### United States
Environmental Protection Agency

December 2011



# 2011 Hazardous Waste Report

Instructions and Forms

EPA Form 8700-13 A/B

(OMB #2050-0024; E xpires 12/31/2014)

### Office of Resource Conservation and Recovery (ORCR) (5303P) Washington, DC 20460

2011 Hazardous Waste Report
Instructions and Forms

This is an ongoing information collection from hazardous waste gene rators and hazardous waste treatment, storage, or disposal
facilities. This collecti on is done on a two-year cycle as required by S ections 3002 and 3004 of the Resource Conservation and Recovery Act (RCRA). The information is collected via a mechanism known as th e Hazardous Waste Report for the required reporting year [EPA Form 8700-13 A/B] (also known as the Bi ennial Report). Both RCRA Sect ions 3002 and 3004 require EPA to establish standards for recordkeeping and reporting of hazar dous waste. Section 3002 applies to hazardous waste generators and Section 3004 applies to hazardous waste treatment, storage, and disposal facilit ies. The implementing regulations are found at 40 CFR Parts 262.40(b) and (d); 262.41(a)(1)-(5), (a)(8), a nd (b); 264.75(a)-(e) and (j); 265 .75(a)-(e) and (j); and 270.30( l)(9). This is mandatory reporting by the respondents.

The respondents’ submissions (reports) describe each generated hazardous waste, the activity by which they generated the wastes, and the waste quantity; the reports also list the management method by which ea ch waste is treated, recycled, or dispos ed and the quantity managed. There are a number of uses of Bienni al Report data. EPA uses Bienni al Report data for planning and developing regulations, compliance monitoring , and enforcement. Also, Biennial Report data allows the Agency to determine whether its regulations are having the desired effect on the generation and management of hazardous waste. For example, Biennial Report data provides informati on on whether waste management has shifted from one method of disposal to another. Some State uses of Report data include support of planning , fee assessment, compliance monitoring, and enforcement.

Some businesses consider some of their hazardous waste information to be Confidential Business Information (CBI). A business may, if it desires, protect its Biennial Report information fro m public disclosure by asserting a claim of confidentiality cove ring all or part of its information. When a claim is made EPA will treat the informa tion in accordance with the confidentiality regulations in 40 CFR Part 2, Subpart B. EPA also ensures that the information coll ection procedures comply with the Privacy
Act of 1974 and OMB Circular 108.

Estimated Burden: The annual reporting burden for the 2011 Hazardous Waste Report is estimated to average 17 hours per respondent, and includes time for reviewing instructions, gather ing data, completing and reviewing the forms, and submitting th e report. The recordkeeping requirement is estimated to average 4 hours per response and includes the time for filing and storin g the 2011 Hazardous Waste Report submission for three years.

To comment on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, in cluding the use of automated collection techniques, EPA has established a public docket for this ICR under Docket ID Number 0976.15, which is available for public viewing at the RCRA Docket in the EPA Docket Center (EPA/DC), EPA West, Room 3334, 1301 Constitu tion 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 tele phone number for the RCRA Docket is (202) 566-0270. An electronic version of the public docket is available through EPA Dockets (EDOCKET) at http://www.epa.gov/dockets/regulations.htm

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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 ar e available electronically. On ce in the system, select “s earch,” then key in the do cket ID number identified above. Also, you can send comments to th e 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 the
EPA Docket ID Number 0976.15 and OMB Cont rol Number 2050-0024 in any correspondence.

## Table of Contents

THE 2011 HAZARDOUS WASTE REPORT ........................................................................... 1
Introduction .................................................................................................................. ............... 1
What’s New .................................................................................................................... ............ 2

WHO MUST FILE THE 2011 HAZ ARDOUS WASTE REPORT ......................................... 4 Sites Required To File The Hazardous Waste Report ................................................................ 4 Sites That Should Not File The Hazardous Waste Report .......................................................... 5 State-Specific Requirements ................................................................................................... .... 5

INSTRUCTIONS FOR FILING THE 2011 HAZARDOUS WASTE REPORT ................... 6
Introduction .................................................................................................................. ............... 6 Authority ..................................................................................................................... ................ 6 Overview Of The 2009 Hazardous Waste Report ...................................................................... 6 When And Where To Send Your Completed Report ................................................................. 6 Which Forms To Submit and What to Report ............................................................................ 7 Filling Out The Forms ......................................................................................................... ....... 9
Contacts for Assistance ....................................................................................................... .... 9 Copies of Hazardous Waste Repor t Instructions and Forms .................................................. 9 Documents Helpful in Filling out the Forms .......................................................................... 9
Code Lists .................................................................................................................... ........... 9 Skip Instructions ............................................................................................................. ........ 9 Explanations .................................................................................................................. .......... 9 Alphanumeric Fields ........................................................................................................... .. 10 Right Justification of Quantities ........................................................................................... 10
Comments Section of Forms ................................................................................................. 10 Page Numbering of Forms .................................................................................................... 10 Photocopies of Forms .......................................................................................................... . 10 Electronic Reporting .......................................................................................................... ... 11 Confidential Business Information (CBI) ............................................................................. 11

INSTRUCTIONS FOR FILLING OUT THE RCRA SUBTITLE C SITE IDENTIFICATION (SITE ID) FORM ..................................................................................... 12
Who Must Submit This Form ................................................................................................... 1 2 Purpose Of This Form .......................................................................................................... ..... 12
How To Fill Out This Form ..................................................................................................... . 12 Item-By-Item Instructions ..................................................................................................... .... 14
Item 1 – Reason for Submittal .............................................................................................. 14
Item 2 – Site EPA ID Number .............................................................................................. 15
Item 3 and 4 – Site Name and Location ................................................................................ 16 Item 5 – Site Land Type........................................................................................................ 16 Item 6 – North American Industry Cla ssification System (NAICS) Code(s) ....................... 16 Item 7 – Site Mailing Address .............................................................................................. 16
Item 8 – Site Contact Person ................................................................................................. 17

### Item 9 – Legal Owner and Operator of the Site .................................................................... 17 Item 10 – Type of Regu lated Waste Activity ....................................................................... 19 Item 11 – Description of Hazardous Wastes ......................................................................... 26 Item 12 – Notification of Hazardous Secondary Material (HSM) Activity .......................... 26
Item 13 – Comments ............................................................................................................ . 27
Item 14 – Certification ....................................................................................................... ... 27

ADDENDUM TO THE SITE IDENTIFICA TION FORM: NOTIFICATION OF
HAZARDOUS SECONDARY MA TERIAL ACTIVITY ....................................................... 28
You Must Fill Out This Section If ............................................................................................ 28
Item 1 – Indicate Reason for Notification ............................................................................. 28 Item 2 – Description of Hazardous S econdary Material (HSM) Activity ............................ 29 Item 3 – Facility has Financial Assurance Pursuant to 40 CFR 261 Subpart H ................... 32

INSTRUCTIONS FOR FILLING OUT THE GM FORM – WASTE GENERATION AND
MANAGEMENT .................................................................................................................... .... 33
Who Must Submit This Form ................................................................................................... 3 3 Purpose Of This Form .......................................................................................................... ..... 33
How To Fill Out This Form ..................................................................................................... . 33 Wastes To Be Reported ......................................................................................................... ... 33 Wastes Not To Be Reported ..................................................................................................... 34 How To Report Similar Wastes On The GM Form .................................................................. 36 Item-By-Item Instructions ..................................................................................................... .... 37 Section 1: Item A – Waste Description ................................................................................. 37
Section 1: Item B – EPA Hazardous Waste Code ................................................................ 37
Section 1: Item C – Stat e Hazardous Waste Code ................................................................ 37 Section 1: Item D – Source and Management Method Code................................................ 38
Section 1: Item E – Form Code............................................................................................. 38 Section 1: Item F – Quantity Generated in 2009 / UOM and Density .................................. 39

Section 1: Item G

– Waste Minimization Code ..................................................................... 39 Section 2: On-Site Management Method Code .................................................................... 40 Section 2: Quantity Treated, Dispos ed, or Recycled On-site in 2009 .................................. 41 Section 3: Item A – Was any of this Wa ste Shipped Off-site in 2009 for Treatment, Disposal, or Recycling? ....................................................................................................... . 41
Section 3: Item B – EPA ID Number of Facility to which Waste was Shipped ................... 41
Section 3: Item C – Off-site Mana gement Method Code Shipped To .................................. 42 Section 3: Item D – Total Quantity Shipped in 2009............................................................ 42

INSTRUCTIONS FOR FILLING OUT THE WR FORM – WASTE RECEIVED FROM
OFF-SITE ...................................................................................................................... .............. 43
Who Must Submit This Form ................................................................................................... 4 3 Purpose Of This Form .......................................................................................................... ..... 43
How To Fill Out This Form ..................................................................................................... . 43 Item-By-Item Instructions ..................................................................................................... .... 44 Item A – Waste Description .................................................................................................. 4 4
Item B – EPA Hazardous Waste Code ................................................................................. 44

### Item C – State Hazardous Waste Code ................................................................................. 44
Item D – Off-site Handler EPA Identification Number ........................................................ 45 Item E – Quantity Received in 2009 ..................................................................................... 45 Item F – UOM and Density .................................................................................................. 45
Item G – Form Code ............................................................................................................ . 46 Item H – Management Method Code.................................................................................... 46

OTHER REFERENCE INFORMAT ION AND CODE LISTS ............................................. 47
Excluded Wastes ............................................................................................................... ........ 48
Definitions.................................................................................................................... ............. 49 Special Instructions .......................................................................................................... ......... 60
EPA Hazardous Waste Codes ................................................................................................... 6 4 HSM Facility Codes ............................................................................................................ ...... 65
HSM Land-Based Unit Codes .................................................................................................. 66
Source Codes .................................................................................................................. .......... 67
Form Codes .................................................................................................................... ........... 69 Management Method Codes ..................................................................................................... 7 1
Waste Minimization Codes ...................................................................................................... . 73

### 1 

## THE 2011 HAZARDOUS WASTE REPORT

Introduction

The U.S. Environmental Protection Agency’s ( EPA) mission to protect human health and the environment includes the responsibility to effectivel y manage, with the States, the nation’s hazardous waste. As part of this task, the EPA and the States collect and maintain information about the generation, management, and final disposition of the natio n’s hazardous waste regulated by the Resource Conservation and Recovery Act (RCRA).

The EPA prepared this booklet for hazardous waste gene rators and for facilities that treat, store, or dispose hazardous waste to report their hazardous waste activities for calendar year 2011. The
information collected will:

 Provide the EPA and the States with an u nderstanding of hazardous waste generation and management in the United States.

 Help the EPA measure the quality of the environm ent, such as monitoring industry compliance with the regulations and evaluating waste minimization efforts taken by industry.

 Be summarized and communicated to the public, primarily through publication of the 2011 National Biennial RCRA Hazardous Waste Report.

The data you provide will be entered into a computer database by the State or the EPA Regional Office to which you return your Hazardous Waste Report. After review, to ensure the quality of the data, EPA will create a national database for this information. Your efforts in carefully filling out all the report forms are appreciated.

IMPORTANT

Before completing the 2011 Hazardous Waste Report forms, please carefully read the instructions in this
booklet.

IF YOU NEED ASSISTANCE

To obtain assistance in filling out the 2011 Hazardous Waste Report forms, please contact your State Office. Some States’ reporting requirements differ fro m the Federal requirements. The list of State and EPA Regional Office addresses, contact names, te lephone numbers, and e-mail addresses is located at: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf

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### The 2011 Hazardous Waste Report (continued)



### 2 What’s New

Below are a list of changes to the 2011 H azardous Waste Report Instructions and Forms.

1. Clarified Underground Injection Control (UIC) Instruction Facilities that generate, treat, store, or dispose of hazardous waste and place th e waste into an underground injection well (e.g., a Class I well) located at their site must mark “Yes” in Section 10.A.9 of the Site ID form.

2. Added “Waste Pharmaceuticals” and “Dried Paint” to the list of Form Codes Form code W005 has been added to track waste pharmaceutic als managed as hazardous waste. Form code W406 has been added to track dried paint (p aint chips, filters, air filters, other).

3. Modified the description for G11, G24, G25, and W206 The source code for G11 is now described as “Discarding off-specification, out-o f-date, and/or unused chemicals or products.”
The source code for G24 is now described as “Solve nt or product distillation as part of production process (including totally enclosed treatment sy stems). Does not include batch treatment in a separate process.” The source code for G25 is now described as “Hazardous waste management – indicate management method (for residuals fro m regulated hazardous waste processes – enter the related H code). The form code W206 is now described as “Waste oil managed as hazardous
waste.”

4. Revised “Groundwater contaminated by Hazardous Waste” instructions Replaced the term
“leachate” with “hazardous waste” and added further instructions regarding contaminated media.

5. Clarified instructions for on-site management Modified the language to clarify that filers should choose the management method code th at best identifies the last substantive purpose/operation it performs onsite.

6. Revised wording of Box 10.D (Academic Labs ) and the Addendum to the Site ID form (Hazardous Secondary Material) Wording changes implemented to both the Site ID form and instructions to help minimize confusion for reporting under these rules.

7. Clarified “Short-term Generator” Added examples, further instruction, and a definition for short-term generator.

8. Developed the “Biennial Reporting: Reportable and Non-Reportable Wastes” reference

document This document offers instruction for dete rmining which wastes should be reported.
This document can be found at http://www.epa.gov/epawaste/inforesour ces/data/biennialreport/index.htm

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9. Revised note for Treater, Storer, or Disposer of Hazardous Waste The note under Box
10.A.6 in the Site ID form now reads “Note: A hazardous waste Part B permit is required for
these activities.”

10. Added instruction for source code G61 If reporting source code G61 (hazardous waste received from off-site for storage/bulking, and transfer off-site for treatment or disposal), the generation amount must be zero (0) in Section 1, Item F.”

11. Added example of sequential process This example complements the existing non-sequential process for reporting on-site management.

### The 2011 Hazardous Waste Report (continued)



### 3 12. Modified language for GM Form, Section 2 On-site Generation and Management Section 2 now asks “Was any of this hazardous waste that wa s generated at this facility treated, disposed, and/or recycled on-site?”

13. Added definition for Waste Minimization and Waste Oil (Biennial Report Only) Definition
for Waste Minimization has been added and defined as “The reduction, to the extent feasible, of hazardous waste that is generated or subsequently treated, stored, or disposed. It includes any source reduction or recycling activity undertaken by a generator that results in: (1) the reduction of total volume or quantity of hazardous waste; (2) the reduction of toxicity of hazardous waste; or (3) both, as long as the reduction is consistent with the goal of minimizing present and future
threats to human health and the environment.” Definition for Waste Oil (Biennial Report Only) has been added and defined as “Any oil that has b een refined from crude oil, or any synthetic oil, that has been used, and as a result of such use, is contaminated by physical or chemical impurities and is managed as a hazardous waste.”

### 4 

## WHO MUST FILE THE 2011 HA ZARDOUS WASTE REPORT

Sites Required to File the Hazardous Waste Report

You are required by Federal statute (mandatory reporti ng) to complete and file the 2011 Hazardous Waste Report (also known as the “Biennial Report”) or your State’s equivalent hazardous waste report if your
site:

 Met the definition (see box below) of a RCRA Large Quantity Generator (LQG) during 2011; or

 Treated, stored, or disposed of RCRA hazardous wastes on-site during 2011.

If you are required to report, see WHICH FORMS TO SUBMIT AND WHAT TO REPORT to determine which forms you must submit.

DEFINITION OF A RCRA LARGE QUANTITY GENERATOR
WHO MUST REPORT FOR CALENDAR YEAR 2011

A site is a RCRA Large Quantity Gene rator (LQG) for 2011 if the site met any of the following criteria:

a. The site generated, in any single calendar m onth, 1,000 kg (2,200 lbs.) or more of RCRA non-acute hazardous waste; or

b. The site generated, in any single calendar month, or accumulated at any time, more than 1 kg (2.2 lbs.) of RCRA acute hazardous waste; or

c. The site generated, in any single calendar m onth, or accumulated at any time, more than 100 kg (220 lbs.) of spill cleanup material contaminated with RCRA acute hazardous

waste.

Note: You will report your current Hazardous Waste Generator status as of the date of submitting your 2011 Hazardous Waste Report on the Site ID Form in Item 10.A.1 – Generator of Hazardous Waste. Your current status may be different from the status during the report year that requires you to file the Hazardous Waste Report.

Note: Hazardous waste imported from a foreign country in 2011 must be counted in determining your generator status if your site is the U.S. Importe r. This waste must be reported on the GM Form or the WR Form in your 2011 Hazardous Waste Report.

Note: Some states, as a matter of state law, require other categories of generators to report as well. See the discussion under “State-Specific Requirements” on page 4.

### Who Must File the 2011 Hazardous Waste Report (continued)



### 5 Sites That Should Not File the Hazardous Waste Report

Do not file the 2011 Hazardous Waste Report if, during 20 11, your site was not a RCRA Large Quantity Generator (your site did not meet any of the LQG criteria) and your site did not treat, store, or dispose of RCRA hazardous wastes on-site in waste manage ment units subject to a RCRA operating permit. Exception: file the report if your state has more stringent reporting requirements. See “State-Specific Requirements” below.”

If you are not required to report, you should notify us if your hazardous waste generator status has changed; please fill out the RCRA Subtitle C Site Iden tification Form and submit it to your State Office. See the Item-by-Item Instructions for information on filling out the Site Identification Form. Place an “X” in the box for Subsequent Notification in Item 1 – Reason for Submittal.

Unless required by your state, do not file the 2011 Hazardous Waste Report if, during 2011, all of your hazardous waste was exported directly out of the United States to a foreign country. Facilities that export hazardous waste must file a separate Annual Report u nder 40 CFR 262.56. (This Annual Report will be in addition to the Hazardous Waste Report, if your st ate requires you to submit a Hazardous Waste Report.)



### State-Specific Requirements

States may impose reporting requirements above and be yond the Federal requirements. If your State does so, it will attach information to (or delete informati on from) this booklet. Alternatively, some States use a modified version of this report or their own instru ctions and forms to fulfill their reporting requirements. Please contact your State Office about State-speci fic requirements. See the Contacts list at: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf

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### 6 

## INSTRUCTIONS FOR FILING TH E 2011 HAZARDOUS WASTE REPORT

Introduction

The instructions and forms for the 2011 Hazardous Wast e Report are prepared by the U.S. Environmental Protection Agency (EPA) for generators and for treatment, storage, and disposal facilities (TSDFs) to report their hazardous waste activities for 2011. Add itionally, facilities may use this Hazardous Waste Report to notify their regulatory authority that they are managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) (these facilities would notify using the RCRA Subtitle C Site Identification Form and Addendum to the Site Identification Form).



### Authority

The authority for the 2011 Hazardous Waste Report is contained in Sections 3002 and 3004 of the Resource Conservation and Recovery Act of 1976 ( RCRA), as amended by the Hazardous and Solid Waste Amendments of 1984 (HSWA). Section 3002 requir es hazardous waste generators to report to the EPA or the authorized States, at least every two years, the quantities, nature, a nd disposition of generated hazardous waste. Under the authority of Section 3004, the EPA requires reporting by treatment, storage, and disposal facilities for the wastes they receive.



### Overview of the 2011 Hazardous Waste Report

To determine if you are required to file the Hazardous Waste Report, read WHO MUST FILE THE
2011 HAZARDOUS WASTE REPORT.

Which Forms to Submit and What to Report describes circumstances and situations under which each of the forms should be completed.

Filling out the Forms provides general guidelines for filling out the Hazardous Waste Report forms. This includes where to find the telephone number for the State Contacts, which you can call with questions about completing the Hazardous Waste Report.



### When and Where to Send Your Completed Report

The 2011 Hazardous Waste Report is due to your Stat e or EPA Regional Office by March 1, 2012. Return your completed Hazardous Waste Report to the address listed for your State or Regional contact. See the additional information sent to you with this bookl et. An updated listing of State and EPA Regional mailing addresses, contact names, telephone numbe rs, and e-mail addresses is maintained at: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf

.

Detailed instructions for filling out each of the form s are provided. Other reference information and code lists are provided, including: a list of excluded wastes; definitions of key terms; special instructions that explains how to report certain types of wastes (e.g ., lab packs, PCBs); a list of hazardous waste codes, HSM facility codes, HSM land-based unit codes, source codes, form codes, management method codes,
and waste minimization codes.

### Instructions for Filing the 2011 Hazardous Waste Report (continued)



### 7 Which Forms To Submit and What to Report

The 2011 Hazardous Waste Report contains the following four forms:

Site ID Form A site required to file the 2011 Hazardous Waste Report MUST submit the RCRA Subtitle C Site Identification Form (Site ID Form) as a component of the Report.

You will report that you are submitting the Site ID form as part of the 2011 Hazardous Waste Report in Item 1- Reason for Submittal. Mark “As a component of the Hazardous Waste Report (If marked, see sub-bullet below)” and mark the sub-bullet, if the status is applicable to you during the 2011 reporting year.

You will fill out the Site ID form by reporting all information current as of the date of submitting your 2 011 Hazardous Waste Report. This includes reporting

your current Hazardous Waste Generator status in Item 10.A.1 (Generator of Hazardous Waste), which may have changed since 2011.

Facilities that will begin managing, are managing, or will stop managing hazardous secondary material unde r 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) must submit the Site Identification Addendum as a component of the Report pursuant to 40 CFR 260.42. These regulations exclude certain hazardous secondary material(s) being reclaimed from the RCRA Subtitle C definition of solid waste provided certa in requirements and conditions are met.

GM Form A site required to file the 2011 H azardous Waste Report must submit Waste Generation and Management (GM) Form(s) for all hazardous waste that was used to determine the site’s generator status

. Hazardous waste must be reported if

it was:

 Generated and accumulated on-site and subsequently managed on-site or shipped off-site in 2011; or

 Generated and accumulated on-site in 2011 but not managed on-site or shipped off-site until after 2011; or

 Generated and accumulated on-site pr ior to 2011 but either managed onsite or shipped off-site in 2011; or

 Imported from a foreign country in 2011.

Examples of RCRA hazardous wastes to be reported include those that were:

 Generated on-site from a production pr ocess, service activity, or routine cleanup;

 Generated from equipment decommissioning, spill cleanup, or remedial cleanup activity;

### Instructions for Filing the 2011 Hazardous Waste Report (continued)



### 8  Shipped off-site, including hazardous waste that was received from offsite (reported on the waste Received From Off-site Form [WR Form]) and subsequently shipped off-site w ithout being treated or recycled onsite;

 Removed from on-site storage for treating, recycling, or disposing onsite or shipped off-site;

 Derived from the management of non-hazardous waste; or

 Derived from the on-site treatment (including reclamation), disposal, or recycling of previously existing hazardous waste (as a residual).

Unless required by your state, DO NOT submit a GM Form for any hazardous waste shipped directly to a foreign country. Facilities that export hazardous waste must file a separate Annual Report under 40 CFR 262.56. (This Annual Report will be in addition to the Hazardous Waste Report, if your state requires you to submit a Hazardous Waste Report.)

WR Form A site required to file the 2011 H azardous Waste Report must submit Waste Received From Off-site (WR) Form(s) if, during 2011, it received RCRA
hazardous waste from off-site and mana ged the waste on-site (including subsequent transfer off-site).

OI Form A site must complete Off-Site Identification (OI) Form(s) only if the site’s State requires it . Instructions for OI Form are on the back of the form. For a list of State Contacts go to: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf

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### Instructions for Filing the 2011 Hazardous Waste Report (continued)



### 9 Filling out the Forms

Contacts for Assistance

To obtain assistance in filling out the 2011 Hazardous W aste Report forms, please contact your State or EPA Regional Office. States’ reporting requirements or forms may differ from the Federal requirements. The list of contact addresses, contact names, telephone numbers, and e-mail addresses is located at: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf

.

Copies of Hazardous Waste Report Instructions and Forms

Additional copies of the 2011 Hazardous Waste Report Instructions and Forms can be obtained from the contact provided for your State. If your State uses the EPA’s version of the instructions and forms, you
can download the booklet from: http://www.epa.gov/epawaste/inforesour ces/data/biennialreport/index.htm

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Documents Helpful in Filling out the Forms

To prepare the 2011 Hazardous Waste Report, you should consult your records on quantities and types of hazardous waste that your site generated, managed, shipped, or received in 2011. Some records that may be helpful are:

 Hazardous waste manifest forms;

 Hazardous Waste Report forms submitted in previous years;

 Records of quantities of hazardous wast e generated or accumulated on-site;

 Results of laboratory analyses of your waste;

 Contracts or agreements with off-s ite facilities managing your wastes; and

 Copies of permits for on-site waste management systems.

Code Lists

LIST This symbol denotes references to relevant code lists. Please use only the codes included in the instructions or in the lists of codes provided.

Skip Instructions

This symbol denotes directions to skip to the next appropriate section or item to be completed, given certain responses to some questions.

Explanations

NOTE This symbol denotes explanatory text of defi nitions of terms used in the instructions.

### Instructions for Filing the 2011 Hazardous Waste Report (continued)



### 10 Alphanumeric Fields

Valid characters for alphanumeric fields are limited to: `~!@#$%^&*()_-+={}[]|\:;”’,.?/12 34567890ABCDEFGHIJKLMNOPQRSTUVWXYZ

Invalid characters for alphanumeric fields include:

> <

If the “<” or “>” symbols are used to indicate less than or greater than, it is recommended that these symbols be replaced with “LT” or “GT”.

Right Justification of Quantities

Right justify all quantities reported on the forms. For example, enter a quantity of 12,000 tons on the form

as: 1 2 0 0 0 . 0

Enter a quantity of 29,599.5 tons as:

2 9 5 9 9 . 5

Comments Section of Forms

Use the Comments section at the bottom of the forms to clarify or continue any entry. For each comment,
reference the section number and item letter of the entr y that is being continued. For example, if a hazardous waste generated on-site has seven EPA hazardous waste codes, enter the first six in Section 1,
Item B of the GM Form. Enter the seventh waste code in the Comments section and cross-reference Section 1, Item B. For example, you would write: “Sec. 1, Item B, continued: D007.”

Page Numbering of Forms

When you have filled out all the appropriate forms in your Hazardous Waste Report submission, number the pages (each piece of paper is a page) consecutively throughout your submission. Do not number each set of forms separately, but rather number each page sequentially. The individual page number and the total number of pages in your submission should appear at the bottom of each page (e.g., Page 1 of 7, Page 2 of 7).

If it is necessary to continue information from one fo rm onto another page, make additional copies of the form and number the additional pages with the same pa ge number as the first page, followed by a letter (e.g., page 27, page 27a;, page 28, page 28a, 28b). When continuing information on a supplemental page, enter only the information that is being continued.

Photocopies of Forms

A single copy of each form is included in this booklet. Photocopy as many forms as you need to complete your Hazardous Waste Report. Make copies after you have written your site name and EPA Identification Number in the top left-hand corner of the form, but before you begin filling out the form.

After you have finished filling out the forms, photocopy the entire Hazardous Waste Report and keep a copy for a period of at least three years from the due date of the report as required by 40 CFR 262.40(b).

### Instructions for Filing the 2011 Hazardous Waste Report (continued)



### 11 Electronic Reporting

The EPA encourages electronic reporting of Hazardous Waste Reports. To obtain instructions on how to file electronically, contact your State or EPA Regional Office.

Confidential Business Information (CBI)

You may not withhold information from the Admini strator of the EPA because it is confidential. However, when the Administrator is requested to c onsider information confidential, it must be treated according to the EPA regulations contained in 40 CFR, Part 2, Subpart B. These regulations provide that a business may, if it desires, assert a claim of business confidentiality coveri ng all or part of the information furnished to the EPA. 40 CFR 2.203(b) explains how to assert a claim.

The EPA will treat information covered by such a claim in accordance with the procedures set forth in Subpart B. If someone requests release of information c overed by a claim of confidentiality, or if the EPA
otherwise decides to make a determination as to wh ether such information is entitled to confidential treatment, the EPA will notify the business. The EPA w ill not disclose information as to when a claim of confidentiality has been made except to the extent of and in accordance with 40 CFR Part 2, Subpart B. However, if the business does not claim confidentiality when it furnishes the information, the EPA may
make the information available to the public without notice to the business.

IF YOU NEED ASSISTANCE

To obtain assistance in filling out the 2011 Hazardous W aste Report forms, please contact your State or EPA Regional Office. States’ reporting requirements or forms may differ from the Federal requirements. The list of State and EPA Regional Office addresses, contact names, telephone numbers, and e-mail
addresses is located at: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf

.

This booklet and other related information can be found at: http://www.epa.gov/epawaste/inforesour ces/data/biennialreport/index.htm

.

### 12 

## INSTRUCTIONS FOR FILLING OUT THE RCRA SUBTITLE C SITE IDENTIFICATION (SITE ID) FORM

Who Must Submit This Form

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

 Initial Notification of Regulated Waste Activity

 Subsequent Notification of Regulated Waste Activity

 First RCRA 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 pursuant to 40 CFR Part 262 Subpart K (if in an eligible State)

 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 th at are different from the Federal requirements. To obtain the appropriate forms or ask questions, refer to a list of contacts at: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf . The list will tell you whether the Federal form or a State form is used, who to contact, and where to mail the completed form.



### Purpose of This Form

The Site ID Form provides site-specific information about your facility and is used to obtain an EPA Identification Number. The Site ID form also provid es updated information for items that have changed at your site and verifies the information fo r 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 your site

 Item 5 – the land type of your site

 Item 6 – the North American Industry Classification System (NAICS) code(s) for your site

 Item 7 – the mailing address for your site

 Item 8 – name, title, address, phone number, fax, and e-mail of a contact person at your site

 Item 9 – name, address, and phone number of th e legal owner(s) and name of the operator(s) of your site

 Item 10 – your site’s regulated waste activities (enter all that apply)

 Item 11 – the description of hazardous waste

### Site ID Form (continued)



### 13  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 pr ovided throughout the form is truthful, accurate and complete

 Addendum to the Site Identification Form – notif ication 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. Signatures 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 Identificati on Number blank. Use Item 13 – Comments to clarify or provide additional information for any entry. When entering in formation in the comments section,
enter the item number and box letter to which the comme nt refers. If you must use additional sheets for comments, enter your site’s EPA Identification Numb er in the top left-hand corner of each sheet.

### Site ID Form (continued)



### 14 Item-By-Item Instructions

Item 1 – Reason for Submittal

Reason for Submittal: Place an “X” in the appropriate box(es) to indicate whether this form is your Initial Notification (i.e., this is your first time submitting site identification information / to obtain an EPA Identification Number for this location); a Subseque nt Notification (to update your site identification information); a component of a First or a Revised Hazardous Waste Part A Permit Application; or a component of the Hazardous Waste Report.

 To provide an Initial Notification (first time submitting site identification information / to
obtain an EPA Identification Number for this location).

o If your waste activity is regulated under Subtitle C of the Resource Conservation and Recovery Act (RCRA) and the rules promulga ted pursuant to the Act (specifically 40 CFR Parts 260-299), you must submit this form to notify the appropriate State or EPA Regional Office of your regulated waste activities and obtain an EPA Identification
Number.

o If you are an eligible academic entity opting into 40 CFR 262 Subpart K for managing laboratory hazardous wastes AND you have never before s ubmitted site identification information, you 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 wast e pursuant to 40 CFR Part 262 Subpart K in order for you to notify.

o If you will begin managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) AND you have never before submitted site identification information, you must subm it this form, pursuant to 40 CFR 260.42, to notify the appropriate State or EPA Regional O ffice 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 notify.

 To provide a Subsequent Notification (to update site identification information for this location).

o You must use this form to submit a subseque nt notification if your site already has an EPA Identification Number and you wish to ch ange information (e.g., generator status, new site contact person, new owner, new mailing address, new regulated waste activity, etc.).

o If you have previously submitted site identification information and are an eligible academic entity opting into or withdrawing from 40 CFR Part 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 e ligible to manage laboratory hazardous waste pursuant to 40 CFR Part 262 Subpart K in order for you to notify.

o If you have previously submitted site identifi cation information and are notifying (or renotifying) that you will begin managing, are managing, or have stopped managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24),

### Site ID Form (continued)



### 15 or (25), 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 material 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 subm it 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 pr omulgated 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 Hazard ous Waste Part A Permit Application. If you must submit a revised Part A Permit Application to reflect changes that have occurred at your site, you must submit this form as part of your revised Part A Permit Application. Examples of site changes requiring a revised Part A Permit Application include managing new wastes not
identified in the first submission of the form or changes to existing waste treatment processes. When submitting a revised Part A Permit Appli cation, please include the Amendment number in the appropriate space.

 As a component of the Hazardous Waste Report. (If marked, see sub-bullet below). If you are required to submit a Hazardous Waste Repor t 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 is equivalent to a Subsequent
Notification.

o 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 ac ute hazardous waste spill cleanup in one or more months of the report year (or State equivalent LQG regulations). The purpose of this check box is to distinguish between s ites 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 TSD facility or a Large Quantity Generator (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 Hazardous Waste Report.

Item 2 – Site EPA ID Number

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

### Site ID Form (continued)



### 16 Item 3 and 4 – Site Name and Location

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

Item 5 – Site Land Type

Place an “X” in the box that best describes the land type of your site. Select only one type: Private, County, District, Federal, Tribal (see below), Municipal, State, or Other. If your site’s Land Type could be described as Municipal and another Land Type, such as County, District, or Tribal, do not place an “X” in Municipal. Instead, choose the other appropria te 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 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

.

Item 6 – North American Industry Cla ssification System (NAICS) Code(s)

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

Box A Provide the North American Industry Classification System (NAICS) code that best describes your site’s primary bus iness production process for your products or services. Referencing the latest 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.

Boxes B – D List other NAICS codes that describe the other business production processes for your site. Referencing the latest NAICS c odes, 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 determ ine your NAICS code(s); the NAICS code is used in tax reporting and other business re ports. You can obtain additional information about NAICS codes at http://www.census.gov/eos/www/naics

.

Item 7 – Site Mailing Address

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

### Site ID Form (continued)



### 17 Item 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. If the person completing the Hazardous Waste Report 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 Waste Report in
Item 13 – Comments.

Note: This is NOT the Facility Permit Contact in formation. The Facility Permit Contact information
should be entered on the RCRA Hazardous Waste Part A Permit Application.

Item 9 – Legal Owner and Operator of the Site

This section should be used to indicate al l owners and operato rs 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 pa rt 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 became the owner of your site. Enter dates as in this example: For April 22, 2011, enter 04/22/2011. 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, choose the other appropriate Owner Type. (For example, if your site’s Owner Type is both Municipal and County, you would place an “X” in the box fo r 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

.

Legal Owner Address: Enter the address of the legal owner. If the address and the Location of Site (Item 4) are the same, you can ente r “Same as Item 4” in the box for Item 9.

Use the Comments section in Item 13 to list an y additional owners, th eir names, the dates they became owners, owner type, mailing address, and which owner(s), if any, are no longer

### Site ID Form (continued)



### 18 owners since your last submission of this form. If necessary, attach a separate sheet of paper. Remember to enter your site’s EPA Identificati on 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 op eration of a RCRA site. Note: This is the legal entity which controls the RCRA s ite operation rather than the plant or site manager. This is usually a company or bus iness name, but may be an individual. 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 Operator: Indicate the date on which the above entity became the operator of your site. Enter dates as in this example: For April 22, 2011, enter 04/22/2011. 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: Private, 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, choose the other appropriate Operator Type. (For exam ple, 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 13 to list an y additional operators, their names, the dates they became operators, operator type, mailing a ddress, and which operator(s), if any, are 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 recommended 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 operator must notif y the State or EPA Regional Office of this change. Since your business has changed locati ons, a new EPA Identification Number will be assigned.

### Site ID Form (continued)



### 19 Item 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 th e site plans to begin after EPA Identification Number assignment. The information you provide in Item 10 w ill 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. For the Hazardous Waste Report, your current status may be different than your status during the reporting year.

A. Hazardous Waste Activities (Complete all parts 1 through 10):

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

1. Generator of Hazardous Waste (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) contai ned in 40 CFR 261.21 through 261.24, place an “X” in the appropriate box for the quan tity of hazardous waste that is generated per calendar month. The regulations for hazardous waste generators are found in 40 CFR Part 262. ( http://ecfr.gpoaccess.gov/cgi/t/text/textidx?c=ecfr&tpl=%2Findex.tpl .) Consult these regulations and your State for details about how the regulations apply to your situation. Below is a brief description of the three types of hazardous waste generators.

If “Yes”, place an “X” in only one of the following – a, b, or c.

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

### Site ID Form (continued)



### 20 NOTE If, in addition to being an LQG, you recycle hazardous wastes at your site, mark both this box and Item 10.A.4.

Hazardous secondary material managed under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) DOES NOT count towards your generator status. However, you must check with your State to determine if you are eligible to manage hazardous secondary material under these
exclusions.

b. SQG: Small Quantity Generator This site is a Small Quantity Generator if the site meets all of the following
criteria: i) Generates, in any calendar month, 100 kg (220 lbs.) but less than 1,000 kg (2,200 lbs.) of RCRA hazardous waste; and ii) Does not generate, in any calendar month, or accumulate at any time, more than 1 kg (2.2 lbs.) of acute hazardous waste; and iii) Does not generate more than 100 kg (220 lbs.) of material from the cleanup of a spill of acute hazardous waste.

OR , the site is Small Quantity Generator if the site: i) Meets i) and iii) of the Conditionally Exempt Small Quantity Generator criteria (see below), but ii) Is storing more than 1,000 kg (2 ,200 lbs.) of RCRA hazardous waste onsite. If the site accumulates, at any tim e, more than 1,000 kg (2,200 lbs.) of RCRA hazardous waste, the site mu st apply for an EPA ID Number using this form.

c. CESQG: Conditionally Exempt Small Quantity Generator This site is a CESQG if the site does all of the following: i) Generates no more than 100 kg (220 lbs.) of RCRA hazardous waste in any calendar month; and ii) Does not accumulate, at any time, more than 1,000 kg (2,200 lbs) of RCRA hazardous waste; and iii) Does not generate, in any calendar month, or accumulate at any time, more than 1 kg (2.2 lbs.) of acute hazardous waste and no more than 100 kg (220 lbs.) of material from the cleanup of a spill of acute hazardous

waste.

NOTE 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 you must notify the EPA.

If you marked “Yes” above, indicate your other generator activities. Mark “Yes” or
“No” for the other hazardous waste activities listed below that may occur at this site. Complete all parts 2-10.

### Site ID Form (continued)



### 21 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 th at is not related to normal production processes. In other words, short-term generators produce hazardous waste from aparticular activity for a limited time and then cease conducting that activity. Shortterm generators would not be consider ed 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 incl ude: 1) one-time highway bridge waste generation; 2) underground storage tank re movals; 3) generation of off-spec or outof-date chemicals at a site that normally doesn’t generate hazardous waste; 4) remediation or spill clean-up at sites with no previous RCRA ID; and 5) site or production process decommissions by a new operator. If you mark “Yes”, you must provide an explanation of your short-te rm generation event in Item 13 - Comments.

3. United States Importer of Hazardous Waste Mark “Yes” if you import hazardous waste from a foreign country into the United
States. Refer to 40 CFR 262.60 for additional information.

4. Mixed Waste Generator Mark “Yes” if you are a generator of mixe d waste (waste that is both hazardous and radioactive). RCRA defines “mixed waste” as waste that contains both hazardous waste and source, special nuclear, or by-p roduct 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: If “Yes”, place an “X” in all that apply.

a. Transporter You transport hazardous waste within the United States. The Federal regulations for hazardous waste transpor ters 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 waste is in transit. The Federal regulations for hazardous waste
transfer facilities are found in 40 CFR Part 263.12.

6. Treater, Storer, or Disposer of Hazardous Waste (at your site): If you treat, store, 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 treatment, storage, and disposal facilities (TSDFs) are found in 40 CFR Parts 264, 265, 266, and 270.

Mark “No” if any of the following co nditions are true for your facility:

1. This facility does not receive hazar dous waste from other generators and ships all waste off-site for management within the regulatory timeframe.

### Site ID Form (continued)



### 22 2. This facility is only involved with on-go ing post-closure activities, corrective actions under HSWA, or a consent or der under a non-traditional permit or without a RCRA permit being required.

3. 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 destination facility for universal wast es in addition to being a treatment, storage, or disposal facility 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 Fe deral and State regulations; 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 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 bein g 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 266.108, place an “X” in the box to indicate th at 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 recovery, as described in 40 CFR 266.100(d), or to recover economically significant amounts of precious metals, as described in 40 CFR 266.100(g), or if you process hazardous wastes in a lead recovery furnace to recover lead, as described in 40 CFR 266 ,100(h), place an “X” in the box to indicate that you qualify for the Smelting, Melting, and Refining Furnace Exemption.

9. Underground Injection Control (at your site): If you generate, treat, store, or dispose of hazardous waste and place the w aste or its residuals into an underground injection well (e.g., a Class I well) located at your site, mark “Yes”. The Federal

### Site ID Form (continued)



### 23 regulations 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 you received hazardous waste from another site, whether th is 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 waste activities listed below that may occur at this site. Comp lete 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, refe r 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 Universal 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 th e 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 what 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 dispose of universal wastes; a permit may be required if you recycle universal wastes.

NOTE If your site, in addition to being a destination facility for universal wastes, is also a treatment, storage, or disposal facility for RCRA 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 regulations 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 used oil within the Unite d States. The Federal regulations for used oil transporters are found in 40 CFR Part 279.40-47.

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 in 40 CFR Part 279.40-47.

### Site ID Form (continued)



### 24 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 regula tions for processors of used oil are
found in 40 CFR Part 279.50-59.

b. Re-Refiner You refine used oil. The Federal regula tions for re-refiners of used oil are
found in 40 CFR Part 279.50-59.

3. Off-Specification Used Oil Burner (at your site): You burn off-specification used oil fuel, mark “Yes” to indicate th is used oil management activity.

4. 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 OffSpecification Used Oil Burners You are a marketer who directs shipmentof off-specification used oil to offspecification used oil burners. The Federal regulations for off-specification
used oil are found in 40 CFR Part 279.70-75.

b. Marketer Who First Claims the Used Oil Meets the Specification
You are the first to claim that used oil meets the used oil specification
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 used 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 Laborato ries – Notification for opting into or withdrawing from managing laboratory hazardous wastes pursuant 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-profit research institute that is owned by or has a formal written affiliation agreement w ith 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 and for any state-specific requirements. (See EPA’s website for more information about these regulations: http://www.epa.gov/wastes/hazard/genera tion/labwaste/implementation.htm .)

Subpart K is an optional alternative set of re quirements for eligible academic 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

### Site ID Form (continued)



### 25 operating under Subpart K, or subsequently w ithdraw from Subpart K must complete this section to meet the notification requirements of this Subpart. Refer to 40 CFR 262.203 and
262.204.

NOTE Eligible academic entities with laboratories must complete a separate Site ID Form for each site (i.e., EPA ID num ber) that is managing hazardous waste under Subpart K. All laboratories with the same EPA ID number will be regulated under this Subpart. If eligible academic entities with laboratories withdraw from Subpart K, all laboratories with the same EPA ID 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 Currently 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 for 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 are 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 li sted 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 university, or (2) has a master aff iliation agreement and program letter of agreement, as defined by the Accred itation 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 university: 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. 501(c)(3) and is either: (1) owned by a college or university, or (2) has a formal written affiliation agreemen t with a college or university that establishes a relationship between ins titutions for the purposes of research and/or education and is signed by 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 laboratories. Withdrawing generators will automatically re vert to regulation under 40 CFR 262.34 (c)

### Site ID Form (continued)



### 26 requirements (or 40 CFR 261.5 for CESQGs). If marking “Yes” for this box, please include comments in Section 13 that explain your reasons for withdrawing from Subpart

K.

Item 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 261 to complete this item. Part 261 identifies those solid wastes which the EPA defines as hazardous and regulates under RCRA. If you n eed 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).

NOTE EPA Hazardous Waste Codes. 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 y ou handle. Attach any additional sheets
to the Site ID Form. Remember to in clude 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 St ate waste code, enter the appropriate code(s) in the box(es) provided. Please list the waste c odes of the State-regulated hazardous wastes handled at your site in the order they are presented in the regulations.

NOTE State Hazardous Waste Code. 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.

Item 12 – Notification of Hazardous Secondary Material (HSM) Activity

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), 40 CFR 261.4(a)(23), (24), or (25). 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 inst ructions for this Addendum after Item 14.

### Site ID Form (continued)



### 27 Item 13 – Comments

Use this section as needed to provide additional in formation for Items 1 through 12. Include the item number and box letter (if any) for each comment you ma ke. You may attach additional sheets if needed. Remember to include your EPA Identification Number on the top of each page.

Item 14 – Certification

This certification must be signed and dated by the owner(s), operator(s), responsible official(s), or 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 H azardous Waste Part A Permit Application signatory specifics.) An “authorized representative” is a person r esponsible for the overall ope ration of the site (i.e., a plant manager or superintendent, or a person of equal responsibility).

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

### 28 

## ADDENDUM TO THE SITE IDENTI FICATION FORM: NOTIFICATION
OF HAZARDOUS SECONDAR Y 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), 261.4(a)(23), (24), or (25). See http://www.epa.gov/epawaste/hazard/dsw/statespf.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), 40 CFR 261.4(a)(23), (24), or (25) and must notify the appropriate State or Regional Office of your activities, pursuant to 40 CFR 260.42. These regulations exclude certain hazardous seconda ry material being reclaimed from the RCRA Subtitle C definition of solid waste provided cer tain requirements and conditions are met. See EPA’s website for more information about these regulations: http://www.epa.gov/epawaste/hazard/dsw/rulemaking.htm#2008

. Complete all parts 1-3.

NOTE You must be managing excluded hazardous secondary material in compliance with 40 CFR 261.2(a)(2)(ii), 261.4(a)(23), (24), and/or (25) (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 their Biennial Report (which is also due by March 1 of each even-numbered year).

If you stop managing hazardous secondary materi al in accordance with the exclusion(s) and do not expect to manage any amount of hazardous secondary material under the exclusion(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.

Item 1 – Indicate Reason for Notification (include dates where requested):

Place an “X” in the box for th e reason that applies to you:

 Facility will begin managing excluded hazardous secondary material as of (mm/dd/yyyy): Place an “X” in this box if you are notifying that you will begin managing hazardous secondary material under the exclusion(s).

 Facilities must notify prior to operating under the exclusion(s).

### Addendum to the Site ID Form

29  If placing an “X” in this box, list the date (mm/dd/yyyy) when you will begin managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25). Note: If the fac ility had previously notified that it will stop managing hazardous secondary material in the past but will now begin anew, list the next planned start date.

 Facility is still managing excluded hazard ous secondary 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 exclusion(s). Note: you must have previous ly notified that you began managing hazardous secondary materials in order to check this box.

 Facilities must notify by March 1 st of each even-numbered year.

 If placing an “X” in this box, you do not have to list a date.

 Facility has stopped managing excluded hazardous secondary material as of (mm/dd/yyyy) and is notifying as required: 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 within 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 choo se 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 4) you temporarily suspend management of hazardous secondary material for at least one year.

 Only place an “X” in this box if you ha ve stopped managing a ll hazardous secondary material under the exclusion(s). For example, if your facility only stopped managing one hazardous secondary material, but c ontinued to manage another hazardous 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 renotify (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 notifi cation, you can leave the Addendum blank for subsequent submissions, including any subsequent biennial report submissions.

Item 2 – Description of Excluded Hazard ous Secondary Material (HSM) Activity

In the table provided on the Addendum to the Site ID Form, list your appropriate facility code, each waste code for the hazardous secondary material you manage, the estimated and actual quantities in short tons for each hazardous secondary material, and the approp riate land-based unit code for how you mange the hazardous secondary material. Do not include any info rmation regarding your hazardous wastes in this section. See examples below on how to answer this question.

### Addendum to the Site ID Form

30 a. Facility Code: Using the facility codes, found in the Code List section of these instructions, enter the appropria te 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 by facility code.

b. Waste Codes(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 wast e code(s) that would apply if you did not manage your material in accordance with 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23),(24), or (25)).

NOTE If you list more codes or manage more hazardous secondary material than will fit in the table under Item 2, please continue under Item 13 – Comments, or on an extra sheet. Remember to include your EPA ID number on the top of each page.

c. Estimated Short Tons of Excluded HSM to be Managed Annually: In the box provided, enter your estimated tonnage (using short tons) of hazardous secondary material you expect to manage annually. Convert all ph ysical 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 estim ated tonnage should be for the entire amount of hazardous secondary material to be reclaime d (NOT just the quantity of constituent or product reclaimed).

d. Actual Short Tons of Excluded HSM Managed During the Most Recent OddNumbered Year: Report the tonnage (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, 2012, enter the amount you actually managed during 2011 (i.e., the tonnage you ma naged from January 1, 2011 to December 31, 2011). 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 actual tonnage should be for the entire amount of hazardous secondary material that was sent for reclama tion (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 Code List section of these instructions, 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 landbased units, enter “NA”. If you use the code “OT” (Other), please describe your landbased unit in Item 13 – Comments. If more th an one land-based unit code applies to a hazardous secondary material, list it separately using another row.

### Addendum to the Site ID Form

31 Examples for Reporting Hazardous Secondary Material Activity:

EXAMPLE 1: A pharmaceutical manufacturer generates spent solvents that are characteristic for ignitability (D001). The manufacturer plans to mana ge spent solvents under 40 CFR 261.2(a)(2)(ii) and 261.4(a)(24) by sending some amount to a reclaimer within its own company and the rest off-site to a reclamation facility within the United States. The ma nufacturer will not manage any spent solvents in a land-based unit. Following the regulations, the manuf acturer submits an initial notification prior to managing its spent solvents under the exclusions. 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 oddnumbered 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 facility within the U.S. and reclaims spent pick le liquor (K062) on-site. Ne ither hazardous secondary material is managed in a land-based unit. The st eel manufacturer has managed both hazardous secondary material under 40 CFR 261.2(a)(2)(ii) and 261.4(a)(24) fo r a number of years and it is now time to renotify. 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 oddnumbered 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 facility has been receivi ng and reclaiming spent solvents under 40 CFR 261.2(a)(2)(ii) and 261.4(a)(24) for a number of years. The facility receives and 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 oddnumbered year e. Land-based unit
code (answer using
codes listed in the
Code List section of the instructions) 03 D001;F002;F003;F005 6,000 7,533 NA 03 D001;D038;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

### Addendum to the Site ID Form

32 EXAMPLE 4: A smelting operation generates furnace bricks that are characteristic for chromium (D007) and sends them off-site for re clamation. Before shipping the br icks off-site, the facility manages some of the bricks in a containment building and the rest in a pile on the la nd. 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) 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 oddnumbered year e. Land-based unit
code (answer using
codes listed in the
Code List section of the instructions)
06 D007 200 235 NA

06 D007 115 126 PL

EXAMPLE 5: An intermediate facility has been managing wastewater treatment sludges from electroplating operations (F006) for the past seven years but, due to company consolidation, it will 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 oddnumbered year e. Land-based unit
code (answer using
codes listed in the
Code List section of the instructions) 08 F006 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 (0 7, 11) and intermediate (08) facilities managing hazardous secondary 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 assuran ce 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 requi red to have financial assurance because the facility codes are 07 and 08, respectively.

 Mark “No”, if you do NOT have financial assu rance 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 secondary 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 exampl e, the facilities in Examples 1, 2, and 4 above are not required to have financial assurance because these facilities did not report facility codes of 07, 08, or 11.

### 33 

## INSTRUCTIONS FOR FILLING OUT THE GM FORM – WASTE
GENERATION AND MANAGEMENT

Who Must Submit this Form

A site required to file the 2011 Hazardous Waste Report must submit a GM Form if the site generated RCRA hazardous waste that, in 2011, was accumulated on- site; managed on-site in a treatment, storage, or disposal unit; and/or shipped off-site for mana gement, consistent with the criteria below. (See Wastes to be Reported , below, for specific instructions on gene rated RCRA hazardous wastes that should be reported on the GM Form. See Wastes Not to be Reported , below, for any exclusions or exemptions from the GM Form reporting requirements under the 2011 Hazardous Waste Report.)



### Purpose of this Form

The GM Form is for reporting on-site hazardous w aste generation and management in 2011. The GM Form is divided into three sections that document 1) the source, characteristics, and quantity of hazardous waste generated; 2) the quantity of hazardous wast e managed on-site along with the management method used; and 3) the quantity of hazardous waste shipped off-site for treatment, disposal, or recycling along with the off-site management method used.



### How to Fill out this Form

Make and submit a photocopy of the GM Form for each generated RCRA hazardous waste that should be reported, consistent with the criteria discussed belo w. Prior to photocopying, place the pre-printed site identification label in the top left-hand corner of th e form or, if you did not receive pre-printed labels, enter the site name and EPA Identification Number in this space.

Use the Comments section at the end of the form to clarify any entry (e.g., “Other” responses) or to continue any entry. When entering information in the Comments section, cross-reference the section
number and item letter to which the comment refers.

NOTE Please review your previous cycle’s GM source, form, and management method codes to see if they are still applicable. If applicable , use those same codes for consistency.

Refer to the Special Instructions for repor ting lab packs, asbestos, PCBs, waste oils, groundwater contaminated by hazardous w aste, RCRA-radioactive mixed wastes, and laboratory clean-out wastes.



### Wastes to be Reported

In general, each generated RCRA hazardous waste that is used to determine the site’s generator status should be reported on the GM Form. (See Wastes Not to be Reported , below, for any exclusions or exemptions from the GM Form reporting requirements under the 2011 Hazardous Waste Report. See also Biennial Reporting: Reportable and Non-Reportable Wastes at http://www.epa.gov/epawaste/inforesour ces/data/biennialreport/index.htm

.

### GM Form (continued)



### 34 A GM Form must be submitted for each generate d RCRA hazardous waste. H azardous waste must be reported if it was:

 Generated and accumulated on-site and subsequently managed on-site or shipped off-site in 2011;

or

 Generated and accumulated on-site in 2011 but not managed on-site or shipped off-site until after 2011; or

 Generated and accumulated on-site pr ior to 2011 but either managed on-site or shipped off-site in 2011; or

 Imported from a foreign country in 2011.

Examples of RCRA hazardous wastes to be reported include those that were:

 Generated on-site from a production process, service activity, or routine cleanup.

 Generated from equipment decommissioning, spill cleanup, or remedial cleanup activity.

 Removed from on-site storage.

 Derived from the management of non-hazardous waste.

 Derived from the on-site treatment (including reclam ation), disposal, or recycling of previously existing hazardous waste (as a residual).

 Shipped off-site, including hazardous waste that was received from off-site (reported on the Waste Received From Off-site Form [WR Form]) and subsequently shipped off-site without being treated or recycled on-site.

 Radioactive wastes mixed with RCRA hazardous wast es should also be reported; be sure to mark
“Yes” on the Site Identification Form in Item 10.A.1.f. See the definitions and the special instructions regarding this waste.

 Hazardous wastes regulated only by your State should be reported if required by your State.



### Wastes Not to be Reported

RCRA hazardous wastes exported directly to a foreign country should not be reported on the GM Form 

### (unless required by your state) . Facilities that export hazardous waste must file a separate Annual Report under 40 CFR 262.56. (This Annua l Report will be in addition to the Hazardous Waste Report, if your state requires you to submit a Hazardous Waste Report.)

In addition, materials an d wastes identified at 40 CFR 261.2(a)(2)( ii) and 261.4(a) and (b) and 261.5(c) should not be reported on the GM Form. Section 261.4(a) and (b) identify materials and solid wastes that do not qualify as solid or hazardous wastes, respectively. Section 261.5(c) identifies hazardous
wastes that should not be included in a site’s generator status determ ination, even if these hazardous wastes were generated at the site.

### GM Form (continued)



### 35 Following are the materials and wastes addressed under 40 CFR 261.4(a) and (b ) and 261.5(c), which should not be reported on the GM Form:

 Materials which are excluded from being a solid w aste, e.g., any mixture of domestic sewage and other wastes that passes through a sewer system to a publicly owned treatment works (unless they are stored or treated in regulated units prior to being discharged). (40 CFR 261.4(a))

 Solid wastes that are excluded from being hazar dous waste, e.g., petroleum-contaminated media and debris that fail the test for the toxicity characteristic (waste codes D018 through D043 only) and are subject to the corrective action regula tions under 40 CFR Part 280. (40 CFR 261.4(b))

 Waste exempt from regulation because the waste has not exited the raw material storage or production unit yet, as specified in 261.4(c). (40 CFR 261.5(c)(1))

 Hazardous waste that has been collected as a sample(s) for the purpose of determining its characteristic or composition, as specified in 261.4(d). (40 CFR 261.5(c)(1))

 Sample(s) undergoing treatability studies, as sp ecified in 261.4(e). (40 CFR 261.5(c)(1))

 Sample(s) undergoing treatability studies at the laboratory or testing facility, as specified in 261.4(f). (40 CFR 261.5(c)(1))

 Hazardous waste that is a specified recyclable material such as ethyl alcohol or scrap metal, as specified in 261.6(a)(3). (40 CFR 261.5(c)(1))

 A residue of hazardous waste in an empty containe r or in an inner liner removed from an empty container, as specified in 261.7(a)(1). (40 CFR 261.5(c)(1))

 PCB wastes regulated under the Toxic Substance C ontrol Act, as specified in 261.8, unless mixed with a hazardous waste. (40 CFR 261.5(c)(1))

 Wastes managed immediately upon generation only in on-site elementary neutralization units, wastewater treatment units, or totally enclosed treatment facilities as defined in 40 CFR 260.10. (40 CFR 261.5(c)(2)) Any hazardous waste residues genera ted from these units, however, must be reported on the GM Form. (For additional information, see the guidance document

“ Biennial Report: Reportable and Non-Reportable Wastes” at http://www.epa.gov/epawaste/inforesour ces/data/biennialreport/index.htm .)

 Wastes recycled, without prior storage, only in an on-site process subject to regulation under 40 CFR 261.6(c)(2). (40 CFR 261.5(c)(3)) Any hazardous waste residues generated from these units, however, must be reported on the GM Form.

 Used oil that is recycled and is also a h azardous waste solely because it exhibits a hazardous waste characteristic and is managed unde r 40 CFR Part 279. (40 CFR 261.5(c)(4))

 Spent lead-acid batteries managed under the require ments of 40 CFR Part 266, Subpart G, which includes persons who reclaim spent lead-acid batteries that are recyclable materials; persons who generate, transport, or collect spent batteries; pe rsons who regenerate spen t batteries; or persons who store them (other than spent batteries that are to be regenerated). (40 CFR 261.5(c)(5)) Any hazardous wastes generated during battery reclam ation, however, must be reported on the
GM Form.

### GM Form (continued)



### 36  Universal wastes managed under 40 CFR 261.9 and 40 CFR Part 273. (40 CFR 261.5(c)(6)) Any hazardous waste residues generated from these uni ts, however, must be reported on the GM

Form.

 Unless required by your state, hazardous wastes that were, during 2011, all exported directly out of the United States to a foreign country. An Annual Report must be filed in this case as required under 40 CFR 262.56. (This Annual Report will be in addition to the Hazardous Waste Report, if your state requires you to submit a Hazardous Waste Report.)



### How to Report Similar Wastes on the GM Form

Generally, a GM Form should be completed for each generated RCRA hazardous waste. Contact your State about combining and reporting similar hazardous wastes on the GM Form.

### GM Form (continued)



### 37 Item-By-Item Instructions

Section 1 – Waste Characteristics Section 1 requests information on each RCRA hazardous waste that, in 2011, was generated and accumulated on-site; managed on-s ite; and/or shipped off-site.

All items in this section are mandatory. Note: Ei ther Item B and/or Item C must be provided for

each waste stream.

Item A – Waste Description

Provide a short narrative description of the waste, such as:

 General type;

 Source;

 Type of hazard; and

 Generic chemical name or primary hazardous constituents.

Example: “Ignitable spent solvent from degreasing operation in tool production; mixture of mineral spirits and kerosene.”

In the example, note that the general type (spe nt solvent), source (degreasing operation in tool production), type of hazard (ignitability), and generic ch emical names (mineral spirits and kerosene) have
all been cited.

Item B – EPA Hazardous Waste Code(s)

Enter the four-character EPA hazardous waste code(s) that applies to the waste reported in Section 1, Item A. EPA hazardous waste codes are provided in the “ Other Reference Information and Code Lists ” section of this booklet. If you need room for additiona l codes, list the codes in the Comments section and cross-reference Section 1, Item B. If fewer than si x EPA hazardous waste codes are applicable, leave the remaining spaces blank. If the waste is regulated onl y by your State, leave Item B blank and report the
State hazardous waste codes in Item C.

LIST For a list of EPA Hazardous Waste Codes, see the “ Other Reference Information and
Code Lists ” section of this booklet.

Item C – State Hazardous Waste Code(s)

Enter the State hazardous waste code(s) that applies to the waste reported in Section 1, Item A, if:

 Your State regulates hazardous wastes not regulat ed as RCRA hazardous waste and requires these wastes to be reported in the 2011 Hazardous Waste Report; or

 Your State uses a hazardous waste code system other than the EPA hazardous waste codes that applies to the waste described in Section 1, Item A.

Otherwise, leave Section 1, Item C blank. If you need space for additional St ate hazardous waste codes, list the codes in the Comments section and cross-reference Section 1, Item C.

### GM Form (continued)



### 38 Item D – Source Code and Management Method Code for Source Code G25

Enter the Source Code that best describes how th e hazardous waste reported in Section 1, Item A originated. If the hazardous waste was mixed with other non-hazardous materials, report the Source Code for only the hazardous waste portion.

If your site is a U.S. Importer, provide the appropr iate Source Code for hazardous waste imported from a foreign country. Also, mark “Yes” on the Site ID Form, Item 10.A.3 – United States Importer of Hazardous Waste. Review the Special Instructions for wastes received from foreign countries.

LIST For a list of Source and Management Method Codes, see the “ Other Reference
Information and Code Lists ” section of this booklet.

NOTE  If reporting Source Code G25 (Hazardous Waste Management), you also need to provide the Management Method Code. Source Code G25 indicates that this waste was generated from a hazardous waste management system described on a separate GM Form or WR Form. Enter the same Management Method Code that is listed on the matching GM Form – Section 2, or on the matching WR Form – Item H, linking this waste with the on-site process that created it. Do not report H141
in this Section 1- Item D.

 If reporting Source Code G61 (Hazardous waste received from off-site for storage/bulking and transfer off-site for treatment or disposal), the generation amount must be zero (0) in Section 1, Item F.

 Source Code G17 (Subpart K laboratory waste clean-out) is for facilities that have opted into the Subpart K Academic Laboratory Waste Rule to report the amount of laboratory waste shipped or managed during clean-out. The generation amount must be zero (0) in Section 1, Item F for this source code. See the Special
Instructions in the “ Other Reference Information and Code Lists ” for additional
information.

Item E – Form Code

Review the Form Codes and enter the code that b est corresponds to the physical form or chemical composition of the hazardous waste reported in Section 1, Item A.

LIST For a list of Form Codes, see the “ Other Reference Information and Code Lists ” section
of this booklet.

### GM Form (continued)



### 39 Item F – Quantity Generated in 2011 / UOM and Density

Enter the total quantity of the hazardous waste describe d in Section 1, Item A that was generated during 2011. Right justify the quantity entry.

Enter the Unit of Measure (UOM) code for the quantit y you reported in Section 1, Item F. Report the quantity in one of the units of measure listed below. If you select a volumetric measure (gallons, liters, or cubic yards), you must also report the density of the waste.

Code Unit of Measure Weight and Volume Conversions

1 kilogram (kg)= 2.2046 pounds (lb) 1 short ton= 2,000 lb 1 metric ton= 1,000 kg
1 metric ton= 1.1023 short tons

1 cubic meter (m)= 1.3079 cubic yards 1 cubic yard (yd) = 27 cubic feet (ft) 1 liter (l)= 0.2642 gallons (gal) 1 Pounds 2 Short tons (2,000 pounds) 3 Kilograms 4 Metric tons (1,000 kilograms)

5 Gallons

6 Liters 7 Cubic yards

Skip to Section 1, Item G if you selected code 1, 2, 3, or 4. Continue to Density if you selected code 5, 6, or 7.

Report the density only if you entered c ode 5, 6, or 7 for the unit of measu re. Provide the density in either pounds per gal (lbs/gal) or specific gravity (sg) and place an “X” in the appropriate box to indicate which
measure was used.

Item G – Waste Minimization Code

40 CFR 262.41(a)(6), 264.75(h), and 265.75(h) requires that data be collected for waste minimization activities. Enter the code that best corresponds to waste minimization, recycling, or pollution prevention efforts implemented to reduce the volume and toxicity of the hazardous waste reported in Section 1, Item A. This waste minimization activity must have occu rred during this reporting cycle. If minimization was not attempted (to the point of implementing a cha nge) for this waste, you must enter an “X” ( no waste minimization efforts were implemented for this waste ) for this item.

LIST For a list of Waste Minimization Codes and definition of waste minimization see the

“ Other Reference Information and Code Lists ” section of this booklet.

Section 2 – On-site Generation and Man agement of Hazardous Waste During 2011

Answering “Yes” or “No” to this question is mandatory . If you answer “Yes”, for each on-site RCRAregulated management system, you must report the management method and quantity treated, disposed, or recycled on-site during 2011.

Was any of this waste that was generated at this facility treated, disposed, and/or recycled on-site?

Mark “Yes” or “No” to this question to indicate if the site did any of the following to the waste reported in Section 1, Item A: treat on-site; dispose on-site; recycle on-site. If you marked “Yes,” complete the blocks for On-site Process Systems below. If you marked “No,” skip to Section 3.

### GM Form (continued)



### 40 Example: Facility A generates spent solvents that it recycles on-site in a distillation column. This facility would mark “Yes” in Section 2 and would fill out the on-site process system box accordingly.

Example: Facility B receives spent solvents from off-site and blends the solvents into fuel. The facility
then sends the fuels off-site to be burned for energy recovery. Facility B would report on its GM form the new waste generated in Secti on 1, Item D as Source Code G25 (“Hazardous waste management”) with the management met hod code of H061 (“Fuel blending”). Facility B
would mark “No” in Section 2 because it did notmanage any of the newly generated fuels onsite. This facility would report the off-site sh ipment in Section 3 and would report the Management Method Code H 050 (“Energy recovery”).

On-Site Management Method Code

Classify the process system (see definition) with a Mana gement Method Code that best identifies the last substantive purpose/operation performed at your site. Sp ace is provided to report up to two different (nonsequential) Management Methods. If you did not use a second on-site process system to manage the waste, leave the Management Method Code under On-site Process System 2 blank. Do not report H141
in this Section 2.

LIST For a list of Management Method Codes, see the “ Other Reference Information and
Code Lists ” section of this booklet.

The space provided for the second on-site process system should be used only in the special case of management of the same waste on-site by more th an one process system during 2011. Use the second onsite process system only when:

 A waste is managed in one process system for a part of a year and in another process system for the rest of the year; or

 A waste is managed by two different process syst ems at the same time (i.e., management of the waste is split between parallel process systems).

Example of Non-Sequential (Parallel) Processes: A firm generated 100 tons of F002 so lvent waste in 2011. Eighty (80) tons were recycled for reuse in a batch distillation process system, generating 5 tons of still bottoms. The remaining 20 tons were burned in an industrial boiler. Under On-site Process System 1, the site enters the Management Method Code for distillation (H020) an d a quantity of 80 tons. Under Onsite Process System 2, the site en ters the Management Method Code for energy recovery of liquids (H050) and a quantity of 20 tons. The 5 tons of still bottoms should be repor ted on a separate GM Form.

If more than two on-site process systems meet one of the above conditions, you need not complete the entire form again. Simply attach a second copy of th e GM Form with the EPA ID number and Site Name. Leave all the other fields blank except Section 2 for on-site process systems



### . Note in the Comments section of each page: “Section 2, On-site Process Syst em Type continued on supplemental page.” (Refer to instructions on page numbering of supplemental pages.)

The space provided for the second on-site process system should not be used to report the following:

### GM Form (continued)



### 41  The on-site management of the treatment resi dual generated from management of the waste by the first management method (on-site management of treatment residuals should be reported on a separate GM Form); or

 To report treatment in a series of process units (see definition in the “ Other Reference
Information and Code Lists ” section). Report only process systems, not process units.

Example of Sequential

Processes: A firm generated 100 tons of D002 and D007 plating waste in 2011. 100 tons were neutralized, stored on-site, and then chemically batch-treated to remove the D007 Chromium. Ninety (90) tons of wastewater and 10 tons of D007 and F006 sludge were shipped off-site for eventual disposal. Under On-site Process System 1, the site enters the last substantive on-site Management Method Code for Ch emical Treatment (H070) and a quantity treated of 100 tons. The site reports the residual 10 tons of sludge on a separate GM Form with Section 1 Item D Management Method Code of H070. (If there was no storage and th e wastewater had been allowed to go into the POTW or NPDES, this pa ge would not be reported, only the D007 and F006 sludge - with a source code of G23.)

Quantity Treated, Disposed, or Recycled On-site in 2011

Enter the quantity of hazardous waste described in Secti on 1 that was treated, disposed, or recycled by the reported on-site process mana gement method during 2011. Enter the quantity in the same unit of measure reported in Section 1, Item F (Quantity generated in 2011).

Section 3 – Off-site Shipment of Hazardous Waste

This section requests information on the off-site shipme nt of hazardous waste. Answering “Yes” or “No” to this question is mandatory . If you answer “Yes”, all items in this section are mandatory

. Do report shipments of previously generated hazardous wastes stored until 2011. Do report waste shipped via transfer facility. Do not report shipments of de-characterized wastes.

Space is provided to report shipments of the waste to three different off-site facilities. If the waste you reported in Section 1 was shipped to more than three off-site facilities during 2011, you need not complete the entire form again. Simply attach a seco nd copy of the GM Form, leaving blank all entries except Section 3, Items B, C, and D. Note in the Comments section of each page: “Section 3, Item B continued on supplemental page.” (Refer to instructions on page numbering of supplemental pages.)

Item A – Was any of this Waste Shipped Off-site in 2011 for Treatment, Disposal, or Recycling?

Mark “Yes” or “No” to indicate if any of the waste described in Section 1 was shipped off-site for treatment, disposal, or recycling during 2011.

This GM Form is complete if you marked “No” in Item A. Continue to Section 3, Item B if you marked “Yes” in Item A.

Item B – EPA ID Number of Facility to which Waste was Shipped

Enter the 12-digit EPA Identification Number of the facility to which the waste was shipped. Do not create a GM Form for hazardous waste shipped directly to a foreign country from this site (unless

### GM Form (continued)



### 42 required by your state). You must complete an A nnual Report as required under 40 CFR 262.56, no later than March 1 of each year.

Item C – Off-site Management Method Code Shipped To

Review the Management Method Codes in the “ Other Reference Information and Code Lists ” section of this booklet. Enter the Management Method Code th at best describes the wa y in which the waste was managed at the initial receiving facilit y reported in Section 3, Item B.

LIST For a list of Management Method Codes, see the “ Other Reference Information and
Code Lists ” section of this booklet.

Item D – Total Quantity Shipped in 2011

Enter the total quantity of the waste shi pped to the off-site facility during 2011. Report the quantity in the same unit of measure entered in Section 1, Item F. Shipment quantities should equal the total quantity
recorded on Uniform Hazardous Waste Manifests for this site during 2011, unless th ere were rejections or other complications. The quantity shipped may not necessarily equal the quantity generated (e.g., because some waste is still on-site at the end of the year or waste was removed from storage from a previous year’s generation).

Comments

Use this section as needed to explain anything cont ained in the form including any waste minimization

efforts. 

### The comments may help make determinations of data validity if questions arise during the review of the report. If there are special circumstances surrounding the waste described on the form, please note this here, especially if you are f iling the report due to a one-time event.

### 43 

## INSTRUCTIONS FOR FILLING OUT THE WR FORM – WASTE
RECEIVED FROM OFF-SITE

Who Must Submit this Form

A site required to file the 2011 Hazardous Waste Report must submit this form if, during 2011, it received
RCRA hazardous waste from off-site.



### Purpose of this Form

The WR Form identifies hazardous wastes that were re ceived from other hazardous waste sites and the method(s) used to manage them. The WR Form is divi ded into three identical parts (i.e., waste blocks), labeled Waste 1, Waste 2, and Waste 3, that collect information on the quantities and characteristics of
each hazardous waste received from an off-site source during 2011 and managed on-site.



### How to Fill out this Form

You may report waste received from more than one off-site handler on the same page of the form. A separate waste block must be filled out for each hazardous waste received from each off-site handler.
Hazardous waste from the same off-site handler ma y be aggregated as long as a single form code describes the physical form or chemical composition, a nd all of the waste is managed in a single process system (i.e., same management method code).

If your site received more than three RCRA ha zardous wastes from off-site handlers during 2011, photocopy and fill out additional copies of this form. Prior to photocopying, place the pre-printed site identification label in the top left-hand corner of th e form or, if you did not receive pre-printed labels, enter the site name and EPA Identification Number in the space provided.

Use the Comments section at the end of the form to clarify any entry (e.g., “Other” responses) or to continue any entry. When entering information in th e Comments section, cross-reference the waste block
and item letter to which the comment refers.

### WR Form (continued)



### 44 Item-By-Item Instructions

All items in this section are mandatory for each wa ste reported. Note: Either Item B and/or Item C must be provided for each reported waste.

Item A – Waste Description

Provide a short narrative description of the waste, such as:

 General type;

 Source;

 Type of hazard; and

 Generic chemical name or primary hazardous constituents.

Example: “Ignitable spent solvent from degreasing operation in tool production; mixture of mineral spirits and kerosene.”

In the example, note that the general type (spe nt solvent), source (degreasing operation in tool production), type of hazard (ignitability), and generic ch emical names (mineral spirits and kerosene) have
all been cited.

Item B – EPA Hazardous Waste Code(s)

Enter the four-character EPA hazar dous waste code(s) that applies to the waste reported in Item A. EPA hazardous waste codes are provided in the “ Other Reference Information and Code Lists ” section of this booklet. If you need room for additional codes, list the codes in the Comments section and crossreference the applicable waste block number (.e.g., Waste 1) and Item B. If fewer than four EPA hazardous waste codes are applicable, leave the remain ing spaces blank. If the waste is regulated only by your State, leave Item B blank and report the State hazardous waste codes in Item C.

LIST For a list of EPA Hazardous Waste Codes, see the “ Other Reference Information and
Code Lists ” section of this booklet.

Item C – State Hazardous Waste Code(s)

Enter the State hazardous waste code(s) that a pplies to the waste reported in Item A, if:

 Your State regulates hazardous wastes not regulat ed as RCRA hazardous waste and requires these wastes to be reported in the 2011 Hazardous Waste Report; or

 Your State uses a hazardous waste code system other than the EPA hazardous waste codes that applies to the waste described in Item A.

Otherwise, leave Item C blank. If you need space fo r additional State hazardous waste codes, list the
codes in the Comments section and cross-reference th e applicable waste block number (e.g., Waste 1) and
Item C.

### WR Form (continued)



### 45 Item D – Off-site Handler EPA Identification Number

Enter the 12-digit EPA Identification Number of the off-site handler from which the waste was received. If the site does not have an EPA Identification Number, it may be a CESQG or foreign country. Refer to the Special Instructions in this booklet for instru ctions on how to complete Item D for these off-site
handlers.

If the waste reported under Waste 2 is received from the same off-site handler as the waste reported under Waste 1, put “Same as above” to indicate that the EPA Identification Number is the same as the one reported in Waste 1; if Waste 3 is received from the same off-site handler as Waste 2, put “Same as
above” to indicate that the EPA Identification Number is the same as the one reported under Waste 2.

NOTE Refer to the Special Instructions for reporting wastes received from CESQGs and for reporting wastes received from foreign countries.

Item E – Quantity Received in 2011

Report the total quantity of the hazardous waste report ed in Item A that was received from the off-site handler reported in Item D during 2011. If more than one shipment of this waste was received from the same off-site handler, add the quantities and report only the sum.

Item F – UOM and Density

Enter the Unit of Measure (UOM) code for the quantit y you reported in Section 1, Item F. Report the quantity in one of the units of measure listed below. If you select a volumetric measure (gallons, liters, or cubic yards), you must also report the density of the waste.

Code Unit of Measure Weight and Volume Conversions

1 kilogram (kg)= 2.2046 pounds (lb) 1 short ton= 2,000 lb 1 metric ton= 1,000 kg
1 metric ton= 1.1023 short tons

1 cubic meter (m)= 1.3079 cubic yards 1 cubic yard (yd) = 27 cubic feet (ft) 1 liter (l)= 0.2642 gallons (gal) 1 Pounds 2 Short tons (2,000 pounds) 3 Kilograms 4 Metric tons (1,000 kilograms)

5 Gallons

6 Liters 7 Cubic yards

Skip to Item G if you selected code 1, 2, 3, or 4. Continue to Density if you selected code 5, 6, or 7.

Report the density only if you entered c ode 5, 6, or 7 for the unit of measu re. Provide the density in either pounds per gal (lbs/gal) or specific gravity (sg) and place an “X’ in the appropriate box to indicate which
measure was used.

### WR Form (continued)



### 46 Item G – Form Code

Review the Form Codes and enter the code that b est corresponds to the physical form or chemical composition of the hazardous waste reported in Section 1, Item A.

LIST For a list of Form Codes, see the “ Other Reference Information and Code Lists ” section
of this booklet.

Item H – Management Method Code

Enter the code that describes the type of process system (see definition) in which the waste was managed.

LIST For a list of Management Method Codes, see the “ Other Reference Information and
Code Lists ” section of this booklet.

Comments

Use this section as needed to explain anything contained in the form. 

### The comments may help make determinations of data validity if questi ons arise during the re view of the report. If there are special circumstances surrounding the waste de scribed on the form, please note this here.

# 2011 Hazardous Waste Report

OTHER REFERENCE INFORM ATION AND CODE LISTS

### 48 EXCLUDED WASTES

This section presents a partial list of excluded materi als 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 addition, it al so 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 RCRA Subtitle C regulations.

Agricultural Waste Fertilizer §261.4(b)(2)

Analytical Samples §261.4(d)

Arsenic Treated Wood and Wood

Products §261.4(b)(9)

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 §261.4(g)

Drilling Fluid §261.4(b)(5)

Excluded Scrap Metal Being Recycled §261.4(a)(13)

Exported Wastes §262.56

Fossil Fuel Emission Control Waste §261.4(b)(4)

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
Transferred Off-site for Reclamation 40 CFR 261.4(a)(24) 40 CFR 261.4(a)(25) Household Waste §261.4(b)(1)(i)-(ii)

HTMR Condenser Residue §261.4(a)(11)

In situ Mining Materials §261.4(a)(5)

Irrigation Return Flows §261.4(a)(3)

Kraft Mill Steam Stripper
Condensates §261.4(a)(15)

Leachate §261.4(b)(15)

Mining and Mineral Process Wastes §261.4(b)(7)

Mining Overburden §261.4(b)(3)

Nuclear Material §261.4(a)(4)

Oil Filters §261.4(b)(13)

Petrochemical Recovered Oil §261.4(a)(18)

Petroleum-contaminated Media and
Debris §261.4(b)(10)

Petroleum Refining §261.4(a)(12)

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)

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 Oil Distillation Bottoms §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)

### 49 DEFINITIONS

This section contains definitions of terms helpful fo r completing the form. For terms defined in the Code of Federal Regulations (CFR), the appropriate citation is provided.

Accumulation A site that does not hold RCRA Interim Status or a RCRA permit may accumulate hazardous waste for a short period of time before shipping i t 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 kg (220 lbs) to 1,000 kg (2,200 lbs) of hazardous waste

p er month may accumulate their waste for up to 180 days before shipping i t 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.

Act 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.

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

Authorized Representative The person responsible for the overall oper ation of the site or an operational unit (i.e., part of a site), e.g., superintendent or plant manager, or person o f equivalent responsibility.

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

Boiler An enclosed device using controlled flame combustion and having the following characteristics: 1. The unit has physical provisions for recovering and exporting energy in the form of steam, heated fluids, or heated gases; 2. The unit's combustion chamber and primary energy recovery section(s) are of integral design (i.e., they are physically formed into one manufactured or assembled unit); 3. The unit continuously maintains an energy recovery efficiency of at least 60 percent, calculated in terms of the recovered energy compared with the thermal value of the fuel;

4. The unit exports and utilizes at le ast 75 percent of the recovered energy, calculated on an annual b asis (excluding recovered hea t used internally in the same unit, for example, to preheat fuel o r combustion air or drive fans or feedwater pumps); or
5. The unit is one which the Regiona l Administrator has determined, on a case-by-case basis, to be a boiler, after considering the
standards in 40 CFR 260.32

### Definitions (continued)



### 50 By-product Material A by-product material is (1) any radi oactive material (except special nuclea r material) yielded in or made radioa ctive by exposure to the radiation incident to the process of producing or utilizing special nuclear material; and (2) the tailings or wastes produced by the extraction or concentration o f uranium or thorium from any ore processed primarily for its source material content (defined in the Atomic Energy Act of 1954).

Code of Federal Regulations (CFR) Codification of the general and perm anent rules published in the Federal Register by the Executive departments and agencies of the Federal
Government. The Code is divided in to 50 titles which represent broad areas subject to Federal regulation. Each title is divided into chapters that usually
bear the name of the issu ing agency. Each chapter is further subdivided into

p arts covering specific regulatory areas. The CFR title applicable for the Hazardous Waste Report is “40,” as in “40 CFR 262.34.”

Conditionally Exempt Small Quantity Generator (CESQG) of

Hazardous Waste A generator that meets the following criteria:

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

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

2. Did not accumulate, at any time, more than 1,000 kg (2,200 lbs.) o f RCRA hazardous waste; and

3. Did not generate, in any calendar month, or accumulate at any time, more than 1 kg (2.2 lbs.) of acute hazardous waste, and no more than 100 kg (220 lbs.) of material from the cleanup of a spill o f
acute hazardous waste.

Confidential Business Information (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. Check with your state to confirm your state’s policy on CBI.

Delisted Waste Site-specific wastes excluded from regulation under 40 CFR 260.20 an d 260.22. A waste at a particular generating site may be excluded by

p etitioning the EPA Administrator for a regulatory amendmen t . These wastes are listed in Appendix IX of 40 CFR Part 261.

Disposal The discharge, deposit, injection, dumping, spilling, leaking, or placing o f any solid waste or hazardous waste into or on any land or water so that such solid waste or hazardous waste or any constituent thereof may enter the
environment or be emitted into the air or discharged into any waters, including ground waters.

Eligible Academic Entity A college or university, or a non-profit research institute that is owned by o r 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 o r university pursuant to 40 CFR Part 262 Subpart K (See 40 CFR 262.200).

### Definitions (continued)



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

EPA Identification (ID)

Number The number assigned by the EPA to each hazardous waste generator, hazardous waste transporter, and treatment, storage, or disposal facility; United States importer of hazardous waste; mixed waste (hazardous and radioactive) generator; recycler of hazardous waste; exempt boiler and/o r industrial furnace burning or processing hazardous waste; large quantity handler of or destination facility for universal wastes; disposer of hazardous waste with an underground injection pe rmit; used oil transporter, used oil

p rocessor/re-refiner, off-specification 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 ID Form that they are managing hazardous secondary material will also be assigned an EPA ID number.

Excluded Wastes Wastes excluded from the definition of solid or hazardous waste under 40 CFR 261.3 and 261.4. For a partial listing, see the “ Other Reference
Information and Code Lists ” section of this booklet.

GM Form Waste Generation and Management form.

Hazardous Waste A hazardous waste as defined in 40 CFR 261.3.

Hazardous Secondary Material (HSM) A secondary material (e.g., spent materi al, by-product, or sludge) that, when discarded, would be identified as hazardous waste under 40 CFR Part 261. Facilities managing hazardous secondary material under 40 CF R 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) must complete the
Addendum to the Site Identificatio n Form: Notification for Managing Hazardous Secondary Material. You must check with your State to determine if you are eligible to ma nage hazardous secondary material unde r these exclusions (see also http://www.epa.gov/epawaste/hazard/dsw/statespf.htm ).

Hazardous Waste
Generator Any person, by site, whose act or process produces hazardous waste
identified or listed in 40 CFR Part 261.

Hazardous Waste Number or Code, 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 CF R 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 waste codes see the “ Other
Reference Information and Code Lists ” section of this booklet.

Hazardous Waste Number or Code, State The number (or code) assigned by the State to each hazardous waste listed in the State regulations. Obtain a list of the States waste codes from you r State.

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

### Definitions (continued)



### 52 Hazardous Waste Transfer Facility Refer to “Transfer Facility" definition.

Hazardous Waste Transporter Refer to “Transporter" definition.

Hazardous Waste
Treatment Any method, technique, or process, in cluding neutralization, designed to change the physical, chemical, or biological character or composition of any
hazardous waste so as to neutralize su ch hazardous waste, or so as to recover energy or material resources fr om 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 fo r 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.

Incineration Burning of certain types of solid, liquid, or gaseous materials; or a treatmen t 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- b urnable ash that can be disposed safely on land, in some waters, or in underground locations).

Industrial Furnace Any of the following enclosed devices that are integral components o f manufacturing processes and that use thermal treatment to accomplish recovery of materials or energy: cem ent kilns; lime kilns; aggregate kilns;

p hosphate kilns; coke ovens; blast fu rnaces; smelting, melting and refining furnaces; titanium dioxide chloride process oxidation reactors; methane reforming furnaces; pulping liquor recovery furnaces; combustion devices used in the recovery of sulfur valu es 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.

Interim (Permit)
Status Period during which the owner/opera tor of an existing TSD facility is treated as having been issued a RCRA permit even though he/she has no t yet received a final determination. An existing facility should have automatically qualified for interim stat us 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 facilities cannot by definition qualify for interim status; rather, they need a RCRA permit prio r to beginning construction of a hazardous waste management facility.

Large Quantity Generator (LQG) of

Hazardous Waste A generator that meets any of the following criteria: 1. Generates, in a calendar month, 1,000 kg (2,200 lbs.) or more o f non-acute RCRA hazardous waste; or

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

### Definitions (continued)



### 53 Large Quantity Handler
of Universal Waste (LQHUW) A universal waste handler (as defined in 40 CFR 273.9) who accumulates 5,000 kg or more total of universal wastes (batteries, pesticides, mercurycontaining 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.

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

Manifest, Uniform

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

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

Municipality A city, village, town, borough, county, parish, district, association, Indian
tribe or authorized Indian tribal organization, designated and approve d management agency under Section 208 of the Clean Water Act, or any othe r

p ublic body created by or under S t ate law and having jurisdiction ove r disposal of sewage, industrial wastes, or other wastes.

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

OI Form Off-Site Identification form.

Off-Specification Used
Oil Burner A site where used oil not meeting the specification requirements in 40 CF R 279.11 (off-specification used oil) is bu rned for energy recovery in devices identified in Section 279.61(a).

Off-Specification Used
Oil Fuel Used oil fuel that does not meet the specification provided under 40 CF R
279.11.

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

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

Operator The person responsible for the overall operation of a RCRA site.

N ote: This is the legal entity whic h controls the RCRA site operation rathe r than the plant or site manager. This is usually a company or business name,
not an individual. See Person

.

### Definitions (continued)



### 54 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.

Process System For purposes of the Hazardous Waste Report, a process system refers to one or more units used together to treat, recover, or dispose of a hazardous waste. The process system begins at the unit where the hazardous waste first
enters and consists of all other tr eatment, recovery, or disposal units downstream from the point of entry. Note that storage is not considered a

p rocess system, 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 . Fo r example, a process system to remove dissolved metals from wastewate r

p rior to shipping the sludge off-site typically includes equalization, pH adjustment, chemical precipitation, flocculation, clarification/settling, an d 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 H077 (chemical precipitation). If the slu dge will be disposed 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

p rocess. However, this process is exem pt if the treated water flows to a POTW or a NPDES outfall with no RCRA-regulated storage or treatmen t units in the system, and should not be reported. A listing of Management Method codes may be found in the “ Other Reference Information and
Code Lists ” section of this booklet.

Process Unit For purposes of the Hazardous Waste Report, a process unit refers to a single type of treatment (e.g., tank, distillation column, surface impoundment) in which hazardous waste is treated, disposed, or recycled.

Resource Conservation and Recovery Act (RCRA) The Solid Waste Disposal Act as amended by the Resource Conservation and Recovery Act (RCRA) (40 CFR 270. 2). It is the Federal statute tha t regulates the generation, treatment, st orage, disposal, recycling, and/o r transportation of solid and hazardous waste.

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

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

### Definitions (continued)



### 55 RCRA Subtitle C Site (RCRA Site or Site) The physical plant or location at which one or more of the following regulated waste activities occurs: the generation, transportation, treatment, storage, or disposal of hazardous wastes; recycling of hazardous wastes; United States importer of hazardous waste; mixed waste (hazardous and radioactive) generator; exempt boiler and/or industrial furnace burning o r

p rocessing hazardous waste; large quantity handler of or destination facility for universal wastes; disposing h azardous waste with an undergroun d injection permit; the transportation (and temporary storage during transportation), processing/re-refining, bur ning, or marketing of used oil; eligible academic entity managing laboratory hazardous waste unde r 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 treatme nt, storage, or disposal operational units. For entities that only transport regu lated wastes, the term site refers to the headquarters of that entity’s operations.

Recycling Use, reuse, or reclamation of a material (40 CFR 261.1(c)(7)). “Reclamation” is the processing or regeneration of a material to recover a usable product (e.g., recovery of lead values from spent batteries, regeneration of spent solvents) (40 CFR 261.1(c)(4)). A material is “used o r reused” if it is either: (1) employed as an ingredient (including use as an intermediate) in an industrial pro cess to make a product (e.g., distillation
b ottoms from one process used as feedstock in another process) (40 CF R 261.1(c)(5)). However, a material will not satisfy this condition if distinc t components of the material are recovered as separate end products (as when
metals are recovered from metal-cont aining secondary material); or (2) employed in a particular function or application as an effective substitute fo r a commercial product (e.g., spent pickle liquor used as phosphorous

p recipitant and sludge conditioner in wastewater treatment).

Residual A hazardous waste derived from the tr eatment, disposal, or recycling of a

p reviously existing hazardous waste (e.g., the sludge remaining after initial wastewater treatment).

Short-term Generator A generator whose generator status is the result of a one-time, nonrecurring, temporary event that is not related to normal production

p rocesses. In other words, short-term generators produce hazardous waste from a particular activity for a limited time and then cease conducting tha t activity. Short-term generators would not be considered episodic generators because episodic generators have the potential to generate on a regula r basis. Examples of short-term generato rs include: one-time highway bridge waste generation, underground storag e tank removals, generation of offspec or out-of-date chemicals at a site that normally doesn’t generate hazardous waste, remediate or spill cl ean-up sites with no previous RCRA ID, and site or production process decommissions by a new operator.

Sludge Any solid, semi-solid, or liquid waste generated from a municipal, commercial, or industrial wastewater treatment plant, water supply treatment plant, or air pollution control facility exclusive of the treated effluent from a wastewater treatment plant (40 CFR 260.10).

### Definitions (continued)



### 56 Small Quantity Generator (SQG) of

Hazardous Waste A generator that meets all the following criteria:
1. 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

2. Does not generate, in any calendar month, or accumulates at any time, more than 1 kg (2.2 lbs.) of acute hazardous waste and

3. Does not generate more than 100 kg (220 lbs.) of material from the cleanup of a spill of acute hazardous waste.

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

1. Meets 1) and 3) of the Conditionally Exempt Small Quantity Generator criteria (see definition), but

2. Is storing more than 1,000 kg (2,200 lbs.) of RCRA hazardous
waste on-site. If the site accumulat es, at any time, more than 1,000 kg (2,200 lbs.) of RCRA hazardous waste, the site must apply fo r an EPA ID Number using this form.

Small Quantity On-Site Burner Exemption The persons who burn small quantities of hazardous waste in an on-site
b oiler or industrial furnace, in accordance with 40 CFR 266.108, are conditionally exempt from regulation for that activity.

Smelting, Melting, and Refining Furnace Exemption Under 40 CFR 266.100(c), owners or operators of smelting, melting, an d refining furnaces that process hazardous wastes solely for metals recovery are conditionally exempt from regulation, except for 40 CFR 266.101 an d 266.112, provided they comply with limited requirements set forth in Section 266.100(c). Similarly, 40 CF R 266.100(f) provides that owners o r 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 requirements specified in Section 266.100(f).

Solid Waste 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

p oint source discharges subject to regulation under the Clean Water Act; irrigation return flows; nuclear materials defined by the Atomic Energy Act; and in situ mining materials (see the “ Other Reference Information and
Code Lists ” section of this booklet.). Wastewaters being collected, stored, or treated before discharge and sludges generated by wastewater treatmen t
are not excluded. The EPA defines ha zardous waste as a subset of solid

waste.

Source Material As defined by the Atomic Energy Act of 1954: (1) Uranium, thorium, o r any other material determined by the Nuclear Regulatory Commission

p ursuant 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.

### Definitions (continued)



### 57 Special Nuclear Material 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 Commissi on, pursuant to the provisions o f Section 2071 of this title, determines to be special nuclear material, but does not include source material; or (2) any material artificially enriched by any of the foregoing, but does not include source material.

Subpart K An alternative set of generator requirements for managing laboratory hazardous waste at eligible academic en tities. Generators that are eligible academic entities with laboratories may elect to opt into 40 CFR Part 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 fo r eligible academic entities (see definition) to opt into Subpart K o r subsequently withdraw from Subpart K, they must use the Site ID Form to notify the appropriate State or EPA Regional Office. Refer to 40 CF R 262.203 and 262.204. Note: You must check with your State to determine i f you are eligible to manage laboratory hazardous waste pursuant to 40 CF R Part 262 Subpart K and for any state-specific requirements.

Superfund The program operated under the legisl ative authority of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the Superfund Amendments and Reauthorization Act (SARA) that funds and carries out the solid waste emergency response and long-term remedial
activities of the EPA.

Surface Impoundment A natural topographic depression, man- made excavation, or diked area formed primarily from earthen materi als (though it may be lined with manmade materials) that is designed to accumulate liquid wastes or wastes containing free liquids, and that is not an injection well (40 CFR 260.10).

Tolling Tolling arrangements describe a particular type of recycling contrac t between two companies. Specifically, the “tolling” company certifies that i t has a contract with a manufacturer to produce a product, and tha t manufacturing process generates a residual material that can be recycled by the tolling company. If the tolling company certifies that the contract specifies that 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 s ubsequently recycled, the material is excluded from regulation (under 40 CFR 261.2(a)(2)(ii) or 261.4(a)(23)),

p rovided certain requirements are met.

Transfer Facility 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 260.10 and 40 CFR 263.12).

Transporter A person engaged in the off-site tran sportation of hazardous waste by air, rail, highway, or water.

Underground Injection
Control The subsurface emplacement of fluids through a bored, drilled or driven well; or through a dug well, where the depth of the dug well is greater than the largest surface dimension. Unde rground injection wells are regulated

### Definitions (continued)



### 58 under both the Safe Drinking Water Act and the Resource Conservation an d Recovery Act (see 40 CFR Part 148). Hazardous wastes must be injected into a Class I well or, if authorized under a federal or state ground wate r remediation project, may be injected into a Class IV well. See http://water.epa.gov/type/g roundwater/uic/wells.cfm for more information.

Unit Refer to “Process Unit" definition.

United States Importer Any person who imports hazardous wast e from a foreign country into the United States. This does not include hazardous waste shipped from a foreign Department of Defense site, Maquiladora, United States territory o r

p rotectorate.

Universal Waste Any of the following hazardous wastes that are managed under the universalwaste requirements of 40 CFR Part 273: batteries, pesticides, mercurycontaining equipment, and lamps. Some States may have State-specific
universal wastes defined as well.

Used Oil Any oil that has been refined from crud e oil, or any synthetic oil, that has
b een used, and as a result of such use, is contaminated by physical o r chemical impurities and is managed under 40 CFR Part 279. Used oil is not reported on the biennial report.

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

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

2. First claims that used oil that is to be b urned for energy recovery meets the used oil fuel specifi cations set forth in 40 CFR 279.11.

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

Used Oil Processing Chemical or physical operations designed to produce from used oil, or to make used oil more amenable for production of, fuel oils, lubricants, o r other used oil-derived pr oducts. Processing includes, but is not limited to:
b lending used oil with virgin petroleu m products, blending used oils to meet the fuel specification, filtration, simple distillation, chemical or physical separation, and re-refining.

Used Oil Processor A site that processes on- specification or off-specification used oil.

Used Oil Re-Refiner A site that produces lubricating oils and greases, industrial fuel, asphal textender, gasoline, and other products from on- specification or offspecification used oil.

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

### Definitions (continued)



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

Waste Minimization The reduction, to the extent feasible, of hazardous waste that is generated o r subsequently treated, stored, or disposed. It includes any source reduction o r recycling activity undertaken by a ge nerator that results in: (1) the reduction of total volume or quantity of hazardous waste; (2) the reduction of toxicity of hazardous waste; or (3) both, as long as the reduction is consistent with the goal of minimizi ng present and future threats to human
health and the environment.

Waste Oil (Biennial Report Only)

WR Form Any oil that has been refined from crud e oil, or any synthetic oil, that has been used, and as a result of such u se, is contaminated by physical o r chemical impurities and is managed as a hazardous waste.

Waste Received from Off-Site form.

### 60 SPECIAL INSTRUCTIONS

These instructions explain how to complete the 2011 Hazardous Waste Report for wastes and sites with unique regulatory or reporting requirements.

Asbestos, PCBs, Waste Oils In most cases, do not report asbestos, PCBs, and waste oils. However, you must report them if any of the following
conditions exist:

(1) If your State specifically requires that these wastes be reported;

(2) If a listed RCRA hazardous waste (i.e., EPA hazardous waste code that begins with “F”, “K”, “P”, or “U”) is mixed with asbestos, PCBs, or waste oil, in which case the entire mixture is a hazardous waste; or

(3) If the waste possesses one or more of the characteristics that result in assigning EPA hazardous waste code beginning with “D”. (This does not apply to used oil that is recycled as explained below.)

Do not report “used oil that is recycled and is also a hazardous waste solely because it exhib its a hazardous characteristic (criterion 3 above). Used oil that is recycled includes any used oil which is reused, following its original use, for any purpose (including the purpose for which the oil was originally used). Such term includes, but is not limited to, oil which is re-refined, reclaimed, burned for energy recovery, or reprocessed.” (40 CFR 261.6(a)(4))

Groundwater Contaminated by

Hazardous Waste Groundwater contaminated by RCRA hazardous waste is not considered a solid waste and is, therefore, not classified as a hazardous waste. However, because hazardous waste is “contained in” the groundwater, it must be treated “as if” it were a RCRA hazardous waste if it is removed for treatment, storage or disposal. 1 When reporting groundwater contaminated by hazardous waste in the 2011 Hazardous waste Report, observe the following conventions:

(1) Enter “0” in the GM Form, Section 1, Item F (quantity). Explain in the Comments section that it is groundwater, not a hazardous waste that was generated on-site.

(2) Report quantities managed on-site (GM Form, Section 2,

1 To determine if the contaminated media must be reported at all (generated OR treated): If the contamination is due to a characteristic waste, then it is the ge nerator’s responsibility to determine if the contaminated groundwater is a hazardous was te. Once the characteristics are eliminated, the media is no longer considered to “contain” hazardous wast e. If a facility has firs t removed groundwater and is claiming that the groundwater is cont aminated with a listed hazar dous waste or “contains” listed hazardous waste, EPA Regions or Authorized States should make a site-specific determination of whether the media is a RCRA Waste. Please see: “Management of Re mediation Waste Under RCRA,” EPA530- F-98-026, October 14, 1998. RCRA Online
Document No. 14291. Available online at: http://yosemite.epa.gov/osw/rcra.nsf /0c994248c239947e85256d090071175f/d9e61a0505db4b6885256817006e32b8!OpenDocu

ment.

### Special Instructions (continued)



### 61 On-site Process Systems 1 and 2); quantities shipped off-site for management (GM Form, Section 3); and quantities received from off-site and managed on-site (WR Form, Item E).

Lab Packs The following rules apply to the reporting of lab pack wastes in the 2011 Hazardous Waste Report:

(1) You may aggregate lab pack wastes if they have the same Form Code. However, you must report them as separate wastes under the following conditions:

If they contain RCRA acute hazardous wastes (i.e., EPA hazardous waste codes F020, F021, F022, F023, F026, F027, and all “P” waste codes). Report separately from lab packs containing other RCRA hazardous wastes (all other EPA hazardous waste codes).

 If they are managed differently from each other. For example, report lab packs shipped to landfills separately from those incinerated.

(2) Enter a Form Code indicating lab packs (i.e., W001 or W004) on the GM Form, in Section 1, Item E or on the WR Form in Item G. These Form Codes are to be used with any lab pack, whether the wastes are gaseous, liquid, solid, or sludge.

(3) It is not necessary to report every EPA hazardous waste code included in a batch of lab packs. Record one, or a few predominant, EPA hazardous wast e codes in Section 1, Item B of the GM Form, or Item B of the WR Form. If there are many EPA hazardous waste codes associated with the batch of lab packs, enter “LABP” in the first four-character field in Section 1, Item B of the GM Form, or Item B of the WR Form; then enter “NA” in the remaining spaces for the EPA
hazardous waste codes.

(4) When reporting quantities for lab packs:

 Include the weight of the containers if they are disposed (e.g., landfilled) or treated (e.g., incinerated) with the waste.

 Exclude the weight of the containers if the waste is
removed from the containers before treatment or disposal.

RCRA-Radioactive Mixed Wastes By themselves, source material, special nuclear material, or byproduct materials (see definitions section), as defined by the Atomic Energy Act of 1954 and amended by 42 U.S.C. 2011 et. Seq., are not classified as hazardous wastes under RCRA. However, if these materials are mixed with a RCRA hazardous waste, the material is controlled under RCRA regulation, as well

### Special Instructions (continued)



### 62 as under the Atomic Energy Act (DOE, NRC, and EPA) regulations, and is to be re ported in the 2011 Hazardous Waste Report.

Subpart K Laboratory Waste
Clean-out A Subpart K laboratory clean-out conducted in accordance with 40 CFR 262.213(a), is defined as: once per 12 months per laboratory, a laboratory will have 30 days to conduct a clean-out
and will not have to count the h azardous waste that consists of unused commercial chemical products (either listed or characteristic) generated during those 30 days towards the eligible academic entity’s genera tor status for the purposes of onsite accumulation. See 40 CFR 262.213(a)(1-4) for other Subpart K laboratory clean-out requirements.

The waste generated from this clean-out should be reported on the GM Form with a source code of “G17 – Subpart K Laboratory Waste Clean-out” with a generation amount of zero (0) (Section 1, Item F). The amount shipped off-site or managed on-site will be reported in Secti ons 2 or 3 of the GM Form as appropriate.

Laboratory waste that is gene rated during routine operations (e.g., spent solvents or spent acids/bases) should be reported separately from Subpart K laboratory clean-out wastes. Routinely generated laboratory waste should be reported with source code(s) other than G17.

Wastes Received from Conditionally Exempt Small Quantity Generators (CESQGs) Waste management facilities sometimes receive hazardous waste from large numbers of Conditionally Exempt Small Quantity Generators (CESQGs) or other s ites that do not have RCRA EPA Identification Numbers. To minimize the response burden for filling out the WR Form for these wastes, you may aggregate the wastes across generating sites, in accordance with these guidelines:

(1) All the wastes must have the same EPA hazardous waste code (Item B), State hazardous waste code (Item C), Form code (Item G), and Manageme nt Method code (Item H).

(2) Wastes received from different States must be reported separately. For the off-site handler EPA Identification Number (Item D), the entry should include the two-letter postal code of the originating State, followed by the letters “CESQG”.

For example, wastes received fro m several CESQGs in the State of Alaska (AK) that share a common EPA hazardous waste code, State hazardous waste code, Form code, and Management Method code could be aggregated in a single waste block of the WR Form (e.g., Waste 1). In Item D, the off-site handler EPA ID number is entered as “AKCESQG”. Note: This method of completing Item D can also be u sed for CESQG waste that is not aggregated.

### Special Instructions (continued)



### 63 Wastes Received from Foreign
Countries Reporting on the GM Form – If your site was the generator of record and was the U.S. Importer for hazardous waste received from a foreign country (other than a foreign Department of Defense site, Maquiladora, U.S. territory or protectorate), complete a GM Form. Enter the appropriate code in Section 1, Item D – Source Code from the list of codes G63 through G75 – Hazardous waste received from [name of foreign country]. Include the Import Notification and other foreign generator information in the Comments. Also, mark “Yes” on the Site ID

Form, Item 10.A.3 – United States Importer of Hazardous Waste. Report on the OI Form the name and address of all foreign generators if this form is required by your State.

Report on the WR Form – If your site received hazardous waste directly from a generator in a foreign country (other than a foreign Department of Defense s ite, Maquiladora, U.S. territory or protectorate), complete a WR Form for the waste treated, recovered, or disposed at your site. This waste was not shipped to your site by a U.S. Importer. Report the code “ FC ” followed by the name of the foreign country in Item D – Off-site Handler EPA ID number. Include the Import Notification and other foreign generator information in the Comments. Report on the OI Form the name and address of all foreign generators if this form is required by your State.

### 64 

## EPA HAZARDOUS WASTE CODES

A list of all the hazardous waste codes is s hown 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 261.31)

– FXXX

HAZARDOUS WASTE FROM SPECIFIC SOURCES (SEE 40 CFR 261.32)
- KXXX DISCARDED COMMERCIAL CHEMICAL PRODUCTS,
OFF-SPECIFICATION SP ECIES, CONTAINER RESIDUALS, AND SPILL RESIDUES THEREOF –
ACUTE HAZARDOUS WASTE (SEE 40 CFR 261.33)

– PXXX

DISCARDED COMMERCIAL CHEMICAL PRODUCTS,
OFF-SPECIFICATION SP ECIES, 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
K149
K150
K151
K156
K157
K158
K159
K161
K169
K170

K171
K172

K174
K175
K176
K177
K178
K181

LABP 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
P038
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
P099
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
U121
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
U173
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
U235
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
U411

### 65 HSM FACILITY CODES

Facility codes describe the specific regulation a facili ty uses to manage its hazardous secondary material (HSM) and the type of activity the facility performs under that regulation (e.g., generator, reclaimer). Review the groups and pick the appropriate code. If mo re than one facility code applies to you, 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))

Code Facility Code Description

01 HSM Generator reclaiming HSM “on-site” : This code applies if you generate and recl aim 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

02 HSM Generator transferring HSM to r eclaimer within the “same company”: This code applies if you generate hazardous secondary material and send th e material for reclamation to a different facility that is either controlled by you or controlled by th e 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

.

03 Reclaimer receiving HSM from HSM gen erator within the “same company”: This code applies if

you receive and reclaim hazardous second ary material from a different fac ility 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.

04 Tolling Contractor reclaiming HSM pursuant to a tolling contract: This code applies if you are a tolling contractor that reclaims h azardous secondary materi al pursuant to a written contract with a toll
manufacturer. 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.

05 Toll Manufacturer managing HSM pursuant to a tolling contract: This code applies if you generate and send hazardous secondary material for reclama tion 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.

Transfer-based Exclusion (40 CFR 261.4(a)(24))

Code Facility Code Description

06 HSM Generator transferring HSM off-site to a domestic reclamation facility: This code applies if you generate and send hazardous secondary material for reclamation to an off- site domestic reclamation facility.

07 Reclaimer receiving HS M from off-site: This code applies if you recl aim hazardous secondary material
received from an off-site domestic hazardous secondar y material generator or other domestic facility.

08 Intermediate facility: This code applies if you receive hazardou s secondary material from an off-site domestic hazardous secondary material generator or another domestic facility and you store it for more than ten days. This code does not apply if you generate or reclaim the hazardous secondary material.

Imports/Exports (40 CFR 261.4(a)(24) or (25))
Code Facility Code Description

09 HSM Generator exporting HSM off-site to a foreign reclamation facility: This code applies if you generate and export hazardous sec ondary material for reclamation to a foreign reclamation facility.

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
material for reclamation to a domestic reclamation facility.

11 HSM Generator AND Reclaimer of imported HSM: This code applies if you import hazardous secondary material from a foreign entity a nd reclaim the material at your facility.

### 66 HSM LAND-BASED UNIT CODES

A 2-digit code that best describ es the land-based unit you use or will use to manage the hazardous secondary material.

Code Land-based Unit Code Description

NA 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 ex cavation or diked area formed primarily of earthen materials (although it may be lined with ma n-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 hazardous secondary material. Pile means any non-containerized accumulation of solid, nonflowing 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.

### 67 SOURCE CODES

Source codes describe the type of process or activ ity (i.e., source) from which a hazardous waste was generated. Review the groups and pick the appropriate code.

Wastes from Ongoing Production and Service Processes (waste from general day to day manufacturing, production, or maintenance activities)

Code Source Code Description

G01 Dip, flush or spray rinsing (using solvents to clean or prepare parts or assemblies for further processing - i.e. painting or assembly)

G02 Stripping and acid or caustic cleaning (using causti cs to remove coatings or layers from parts or assemblies )

G03 Plating and phosphating (electro- or non-electroplating or phosphating)

G04 Etching (using caustics or other methods to remove layers or partial layers)

G05 Metal forming and treatment (pickling, heat tr eating, punching, bending, annealing, grinding, hardening, etc.)

G06 Painting and coating (manufacturing, building, or maintenance)

G07 Product and by-product processing (direct flow of wastes from chemical manufacturing or processing, etc.)

G08 Removal of spent process liquids or catalysts (bulk removal of wastes from chemical manufacturing or processing, etc.)

G09 Other production or service-related processes from whic h the waste is a direct outflow or result (specify in comments)

Other Intermittent Events or Processes

Code Source Code Description

G11 Discarding off-specification, out-of-date, and/or unused chemicals or products

G12 Lagoon or sediment dragout and leachate collection (large scale operations in open pits, ponds, or lagoons)

G13 Cleaning out process equipment (periodic sludge or residual removal from enclosed processes including internal scrubbing or cleaning)

G14 Removal of tank sludge, sediments, or slag (per iodic sludge or residual removal from storage tanks including internal scrubbing or cleaning)

G15 Process equipment change-out or discontinuation of equipment use (final materials and residuals removal including cleaning)

G16 Oil changes and filter or battery replacement (automotive, machinery, etc)

G17 Subpart K laboratory waste clean-out (facility must have opted into the Subpart K rule to use this source code)

G19 Other one-time or intermittent processes (specify in comments)

Pollution Control and Waste Management Process Residuals

Code Source Code Description

G21 Air pollution control devices (baghouse dust or ash from stack scrubbers or precipitators; vapor collection, etc.)

G22 Laboratory analytical wastes (used chemicals from laboratory operations)

G23 Wastewater treatment (sludge , filter cake, etc., including wastes from treatment before discharge by NPDES or POTW or by UIC disposal)

G24 Solvent or product distillation as part of a pr oduction process (including totally enclosed treatment systems). Does not include batch treatment in a separate process.

G25 Hazardous waste management - indicate mana gement method (for residuals from regulated hazardous waste processes - enter the related H code)

G26 Leachate collection (from landfill operations or other land units)

G27 Hazardous residual from treatment or recovery of universal waste

### Source Codes (continued)



### 68 Spills and Accidental Releases

Code Source Code Description

G31 Accidental contamination of products, materials, or containers ( other than G11)

G32 Cleanup of spill residues (infrequent, not routine)

G33 Leak collection and floor sweeping (ongoing, routine)

G39 Other cleanup of current contamination (specify in comments)

Remediation of Past Contamination

Code Source Code Description

G41 Closure of hazardous waste management unit under RCRA

G42 Corrective action at a solid waste management unit under RCRA

G43 Remedial action or emergency response under Superfund

G44 State program or voluntary cleanup

G45 Underground storage tank cleanup

G49 Other remediation (specify in comments)

Waste Not Physically Generated On-Site

Code Source Code Group

G61 Hazardous waste received from off-site for storage/ bulking and transfer o ff-site for treatment or disposal

For
codes
G63 -
G75 Hazardous waste received from a foreign country (o ther than a foreign Department of Defense site, Maquiladora, U.S. territory or protectorate). This site was the generator of record and is the U.S. Importer. Enter the appropriate code from the list below -

G63 Hazardous waste received from Antarctica

G64 Hazardous waste received from Aruba

G65 Hazardous waste received from Bahamas

G66 Hazardous waste received from Belgium

G67 Hazardous waste received from Brazil

G68 Hazardous waste received from Canada

G69 Hazardous waste received from Holland

G70 Hazardous waste received from Malaysia

G71 Hazardous waste received from Mexico

G72 Hazardous waste received from New Zealand

G73 Hazardous waste received from Taiwan

G74 Hazardous waste received from Venezuela

G75 Hazardous waste received from other foreign country - see Comments for country name

### 69 FORM CODES

Form codes describe the general physical and chemi cal characteristics of a hazardous waste. Review the groups and pick the appropriate code.

Mixed Media/Debris/Devices - Waste that is a mixture of organic and inorganic wastes, liquid and solid wastes, or devices that are not easily categorized

Code Form Code Description

W001 Lab packs from any source not containing acute hazardous waste

W002 Contaminated debris (see definition at 40 CFR 268.2(g) and requirements at 40 CFR 268.45): for example, certain paper, clothing, rags, w ood, empty fiber or plastic containers, glass, piping, or other solids

W004 Lab packs from any source containing acute hazardous waste

W005 Waste pharmaceuticals managed as hazardous waste

W301 Contaminated soil (usually from spill clean up, demolition, or remediation); see also W512

W309 Batteries, battery parts, cores, casings (lead-acid or other types)

W310 Filters, solid adsorbents, ion exchange resi ns and spent carbon (usually from production, intermittent processes, or remediation)

W320 Electrical devices (lamps, fluorescent lamps, or thermostats usually containing mercury; CRTs containing lead; etc)

W512 Sediment or lagoon dragout, drilling or other muds (wet or muddy soils); see also W301

W801 Compressed gases of any type

Inorganic Liquids - Waste that is primarily inorganic and highly fluid (e.g., aqueous), with low suspended inorganic solids and low organic content

Code Form Code Description

W101 Very dilute aqueous waste containing more than 99% water (land disposal restriction defined wastewater that is not exempt under NPDES or POTW discharge)

W103 Spent concentrated acid (5% or more)

W105 Acidic aqueous wastes less th an 5% acid (diluted but pH <2)

W107 Aqueous waste containing cyanides (generally caustic)

W110 Caustic aqueous waste without cyanides (pH >12.5)

W113 Other aqueous waste or wastewaters (fluid but not sludge)

W117 Waste liquid mercury (metallic)

W119 Other inorganic liquid (specify in comments)

Organic Liquids - Waste that is primarily organic and is highly fluid, with low inorganic solids
content and low-to-moderate water content

Code Form Code Description

W200 Still bottoms in liquid form (fluid but not sludge)

W202 Concentrated halogenated (e.g., chlorinated) solvent

W203 Concentrated non-halogenated (e .g., non-chlorinated) solvent

W204 Concentrated halogenated/ non-halogenated solvent mixture

W205 Oil-water emulsion or mixture (fluid but not sludge)

W206 Waste oil managed as hazardous waste

W209 Paint, ink, lacquer, or varnis h (fluid – not dried out or sludge)

W210 Reactive or polymerizable organic liquids and adhesives (fluid but not sludge)

W211 Paint thinner or petroleum distillates

W219 Other organic liquid (specify in comments)

### Form Codes (continued)



### 70 Inorganic Solids - Waste that is primarily inorganic and so lid, with low organic content and low-tomoderate water content; not pumpable

Code Form Code Description

W303 Ash (from any type of burning of hazardous waste)

W304 Slags, drosses, and other solid thermal residues

W307 Metal scale, filings and scrap (including metal drums)

W312 Cyanide or metal cyanide bearing solids, salts or chemicals

W316 Metal salts or chemicals not containing cyanides

W319 Other inorganic solids (specify in comments)

Organic Solids - Waste that is primarily organic and solid, with low-to-moderate inorganic content and water content; not pumpable

Code Form Code Description

W401 Pesticide solids (used or discarded – not contaminated soils - W301)

W403 Solid resins, plastics or polymerized organics

W405 Explosives or reactive organic solids

W406 Dried paint (paint chips, filters, air filters, other)

W409 Other organic solids (specify in comments)

Inorganic Sludges - Waste that is primarily inorganic, with moderate-to-high water content and low organic content; mostly pumpable

Code Form Code Description

W501 Lime and/or metal hydroxide sludges and solids with no cyanides (not contaminated muds - W512)

W503 Gypsum sludges from wastewater treatment or air pollution control

W504 Other sludges from wastewater treatment or air pollution control

W505 Metal bearing sludges (including plating sludge) not containing cyanides

W506 Cyanide-bearing sludges (not contaminated soils - W512)

W519 Other inorganic sludges (not contaminated muds - W512; specify in comments)

Organic Sludges - Waste that is primarily organic with lo w-to-moderate inorganic solids content and water content; pumpable

Code Form Code Description

W603 Oily sludge (not contaminated muds - W512)

W604 Paint or ink sludges, still bottoms in sludge form (not contaminated muds - W512)

W606 Resins, tars, polymer or tarry sludge (not contaminated muds - W512)

W609 Other organic sludge (specify in comments)

### 71 MANAGEMENT METHOD CODES

Management method codes describe the type of h azardous 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.

Reclamation and Recovery Code Management Method Code Description

H010 Metals recovery including retor ting, smelting, chemical, etc.

H020 Solvents recovery (distillation, extraction, etc)

H039 Other recovery or reclamation for reuse incl uding acid regeneration, 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 a nother site (waste generated either 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 u se as a fuel (includes any preparation prior to burning)

H071 Chemical reduction with or without precipitati on (includes any preparation or final processes for consolidation of residuals)

H073 Cyanide destruction with or without precipitation (includes any preparation or final processes for consolidation of residuals)

H075 Chemical oxidation (includes any preparation or final processes for consolidation of residuals)

H076 Wet air oxidation (includes any preparation or final processes for conso lidation of residuals)

H077 Other chemical precipitation with or wit hout pre-treatment (includes processes for consolidation of residuals)

H081 Biological treatment with or without precipitation (includes any preparation or final processes for consolidation of residuals)

H082 Adsorption (as the major component of treatment)

H083 Air or steam stripping (as the major component of treatment)

H101 Sludge treatment and/or dewatering (as the major component of treatment; not H071-H075, H077, or H082)

H103 Absorption (as the major component of treatment)

H111 Stabilization or chemical fixation prior to dispo sal at another site (as the major component of treatment; not H071-H075, H077, or H082)

H112 Macro-encapsulation prior to disposal at another site (as the major component of treatment; not reportable as H071-H075, H077, or H082)

H121 Neutralization only (no other treatment)

H122 Evaporation (as the major component of treatment; not reportable as H071-H083)

H123 Settling or clarification (as the major component of treatment; not reportable as H071-H083)

H124 Phase separation (as the major component of treatment; not reportable as H071-H083)

H129 Other treatment (specify in comments; not reportable as H071-H124)

### Management Method Codes (continued)



### 72 Disposal Code Management Method Code Description

H131 Land treatment 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 wit hout treatment; this w aste 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 transferred the waste with no treatment or recovery (H010-H129), fuel ble nding (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.

### 73 WASTE MINIMIZATION CODES

Waste minimization codes describe the type of waste minimization, recycling, or pollution prevention efforts used to reduce the volume and toxicity of the hazardous waste generated at your facility. Select the most detailed, appropriate, and specific method used. If minimization was not attempted (to the point of implementing a change) for this waste, you must select the “X” code.

Waste Minimization was not attempted or was unsuccessful Code Waste Minimization Code Description X No waste minimization efforts were implemented for this waste

N Waste minimization efforts were unsuccessful in reducing quantity and/ or toxicity (please detail reasons in the Comments section)

Waste Minimization was attempted and was successful Code Waste Minimization Code Description S Began to ship waste off-site for recycling R Recycling on-site was implemented and was successful

Y Waste minimization was implemented and was successful in reducing quantity and/or toxicity (please detail reasons in the Comments section)

# DRAFT OMB# 2050-0024; Expires ____________

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
APPLY Reason for Submittal:

 To provide an Initial Notification (f irst time submitting site identificati on information / to obtain an EPA ID number for this location)

 To provide a Subsequent Notification (to update site identifica tion information for this location)

 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 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)

2. Site EPA ID
Number EPA ID Numbe r

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 Code:

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:

9. Legal Owner and Operator of the Site A. Name of Si te’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: Phone:

State: Country: Zip Code:

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

Type: Private County District Federal Tribal Municipal State Other

EPA Form 8700-12, 8700-13 A/B, 8700- 23 (Revised Page 1 of

# DRAFT EPA ID Numbe r OMB#: 2050-0024; Expires ____________

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 instructe d.

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. Transporter of Hazardous Waste If “Yes”, mark all that apply.

a. LQG: Generates, in any calen dar month, 1,000 kg/mo (2,200 lbs./mo.) or more of hazardous waste; or Generates, in any ca lendar month, or accumulates at any time, more than 1 kg/mo (2.2 lbs./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. Treater, 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 nonacute hazardous waste.

c. CESQG: Less than 100 kg/mo (220 lbs./mo) of non-acute
hazardous waste. Y N 8. Exempt Boiler and/or Industrial Furnace If “Yes”, mark all that apply.

If “Yes” above, indicate other generator activities in 2-4. 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. Mixed Waste (hazardous and radioactive) Generator Y N 10. Receives Hazardous Waste from Offsite

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 Waste (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. Y N 1. Used Oil Transporte r If “Yes”, mark all that apply.

a. Transporter

b. Transfer Facility (at your site)

a. Batteries

b. Pesticides

c. Mercury containing equipment

d. Lamps

e. Other (specify)

f. Other (specify)

g. Other (specify) Y N 2. Used Oil Processor and/or Re-refine r 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 OffSpecification Used Oil to OffSpecification Used Oil Burner
b. Marketer Who First Claims the Used
Oil Meets the S pecifications

EPA Form 8700-12, 8700-13 A/B, 8700-23 (Revised Page 2 of

# DRAFT EPA ID Numbe r OMB#: 2050-0024; Expires ____________

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 affiliat ion agreement with a college or university; or a non-profit research institute that is owned by or has a formal affiliation agreeme nt 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 management of hazardous wastes in laboratories See the item-by-item instructions for definitions of ty pes of eligible academic entities. Mark all that apply:

a. College or University

b. Teaching Hospital that is owned by or has a formal written affiliation agreement with a college or university

c. Non-profit Institut e that is owned by or has a formal written a ffiliation agreement with a college or university

Y N N 2. Withdrawing from 40 CFR Part 262 Subpart K for t he management of hazardous wastes 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 regulations (e.g., D001, D003, F007, U112). Use an additional page if more spaces are needed.

B. Waste Codes for State-Regulated (i.e., non-Federal) Hazardous Wastes. Please list the waste code s 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 i f more spaces are needed.

EPA Form 8700-12, 8700-13 A/B, 8700-23 (Revised Page 3 of

# DRAFT EPA ID Numbe r OMB#: 2050-0024; Expires ____________

12. Notification of Hazardous Secondary Material (HSM) Activity

Y N Are you notifying under 40 CFR 260.42 that you will begin m anaging, are managing, or will stop managing hazardous secondary material under 40 CFR 261.2(a)(2 )(ii), 40 CFR 261.4(a)(23), (24), or (25)?

If “Yes”, you must fill out the Addendum to the Site Identi fication Form: Notification for Managing Hazardous Secondary
Material.

13. Comments

14. Certification. I certify under penalty of law that this document and all atta chments were prepared under my direction or supervision in accordance with a system designed to assure that qualified perso nnel properly gather and evaluate the information submitted. B ased on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the informati on, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are sign ificant penalties for submitting false information, including the possibilit y of fines and imprisonment for knowing violations. For th e 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) Date Signed (mm/dd/yyyy)

EPA Form 8700-12, 8700-13 A/B, 8700-23 (Revised Page 4 of

# DRAFT EPA ID Numbe r OMB#: 2050-0024; Expires ____________



### ADDENDUM TO THE SITE IDENTIFICATION FORM:

NOTIFICATION OF HAZARDOUS SEC ONDARY MATERIAL ACTIVITY

ONLY fill out this form if:

 You are located in a State that allows you to manage excluded hazardous secondary material (HSM) under 40 CFR 261.2(a)(2)(ii), 261.4(a)(23), (24), or (25) (or state equivalent). See http://www.epa.gov/epawast e/hazard/dsw /statespf.htm for a list of eligible states; AND

 You are or will be managing excluded HSM in compliance with 40 CFR 261.2(a)(2)(ii), 261.4(a)( 23), (24), or (25) (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.

1. Indicate reason for no tification. 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 managing 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 information regarding your haz ardous 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 annually d. Actual short tons of excluded HSM that was managed during the most
recent oddnumbered year e. Land-based unit
code (answer using
codes listed in the Code List section of the instructions)

3. Facility has financial assurance pur suant 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 pursuant to 40 CFR 261.4(a)(24)(vi)?

EPA Form 8700-12, 8700-13 A/B, 8700-23 (Revised Addendum Page of

# This page intentionally left blankOMB# 2050-0024; Expires

BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL

OR ENTER:

SITE NAME:

EPA ID Number U.S. ENVIRONMENTAL

PROTECTION AGENCY

2011 Hazardous Waste Report

WASTE GENERATION

AND MANAGEMENT GM

FORM

Sec. 1 A. Waste description:

B. EPA hazardous waste code(s) C. State hazardous waste code(s)

D. Source code

G

Management Method code for Source code G25

H E. Form code

W F. Quantity generated in 2011

.

UOM

Density

. lbs/ g al s g G. Waste
minimization code

Sec. 2 Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site?

 Yes (CONTINUE TO ON-SITE PROCESS SYSTEM 1)
 No (SKIP TO SEC. 3)

ON-SITE PROCESS SYSTEM 1 ON-SITE PROCESS SYSTEM 2
On-site Management Quantity treated, disposed, or Method code recycled on site in 2011

H

. On-site Management Quantity treated, disposed, or Method code recycled on site in 2011

H

.

Sec. 3 A. Was any of this waste shipped off site in 2011 for treatment, disposal, or recycling?
 Yes (CONTINUE TO ITEM B)

 No (FORM IS COMPLETE)

Site 1 B. EPA ID No. of facility to which waste was shipped C. Off-site Management Method code shipped to

H D. Total quantity shipped in 2011

.

Site 2 B. EPA ID No. of facility to which waste was shipped C. Off-site Management Method code shipped to

H D. Total quantity shipped in 2011

.

Site 3 B. EPA ID No. of facility to which waste was shipped C. Off-site Management Method code shipped to

H D. Total quantity shipped in 2011

.

Comments:

Page __ of ___

# This page intentionally left blankOMB# 2050-0024; Expires

BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL

OR ENTER:

SITE NAME:

EPA ID Number U.S. ENVIRONMENTAL

PROTECTION AGENCY

2011 Hazardous Waste Report

WASTE RECEIVED

FROM OFF SITE WR

FORM

Waste 1 A. Description of hazardous waste

B. EPA hazardous waste code(s) C. State hazardous waste code(s) D. Off-site handler EPA ID number

E. Quantity received in 2011

. F. UOM

Density

. lbs/gal sg G. Form code

W H. Management Method code

H

Waste 2 A. Description of hazardous waste

B. EPA hazardous waste code(s) C. State hazardous waste code(s) D. Off-site handler EPA ID number

E. Quantity received in 2011

. F. UOM

Density

. lbs/gal sg G. Form code

W H. Management Method code

H

Waste 3 A. Description of hazardous waste

B. EPA hazardous waste code(s) C. State hazardous waste code(s) D. Off-site handler EPA ID number

E. Quantity received in 2011

. F. UOM

Density

. lbs/gal sg G. Form code

W H. Management Method code

H

Comments:

Page __ of __

# This page intentionally left blankOMB#: 2050-0024; Expires

BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL

OR ENTER:

SITE NAME:

EPA ID NO: U.S. ENVIRONMENTAL

PROTECTION AGENCY

2011 Hazardous Waste Report

OFF-SITE

IDENTIFICATION OI

FORM

Site 1 A. EPA ID number of off-site installation or transporter B. Name of off-site in stallation or transporter

C. Handler type (MARK ALL THAT APPLY)

 Generator

 Transporter

 Receiving facility D. Address of off-site installation

Street

City

State Zip -

Site 2 A. EPA ID number of off-site installation or transporter B. Name of off-site in stallation or transporter

C. Handler type (MARK ALL THAT APPLY)

 Generator

 Transporter

 Receiving facility D. Address of off-site installation

Street

City

State Zip -

Site 3 A. EPA ID number of off-site installation or transporter B. Name of off-site in stallation or transporter

C. Handler type (MARK ALL THAT APPLY)

 Generator

 Transporter

 Receiving facility D. Address of off-site installation

Street

City

State Zip

-

Site 4 A. EPA ID number of off-site installation or transporter B. Name of off-site in stallation or transporter

C. Handler type (MARK ALL THAT APPLY)

 Generator

 Transporter

 Receiving facility D. Address of off-site installation

Street

City

State Zip

-

Comments:

Page __ of __

## INSTRUCTIONS FOR FILLING OUT THE OI FORM –
OFF-SITE IDENTIFICATION

Who Must Submit this Form

Sites required to file the 2011 Hazardous Waste Report must submit the OI Form if:

 The OI Form is required by your State; AND

 The site received hazardous waste from off-site or sent hazardous waste off-site during 2011.

For a list of State Contacts go to: http://www.epa.gov/epawaste/inforesources/data/form8700/contact.pdf

.



### Purpose of this Form

The OI Form documents the names and addresses of off-site installations and transporters.



### How to Fill out this Form

The OI Form is divided into five identical parts. You must fill out one part for each off-site installation to which you shipped hazardous waste, each off-site inst allation from which you received hazardous waste, and each transporter you used to ship hazardous wast e during 2011. If these off-site installations and transporters total more than four, you must photocopy and complete additional copies of the form. Prior to photocopying, place the pre-printed site identification label in the top left-hand corner of the form or, if you did not receive pre-printed labels, enter the site name and EPA Identification Number in this space.

Use the Comments section at the end of the form to clarify any entry (e.g., “Other” responses) or to continue any entry. When entering information in the Comments section, cross-reference the site number
and item letter to which the comment refers.



### Item-By-Item Instructions

Complete Items A through D for each off-site insta llation to which you shipped hazardous waste and each off-site installation from which you received hazardous waste during 2011. Complete Items A through C for each transporter you used during the year (address in Item D is not required for transporters).

Item A – EPA ID No. of Off-site Installation or Transporter

Enter the 12-digit EPA ID number of the off-site in stallation to which you shipped hazardous waste or from which you received hazardous waste. Or, enter the EPA ID number of the transporter who shipped hazardous waste to or from your site. Each EPA ID number should appear only once. If the off-site installation or transporter did not have an EPA ID number during 2011, leave blank if this item is not applicable or “don’t know” in Item A and note the reason in the Comments section.

### OI Form (continued)

Item B – Name of Off-Site Installation or Transporter

Enter the name of the off-site installati on or transporter reported in Item A.

Item C – Handler Type

Place an “X” in all boxes that apply to the handler type (i.e., generator, transporter, or receiving facility) of the off-site installation or transporter reported in Item A.

Item D – Address of Off-site Installation

Enter the address of the off-site installation reported in Item A. If the EPA ID number reported in Item A refers to a transporter, leave blank if this ite m is not applicable or “don’t know” in Item D.