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An

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ort

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Book 1

2000 Forms and Instructions

Your Report must be postmarked no later

than March 1, 2001

Mail completed forms to:

Department ofEcology

PO Box 47658

Olympia WA 98504-7658

. December 2000

. Printed on recycled paper

96-437 .

Revised 10/00
The completed forms are due back to 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

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Book 1

2000 Forms and Instructions

Your Report must be postmarked no later

than March 1, 2001

Note: Along with this book offonns you should have received Book 2: Guidebook and Codes. Many

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

ofBook 2: Guidebook and Codes. If you need further clarification or ifyou did not receive Book 2:

Guidebook and Codes, contact Ecology at (800) 874-2022 (within state) or (360) 407-6170.

WASHINGTON STATE

OEPARTMENT Of

E COL 0 G Y

The Department ofEcology is an equal opportunity and affirmative action employer and shall not discriminate on the basis

ofrace, creed, color, national origin. gender, marital status, 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 Toxics Reduction 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

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• DANGEROUS WASTE

ANNUAL REPORT

INTRODUCTION

What is the Dangerous Waste

Annual Report?

The Washington Department of Ecology (Ecology) Dangerous Waste Annual Report is an

annual report of dangerous waste generation and

management activities within Washington.

Handlers of dangerous 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 ifyou did not generate or manage any

dangerous waste during 2000. You must at least

complete the Verification Form to inform Ecology

of whether 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?

If you 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.

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Ifyou had an active RCRA Site ID Number at any

time during 2000, you will need to complete at

least one of the five enclosed forms. Those

companies required to report are:

• Dangerous Waste Generators

• Dangerous Waste Treatment, Storage, or

Disposal Facilities (TSDs)

• Dangerous Waste Recycling Facilities (as

specified in WAC 173-303-120)

• Dangerous Waste Transporters

• Burners/Marketers/Blenders of dangerous

waste fuels

• Transfer Facilities

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

When to submit the Annual Report

forms

The completed forms are due back to Ecology

with a postmark of no later than March 1, 2001.

Submit completed paper forms by U.S. mail to:

Washington Department of Ecology

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, if you wish. Use the following street

address for deliveries:

Washington Department of Ecology

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 of workshops

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, contact Ecology 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/.

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E-mail electronic files to Ecology at

cjam461@ecy.wa.gov. Include the following

information in your e-mail:

• Your name and phone number.

• Your company name and RCRA site ID#.

• Year of your annual report submittal.

• Types of data 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 of the form."

Upon written request and reasonable justification,

Ecology may grant an extension to the reporting

deadline of up 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 of ways to help

you completethe forms.

4. Telephone Assistance.

You may call Ecology at 1-800-874-2022 (within

state) or 360-407-6170 if you 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 of dangerous 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 Instructions
Introduction

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Recordkeeping

"Ge~erator recordkeeping," (WAC 173-303-210)

requires the generator to keep on-site copies of

annual reports, Notification of Dangerous 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.

If a 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 of this form asks descriptive questions

about the waste stream, such as the type of waste

stream generated and whether the waste stream is

a residual from management of another 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.

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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 of your

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-

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cation Fo~ is if there 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 of all dangerous waste handlers

with whom you interacted in sending waste offsite or in receiving waste from off-site. For

example, if you 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 of your waste. If you 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 3
Dangerous 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 of waste 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 of Helpful Hints to answer specific questions as you work through the forms. It also has

three Worksheets to help you complete specific

aspects of the forms. In addition, it contains a

Definitions section and all of the 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 of your 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 of each page. The Verification

Form starts as page number "1". Number each

subsequent page consecutively (i.e., 2, 3, 4, etc.).

Attach page 45 of this 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 of pages that you are

submitting.

Remember to enter your RCRA Site ID Number

on every page of your report.

Typing the forms

Ecology requests that forms be typed. If you

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, of an authorized representative of your 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 of a 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 of your

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 paper

GM, 01 and WR forms). Or, if you have an automated information management system containing

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4 Book 1: 2000 Forms and Instructions
Introduction

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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 reporting

sites to submit their annual reporting data electronically. It is especially recommended for sites

that have multiple waste streams or large numbers

ofwaste shipments. Ifyour 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.

If you choose to report electronically, you still

need to submit a paper copy of your 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 of GM, 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 of computer-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.

If after 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 of your 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.

If you 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, of course, 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 5
Dangerous Waste Annual Report

You should note the following guidelines in preparing and submitting your computer-generated forms.

• Use 8.5" by II" paper.

• Use blue or black ink.

• Double sided pages are encouraged.

• If you are using continuous-feed paper, separate

the print-out into individual sheets with the side

holes removed.

• Number all pages of your 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, if you 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.

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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 of your most recent Notification Form

(Form 2).

• Records of dangerous waste quantities generated, accumulated, or managed.

• Dangerous waste manifest forms.

• Results oflaboratory analyses of your wastes

(e.g., waste profiles).

• Contracts or agreements with the off-site

facilities that manage your wastes.

• Copies of permits for your on-site waste

management systems.

• Copies of Material Safety Data Sheets

(MSDSs).

• Documenation ofrecycling credits issued by

your TSDRs.

• Make sure you only fill out the forms that are

required of you. Use Worksheet #2 (pages lO11) to determine this.

• Use Book 2: .Guidebook and 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.

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6 Book 1: 2000 Forms and Instructions
• WORKSHEET #1

DEFINING YOUR STATUS

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This Worksheet isfor your use only.

Do NOT submit this Worksheet to

Ecology.

Before completing this worksheet,

you will wantto knowthe following:

• The definition of a 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 ofBook 2:

Guidebook and Codes).

In determining your generator status,

you should note the following:

• Your regulatory 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, of what Quantity Exclusion Limit, you generate in a given

month or accumulate at any time.

• The Quantity Exclusion Limit (QEL) of a 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 ofBook 2:

Guidebook and 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 of waste

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 of completing the Annual

Report forms-is defined based on the greatest

quantity of dangerous waste you generated in

anyone calendar month or accumulated at any

time in 2000.

For example, if you 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,

if you generated more than 2,200 pounds in

anyone month in 2000-even if you 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 7
Dangerous Waste Annual Report

Now determine if you 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 of completing 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)? If any 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 of dangerous waste(s) with a QEL of 220.pounds, or

o greater than 2.2 pounds of dangerous waste(s) with a QEL of 2.2 pounds?

If I checked any of the above boxes, then I am a Large Quantity Generator.

Am I a Medium Quantity Generator (MQG)? If anyofthe following criteria apply to you, check the box.

In anyone calendar month in 2000, did I generate:

o 220-2,200 pounds of dangerous waste(s) with a QEL of220 pounds?

AND at all times during 2000, did I accumulate:

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

If I checked the above box, then I am a Medium Quantity Generator.

Am I a Small Quantity Generator (SQG)? If any ofthe following criteria apply to you, check the box.

In each calendar month in 2000, did I generate:

o less than 220 pounds of dangerous waste(s) with a QEL of 220 pounds, or

o less than 2.2 pounds of dangerous waste(s) with a QEL of 2.2 pounds?

AND, at all times during 2000, did I accumulate:

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

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

If I checked any of the above boxes, then I am a Small Quantity Generator.

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

If I checked this box, then I am a TSD.

.€>AmI a Treatment, Storage, or Disposal Facility (TSD)? If the following criterion applies to you,

TSDR· check the box. .

o My facility has filed a Part A application or has a Part B permit for the Treatment, Storage, or

Disposal of dangerous waste as required under WAC 173-303-800 to 840. (Do not check this box

if your treatment activity is treatment-by-generator. These terms are defined in the Definitions

section ofBook 2: Guidebook and 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.

If I checked this box, then I am a Commercial Recycling Facility.

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Am I a Transporter? Ifthe following criterion applies to you, check the box..

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

If I checked this box, then I am a transporter. Sites that are Transporters only (i.e., did not meet

any of the criteria above for generators, 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 only the Verification Form. The instructions start

on page 13.

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Book 1: 2000 Forms and Instructions 9
WORKSHEET #2

DETERMINING WHICH FORMS

TO COMPLETE

This Worksheet isfor your use only. Do NOT submit this 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 Instructions
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Worksheet #2

o I am a Treatment/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.

IfI received waste from 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.

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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

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Book 1: 2000 Forms and Instructions

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• VERIFICATION FORM

INTRODUCTION

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Who needs to complete this form?

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 Waste Recycling 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 of Dangerous Waste

Activities if your 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, if your 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. If you are

an MQG or LQG, refer to the Worksheets #1

and #2 in Book 1 of your annual report forms

to determine whether additional forms are to

be included with your annual report. Include

the total number of pages for your report in

section #7.

II' For electronic data submittal, please

indicated method of your 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 13
Dangerous 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 of questions 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 of your

report.

What information does this form

collect?

This form collects information about your site,

such as the name of your business; the name,

address, and phone number of a contact at the

site; and the regulatory status of your 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 of your most recent Notification Form

(Form 2) on which you notified Ecology and

EPA of your dangerous waste generation and

management activities; and

• Copies of your dangerous waste shipment

manifests (if relevant).

• 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

,If blank, complete the missing information in the sections provided.

IQuestions 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 of updated Notification (Form 2) reporting.

WAC 173-303 of the 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 of the 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 Instructions
Dangerous 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) - if you shipped waste off-site for management in 2000

o Treatment, storage, disposal, and recycling facilities (TSDRs): If your 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 Part A 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 immediately upon 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.

If you are claiming recycling credits, the supporting documentation from your TSDR must be attached to your

VF form (for electronic submittals) or at the end of your 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, of an authorized

representative of your site. Refer to-Book 1, page 4, "Certification" for additional details.

c

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16 Book 1: 2000 Forms and Instructions
I

2000

VerificationI

Page 1 of _

This Report is

Due

No Later Than

March 1, 2001

Review HWIMSy Entry

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

All information listed below Is required. If information is missing or incorrect, please enter the changes in the right hand column.

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: •

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Book 1: 2000 Forms and Instructions 17
Dangerous 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

DVerification (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 under penalty of law that this document and all attachments were prepared under my direction or supervision in

accordance with a system designed to assure that qualified personnel properly gather and evaluate the information

submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for

gathering the information, the information submitted is, to the best ofmy knowledge and belief, true, accurate and

complete. I am aware that there are significant penalties for submitting false information, including the possiblity of fine 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 this form?

•

•

All MQGs, LQGs, and TSDRs must complete a

Generation and Management (GM) Form for each

waste stream. (Small Quantity Generators do not

have to complete this form. SQGs should complete only the Verification Form, beginning on

page 15.) See the Definitions section ofBook 2:

Guidebook and Codes, for defmitions of LQG

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 wish

to 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 of the 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 (question A-5).

Thus, if you 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: Guidebook and 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: Guidebook and

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: Guidebook and

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 19
Dangerous Waste Annual Report

Please note that Ecology asks you to use your

best judgment in defining the individual waste

streams you generate and report. Ecology

recognizes that the complexities of dangerous

waste generation and management are sometimes difficult to portray in the context of a

standardized form with a series of standardized 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 of your

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:

Book 2: Guidebook and Codes for instructions on how to complete the GM Form for

those waste streams.

• On-site Management Activities: On-site

management of a 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.

If you 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: If you generate a lab pack waste

stream; refertoWorksheet-#3-onpage 1Lof2. 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

l

e 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. If you 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 of dangerous 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 if you

follow the instructions in the TIM. If you are

unsure whether you are handling a waste

stream according to the

tor guidance, please refer to TIM #96-412, TSDR

treatment-by-genera-€>

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 of a

dangerous waste stream (see the definition of

storage/transfer in the Definitions section of

Book 2: Guidebook and Codes), then you

should follow these special instructions for

storage/transfer of the 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: If you 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: Guidebook and Codes for guidance on

how to report shipments of dangerous 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

If your waste stream is a "lab pack," please review Worksheet #3, on page 11 ofBook 2: Guidebook and Codes,

before completing this form.

If you hold a RCRA storage permit, please review Worksheet #6 on page 17 ofBook 2: Guidebook and 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 of your 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..

}

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22 Book 1: 2000 Forms and Instructions
Ie

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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. Enter Washington state-only

codes under question A-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. If you 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 question A-3.

Washington state-only dangerous waste codes begin with a "W". They are referenced in Helpful Hint #2

(page 3 ofBook 2: Guidebook and 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. If you 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 ofBook 2: Guidebook and 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. If none 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 ofBook 2: 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 23
Dangerous 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: Guidebook and 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 identify just 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 ofBook 2: Guidebook and 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 identify just 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 of generation 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 of a spill cleanup, equipment decommissioning, or

other remedial cleanup activity.

iii. The waste stream is a residual derived from the management of a 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 ofBook 2: Guidebook

and Codes for the definition ofstorage/transfer.)

v. The waste stream is a residual derived from the management of a previously existing dangerous waste

stream. If you specify this origin code, please go to questionA-9.a.

A-9.a. If you specified origin code v in question A-9 (l.e., the waste is a residual from

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 ofBook 2: Guidebook and Codes.

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

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Book 1: 2000 Forms and Instructions
Generation and Management Form

I

:B. Waste Management Activities

This section collects information on the management-treatment, storage, disposal and recycling-of

dangerous waste. Do not report waste in accumulation. '

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Ifthe waste stream received consecutive treatment by more than one type ofmanagement, only report .

the first activity on this form.

Ifin treating the 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 managed in 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 only if you specified G, L, or C, in question B-1.

Check the appropriate code for the unit ofmeasure used: ST=Short Tons; 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 your waste amounts.

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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 25
Dangerous 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:

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• If you 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.

If you 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.

• If you 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?

If you 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. If you 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 ofBook 2: Guidebook and 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: Guidebook and Codes.

Use the same unit of measure 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 of treatment-by-generator on pages 20-21 of

this book. If your on-site management activity is recycling (e.g. distillation) then answer "no" to B-3.a.

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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 10 ofyour 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

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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: Guidebook and Codes). You should contact the

designated facility if you 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 management provided by the first 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 of measure from question B-1).

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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: Guidebook and Codes, for detailed information on whether

you qualify for recycling credits and how to obtain the credits. If no 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 of management that different portions of the waste

received);

• enter one system code in each row;

• enter in each row the quantity of waste that went to the system code identified in ii; and

• if applicable, enter the percent ofthe waste that was recycled in the system code identified in iii.

Book 1: 2000 Forms and Instructions 27
Dangerous Waste Annual Report

Spaces are provided to identify up to four off-site facilities. If you 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. If you are an MQG, skip to Section C, Comments, if appropriate; otherwise, you have now completed this form.

Remember - If any of your waste is managed off-site, you must complete the Off-Site Identification Information (01) form beginning on page 33.

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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. If you need to repeat information on multiple lines (for example,

many shipments to a single facility), you may use ditto (") marks to represent the repeated 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 their Annual 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 if and 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. of question 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. If you 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 Instructions
Reference the instructions on pages 19 through 28 as you complete this form. Please type or print legibly in blue or black ink.

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 of your

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 _

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B-2. DOn-site DOff-site D Both

B-3. M __ B-3a. Dyes DNo

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B-4. t. Designated Facility (TSDR)

ID Numbers

ii . System Code

M _

M _

M _

M _

iii. Quantity iv. Recycling Percent

Page

Book 1: 2000 Forms and Instructions 29
Dangerous Waste Annual Report

PLEASE ENTER:

YOUR SITE ID #: _

Site name: _

8-5. To be completed by LQ.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

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

C.Comments

--~- -------Page-------

Book 1: 2000 Forms and Instructions

o
PLEASE ENTER:

Sitename: _

Your SITE ID #: _

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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 31
Dangerous Waste Annual Report

You're not done yet. .....

MaG and LaGs (with off-site shipments) and all TSDRs

continue on to the 01 Form:

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- - - -- - - ----------~--- -- - -_.- - ---_.-

Book 1: 2000 Forms and Instructions
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OFF-SITE

IDENTIFICATION

INFORMATION FORM

INTRODUCTION

Who needs to complete this form?

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 this form

collect?

The 01 Form collects the RCRA Site ID Number,

name, and address of all 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 of all

off-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 of Household 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 of the 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 ofBook 2: Guidebook and 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 designatedfacility

on the uniform Hazardous Waste Manifest.

If you are a generator, and the transporter of your

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

just the 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

()

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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.

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Page

Book 1: 2000 Forms and Instructions 35
PLEASE 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
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WASTE RECEIVED FORM

INTRODUCTION

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Who needs to complete this form?

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 receive

dangerous waste from off-site and then ship it offsite without first providing it any kind oftreatment-i.e., TSDRs that conduct storage/transfer

of dangerous wastes.

What information does this form

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 of waste received, and how

the waste was managed (i.e., treated, recycled, or

disposed) at your facility.

If you treated, stored, recycled, and/or disposed of

dangerous 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.

If you 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 ofBook 2: Guidebook and

Codes.

What information do I needto

complete this form?

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! waste

stream, 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.)

If you 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 that you

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 from this 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 of the sheets as you will need for

each waste stream. Double sided pages

are encouraged.

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

How to identify a dangerous waste stream: One answer sheet per 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 ofBook 2: Guidebook and solvent from several different dry 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

if you 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: If you 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 ofBook 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 ofBook 2:

own WRForm. Guidebook and Codes, for guidance on (

• In most cases, a waste stream reported on a reporting the receipt of wastes from

single answer sheet should have only one foreign countries. (

form (question 7). Waste form codes are (

listed on pages 42-43 ofBook 2: 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

best judgment 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 of dangerous 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 of household

standardized form with a series of standard- hazardous waste is not required. Do NOT

ized codes. In certain instances, the coding report receipt of these 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 of dangerous 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

the best codes to describe that waste stream. 0 Washington) is not required. Do NOT I

report receipt of these wastes.

38 Book 1: 2000 Forms and Instructions
Waste Received Form

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• Dangerous waste residuals: If your facility

received 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 of the original waste on this WR

Form; and

• report the generation of the 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) of the 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 of a previously-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 of Book 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 of your facility.

Please note that only the following types of

management, denoted by system code, constitute

"recycling" for purposes of the recycling credit.

If your facility did not perform one ofthese types

of management on the waste, then you did not

"recycle" any of the waste for purposes of the

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 in Book 2: Guidebook and

Codes.)

Metals Recovery

MO11 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

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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 of your

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)?

If you hold a RCRA storage permit and you received waste from off-site for storage, please review

Worksheet #6, on-page 17 of Book 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 of Book 2: Guidebook and

Codes, before completing this form.

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Do NOT enter Washington state-only dangerous waste codes in this section. Enter Washington state-only

codes under question 4.

EPA hazardous 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. If you 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 ofBook 2: Guidebook and 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. If you 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 ofBook 2: Guidebook and 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 of OW.

Is this a "mixed radioactive" waste stream?

Mixed radioactive wastes are wastes that are both:

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

Helpful Hint #1 on page 2 ofBook 2: 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.

Which form code best describes the form of the waste stream received?

Form codes can be found on pages 42-43 ofBook 2: Guidebook and 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 of form codes to an individual waste stream. Ecology

asks you to identify just 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=Short Tons; 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 select G,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 if you 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. If you 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 of measure 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: Guidebook and Codes, for guidance on selecting the appropriate system code; the fulllist of

system codes is provided on pages 45-46 ofBook 2: Guidebook and Codes).

If you managed part ofthe shipment one way and another portion a different way (i.e., you need to report

two or more different system codes for the management of a 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 of management that different portions of the

shipment received);

• "ditto" the shipment date;

• "ditto" the manifest document number information;

• split th~ overall quantity of waste in the shipment among the different lines, as appropriate; and

• identify the single, appropriate system code associated with each quantity, on each line.

If you received this waste stream in more than 8 shipments, please continue onto the back ofthe answer

sheet page 44. If you 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 of your 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.

PLEASE ENTER:

Your RCRA Site ID #: _

Site name: _

FOR ECOLOGY USE ONLY:

Date received: _

Please type or print legibly in blue or black ink.

!

1.

2.

8. _ D ST D MT D p D K D G D L D C (If G, L, or C, answer 8.a.)

8.a. D Lbs/gal D Specific Gravity D Lbs yd3

4. _

B _ 5. DEHW Dow 6. DNo Dves 7.

3.

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9. If additional 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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10. Comments

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Page _

Book 1: 2000 Forms and Instructions 43
Site name: _

Your ReRA Site ID #: _

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)

Page __

Book 1: 2000 Forms and Instructions 45
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