# • -. An te ort



# • Book 1 2000 Forms and Instructions Your Report mustbe postmarkedno later than March 

# 1, 2001

Mail completed forms to:

DepartmentofEcology PO Box 47658 OlympiaWA 98504-7658

. December 2000

. Printed on recycled paper 96-437

. Revised 10/00

### The completed forms are due backto Ecology with a postmark ofno later than March 1, 2001. Submit completed forms by U.S. Mail to: Washington Department ofEcology Hazardous-Waste Information

. POBox 47658 Olympia, WA 98504-7658 You may express deliver (by private carrier such as Federal

Express or U.P.S.) the forms to Ecology, ifyou wish. Use the following street address for deliveries: Washington Department ofEcology Hazardous Waste Information 300 Desmond Drive

Lacey, WA 98503 

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# ..

# •

Ann port



# •

• Book 1 

# 2000 Forms and Instructions
Your Reportmustbepostmarkedno later than March 1, 

# 2001

Note: 

### Along with this book offonns you should have receivedBook

### 2: Guidebookand Codes. 

### Many ofthe technical terms in this section and in the fonns are defined in the Definitions section, pages 23-28 ofBook

### 2: Guidebook andCodes. 

### Ifyou need further clarification or ifyou did not receive Book2: GuidebookandCodes, 

### contact Ecology at (800) 874-2022 (within state) or (360) 407-6170.

WASHINGTON STATE OEPARTMENT Of 

## E COL 0 G Y The Department of Ecology is an equal opportunity andaffirmative action employer and shall not discriminate on the basis of race, creed, color, national origin. gender, maritalstatus, sexual orientation. age. religion or disability as defined by applicable state and/orfederal regulations or statutes. Jfyou have special accommodation needs or want more information. please contact the Hazardous Waste and ToxicsReduction Program at (360) 407-6700 (voice) or (360) 407-6006 (TDD).



## •

# TABLE OF CONTENTS

Introduction 1 What is the Dangerous Waste Annual Report? 1 Why did I receive this packet? 1 Do I need to complete these forms? 1 What if I think I received these forms in error? 1 When to submit the 2000 Annual Report forms 2 Where to go for help 2 Ecology's authority to collect this information 2 Recordkeeping '" 3 Overview ofthe 2000 Dangerous Waste Annual Report Forms packet 3 Page numbering your submittal 4 Typing the forms 4 Certification 4 Annual Reporting Software 4 Submitting computer-generated facsimiles of the forms 5 Ecology has an Internet Home Page 6 Documents useful in completing these forms 6 What's next? 6 

### Worksheet #1: Defining Your Status 7 Worksheet #2: Determining Which Forms to Complete 

## 10**Verificat~on** 

### (VF) Form 17 Generation and Management Form (GM) Form 29 Off-Site Identification Information (01) 

### Form 35 Waste Received (WR) Form 43

Book 1: 2000 Forms and Instructions , I'


## J

# O~ j

,



# C)

# • DANGEROUS WASTE ANNUAL REPORT INTRODUCTION

What is the Dangerous Waste Annual Report? The Washington Department ofEcology (Ecology) Dangerous Waste Annual Report is an annual report ofdangerous waste generation and management activities within Washington. Handlers ofdangerous waste-e.g., generators, transporters, transfer facilities, and management facilities-are required to use these forms to report their activities to Ecology every year. The worksheets, 

### Worksheet #1: 

### Defining Your Status and 

### Worksheet #2: 

### Determining Which Forms to Complete, pages 7-9 and pages 10-11, respectively, will help you determine first what your regulatory status is (i.e., a dangerous waste generator or a TSDR) and then which forms you must complete.


## Why did I receive this packet? All companies with an active RCRA Site Identification (ID) Number (WA ) receive an Annual Report mailing each year. You are required to report back to Ecology using these forms 

### even 

## if you did notgenerate or manage any dangerous waste during 2000. You must 

### at least complete the Verification Form to inform Ecology ofwhether or not you conducted any dangerous waste handling activities during 2000. Some facilities will need to complete one or two other forms in addition to the Verification Form. 

## Do I need to complete these forms? What if I think I received these forms in error? Ifyou believe you do not need to complete the Annual Report forms, please call Ecology at 1-800-874-2022 (within state) or 360-407-6170'so that the agency can correct its records. Please recycle the unused reporting packet or return it to Ecology.



# • Ifyou had an active RCRA Site ID Number at any time during 2000, you will need to complete at least one ofthe five enclosed forms. Those companies required to report are:

• Dangerous Waste Generators
• Dangerous WasteTreatment, Storage, or

Disposal Facilities (TSDs)
• Dangerous Waste Recycling Facilities (as

specified in WAC 173-303-120)

• Dangerous Waste Transporters
• Burners/Marketers/Blenders ofdangerous

waste fuels • Transfer Facilities


### Book 1: 2000 Forms and Instructions 1Dangerous Waste Annual Report 

### When to submit the Annual Report forms The completed forms are due back to Ecology with a postmark ofno later than March 1, 2001. Submit completed paper forms by U.S. mail to: Washington Department ofEcology Hazardous Waste Information PO 

### Box 47658 Olympia, WA 98504-7658 You may express deliver the paper forms (by private carrier such as Federal Express or u.P.S.) to Ecology, ifyou wish. Use the following street address for deliveries: Washington Department ofEcology Hazardous Waste Information 300 Desmond Drive Lacey, WA 98503 DO NOT FAX annual Report forms unless requested by Ecology. 

### 1. Workshops Ecology will be holding a number ofworkshops during the months of January and February on dangerous waste management which will include information about completing your Annual Report forms. For more information on attending a workshop, contactEcology at 1-800-874-2022 (within state) or 360-407-6170.lnformation may also be down loaded from Ecology's website at http://www.ecy.wa.gov/programs/hwtr/.

# c~

E-mail electronic files to Ecology at cjam461@ecy.wa.gov. Include the following information in your e-mail: • Your name and phone number. • Yourcompany name and RCRA site ID#. • Year ofyour annual report submittal. • Types ofdata file you are sending (i.e., GM, 01, 

### and/or WR).
• Zipped data file attachment. Your Verification Form (VF) and Recycling Credit Sheet(s) must be sent to Ecology the "old fashion way" by US Postal mail or private carrier. Be sure to check the "Data submitted on Internet" box in Section 7 on the back ofthe form." Upon written request and reasonablejustification, Ecology may grant an extension to the reporting deadline ofup to 30 days. Written requests for extension must be received by February 15,2001, at the above address. 

### Where to go for help Ecology has developed a number ofways to help you completethe forms. 4. Telephone Assistance. You may call Ecology at 1-800-874-2022 (within state) or 360-407-6170 ifyou have questions about completing the forms. 

### Ecology's authority to collect this information The Washington Administrative Code (WAC)173-303-220 and 173-303-390, authorizes Ecology to collect information regarding the generation and management ofdangerous wastes. Further, Ecology is required by EPA to collect information on the generation and management of hazardous wastes, as implemented through the 

# 0 federal Biennial Report (Form 8700-13).



### 2 

### Book 1: 2000 Forms and InstructionsIntroduction 

# •

• Recordkeeping**"Ge~erator** recordkeeping," (WAC 173-303-210) requires the generator to keep on-site copies of annual reports, Notification ofDangerous Waste Activities, manifests, exception reports, test results, and waste analyses, etc., for a minimum offive years. 

## Overview of the 2000 Dangerous Waste Annual Report Forms packet
The 2000 Dangerous Waste Annual Report Forms packet is made up oftwo books: 

### • Book 1: Forms and Instructions Book I contains the forms that you will have to complete and instructions on how to complete them. It contains four forms, but few facilities will have to complete all four forms. Book I includes worksheets that will help you determine which forms you will need to complete. 

### Verification (VF) Form All facilities need to complete this form. Ifa pre-printed Verification Form is not included with this Form Packet, complete the blank verification form on pages 17 and 18, or call Ecology at (800) 874-2022, (within state) (360) 407-6170 to receive your pre-printed VF Form. 

### Generation and Management (GM) Form LQGs and MQGs have to complete this form. You are to complete a separate GM Form for each waste stream generated at your facility and then managed or shipped off-site. Copy a blank GM Form answer sheet (and continuation sheet if

. needed) to obtain a form for each waste stream

generated at your facility. Section A ofthis form asks descriptive questions about the waste stream, such as the type ofwaste stream generated and whether the waste stream is a residual from management ofanother dangerous waste stream. Section B ofthis form asks questions about the management ofthe waste stream, such as where the waste stream was managed (on-site or off-site) and how it was managed. 

# I l '.

r., The Verification Form is a pre-printed form the agency provides you. This form contains the general information that you reported in the previous reporting year, such as the name ofyour facility, the name, address and telephone number ofthe contact person at your facility. You are to check that the information contained on the Verification Form is current, indicate any changes as necessary, certify the information, and send the form back to Ecology with any other Annual Report formes) required. 

# O In order to reduce your overall-reporting burden, Ecology will use the Verification Form in lieu of 

# !**~pdated Notificat~on**  (Form 2),reporting. The only time you are required to submit a revised Notifi-

• cation**Fo~** is ifthere is a change in activities such as**~ddmg** treatment by generator activity, and to WIthdraw/cancel a RCRA Site ID Number. 

### Off-Site Identification Information (01) Form MQGs, LQGs and TSDRs that either sent waste off-site or received waste from off-site must complete this 01 Form. T?is form collects the name, address, and RCRA SIte ID Number ofall dangerous waste handlers with whom you interacted in sending waste offsite or in receiving waste from off-site. For example, ifyou are a generator, it collects information on any transporters you used to move waste off-site to a management facility and on the off-site management facilities you used to treat! recycle/dispose ofyour waste. Ifyou are a TSDR**facil~ty,** you would provide information on any off-SIte generators from whom you received waste, and any transporters you used to receive the waste.



### Book 1: 2000 Forms and Instructions 3Dangerous Waste Annual Report
Waste Received (WR) Form Facilities that receive dangerous waste from off-site must complete this form. These

€>. . include facilities that receive wastes from TS off-site and then ship them off-site without DR any treatment.

You are to complete one WR Form for each waste stream received by your facility. Copy the WR Form answer sheet (and continuation sheet if needed) for each waste stream received by your facility. This form asks questions about the waste stream received, such as how much waste was received, the type ofwaste received, from whom the waste was received, and how the waste was managed at your facility.

• Book 2: Guidebook and Codes As described above, this book is designed to assist you in completing the forms. It includes a series ofHelpfulHints to answer specific questions as you work through the forms. It also has three Worksheets to help you complete specific aspects ofthe forms. In addition, it contains a Definitions section and all ofthe Codes that you need to complete the forms. 

### Page numbering your submittal Once you have completed all forms required, compile your forms in the same order as they are presented in this book (i.e., Verification (VF) Form first, followed by the Generation and Management (GM) Form(s), the Off-site Identification Information (01) Form, and the Waste Received (WR) Form(s). Do NOT include any of the worksheets as part ofyour submittal; these are for your use only. Once you have compiled your forms in the correct order, complete the page numbering space at the lower right comer ofeach page. The Verification Form starts as page number "1". Number each subsequent page consecutively (i.e., 2, 3, 4, etc.). Attach page 45 ofthis book as the last page of your submittal; you should also manually number this page. In the space provided above the Certification on the last page ofthe Verification Form, enter the total number ofpages that you are submitting. Remember to enter your RCRA Site ID Number on every page ofyour report. 

### Typing the forms Ecology requests that forms be typed. Ifyou cannot type the forms, please print legibly in blue or black ink. 

### Certification
Your completed forms must be returned to Ecology with the signature, in ink, ofan authorized representative ofyour site. Ecology's guidance includes references to 40 CFR 260.10 where authorized representative is defined by the USEPA as the person responsible for the overall operation of a facility or an operational unit (i.e., part ofa facility), e.g., the plant manager, superintendent or person of equivalent responsibility. [Permitted TSDRs should refer to WAC 173-303- 810(12) for guidance on designating the appropriate representative.] A contracted consultant does not qualify as an authorized representative ofyour facility in this context. Any forms that do not have a signature in the Certification section will be returned. 

### Annual Reporting Software To assist you with your Annual Reporting, Ecology has developed a software program called Turbo Waste. This software has been designed to meet the needs ofboth large and small companies. With Turbo Waste you can data enter your GM, 01 and WR report information directly into the program (with a screen display that is identical to the paperGM, 01 and WR forms). Or, if you have an automated information management system containing 

# o

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4 Book 1: 2000 Forms and InstructionsIntroduction

r 

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# ,

# •

•

• your annual reporting data, you can import these data files directly into the program. Then Turbo Waste will compress your files so you can submit them to Ecology (either on disk or over the Internet). Ecology encourages all MQG and LQG reportingsites to submit their annual reporting data electronically. It 

### is especially recommended for sites that have multiple waste streams or large numbers ofwaste shipments. If

### your site has greater than 10 individual GM and/or WR forms to submit, or you are an LQG with many waste shipments to report, you are a good candidate for electronic reporting. Ifyou choose to report electronically, you still need to submit a paper copy ofyour Verification form (VF) and recycling credit documentation. Why Use Turbo Waste? The following are just a few benefits TurboWaste has to offer: • The screen displays in Turbo Waste are identical to the GM, WR and 01 

### forms. You can data enter your report information right onto GM, WR and 

# or forms. • You can print out paper copies ofGM, WR and 

# or forms for your files. • Turbo Waste is equipped with data validation checks that alert you to reporting error's before you submit your data to Ecology. • Turbo Waste is designed for multi-year reporting. • The Turbo Waste program packages your electronic data so that it can be copied onto a floppy disk and mailed to Ecology, or sent via e-mail. What Hardware and Software Do 1 Need? • IBM Compatible PC. Minimum requirement = 

### 486-66 with 16 Meg RAM and 30 Meg offree hard disk space. (Pentium P-133 with 32 meg RAM and 30 meg offree hard space recommended) • Windows 95 or Windows NT • Turbo Waste Software (supplied by Department ofEcology) • Microsoft Access 8.0 (optional) How Do 1 Get Started? To order the software package, use the order form that was mailed to you with this book or call Ecology at 1-800-874-2022 (within state) or 360-407-6170 or e-mail to cjam461@ecy.wa.gov. There is a $10.00 media charge for the software on CD-ROM. You can also download the software and instructions for free from Ecology's Internet site at www.ecy.wa.gov/ programslhwtr/. 

### Submitting computer-generated facsimiles of the forms Facsimiles ofthe VF Form are no longer accepted. The submittal ofcomputer-generated GM, WR, and 01 

### Forms is still allowed though no longer encouraged by Ecology. Instead, Ecology requests you use the Turbo Waste Software Program for preparing your Annual Report. Please refer to the previous section on annual reporting software. Ifafter reviewing the information on annual reporting software, you still want to submit your own computer-generated facsimile, please note the following guidance. You are not required to obtain Ecology's prior approval ofyour proposed computer-generated facsimile. You should re-create, as closely as possible, the actual forms. Computer generated forms that are not facsimiles will not be accepted. Ifyou are submitting computer-generated forms, you should note that the information you would normally continue in the Comments Section on the paper forms may be continued within the answer space in your computer-generated form. (For example, on the paper GM Form, space is provided for 6 EPA waste codes in question A-3; any additional codes must be provided in Section D, Comments. In your computer-generated forms, however, you may provide as many EPA waste codes as necessary in the space created for question A-3.) You may, ofcourse, use the Comments Section in the computer-generated format for any comments that are not specific to an individual question. 

### Book 1: 2000 Forms and Instructions 5Dangerous Waste Annual Report
You should note the following guidelines in preparing and submitting your computer-generatedforms. • Use 8.5" by II" paper. • Use blue or black ink.

• Double sided pages are encouraged.

• Ifyou are using continuous-feed paper, separate

the print-out into individual sheets with the side holes removed.

• Number all pages ofyour submittal according

to the guidelines on page 4. • Be sure that each page has the appropriate form

header, as indicated in the sample formats. • Be sure that your facility's site name and

RCRA Site ID Number are provided on each page. 

## Ecology has an Internet Home Page
To access information about Annual Dangerous Waste Reporting forms, instructions, and electronic reporting, go to http://www.ecy.wa.gov/ programs/hwtr/ 

## What's next? 1. 

### Look at the two worksheets 

### following this section. • Worksheet #1: Defining Your Status (pages 7 -

8) will help you determine whether you need to complete these forms and, ifyou do, into which regulatory status category or categories you fit. • Worksheet #2: Determining Which Forms to Complete (pages 10 -11) will help you figure out which forms you must complete. 

### These worksheets are designed to help you. You should NOT submit them to Ecology.
2. Read the instructions at the beginning of each form. This icon identifies areas in the instructions that you should read particularly closely. In many cases, the icon highlights a common source of error. 

### 3. Complete the forms. 

# o

Documents useful in completing these forms As you prepare your 2000 Dangerous Waste Annual Report forms, you may find the following documents useful. • A copy ofyour most recent Notification Form

(Form 2).

• Records ofdangerous waste quantities generated, accumulated, or managed.

• Dangerous waste manifest forms.

• Results oflaboratory analyses ofyour wastes

(e.g., waste profiles).

• Contracts or agreements with the off-site

facilities that manage your wastes.

• Copies ofpermits for your on-site waste

management systems.

• Copies ofMaterial Safety Data Sheets

(MSDSs).
• Documenation ofrecycling credits issued by

your TSDRs. • Make sure you only fill out the forms that are required ofyou. Use Worksheet #2 (pages lO11) to determine this. • Use Book2: .Guidebookand Codes as you

work through the forms. The forms' instructions will refer you to Helpful Hints, Worksheets, Definitions, and Codes that will help you to complete the forms. • Call Ecology at 1-800-874-2022 (within state)

or 360-407-6170 if you have**~ny** questions. This icon identifies areas in the instructions that pertain only to Treatment, Storage, Disposal, and commercial Recycling Facilities (TSDRs) This icon identifies areas in the instructions that pertain to new reporting instructions. 

# ()

6 

### Book 1: 2000 Forms and Instructions

# • WORKSHEET #1 DEFINING YOUR STATUS

r l.

# • This Worksheet is foryour use only. Do NOTsubmit this Worksheet to Ecology. 

## Before completing thisworksheet, you will wantto knowthefollowing: • The definition ofa dangerous waste (defined in

the Definitions section ofBook 

### 2: Guidebook and Codes and described in Helpful Hint #1 on page 2 ofBook

### 2: Guidebook and Codes). • The Quantity Exclusion Limit (QEL) ofthe

waste(s) you generate (discussed in Helpful Hint #4 on page 3 ofBook 

### 2: Guidebook and Codes and listed on pages 47-48 ofBook2: Guidebookand Codes). 

## In determining yourgenerator status, you should note thefollowing:
• Yourregulatory status, for compliance purposes, as a Large, Medium, or Small Quantity Generator (LQG, MQG, SQG) may change from one calendar month to the next, depending on how much dangerous waste, ofwhat Quantity Exclusion Limit, you generate in a given month or accumulate at any time. • The Quantity Exclusion Limit (QEL) ofa waste

is the quantity, by weight, at which the waste becomes regulated under the requirements for MQGs and LQGs, per WAC 173-303-070. There are two different QELs: • 220 pounds • 2.2 pounds The QEL List, on pages 47-48 ofBook2: Guidebookand Codes, identifies which dangerous wastes are subject to the 220 pound QEL and which to the 2.2 pound QEL. You need to know which QELs apply to your wastes so that you will know whether the quantities ofwaste you generate and/or accumulate make you a MQGor LQG. • What wastes to count to determine your generator status. 1) All monthly waste generation including waste manifested for offsite disposal. 2) All designated dangerous waste managed on site including: • Waste recycled on-site (e.g. distillation ofsolvent.)
• Treatment-by-generator • Your reporting status-that is, your generator status for purposes ofcompleting the Annual Report forms-is defined based on the greatest quantity ofdangerous waste you generated in anyone calendar month or accumulated at any time in 2000. For example, ifyou were an LQG for one calendar month in 2000, you are considered an LQG for the entire year for purposes of completing the Annual Report forms. That is, ifyou generated more than 2,200 pounds in anyone month in 2000-even ifyou did not generate that much waste in any other month in 2000-you must complete the Annual Report forms as an LQG for the entire year. • Wastes that do not count towards determining your generator status: 1) Wastes that are excluded under WAC 173-303-071. For example, domestic sewage. 2) Antifreeze sent for recycling, as defined in WAC 173-303-522. 3) Universal waste as defined in WAC173-303-573 including lamps, batteries and mercury containing thermostats.

. 4) Permit-by-Rule (PBR) waste managed immediately upon generation in on-site PBR units. 5) Recycled without prior storage or accumulation as described in WAC l73-303-120(4)(a). 6) Materials managed under the used oil regulations, WAC 173-303-515.



### Book 1: 2000 Forms and Instructions 

### 7Dangerous Waste Annual Report Now determine ifyou are a generator, a treatment/storage/disposal (TSD) facility, or a recycling facility. It is possible to be more than one-i.e., you may be both a generator and a TSDR. As you review the following criteria for determining your generator status, remember that your status, for purposes ofcompleting the Annual Report forms, is defined according to the greatest quantity ofwastes of common QELs that you generated in anyone month in the year and/or accumulated at any given time during the year.



### Am I a Large Quantity Generator (LQG)? Ifany ofthe following criteria apply to you, check the box. In anyone calendar month in 2000, did I 

### generate and/or accumulate: 

# o greater than 2,200 pounds ofdangerous waste(s) with a QEL of220.pounds, or 

# o greater than 2.2 pounds ofdangerous waste(s) with a QEL of2.2 pounds? 

### IfI checkedanyofthe above boxes, then I

### am a Large Quantity Generator.



### Am I a Medium Quantity Generator (MQG)? Ifanyofthe following criteria apply to you, check the box. In anyone calendarmonth in 2000, did I generate: 

# o 220-2,200 pounds ofdangerous waste(s) with a QEL of220 pounds? AND at all times during 2000, did I accumulate: 

# o ·less than 2,200 pounds ofdangerous waste(s) with a QEL of220 pounds? 

### IfI checked the above box, then I 

### am a Medium Quantity Generator. 

### Am I a Small Quantity Generator (SQG)? Ifany ofthe following criteria apply to you, check the box. In each calendar month in 2000, did I generate: 

# o less than 220 pounds ofdangerous waste(s) with a QEL of220 pounds, or 

# o less than 2.2 pounds ofdangerous waste(s) with a QEL of2.2 pounds? AND, at all times during 2000, did I accumulate: 

# o less than 2,200 pounds ofdangerous waste(s) with a QEL of220 pounds, or 

# . 0 less than 2.2 pounds ofdangerous waste(s) with a QEL of2.2 pounds? 

### IfI checkedanyofthe above boxes, then I am 

### a Small Quantity Generator. 

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8 

### Book 1: 2000 Forms and Instructions. Worksheet #1



### IfI checked this box, then I

### am a TSD. 

### .€>AmI aTreatment, Storage, or Disposal Facility (TSD)? Ifthe following criterion applies to you, check the box. 

### TSDR·

. 

# o My facility has filed a Part A application or has a Part B permit for the Treatment, Storage, or Disposal ofdangerous waste as required under WAC 173-303-800 to 840. (Do not check this box ifyour treatment activity is treatment-by-generator. These terms are defined in the Definitions section ofBook2: Guidebookand Codes.)



### I 

### a Commercial Recycling Facility? Ifthe following criterion applies to you, check the box. (Note 

### TSDR that this does not include those generators that recycle their own wastes on-site.)

. 

# o My facility recycles dangerous waste received from off-site, as described underWAC 173-303-120.


### IfI checked this box, then I

### am a Commercial Recycling Facility. 

# • Am I aTransporter? Ifthe following criterion applies to you, check the box

.. 

# o I transport dangerous waste as described under WAC 173-303-240

. 

### IfI checked this box, then I

### am a transporter. Sites thatare Transporters only 

### (i.e., did notmeet any ofthe criteria above forgenerators, TSDs, and commercial recyclers) should complete only the Verification Form.

# ~Am I aTransfer facilily? Ifthe following criterion applies to you: check the box. 

# o I am a transfer facility as described under WAC 173-303-040 and 240.



### If you fit into any of these categories, continue on to Worksheet #2 to determine 

### which forms you must complete. If you do NOT fit into any of these categories, but you 

### do have an active RCRA Site 10 Number, you are required to complete 

### onlythe 

### Verification Form.The instructions start on page 

### 13. 

# '.

Book 1: 2000 Forms and Instructions 9

# WORKSHEET #2 DETERMINING WHICH FORMS TO COMPLETE
This Worksheet isforyour use only. Do NOTsubmitthis Worksheet to Ecology.
Which forms do you need to complete? Use the information from Worksheet 

### #1 to help you determine which forms you need to complete.



# o I am a Large Quantity Generator. I must complete the following forms: • the Verification Form; and • the Generation and Management Form (front and back); and • the Off-Site Identification Information Form.


# o I am a Medium Quantity Generator. I must complete the following forms: • the Verification Form; and • the Generation and Management Form (front only); and • the Off-Site Identification Information Form.


# o I am a Small Quantity Generator. I must complete 

### only the Verification Form.



### 10 

### Book 1: 2000 Forms and InstructionsI

I I

# , I r

# !.

I 

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# l I

# I l r 

# t


# • Worksheet #2 

# o I am aTreatment/Storage/Disposal Facility. 

### I must complete the following forms: • the Verfication Form; and • the Generation and Management Form (front and back); and • the Off-Site Identification Information Form. If

### I received wastefrom off-site, 

### then I must also complete the Waste Received Form.


# o I am a Commercial Recycling Facility. 

### I must complete the following forms: • the Verification Form; and • the Generation and Management Form (front and back); and • the Waste Received Form; and • the Off-Site Identification Information Form
. 

# o I am a Transporter only. 

### I must complete ONLY the Verification Form.



# l


# • I am a Transfer facility only. 

### I must complete ONLY the Verification Form.



### Book 1: 2000 Forms and Instructions 11

### 12 Dangerous Waste Annual Report



# Page intentionally left blank .

Book 1: 2000 Forms and Instructions 

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J J 1

# • VERIFICATION FORM INTRODUCTION



# •

• Who needs to complete thisform? All companies/agencies with an active RCRA Site ID Number (WA ) at any time during 2000 must complete this form. They include: • Dangerous Waste Generators; • Dangerous Waste Treatment, Storage, and

Disposal Facilities (TSDs); • Dangerous WasteRecycling Facilities; • Dangerous Waste Transporters; • Transfer Facility; • Dangerous Waste Fuel Burners/Blenders/

Marketers; and • Used Oil Burners/Blenders/Marketers. The Dangerous Waste Annual Report Verification Form was developed as a means to streamline annual reporting. The information pre-printed on the VF comes from your 1999 Annual Report VF form (or your Notification ofDangerous Waste Activities ifyour site ID# is new). 

## SQG, Non-Generator, TransporteronlyandTransfer Facility If your site qualifies as SQG, non-generator,. transporter-only, or transfer facility for 2000 reporting, the VF is the only document that you need to complete and send to Ecology in order to satisfy your 2000 Annual Reporting requirement. However, ifyour status changed to a medium or large quantity generator in 2000, you will need to complete additional forms. 

## How do I complete the pre-printed form? Carefully review the information on your VF and mark any changes or corrections. Ifthere is information missing on the left hand column of the VF, please fill the information on the right side ofthe page. 

### II' Verify the information displayed in each numbered box la-5a on the left to see ifthe information is true and correct. 

### II' Mark changes 

### oradditions in the corresponding numbered box 1b-5b on the right, as needed. Please type or use blue or black ink. 

### II' Ownership Change in box 2a refers to company/agency/corporation that owns and operates the business. If the ownership changed in 2000, please provide the new owner information in box 2b. Indicate in the space provided the date the ownership change occurred and check the appropriate boxes. 

### II' 6.a Generator Status. Indicate the facility's generator status for 2000 by checking the appropriate box. 

### II' Check only the boxes that apply to your company. 

### II' Complete the Report Summary. Ifyou are an MQG or LQG, refer to the Worksheets #1 and #2 in Book 1 ofyour annual report forms to determine whether additional forms are to be included with your annual report. Include the total number ofpages for your report in section #7. 

### II' For electronic data submittal, please indicated method ofyour submission in Section #7. 

### II' Do not mail your VF Form separately if your facility is required to submit additional forms

.



### .II' Sign and date your VF in ink in Section #9.



### Book 1: 2000 Forms and Instructions 13Dangerous Waste Annual Report



## If you misplaced or did not receive a pre-printed VF from Ecology Call Ecology at (800) 874-2022 (within state) (360) 407-6170 to request one. You may also use the blankVF which fol1ows on page 17. Note: Ecology will not accept any facsimile ofthe VF Form. Please type or print legibly in blue or black ink the information requested on the right hand column ofquestions 1 through 5 and answer appropriately for questions 6 and 7. Sign the VF in ink, and return it to Ecology along with any additional annual report forms required. Please do not send your VF separate from the rest ofyour report. 

## What information does this form collect? This form collects information about your site, such as the name ofyour business; the name, address, and phone number ofa contact at the site; and the regulatory status ofyour site (e.g., generator or TSDR). 

## What information will I needto completethis form? You will need general information about dangerous waste activities at your site. Completing Worksheet # 1 on pages 7-8 should help you identify these activities. You also will need general information regarding your site's regulatory status, the names and addresses ofsite contacts, and some general information regarding the site itself. 

## Helpful Hints Complete Worksheet # 1,beginning on page 7, before completing this form. The following docu- 

# 0
ments should help you:

• Copies ofyour most recent Notification Form

(Form 2) on which you notified Ecology and EPA ofyour dangerous waste generation and management activities; and
• Copies ofyour dangerous waste shipment

manifests (ifrelevant). • Logs and/or records for on-site waste management acitiviites.

14 

### Book 1: 2000 Forms and Instructions

### 15 

# •

• Verification Form 

# VERIFICATION FORM QUESTIONS
This is a question sheet. Record your answers on the Verification Form (VF) (either the pre-printed VF you received from Ecology or a blank VF from Book I ofthe Dangerous Waste Annual Report). Please read all instructions before completing the form. 

## i Site Location Information ,Ifblank, complete the missing information in the sections provided.



# I Questions 1·-·5 Complete any missing information (blank boxes) in the corresponding (b) section on the right. 

### 1. Mailing address The address where site mail is to be delivered (deliverable mail address). 

### 2. Legal owner The name/mailing address/telephone number ofthe company/agency/corporation that owns the business. Ifthe ownership changed in 2000, provide the new information in box 2b and check the appropriate boxes. 

### 0' Indicate when in 2000 the ownership change occurred. 

### 0' Indicate which owner you represent (current, previous or both). 

### 0' Indicate ifthis report covers the waste activity for the entire year or for your company's term of owner ship only. 

### 0' Ecology will now accept the Verification Form in lieu ofupdated Notification (Form 2) reporting. WAC 173-303 ofthe Dangerous Waste regulations will be revised in 200 I to reflect this administrative policy change. 

### 3. Land Owner The name/title, mailing address, telephone number ofthe owner that owns the property the business is located on. 

### 4. Contact for site inspections The name/title, mailing address, telephone number ofthe person for site related questions and inspections. 

### 5. Contact for annual reports The name/title, address, telephone number ofthe authorized person within your company for annual reporting questions and to whom future reports should be sent.

6a. Generator Status Indicate your facility's 2000 generator status by checking the appropriate boxes) on the form. 

### Small quantity generator, no regulated dangerous waste generated or transporter: Check this box if your status falls into one ofthese categories. The VF form is the only document that you need to complete and submit to Ecology in order to satisfy your 2000 Annual Reporting requirements. 

### Book 1: 2000 Forms and InstructionsDangerous Waste Annual Report


# o Medium or large quantity generator: Ifyour status falls in one ofthese categories you are required to complete and submit the following forms:

• Generation and Management Form (GM)
• Off-site Identification Form (01)

- ifyou shipped waste off-site for management in 2000 

# o Treatment, storage, disposal, and recycling facilities (TSDRs): Ifyour status falls into one of these categories you are required to complete and complete the following forms:

• Generation and Management Form (GM)
• Off-site Identification Form (01) • Waste Received Form (WR) 6b. Transportation Activities Check only the boxes that apply to your company. 

# o You transport your own waste off-site (this does not include hiring a business for this 

# €> service).

NEW 

### 0 You transport waste from other facilities for commercial purposes. 

# o You own or lease and operate a transfer facility. 6c. Treatment, Storage, Disposal, Recycling (TSDR) Facility Check only the boxes that apply to your company. 

# o For waste generated at this facility

- your facility has filed a PartA application or has a Part B permit. 

# o For waste generated by other facilities - you are a recycling facility that recycles dangerous waste received from off-site 6d. Excluded On-site Waste Management Check only the boxes that apply to your company. 

# o Permit-by-Rule (PBR) - waste managed immediatelyupon generation and only in on-site PBR units. 

# o Recycling without prior storage or accumulation 

### Question 

## 7
Indicate which forms and/or electronic data files you are submitting in your annual report. Include the total number ofreport "paper" pages being submitted to Ecology. Ifyou are claiming recycling credits, the supporting documentation from your TSDR must be attached to your VF form (for electronic submittals) or at the end ofyour report (for paper submittals).



### Question 

## 8

Use the Comment Section on the VF to provide any additional comments, information, or explanations, as necessary. In your comments, always provide the reference to the specific question (e.g. 6a.). 

### Question 

## 9

Sign the VF Form. Your form must be submitted to Ecology with the signature, in ink, ofan 

### authorized representative ofyour site. Refer to-

### Book1, 

### page4, 

### "Certification" for additional details. 

# c



# o

o

16 

### Book 1: 2000 Forms and Instructions

### I 

## 2000

Verification

## I

Page 1 of _ 

### This Report is Due No Later Than March 1, 2001 HWIMSy Entry Review OM VF
WR

Primary SIC: Form For Ecology Use Only - Date Received:

Name: Mail Address: County: Verification Form

Washington State Department of Ecology Hazardous Waste Information P. O. Box 47658 Olympia, WA 98504-7658 (800) 874-2022 (within state) (360) 407-6170 

### Dangerous Waste Annual Report Verification Form

Allinformation listedbelowIs required. Ifinformation is missing orincorrect, please enterthe changes in the righthandcolumn. WASHINGTON STATE OEPARTMENT OF 

## ECOLOGY

RCRA Site 10: Company Name: Site Location: City/State/Zip: Dept. of Revenue Tax Registration Number: Current company name if different from above 

# I Name Mall Address:

,c .•. ,,":'.:;**:;;2~>. ,~**  Name: Name: Mail Address: Mail Address:
Work Phone: Ext: Phone: Ext: Did the company ownership of this site change in 20007



### 0 I represent the This report covers waste activity for: Yes Date: 

### 0 Current Company Owner 

# o Entire year (continue to the right): 

### 0 0 Previous Company Owner 

# o My term of ownership only No (go to 3a):

•**0~** !':ITP.>-I!':;,C, ,.;/.": ••,, '::/<."**~;b:;,:** .. ·:...••·.....•...•< .:..... .. 

# ... Name: Name: Mail Address: Mail Address:
Phone: Ext: Work Phone: Ext:

....

## 0.~': .. ;

" " 3" . .• < 

# .. ., .. , 

## ...- "':";:;\) 

## . ... NamelTitle: NamelTitle: Mail Address: Mail Address:
Work Phone: Ext: Work Phone: Ext: IS::I".**TqL~I:' ;~**  .5b

. "". 

# ".
.. . . «.:';

.

### ... . NamelTitle: NamelTitle: Mail Address: Mail Address:



## . Work Phone: Ext: Work Phone: Ext: 

# • • I t 

## I 

# f·.

t


### t r. 

# I

Book 1: 2000 Forms and Instructions 17Dangerous Waste Annual Report 6. Generator Status and Waste Management Activities

Indicate the facility's generator status for 2000 by checking the appropriate boxes below. If your status has changed from last year, please use the Comments section (#8, below) to explain. 

# c

6a. Generator Status



### D Large Quantity Generator (LQG) 

### D Medium Quantity Generator (MQG) 

### D Small Quantity Generator (SQG) 

### D No regulated dangerous waste generated 6c. Treatment, Storage, Disposal, Recycling (TSDR) Facility (Requires Permit) 

### D For waste generated at this facility 

### D For waste generated by other facilities 6d. Excluded On-Site Waste ManagementActivities (for waste streams that are not reported on a GM form) 6b. Transportation Activity (requires prior notification)



### D Transporter for your own waste 

### D Transporter for commercial purposes 

### D .Transfer facility 

### D Permit-by-Rule - (PBR) 

### D Recycling without prior storage or accumulation

Recycling Credit documentation attached (paper only)

8. Comments Data submitted on Internet 7b. Electronic Data Submittal 

# o For electronic data


### D Verification (VF) Form (paper only) 

### D Disk(s) included 

### D D 7. Report Summary Please check off which forms are included in this report and provide the total number of pages. submittal, please indicate method of your submission.

7a. Paper Form Submittal



### D Verification (VF) Form 

### D Generation and Management (GM) Form 

### D Off-site Identification Information (01) Form 

### D Waste Received (WR) Form 

### D Recycling Credit documentation attached 

# c=J Total Number of pages submitted

9. Certification The following must be signed by authorized representative of the company/agency. This certification language is required under EPA's Biennial Report. Ecology is required to implement reporting requirements at least as stringent as those in that report. I certify underpenaltyoflaw that this document andall attachments were prepared undermy direction or supervision in accordance with a system designed to assure that qualifiedpersonnelproperlygatherandevaluate the information submitted. Based on my inquiry ofthe person orpersons who manage the system, or those persons directly responsible for gathering the information, the information submittedis, to the best ofmy knowledge andbelief, true, accurate and complete. Iam aware that there are significantpenalties for submitting false information, including the possiblityoffine and imprisonment for knowing violations. Signature (in ink) Name (print/type) Date Title If you have special accommodation needs or require this document in an alternative format, please contact the Hazardous Waste and Toxics Reduction Program at (360) 407-6700 (voice) or (360) 407-6006 (TOO). Do Not FAX this document unless requested by the Department of Ecology. Page 2 of

__ 

# o

18 Book 1: 2000 Forms and Instructions

# • GENERATION AND MANAGEMENT FORM INTRODUCTION
Who needs to complete thisform?



# •

• All MQGs, LQGs, and TSDRs must complete a Generation andManagement (GM) Form for each waste stream. (Small Quantity Generators do nothave to complete this form. SQGs should complete only the Verification Form, beginning on page 15.) See the Definitions section ofBook2: Guidebookand Codes, 

### for defmitions ofLQG and MQG.Also refer to Worksheet #1 on pages 7- 8 and Worksheet #2 on pages 10-11, to determine whether GM Forms are required for your generator status. 

## Whatinformation do I need to complete this form? To complete this GM Form, you need detailed informationon the dangerous waste generated and then managed or shipped off-site from your site. For each waste streamthat you identify you need to know how much was generated, how it was managed in 2000, and where and how it was managed. 

## Helpful Hints

• Questions and Answers: This form is in two

parts: a question sheet and an answer sheet. The answer sheet is perforated. You may wishto separate it from this book and lay it alongside the questions as you answer them. Fill out one answer sheet for each waste stream generated at your site and then managed. For both the answer and the continuation sheets, be sure to complete the "Please Enter" box at the top ofthe pages ofthe answer sheet. Fill in your RCRA Site ID Number and site name. Do not enter any information in the spaces marked "For Ecology Use Only." Then make as many copies of the sheets as you will need for each waste stream. Double sided pages are encouraged. • How to identify a dangerous waste stream: See "What is a dangerous waste?", Helpful Hint #1 and #2 on page 2 ofBook 

### 2: Guidebook and Codes, 

### for help in identifying a dangerous waste. Use the following guidelines to identify an individual waste stream: • A single waste stream may have several

waste codes (questions A-3 andA-4). Waste codes are identified in WAC 173-303. • A single waste stream will designate either as

dangerous waste (DW) or extremely hazardous waste (EHW), not both (questionA-5). Thus, ifyou generate a waste stream that is sometimes EHW and is OW at other times these are actually separate waste streams and should be reported on separate GM Forms. • A single waste stream will be either a mixed

radioactive waste or not (question A-6). Mixed radioactive wastes (see the definition in the Definitions section ofBook

### 2: Guidebookand Codes) 

### should never be combined with non-radioactive dangerous wastes. Thus, a mixed radioactive waste stream will always be reported on its own GM Form. • In most cases, a waste stream will have only

one source (questionA-7). Source codes are listed on page 41 ofBook 

### 2: Guidebookand Codes. An 

### example is A07, vapor degreasing. • A waste stream will have only one form

(question A-8). Waste form codes are listed on pages 42-43 ofBook

### 2: Guidebookand Codes. An 

### example is BIOI, aqueous waste with low solvents. • Each dangerous waste stream will have one

origin (question A-9). For example, the waste may originate from a recurrent or from a non-recurrent activity. Origin codes are listed in question A-9 and on page 44 ofBook 2: Guidebook and Codes.



### Book 1: 2000 Forms and Instructions 19Dangerous Waste Annual Report
Please note that Ecology asks you to use your bestjudgment in defining the individual waste streams you generate and report. Ecology recognizes that the complexities ofdangerous waste generation and management are sometimes difficult to portray in the context ofa standardized form with a series ofstandardized codes. In certain instances, the coding scheme may not allow you to portray your waste in a fully accurate manner. Follow the guidelines listed above to the best ofyour ability when identifying a waste stream at your site and assigning what you believe to be the best codes to describe that waste stream.

• Which wastes to report on your GM Form: Book2: Guidebookand Codes for instructions on how to complete the GM Form for those waste streams.

• On-site ManagementActivities: On-site management ofa dangerous waste includes on-site recycling (distillation for example) and treatment-by-generator. In contrast, offsite management refers to all manifested waste that you ship to a TSDR. Ifyou generate a dangerous waste stream, manage it on-site, and a dangerous waste residual is generated from this management, you have generated two separate waste streams and need to complete two separate GMForms. DO report all dangerous wastes generated and then managed on-site during 2000. • DO report all dangerous waste shipped during 2000 for management off-site. DO report all dangerous wastes that were managed according to treatment-by-generator guidance* (*see definitions, Book 2 page 23).

• Which wastes NOT to report on your GM Form: For example, you recycle used paint thinner at your site by running it through a still. Dangerous waste still bottoms result from this activity. The still bottoms are shipped off-site to your TSDR for fuel blending. You need to complete two GM Forms: 1. On the first GM Form, describe the spent solvent (paint thinner). Indicate that the waste's origin (question A-9) is from recurrent generation (origin code i); and that its management (question B-3) is from distillation (system code M021). 

# o

DO NOT report excluded wastes as defined by Chapter 173-303 WAC (e.g., do not report TSCA [Toxic Substances Control Act, 40 CFR Parts 700-799] wastes such as PCBs unless they also classify as dangerous waste). DO NOT report waste accumulations that were generated during 2000 but were not managed on-site or shipped off-site during 2000. DO NOT report wastes that are excluded such as antifreeze that is recycled, materials managed under the used oil regulations (WAC 173-303-515), universal waste, * permit by rule, * or waste recycled on-site without prior storage or accumulation* (closed loop recycling) (*see definitions, Book 2, page 23).

• Lab packs: Ifyou generate a lab pack waste stream; refertoWorksheet-#3-onpage 1Lof

2. On the second GM Form, describe the still bottoms. Indicate that the waste's origin is residual from managing a previously existing dangerous waste (origin code v); and that its management (question B4ii) is off-site fuel blending (system code M061).

• Ecology has developed guidance on how to count generation, on-site recycling and management ofa dangerous waste. You may need to refer to this guidance as you calculate your waste generation quantities for two purposes: for determining your generator status on a monthly basis; and for determining how to complete the Annual Report forms. To request Publication 98-414, Counting Dangerous wastelUnder th le Dangerous 

# 0 Waste Regulations, p ease cal Ecology at 1- 800-874-2022 (within state) or (360) 407- _6L70. 

### 20 Book 1: 2000 Forms and Instructions

# -. Generation and Management Form



# i 

# f.

r


### r I



# • • Reporting treatment-by-generator activi- • ties: As you complete the GM Form, you will be asked whether you manage the waste stream on-site or off-site. Ifyou answer "onsite," then you will be asked to indicate whether that on-site management activity is conducted according to the treatment-bygenerator guidance. Ecology, in Technical Information Memorandum (TIM) #96-412, has set forth guidance on how generators may conduct certain types ofdangerous waste treatment activities on-site without first obtaining review, written approval, or a permit from Ecology. SpecificalIy, the guidance addresses filtration, separation, evaporation, carbon adsorption, elementary neutralization, and solidification. You are allowed to conduct such treatment activities on-site without a permit ifyou follow the instructions in the TIM. Ifyou are unsure whether you are handling a waste stream according to the treatment-by-genera-

# €>
tor guidance, please refer to TIM #96-412, TSDR available from Ecology at (360) 407-6752. For specific questions on treatment-by-

. generator activity, please call your Ecology regional office (see back cover ofBook 1).

• Reporting storage/transfer activities: If you are conducting storage/transfer ofa dangerous waste stream (see the definition of storage/transfer in the Definitions section of Book

### 2: Guidebookand Codes), 

### then you should follow these special instructions for storage/transfer ofthe waste stream on the GMform: For question A-7, source code, assign code A80, indicating that the waste is a storage/ transfer. For question A-9, origin code, assign code 

### iv, indicating that the waste is a storage/transfer. Complete the other questions on the form as appropriate, given the nature ofthe waste stream and your handling ofit.

• Reporting extended storage: Ifyou hold a RCRA storage permit, please review Worksheet #6 on page 17 ofBook

### 2: Guidebook and Codes, 

### before completing this form. Waste shipments to foreign countries: Refer to Helpful Hint #8 on page 8 ofBook 2: Guidebookand Codes 

### for guidance on how to report shipments ofdangerous waste to foreign countries.



### Book 1: 2000 Forms and Instructions 21

# GENERATION AND MANAGEMENT FORM QUESTIONS

This is a question sheet. Record your answers on the separate answer sheet! (One answer sheet for 

### each dangerous waste stream managed during 2000.) Please read all of the instructions before completing the answer sheet. Enter your RCRA Site 10 

### Number and site name where indicated on the answer sheet before making as many copies of the answer sheet as you will need to report each of your waste streams. Each dangerous waste stream should be reported on a separate answer sheet. Do not report any waste 

### stream that was generated during 2000 but not managed or shipped off-site until 2001. This waste should be reported next year on your 2001 Annual Report.



## A. Description of Dangerous Waste Stream
Ifyour waste stream is a "lab pack," please review Worksheet #3, on page 11 ofBook

### 2: Guidebook and Codes, before completing this form. Ifyou hold a RCRA storage permit, please review Worksheet #6 on page 17 ofBook2: Guidebookand Codes, before completing this form. 

### A-1. What is your "profile" code? (Optional.) This data element is provided for your optional use to help you track the waste profiles or waste streams that you report on the Annual Report. You may enter any desired information that will help you relate the waste streams you generate and manage in your facility to how you report in the Annual Report. This data element is provided solely for your use; Ecology will not use this information in any way. 

### A-2. Briefly describe the dangerous waste stream reported on this form. Please describe the waste stream as you best recognize it. Limit the length ofyour description to 70 characters, including spaces; although you may prepare a longer description, Ecology will only record the first 70 characters in its information system.
Note: Ecology can no longer accept D.O.T. hazardous classs names from manifests such as; "toxic liquid flammable, organic, N.O.S."; "selfreactive liquid, type B", etc .. Please provide a more recognizable description such as; "used paint thinner"; "electroplating wastewater"; "stabilized solid generated from stablizing wastewater treatment sludge", etc.. 

### } 

## 'i

# I I 

# 0 1



# o

o.

22 Book 1: 2000 Forms and Instructions

# Ie

I I 

## I 

# l I

## ~.

# , , I I I

# , , , I 

# I

I

### I 

## i
I

# Ie I. I ' Generation and Management Form



### A-3. Which EPA hazardous waste code(s) are associated with this waste stream? Do not enter Washington state-only dangerous waste codes in this section. EnterWashington state-only codes under questionA-4. EPA hazardous waste codes begin with a P, U, F, K, or D. They are provided in WAC 173-303-081 and 082 and WAC 173-303-090. Enter up to six codes. Ifyou need to list more than six codes, continue in Section C, Comments; please reference question A-3 in your comments. 

### A-4. Which Washington state-only dangerous waste code(s) are associated with this waste? Do not enter EPA waste codes in this section. Enter EPA codes under questionA-3. Washington state-only dangerous waste codes begin with a "W". They are referenced in Helpful Hint #2 (page 3 ofBook2: Guidebookand Codes) and are provided in WAC 173-303-082, 090, 100, 104, 180, and 9904. Ifthese codes apply to your waste, enter up to two in the spaces provided. Ifyou need to list more than two codes, continue in Section C, Comments; please reference question A-4 in your comment 

### A-5. What is the designation of this waste stream? Indicate whether the waste is designated Dangerous Waste (DW) or Extremely Hazardous Waste (EHW) 

# k -, Helpful Hints #1 and #2, on pages 2 and 3 ofBook2: Guidebookand Codes, will help you designate your wastes per WAC 173-303. WL01, WP01, WP03, and WTOI are the only dangerous waste codes that designate as EHW. Ifnone of these codes apply to your waste, then enter the designation ofDW.



# e A-6; Is this a "mixed radioactive" waste? Mixed radioactive wastes are wastes that are both: • dangerous as defined by WAC 173-303-080 through 173-303-104 (see "What is a dangerous waste?",

Helpful Hint #1 on page 2 ofBook2: Guidebook and Codes); and • radioactive as defined by the Atomic Energy Act. Radioactive waste that is not mixed with a dangerous waste should not be reported on this form.



### Book 1: 2000 Forms and Instructions 23Dangerous Waste Annual Report
A-7. Which source code best identifies the (production, service, management process, or clean-up) activity associated with the generation of this waste stream? Select one. Source codes can be found on page 41 ofBook 

### 2: Guidebookand Codes. The source code describes the process (e.g., painting, degreasing, clean-up) associated with the generation ofthis waste stream. Please select the code that best describes the source ofthis waste stream. Ecology recognizes that it may be possible to assign a number ofsource codes to an individual waste stream. Ecology asks you to identifyjust one source code in this report. 

### A-S. Which form code best describes the form of this waste stream? Select one. Form codes can be found on pages 42-43 ofBook2: Guidebookand Codes. The form code describes the form ofthe waste stream (for example, mixed lab packs, scrubber water, oily sludge). Please select the one code that best describes the form ofthis waste stream. Ecology recognizes that it may be possible to assign a number ofform codes to an individual waste stream. Ecology asks you to identifyjust one form code in this report.

. A-9. What is the origin of this waste stream? Select one. Select the one option that best describes the origin ofgeneration for this waste stream. i. The waste stream is recurrent: it was generated on-site from a production process, a service activity, or a routine cleanup (including off-specification or spent chemicals). ii
. The waste stream is non-recurrent: it is the result ofa spill cleanup, equipment decommissioning, or other remedial cleanup activity. iii. The waste stream is a residual derived from the management ofa non-dangerous waste. iv. The waste stream is a storage/transfer: it was received from off-site and was not treated, recycled, or disposed on-site before being shipped off-site. (See the Definitions section ofBook2: Guidebook and Codes for the definition ofstorage/transfer.) 

### v. The waste stream is a residual derived from the management ofa previously existing dangerous waste stream. Ifyou specify this origin code, please go to questionA-9.a.
A-9.a. Ifyou specified origin code vin question A-9 (l.e., the waste is a residualfrom management of a previously existing dangerous waste stream), 

### enter the system code for the management system that generated the waste. System codes can be found on pages 45-46 ofBook2: GuidebookandCodes. For example, ifthe waste stream reported on this form is still bottoms from the distillation of waste paint thinner, enter system code M021, the code for fractionation/distillation. 

# 0 1



# o

24 ---------------- - ---------. 

### Book 1: 2000 Forms and InstructionsGeneration and Management Form
I 

## : B. Waste ManagementActivities

This section collects information on the management-treatment, storage, disposal and recycling-of dangerous waste. Do not report waste in accumulation. ' 

### I

# , 

# ,- , ,
I

# I • 

# /f', W· Ifthe waste stream received consecutive treatment by more than one type ofmanagement, only report
. the first activity on this form. Ifin treatingthe waste stream a dangerous waste residual is generated, then that residual constitutes a new waste stream that must be reported on a separate GM Form answer sheet. For example, you recycle on-site spent solvents in a still for solvent recovery, this recycling activity generates a dangerous waste still bottom in which case two GM Form answer sheets are required. 1) to report the management ofspent solvent 2) to report the management ofthe still bottoms 

### B-1. What was the total amount of this individual waste stream managedin 2000, and what is the unit of measure?

Ifyou select G,L, or C, go to question B-l.a. Ifyou select ST, MT, P, or K, skip to question B-2. 

### B-1.a. If .the waste stream is measured in gallons, liters, or cubic yards, what is its density? Answer this question onlyif you specified G, L, or C, in question B-1. Check the appropriate code for the unit ofmeasure used: ST=ShortTons; MT=Metric Tons; P=Pounds; K=Kilograms; G=Gallons; L=Liters; and C=Cubic Yards. You must use the same unit of measure when responding to questions B-3, B-4 and B-5.

Density information for the constituent chemicals in the waste is provided on Material Safety Data Sheets. You should estimate the density ofthe waste stream based on that or other information available to you. Ifyou do not provide a density, the density ofwater (8.34 pounds/gallon) will be assumed for wastes measured in gallons or liters; the density ofsoil (2,700 pounds/cubic yard) will be assumed for wastes measured in cubic yards. Be sure to check the unit ofmeasure box (e.g. lbs/gal). 

### Was this dangerous waste stream managed (treated, recycled, or disposed of) onsite or off-site in 2000? Remember on-site management includes on-site (not immediate) recyclinq, or treatment-by-generator. Off-site management refers to all manifested waste shipments to a TSDR. B-2. Provide the total amount ofthis waste stream that was managed in 2000. Ifyou manage this waste stream onsite, you should.indicate the total volume ofthe waste stream that entered your on-site management system in 2000. Ifyou sent this waste stream off-site for management, you should add the quantities ofthis waste stream manifested in 2000. Do not exceed two decimal places when reporting yourwaste amounts.



# o

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

# -

"

# ,

, I

# , I I I I I I I t I I
I



# - 1.This dangerous waste stream was managed on-site (treatment-by-generator activity)---+ answer B-3 and then skip to section C. 2.This dangerous waste stream was managed off-site ---+ skip to question B4. 3.Part ofthis waste stream was managed on-site and part was managed off-site ---+ answer both B-3

and B-4. 

### Book 1: 2000 Forms and Instructions 25Dangerous Waste Annual Report

Remember-ifthe waste stream was first managed on-site and its residual (see Book 2 for definition of residual) was managed off-site, you should report only the on-site management here. The residual is a separate waste stream, and its generation'and management should be reported on a separate GM Form answer sheet. As you complete the remaining questions in this section, please note the following: 

# o

• Ifyou manage the waste stream entirely on-site, then the quantity that you enter in question B-3 should

equal the quantity that you entered in question B-1. Ifyou manage the waste stream entirely off-site, then the quantity (or quantities) that you enter for question B-4 should equal the quantity that you entered in question B-1.

• Ifyou manage the waste stream both on-site and off-site, then the quantities that you enter in questions

B-3 and B-4 when added together should equal the same quantity that you entered in question B-1. 

### B-3. If all or part of this dangerous waste stream was managed on-site in 2000, how much was managed on-site and how was it managed? Ifyou managed this waste stream on-site, provide an annual aggregate quantity for each method in which the waste stream was managed on-site. Do not attempt to list monthly generation/management quantities anywhere else in this GM Form or on the WR Form. Space is provided on the answer sheet to report management ofthis waste stream on-site by one system type. Ifyou need additional space-i.e., to report a second on-site management method-use Section C, 

# 0 Comments; reference question B-3 in your comments. Only report on additional management methodes) in the Comments Section for those circumstances when you managed the waste on-site one way part of the time and another way another time. Do not attempt to report sequential management ofthe waste stream (i.e., neutralization followed by chemical precipitation). Rather, continue in the Comments only if the waste stream was managed on-site by entirely different systems, rather than in two sequential systems. Please refer to Worksheet #4, on pages 12-13 ofBook2: Guidebookand Codes, for help in identifying a management system. After you have reviewed that worksheet, select the appropriate system code from the list on pages 45-46 ofBook

### 2: Guidebookand Codes. Use the same unit ofmeasure as in question B-1.
B-3.a. For on-site management, indicate whether this waste stream was managed according to the treatment-by-generator guidance. Refer to the discussion oftreatment-by-generator on pages 20-21 of this book. Ifyour on-site management activity is recycling (e.g. distillation) then answer "no" to B-3.a. ( ( ( 

### ( [ ( 

### I
( I



### 26 B-4. Indicate the amount of this waste stream that was managed at off-site facilities in 2000. Do not attempt to report on-site management ofthis waste stream here. Only report on-site management in question B-3. Provide the following information: 

### i. The RCRA Site ill Number ofthe designated facility (TSDR

- not transporter) to which you directly shipped this waste stream. Reference section 9 and 10ofyour waste manifest for the name and RCRA Site ill number (or US EPAill number) ofthe designated facility that received your waste. Transporter information is only entered on the 01 form.

--**-~-** --- - ---------- 

### Book 1: 2000 Forms and Instructions 

# o!

I ----1

# • o Generation and Management Form ii . 

### The system code for how this waste stream was managed at the designated facility identified in 

### item i 

### (system codes are listed on pages 45-46 ofBook

### 2: Guidebookand Codes). 

### You should contact the designated facility ifyou have questions about which system code to assign. 

### Be careful in completing this information! Be sure to specify the management that the facility identified in item i 

### provided this waste stream. If, for example, you sent this waste stream to a TSDR, provide the system code for the type ofmanagement that the TSDR provided the waste stream. If, for example, the TSDR sorted the waste stream and then 

### sent it on to a landfill, do not 

### specify the system code for landfill; rather, indicate that the TSDR conducted a storage/transfer-system code M141, storage/transfer. In other words, always specify the direct, 

### rather than the ultimate, management of the waste stream-that is, that managementprovided by thefirst 

### facility (or TSDR) to which you shipped the waste stream.
iii. 

### The total quantity ofthe waste stream that was sent in 2000 to the facility specified under item 

### i for the management identified in item 

### ii, above (use the same unit ofmeasure from question B-1).



# ,.0

, l
, 

## i 

# I ! I 

### I I I 

## I I

# •• iv. 

### The percent ofthis waste stream that was recycled by the facility providing ultimate off-site management identified in item 

### i. This column is optional. It 

### is provided if you wish to obtain a recycling credit for the portion ofthis waste stream that was recycled off-site in 2000. Please refer to Worksheet #5, on pages 14-16 ofBook

### 2: Guidebookand Codes, 

### for detailed information on whether you qualify for recycling credits and how to obtain the credits. Ifno recycling credits are claimed, please leave blank. Remember to attach written documentation from your TSDR to confirm your recycling credit c1aim(s). Claims for recycling credits without documentation will be denied. Ifthe facility identified in 

### i managed the waste stream in different manners during the year, then do the following:

• "ditto" the RCRA Site ID Number ofthe facility to whom you sent the waste on two or more lines (as many as are needed to capture the different types ofmanagement that different portions ofthe waste received); • enter one system code in each row; • enter in each row the quantity ofwaste that went to the system code identified in 

### ii; and

• ifapplicable, enter the percent ofthe waste that was recycled in the system code identified in 

### iii.



### Book 1: 2000 Forms and Instructions 

### 27Dangerous Waste Annual Report
Spaces are provided to identify up to four off-site facilities. Ifyou need additional lines, please continue in Section D, Comments. Reference question B-4 in your comments. Ifyou are an LQG or a TSDR, proceed to question B-5. Ifyou are an MQG, skip to Section C, Comments, ifappropriate; otherwise, you have now completed this form. Remember

- Ifany ofyour waste is managed off-site, you must complete the Off-Site Identification Information (01) form beginning on page 33. 

# o

B-5. Please provide the following individual off-site shipment information for this waste stream. 

### (Only LaGs and TSDRs are required to complete this question.) Provide the following information. Ifyou need to repeat information on multiple lines (for example, many shipments to a single facility), you may use ditto (") marks to represent therepeated information. i. The shipment date (mm1dd). ii . The manifest document number 

### iii. The internal tracking code, optional. This is provided for your optional and internal use. Ecology has created this column in response to comments from members ofthe regulated community that such a column would help them to relate their internal waste tracking systems to the information they provide on theirAnnual Report forms. This column allows you to enter any internal information or code that your company may wish to use to track shipments. Ecology does not require you to provide this information and will not use it in any way. Please use this column ifand how you 

# 0 see fit. iv. The RCRA Site ID Number ofthe facility to which you directly shipped the waste (please review the instructions under item 

### i. ofquestion B-4). v. The quantity ofthis waste stream in this shipment to the facility identified in item 

### iv (use unit of measure from question B-1). Note that the shipment quantities that you list here should, in total, equal the quantity (or quantities) you identified in question B-4. Spaces are provided to list up to 18 shipments ofthis waste stream. Ifyou sent this waste stream off-site in more than 18 shipments in 2000. Please use the continuation sheet (page 31) to provide the additional information under question B-5. Or see page 5 for instructions on providing a computer-generated answer sheet.



### 28

# C. Comments
Use the Comments Section on the answer sheet to provide any additional comments, information, or explanations, as necessary. In your comments, always provide the reference to the specific question number (e.g., A-7).



### Book 1: 2000 Forms and InstructionsReference the instructions on pages 19 through 28 as you complete this form. Please type or print legibly in blue or blackink. 

## A. Description of Dangerous Waste Stream 

# GENERATION AND MANAGEMENT FORM ANSWER SHEET Please enter your RCRA Site ill number and your site name in the small box at the right, before making as many two-sided copies ofthis answer sheet as you will need to report each ofyour waste streams. Then complete one answer sheet for each waste stream. PLEASE ENTER: YOUR SITE 10#:

_ Site name:

_

FOR ECOLOGY USE ONLY: Date received:

_



### A-l.

_ (optional) A-2.

_



## B.Waste Management Activities A-3.

_ A-7. A _ 

### A-4.

_ Dyes

A-9.a. M

_

B-1.a. 1:) 

### Lbs/gal D Specific Gravity D Lbs/yd" A-6. 

### D No

D ST D MT D P D K D G 

### 0 L Dc (lfG, L, orC, answerB-1.a.) A-9. DiD 

### ii D 

### iii D 

### iv D 

### v (If

### v, answer A-9.a.) DEHW DDW

B-1.

_ 

### A-5. A-8.B

_ 

# t 

# I. I

J 

## i 

# l I ,I l I I 

### I B-2. DOn-site DOff-site D Both B-3. M

__ B-3a. 

### Dyes DNo


# • B-4. 

### t. Designated Facility (TSDR) ID Numbers 

### ii
. System Code M

_ 

### M _ M _ M _ 

### iii. Quantity 

### iv. RecyclingPercent



### Page Book 1: 2000 Forms and Instructions 

### 29Dangerous Waste Annual Report

PLEASE ENTER: YOUR SITE ID #:

_ Site name:

_ 8-5. To be completed 

### byLQ.G 

### Be TSDR only. 

# c

i. Date Shipped (mm/dd) ii
. Manifest Document Number iii. Internal Tracking Code (optional) iv. Desigation Facility (TSDR) RCRA Site ID Number v. Quantity Shipped



# o

30 H additional space is required, use continuation sheet on the following page. 

### C.Comments**--~-** 

### --- ----Page------- 

### Book 1: 2000 Forms and Instructions 

# oPLEASE ENTER:

Sitename:

_ Your SITE ID #:

_ 

# •

•

• GENERATION AND MANAGEMENT FORM ANSWER SHEET (CONTINUED)

805. (Continued)

i. Date Shipped ii . Manifest Document iii. Internal Tracking io. Designated Facility (TSDR) v. Quantity Shipped (mm/dd) Number Code (optional) RCRA SITE ID Number

Page

_ 

### Book 1: 2000 Forms and Instructions 31Dangerous Waste Annual Report



# You're not done yet. ..... MaG and LaGs (with off-site shipments) and all TSDRs continue on to the 01 Form: 

# o



# o

# I 1 

# I

32 - - - -- - -**----------~---** --

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

### Book 1: 2000 Forms and InstructionsI



### I 

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# • OFF-SITE IDENTIFICATION INFORMATION FORM INTRODUCTION

Who needs to complete thisform? All Large Quantity Generators, Medium Quantity Generators, Treatment/Storage/Disposal Facilities, and Recycling Facilities that sent dangerous waste off-site or received dangerous waste from off-site during 2000 must complete this Off-Site Identification Information (01) 

### Form. 

## What information does thisform collect? The 01 

### Form collects the RCRA Site ID Number, name, and address ofall off-site installations and transporters with whom you interacted in 2000 in the process ofsending dangerous waste off-site or receiving dangerous waste.from off-site. 

## What information do I need to complete thisform? To complete this form, you need to know the RCRA Site ID Number, name, and address ofalloff-site installations to which you shipped dangerous waste or from which you received dangerous waste and all transporters that you used during 2000. Do not provide information regarding generators ofHousehold Hazardous Waste or Conditionally Exempt Generators (called Small Quantity Generators in Washington) from which you received waste. 

## Helpful Hints Before completing the form, be sure to complete the "Please Enter" box at the top ·of the page. Fill in your RCRA Site ID Number and site name. Do not enter any information in the spaces marked "For Ecology Use Only." Then make as many copies ofthe answer sheet as you will need. You do not need to list your own company in the body ofthe 01 

### Form: list your company above in the "please enter" box only. For each off-site installation or transporter, provide the following information: • RCRA Site ID Number (remember, ifthe offsite entity is from a foreign county and does not have an RCRA Site ID Number, use the "FC" designation as described in Helpful Hint #8 on page 8 ofBook2: 

### Guidebookand Codes) • Company Name • Location address (city and state associated with

the RCRA Site ID Number, and Country if appropriate)
• Handler type (e.g., generator, transporter, or

TSDR) as defined by their relationship to your site. Select all that apply to the installation or transporter: e.g., the given entity might both transport (mark Transporter) and manage (mark TSDR) your waste. Note: A TSDR is 

### referred to as designated facility on the uniform Hazardous Waste Manifest. Ifyou are a generator, and the transporter ofyour waste has been provided by the TSDR, you may not have full name and address information for the transporter. In that case, you may provide justthe RCRA Site ID Number and name ofthe transporter. Use the Comments Section to continue any entry and/or to clarify any information provided. Reference the comment by entering the site name and indicating the information point being continued (i.e., RCRA Site ID Number, name, address, or handler type).



### Book 1: 2000 Forms and Instructions 33

### 34 Dangerous Waste Annual Report



## Page Intentionally Left Blank

Book 1: 2000 Forms and Instructions 

# ()

I 

### I 

## I I I I I I 

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### I I I I 

# 0:

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### Please type or print legibly in blue or black ink. RCRA Site 10 Number:

_ Name: 

### Please complete this form if your facility received dangerous waste from off-site or shipped dangerous waste off-site during 2000. Your Site 10 #:

_ Site name:

_

Date received:

_**FORECOLOGYUSEON~:** 

### PLEASE ENTER:

Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter 

# o TSOR RCRA Site 10 Number: Name:
Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter OTSOR RCRA Site 10 Number: Name:
Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter OTSDR Comments: 

# OFF-SITE IDENTIFICATION INFORMATION FORM ANSWER SHEET Please enter your RCRA Site ID number and your site name in the small box at the right, before making as many copies ofthis two-sided answer sheet as you will need. 

# ! 

# , I 

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# • Page Book 1: 2000 Forms and Instructions 

### 35PLEASE ENTER: YOUR Site ID #: Site name:
RCRA Site 10 Number: Name:
Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter DTSOR RCRA Site 10 Number: Name:
Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter 

# o TSOR RCRA Site 10 Number: Name:
Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter 

# o TSOR RCRA Site 10 Number: Name:
Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter DTSOR RCRA Site 10 Number: Name:
Address:
Handler type: (Check all that apply.) 

# o Generator 

# o Transporter 

# o TSOR Page

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36 

### Book 1: 2000 Forms and 

### Instructions

## I



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I 

# WASTE RECEIVED FORM INTRODUCTION



# ,. : t 

# /!', l 

# '\ij l

# , I 

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### I I I I I

# • Who needs to complete thisform? All treatment, storage, disposal, and recycling facilities (TSDRs) that receive dangerous waste from off-site must complete this Waste Received (WR) Form. This includes TSDRs that receivedangerous waste from off-site and then ship it offsite without first providing it any kind oftreatment-i.e., TSDRs that conduct storage/transfer ofdangerous wastes. 

## What information does thisform collect? This form collects information on dangerous wastes received by your facility from off-site for treatment, storage, disposal, and/or recycling. It 

### collects information on the type ofwaste received, the amount ofwaste received, and how the waste was managed (i.e., treated, recycled, or disposed) at your facility. Ifyou treated, stored, recycled, and/or disposed ofdangerous waste at your site that your site generated, do NOT report that activity on this WR Form. Report your generation and on-site management on the GM Form. Ifyou conduct a storage/transfer (i.e.; passthrough) activity (i.e., if you received a waste from off-site and subsequently .shipped it off-site without first providing any form oftreatment, recycling, or disposal to the waste), you will report the receipt ofthe waste on this WR Form and the transfer ofthe waste on the GM Form. Refer to the definition ofstorage/transfer in the Definitions section ofBook2: Guidebook and Codes. 

## What information do I needto complete thisform? To complete this form, you will need information on the dangerous waste received from offsite by your facility. For each dangerous waste stream, you will need to know how much you received from off-site in 2000, the RCRA Site ID Number of the site(s) from which you received the! wastestream, and how the waste stream was managed (i.e., treated, stored, recycled, and/or disposed) at your facility. (You will need to provide the names and addresses ofthese entities on the 01 

### Form.) Ifyou transferred the waste, you will need to know where (i.e., RCRA Site ID Number) you sent the waste for management and how it was managed at that receiving facility so thatyou can complete the GM Form for the transferred waste stream. (You will need to provide the names and addresses ofthese entities on the 01 

### Form.) 

## Helpful Hints • Questions and Answers: This form is in two

parts: a question sheet and an answer sheet. The answer sheet is perforated. You may wish to separate it fromthis book and lay it alongside the questions as you answer them. Fill out one answer sheet for each waste , stream received by your facility. On both the answer and continuation sheets, be sure to complete the "Please Enter" box at the top ofthe sheets with your RCRA Site ID Number and your site name. Do not enter any information in the spaces marked "For Ecology Use Only." Then make as many copies ofthe sheets as you will need for each waste stream. Double sided pages are encouraged. 

### Book 1: 2000 Forms and Instructions 37Dangerous Waste Annual Report

How to identify a dangerous waste stream: One answer sheetper waste stream received: 

# C

• • Use the following guidelines to identify an Complete one answer sheet for each waste individual waste stream: stream received. If, for example, you received the same waste stream from a number of


### • A single waste stream may have several different sites, you only need to complete one waste codes. Waste codes are identified answer sheet for the waste stream. For ex- I in WAC 173-303. Refer to Helpful Hint ample, you receive still bottoms of halogenated #1 on page 2 of

### Book2: 

### Guidebookand solvent from several differentdry cleaners. The 

# , Codes for help in using WAC 173-303 to dangerous waste from all the dry cleaners I designate your waste and assign waste shares a common Form Code (B601 - still 1 codes to it. Questions 3 and 4 capture EPA bottoms ofhalogenated solvents or other 

### 1 and Washington state-only waste codes, organic liquids), a common Waste Code (F002 - I respectively. a listing ofspecific spent halogenated solvents), 1



# · A single waste stream will designate either and a common designation (DW). The receipt 

### I as dangerous waste (DW) or extremely ofthis same dangerous waste stream from I hazardous waste (EHW), not both. Thus, several different generators should be reported 

### I ifyou receive a waste stream that is on one answer sheet. 1 sometimes EHW and is DW at other times, Which wastes to report: 

### I these are actually separate waste streams 

# • and should be reported on separate WR 

# · DO report all dangerous wastes received 

### I ( Forms. Specify the designation in question 5. from off-site during 2000. 

## i



# · A single waste stream will be either a 

### • Lab packs: Ifyou receive a lab packs mixed radioactive waste or not (question waste stream from off-site for manage- ( 6). Mixed radioactive wastes (see the ment, refer to Worksheet #3 on page 11 of I Definitions section of

### Book 2: 

### Guidebook Book2: Guidebook and Codes, for in 

# 0 I 

### and Codes) should never be combined structions on how to complete the WR 

### I with non-radioactive wastes. Thus, a Form for that waste stream. 

### t mixed radioactive waste stream received 

# · Wastes from foreign countries: Refer to 

### ! from off-site will always be reported on its Helpful Hint #8, on page 8 of

### Book2: own WRForm. 

### Guidebookand Codes, for guidance on 

### (

• In most cases, a waste stream reported on a reporting the receipt ofwastes from single answer sheet should have only one foreign countries. 

### ( form (question 7). Waste form codes are 

## ( listed on pages 42-43 of

### Book2: 

### Guide 

# • Which wastes NOT to report: 

### ( book and Codes. 

### • DO NOT report excluded wastes as 

### (

. defined by Chapter 173-303 WAC (e.g., do Please note that Ecology asks you to use your not report TSCA [Toxic Substances bestjudgment in defining the individual waste Control Act, 40 CFR Parts 700-799] streams that you receive and manage. Ecology wastes such as PCBs unless they also recognizes that the complexities ofdangerous classify as dangerous waste). waste generation and management are some- 

# · Household Hazardous Waste: Reporting times difficult to portray in the context of a the receipt and management ofhousehold standardized form with a series ofstandard- hazardous waste is not required. Do NOT ized codes. In certain instances, the coding report receipt ofthese wastes. scheme may not allow you to portray your 

# · Conditionally Exempt Small Quantity waste in a fully accurate manner. Follow the Generator Waste: Reporting the receipt guidelines listed above to the best of your and management ofdangerous wastes from ability when identifying a waste stream at 

# (!) conditionally exempt generators (i.e., your site and assigning what you believe to be Small Quantity Generators in the State of 

# 0 the best codes to describe that waste stream. Washington) is not required. Do NOT I report receipt ofthese wastes. 

### 38 Book 1: 2000 Forms and Instructions

### Waste Received Form



## i

# I

•

# I.

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## I I 

# , , 

# ! I I 

## I I 

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# • • Dangerous waste residuals: Ifyour facilityreceived a waste stream from off-site, managed it on-site, and, in managing the waste stream, generated a dangerous waste residual, you should report this activity as follows: • report the receipt and primary management ofthe original waste on this WR Form; and • report the generation ofthe residual as a new waste stream on the GM Form. For example, you receive a dangerous waste sludge. You dewater it. A dangerous waste residual-a filtercake-results from the dewatering. You then landfill the filtercake. You will need to: • report the receipt and management (dewatering, system code M 101) ofthe danger ous waste sludge on this WR Form; and • report the generation and then management (landfill) ofthe filtercake on the GM Form. Note that the source ofthe filtercake, under question A-7 ofthe GM Form, will be "A76, sludge dewatering." The origin ofthe filtercake, under question A-9, will be "residual from the management ofapreviously-existing dangerous waste," choice v. For question A-9a, you will indicate the system of origin ofthat residual as system code M101, dewatering.

• Reporting extended storage: If you hold a RCRA storage permit and you received waste from off-site for storage, please review Worksheet #6, on page 17 ofBook 2: Guidebook and Codes, before completing this form. 

## Providing recycling credit information to generators If you recycle dangerous wastes received at your facility, it is likely that the

.generators using your services will contact you to obtain information about the percentage oftheir waste that your facility reclaimed during 2000. Ecology asks that you provide them that information. You may tell them the percentage over the telephone, but you must also fax or mail to them written material that documents the recycling percentage that you are claiming you achieved with their waste. That written documentation may be in any format most convenient for you, but it must include the following information: the waste description, the waste system code, the waste form code, the percent recycled during 2000, and the name, title, and signature of an authorized representative ofyour facility. Please note that only the following types of management, denoted by system code, constitute "recycling" for purposes ofthe recycling credit. Ifyour facility did not perform one ofthese types ofmanagement on the waste, then you did not "recycle" any ofthe waste for purposes ofthe recycling credits. (For guidance on applying these system codes to the waste management processes at your facility, refer to Worksheet #4 on pages 12-13 inBook2: Guidebookand Codes.) Metals Recovery MO 11 High temperature metals recovery MO 12 Retorting MO 13 Secondary smelting M014 Other metals recovery for reuse (e.g., ion exchange, reverse osmosis, acidleaching, etc.) MO 19 Metals recovery-type unknown Solvents Recovery M021 Fractionation/distillation M022 Thin Film Extraction M023 Solvent extraction M024 Other solvent recovery M029 Solvents recovery-type unknown Other Recovery M031 Acid regeneration M032 Other recovery (e.g., waste oil recovery non-solvent organics recovery, etc.) M039 Other recovery-type unknown Aqueous Organic Treatment M082 Carbon Adsorbtion Other M141 Storage/Transfer



### Book 1: 2000 Forms and Instructions 39

# WASTE RECEIVED FORM QUESTIONS 

# o

) I, f I I I I I I I I I i II I I I [ 

## i I 

### , [ This data element is provided for your optional use to help you track the waste profiles or waste streams that you report on the Annual Report. You may enter any desired information that will help you relate the waste streams you receive and manage at your facility to how you report in the Annual Report. This data element is provided solely for your use; Ecology will not use this information in any way. 2. Briefly describe the dangerous waste stream reported on this form. Please describe the waste stream as you best recognize it. You should attempt to limit the length ofyour description to 70 characters, including spaces; although you may prepare a longer description, Ecology will only record the first 70 characters in its information system. 3. Which EPA hazardous waste code(s) are associated with this waste stream? 1. What is your "profile" code (Optional)? Ifyou hold a RCRA storage permit andyou received waste from off-site for storage, please review Worksheet #6, on-page 17 ofBook 2: Guidebook and Codes before completing this form. 

### This is a question sheet. Record your answers on the separate answer sheet! (One sheet for each dangerous waste stream or dangerous waste residual.) Please complete one answer sheet for each dangerous waste stream that was received from off-site during 2000, even if the waste stream was subsequently shipped off-site without first being treated, recycled, or disposed of. Ifyour waste stream is a "lab pack," please review Worksheet #3, on page 11 ofBook 2: Guidebook and Codes, before completing this form.

# ----------~O

Do NOT enterWashington state-only dangerous waste codes in this section. Enter Washington state-only codes under question 4. EPAhazardous waste codes begin with a P, D, F, K or D. They are listed in WAC 173-303-081 through 083 and WAC 173-303-090, 104, 180, and 9904. Enter up to six codes. Ifyou need to list more than six codes, continue in the Comments section under question 10; please reference question 3 in your comments. 4. Which Washington state-only dangerous waste code(s) are associated with this waste stream? Do NOT enter EPA waste codes in this section. Enter EPA codes under question 3. Washington state-only dangerous waste codes begin with a "W". They are referenced in Helpful Hint #2 on page 3 ofBook2: Guidebookand Codes and are provided in WAC 173-303-082, -090 and -100. If these codes apply to your waste stream, enter up to two codes in the spaces provided. Ifyou need to list 

# 0 more than two codes, continue in the Comments section under question 10; please reference question 4 in your comments. 40 

### Book 1: 2000 Forms and Instructions

# • Waste Received Form


### What is the designation of this waste stream? Indicate whether the waste is designated Dangerous Waste (OW) or Extremely Hazardous Waste (EHW). Helpful Hint #1, on page 2 of

### Book

### 2: Guidebookand Codes, will help you designate your wastes per WAC 173-303. WL01, WP01, WP03 and WTOI are the only dangerous waste codes that designate as EHW. Ifnone of these apply to your waste, then enter the designation ofOW. 

### Is this a "mixed radioactive" waste stream? Mixed radioactive wastes are wastes that are both:

• dangerous underWAC 173-303-070 through 173-303-104 (see "What is a dangerous waste?",

Helpful Hint #1 on page 2 of

### Book

### 2: Guidebookand Codes), and

• radioactive as defined by the Atomic Energy Act. Radioactive waste that is not mixed with a dangerous waste should not be reported on this form. 

### Which form code best describes the form of the waste stream received? Form codes can be found on pages 42-43 of

### Book2: 

### Guidebookand Codes. The form code describes the form ofthe dangerous waste (e.g., mixed lab packs, scrubber water, oily sludge). Please select the one code that best describes the form ofthis waste stream. Ecology recognizes that it may be possible to assign a number ofform codes to an individual waste stream. Ecology asks you to identifyjust one in this report. 

### What is the total quantity of this waste stream received by your facility in 2000, and what is the unit of measure? Remember, do not report the receipt ofhousehold hazardous waste or conditionally exempt generator waste. Check the appropriate code for the unit ofmeasure used: ST=ShortTons; MT=Metric Tons; P=Pounds; K=Kilograms; G=Gallons;L=Liters; and C=Cubic Yards. You must use the same unit ofmeasure when responding to question 9. Ifyou selectG,L, or C, go to question 8.a. Ifyou select ST, MT, P, or K, skip to question 9. 

### B.a. If 

### the waste stream is measured in either gallons, liters, or cubic yards, what is its density? Answer this question only ifyou specified G, 

### L, or C in question 8. Density information for the chemical constituents ofthe waste is provided on Material Safety Data Sheets. Use that or other information available to you to determine the density. Ifyou do not provide a density, the density ofwater (8.34 pounds/gallon) will be assumed for wastes measured in gallons or liters; the density ofsoil (2,700 pounds per cubic yard) will be assumed for wastes measured in cubic yards. Be sure to choose a density unit ofmeasure (e.g. Ibs/ gal). 

### Book 1: 2000 Forms and Instructions 41

### 10. Use the Comments Section on the answer sheet to provide any additional comments, information, or explanations, as necessary. In your comments, always provide the reference to the specific question number (e.g., 3). 

### 9.

42 Dangerous Waste Annual Report



### Please provide the following information for each shipment

### of this waste stream received from off-site. Provide the following information. Ifyou need to repeat information on multiple lines (for example, many shipments received from a single facility), you may use ditto (") marks to represent the repeated information. Report only MQG and LQG waste shipments. (Do not report waste shipments from conditionally exempt generators, i.e. small quantity generators in the State ofWashington.) i. the date the shipment was received (mmldd) 

### ii. the manifest document number 

### iii. the "internal tracking code," optional. This column is provided for your optional and internal use. Ecology has created this column in response to comments from members of the regulated community that such a column would help them to relate their internal waste tracking systems to the information they provide on their Annual Report forms. This column allows you to enter any internal information or code which your company may wish to use to track shipments. Ecology does not require you to provide this information and will not use itin any way. Please use this column if and how you see fit. iv. the RCRA Site ID Number ofthe facility from which the waste was received . v. the quantity received in this shipment (using the same unit ofmeasure as in question 8) vi. the system code for how your facility managed the waste (refer to Worksheet #4, on pages 12-13 of Book 2: Guidebookand Codes, for guidance on selecting the appropriate system code; the fulllist of system codes is provided on pages 45-46 ofBook2: Guidebookand Codes). Ifyou managed part ofthe shipment one way and anotherportion a different way (i.e., you need to report two or more different system codes for the management ofa single shipment received), then do the following:

• "ditto" the RCRA Site ID Number ofthe facility from whom you received the waste on two or more

lines (as many as are needed to capture the different types ofmanagement that different portions ofthe shipment received);

• "ditto" the shipment date;

• "ditto" the manifest document number information; • split**th~** overall quantity ofwaste in the shipment among the different lines, as appropriate; and • identify the single, appropriate system code associated with each quantity, on each line. Ifyou received this waste stream in more than 8 shipments, please continue onto the back ofthe answer sheet page 44. Ifyou need more space, you may need to make additional copies of the answer sheet, or see page 5 for instructions on providing a computer-generated answer sheet.



### Book 1: 2000 Forms and Instructions 

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# • WASTE RECEIVED FORM ANSWER SHEET Please enter your RCRA Site ID number and site name at right, before making as many two-sided copies ofthis answer sheet as you will need to report all ofyour waste streams. Then complete one answer sheet for each waste stream received. Be sure to reference the instructions on pages 40-42 as you complete this form. PLEASEENTER: Your RCRA Site ID #:

_ Site name:

_
FORECOLOGY USE ONLY: Date received:

_

Please type or print legibly in blue or black ink. 

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### 2.

8.

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### D ST 

### D MT 

### D p 

### D K 

### D G 

### D L 

### D C (IfG, L, or C, answer 8.a.) 

### 8.a. 

### D Lbs/gal 

### D Specific Gravity

### D Lbs yd3 

### 4.

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### 7. 

### Dves DNo 

### 6. 

### DEHW Dow 

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9. Ifadditional space is required, use continuation sheet on the back ofthis page. i. Date Received ii. Manifest Document iii. Internal Tracking iv. Sending Facility II. Quantity (mm/dd)

. Number Code (optional) RCRA Site 10 Number Received vi. System Code
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### Book 1: 2000 Forms and Instructions 43Site name:

_ Your ReRA Site ID #:

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### 9. (Continued)

i. Date Received ii

. Manifest Document (mm/dd) Number iii. Internal Tracking Code (optional) PLEASE ENTER:

iv. Sending Facility RCRA Site fD Number v. Quantity vi. System Received Code

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### Book 1: 2000 Forms and Instructions

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# • END OF REPORT (Attach this page as the last page of your submission)

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### Book 1: 2000 Forms and Instructions 45

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• NORTHWEST( REGION 

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EASTERN REGION 1(509) 456-2926\