o ra g e a r e a

, etc

. ) ;

• A r e as o f p ast s t o ra g e

, tr e a t me n t, o r d is p o sal o p e r ati on s;

• A r e as o f f u t u re s t o ra g e

, tr e at m e n t, o r d is po sal o p e ra t i o n s; a n d

• T h e a pp r o x i m ate d i me n s i o n s o f t h e p r o p e r t y b o und ari e s a n d all s t o ra g e

, tr e a t me n t

, a n d

d is p o sal ar e a s. ( W h e re a p p lica b le

, u se t h e p r o c e s s c o d e s li s t e d in I te m s 7 a n d 8 t o i nd ica t e t h e

l o cat i o n o f all s t o ra g e

, t r e a t me n t, a n d d is po sal ar e as

. )

N OTE N e w f a c i liti e s d o no t ha v e to c o m p l e te I t e m

11.

I T E M 1 2

– P H O T O G R A P H S

A ll e xisti n g facil i ties m u st i n cl u d e ph o t o g ra ph s t h at c learly d e li n e ate all e x i sti n g str u ct u r e s ; all e xisti n g

ar e as f o r s t o ri ng

, tr e a ti ng

, o r d is p o si n g o f h a z ar dou s was t e ; a n d all k n o wn sit e s o f f u t u r e s t o ra g e

,

tr e a t me n t

, o r d is p o sal o p e ra t i o n s. P h o t o g ra ph s m ay b e c o l o r o r b lack a n d w h i te

, g r o und

- le ve l o r a e rial.

I nd icate t h e d ate t h e pho t o g ra p h was ta k e n o n t h e b ack o f e ach pho t o g ra ph

. Use t h e p r o c e ss c o d e s

list e d in I t em s 7 a n d 8 to i nd icate t h e l o cat i o n o f all st o ra g e

, tr e a t m e n t, a n d d is p o sal a r e as.

N OTE N e w f a c i liti e s d o no t h a v e to c o m p l e te I t e m

11.

I T E M 1 3

- C O M M E N T S

Use t h is s p a ce f o r a n y a d d iti o n al c o mm e n ts a n d a tt ach a dd iti o n al s h e e ts if n e c e ssa r y

. R e m em b e r t o

i n cl ud e y o u r E P A I d e n tifi c a ti o n N u m b e r a n d S i t e N a m e in t h e upp e r l e f t

- h a n d c o r n e r o f e ach att a c h e d

p a g e

.41 

# T h is p age i n t en t i on ally l e f t b l a n k

# R C RA H az a r dous W a s te

P a r t A P e r m i t A pp l i c at i on

O T H E R R E F E R E N C E I N F OR M A T I O N

A ND

C O D E L IS T SDefinitions

(continued)

43 

## EXCLUDED WASTES

T his section presents a partial list of excluded materials and wastes. This list includes materials excluded from the

definition of solid waste in 40 CFR 261.4(a) and solid wastes excluded from the definition of hazardous waste in

40 CFR 261.4(b). In addi tion, it also includes specific solid waste samples that are excluded from the definition of

hazardous waste in 40 CFR 261.4(d)

- (f). Finally, this list includes specific hazardous wastes, as described in 40 CFR

261.4(c), that are exempted from certain RCR A Subtitle C regulations.

Agricultural Waste Fertilizer

§261.4(b)(2)

Analytical Samples

– A Sample Of Solid

Waste Or A Sample Of Water, Solid, Or

Air, Which Is Collected For The Sole

Purpose Of Testing To Determine Its

Characteristics Or Composition

§261 .4(d)

Arsenic Treated Wood and Wood

Products

§261.4(b)(9)

Carbon Dioxide Stream Injected For

Geologic Sequestration. Carbon

Dioxide Stream s That Are Captured

And Transported For Purposes Of

Injection Into An Underground

Injection Wells, Including The

Re quirements in 40 CFR Parts 144 And

146 Of The Underground Injection

Control Program Of The Safe Drinking

Water Act

§261.4(h )

Cement Kiln Dust

§261.4(b)(8)

Coking By

- products

§261.4(a)(10)

Comparable/Syn gas Fuels

§261.4(a)(16)

Domestic Sewage

§261.4(a)(1)

Dredged Material That Is Subject To

The Requirements Of A Permit That

Has Been Issued Under 404 Of The

Federal Water Pollution Control Act

(33 U.S.C. 1344) Or Section 103 Of The

Marine Protection, Research, And

Sanctuaries Act of 1972 (33 U.S.C.

1413)

§261.4(g) Drilling Fluid

§261.4(b)(5)

Excluded Scrap Metal Being Recycled

§261.4(a)(13)

Exp orted Wastes

§262.56

Fossil Fuel Emission Control Waste

§261.4(b)(4)

Hazardous Secondary Material Being

Remanufactured

§261.4(a)(27)

Hazardous Secondary Material s

Generated And Legitimately

Reclaimed Under The Control Of The

Generator

§26 1.4(a)(23 )

Hazardous Secondary Material

Generated and Reclaimed Under the

Control of the Generator

40 CFR §261.2(a)(2)(ii)

40 CFR §261.4(a)(23)

Hazardous Secondary Material

That Is Generated And Then

Transferred To A Verified Reclamation

Facility For The Hazardous Secondary

Material Purpose Of Reclamatio n

§26 1.4(a)(24 )

Hazardous Secondary Material

Transferred Off

- site for Reclamation

to A Verified R ecycler

40 CFR §261.4(a)(25)

40 CFR §261.4(a)(24)

Hazardous Secondary Material Used to

Make Zinc Fertilizers, Provided That

The Following Conditions Specified Are

Satisfied

§261.4(a)(20) Household Waste

§261.4(b)(1)(i)

- (ii)

HTMR Condenser Residue

§261.4(a)(11)

In situ Mining Materials

§26 1.4(a)(5)

Irrigation Return Flows

§261.4(a)(3)

Kraft Mill Steam Stripper Condensates

§261.4(a)(15)

Leachate Or G as Condensate Collected

From Landfills Where Certain Solid

Wastes Have Been Disposed

§261.4(b ) (15)

Mining and Mineral Process Wastes

§261.4(b)(7)

Mining Overburden

§261.4(b)(3)

Non

- terne plated used oil filters that

are not mixed with wastes listed in

subpart D of this part if these oil filters

have been gravity hot

- drained using

one of the following methods:

- §261.4(b)(13)

Nuclear Material

§261.4(a)(4)

Oil Filters

§261.4(b)(13)

Petrochemical Recovered Oil

§261.4(a)(18)

Petroleum

- c ontaminated Media and

Debris

§261.4(b)(10)

Petroleum Refining

§261.4(a)(12)Definitions

(continued)

44 Pulping Liquor

§261.4(a)(6)

Refrigerants

§261.4(b)(12)

Secondary Material Returned to

Original Process

§261.4(a)(8)

Secondary Material from Mineral

Processing

§261.4(a)(17 )

Shredded Circuit Boards Being

Recycled

§261.4(a)(14)

Solid Waste That Would Otherwise

Meet The Definition Of Low

- level

Mixed Wastes (LLMW) Pursuant to

§266.210

§261.4(b)(17)

Solvent

- Contaminated Wipes , Except

For Wipes That Are Hazardous Waste

Due To The Presence Of

Trichloroethylene, That Are Sen t F or

Disposal Are Not Hazardous Waste

From The Point Of Generation

§261.4(b)(18) Solvent

- Contaminated Wipes Sent for

Cleaning or Disposal

§261.4(a)(26)

Spent Caustics from Petroleum

Refining

§261.4(a)(19)

Spent Wood Preserving Solutions and

Wastewaters

§261.4(a)(9)

Sulfuric Acid

§261.4(a)(7)

Treatability Study Samples

§261.4(e)

Treatability Studies at Laboratories

and Testing Facilities

§261.4(f)

Trivalent Chromium Waste

§261.4(b)(6)

Used Cathode Ray Tubes (CRTs)

§261.4(a)(22)

Used Chlorofluorocarbon Refrigerants

From Totally Enclosed Heat Transfer

Equipment

§261.4(b)(1 2) Used Oil Distillation Bottoms

§261.4(b)(14)

Used Oil Re

- refining Distillation

Bottoms That Are Used As Feedstock

To Manufacture Asphalt Products

§261.4(b)(14)

Wastes Generated in Storage Tanks,

Transport Vehicles, Pipelines, or

Manufacturing Process Units

§261.4(c)

Wastewater Point Source Discharge

§261.4(a)(2)

Zinc Fertilizers Made From Hazardous

Wastes, Or Hazardous Secondary

Material That Are Excluded Under

Paragraph (a)(20) Of This Section

§261.4(a)(21)Definitions

(continued)

45 

## DEFINITIONS

This section contains definitions of terms helpful for completing the form. For terms defined in the Code

of Federal Regulations (CFR), the appropriate citation is provided.

A CCUMULATION

– A site that does not hold RCRA Interim Status or a RCRA permit m ay accumulate

hazardous waste for a short period of time before shipping it off

- site. The waste must be accumulated

in either tanks or containers; it may not be accumulated in surface impoundments.

Generators of more than 1,000 kg (2,200 lbs) of hazardous waste per month may accumulate their

waste for up to 90 days before shipping it off

- site. Generators of 100 kilograms (kg; 220 pounds [lbs])

to 1,000 kg (2,200 lbs) of hazardous waste per month may accumulate their waste for up to 180 days

before shippin g it off

- site. If the nearest treatment, storage, disposal, or recycling facility to which

they can send their waste is more than 200 miles away, they may accumulate their waste for 270 days.

See 40 CFR 262.34.

A CT OR RCRA

– The Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act

of 1976, as amended by the Hazardous and Solid Waste Amendments of 1984, 42 U.S.C. Section 6901

et seq

.

A CUTE H AZARDOUS W ASTE

– Any hazardous waste with an EPA hazardous waste code beginning with t he

letter “P” (40 CFR 261.33(e)) or any of the following “F” codes: F020, F021, F022, F023, F026, and

F027 (40 CFR 261.31). These wastes are subject to stringent quantity standards for accumulation and

generation (40 CFR 261.5(e)).

A UTHORIZED R EPRESENTAT IVE

– The person responsible for the overall operation of the site or an operational

unit (i.e., part of a site), e.g., superintendent or plant manager, or person of equivalent responsibility.

A UTHORIZED S TATE

– A State that has obtained authorization from the EPA to direct its own RCRA program.

B OILER

– An enclosed device using controlled flame combustion and having the following characteristics:

 The unit has physical provisions for recovering and exporting energy in the form of steam, heated

fluids, or he ated gases;

 The unit’s combustion chamber and primary energy recovery section(s) are of integral design (i.e.,

they are physically formed into one manufactured or assembled unit);

 The unit continuously maintains an energy recovery efficiency of at least 60 percent, calculated

in terms of the recovered energy compared with the thermal value of the fuel;

 The unit exports and utilizes at least 75 percent of the recovered energy, calculated on an annual

basis (excluding recovered heat used internally in the sam e unit, for example, to preheat fuel or

combustion air or drive fans or feedwater pumps); or

 The unit is one which the Regional Administrator has determined, on a case

- by

- case basis, to be

a boiler, after considering the standards in 40 CFR 260.32.

B Y

- PR ODUCT M ATERIAL

– A by

- product material is (1) any radioactive material (except special nuclear

material) yielded in or made radioactive by exposure to the radiation incident to the process of

producing or utilizing special nuclear material; and (2) the tai lings or wastes produced by the

extraction or concentration of uranium or thorium from any ore processed primarily for its source

material content (defined in the Atomic Energy Act of 1954).Definitions

(continued)

46 C ODE OF F EDERAL R EGULATIONS (CFR)

– Codification of the general and permanent rules published in the

Federal Register by the Executive departments and agencies of the Federal Government. The Code is

divided into 50 titles which represent broad areas subject to Federal regulation. Each title is divided

into chapters t hat usually bear the name of the issuing agency. Each chapter is further subdivided

into parts covering specific regulatory areas. The CFR title applicable for the Hazardous Waste Report

is “40,” as in “40 CFR 262.34.”

C ONDITIONALLY E XEMPT S MALL Q UANTIT Y G ENERATOR (CESQG) OF H AZARDOUS W ASTE is a generator who

generates less than or equal to the following amounts in a calendar month:

(i) 100 kilograms (kg; 220 pounds [lbs]) of hazardous waste; and

(ii) 1 kg (2.2 lbs) of acute hazardous wastes listed in se ctions 261.31, or 261.33(e); and

(iii) 100 kg (220 lbs) of any residue or contaminated soil, waste, or other debris resulting from the

cleanup of a spill, into or on any land or water, of any acute hazardous wastes listed in sections

261.31, or 261.33(e).

C ONFIDENTIAL B USINESS I NFORMATION (CBI)

– Information a facility does not wish to make available to the

general public for competitive business reasons. Confidential Business Information (CBI) may be

claimed for certain information in your submittal. A claim may be made in accordance with 40 CFR

Part 2, Subpart B.

D ELISTED W ASTE

– Site

- specific wastes excluded from regulation under 40 CFR 260.20 and 260.22. A waste

at a particular generating site may be excluded by petitioning the EPA Administrator for a regulatory

amendment. These wastes are listed in Appendix IX of 40 CFR Part 261.

D ISPOSAL

– The discharge, deposit, injection, dumping, spilling, leaking, or placing of any solid waste or

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

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

waters, including groundwaters.

E LIGIBLE A CADEMIC E NTITY

– A college or university, or a non

- profit research institute that is owned by or has

a formal written affiliation with a college or university, or a teaching hospital that is owned by or has

a formal written affiliation with a college or university pursuant to 40 CFR Part 262, Subpart K (See 40

CFR 262.200).

E NVIRONMENTAL P ROTECTION A GENCY (EPA)

– The EPA, also called U.S. EPA, means the U.S. Environmental

Protection Agency. Some State environmental authorities may be called the EPA also, as in “Illinois

EPA.”

EPA I DENTIFICATION (ID) N UMBER

– The number assigned by the EPA to each hazardous waste generator,

hazardous waste transporter, and treatment, storage, or disposal facility; U.S. importer of hazardous

waste; mixed waste (hazardous and radioactive) generator; recycler of hazardous waste; exempt

boiler and/or industr ial furnace burning or processing hazardous waste; large quantity handler of or

destination facility for universal wastes; disposer of hazardous waste with an underground injection

permit; used oil transporter, used oil processor/re

- refiner, off

- specificat ion used oil fuel burner, used

oil fuel marketer; eligible academic entity managing laboratory hazardous waste under Subpart K; or

site undergoing corrective action. Additionally, facilities that must notify using the Site ID Form and

Addendum to the Site Identification Form that they are managing hazardous secondary material willDefinitions

(continued)

47 also be assigned an EPA Identification Number.

E XCLUDED W ASTES

– Wastes excluded from the definition of solid or hazardous waste under 40 CFR 261.3

and 261.4. For a partial lis ting, see the “ EXCLUDED WASTES ” section of this booklet.

H AZARDOUS W ASTE

– A hazardous waste as defined in 40 CFR 261.3.

H AZARDOUS S ECONDARY M ATERIAL (HSM)

– A secondary material (e.g., spent material, by

- product, or s ludge)

that, when discarded, would be identified as hazardous waste under 40 CFR Part 261. Facilities

managing hazardous secondary material under 40 CFR 260.30, 40 CFR 261.4(a)(23), (24), or (27) must

complete the Addendum to the Site Identification Form: Notification for Managing Hazardous

Secondary Material. You must check with your State to determine if you are eligible to manage

hazardous secondary material under these exclusions (see also

http://www.epa.gov/epawaste/hazard/dsw/statespf.htm ).

H AZARDOUS W ASTE G ENERATOR

– Any person, by site, whose act or process produces hazardous waste

identified or listed in 40 CFR Part 261.

H AZARDOUS W ASTE N UMBER OR C ODE

, EPA

– The number (or code ) assigned by the EPA to each hazardous

waste listed in 40 CFR Part 261, Subpart D and to each characteristic identified in 40 CFR Part 261,

Subpart C. The codes consist of one letter (D, F, P, U, or K) and three numbers. For a list of EPA

hazardous wast e codes see the “ EPA HAZARDOUS WASTE CODES ” section of this booklet.

H AZARDOUS W ASTE N UMBER OR C ODE

, S TATE

– The number (or code) assigned by the State to each hazardous

waste listed in the State regulations. Obtai n a list of the States waste codes from your State.

H AZARDOUS W ASTE S TORAGE

– The holding of hazardous waste for a temporary period, at the end of which

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

H AZARDOUS W ASTE T RANSFER F ACILITY

– Refer to “Transfer Facility” definition.

H AZARDOUS W ASTE T RANSPORTER

– Refer to “Transporter” definition.

H AZARDOUS W ASTE T REATMENT

– Any method, technique, or process, including neutralization, designed to

change the physical, chemical, or biological c haracter or composition of any hazardous waste so as to

neutralize such hazardous waste, or so as to recover energy or material resources from the hazardous

waste, or so as to render such hazardous waste nonhazardous, or less hazardous; safer to transport,

store, or dispose of; or amenable for recovery, amenable for storage, or reduced in volume. Such

term includes any activity or processing designed to change the physical form or composition of

hazardous waste so as to render it nonhazardous.

I NCINERATI ON

– Burning of certain types of solid, liquid, or gaseous materials; or a treatment technology

involving destruction of waste by controlled burning at high temperatures (e.g., burning sludge to

remove the water and reduce the remaining residues to a safe, non

- burnable ash that can be disposed

safely on land, in some waters, or in underground locations).

I NDUSTRIAL F URNACE

– Any of the following enclosed devices that are integral components of manufacturingDefinitions

(continued)

48 processes and that use thermal treatment to accom plish recovery of materials or energy: cement

kilns; lime kilns; aggregate kilns; phosphate kilns; coke ovens; blast furnaces; smelting, melting, and

refining furnaces; titanium dioxide chloride process oxidation reactors; methane reforming furnaces;

pulp ing liquor recovery furnaces; combustion devices used in the recovery of sulfur values from spent

sulfuric acid; halogen acid furnaces, as defined under industrial furnace in 40 CFR 260.10; and such

other devices as the Administrator may add to this list.

I NTERIM (P ERMIT ) S TATUS

– Period during which the owner/operator of an existing TSD facility is treated as

having been issued a RCRA permit even though he/she has not yet received a final determination. An

existing facility should have automatically qual ified for interim status if the owner/operator filed both

timely “notification” and the first part (Part A) of the RCRA permit application. Interim status

continues until a final determination is made to issue or deny the permit. Owner/operator of new

fa cilities cannot by definition qualify for interim status; rather, they need a RCRA permit prior to

beginning construction of a hazardous waste management facility.

L ARGE Q UANTITY G ENERATOR (LQG) OF H AZARDOUS W ASTE

– is a generator who generates any of the

following amounts in a calendar month :

(i) Greater than or equal to 1,000 kilograms (kg; 2,200 pounds [lbs]) or more of hazardous waste;

or

(ii) Greater than 1 kg (2.2 lbs) of any acute hazardous wastes listed in §§ 261.31 or 261.33 (e); or

(iii) Greater than 100 kg (220 lbs) of any residue or contaminated soil, waste, or other debris

resulting from the cleanup of a spill, into or on any land or water, of any acute hazardous wastes

listed in sections 261.31 or 261.33(e).

L ARGE Q UANTITY H ANDLER OF U NIVERS AL W ASTE (LQHUW)

– A universal waste handler (as defined in 40 CFR

273.9) who accumulates 5,000 kilograms (kg) or more total of universal wastes (batteries, pesticides,

mercury

- containing equipment, or lamps

– calculated collectively) at any time. This de signation is

retained through the end of the calendar year in which the 5,000 kg limit is met or exceeded.

M ANAGEMENT

, OR H AZARDOUS W ASTE M ANAGEMENT

– Systematic control of the collection, source separation,

storage, transportation, processing, treatment, recovery, or disposal of hazardous waste (40 CFR

260.10).

M ANIFEST

, U NIFORM H AZARDOUS W ASTE

– The shipment document EPA Form 8700

- 22 and, if necessary,

Form 8700

- 22A, originated and signed by a generator in accordance with the instructions included in

th e Appendix to 40 CFR Part 262. The “cradle

- to

- grave” paperwork must accompany a shipment of

hazardous waste as it moves from the generator to the transporter and eventually to the hazardous

waste management facility.

M IXED W ASTE

– Waste that contains bot h hazardous and source, special nuclear, or by

- product material

subject to the Atomic Energy Act (AEA), RCRA section 1004(41), 42 U.S.C. 6903 (63 FR 17414; April 9,

1998).

M UNICIPALITY

– A city, village, town, borough, county, parish, district, associatio n, Indian tribe or

authorized Indian tribal organization, designated and approved management agency under Section

208 of the Clean Water Act, or any other public body created by or under State law and having

jurisdiction over disposal of sewage, industrial wastes, or other wastes.Definitions

(continued)

49 O FF

- SITE F ACILITY

– A hazardous waste treatment, storage, disposal, or recycling area located at a place

away from the generating site.

O FF

- S PECIFICATION U SED O IL B URNER

– A site where used oil not meeting the specification requ irements in

40 CFR 279.11 (off

- specification used oil) is burned for energy recovery in devices identified in Section

279.61(a).

O FF

- S PECIFICATION U SED O IL F UEL

– Used oil fuel that does not meet the specification provided under 40 CFR

279.11.

O N

- SITE F A CILITY

– A hazardous waste treatment, storage, disposal, or recycling area located on the

generating site.

O N

- S PECIFICATION U SED O IL F UEL

– Used oil fuel that meets the specification provided under 40 CFR 279.11.

O PERATOR

– The person responsible for the overall operation of a RCRA site. Note: This is the legal entity

which controls the RCRA site operation rather than the plant or site manager. This is usually a

company or business name, not an individual. See Person

.

O WNER

– The person who owns a RC RA site or part of a RCRA site. Note: This includes the owner(s) of the

building(s) and/or land. This may be an individual, company, or business name. See Person

.

P ERSON

– An individual, trust, firm, joint stock company, Federal Agency, corporation (i ncluding a

government corporation), partnership, association, State, municipality, commission, political

subdivision of a State, or any interstate body.

P ROCESS S YSTEM

– A process system refers to one or more units used together to treat, recover, or dis pose

of a hazardous waste. The process system begins at the unit where the hazardous waste first enters

and consists of all other treatment, recovery, or disposal units downstream from the point of entry.

Note that storage is not considered a process sys tem, except for storage at a bulking and re

- shipping

facility (H141).

Classify each process system with a Management Method code that best identifies the last

substantive purpose/operation it performs. For example, a process system to remove dissolved

metals from wastewater prior to shipping the sludge off

- site typically includes equalization, pH

adjustment, chemical precipitation, flocculation, clarification/settling, and dewatering of the sludge

removed from the bottom of the clarifier. The chemical precipitation process best identifies the last

purpose of this treatment system

– to remove metals from the wastewater. If this wastewater

treatment system is RCRA

- regulated, it would be reported as H070 (Chemical Treatment). If the

sludge will be dispos ed at the reporting site in a landfill, the code will be H132 (Landfill) and will need

to be reported on a separate GM Form because it is a residual from a treatment process. However,

this process is exempt if the treated water flows to a POTW or a NPDES outfall with no RCRA

- regulated

storage or treatment units in the system, and should not be reported. A listing of Management

Method codes may be found in the “ MANAGEMENT METHOD CODES ” section of this booklet.

P R OCESS U NIT

– A process unit refers to a single type of treatment (e.g., tank, distillation column, surfaceDefinitions

(continued)

50 impoundment) in which hazardous waste is treated, disposed, or recycled.

R ESOURCE C ONSERVATION AND R ECOVERY A CT (RCRA)

– The Solid Waste Disposal Ac t as amended by the

Resource Conservation and Recovery Act (RCRA) (40 CFR 270.2). It is the Federal statute that regulates

the generation, treatment, storage, disposal, recycling, and/or transportation of solid and hazardous

waste.

RCRA I NTERIM (P ERMIT ) S TATUS

– Refer to “Interim (Permit) Status” definition.

RCRA P ERMIT

– A complete RCRA permit is comprised of an operating permit for hazardous waste

treatment, storage, and disposal, and a corrective action permit addressing releases from solid waste

mana gement unit (SWMUs). To apply for a permit, a site must file a two

- part application (Part A and

Part B). A facility is not considered to have a complete RCRA permit until both parts have been issued.

RCRA S UBTITLE C S ITE (RCRA S ITE OR S ITE )

– The physi cal plant or location at which one or more of the

following regulated waste activities occurs: the generation, transportation, treatment, storage, or

disposal of hazardous wastes; recycling of hazardous wastes; U.S. importer of hazardous waste; mixed

wast e (hazardous and radioactive) generator; exempt boiler and/or industrial furnace burning or

processing hazardous waste; large quantity handler of or destination facility for universal wastes;

disposing hazardous waste with an underground injection permit; the transportation (and temporary

storage during transportation), processing/re

- refining, burning, or marketing of used oil; eligible

academic entity managing laboratory hazardous waste under Subpart K; facility managing hazardous

secondary material being reclaimed that must comply with certain requirements and conditions; or

undergoing corrective action.

A site may consist of several treatment, storage, or disposal operational units. For entities that only

transport regulated wastes, the term site refer s to the headquarters of that entity’s operations.

R ECYCLING

– Use, reuse, or reclamation of a material (40 CFR 261.1(c)(7)). “Reclamation” is the processing

or regeneration of a material to recover a usable product (e.g., recovery of lead values from sp ent

batteries, regeneration of spent solvents) (40 CFR 261.1(c)(4)). A material is “used or reused” if it is

either: (1) employed as an ingredient (including use as an intermediate) in an industrial process to

make a product (e.g., distillation bottoms f rom one process used as feedstock in another process) (40

CFR 261.1(c)(5)). However, a material will not satisfy this condition if distinct components of the

material are recovered as separate end products (as when metals are recovered from metal

containi ng secondary material); or (2) a commercial product (e.g., spent pickle liquor used as

phosphorous precipitant and sludge conditioner in wastewater treatment).

S HORT

- TERM G ENERATOR

– A generator whose generator status is the result of a one

- time, non

- rec urring,

temporary event that is not related to normal production processes. In other words, short

- term

generators produce hazardous waste from a particular activity for a limited time and then cease

conducting that activity. Short

- term generators would n ot be considered episodic generators because

episodic generators have the potential to generate on a regular basis. Examples of short

- term

generators include: one

- time highway bridge waste generation, underground storage tank removals,

generation of off

- spec or out

- of

- date chemicals at a site that normally does not generate hazardous

waste, remediate or spill clean

- up sites with no previous RCRA EPA Identification Number, and site or

production process decommissions by a new operator.Definitions

(continued)

51 S MALL Q UANTITY G ENE RATOR (SQG) OF H AZARDOUS W ASTE

– is a generator if the site meets all of the following

criteria:

(i) Generates, in any calendar month, more than 100 kilograms (kg; 220 pounds [lbs]) but less than

1,000 kg (2,200 lbs) of RCRA hazardous waste; and

(ii) Does not gene rate, in any calendar month, more than 1 kg (2.2 lbs) of acute hazardous waste

listed in sections261.31 or 261.33(e) ; and

(iii) Does not generate more than 100 kg (220 lbs) of material from the cleanup of any residue or

contaminated soil, waste, or other debris resulting from the cleanup of a spill, into or on any land

or water, of any acute hazardous wastes listed in sections 261.31 or 261.33(e).

S MALL Q UANTITY O N

- SITE B URNER E XEMPTION

– The persons who burn small quantity of hazardous waste in

an on

- site boile r or industrial furnace, in accordance with 40 CFR 266.108, are conditionally exempt

from regulation for that activity.

S MELTING

, M ELTING

, AND R EFINING F URNACE E XEMPTION

– Under 40 CFR 266.100(c), owners or operators of

smelting, melting, and refining fur naces that process hazardous wastes solely for metals recovery are

conditionally exempt from regulation, except for 40 CFR 266.101 and 266.112, provided they comply

with limited requirements set forth in Section 266.100(c). Similarly, 40 CFR 266.100(f) pr ovides that

owners or operators of smelting, melting, and refining furnaces that process hazardous wastes for the

recovery of precious metals are conditionally exempt from regulation, except for 40 CFR 266.112,

provided they comply with limited requirement s specified in Section 266.100(f).

S OLID W ASTE

– Any garbage, refuse, or sludge, or other materials not excluded under 40 CFR 261.4(a).

Exclusions include, for example, domestic sewage and any mixture of other wastes that pass through

a sewer system to a publicly owned treatment works (POTWs); industrial wastewater discharges that

are point source discharges subject to regulation under the Clean Water Act; irrigation return flows;

nuclear materials defined by the Atomic Energy Act; and in situ mining mate rials (see the “ EXCLUDED

WASTES ” section of this booklet). Wastewaters being collected, stored, or treated before discharge

and sludges generated by wastewater treatment are not excluded. The EPA defines hazardous wast e

as a subset of solid waste.

S OURCE M ATERIAL

– As defined by the Atomic Energy Act of 1954: (1) Uranium, thorium, or any other

material determined by the Nuclear Regulatory Commission pursuant to the provisions of Section

2091 of this title to be source material; or (2) ores containing one or more of the foregoing materials

in such concentration as the Commission may by regulation determine from time to time.

S PECIAL N UCLEAR M ATERIAL

– As defined by the Atomic Energy Act of 1954: (1) plutonium, uranium enriched

in the isotope 233 or in the isotope 235, and any other material which the Nuclear Regulatory

Commission, pursuant to the provisions of Section 2071 of this title, determines to be special nuclear

material, but does not include source material; o r (2) any material artificially enriched by any of the

foregoing, but does not include source material.

S UBPART K

– An alternative set of generator requirements for managing laboratory hazardous waste at

eligible academic entities. Generators that are el igible academic entities with laboratories may elect

to opt into 40 CFR 262 Subpart K and manage their laboratory hazardous waste under Subpart K in

lieu of 40 CFR 262.34(c) (or 40 CFR 261.5 for CESQGs). In order for eligible academic entities (seeDefinitions

(continued)

52 defini tion) to opt into Subpart K or subsequently withdraw from Subpart K, they must use the Site ID

Form to notify the appropriate State or EPA Regional Office. Refer to 40 CFR 262.203 and 262.204.

Note: You must check with your State to determine if you are eligible to manage laboratory hazardous

waste pursuant to 40 CFR Part 262 Subpart K and for any State

- specific requirements.

T OLLING

– Tolling arrangements describe a particular type of recycling contract between two companies.

Specifically, the “tollin g” company certifies that it has a contract with a manufacturer to produce a

product, and that manufacturing process generates a residual material that can be recycled by the

tolling company. If the tolling company certifies that the contract specifies th at the tolling company

owns and has responsibility for the recyclable material once it is generated, and the material is

returned to the tolling company for reclamation, and subsequently recycled, the material is excluded

from regulation (under 40 CFR 261. 4(a)(23)), provided certain requirements are met.

T RANSFER F ACILITY

– Any transportation

- related facility including loading docks, parking areas, storage

areas, and other similar areas where shipments of hazardous waste are held for 10 days or less during

the normal course of transportation ( 40 CFR 261.2(a)(2)(ii) 40 CFR 261.4(a)(23) and 40 CFR 263.12).

T RANSPORTER

– A person engaged in the off

- site transportation of hazardous waste by air, rail, highway, or

water.

U NDERGROUND I NJECTION C ONTROL

– The sub surface emplacement of fluids through a bored, drilled or driven

well; or through a dug well, where the depth of the dug well is greater than the largest surface

dimension. Underground injection wells are regulated under both the Safe Drinking Water Act a nd

the Resource Conservation and Recovery Act (see 40 CFR Part 148).

U NITED S TATES I MPORTER

– Any person who imports hazardous waste from a site located in a foreign country

into the U.S. This does not include hazardous waste shipped from a foreign Depar tment of Defense

site, Maquiladora, U.S. territory or protectorate.

U NIVERSAL W ASTE

– Any of the following hazardous wastes that are managed under the universal waste

requirements of 40 CFR Part 273: batteries, pesticides, mercury

- containing equipment, a nd lamps.

Some States may have State

- specific universal wastes defined as well.

U SED O IL

– Any oil that has been refined from crude oil, or any synthetic oil, that has been used, and as a

result of such use, is contaminated by physical or chemical impuri ties.

U SED O IL F UEL M ARKETER

– Any person who conducts either of the following activities:

1. Directs a shipment of off

- specification used oil from their site to an off

- specification used oil

burner; or

2. First claims that used oil that is to be burned for ene rgy recovery meets the used oil fuel

specifications set forth in 40 CFR 279.11.

U SED O IL M ANAGEMENT A CTIVITIES

– For the purposes of the Site ID Form, includes used oil transportation;

used oil processing and re

- refining; burning off

- specification used oi l fuel; and used oil fuel marketing.

U SED O IL P ROCESSING

– Chemical or physical operations designed to produce from used oil, or to make used

oil more amenable for production of, fuel oils, lubricants, or other used oil

- derived products.Definitions

(continued)

53 Processing inclu des, but is not limited to: blending used oil with virgin petroleum products, blending

used oils to meet the fuel specification, filtration, simple distillation, chemical or physical separation,

and re

- refining.

U SED O IL P ROCESSOR

– A site that processes on

- specification or off

- specification used oil.

U SED O IL R E

- R EFINER

– A site that produces lubricating oils and greases, industrial fuel, asphalt extender,

gasoline, and other products from on

- specification or off

- specification used oil.

U SED O IL T RANSF ER F ACILITY

– Any transportation

- related facility, including loading docks, parking areas,

storage areas, and other areas where shipments of used oil are held for more than 24 hours during

the normal course of transportation and not longer than 35 days. T ransfer facilities that store used

oil for more than 35 days are subject to regulation under 40 CFR Part 279, Subpart F.

U SED O IL T RANSPORTER

– Any person who transports used oil, any person who collects used oil from more

than one generator and transpor ts the collected oil, and owners and operators of used oil transfer

facilities. Used oil transporters may consolidate or aggregate loads of used oil for purposes of

transportation but, with the following exception, may not process used oil. Used oil tran sporters may

conduct incidental processing operations that occur in the normal course of used oil transportation

(e.g., settling and water separation), but that are not designed to produce (or make more amenable

for production of) used oil

- derived products or used oil fuel.Form Codes

(continued)

54 

## EPA HAZARDOUS WASTE CODES

A list of all the hazardous waste codes is shown below. See the regulations for details.

CHARACTERISTICS OF HAZARDOUS WASTE (SEE 40 CFR

261.24)

– DXXX

HAZARDOUS WASTE FROM NON

- SPECIFIC SOURCES (SEE 40

CFR 26 1.31)

– FXXX

HAZARDOUS WASTE FROM SPECIFIC SOURCES (SEE 40 CFR

261.32)

- KXXX DISCARDED COMMERCIAL CHEMICAL PRODUCTS, OFF

SPECIFICATION SPECIES, CONTAINER RESID UES , AND SPILL

RESIDUES THEREOF

– ACUTE HAZARDOUS WASTE (SEE 40

CFR 261.33)

– PXXX

DISCARDED C OMMERCIAL CHEMICAL PRODUCTS, OFF

SPECIFICATION SPECIES, CONTAINER RESIDUES, AND SPILL

RESIDUES THEREOF

– TOXIC WASTES (SEE 40 CFR 261.33)

–

UXXX

D001

D002

D003

D004

D005

D006

D007

D008

D009

D010

D011

D012

D013

D014

D015

D016

D017

D018

D019

D020

D021

D022

D023

D024

D025

D026

D027

D028

D029

D030

D031

D032

D033

D034

D035

D036

D037

D038

D039

D040

D041

D042

D043 F001

F002

F003

F004

F005

F006

F007

F008

F009

F010

F011

F012

F019

F020

F021

F022

F023

F024

F025

F026

F027

F028

F032

F034

F035

F037

F038

F039 K001

K002

K003

K004

K005

K006

K007

K008

K009

K010

K011

K013

K014

K015

K016

K017

K018

K019

K020

K021

K022

K023

K024

K025

K026

K027

K028

K029

K030

K031

K032

K033

K034

K035

K036

K037

K038

K039

K040

K041

K042

K043

K044

K045

K046 K047

K048

K049

K050

K051

K052

K060

K061

K062

K069

K071

K073

K083

K084

K085

K086

K087

K088

K093

K094

K095

K096

K097

K098

K099

K100

K100

K101

K102

K103

K104

K105

K106

K107

K108

K109

K110

K111

K112

K113

K114

K115

K116

K117

K118 K123

K124

K125

K126

K131

K132

K136

K141

K142

K143

K144

K145

K147

K148

K 149

K150

K151

K156

K157

K158

K159

K161

K169

K170

K171

K172

K174

K175

K176

K177

K178

K181 P001

P002

P003

P004

P005

P006

P007

P008

P009

P010

P011

P012

P013

P014

P015

P016

P017

P018

P020

P021

P022

P023

P024

P026

P027

P028

P029

P030

P031

P033

P034

P036

P037

P0 38

P039

P040

P041

P042

P043

P044

P045

P046

P047

P048

P049 P050

P051

P054

P056

P057

P058

P059

P060

P062

P063

P064

P065

P066

P067

P068

P069

P070

P071

P072

P073

P074

P075

P076

P077

P078

P081

P082

P084

P085

P087

P088

P089

P092

P093

P094

P095

P096

P097

P098

P09 9

P101

P102

P103

P104

P105 P106

P108

P109

P110

P111

P112

P113

P114

P115

P116

P118

P119

P120

P121

P122

P123

P127

P128

P185

P188

P189

P190

P191

P192

P194

P196

P197

P198

P199

P201

P202

P203

P204

P205 U001

U002

U003

U004

U005

U006

U007

U008

U009

U010

U011

U012

U014

U015

U016

U017

U018

U019

U020

U021

U022

U023

U024

U025

U026

U027

U028

U029

U030

U031

U032

U033

U034

U035

U036

U037

U038

U039

U041

U042

U043

U044

U045

U046

U047 U048

U049

U050

U051

U052

U053

U055

U056

U057

U058

U059

U060

U061

U062

U063

U064

U066

U067

U068

U069

U070

U071

U072

U073

U074

U075

U076

U077

U078

U079

U080

U081

U082

U083

U084

U085

U086

U087

U088

U089

U090

U091

U092

U093

U094 U095

U096

U097

U098

U099

U101

U102

U103

U105

U106

U107

U108

U109

U110

U111

U112

U113

U114

U115

U116

U117

U118

U119

U120

U 121

U122

U123

U124

U125

U126

U127

U128

U129

U130

U131

U132

U133

U134

U135

U136

U137

U138

U140

U141

U142 U143

U144

U145

U146

U147

U148

U149

U150

U151

U152

U153

U154

U155

U156

U157

U158

U159

U160

U161

U162

U163

U164

U165

U166

U167

U168

U169

U170

U171

U172

U1 73

U174

U176

U177

U178

U179

U180

U181

U182

U183

U184

U185

U186

U187

U188 U189

U190

U191

U192

U193

U194

U196

U197

U200

U201

U202

U203

U204

U205

U206

U207

U208

U209

U210

U211

U213

U214

U215

U216

U217

U218

U219

U220

U221

U222

U223

U225

U226

U227

U228

U234

U23 5

U236

U237

U238

U239

U240

U243

U244

U246 U247

U248

U249

U271

U278

U279

U280

U328

U353

U359

U364

U367

U372

U373

U387

U389

U394

U395

U404

U409

U410

U411Form Codes

(continued)

55 

## HAZARDOUS SECONDARY MATERIAL (HSM) FACILITY CODES

Facility codes describe the specific regulation a facility uses to manage its hazardous secondary material

(HSM) and the type of activity the facility performs under the regulation (e.g., generator, reclaimer).

Review the groups and pick the appropriate code. If more than one facility code applies to yo u, enter

each code on a separate row under Item 2 of the Addendum to the Site ID Form.

Under Control of the Generator Exclusion (40 CFR 261.2(a)(2)(ii) or 261.4(a)(23)) Under

Generator Exclusion (40 CFR 261.4(a)(23))

Code Facility Code Description

01 HS M Generator reclaiming HSM “on

- site”: This code applies if you generate and reclaim hazardous secondary

material at your generating facility. See also paragraph (1) in the Federal definition of “Hazardous secondary material

generated and reclaimed under the control of the generator” in 40 CFR Part 260.10. See also 40 CFR 261.4(a)(23)(i)(A).

02 HSM Generator transferring HSM to reclaimer within the “same company”: This code applies if you generate

hazardous secondary material and send the material for re clamation to a different facility that is either controlled by

you or controlled by the same person that controls your generating facility. See also paragraph (2) in the Federal

definition of “Hazardous secondary material generated and reclaimed under the control of the generator” in 40 CFR

Part 260.10. See also 40 CFR 261.4(a)(23)(i)(B).

03 Reclaimer receiving HSM from HSM generator within the “same company”: This code applies if you receive and

reclaim hazardous secondary material from a different fa cility that either controls you or is controlled by the same

person that controls you. See also paragraph (2) in the Federal definition of “Hazardous secondary material generated

and reclaimed under the control of the generator” in 40 CFR Part 260.10. Se e also 40 CFR 261.4(a)(23)(i)(B).

04 Tolling Contractor reclaiming HSM pursuant to a tolling contract: This code applies if you are a tolling contractor that

reclaims hazardous secondary material pursuant to a written contract with a toll manufacturer. See also paragraph (3)

in the Federal definition of “Hazardous secondary material generated and rec laimed under the control of the

generator” in 40 CFR Part 260.10. See also 40 CFR 261.4(a)(23)(i)(C).

05 Toll Manufacturer managing HSM pursuant to a toll ing contract: This code applies if you generate and send

hazardous secondary material for reclamation to a tolling contractor pursuant to a written contract. See also

paragraph (3) in the Federal definition of “Hazardous secondary material generated and reclaimed under the control of

the generator” in 40 CFR Part 260.10. See also 40 CFR 261.4(a)(23)(i)(C).

Transfer

- based Exclusion (40 CFR 261.4(a)(24)) Verified Recycler Exclusion (40 CFR 261.4(a)(24))

Code Facility Code Description

06 HSM Generator transferring HSM off

- site to a domestic reclamation permitted or verified recycling facility: This code

applies if you generate and send hazardous secondary material for reclamation to an off

- site domestic reclamation

permitted or verified recycling faci lity.

07 Permitted Reclaimer receiving HSM from off

- site: This code applies if you have a RCRA Part B permit, or operate under

interim status standards, and reclaim hazardous secondary material received from an off

- site domestic hazardous

secondary mater ial generator or other domestic facility. (If you do not have a RCRA Part B permit and are not operating

under interim status standards and, instead, have obtained a variance to receive hazardous secondary material under

this exclusion, use code 17 below.)

08 Permitted Intermediate facility: This code applies if you have a RCRA Part B permit, or operate under interim status

standards, and receive hazardous secondary material from an off

- site domestic hazardous secondary material generator

or another domes tic facility and you store it for more than ten days. This code does not apply if you generate or reclaim

the hazardous secondary material. (If you do not have a RCRA Part B permit and are not operating under interim status

standards and, instead, have obt ained a variance to receive hazardous secondary material under this exclusion, use code

18 below.)

09 HSM Generator exporting HSM off

- site to a foreign reclamation facility: This code app lies if you generate and export

hazardous secondary material for rec lamation to a foreign reclamation facility. (Reserved)

10 HSM Generator importing HSM from a foreign entity to send to another domestic reclamation facility: This code

applies if you import hazardous secondary material from a foreign entity and send the m ater ial for reclamation to a

domestic reclamation facility

. HSM Generator importing HSM from a foreign entity to send to recycling: This codeForm Codes

(continued)

56 applies if you import hazardous secondary material from a foreign entity and send the material for reclamation t o a

permitted or verified recycling facility.

11 HSM Generator AND Reclaimer of imported HSM: This code applies if you import ha zardous secondary material from

a foreign entity and reclaim the material at your facility. HSM Generator AND Permitted Reclai mer of imported HSM:

This code applies if you import hazardous secondary material from a foreign entity and reclaim the material at your

facility under a RCRA Part B permit or under interim status standards. (If you do not have a RCRA Part B permit and ar e

not operating under interim status standards and, instead, have obtained a variance to receive hazardous secondary

material under this exclusion, use code 18 below.)

Imports/Exports (40 CFR 261.4(a)(24) or (25)) Remanufacturing Exclusion (40 CFR 261. 4(a)(27))

Code Facility Code Description

12 HSM Generator transferring HSM off

- site to a remanufacturer: This code applies if you generate and send hazardous

secondary material to a remanufacturer in the pharmaceutical, basic organic chemical, plastics a nd resins, and/or paint

and coatings manufacturing sectors.

13 Remanufacturer receiving HSM from off

- site: This code applies if you remanufacture hazardous secondary material

received from an off

- site domestic hazardous secondary material generator. You must be in the pharmaceutical, basic

organic chemical, plastics and resins, and/or paint and coatings manufacturing sectors to use this code.

Non

- waste Determinations and Solid Waste Variances (40 CFR 260.30)

Code Facility Code Description

14 Variance for Materials that are Accumulated Speculatively: This code applies if you operate under an approved variance

from EPA or your State for materials that are accumulated speculatively without sufficient amounts being recycled (see

40 CFR 260.31(a))

.

15 Vari ance for Materials that are Reclaimed and then Reused within the Original Production Process: This code applies

if you operate under an approved variance from EPA or your State for materials that are reclaimed and then reused as

feedstock within the origin al production process in which the materials were generated (see 40 CFR 260.31(b))

.

16 Variance for Materials that are Partially

- Reclaimed: This code applies if you operate under an approved variance from

EPA or your State for materials that have been par tially

- reclaimed but must be reclaimed further before recovery is

completed if the partial reclamation has produced a commodity

- like material (see 40 CFR 260.31(c))

.

17 Variance for HSM transferred for reclamation and managed at a verified reclamation fac ility: This code applies if you

operate under an approved variance from EPA or your State for hazardous secondary materials that are transferred to

you for reclamation under 40 CFR 261.4(a)(24) (see 40 CFR 260.31(d)) . (If you have not obtained a variance t o receive

hazardous secondary material under this exclusion and, instead, have a RCRA Part B permit or operate under interim

status standards, use code 07 above.)

18 Variance for HSM transferred and managed at a verified intermediate facility: This code a pplies if you operate under

an approved variance from EPA or your State for hazardous secondary materials that are transferred to you for storage

greater than 10 days under 40 CFR 261.4(a)(24) (see 40 CFR 260.31(d)) . (If you have not obtained a variance to receive

hazardous secondary material under this exclusion and, instead, have a RCRA Part B permit or operate under interim

status standards as an intermediate facility, use code 08 above.)

19 Variance for HSM imported AND managed at a verified reclamatio n facility: This code applies if you operate under an

approved variance from EPA or your State for hazardous secondary materials that are imported to you for reclamation

at your site under 40 CFR 261.4(a)(24) (see 40 CFR 260.31(d)) . (If you have not obtain ed a variance to receive hazardous

secondary material under this exclusion and, instead, have a RCRA Part B permit or operate under interim status

standards, use code 07 above.)

20 Non

- waste determination for HSM reclaimed in a continuous industrial proce ss: This code applies if you operate under

an approved non

- waste determination from EPA or your State for hazardous secondary material which is reclaimed in a

continuous industrial process (see 40 CFR 260.34(b))

.

21 Non

- waste determination for HSM that ar e indistinguishable from a product or intermediate: This code applies if you

operate under an approved non

- waste determination from EPA or your State for hazardous secondary materials which

is indistinguishable in all relevant aspects from a product or int ermediate (see 40 CFR 260.34(c))

.Form Codes

(continued)

57 

## HAZARDOUS SECONDARY MATERIAL (HSM) LAND

- BASED UNIT CODES

A 2

- digit code that best describes the land

- based unit you use or will use to manage the hazardous

secondary material.

Code Land

- based Unit Code Description

N A Do not use land

- based units to manage hazardous secondary material.

SI Use surface impoundment(s) to manage hazardous secondary material. A surface impoundment

is a natural topographic depression, man

- made excavation or diked are a formed primarily of

e arthen materials (although it may be lined with man

- made materials), which is designed to hold

an accumulation of liquid hazardous secondary materials or materials containing free liquids and

which is not an injection well.

PL Use pile(s) to manage hazard ous secondary material. Pile means any non

- containerized

accumulation of solid, non

- flowing hazardous secondary material that is used for storage and is

not a containment building.

OT Use other land

- based unit(s) to manage hazardous secondary material.58 

## Management Method Codes

Management method codes describe the type of hazardous waste management system used to treat,

recover, or dispose a hazardous waste. Select the final substantive method used. Review the groups and

pick the appropriate code.

R eclamation and Recovery

Code Management Method Code Description

H010 Metals recovery including retorting, smelting, chemical, etc.

H020 Solvents recovery (distillation, extraction, etc.)

H039 Other recovery or reclamation for reuse including acid regen eration, organics recovery, etc. (specify in comments)

H050 Energy recovery at this site

– used as fuel (includes on

- site fuel blending before energy recovery; report only this code)

H061 Fuel blending prior to energy recovery at another site (waste gene rated on

- site or received from off

- site)

Destruction or Treatment Prior to Disposal at Another Site

Code Management Method Code Description

H040 Incineration

– thermal destruction other than use as a fuel (includes any preparation prior to burning)

H0 70 Chemical treatment (reduction/destruction/oxidation/precipitation); do not include immediate treatment in an

exempt wastewater treatment unit with discharge to a NPDES

- POTW (unless required by State)

H081 Biological treatment; do not include immediate treatment in an exempted wastewater treatment unit with discharge

to a NPDES

- POTW (unless required by State)

H100 Physical treatment only (adsorption/absorption/separation/stripping/dewatering); do not include immediate

treatment in an exempted wastewat er treatment unit with discharge to a NPDES

- POTW (unless required by State)

H110 Stabilization prior to land disposal at another site (encapsulation/stabilization/fixation)

H120 Combination of chemical, biological, and/or physical treatment; do not inc lude immediate treatment in an exempted

wastewater treatment unit with discharge to a NPDES

- POTW (unless required by State)

H121 Neutralization only (no other treatment)

H122 Evaporation (as the major component of treatment; not reportable as H070, H081, H100 or H120)

H129 Other treatment that does not include onsite disposal (specify in comments)

Disposal

Code Management Method Code Description

H130 Surface Impoundment that will be closed as a landfill (to include prior treatment)

H131 Land treatme nt or application (to include any prior treatment and/or stabilization)

H132 Landfill or surface impoundment that will be closed as landfill (to include prior treatment and/or stabilization)

H134 Deepwell or underground injection (with or without treatm ent; this waste was counted as hazardous waste)

H135 Discharge to sewer/POTW or NPDES(with prior storage

– with or without treatment)

Transfer Off

- site

Code Management Method Code Description

H141 The site receiving this waste stored/bulked and transf erred the waste with no treatment or recovery (H010

- H129), fuel

blending (H061), or disposal (H131

- H135) at that receiving site. Do not use this code on GM Form in Section 1

– Item

D or in Section 2.

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# DRAFT OMB# 2050

- 0024; Expires 01 / 31 / 2017

SEND

COMPLETED

FORM TO:

The Appropriate

State or Regional

Office. 

### United States Environmental Protection Agency

RCRA SUBTITLE C SITE IDENTIFICATION FORM

1. Reason for

Submittal

MARK ALL

BOX(ES) THAT

APP LY Reason for Submittal:

 To provide an Initial Notification (first time submitting site identification information / to obtain an EPA ID number

for this location)

 To provide a Subsequent Notification (to update site identification information for this loca tion)

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

 As a component of a Revised RCRA Hazardous Waste Part A Permit Application (Amendment # )

 As a component of the Hazardous Waste Report (If marked, see sub

- bullet below)

 Site wa s a TSD facility and/or generator of >1,000 kg of hazardous waste, >1 kg of acute hazardous waste, or

>100 kg of acute hazardous waste spill cleanup in one or more months of the report year (or State

equivalent LQG regulations)

2. Site EPA ID

Number EPA ID N umber

3. Site Name Name:

4. Site Location

Information Street Address:

City, Town, or Village: County:

State: Country: Zip Code:

5. Site Land Type Private County District Federal Tribal Municipal State Other

6. NAICS Code(s)

for the Site

(at least 5

- digit

codes) A.

- C

. -

B

. - D.

-

7. Site Mailing

Address Street or P.O. Box:

City, Town, or Village:

State: Country: Zip Co de:

8. Site Contact

Person First Name: MI: Last:

Title:

Street or P.O. Box:

City, Town or Village:

State: Country: Zip Code:

Email:

Phone: Ext : Fax :

EPA Form 8700

- 12, 8700

- 13 A/B, 8700

- 23 Page 1 of9. Legal Owner

an d Operator

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

Owner:

Owner

Type: Private County District Federal Tribal Municipal State Other

Street or P.O. Box:

City, Town, or Village:

State: Country: Zip Code:

Email:

Phone: Ext: Fax:

Notes:

B. Name of Site’s Operator: Date Became

Operator:

Operator

Type: Private County District Federal Tribal Municipal State Other

Street or P.O. Box:

City, Town, or Village:

State: Country: Zip Code:

Email:

Phone: Ext: Fax:

Notes:

EPA Form 8700

- 12, 8700

- 13 A/B, 8700

- 23 Page 2 ofEPA ID Number OMB#: 2050

- 0024; Expires 01 / 31 / 2017

10. Type of Regulated Waste Activity (at your site)

Mark “Yes” or “No” for all current activities (as of the date submitting the form); complete any additional boxes as instructed.

A. Hazardous Waste Activities; Complete all parts 1

- 10.

Y N 1. Generator of Hazardous Waste

If “Yes

, ” mark only one of the following

– a, b, or c. Y N 5. Transport er of Hazardous Waste

If “Yes

, ” mark all that apply.

a. LQG: Generates, in any calendar month, 1,000 kg/mo

(2,200 lbs/mo.) or more of non

- acute hazardous

waste; or Generates, in any calendar month, or

accumulates at any time, more than 1 kg/mo

(2.2 l bs/mo) of acute hazardous waste; or

Generates, in any calendar month, or

accumulates at any time, more than 100 kg/mo

(220 lbs/mo) of acute hazardous spill cleanup

material. a. Transporter

b. Transfer Facility (at your site)

Y N 6. Tr eater, Storer, or Disposer of Hazardous

Waste Note: A hazardous waste Part B

permit is required for these activities.

Y N 7. Recycler of Hazardous Waste

b. SQG: 100 to 1,000 kg/mo (220

– 2,200 lbs/mo) of

non

- acute hazardous waste and no more than 1

kg (2.2 lbs) of acute hazardous waste and no

more than 100 kg (220 lbs) of any acute

hazardous spill cleanup material

.

c. CESQG: Less than or equal to 100 kg/mo (220 lbs/mo) of

non

- acute hazardous waste. Y N 8. Exempt Boiler and/or Industr ial Furnace

If “Yes

, ” mark all that apply.

If “Yes” above, indicate other generator activities in 2

- 10

. a. a. Small Quantity On

- site Burner

Exemption

Y N 2. Short

- Term Generator (generate from a short

- term or one

- time

event and not from on

- going processes). If “Yes

, ” provide an

explanation in the Comments section. b. Smelting, Melting, and Refining

Furnace Exemption

Y N 3. United States Importer of Hazardous Waste Y N 9. Underground Injection Control

Y N 4. Mi xed Waste (hazardous and radioactive) Generator Y N 10. Receives Hazardous Waste from Off

- site

B. Universal Waste Activities; Complete all parts 1

- 2. C. Used Oil Activities; Complete all parts 1

- 4.

Y N 1. Large Quantity Handler of Universal W aste (you

accumulate 5,000 kg or more) [refer to your State

regulations to determine what is regulated]. Indicate

types of universal waste managed at your site. If “Yes

, ”

mark all that apply.

a. Batteries

b. Pesticides

c. Mercury containing equipment

d. Lamps

e. Other (specify)

f. Other (specify)

g. Other (specify) Y N 1. Used Oil Transporter

If “Yes

, ” mark all that apply.

a. Transporter

b. Transfer Facility (at your site)

Y N 2. Used Oil Processor and/or Re

- refiner

If “Yes

, ” mark all that apply.

a. Processor

b. Re

- refiner

Y N 3. Off

- Specification Used Oil Burner

Y N 4. Used Oil Fuel Marketer

If “Yes

, ” mark all that apply.

Y N 2. Destination Facility for Universal Waste

Note: A hazardous waste permit may be required for this

activity. a. Marketer Who Directs Shipment of

Off

- Specification Used Oil to

Off

- Specification Used Oil Burner

b. Marketer Who First Claims the Used

Oil Meets the Specifications

EPA Form 8700

- 12, 8700

- 13 A/B, 8700

- 23 Page 3 o fEPA ID Number OMB#: 2050

- 0024; Expires 01 / 31 / 2017

D. Eligible Academic Entities with Laboratories

— Notification for opting into or withdrawing from managing laboratory hazardous

wastes pursuant to 40 CFR Part 262 Subpart K

 You can ONLY Opt into Subpart K if:

 you are at least one of the following: a college or university; a teaching hospital that is owned by or has a formal affilia tion

agreement with a college or university; or a non

- profit research institute that is owned by or has a fo rmal affiliation agreement with

a college or university; AND

 you have checked with your State to determine if 40 CFR Part 262 Subpart K is effective in your state

Y N N 1. Opting into or currently operating under 40 CFR Part 262 Subpart K for the man agement of hazardous wastes in laboratories

See the item

- by

- item instructions for definitions of types of eligible academic entities. Mark all that apply:

a. College or University

b. Teaching Hospital that is owned by or has a formal written affili ation agreement with a college or university

c. Non

- profit Institute that is owned by or has a formal written affiliation agreement with a college or university

Y N N 2. Withdrawing from 40 CFR Part 262 Subpart K for the management of hazardous wa stes in laboratories

11. Description of Hazardous Waste

A. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes handled at

your site. List them in the order they are presented in the regulati ons (e.g., D001, D003, F007, U112). Use an additional page if more

spaces are needed.

B. Waste Codes for State

- Regulated (i.e., non

- Federal) Hazardous Wastes. Please list the waste codes of the State

- Regulated

hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if more

spaces are needed.

EPA Form 8700

- 12, 8700

- 13 A/B, 8700

- 23 Page 4 of

# DRAFT EPA ID Number OMB#: 2050

- 0024; Expires 01 / 31 / 2017

12. Notification of Hazardous Secondary Material (HSM) Activity

Y N A. Are you notifying under 40 CFR 260.42 that you will begin managing, are managing, o r will stop managing hazardous

secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) 40 CFR 260.30, 40 CFR 261.4(a)(23),

(24), or (27) ?

If “Yes

, ” you must fill out the Addendum to the Site Identification Form: Notification fo r Managing Hazardous Secondary

Material

.

Y N B. Are you notifying under 40 CFR 260.43(a)(4)(iii) that the product of your recycling process has levels of hazardous

constituents that are not comparable to or unable to be compared to a legitimate prod uct or intermediate but that the recycling

is still legitimate?

If “Yes,” you may provide comments in Item 13 below. You must also document that your recycling is still legitimate and

maintain that documentation on

- site.

13. Comments

14. Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in

accordance with a system designed to assure that qualified personnel properly gather and evaluate the informat ion submitted. Based

on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the informa tion, the

information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant

penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. For the RCRA

Hazardous Waste Part A Permit Application, all owner(s) and operator(s) must sign (see 40 CFR 270.10(b) and 270.11).

Signature of legal owner, operator, or an

authorized representative Name and Official Title (type or print :

first name, middle initial, last name, and

title ) Date Signed

(mm/dd/yyyy) Email

EPA Form 8700

- 12, 8700

- 13 A/B, 8700

- 23 Page 5 ofEPA ID Number OMB#: 2050

- 0024; Expires 01 / 31 / 2017



### ADDENDUM TO THE SITE IDENTIFICATION FORM:

NOTIFICATION OF HAZARDOUS SECONDARY MATERIAL ACTIVITY

ONLY fill out this form if:

 You are located in a Stat e that allows you to manage excluded hazardous secondary material (HSM) under 40 CFR 260.30 40

CFR 261.2(a)(2)(ii)

, 261.4(a)(23), (24), or (25) (27) (or state equivalent); See

http://www.epa.gov/epawaste/hazard/dsw/statespf.htm for a list of eligible state s; AND

 You are or will be managing excluded HSM in compliance with 40 CFR 261.2(a)(2)(ii) 40 CFR 260.30 , 261.4(a)(23), (24), or (25)

(27) (or state equivalent) or you have stopped managing excluded HSM in compliance with the exclusion(s) and do not expect to

manage any amount of excluded HSM under the exclusion(s) for at least one year. Do not include any information regarding your

hazardous waste activities in this section. Note: If your facility was granted a solid variance under 40 CFR 260.30 prior

to J uly 13, 2015, your management of hazardous secondary materials under 40 CFR 260.30 is grandfathered under

the previous regulations and you are not required to notify for the HSM management activity excluded under 40

CFR 260.30.

1. Indicate reason for noti fication. Include dates where requested.

Facility will begin managing excluded HSM as of _____________ (mm/dd/yyyy).

Facility is still managing excluded HSM/re

- notifying as required by March 1 of each even

- numbered year.

Facility has stopped managi ng excluded HSM as of ____________ (mm/dd/yyyy) and is notifying as required.

2. Description of excluded HSM activity. Please list the appropriate codes and quantities in short tons to describe your excluded HSM

activity ONLY (do not include any informa tion regarding your hazardous wastes). Use additional pages if more space is needed.

a. Facility code

(answer using

codes listed in the

Code List section of

the instructions) b. Waste code(s) for HSM c. Estimated short

tons of excluded HSM

to be managed

a nnually d. Actual short tons

of excluded HSM

that was managed

during the most

recent odd

numbered year e. Land

- based unit

code (answer using

codes listed in the

Code List section of

the instructions)

3. Fa cility has financial assurance pursuant to 40 CFR 261.4(a)(24)(vi). (Financial assurance is required for reclaimers and

intermediate facilities managing excluded HSM under 40 CFR 261.4(a)(24) and (25))

Y N Does this facility have financial assurance pu rsuant to 40 CFR 261.4(a)(24)(vi)?

EPA Form 8700

- 12, 8700

- 13 A/B, 8700

- 23 Addendum Page of

# This page intentionally left blankO M B # : 20 5 0

- 0024 ; E x p i r es 0 1 / 31 / 2 0 17 EPA ID N umbe r

U n i t ed S t a t e s E n v i r on m e n t al P r o t ec t i on A g e n cy



## H A Z A R D O U S W A S T E PE R MI T I NF O R M A T I ON F O R M

1

. F ac ili t y P e r m it

Cont ac t Fir s t N ame: M I: L as t N a m e:

Cont ac t Ti t l e :

Phon e : E x t.: E ma il:

2

. F a c ili t y P e r m it

Cont ac t M a ili n g

A ddr es s Str ee t or P. O

. Bo x :

Ci t y

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St a t e :

Count r y : Zip Cod e :

3

. O p e r a tor Ma il i ng

A ddr es s a nd

T e l e ph o ne Nu m b e r Str ee t or P. O

. Bo x :

Ci t y

, T o w n, or V i ll a g e :

St a t e : Phon e :

Count r y : Zip Cod e :

4

. F a c ili t y E x i s t e n ce

D a te F ac ili t y E x i s t e n c e D a te ( mm / dd / yyy y ) :

5

. O th e r En v iron me n t a l P e r m its

A

. F ac ili t y T y pe

(E n t e r c ode) B. P e r m it Nu m b e r C. D esc ript i on

6

. N a ture of Bu s i n ess:

P ag e 1 o f 7EPA ID N umbe r O M B # : 2 0 50

- 00 2 4 ; E x p i r es 01 / 31 / 2 0 17

7

. Pro c e s s Co d e s a n d D es i gn C a p a c iti e s

– Ent e r infor m a tion in the S e c tion on Form P a ge 3

A

. P R O C E S S C O D E

– E n te r t he c o de f r o m t he li s t of p r o ces s c od e s b e l o w t h a t b es t d esc r i b e s ea c h pro ces s t o be u se d a t t he facil i t y

. I f m ore l in es

a re n ee d e d, attac h a s e p a r at e s h ee t of p a p e r w i t h the a dd i t i on a l i n f o r m ati on. For “ o t h e r ” pro c e sse s ( i. e.

, D99

, S 9 9

, T 0 4 a nd X 9 9 )

, d esc r i be t he

pro ces s ( i n c l u d i ng i t s d es i g n c a p ac i t y ) i n t he s p ac e p ro v i d e d i n I te m 8

.

B

. P R O C E S S D E S I GN C A P A C I T Y

– For eac h c o de e n te r e d i n I t e m 7

. A ; e n te r t he ca p ac i t y of t he p r o cess.

1

. A M O U N T

– E n te r t he am oun t

. I n a cas e wh e re d e s i gn ca p ac i t y i s not a p p li ca b l e (s u c h a s i n a cl o s ur e / po s t

- cl o s ure or e n f or c e me nt act i on )

e n te r t he t o ta l am ount of w ast e f or t h a t pro ces s

. 2

. UN I T OF M E A

S UR E

– For eac h a m ount e n te r e d i n I t e m 7

. B(1)

, e n te r t he c ode i n I te m 7

. B(2 ) f r o m t he l i s t of u n i t of m eas ure c od e s b e l o w t h at

d esc r i b e s t he u n i t of m eas ure u se d. S e l ec t o n l y f rom t he u n i t s of m eas ure i n t h i s l i st

.

C

. P R O C E S S T OT A L NU M B E R OF UN I T S

– E n te r t he t o t a l n u m b e r of u n i t s f or eac h c orr es p on d i ng p r o ces s c od e

.

P ro ces s A p propr i at e U n i t of M ea s ure f or

C ode P ro ces s P ro ces s Des i g n Ca p a c i t y P ro ces s P ro ces s A p propr i at e U n i t of M ea s ure f or

C ode P ro ces s Des i g n Ca p a c i t y

D i s po sal T r eat m e nt (C on t i nu e d) (f or T 8 1

– T 94)

D7 9 Undergroun d I n j e ct i o n G a ll on s ; L i t e r s ; G a ll o n s P e r Day ; o r

W e ll D i s po s a l L i t er s P e r Day

D8 0 Land f ill Ac re

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D i s po s a l Cub ic Y ards

D9 9 O t he r D i s p o s a l A n y Un it o f M ea s ur e L i s t e d B e l ow T 8 1 Ce m e n t K iln G a ll on s P e r Day ; L i t e r s P e r Day ; P ounds

P e r Hour ; S hor t T on s P e r Hour ;

K il ogr a ms P e r Hour ; M e t r i c T o n s P er

T 8 2 L i m e K iln Day ; M e t r ic T on s P e r Hour ; S hor t T ons

P e r Day ; B TU P e r Hour ; L i t er s P e r Hour ;

T 8 3 A ggrega t e K iln K il ogr a ms P e r Hour ; o r M il l i o n BT U P er

Hour

T 8 4 P ho s pha t e K i ln

T 8 5 Co k e O ven

T 8 6 B l as t F urna c e

T 8 7 S m e l t i ng

, M e l t i ng

, o r Re f i n i n g F u r na c e

T 8 8 Ti t an i u m D i o x i d e Ch l or i d e O x i da t i o n Rea ct or

T 8 9 M e t han e Re f or mi n g F urna c e

T 9 0 P u l p i n g L i quo r R e c over y F urna c e

T 9 1 Co m b u st i o n Dev i c e U s e d in t h e Re c over y o f S u l f u r V a l ue s f r o m S p e nt

S u l f ur i c A c id

T 9 2 Ha l oge n Ac id F urna c es

T 9 3 O t he r I nd u st r i a l F urna c e s L i st e d in 4 0 C FR 260

. 10

T 9 4 Con t a i n m en t B u il d i n g Cub ic Y ard s ; Cub ic M e t ers ; S hor t T ons

T reat m en t P e r Hour ; G a l l on s P e r Hour ; L i t e r s P er

Hour ; B TU P e r Hour ; P oun d s P e r Hour ;

S hor t T o n s P e r Day ; K il ogr a ms P e r

Hour ; M e t r ic T on s P e r Day ; G a ll o n s P er

Day ; L i t er s P e r Day ; M e t r ic T o n s P er

Hour ; o r M illi o n B TU P e r Hour S t or a ge

S 0 1 Con t a i ne r G a ll on s ; L i t e r s ; Cub ic M e t ers ; or

Cub ic Y ards

S 0 2 T an k St orag e G a ll on s ; L i t e r s ; Cub ic M e t ers ; or

Cub ic Y ards

S 0 3 W a s t e P ile Cub ic Y ard s o r Cub ic M e t er s

S 0 4 S ur f a c e I m poun d m en t G a ll on s ; L i t e r s ; Cub ic M e t ers ; or

C ub ic Y ards

S 0 5 Dr ip P a d G a ll on s ; L i t e r s ; Cub ic M e t ers ;

He ct ares ; o r Cub i c Y ards

S 0 6 Con t a i n m en t B u il d i n g Cub ic Y ard s o r Cub ic M e t er s

St orage

S 9 9 O t he r S t orag e A n y Un it o f M ea s ur e L i s t e d B e l ow

T r eat m e nt

T 0 1 T an k T reat m en t G a ll on s P e r Day ; L i t er s P e r Day

T 0 2 S ur f a c e I m poun d m en t G a ll on s P e r Day ; L i t er s P e r Day

T 0 3 I n c i nera t o r S hor t T o n s P e r Hour ; M e t r ic T ons

P e r Hour ; G a l l on s P e r Hour ; L i t e r s

P e r Hour ; B T U s P e r Hour ; P ounds

P e r Hour ; S hor t T on s P e r Day ;

K il ogr a ms P e r Hour ; G a l l on s P er

Day ; M e t r ic T on s P e r Hour ; or

M illi o n B TU P e r Hour

T 0 4 O t he r T reat m en t G a ll on s P e r Day ; L i t er s P e r Day ;

P ound s P e r Hour ; S hor t T on s P er

Hour ; K il ogr a ms P e r Hour ; M e t r ic

T on s P e r Day ; S hor

t T on s P e r D a y ;

B T U s P e r Hour ; G a ll o n s P e r Day ;

L i t er s P e r Hour ; o r M illi o n B TU P e r

Hou r

T 8 0 B o il e r G a ll on s ; L i t e r s ; G a ll o n s P e r Hour ;

L i t er s P e r Hour ; B T U s P e r Hour ; or

M illi o n B TU P e r Hour M i scel l a n e ous ( S u bp a rt X )

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t T on s P e r Day ; M e t r ic T ons

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P e r Hour ; G a l l on s P e r Hour ; L i t e r s P er

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X 0 3 T her m a l Un it G a ll on s P e r Day ; L i t er s P e r Day ; P ounds

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K il ogr a ms P e r Hour ; M e t r i c T o n s P er

Day ; M e t r ic T on s P e r Hour ; S hor t T ons

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P e r Hour

X 0 4 G eo l og ic Rep o s i t or y Cub ic Y ard s ; Cub ic M e t ers ; Ac r e

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He ct ar e

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X 9 9 O t he r S ubpar t X A n y Un it o f M ea s ur e L i s t e d B e l ow

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G a ll o ns

............................... . .............. . G

G a ll o ns P e r H our

............................... .. E

G a ll o ns P e r D a y

............................... . . . U

L i te r s

............................... . ......... .......... . L

L i te rs P e r H our

................................... . H

L i te rs P e r D ay

............................... . ..... . V U n i t of M eas ure U n i t of M eas ure C o de

S hort T ons P e r H our

............................. . D

S hort T ons P e r D a y

......... ...................... . N

M et r i c T ons P e r H o ur

............................ . W

M et r i c T ons P e r D a y

............................... . S

P ou n ds P e r H our

.................................... . J

K il ogr a m s P e r H our

................................ . X

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.............................. . X U n i t of M eas ure U n i t of M eas ure C o de

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............................... . ............ . Y

C ub i c M ete r s

............................... . ........... . C

A c r e s

......................................... ............... B

A c r e

- fee t

.................................................. A

Hecta r e s

................................................. . Q

Hecta r e

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......................................... . F

B T U P e r H ou r

............................... . ........... . I

P ag e 2 o f 7P ag e 3 o f 7 EPA ID N umbe r O M B # : 20 5 0

- 0024 ; E x p i r es 0 1 / 31 / 2 0 17

7

. Pro c e s s Co d e s a n d D es i gn C a p a c iti e s ( C ontin u e d)

E X A M P L E F OR C O M P L E T I N G I t e m 7 (s h o w n i n l i ne n u m b e r X

- 1 b e l o w ) : A fac ili t y h a s a st or a ge ta n k

, w h i c h c a n h o l d 533

. 78 8 g a ll o n s.

L i ne

N u m b er A

. P ro cess

C ode

( F ro m l i s t above) B

. P R O C E S S D E SI GN C A P A C I TY C

. P ro ces s T o tal

N u m b e r of U n i t s For O ff i c i a l Us e O n l y

(1 ) A m ount ( S pe c i f y ) (2 ) U n i t of M eas ure

X 1 S 0 2 533

. 7 88 G 001

1

2

3

4

5

6

7

8

9

1 0

1 1

1 2

1 3

Not e : If y o u n e e d to l

i s t m ore th a n 1 3 pro c es s c od e s

, a t t ac h a n a ddi t

ion a l s h e e t(

s ) w ith the in f

o r ma ti o n in t h e s a m e for

ma t a s a bo v

e.

Nu m b e r the line se q u e nti a l l y

, t ak ing into acc o unt a n y li n e s th a t w

i l l be u se d f

or “ o th e r” pro c es s (

i

. e

., D 9 9

, S 9 9

, T 04

, a n d X99

) in It e m 8.

8

. O th e r Pro c e ss e s (Fol lo w in s tru c tio n s fro m It e m 7 for D 99

, S 99

, T 0 4

, a nd X 9 9 pr oc es s c o d es)

L i ne

N u m b e r

( E n t e r # s in

s e q ue n ce

w i t h I t e m 7) A

. P ro ces s C o de

( F ro m l i s t above) B

. P R O C E S S D E SI GN C A P A C I TY

C

. P ro ces s T o tal

N u m b e r of U n i t s For O ff i c i a l Us e O n l y

(1 ) A m ount ( S pe c i f y ) (2 ) U n i t of

M eas u re

X 2 T 0 4 100

. 0 0 U 001P ag e 4 of 7 EN G L ISH UNIT O F M E A SU R E C O DE M E T RIC UNIT O F

M EA SURE C O DE

P O UNDS

T O NS P

T KI L OG R A M S

M E T RIC T O NS K

M EPA ID N umbe r O M B # : 20 5 0

- 0024 ; E x p i r es 0 1 / 31 / 2 0 17

9

. D esc ription of H a za rdous W as t e s

- Ent e r Info r ma tion in t he S ec t i ons o n Form P a ge 5

A

. E P A H A

Z A RD O U S W A

S T E NU M B E R

– E n te r t he f our

- d i g i t n u m b e r f rom 4 0 C F R

, P a rt 26 1 S ubp a r t D of eac h l i ste d h a z a rd o us w a st e y o u w i l l

h a nd l e

. For h a z a rdous w aste s w h i c h a re not l i ste d i n 4 0 C F R

, P a rt 26 1 S ubp a rt D

, e n te r t he f o ur

- d i g i t n u m b e r (s ) f r om 4 0 C FR P a rt 261

, S u bp a rt

C t h a t d esc r i b e s t he c h a r acte r i s t i c s a n d / or t he t o x i c c on t a mi n a n t s of t ho s e h a z a r d ous w astes.

B. ESTI M A TED ANN U A L Q U A N TITY

– For eac h li s t e d w as te e nt e r e d in It e m 9

. A

, es ti m a t e the q u a nti t y of th a t w as te t h a t w i ll be

h a ndl e d on a n a n n u a l b as i s

. For e a c h c h a r ac t e r i s tic or t o x ic c ont a m in a nt e nt e r e d in It e m 9

. A

, es t i ma te t he to t a l a nnu a l

qu a nti t y of a ll the n o n

- li s t e d w as t e ( s ) t h a t w ill be h a n d l e d w hi c h po s se s s th a t c h a r a c t e ri s tic or c ont a m in a n t

.

C. UNIT O F M E A SURE

– For e a c h qu a n t i t y e nt e r e d in It e m 9 .B, e nt e r t h e unit of m e as ure c od e

. Units of me a s ure w h i c h m u s t be

u se d a nd the a ppr opr i a te co d e s a r e :

If f ac ili t y r ec ords u s e a n y o t h e r unit of me a s ure for q u a n ti t y

, the units of m e as ure m u s t be c on v e rt e d into one o f t he r e qui r ed

units of me a s ur e

, t a k ing into acc o u nt the a ppropri a te d e n s i t y or s p ec ific gr a v i t y of the w a s t e

.

D. PR O CESSES

1

. PR O CESS C O DE S :

For li s t e d h a za rdous w as t e : For ea c h li s t e d h a za rd o us w as t e e nt e r e d in It e m 9

. A

, se l ec t t h e c o d e ( s ) fr o m the li s t of

pro ces s c od e s c o nt a in e d in It em s 7 .A a nd 8 .A on p a ge 3 to indi c a te a ll the pro c e sse s th a t w ill b e u s e d to s to r e

, t r ea t,

a nd/or d i s po s e of a ll li s t e d h aza rdo u s w as t e s.

For no n

- l i s t e d w as t e : For e a c h c h a r a c t e ri s t ic or t o x ic co nt am in a nt e n t e r e d in It e m 9

. A

, se l ec t the c od e ( s ) from t h e li s t of

pro ces s c od e s c o nt a in e d in It em s 7 .A a nd 8 .A on p a ge 3 to indi c a te a ll th e pro c e sse s th a t w ill b e u s e d to s tor e

, t r ea t,

a nd/or d i s po s e of a ll the no n

- li s t e d h a z a rdous w a s t e s t h a t po ss e s s t h a t c h a r ac t e r i s tic or to x ic c ont a m in a n t.

N O TE: THREE S P A C E S A R E PR O VIDED F O R ENTERI N G PR O CESS C O D ES. IF M O RE A RE NE E DE D :

1

. Ent e r the fir s t t w o a s d esc r i b e d a bo v e.

2

. Ent e r “ 0 00 ” in the ex tr e m e r i ght box of It e m 9 .D( 1 ).

3

. U s e a ddi t ion a l s h e e t, e n t e r l i ne nu m b e r from p r e v ious s h ee t, a n d e n t e r a ddit i on a l c o d e ( s ) in I t e m 9 .E.

2

. PR O CESS DESCRIPTI O N : If c ode i s not li s t e d for a pr oc es s t h a t w i ll be u s e d, d e sc r i be the pr o ce s s in I t e m 9 .D( 2 ) or in

It e m 9 .E ( 2 ).

N O TE: H A Z A R D O US W A S T ES DESCRIBED BY M O RE THAN O NE E P A H A Z A R D O US W A STE NU M BER

– H aza rd o us

w as t e s th a t ca n be d esc ri be d b y m ore th a n one EPA H a z a rdous W as te N u m b e r s h a ll be d e s c rib e d on the form a s foll o w s:

1

. S e l ec t o ne of t he EPA H aza r dous W a s te N u m b e rs a nd e nt e r it in I t e m 9

. A

. O n the s a m e li n e c o m pl e te It e m s 9 .B, 9 .C,

a nd 9 .D b y es ti ma ting the t o t a l a nn u a l q u a nti t y of the w a s te a nd d e s c ribing a ll t h e p r o ces s e s to be u se d to s tor e,

tr ea t

, a n d /or di s po s e of the w as t e.

2

. In It e m 9 .A of the n e x t li n e e nt e r the o t h e r EPA H aza rdo u s Was t e Nu m b e r t h a t c a n b e u se d to d e s c ribe t h e w as t e

. In

It e m 9 .D

. 2 on t h a t l i ne e n t e r “ in c l u d e d w ith a bo v e ” a nd mak e no ot h e r e ntri e s on t h a t lin e

.

3

. R e p ea t s t e p 2 f or ea c h EPA H aza rdo u s Wa s te Nu m b e r t h a t ca n be u s e d to d e s c ribe t he h a za rdo u s w as t e.

EX A M PLE F O R C O M PLETING It e m 9 ( s h o w n in line nu m b e rs X

- 1

, X

- 2

, X

- 3

, a nd X

- 4 b e l o w )

– A f ac ili t y w i l l tr ea t a n d di s p o s e of an

es ti ma t e d 9 0 0 p o unds p e r y ea r of c hr o m e s h a v ings fr o m l ea t h e r t a nn i ng a n d fin i s h i ng op e r a t i on s

. In a dditio n

, t he f ac i li t y w i ll t r ea t

a nd di s po s e of thr e e no n

- l i s t e d w as t e s

. T w o w as t e s a r e c orro s i v e on l y a nd th e re w ill be a n es ti m a t e d 20 0 poun d s p e r y ea r of each

w as t e

. T h e ot h e r w a s te i s c orro s i v e a nd i g nit a b l e a nd t h e re w ill be a n es ti m a t e d 1 0 0 poun d s p e r y ea r of th a t w a s t e

. Tr e a t me nt w i ll

be in a n in c in e r a tor a nd d i s p o sa l w ill be in a l a ndfill.

L i ne

N u m b e r A

. E P A Ha z a rdous

W ast e N o

. ( E n te r c od e) B

. E sti m ated

A n nu a l

Q t y of

W ast e C

. U n i t of

M eas u re

( E n te r c od e) D

. P R O C E S S E S

(1 ) P R O C E S S C O D E S ( E n te r C o d e ) (2 ) P R O C E S S D ES C R IP T I ON

( I f c ode i s not e n te r e d i n 9

. D(1) )

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

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

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

X 4 D 0 0 2 I nc l ude d W it h A bo v eO M B # : 20 5 0

- 0024 ; E x p i r es 0 1 / 31 / 2 0 17 EPA ID N umbe r

9

. D esc ription of H a za rdous W as t e s (C o ntinu e d. U s e a ddi t io na l s h ee t

( s ) a s n ec e ssa r

y ; nu m b e r p a g e s a s 5a

, e t c .)

L i ne N u m b e r A

. E P A H a z a rdous

W ast e N o

. ( E n te r c od e) B

. E sti m ated

A n nu a l

Q t y of

W ast e C

. U n i t of

M eas u re

( E n te r c od e) D

. P R O C E S S E S

(1 ) P R O C E S S C O D E S ( E n te r C o d e ) (2 ) P R O C E S S D ES C R IP T I ON

( I f c ode i s not e n te r e d i n 9

. D(1) )

1

2

3

4

5

6

7

8

9

1 0

1 1

1 2

1 3

1 4

1 5

1 6

1 7

1 8

1 9

2 0

2 1

2 2

2 3

2 4

2 5

2 6

2 7

2 8

2 9

3 0

3 1

3 2

3 3

3 4

3 5

3 6

P ag e 5 o f 7EPA ID N umbe r O M B # : 20 5 0

- 0024 ; E x p i r es 0 1 / 31 / 2 0 17

9

. D esc ription of H a za rdous W as t e s (C o ntinu e d. U s e a ddi t ion a l s h e e t

( s ) a s n ec e ssa r

y ; nu m b e r p a g e s a s 5a

, e t c .)

L i ne N u m b e r A

. E P A H a z a rdous

W ast e N o

. ( E n te r c od e) B

. E sti m ated

A n nu a l

Q t y of

W ast e C

. U n i t of

M eas u re

( E n te r c od e) D

. P R O C E S S E S

(1 ) P R O C E S S C O D E S ( E n te r C o d e ) (2 ) P R O C E S S D ES C R IP T I ON

( I f c ode i s not e n te r e d i n 9

. D

. 1)

P ag e 6 o f 7O M B # : 20 5 0

- 0024 ; E x p i r es 0 1 / 31 / 2 0 17 EPA ID N umbe r

10

. Map

Att ac h to t hi s ap p l i ca t i o n a t o p og r ap h i c a l map

, o r o t he r e qui v alen t m a p

, o f t h e a r e a e x t end i n g to a t l ea s t o n e m il e be y on d p r ope rty

boun d a r i e s

. T h e ma p m u s t s h o w t h e ou t l in e o f t h e f a ci l i t y

, t h e l o ca t i o n o f e a c h o f i t s e x is t i n g in t ak e an d d i sc h a r g e s tr u c t u r es

, e ac h o f i ts

ha z a r d o u s w as te t r ea t men t, s t o r age

, o r d is p os a l f a c i li t i es

, a n d e a c h w el l w he re i t in j ec t s f l u i d s u nde r g r ou n d

. I n c l ud e al l s p r ing

, r i v e r s

, and

o t he r su rf a c e w a t e r b od i e s i n t hi s ma p a r e a

. S e e i n s tr u c t i on s f o r p r e c is e r e q ui r e men t s

.

11

. F ac ili t y D r a w i ng

A l l e x is t in g f a ci l i t i e s mu s t i n cl u d e a sc a l e d r a w in g o f t h e f a c il i ty ( se e i ns t r uc t io n s f o r mo r e d e t ail )

.

12

. Photogr a phs

A l l e x is t in g f a ci l i t i e s mu s t i n cl u d e p h o t og r ap h s ( ae r ia l o r g r o u n d

- le v el ) t ha t c l ea r l y d el i nea t e al l e x is t i n g s tr u c t u r e s ; e x is t i n g s t o r a ge,

tr ea t m en t, an d d i sp o sa l a r e a s ; an d si t e s o f f u t u re s t o r a ge

, t re a t m e n t, o r d i sp o sa l a r e a s ( se e ins t r uc t io n s f o r mo r e d e t a i l ).

13

. Co mme nts

P ag e 7 o f 7