### United States Environmental Protection Agency

[INSERT MONTH] 2011



# RCRA Hazardous Waste Part A Permit Application

Instructions and Form

EPA Form 8700-23

(OMB #2050-0024; E xpires xx/xx/xxxx)

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

RCRA Hazardous Waste Part A Permit Application Instructions and Form

The Resource Conservation and Recovery Act (RCRA) Section 3005 requires EPA to establish permitting requirements applicable to hazardous waste treatment, storage, or disposal fa cilities (TSDFs). The owner and operator of a TSDF must obtain a permit as required under 40 CFR Part 270. Respondents must submit the information required in the RCRA Hazardous Waste Part A Permit Application (EPA Form 8700-23) for a first permit applicat ion or for a revised permit application. Owners and operators of four types of TSDFs are subject to the requirement s: new facilities not yet constructed; newly regulated existing facilities subject to RCRA permitting requirements for the firs t time; permitted facilities with newly regulated units; and int erim status facilities. EPA needs information contained in the app lication to identify the person(s) legally responsible for hazard ous waste activity, to determine wh ich facilities require permits unde r more than one program, to assess potential for the facility to pollute nearby ground and surface waters, to identify the timeframe available for EPA to process permit applications, and to determine the specific wastes a facility is legally allowed to handle for differe nt purposes. EPA must ensure that hazardous wastes are managed in a way that protects human health and the envir onment as required by RCRA. This is mandatory reporting by the respondents.

EPA enters Part A Permit application information submitted by respondents into RCRAInfo, the EPA national database, and issues permits. EPA uses this informa tion to identify the universe of regulated waste TSDFs and their specific regulated hazardous waste activities. EPA also uses the information fo r tracking and planning and for a variety of enforcement and inspection purposes. Finally, EPA uses th is information to ensure that: hazardous wastes are managed properly; TSDFs are operated and maintained as require d; statutory provisions are upheld; and that regu lations are adhered to by facility owners an d operators.

Section 3007(b) of RCRA and 40 CFR Part 2, Subpart B, which defi nes EPA’s general policy on public disclosure of information, both contain provisions for confidentiality. Howeve r, the Agency does not anticipate that businesses will assert a claim of confidentiality covering all or part of the RCRA H azardous Waste Part A Permit Application. If such a claim were asserted, EPA must and will treat the information in accordance w ith the regulations cited above. EPA also will assure that th is information collection complies with the Privacy Act of 1974 and OMB Circular 108.

Estimated Burden: The publ ic reporting burden for First Part A Permit Applica tions (new applications ) is estimated to be approximately 26 hours. The public reporting burden for Revised Part A Permit Applica tions is estimated to be approximately 13 hours. This reporting burden includes time for reviewing instru ctions, searching existing data sources, gathering the data, completing the application, and recordkeeping.

To comment on EPA 's need for this information, the accuracy of the provided burden estimates, a nd any suggested methods for minimizing respondent burden, including the use of automated collection techniques, EP A has established a public docket for thi s ICR under Docket ID Number EPA-HQ- RCRA-2011-0280, which is available for online viewing at www.regulations.gov, or in person viewing at the RCRA Docket in the EPA Docket Center (EPA/DC), EPA West, Room B1 02, 1301 Constitution Avenue, NW, Washington, D.C. The EPA Docket Ce nter Public Reading Room is open from 8:30 a.m. to 4:30 p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading Room is (202) 566-1744, and the telephone number for the RCRA Docket is (202) 566-0270. An elec tronic version of the public docket is available at www.regulations. gov. This site can be used to submit or view public comments, access the index listing of th e contents of the public docket, and to access tho se documents in the public docke t that are available electronically. When in the system, select “search,” then key in the Docket ID Number identified above. Also, you can send comments to th e Office of Information and Regulatory Affair s, Office of Management and Budget, 725 17th Street, NW, Washington, D.C. 20503, Attention: Desk Officer for EPA. Please include the EPA Docket ID Number EPA-HQ-RCRA-2011-0280 and O MB Control Number 2050-0024 in any correspondence.

## Table of Contents

PURPOSE OF THE RCRA HAZARDOUS WASTE PART A PERMIT ............................... 1 Where to Get Help ............................................................................................................. ......... 1 Existing Facilities ........................................................................................................... ............. 2 New Facilities ................................................................................................................ ............. 3 First Part A Submission ....................................................................................................... ....... 3 Revised Part A Submission ..................................................................................................... .... 4

DETERMINING IF YOU MUST FILE ..................................................................................... 5 Who Must File a RCRA Hazardous Waste Permit Application? ............................................... 5 How Do I Know if I Handle a Re gulated Hazardous Waste? ..................................................... 5 Off-Site Facilities ........................................................................................................... ......... 5 On-Site Facilities ............................................................................................................ ........ 5

HOW TO FILE A RCRA HAZARDOUS WASTE PERMIT APPLICATION ..................... 7 How Many Permit Applications Should I File? .......................................................................... 7 Can I Request that this Information be Kept Confidential? ........................................................ 7 Where Should I Send My Completed Permit Application? ........................................................ 8 When Should I File My Permit Application? ............................................................................. 8 When Should My Permit Application be Revised? .................................................................... 9 Facilities Operating U nder Interim Status .............................................................................. 9 Facilities Operating Under a RCRA Hazardous Waste Permit .............................................. 9

INSTRUCTIONS FOR FILLING OUT THE RCRA SUBTITLE C SITE IDENTIFICATION (SITE ID) FORM ..................................................................................... 11 Who Must Submit This Form ................................................................................................... 1 1 Purpose Of This Form ................................................................ Error! Bookmark not defined. How To Fill Out This Form ....................................................... Error! Bookmark not defined. Item-By-Item Instructions .......................................................... Error! Bookmark not defined. Item 1 – Reason for Submittal ............................................... Error! Bookmark not defined. Item 2 – Site EPA ID Number ............................................... Error! Bookmark not defined. Item 3 and 4 – Site Name and Location ................................. Error! Bookmark not defined. Item 5 – Site Land Type......................................................... Error! Bookmark not defined. Item 6 – North American Industry Cla ssification System (NAICS) Code(s) ................ Error! Bookmark not defined. Item 7 – Site Mailing Address ............................................... Error! Bookmark not defined. Item 8 – Site Contact Person .................................................. Error! Bookmark not defined. Item 9 – Legal Owner and Operator of the Site ..................... Error! Bookmark not defined. Item 10 – Type of Regu lated Waste Activity ........................ Error! Bookmark not defined. Item 11 – Description of Hazardous Wastes .......................... Error! Bookmark not defined. Item 12 – Notification of Hazardous Secondary Material (HSM) Activity Error! Bookmark not defined. Item 13 – Comments .............................................................. Error! Bookmark not defined.

### Item 14 – Certification ........................................................... Error! Bookmark not defined. ADDENDUM TO THE SITE IDENTIFICA TION FORM: NOTIFICATION OF HAZARDOUS SECONDAR Y MATERIAL ACTIVITY

........ Error! Bookmark not defined. You Must Fill Out This Section If ............................................. Error! Bookmark not defined. Item 1 – Indicate Reason for Notification .............................. Error! Bookmark not defined. Item 2 – Description of Hazardous S econdary Material (HSM) Activity .. Error! Bookmark not defined. Item 3 – Facility has Financial Assurance Pursuant to 40 CFR 261 Subpart H ............ Error! Bookmark not defined.

INSTRUCTIONS FOR FILLING OUT THE HAZARDOUS WASTE PERMIT INFORMATION FORM ............................................................................................................ 32 General Instructions .......................................................................................................... ........ 32 Item-By-Item Instructions ..................................................................................................... .... 33 Item 1 – Facility Permit Contact ........................................................................................... 33 Item 2 – Facility Permit Contact Address ............................................................................. 33 Item 3 – Operator Mailing Addr ess and Telephone Number ............................................... 33 Item 4 – Facility Existence Date ........................................................................................... 33 Item 5 – Other Environmental Permits ................................................................................. 33 Item 6 – Nature of Business .................................................................................................. 34 Item 7 – Process Codes and Design Capacities .................................................................... 34 Item 8 – Other Processes ...................................................................................................... . 34 Item 9 – Description of Hazardous Wastes ........................................................................... 34 Item 10 – Map ................................................................................................................. ...... 35 Item 11 – Facility Drawing ................................................................................................... 36 Item 12 – Photographs ......................................................................................................... . 36 Item 13 – Comments ............................................................................................................ . 36

OTHER REFERENCE INFORMATION AND CODE LISTS ............................................. 37 Excluded Wastes ............................................................................................................... ........ 38 Definitions.................................................................................................................... ............. 39 EPA Hazardous Waste Codes ................................................................................................... 4 8 HSM Facility Codes ............................................................................................................ ...... 49 HSM Land-Based Unit Codes .................................................................................................. 50

### 1 

## PURPOSE OF THE RCRA HAZARD OUS WASTE PART A PERMIT APPLICATION

The Resource Conservation and Rec overy Act (RCRA) requires anyone who owns or operates a facility where hazardous waste is treated, stored, or disposed to have a RCRA hazardous waste permit issued by the U.S. Environmental Protection Agency (EPA). Th is booklet is designed to help you determine if you are subject to RCRA hazardous waste permitting requirem ents. The instructions contained in this booklet will assist you in starting the permitting process by completing and submitting a RCRA Hazardous Waste Part A Permit Application [EPA Form 8700-23] (Par t A Permit Application) or in modifying your hazardous waste permit by submitting a revised application.

There are two parts to a RCRA hazardous waste permit application – Part A and Part B. Part A of the RCRA hazardous waste permit app lication consists of EPA Form 8700-23 (includes both the RCRA Subtitle C Site Identification Form and the Hazardou s Waste Permit Information Form), along with maps, drawings, and photographs, as required by 40 CFR 270. 13. Part B of the RCRA hazardous waste permit application contains detailed, s ite-specific information. There is no form for the Part B Permit Application; rather, the Part B Permit Application mu st be submitted in narrative form and contain the information described in applicable sections of 40 CFR 270.14 through 270.27.

NOTE • Although this booklet contains informati on and instructions for completing a RCRA Hazardous Waste Part A Permit Application, it should not be considered a substitute for the regulations in Title 40 of the Code of Federal Regulations (40 CFR). Rather, this booklet serves as a s upplement to the regulations and provides additional information not contained in 40 CFR. As an owner or operator of a hazardous waste treatment, storage, or di sposal facility, you are responsible for learning and complying with all the requirements that apply to you and the operations at your facility.

• In addition, remember that this booklet and the regulations in 40 CFR address only the Federal hazardous waste program. Many States may have hazardous waste permitting requirements that differ from th e Federal requirements; those States may use EPA Form 8700-23 for the RCRA Part A submission or they may use a similar State form that requires information not requested in the EPA form. Again, it is your responsibility to make sure th at you have completed and submitted all forms required under the Federal or your State program.



### Where to Get Help

We realize that the regulations are complex. A lthough we are not providing reprints of the 40 CFR regulations in this booklet, copies of the Federal re gulations are available from EPA (see below). The list of State and EPA Regional Office addresses, cont act names, telephone numbers, and e-mail addresses located at: http://www.epa.gov/osw/inforesources/data/form8700/contact.pdf.

### Purpose of the RCRA Hazardous Waste Part A Permit Application (continued)



### 2 In addition to those contacts, there are several other sources available to help with your questions and provide information on EPA regulations:

• RCRA Frequently Asked Questions. This allows users to find answers to commonly asked questions that cover a wide range of RCRA is sues and topics. Find at: http://www.custhelp.com/ cgi-bin/waste.cfg/php/enduser/entry.php.

• RCRA Online. The RCRA Online database is designed to enable users to locate documents, including publications and other outreach materi als that cover a wide range of RCRA issues and topics. Find at: http://www.epa.gov/rcraonline.

• RCRA Regulations. The Federal regulations can be found at: http://www.access.gpo.gov /nara/cfr/cfr-table-search.html.

• Compliance Assistance Centers. The Environmental Protection Agency (EPA) has sponsored partnerships with industry, academic instituti ons, environmental groups, and other agencies to launch sector-specific Compliance Assistance Centers (Centers). Each Center addresses real world issues in understandable language for you to understand Fe deral environmental requirements and how to save money through pollution prevention techniques. Visit the Compliance Assistance Centers at: http://www.assistancecenters.net.

• EPA National Compliance A ssistance Clearinghouse. The Clearinghouse is a comprehensive source of compliance assistance information and resources. Use links to Federal, State, local, and other compliance assistance providers to find th e tools you need. Visit the Clearinghouse at: http://www.epa.gov/clearinghouse.

• EPA Small Business Ombudsman Office – 1-800-368-5888.

• Your Trade Association



### Existing Facilities

Existing hazardous waste management facilities are those hazardous waste treatment, storage, or disposal facilities which were in operation or for which cons truction had commenced on or before November 19, 1980, or which were in existence on the effective date of the statutory or regulatory amendments that render the facility subject to the requirement to obt ain a RCRA permit. RCRA establishes a procedure for obtaining interim status that allows these existi ng facilities to continue operating until a final hazardous waste permit is issued.

You must submit a RCRA Hazardous Waste Part A Pe rmit Application completing all forms included in this booklet. If you do not file a Notification of RCRA Subtitle C Activity and complete the Part A Permit Application by the deadlines specified in page 8 of these instructions, you will be required by law to halt your operations until a RCRA hazardous waste permit is issued.

Facility owners or operators with interim status are treated as having been issued a permit until EPA reviews the RCRA Part B Permit Application and issues a RCRA hazardous waste permit. You may submit your Part B Permit Application voluntarily; however, you are not required to submit it until it is requested by EPA. You will then have up to six m onths to submit the Part B Permit Application.

### Purpose of the RCRA Hazardous Waste Part A Permit Application (continued)



### 3 New Facilities

New hazardous waste management facilities are those hazardous waste treatment, storage, or disposal facilities which were not in operation or for whic h construction had not co mmenced on or before November 19, 1980. Owners or operators of ne w hazardous waste management facilities must submit both Parts A and B of the RCRA hazardous waste perm it application at least 180 days before physical construction of the facility is expected to commence. In addition, these owners or operators are not allowed to begin physical construction of the new facilit y or to treat, store, or dispose of hazardous wastes until receiving a RCRA hazardous waste permit. As such , new facilities do not receive interim status. In addition, new facilities are those facilities that are newly subject to the requirement to obtain a RCRA hazardous waste permit (e.g., through EPA’s promul gation of a new hazardous waste listing). An application for a permit may be submitted any time after promulgation of those standards in 40 CFR subjecting the facility to hazardous waste permitting requirements.

Most State governments are authorized by EPA to administer hazardous waste management programs in lieu of the Federal RCRA program. You should contact your State hazardous waste management agency to determine any additional State requirements. Y ou will need to comply with the specific permit application requirements of that State.

The following instructions provide specific information for completing and submitting a RCRA Hazardous Waste Part A Permit Application using the forms included in this booklet. The instructions also provide general information for completing a RCRA Part B Permit Application. If, after reading the instructions, you have any questions regarding th e RCRA hazardous waste permit application process, contact your State Representative who can answer y our questions and help yo u understand the Federal and State requirements that apply to you. A list of State contacts is available at: http://www.epa.gov/osw /inforesources/data/form8700/contact.pdf.

.



### First Part A Submission

Both new and existing facilities that treat, store, or dispose of regulated hazardous waste are required to submit a RCRA Hazardous Waste Part A Permit Applica tion in accordance with th e deadlines set forth in page 8 of these instructions. Owners or operators of facilities that have not previously submitted a Part A Permit Application will need to submit a permit app lication for the first time. Examples of facilities making their first Part A submission are new facilities or existing facilities that become newly subject to the requirement to have a RCRA hazardous waste perm it. You should mark the box in Item 1 of the RCRA Subtitle C Site Identification Form (Site ID Form) to indicate as a component of a first RCRA Hazardous Waste Part A Permit Application. Th is booklet contains information and item-by-item instructions for completing both the Site ID Form and the Hazardous Waste Permit Information Form.

### Purpose of the RCRA Hazardous Waste Part A Permit Application (continued)



### 4 Revised Part A Submission

There are several conditions under which a facility that has previously submitted a RCRA Hazardous Waste Part A Permit Application must revise that firs t submission to reflect changes that have occurred at the facility. Both facilities operating under in terim status and facilities operating under a RCRA hazardous waste permit may find it necessary to revise their Part A Permit Application. You should mark the box in Item 1 of the RCRA Subtitle C Site Identification Form (Site ID Form) to indicate as a component of a revised RCRA Hazardous Waste Part A Permit Application.

If the owner or operator of this facility has change d since the facility last submitted the Part A Permit Application, be sure to submit a Revised Part A Ap plication. The conditions requiring submission of a Revised Part A Permit Application are summarized in the “How to File a RCRA Hazardous Waste Permit Application” section of this booklet. There is also item-by-item instructions for completing both the Site ID Form and the Hazardous Waste Permit Info rmation Form contained in this booklet.

### 5 

## DETERMINING IF YOU MUST FILE

Who Must File a RCRA Hazardous Waste Permit Application ?

The Resource Conservation and Recovery Act of 1976 (RCRA), as amended, requires each person owning or operating a facility for the treatment, storag e, or disposal of regulated hazardous waste to have a RCRA hazardous waste permit. This includes individua ls, trusts, firms, joint stock companies, Federal agencies, corporations (including government co rporations), partnerships, associations, States, municipalities, commissions, interstate bodies, other politi cal subdivisions of a State, or Indian tribes (or an authorized Indian tribe organization). If you treat, store, or dispose of regulated hazardous waste without obtaining a permit, you may be subject to a civil or criminal penalty.

Both new and existing facilities that treat, store, or dispose of regulated hazardous waste are required to submit a RCRA Hazardous Waste Part A Permit Appli cation as described in 40 CFR Part 270. Four types of facilities are required to submit the Part A Pe rmit Application; new facilities not yet constructed; newly regulated existing facilities subject to RCRA pe rmitting requirements for the first time; permitted facilities with newly regulated units; and interim status facilities.

In an instance where the State may have a newly regulat ed unit, a Part A Permit Application is required. Adding new units for treating, storing, and disposing of waste creates a change to the facility (be it an existing facility or interim status facility) which w ould require a revised Part A Permit Application, as does a major permit modification.

Contact your State if you have questions about the applicability of the Part A form to your facility. A list of Part A contacts can be found at: http://www. epa.gov/osw/inforesources/data/form8700/contact.pdf.



### How Do I Know if I Handle a Regulated Hazardous Waste ?

Off-Site Facilities

Owners or operators of off-site facilities that treat, stor e, or dispose of solid wastes, as defined by 40 CFR 261.2, are encouraged to obtain information on the so lid wastes they receive from generators. If the generators will not supply this information, you are still responsible for determining if the solid wastes you handle are also hazardous wastes that are regul ated by RCRA. To do so, you should follow the procedures for on-site facilities that are described below.

On-Site Facilities

Generators who treat, store, or dispose, on-site, their own solid wastes (as defined by 40 CFR 261.2), should employ the following procedures in determining if their solid wastes are hazardous wastes that are regulated by RCRA. This determination is made as follows:

• First, you need to determine if the solid w aste handled is excluded from regulation under RCRA. The list of exclusions can be found in the re gulation entitled “Identification and Listing of Hazardous Waste,” 40 CFR 261.4. If the solid wastes handled are excl uded, a RCRA hazardous waste permit is not needed to treat, store, or dispose of these solid wastes. If the solid waste handled is not excluded by Section 261.4, you need to determine if the solid waste handled is a

### Determining if You Must File (continued)



### 6 hazardous waste that is regulated under RCRA. As described below, EPA regulates a solid waste as a hazardous waste by specifically listing it as a hazardous waste or by assigning it a generic hazardous waste code because it possesses any of the four hazardous waste characteristics.

• If the solid waste handled is not excluded by S ection 261.4, you need to determine if it is a hazardous waste that is listed in 40 CFR Part 261, Subpart D, “Lists of Hazardous Wastes”. If you own or operate a facility where listed hazardous waste is treated, stored, or disposed, you are subject to regulation and must file a RCRA hazardous waste permit application, unless the hazardous waste has been exem pted as described below.

• If the solid waste handled is not listed in 40 CFR Part 261, Subpart D, the solid waste may still be a hazardous waste if it possesses certain characteris tics or contains certain contaminants. These characteristics and contaminants are described in 40 CFR Part 261, Subpart C, “Characteristics of Hazardous Waste”. A determination that a solid waste possesses these characteristics or contaminants may be made based on either:

1. your knowledge of the hazard characteristic of the solid waste in light of the materials or processes used; or

2. the results of testing the solid waste ac cording to the methods in 40 CFR Part 261, Subpart C.

If you own or operate a facility where characteristic hazardous waste is treated, stored, or disposed, you are subject to regulation and must file a RCRA Hazardous Waste Permit Application, unless the hazardous waste h as been exempted as described below.

• If the hazardous waste that you handle has been exempted under 40 CFR 261.5 or 261.6(a)(3), you are not subject to regulation and do not need to file a RCRA Hazardous Waste Permit Application.

In addition, certain other persons who handle h azardous waste are not required to obtain a RCRA hazardous waste permit. They are:

• Generators who accumulate their own hazardous wa ste on-site for less then 90 days as provided in 40 CFR 262.34;

• Farmers who dispose of hazardous waste pestic ides from their own use as provided in 40 CFR 262.70; and

• Owners and operators of totally enclosed tr eatment facilities as defined in 40 CFR 260.10.

### 7 

## HOW TO FILE A RCRA HA ZARDOUS WASTE PERMIT APPLICATION

As noted above, there are two parts to the RCRA Haza rdous Waste Permit Appli cation – Part A and Part B. As required by 40 CFR 270.13, the Part A Permit Application defines the processes to be used for treatment, storage, and disposal of hazardous wast es; the design capacity of such processes; and the specific hazardous wastes to be handled at a fac ility. The RCRA Hazardous Waste Part A Permit Application is submitted by completing the two forms included in this booklet: the RCRA Subtitle C Site Identification Form and the Hazardous Waste Permit Information Form.

The Part A Permit Application serves as a vehicle through which an owner or operator may submit facility-specific information to the regulatory authority and keep this information current. As specified by 40 CFR 270.14 through 270.27, the Part B Permit Appli cation requires detailed site-specific information such as geologic, hydrologic, and engineering data . The Part B Permit Application is submitted in narrative form.



### How Many Permit Applications Should I File ?

You need submit only one RCRA Hazardous Waste Permit Application (Part A and Part B) per facility, provided that you describe all of the activities at that facility. If you conduct hazardous waste activity(ies) at more than one facility, you must submit a separat e RCRA Hazardous Waste Permit Application (Part A and Part B) for each facility location. You must also have an EPA Identification Number for each of the facilities.

NOTE Only one permit application is required per fac ility. At some point, you may be required to submit revised applications to update your firs t Part A Permit Application submission. At any given time, the first submission and any subsequent revised submissions represent the Part A Permit Application for your facility.



### Can I Request that this Inform ation be Kept Confidential?

All information submitted in this form will be subject to public disclosure, to the extent provided by the Freedom of Information Act, 5 U.S.C. Section 552, and EPA’s Business Confidentiality Regulations, 40 CFR Part 2 and 40 CFR 270.12. Claims of confid entiality for the name and address of any permit applicant or permittee will be denied. Persons fili ng this form may make claims of confidentiality for certain information. Such claims must be clearly indicated by submitting an attachment listing the specific information for which confidential treatment is requested at the time of filing. This attachment must include a written substantiation of the claim for confidentiality that answers the following questions:

• Which sections of the Part A Permit Application form contain the information you claim is entitled to confidential treatment?

• For how long is confidential treatment desired for the information?

### How to File a RCRA Hazardous Waste Permit Application (continued)



### 8 • What measures have you taken to guard against unde sired disclosure of the information to others?

• To what extent has the information been disclo sed to others, and what precautions have been taken in connection with that disclosure?

• Has EPA or any other Federal agency made a pe rtinent confidentiality determination? If so, include a copy of such determination or reference to it, if available.

• Will disclosure of the information be likely to result in substantial harmful effects on your competitive position? If so, what would those harm ful effects be and why should they be viewed as substantial? Explain the causal relationshi p between disclosure and the harmful effects.

Information covered by a confidentiality claim and the above substantiation will be disclosed by EPA only to the extent and by means of the procedures set forth in 40 CFR Part 2 and 40 CFR 270.12.

If no claim of confidentiality or no substantiation accom panies the information when it is submitted, EPA may make the information available to the pub lic without further notice to the submitter.



### Where Should I Send My Completed Permit Application ?

You should submit the RCRA Hazardous Waste Perm it Application to your State or EPA Regional contact. A list of State Contacts can be found a t: http://www.epa.gov/osw/inforesources/data/form8700/ contact.pdf.

Many States use the form included at the end of this booklet; some also require additional information. Other States require that you complete and submit a State-specific form. The Contact list indicates which form to use. Even if you use the included form, yo u should check with your State to determine if you need to submit additional information. Also, contact your State if you have any questions about your submission.



### When Should I File My Permit Application ?

As required by 40 CFR 270.10, the deadlines for filing RCRA Hazardous Waste Permit Applications are:

• Existing Facilities: Under 40 CFR 270.10(e), existing facilities must submit a Part A Permit Application no later than six months following the publication of regulations that subject the facility to the requirement to have a RCRA hazardous waste permit.

• New Facilities: Under 40 CFR 270.10(f), new facilities must submit both Part A and Part B Permit Applications at least 180 days before comme ncing physical construction of the facility. A permit must be received be fore construction begins.

### How to File a RCRA Hazardous Waste Permit Application (continued)



### 9 When Should My Permit Application be Revised ?

Facilities Operating Under Interim Status

In accordance with 40 CFR 270.72(a), the owner or opera tor of a facility operating under interim status must submit a Revised Part A Permit Application at the following times:

• Prior to treating, storing, or disposing of ne w hazardous wastes not previously identified in the facility’s Part A permit. Similarly, when EPA (or a State with an authorized RCRA program) promulgates a rule listing or identifying new h azardous wastes, facilities managing these wastes must revise their Part A Permit Application to reflect this activity.

• Prior to increasing the design capacity of the pr ocesses used at the facility. The EPA Regional Administrator (or the State Director, for an aut horized State) must approve changes in capacity before they take effect at the facility.

• Prior to changing existing processes or adding new processes for treating, storing, and disposing of hazardous wastes at the facility. Changes in tr eatment, storage, and disposal practices must be approved by the Regional Administrator (or State Director) before they are implemented by a facility.

• Prior to undergoing a change in owners hip or operational control of a facility.

• Whenever facility changes occur in accordance with an interim status corrective action order issued by EPA, an authorized State, or by a cour t in a judicial action brought by EPA or the State.

• When a facility adds units for the treatment, stor age, and disposal of h azardous waste that are newly regulated by EPA or a State. A revised Part A Permit Application must be submitted on or before the date on which the unit becomes subject to the new requirements.

Changes in the quantity of hazardous waste currently sp ecified in the first Part A Permit Application can be made without submitting a revised Part A Permit Application, provided the quantity does not exceed the design capacities of the processes sp ecified in the first Part A Permit Application or a subsequent Part A Permit Application.

Failure to furnish all information required to pr ocess a RCRA Hazardous Waste Permit Application is grounds for termination of interim status.

Facilities Operating Under a RCRA Hazardous Waste Permit

Owners or operators of facilities operating under a RCRA hazardous waste permit may modify their permit at any time, in accordance with the specific requirements in 40 CFR 270.42. Appendix I to 40 CFR 270.42 divides the various types of permit modifi cations into Classes 1, 2, and 3, based on the complexity of facility changes necessitating a permit modification. Class 1 modifications are minor changes that keep the permit current with changes that occur to the facility or its operation. Class 2 and 3 modifications involve more significant changes in facility operations.

### How to File a RCRA Hazardous Waste Permit Application (continued)



### 10 In all cases when a facility owner or operator requ ests a permit modification, however, he or she must submit the information required in the Part A Pe rmit Application (in 40 CFR 270.13) as part of the modification submittal.

Finally, under 40 CFR 270.10(h), facilities with a RCRA hazardous waste permit must submit a new application (Part A and Part B) at least 180 days prior to the expiration date of the permit.

### 11 

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

Who Must Submit This Form

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

• Initial Notification of Regulated Waste Activity

• Subsequent Notification of Regulated Waste Activity

• First RCRA Hazardous Waste Part A Permit Application

• Revised RCRA Hazardous Waste Part A Permit Application

• Hazardous Waste Report

• Notification for eligible academic entities opting into or withdrawing from managing laboratory hazardous wastes pursuant to 40 CFR Part 262 Subpart K (if in an eligible State)

• Notification for facilities managing hazardous secondary material pursuant to 40 CFR 260.42 (if in an eligible State)

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



### Purpose of This Form

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



### How to Fill Out This Form

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

• Item 1 – your reason for submitting the form

• Item 2 – your site’s EPA Identification Number

• Item 3 – the name of your site

• Item 4 – the physical location of your site

• Item 5 – the land type of your site

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

• Item 7 – the mailing address for your site

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

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

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

• Item 11 – the description of hazardous waste

### Site ID Form (continued)



### 12 • Item 12 – your site’s hazardous secondary material activity, if you manage any

• Item 13 – additional comments on Items 1 – 12

• Item 14 – certification that the information you pr ovided throughout the form is truthful, accurate and complete

• Addendum to the Site Identification Form – notif ication of hazardous secondary material activity

Type or print, in black ink, all items except the Signature box in Item 14. In Item 14, provide the required ink signatures. Signatures must be original. Stamped or photocopied signatures are not acceptable. Enter your site’s EPA Identification Number in the top left-hand corner on all pages of the form; for an Initial Notification for this site, leave the EPA Identification Number blank. Use Item 13 – Comments to clarify or provide additional informatio n for any entry. When entering information in the comments section, enter the item number and box lett er to which the comment refers. If you must use additional sheets for comments, enter your site’s EPA Identification Number in the top left-hand corner of each sheet.

### Site ID Form (continued)



### 13 Item-By-Item Instructions

Item 1 – Reason for Submittal

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

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

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

o If you are an eligible academic entity opting into 40 CFR 262 Subpart K for managing laboratory hazardous wastes AND you have never before s ubmitted site identification information, you must submit this form to notify the appropriate State or EPA Regional Office of your activities. Note: You must check with your State to determine if you are eligible to manage laboratory hazardous wast e pursuant to 40 CFR Part 262 Subpart K in order for you to notify.

o If you will begin managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) AND you have never before submitted site identification information, you must submit this form, pursuant to 40 CFR 260.42, to notify the appropriate State or EPA Regional Office of your activities. Note: You must check with your State to determine if you are eligible to manage hazardous secondary material under these exclusions in order for you to notify.

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

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

o If you have previously submitted site identif ication information and are an eligible academic entity opting into or withdr awing from 40 CFR Part 262 Subpart K for managing laboratory hazardous wastes, you must use this form. Note: You must check with your State to determine if you are e ligible to manage laboratory hazardous waste pursuant to 40 CFR Part 262 Subpart K in order for you to notify.

o If you have previously submitted site identifi cation information and are notifying (or renotifying) that you will begin managing, are managing, or have stopped managing hazardous secondary material under 40 CFR 261. 2(a)(2)(ii), 40 CFR 261.4(a)(23), (24),

### Site ID Form (continued)



### 14 or (25), you must submit this form, pursuant to 40 CFR 260.42, to notify the appropriate State or Regional Office of your activities. Note: You must check with your State to determine if you are eligible to mana ge hazardous secondary material under these exclusions in order for you to notify.

• As a component of a First RCRA Hazardous Waste Part A Permit Application. If your site is planning to treat, store, or dispose of hazardous waste on-site in a unit that is not exempt from obtaining a hazardous waste permit, you must subm it this form as part of the Part A Permit Application. Also, if the activity at this site (treatment, storage, or disposal) became newly regulated under RCRA Subtitle C and the rules prom ulgated pursuant to the Act (specifically 40 CFR Parts 260-299), you must submit this form as part of the Part A Permit Application.

• As a component of a Revised RCRA Hazardous Waste Part A Permit Application. If you must submit a revised Part A Permit Application to reflect changes that have occurred at your site, you must submit this form as part of your revised Part A Permit Application. Examples of site changes requiring a revised Part A Perm it Application include managing new wastes not identified in the first submission of the form or changes to existing waste treatment processes. When submitting a revised Part A Permit App lication, please include the Amendment number in the appropriate space.

• As a component of the Hazardous Waste Re port. (If marked, see sub-bullet below). If you are required to submit a Hazardous Waste Repor t indicating the amount of hazardous waste you generate, treat, recycle, dispose, ship off-site, or receive from off-site, you must fill out this form. A Site ID Form submitted with a Hazardous W aste Report is equivalent to a Subsequent Notification.

o Site was a TSD facility and/or generator of ≥ 1,000 kg of hazardous waste, > 1 kg of acute hazardous waste, or > 100 kg of acut e hazardous waste spill cleanup in one or more months of the report year (or State equivalent LQG regulations). The purpose of this check box is to distinguish between sit es that meet the criteria and are required to file a report versus those who file voluntarily or by State-only requirement but were not a TSD facility or a Large Quantity Generator (LQG) during the report year. Sites required to file the report should place an “X” in this box while non-LQG/TSD sites should not. For more information about who must file a report, refer to Who Must File the Hazardous Waste Report.

Item 2 – Site EPA ID Number

Provide your EPA Identification Number in Item 2 for this site . The first two characters of the EPA ID Number must be a valid state postal code. Be sure to incl ude your EPA Identification Number at the top of all pages of the form (as well as on any attachments to the Site ID Form).

NOTE If this is your Initial Notification for this site, leave the EPA Identification Number blank and proceed to Item 3.

### Site ID Form (continued)



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

Provide the legal name of your site and a complete location address. Please note that the address you give for Item 4, Site Location, must be a physical address, not a post office box or route number. Only foreign hazardous waste transporters, with their headquarter s located outside the U.S., may provide a Site Location Country outside of the U.S.

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

Item 5 – Site Land Type

Place an “X” in the box that best describes the land type of your site. Select only one type: Private, County, District, Federal, Tribal (see below), Municipa l, State, or Other. If your site’s Land Type could be described as Municipal and another Land Type, such as County, District, or Tribal, do not place an “X” in Municipal. Instead, choose the other appropria te Land Type. (For example, if your site’s Land Type is both Municipal and County, you would place an “X” in the box for County.) You may explain this in Item 13 – Comments.

Tribal – A member of one of the tribes/entities on the list of federally recognized American Indian tribes and Alaskan Native entities located at: http://www.epa.gov/tribal/whereyoulive/tribes-a-z.htm

.

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

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

Box A Provide the North American Industry Classification System (NAICS) code that best describes your site’s primary business production process for your products or services. Referencing the latest NAICS codes, use the 6-digit code (most specific description) if available for your business; if not, use the 5-digit code; do not enter any four (4) or less digit codes.

Boxes B – D List other NAICS codes that describe the other business production processes for your site. Referencing the latest NAICS c odes, use the 6-digit code (most specific description) if available for your business; if not, use the 5-digit code; do not enter any four (4) or less digit codes.

Check with your accounting or business staff to determ ine your NAICS code(s); the NAICS code is used in tax reporting and other business re ports. You can obtain additional information about NAICS codes at http://www.census.gov/eos/www/naics

.

Item 7 – Site Mailing Address

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

### Site ID Form (continued)



### 16 Item 8 – Site Contact Person

Enter the name, title, business address, telephone number , extension, fax number, and e-mail address of the individual who should be contacted regarding th e information submitted in the Site ID Form. A Subsequent Notification is recommended when the Site Contact Person changes. Do not enter other contact persons here; if there are other persons, who may be contacted about this submission, list them and their other contact information in Item 13. If the person completing the Hazardous Waste Report is not the primary site RCRA hazardous waste contact , enter the primary site RCRA hazardous waste contact here and add the contact information for the person completing the Hazardous Waste Report in Item 13 – Comments.

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

Item 9 – Legal Owner and Operator of the Site

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

A. Name of Site’s Legal Owner: Provide the name of your site’s legal owner(s). This includes owner(s) of the building(s) and la nd. Please review these definitions:

Owner – The person who owns a RCRA site or pa rt of a RCRA site. Note: This includes the owner(s) of the building(s) and/or land. This may be an individual, company, or business name. See Person

.

Person – An individual, trust, firm, joint stock company, Federal Agency, corporation, (including a government corporation), part nership, association, State, municipality, commission, political subdivision of a State, or any interstate body.

Date Became an Owner: Indicate the date on which the above entity became the owner of your site. Enter dates as in this example: For April 22, 2011, enter 04/22/2011. This is a required field and a date must be reported.

Owner Type: Place an “X” in the box that best describes the owner type for your site. Select only one type: Private, County, District, Federal, Tribal (see below), Municipal, State, or Other. If your site’s Owner Type could be described as Municipal and another Owner Type, such as County, District, or Tribal, do not place an “X” in Municipal. Instead, choose the other appropriate Owner Type. (For example, if your site’s Owner Type is both Municipal and County, you would place an “X” in the box for County.). You may explain this in Item 13 – Comments.

Tribal – A member of one of the tribes/entities on the list of federally recognized American Indian tribes and Alaskan Native entities located at: http://www.epa.gov/tribal/whereyoulive/tribes-a-z.htm

.

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

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

### Site ID Form (continued)



### 17 owners since your last submission of this form. If necessary, attach a separate sheet of paper. Remember to enter your site’s EPA Identificati on Number in the top left-hand corner of each sheet.

B. Name of Site’s Operator. Provide the name of your site’s operator. Please review these definitions.

Operator – The person responsible for the overall op eration of a RCRA site. Note: This is the legal entity which controls the RCRA s ite operation rather than the plant or site manager. This is usually a company or bu siness name, but may be an individual. See Person

.

Person – An individual, trust, firm, joint stock company, Federal Agency, corporation, (including a government corporation), part nership, association, State, municipality, commission, political subdivision of a State, or any interstate body.

Date Became an Operator: Indicate the date on which the above entity became the operator of your site. Enter dates as in this example: For April 22, 2011, enter 04/22/2011. This is a required field and a date must be reported.

Operator Type: Place an “X” in the box that best describes the operator type for your site. Select only one type: Private, County, District, Federal, Tribal (see below), Municipal, State, or Other. If your site’s Operator Type could be described as Municipal and another Operator Type, such as County, District, or Tribal, do not place an “X” in Municipal. Instead, choose the other appropriate Operator Type. (For exam ple, if your site’s Operator Type is both Municipal and County, you would place an “X” in the box for County.) You may explain this in Item 13 – Comments.

Tribal – A member of one of the tribes/entities on the list of federally recognized American Indian tribes and Alaskan Native entities located at: http://www.epa.gov/tribal/whereyoulive/tribes-a-z.htm

.

Use the Comments section in Item 13 to list a ny additional operators, their names, the dates they became operators, operator type, mailing a ddress, and which operator(s), if any, are no longer operators since your last submission of th is form. If necessary, a ttach a separate sheet of paper. Remember to enter your site’s EPA Identification Number in the top left-hand corner of each sheet.

NOTE A subsequent notification is recommended when the owner or operator of a site changes. Because an EPA Identification Number is s ite-specific, the new owner will keep the existing EPA Identification Number for that location. If your business moves to another location, the owner or operator must notify the State or EPA Regional Office of this change. Since your business has changed locations, a new EPA Identification Number will be assigned.

### Site ID Form (continued)



### 18 Item 10 – Type of Regulated Waste Activity

Mark box “Yes” or box “No” as appropriate for all current activities ( as of the date submitting the form ) at this site; complete any additional boxes as instructed. Current activities mean activities that are in effect when the form is submitted or those that th e site plans to begin after EPA Identification Number assignment. The information you provide in Item 10 will be considered current as of the date you certify the form. If the site is no longer a generator as of th e date you certify the form, you should mark the “No” (not a generator) box for Generator of Hazardous Waste.

NOTE You must report your current regulated waste activities as of the date of submitting the Site ID Form. For the Hazardous Waste Report, your current status may be different than your status during the reporting year.

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

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

1. Generator of Hazardous Waste (at your site): If you generate a hazardous waste that is listed in 40 CFR 261.31 through 261.33 or identified by one or more hazardous waste characteristic(s) contai ned in 40 CFR 261.21 through 261.24, place an “X” in the appropriate box for the quan tity of hazardous waste that is generated per calendar month. (These regulations can be found at http://ecfr.gpoaccess.gov/cgi/t/text/te xt-idx?c=ecfr&tpl=%2Findex.tpl .) The regulations for hazardous waste generators are found in 40 CFR Part 262. Consult these regulations and your State for details about how the regulations apply to your situation. Below is a brief description of the three types of hazardous waste generators.

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

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

### Site ID Form (continued)



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

Hazardous secondary material managed under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) DOES NOT count towards your generator status. However, you

must check with your State to dete rmine if you are eligible to manage hazardous secondary material under these exclusions.

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

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

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

waste.

NOTE If you generate acute hazardous wastes listed in 40 CFR 261.31, 261.32, or 261.33(e), please refer to 40 CFR 261.5(e) to determine the circumstances under which you must notify the EPA.

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

### Site ID Form (continued)



### 20 2. Short-Term Generators Mark “Yes” if the site is currently gene rating hazardous waste only as the result of a one-time, non-recurring, temporary event th at is not related to normal production processes. In other words, short-term generators produce hazardous waste from aparticular activity for a limited time and then cease conducting that activity. Shortterm generators would not be considered episodic generators because episodic generators have the potential to generate on a regular basis (for example, a facility that fluctuates from SQG to LQG in one month is not a short-term generator). Examples of short-term generators incl ude: 1) one-time highway bridge waste generation; 2) underground st orage tank removals; 3) generation of off-spec or outof-date chemicals at a site that normally doesn’t generate hazardous waste; 4) remediation or spill clean-up at sites with no previous RCRA ID; and 5) site or production process decommissions by a new operator. If you mark “Yes”, you must provide an explanation of your short-term generation event in Item 13 - Comments.

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

4. Mixed Waste Generator Mark “Yes” if you are a generator of mixed waste (waste that is both hazardous and radioactive). RCRA defines “mixed waste” as waste that contains both hazardous waste and source, special nuclear, or by-product material subject to the Atomic Energy Act (AEA), RCRA Section 1004(41), 42 U.S.C. 6903 (63 FR 17414; April 9, 1998). See the Definitions section.

5. Transporter of Hazardous Waste: If “Yes”, place an “X” in all that apply.

a. Transporter You transport hazardous waste within the United States. The Federal regulations for hazardous waste transpor ters are found in 40 CFR Part 263.

b. Transfer Facility (at your site) You are a hazardous waste transfer facility, at your site, if you hold manifested hazardous waste(s) at your site for a period of ten (10) days or less while the waste is in transit. The Federal regulations for hazardous waste transfer facilities are found in 40 CFR Part 263.12.

6. Treater, Storer, or Disposer of Hazardous Waste (at your site): If you treat, store, or dispose of hazardous waste, mark “Yes”. A RCRA Hazardous Waste Part B Permit is required for this activity. Contact the appropriate office for your State for more information. The Federal regulations for owners and operators of permitted treatment, storage, and disposal facilities (TSDFs) are found in 40 CFR Parts 264, 265, 266, and 270.

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

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

### Site ID Form (continued)



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

3. Receives waste from off-site but does not store greater than 10 days before re-shipping (i.e., transfer facility).

NOTE If your site is a destination facility for universal wastes in addition to being a treatment, storage, or disposal facility for other RCRA hazardous wastes, mark “Yes” for both this box and Item 10.B.2.

7. Recycler of Hazardous Waste (at your site): If you recycle regulated hazardous wastes (recyclable materials) at your site , mark “Yes”. The Federal regulations for owners and operators of sites that recycle hazardous waste are found in 40 CFR 261.6. You also may be subject to other Fe deral and State regulations; in some cases a permit is required.

NOTE If your site, in addition to being a recycling site for hazardous waste, is a treater, storer, or disposer of hazardous waste, mark “Yes” for both this box and Item 10.A.6. If your site is a destination facility for universal wastes in addition to bein g a recycling site for other RCRA hazardous wastes, mark “Yes” for both this box and Item 10.B.2.

8. Exempt Boiler and/or Industrial Furnace (at your site): If “Yes”, place an “X” in all that apply.

a. Small Quantity On-Site Burner Exemption You burn small quantities of hazardous waste in an on-site boiler or industrial furnace in accordance with the conditions in 40 CFR 266.108, place an “X” in the box to indicate th at you qualify for the Small Quantity On-Site Burner Exemption.

b. Smelting, Melting, and Refining Furnace Exemption You process hazardous wastes in a smelting, melting, or refining furnace solely for metals recovery, as described in 40 CFR 266.100(d), or to recover economically significant amounts of precious metals, as described in 40 CFR 266.100(g), or if you process hazardous wastes in a lead recovery furnace to recover lead, as described in 40 CFR 266 ,100(h), place an “X” in the box to indicate that you qualify for the Smelting, Melting, and Refining Furnace Exemption.

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

### Site ID Form (continued)



### 22 regulations for owners and operators of underground injection wells are found in 40 CFR Part 148.

10. Receives Hazardous Waste From Off-site (at your site): If you received hazardous waste from another site, whether this waste was received as a commercial transaction or waste received from a restri cted group of off-site generators, mark “Yes”.

In addition to the above , mark “Yes” or “No” for the other regulated waste activities listed below that may occur at this site. Comp lete Items B, C, and D as appropriate.

B. Universal Waste Activities (at your site): Refer to your State-specific requirements and definitions for universal waste. Also, refer to 40 CFR 261.9 and 40 CFR Part 273 for the Federal regulations covering universal waste. Complete parts 1 and 2.

1. Large Quantity Handler of Universal Waste (LQHUW): You are an LQHUW if you accumulate a total of 5,000 kg or more total of universal wastes (batteries, pesticides, mercury-containing equipment, or lamps - calculated collectively) at any time. This designation is retained through the end of the calendar year in which the 5,000 kg limit is met or exceeded. If “Yes”, place an “X” in the appropriate box(es) to indicate the type(s) of universal wastes managed at your site. If your State has other additional universal wastes, indicate what they are by placing an “X” in the corresponding box(es) (10.B.1.e, f, or g.).

2. Destination Facility for Universal Waste: Mark “Yes” if you treat, dispose, or recycle universal wastes on-site. A hazardous waste permit is required if you treat or dispose of universal wastes; a permit may be required if you recycle universal wastes.

NOTE If your site, in addition to being a destination facility for universal wastes, is also a treatment, storage, or disposal facility for RCRA hazardous wastes, mark “Yes” for both this box and Item 10.A.6. In addition, if your site recycles RCRA hazardous wastes, mark “Yes” for both this box and Item 10.A.7.

C. Used Oil Activities: Mark the appropriate box(es) to indicate which used oil management activities are taking place at this site. The Fede ral regulations for used oil management are found in 40 CFR Part 279. Complete all parts 1 through 4.

1. Used Oil Transporter: If “Yes”, place an “X” in all that apply.

a. Transporter You transport used oil within the Unite d States. The Federal regulations for used oil transporters are found in 40 CFR Part 279.40-47.

b. Transfer Facility (at your site) You own or operate a used oil transfer facility. The Federal regulations for used oil transfer facilities are found in 40 CFR Part 279.40-47.

### Site ID Form (continued)



### 23 2. Used Oil Processor and/or Re-refiner (at your site): If “Yes”, place an “X” in all that apply.

a. Processor You process used oil. The Federal regula tions for processors of used oil are found in 40 CFR Part 279.50-59.

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

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

4. Used Oil Fuel Marketer (at your site): If “Yes”, place an “X” in all that apply.

a. Marketer Who Directs Shipment of Off-Specification Used Oil to OffSpecification Used Oil BurnersYou are a marketer who directs shipment of off-specification used oil to offspecification used oil burners. The Fede ral regulations for off-specification used oil are found in 40 CFR Part 279.70-75.

b. Marketer Who First Claims the Used Oil Meets the Specification You are the first to claim that used oil meets the used oil specification established in 40 CFR 279.11.

NOTE If either of these boxes is marked, you must also notify (or have previously notified) as a used oil transporter (10.C.1), used oil processor/re-refiner (10.C.2.), or off-specification used oil fuel burner (10.C.3), unless you are a used oil generator. (Used oil generators are not required to notify.)

D. Eligible Academic Entities with Laborato ries – Notification for opting into or withdrawing from managing laboratory hazardous wastes pursuant to 40 CFR Part 262 Subpart K: Note: Fill out Box D ONLY if you are at least one of the following: a college or university; a teaching hospital that is ow ned by or has a formal written affiliation agreement with a college or university; or a non- profit research institute that is owned by or has a formal written affiliation agreement with a college or university; AND you have checked with your State to determine if 40 CFR Part 262 Subpart K is effective in your state and for any state-specific requirements. (See EPA’s website for more information about these regulations: http://www.epa.gov/wastes/hazard/genera tion/labwaste/implementation.htm .)

Subpart K is an optional alternative set of requirements for eligible academic entities with laboratories. Certain generators (i.e., eligib le academic entities defined under (1) below) are eligible to operate under Subpart K for manage ment of their hazardous wastes in laboratories in lieu of 40 CFR 262.34(c) (or 40 CFR 261.5 fo r CESQGs). Eligible academic entities with laboratories that generate hazardous waste that elect to opt into Subpart K, are currently

### Site ID Form (continued)



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

NOTE Eligible academic entities with laboratories must complete a separate Site ID Form for each site (i.e., EPA ID num ber) that is managing hazardous waste under Subpart K. All laboratories with the same EPA ID number will be regulated under this Subpart. If eligible academic entities with laboratories withdraw from Subpart K, all laboratories with the same EPA ID number associated with the withdrawal from Subpart K will be regulated under 40 CFR 262.34(c) requirements (or 40 CFR 261.5 for CESQGs).

1. Opting Into or Currently Operating U nder 40 CFR Part 262 Subpart K for the Management of Hazardous Wastes in Laboratories: Mark “Yes” for this box if you are an eligible academic entity and you elect to opt into or are currently operating under 40 CFR Part 262 Subpart K for the hazardous w astes generated in your laboratories. If you mark “Yes” for this box, you must place an “X ” in at least one of the following to indicate your type of eligible academic entity. Place an “X” in all that apply:

a. College or University. You are an eligible college or university if you are a private or public, post-secondary, degree- granting, academic institution, that is accredited by an accrediting agency listed annually by the U.S. Department of Education.

b. Teaching Hospital that is owned by or has a formal written affiliation agreement with a college or university: You are an eligible teaching hospital if you are a hospital that tr ains students to become physicians, nurses, or other health personnel and is either: (1) owned by a college or university, or (2) has a master affiliation agreement and program letter of agreement, as defined by the Accreditation Council for Graduate Medical Education, with an accredited medical program or medical school.

c. Non-profit Institute that is owned by or has a formal written affiliation agreement with a college or university: You are an eligible non-profit institute if you are an organization that conducts research as its primary function and files as a non-profit organization under the tax code of 26 U.S.C. 501(c)(3) and is either: (1) ow ned by a college or university, or (2) has a formal written affiliation agreement with a college or university that establishes a relationship between ins titutions for the purposes of research and/or education and is signed by authorized representatives from each institution. A relationship on a project-by-project or grant-by-grant basis is not considered a formal written affiliation agreement.

2. Withdrawing from 40 CFR Part 262 Subpart K for the Management of Hazardous Wastes in Laboratories: Mark “Yes” for this box if you have previously elected to opt into 40 CFR Part 262 Subpart K and are now withdrawing from participation in this optional set of alternative requirements for hazardous waste generation in laboratories. Withdrawing generators will automatically revert to regulation under 40 CFR 262.34 (c)

### Site ID Form (continued)



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

Item 11 – Description of Hazardous Wastes

Complete this item if you marked “Yes” for any activity 1 (a-c), 6, 7, or 8 in Item 10.A You will need to refer to 40 CFR Part 261 to complete this item. Part 261 identifies those solid wastes which the EPA defines as hazardous and regulates under RCRA. If you need help completing this section, please contact your State Office.

A. Waste Codes for Federally Re gulated Hazardous Wastes: Please list the waste codes of the Federal hazardous wastes (described in 40 CFR Part 261) handled at your site. List them in the order they are presented in the regulati ons using the appropriat e 4-digit code(s) (e.g., D001, D003, F007, U112).

NOTE EPA Hazardous Waste Codes. If you hand le more hazardous wastes than will fit under Item 11.A, please continue under Item 13 – Comments or on an extra sheet. Remember to include your EPA Identification Number on the top of each page. If you handle a large number of codes, you may copy the list in this booklet and mark the ones that you handle. Attach any additional sheets to the Site ID Form. Remember to include your EPA Identification Number on the top of each page.

B. Waste Codes for State-Regulated (i .e., non-Federal) Hazardous Wastes: If you manage State-regulated hazardous wastes that have a St ate waste code, enter the appropriate code(s) in the box(es) provided. Please list the waste codes of the State-regulated hazardous wastes handled at your site in the order they are presented in the regulations.

NOTE State Hazardous Waste Code. If you handle more hazardous wastes than will fit under Item 11.b, please continue under Item 13 – Comments or on an extra sheet. Remember to include your EPA Identification Number on the top of each page.

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

Mark “Yes” if you are notifying under 40 CFR 260.42 that you will begin managing, are still managing, or will stop managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25). Mark “No” if you are not notifying under 40 CFR 260.42. Note: You must check with your State to determine if you are eligible to manage hazardous secondary material under these regulations.

NOTE If you mark “Yes”, you must fill out the Addendum to the Site ID Form: Notification of Hazardous Secondary Material Activity. See inst ructions for this Addendum after Item 14.

### Site ID Form (continued)



### 26 Item 13 – Comments

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

Item 14 – Certification

This certification must be signed and dated by the owner(s), operator(s), responsible official(s), or authorized representative(s) of the site. (See 40 CFR 270.11 for more information on signatories in general. See also 40 CFR 270.10(b) for additional Ha zardous Waste Part A Perm it Application signatory specifics.) An “authorized representative” is a person responsible for the overall ope ration of the site (i.e., a plant manager or superintendent, or a person of equal responsibility).

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

### Addendum to the Site ID Form (continued)



### 27 

## ADDENDUM TO THE SITE IDENTI FICATION FORM: NOTIFICATION OF HAZARDOUS SECONDAR Y MATERIAL ACTIVITY

You Must Fill Out This Section If:

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

 You will begin managing, are still managing, or will stop managing excluded hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25) and must notify the appropriate State or Regional Office of your activities, pursuant to 40 CFR 260.42. These regulations exclude certain hazardous seconda ry material being reclaimed from the RCRA Subtitle C definition of solid waste provided cer tain requirements and conditions are met. See EPA’s website for more information about these regulations: http://www.epa.gov/epawaste/hazard/dsw/rulemaking.htm#2008

. Complete all parts 1-3.

NOTE You must be managing excluded hazardous sec ondary material in compliance with 40 CFR 261.2(a)(2)(ii), 261.4(a)(23), (24), and/or (25) (or state equivalent). Do not include any information regarding your hazardous w astes in this section. See 73 FR 64668 or http://www.epa.gov/epawaste/hazard/dsw/impresource.htm for more information on these exclusions.

You must submit a completed Site ID Form, in cluding this Addendum, prior to operating under the exclusion(s) and by March 1 of each even-numbered year thereafter to your regulatory authority using the Site ID Form as pursuant to 40 CFR 260.42. Persons who must satisfy this notification requirement can submit this information at the same time as their Biennial Report (which is also due by March 1 of each even-numbered year).

If you stop managing hazardous secondary material in accordance with the exclusion(s) and do not expect to manage any amount of hazardous secondary material under the exclusion(s) for at least one year, you must also submit a completed Site ID Form, including this Addendum, within thirty (30) days pursuant to 40 CFR 260.42.

Remember to include your EPA Identification Number on the top of each page.

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

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

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

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

### Addendum to the Site ID Form (continued)



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

• Facility is still managing excluded hazardous secondary material/re-notifying as required by March 1 of each even-numbered year: Place an “X” in this box if you are re-notifying that you are still managing hazardous secondary material under the exclusion(s). Note: you must have previously notified that you began managing hazardous secondary materials in order to check this box.

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

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

• Facility has stopped managing excluded hazardous secondary material as of (mm/dd/yyyy) and is notifying as required: Place an “X” in this box if you are notifying that you have stopped managing hazardous seconda ry material under the exclusion(s) and do not expect to manage any amount of hazardous secondary material for at least one year (pursuant to 40 CFR 260.42(b)). List th e date when you stopped managing hazardous secondary material. Enter the date in “mm/dd/yyyy” format.

 Facilities must notify within 30 days of when they stopped managing hazardous secondary material. You are considered to have stopped managing hazardous secondary material if: 1) you stop managing hazardous secondary material completely (e.g., you cease operations); 2) you choose to manage the hazardous secondary material as hazardous waste; 3) you undergo closure and request release from financial assurance per 40 CFR 261.143(h); or 4) you temporarily suspend management of hazardous secondary material for at least one year.

 Only place an “X” in this box if you have stopped managing all hazardous secondary material under the exclusion(s). For exampl e, if your facility only stopped managing one hazardous secondary material, but c ontinued to manage another hazardous secondary material, you would leave this box blank since your facility continues to manage some amount of hazardous secondary material.

 If you submit a notification that you have stopped managing hazardous secondary material, you do not need to renotify (unless you choose to manage hazardous secondary material again, in which case you would have to submit a notification prior to managing). After submitting a stop notification, you can leave the Addendum blank for subsequent submissions, including any subsequent biennial report submissions.

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

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

### Addendum to the Site ID Form (continued)



### 29 a. Facility Code: Using the facility codes, found in the Code List section of these instructions, enter the appropria te 2-digit code(s) that correc tly describes your facility. If more than one code applies to your facility, enter each 2-digit code on a separate row. Each hazardous secondary material should be reported by facility code.

b. Waste Codes(s) for HSM: Use the box provided to enter the appropriate 4-digit hazardous waste code(s) that would apply to your hazardous secondary material if you managed it as hazardous waste (i.e., the waste code(s) that would apply if you did not manage your material in accordan ce with 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23),(24), or (25)).

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

c. Estimated Short Tons of Excluded HSM to be Managed Annually: In the box provided, enter your estimated tonnage (using short tons) of hazardous secondary material you expect to manage annually. Convert all physical quantities (e.g., gallons, cubic yards, kilograms, metric tons, etc.) to short tons (1 short ton = 2,000 pounds) and round to the nearest ton (no decimals). Note: Your estim ated tonnage should be for the entire amount of hazardous secondary material to be reclaimed (NOT just the quantity of constituent or product reclaimed).

d. Actual Short Tons of Excluded HSM Managed During the Most Recent OddNumbered Year: Report the tonnage (using short t ons) of each hazardous secondary material you actually managed during the most recent odd-numbered year. For example, if you are submitting this notification on February 20, 2012, enter the amount you actually managed during 2011 (i.e., the tonnage you mana ged from January 1, 2011 to December 31, 2011). Convert all physical quantities (e.g ., gallons, cubic yards, kilograms, metric tons, etc.) to short tons (1 short ton = 2,000 pounds) and round to the nearest ton (no decimals). Note: Your actual tonnage should be for the entire amount of hazardous secondary material that was sent for reclamation (NOT just the quantity of constituent or product reclaimed). If this is your initial notification, enter “0”.

e. Land-Based Unit Code: Using the land-based unit codes, found in the Code List section of these instructions, enter in the 2-digit c ode that best describes the land-based unit youuse or will use to manage the hazardous secondary material. If you do not use any landbased units, enter “NA”. If you use the code “OT” (Other), please describe your landbased unit in Item 13 – Comments. If more th an one land-based unit code applies to a hazardous secondary material, list it separately using another row.

### Addendum to the Site ID Form (continued)



### 30 Examples for Reporting Hazardous Secondary Material Activity:

EXAMPLE 1: A pharmaceutical manufacturer generates sp ent solvents that are characteristic for ignitability (D001). The manufacturer plans to manage spent solvents under 40 CFR 261.2(a)(2)(ii) and 261.4(a)(24) by sending some amount to a reclaimer w ithin its own company and the rest off-site to a reclamation facility within the United States. The manu facturer will not manage any spent solvents in a land-based unit. Following the regulations, the manuf acturer submits an initial notification prior to managing its spent solvents under the exclusions . The facility would report its hazardous secondary material activity as follows: a. Facility code (answer using codes listed in the Code List section of the instructions) b. Waste Code(s) for hazardous secondary material (HSM) c. Estimated short tons of HSM to be managed annually d. Actual short tons of HSM that was managed during themost recent oddnumbered year e. Land-based unit code (answer using codes listed in the Code List section of the instructions) 02 D001 15 0 NA 06 D001 40 0 NA

EXAMPLE 2: A steel manufacturer generates electric arc furnace dust and spent pickle liquor from one of its steel operations. The manufacturer sends elect ric arc furnace dust (K061) off-site to a reclamation facility within the U.S. and reclaims spent pick le liquor (K062) on-site. Neither hazardous secondary material is managed in a land-based unit. The st eel manufacturer has managed both hazardous secondary material under 40 CFR 261.2(a)(2)(ii) and 261.4(a)(24) for a number of years and it is now time to renotify. The facility would report its hazardous secondary material activity as follows: a. Facility code (answer using codes listed in the Code List section of the instructions) b. Waste Code(s) for hazardous secondary material (HSM) c. Estimated short tons of HSM to be managed annually d. Actual short tons of HSM that was managed during themost recent oddnumbered year e. Land-based unit code (answer using codes listed in the Code List section of the instructions) 01 K062 60 52 NA 06 K061 20,000 22,468 NA

EXAMPLE 3: A reclamation facility has been receivi ng and reclaiming spent solvents under 40 CFR 261.2(a)(2)(ii) and 261.4(a)(24) for a number of years. The facility receives and reclaims spent solvents from multiple hazardous secondary material generators, some of which are within the same company. No spent solvents are managed in a land- based unit. It is now time to re- notify. The facility would report its hazardous secondary material activity as follows: a. Facility code (answer using codes listed in the Code List section of the instructions) b. Waste Code(s) for hazardous secondary material (HSM) c. Estimated short tons of HSM to be managed annually d. Actual short tons of HSM that was managed during themost recent oddnumbered year e. Land-based unit code (answer using codes listed in the Code List section of the instructions) 03 D001;F002;F003;F005 6,000 7,533 NA 03 D001;D038;F002;F003 1,500 918 NA 07 D001;F002;F003;F005 3,000 3,509 NA 07 D001;D038;F002;F003 1,000 523 NA

### Addendum to the Site ID Form (continued)



### 31 EXAMPLE 4: A smelting operation generates furnace bricks that are characteristic for chromium (D007) and sends them off-site for reclamation. Befo re shipping the bricks off-site, the facility manages some of the bricks in a containment building and th e rest in a pile on the land. The facility has been managing the bricks under 40 CFR 261.4(a)(24) for a number of years and must now re-notify. The facility would report its activity as follows: a. Facility code (answer using codes listed in the Code List section of the instructions) b. Waste Code(s) for hazardous secondary material (HSM) c. Estimated short tons of HSM to be managed annually d. Actual short tons of HSM that was managed during themost recent oddnumbered year e. Land-based unit code (answer using codes listed in the Code List section of the instructions) 06 D007 200 235 NA 06 D007 115 126 PL

EXAMPLE 5: An intermediate facility has been managing wastewater treatment sludges from electroplating operations (F006) for the past seven y ears but, due to company consolidation, it will soon shut down. In accordance with 40 CFR 260.42, the f acility notifies that it will stop managing hazardous secondary material. The facility would report its activity as follows: a. Facility code (answer using codes listed in the Code List section of the instructions) b. Waste Code(s) for hazardous secondary material (HSM) c. Estimated short tons of HSM to be managed annually d. Actual short tons of HSM that was managed during themost recent oddnumbered year e. Land-based unit code (answer using codes listed in the Code List section of the instructions) 08 F006 0 5,034 NA

Item 3 – Facility has Financial Assurance Pursuant to 40 CFR 261.4(a)(24)(vi)

Financial assurance is required for reclaimers ( 07, 11) and intermediate (08) facilities managing hazardous secondary material under 40 CFR 261.4(a)( 24) and (25). See EPA’s website for more information about these regulations: http://www.epa.gov/epawaste/hazard/dsw/impresource.htm

.

• Mark “Yes”, if you have financial assuran ce pursuant to 40 CFR 261.4(a)(24)(vi) AND you use at least one facility code that is 07, 08 , or 11 in Item 2.a above. For example, the facilities in Examples 3 and 5 above are require d to have financial assurance because the facility codes are 07 and 08, respectively.

• Mark “No”, if you do NOT have financial assurance pursuan t to 40 CFR 261.4(a)(24)(vi). Note: Reclaimers (07, 11) and intermediate (08) facilities must have financial assurance in order to manage hazardous secondary ma terial under 40 CFR 261.4(a)(24) and (25). Answering “No” to this question may mean you are in violation of these regulations if you report facility codes 07, 08, or 11. For exam ple, the facilities in Examples 1, 2, and 4 above are not required to have financial assurance because these facilities did not report facility codes of 07, 08, or 11.

### 32 

## INSTRUCTIONS FOR FILLING OUT THE HAZARDOUS WASTE PERMIT INFORMATION FORM

General Instructions

Please type or print, leaving only one blank box between words. Abbreviate, if necessary, to stay within the number of boxes allowed for each item. Some items in the form require narrative explanation. If more space is necessary to answer a question, use the space provided in Item 13 and reference the item number to which the additional in formation applies or attach a separate sheet entitled “Additional Information”. Remember to include your EPA Iden tification Number and site name in the upper lefthand corner of each attached page.

Unless otherwise specified in the inst ructions to the form, each item must be answered. To indicate that each item has been considered, enter “NA” for not applicable, if a particular item does not fit the circumstances or characteristics of your facility or activity.

For a Revised Part A Permit Application, circle the item numbers with new information or changes.

### Hazardous Waste Permit Information Form (continued)



### 33 Item-By-Item Instructions

Item 1 – Facility Permit Contact

Give the name, title, work telephone number, and e-ma il of a person who is thor oughly familiar with the activities at the facility that require a hazardous wast e permit and with the facts reported in the Hazardous Waste Permit Information Form. This person must be available to be contacted by offices reviewing the permit application, if necessary. If the Facility Pe rmit Contact person is the same as the Site Contact Person identified in Item 8 of the RCRA Subtitle C Site Identification Form (Site ID Form), you may print “Same as Site Contact” in this box.

Item 2 – Facility Permit Contact Mailing Address

Enter the mailing address for the facility permit contact . If the mailing address is the same as the Site Mailing Address (Item 7) on the Site ID Form, you may print “Same as Site Mailing Address” in this box.

Item 3 – Operator Mailing Address and Telephone Number

Enter the mailing address and telephone number of the f acility operator identified in Item 9.B of the Site ID Form.

Item 4 – Facility Existence Date

Enter the appropriate date that applies to your facility from among the following:

• the date that hazardous waste opera tions at the facility commenced;

• the date construction on the facility commenced; or

• the date operation is expected to begin.

Item 5 – Other Environmental Permits

A. Permit Type: Using the codes listed below, enter a le tter on the form for all other environmental permits the facility has received, or for which the facility has filed an application, even if the permit has not yet been received.

N = NPDES (National Pollutant Discharge Elimination System) Clean Water Act P = PSD (Prevention of Significant Deterioration) Clean Air Act R = RCRA (Resource Conservation and Recovery Act) U = UIC (Underground Injection Control) Safe Drinking Water Act F = EPA 404 (Dredge or Fill Permits unde r Section 404 of the Clean Water Act) E = Other relevant environmental permits. List any other relevant Federal (e.g., permits under the Ocean Dumping Act), State (e.g., State permits for new air emission sources in nonattainment areas under Part D of the Clean Air Act or State permits under Section 404 of the Clean Water Act), or local environmental permits or applications.

B. Permit Number: Give the number of each presently eff ective permit issued to the facility for each program, or if you have previously filed an application, but have not yet received a permit, give the number of the application and note this in the description. You may list additional permit numbers on a separate sheet of paper if you have more than one currently effective permit

### Hazardous Waste Permit Information Form (continued)



### 34 for your facility under a particular permit pr ogram. Remember to include your EPA Identification Number and site name in the upper left-hand corner of each attached page.

C. Description: Use the space provided for any additional information identifying or describing the permits.

Item 6 – Nature of Business

Briefly describe the nature of your business (e.g., pr oducts produced or services provided). If more space is needed, please attach additional sh eets. Remember to include your EPA Identification Number and site name in the upper left-hand corner of each attached page.

Item 7 – Process Codes and Design Capacities

The information in Item 7 describes all the processes th at will be used to treat, store, or dispose of hazardous waste at the facility. The process code and design capacity of each process must be provided as part of the description. The design capacity of in jection wells and landfills at existing facilities should be measured as the remaining, unused capacity. Tank storage should refer to each tank, not each tank farm. Please indicate the location of each process listed in Item 7 on either the map provided for Item 10 or the photographs provided for Item 12. Use the line number from Item 7 to indicate where the process(es) are located. See the form for detailed instructions on Item 7.

NOTE Submission of a Revised Part A Permit Application is required before processes for treating, storing, or disposing of hazardous wastes are changed; before new processes are added; and/or before the design cap acities of these processes are increased.

Item 8 – Other Processes

Use this space to describe other processes that did not have a specific process code listed in Item 7.A of the form. Follow the instructions for Item 7.A on th e form for other process codes (i.e., D99, S99, T04, and X99 process codes). Describe the other processes in Item 13 - Comments.

Item 9 – Description of Hazardous Wastes

This information describes all the hazardous wastes , using their hazardous waste codes, that will be treated, stored, or disposed at the facility. In additi on, the processes that will be used to treat, store, or dispose of each hazardous waste and the estimated annual quantity of each hazardous waste must be provided. The form contains three pages to capture th e information for Item 9: Page 4 of 6, which has detailed instructions; Page 5 of 6, wh ich is to be filled out; and Page 5_ of _, which is used if additional pages are needed. If additional pag es are needed, the pages should be num bered as follows: Page 5a of 6, Page 5b of 6, Page 5c of 6, etc. See th e form for detailed instructions on Item 9.

### Hazardous Waste Permit Information Form (continued)



### 35 NOTE Submission of a Revised Part A Permit Appli cation is required before a facility begins treating, storing, or disposing of new hazar dous wastes not previously identified in the facility’s Part A Permit Application. Changes in the quantity of hazardous waste previously specified in the Part A Permit Application can be made without submitting a Revised Part A Permit Application, provide d the quantity does not exceed the process design capacities specified in the first Part A submission.

Item 10 – Map

Provide a topographic map or maps of the area exte nding to at least one mile beyond the property boundaries of the facility. The map must clearly show the following:

• The legal boundaries of the facility;

• The location and serial number of each of your existing and proposed intake and discharge structures;

• All hazardous waste management facilities;

• Location of all processes listed in Items 7 and 8 identified by process code;

• Each well where you inject fluids underground; and

• All springs and surface water bodies in the area, plus all drinking water wells within 1⁄4 mile of the facility which are identified in the public record or otherwise known to you.

If an intake or discharge structure, hazardous waste disposal site, or injection well associated with the facility is located more than one mile from the plant, include it on the map, if possible. If not, attach additional sheets describing the location of the structur e, disposal site, or well, and identify the U.S. Geological Survey (or other) maps corresponding to the location. Remember to include your EPA Identification Number and site name in the uppe r left-hand corner of each attached page.

On each map, include the map scale, a meridian a rrow showing north, and latit ude and longitude at the nearest whole second. On all maps of rivers, show th e direction of the current, and in tidal waters, show the directions of the ebb and flow tides. Use a 7- 1/2 minute series map published by the U.S. Geological Survey. If a 7-1/2 minute series map has not been pub lished for your facility site, then you may use a 15- minute series map from the U.S. Geological Survey. If neither a 7-1/2 nor 15-minute series map has been published for your facility site, use a plant map or ot her appropriate map, and include all the requested information; in this case, briefly describe land u ses in the map area (e.g., residential, commercial).

For information about obtaining maps, contact the U.S. Geological Survey at (888) 275-8747 or see the USGS web site at http://www.usgs.gov/pubprod.

You may trace your map from a geological survey chart, or other map meeting the above specifications. If you do, your map should bear a note showing the num ber or title of the map or chart from which it was traced. Include the names of nearby towns, water bodies, and other prominent points.

### Hazardous Waste Permit Information Form (continued)



### 36 Item 11 – Facility Drawing

All existing facilities must include a drawing showing the general layout of the facility. This drawing should be approximately to scale and fit on an 8 1⁄2” x 11” sheet of paper. The drawing should show the following:

• The property boundaries of the facility;

• The areas occupied by all storage, treatment, or disposal operations that will be used during interim status;

• The name of each operation (e.g., multiple hearth incinerator, drum storage area, etc.);

• Areas of past storage, treatment, or disposal operations;

• Areas of future storage, treatment, or disposal operations; and

• The approximate dimensions of the property boundaries and all storage, treatment, and disposal areas. (Where applicable, use the process codes listed in Items 7 and 8 to indicate the location of all storage, treatment, and disposal areas.)

NOTE New facilities do not have to complete Item 11.

Item 12 – Photographs

All existing facilities must include photographs that cl early delineate all existing structures; all existing areas for storing, treating, or disposing of hazardous waste; and all known sites of future storage, treatment, or disposal operations. Photographs may be color or black and white, ground-level or aerial. Indicate the date the photograph was taken on the back of each photograph. Use the process codes listed in Items 7 and 8 to indicate the location of all storage, treatment, and disposal areas.

NOTE New facilities do not have to complete Item 11.

Item 13 – Comments

Use this space for any additional comments and att ach additional sheets if necessary. Remember to include your EPA Identification Number and site name in the upper left-hand corner of each attached

page.

# RCRA Hazardous Waste Part A Permit Application

OTHER REFERENCE INFORMATION

AND

CODE LISTS

### 38 

## EXCLUDED WASTES

This section presents a partial list of excluded material s and wastes. This list includes materials excluded from the definition of solid waste in 40 CFR 261.4(a) and solid wastes excluded from the definition of hazardous waste in 40 CFR 261.4(b). In addition, it also includes specific solid waste samples that are excluded from the definition of hazardous waste in 40 CFR 261.4(d)-(f). Finally, this list includes specific hazardous wastes, as descr ibed in 40 CFR 261.4(c), that are exempted from certain RCRA Subtitle C regulations.

Agricultural Waste Fertilizer §261.4(b)(2)

Analytical Samples §261.4(d)

Arsenic Treated Wood and Wood Products §261.4(b)(9)

Cement Kiln Dust §261.4(b)(8)

Coking By-products §261.4(a)(10)

Comparable/Syn gas Fuels §261.4(a)(16)

Domestic Sewage §261.4(a)(1)

Dredged Material §261.4(g)

Drilling Fluid §261.4(b)(5)

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

Exported Wastes §262.56

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

Hazardous Secondary Material Generated and Reclaimed Under the Control of the Generator 40 CFR 261.2(a)(2)(ii) 40 CFR 261.4(a)(23)

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

HTMR Condenser Residue §261.4(a)(11)

In situ Mining Materials §261.4(a)(5)

Irrigation Return Flows §261.4(a)(3)

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

Leachate §261.4(b)(15)

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

Mining Overburden §261.4(b)(3)

Nuclear Material §261.4(a)(4)

Oil Filters §261.4(b)(13)

Petrochemical Recovered Oil §261.4(a)(18)

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

Petroleum Refining §261.4(a)(12)

Pulping Liquor §261.4(a)(6)

Refrigerants §261.4(b)(12) Secondary Material Returned to Original Process §261.4(a)(8)

Secondary Material from Mineral Processing §261.4(a)(17)

Shredded Circuit Boards Being Recycled §261.4(a)(14)

Spent Caustics from Petroleum Refining §261.4(a)(19)

Spent Wood Preserving Solutions and Wastewaters §261.4(a)(9)

Sulfuric Acid §261.4(a)(7)

Treatability Study Samples §261.4(e)

Treatability Studies at Laboratories and Testing Facilities §261.4(f)

Trivalent Chromium Waste §261.4(b)(6)

Used Oil Distillation Bottoms §261.4(b)(14)

Wastes Generated in Storage Tanks, Transport Vehicles , Pipelines, or Manufacturing Process Units §261.4(c)

Wastewater Point Source Discharge §261.4(a)(2)

### 39 

## DEFINITIONS

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

Accumulation A site that does not hold RCRA Interim Status or a RCRA permit may accumulate hazardous waste for a short period of time before shipping i t off-site. The waste must be accumulate d in either tanks or containers; it may not be accumulated in surface impoundments.

Generators of more than 1,000 kg (2, 200 lbs) of hazardous waste per month may accumulate their waste for up to 90 days before shipping it off-site. Generators of 100 kg (220 lbs) to 1,000 kg (2,200 lbs) of hazardous waste

p er month may accumulate their waste for up to 180 days before shipping i t off-site. If the nearest treatment, storage, disposal, or recycling facility to which they can send their waste is more than 200 miles away, they may accumulate their waste for 270 days. See 40 CFR 262.34.

Act or RCRA The Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act of 1976, as amended by the Hazardous and Solid Waste Amendments of 1984, 42 U.S.C. Section 6901 et seq.

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

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

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

Boiler An enclosed device using controlled flame combustion and having the following characteristics: 1. The unit has physical provisions for recovering and exporting energy in the form of steam, heated fluids, or heated gases; 2. The unit's combustion chamber and primary energy recovery section(s) are of integral design (i.e., they are physically formed into one manufactured or assembled unit); 3. The unit continuously maintains an energy recovery efficiency of at least 60 percent, calculated in terms of the recovered energy compared with the thermal value of the fuel; 4. The unit exports and utilizes at le ast 75 percent of the recovered energy, calculated on an annual b asis (excluding recovered hea t used internally in the same unit, for example, to preheat fuel o r combustion air or drive fans or feedwater pumps); or 5. The unit is one which the Regiona l Administrator has determined, on a case-by-case basis, to be a boiler, after considering the standards in 40 CFR 260.32

### Definitions (continued)



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

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

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

Conditionally Exempt Small Quantity Generator (CESQG) of Hazardous Waste A generator that meets the following criteria: In every month during the year, the site did all of the following:

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

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

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

Confidential Business Information (CBI) Information a facility does not wish to make available to the general public for competitive business reasons. Conf idential Business Information (CBI) may be claimed for certain informati on in your submittal. A claim may be made in accordance with 40 CFR Part 2, Subpart B.

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

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

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

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

### Definitions (continued)



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

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

p rocessor/re-refiner, off-specification used oil fuel burner, used oil fuel marketer; eligible academic entity managing laboratory hazardous waste under Subpart K; or site undergoing corrective action. Additionally, facilities that must notify using the Site ID Form and Addendum to the Site ID Form that they are managing hazardous secondary material will also be assigned an EPA ID number.

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

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

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

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

Hazardous Waste Number or Code, EPA The number (or code) assigned by the EPA to each hazardous waste listed in 40 CFR Part 261, Subpart D and to each characteristic identified in 40 CF R Part 261, Subpart C. The codes consist of one letter (D, F, P, U, or K) and three numbers. For a list of EPA hazardous waste codes see the “Othe r Reference Information” section of this booklet.

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

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

### Definitions (continued)



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

Hazardous Waste Transporter Refer to “Transporter" definition.

Hazardous Waste Treatment Any method, technique, or process, including neutralization, designed to change the physical, chemical, or biological character or composition of any hazardous waste so as to neutralize su ch hazardous waste, or so as to recover energy or material resources fr om the hazardous waste, or so as to render such hazardous waste nonhazardous, or less hazardous; safer to transport, store or dispose of; or amenable for recovery, amenable fo r storage, or reduced in volume. Such term includes any activity o r p rocessing designed to change the physical form or composition o f hazardous waste so as to render it nonhazardous.

Incineration Burning of certain types of solid, liquid, or gaseous materials; or a treatmen t technology involving destruction of waste by controlled burning at high temperatures (e.g., burning sludge to remove the water and reduce the remaining residues to a safe, non- b urnable ash that can be disposed safely on land, in some waters, or in underground locations).

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

p hosphate kilns; coke ovens; blast fu rnaces; smelting, melting and refining furnaces; titanium dioxide chloride process oxidation reactors; methane reforming furnaces; pulping liquor recovery furnaces; combustion devices used in the recovery of sulfur valu es from spent sulfuric acid; halogen acid furnaces, as defined under industrial furnace in 40 CFR 260.10; and such other devices as the Administrator may add to this list.

Interim (Permit) Status Period during which the owner/opera tor of an existing TSD facility is treated as having been issued a RCRA permit even though he/she has no t yet received a final determination. An existing facility should have automatically qualified for interim stat us if the owner/operator filed both timely “notification” and the first part (Part A) of the RCRA permit application. Interim status continues until a final determination is made to issue or deny the permit. Owner/o perator of new facilities cannot by definition qualify for interim status; rather, they need a RCRA permit prio r to beginning construction of a hazardous waste management facility.

Large Quantity Generator (LQG) of Hazardous Waste A generator that meets any of the following criteria: 1. Generates, in a calendar month, 1,000 kg (2,200 lbs.) or more o f non-acute RCRA hazardous waste; or 2. Generates, in a calendar month, or accumulates at any time, more than 1 kg (2.2 lbs.) of RCRA acute hazardous waste; or 3. Generates, in a calendar month, or accumulates at any time, more than 100 kg (220 lbs.) of spill cleanup material contaminated with RCRA acute hazardous waste.

### Definitions (continued)



### 43 Large Quantity Handler of Universal Waste (LQHUW) A universal waste handler (as defined in 40 CFR 273.9) who accumulates 5,000 kg or more total of universal wastes (batteries, pesticides, mercurycontaining equipment, or lamps – calculated collectively) at any time. This designation is retained through the end of the calendar year in which the 5,000 kg limit is met or exceeded.

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

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

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

Municipality A city, village, town, borough, county, parish, district, association, Indian tribe or authorized Indian tribal organization, designated and approve d management agency under Section 208 of the Clean Water Act, or any othe r p ublic body created by or under State law and having jurisdiction ove r disposal of sewage, industrial wastes, or other wastes.

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

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

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

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

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

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

.

Owner The person who owns a RCRA site or part of a RCRA site. Note: This includes the owner(s) of the building(s) and/or land. This may be an individual, company, or business name. See Person

.

### Definitions (continued)



### 44 Person An individual, trust, firm, joint stock company, Federal Agency, corporation (including a government corporation), partnership, association, State, municipality, commission, political subdivision of a State, or any interstate body.

Resource Conservation and Recovery Act (RCRA) The Solid Waste Disposal Act as amended by the Resource Conservation and Recovery Act (RCRA) (40 CFR 270.2) . It is the Federal statute that regulates the generation, treatment, st orage, disposal, recycling, and/o r transportation of solid and hazardous waste.

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

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

RCRA Subtitle C Site (RCRA Site or Site) The physical plant or location at which one or more of the following regulated waste activities occurs: the generation, transportation, treatment, storage, or disposal of hazardous wastes; recycling of hazardous wastes; United States importer of hazardous waste; mixed waste (hazardous and radioactive) generator; exempt boiler and/or industrial furnace burning o r p rocessing hazardous waste; large quantity handler of or destination facility for universal wastes; disposing h azardous waste with an undergroun d injection permit; the transportatio n (and temporary storage during transportation), processing/re-refining, bur ning, or marketing of used oil; eligible academic entity managing laboratory hazardous waste unde r Subpart K; facility managing hazardous secondary material being reclaimed that must comply with certain requirements and conditions; or undergoing corrective action.

A site may consist of several treatme nt, storage, or disposal operational units. For entities that only transport regu lated wastes, the term site refers to the headquarters of that entity’s operations.

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

p recipitant and sludge conditioner in wastewater treatment).

### Definitions (continued)



### 45 Small Quantity Generator (SQG) of Hazardous Waste A generator that meets all the following criteria: 1. Generates, in any calendar month, more than 100 kg (220 lbs.) but less than 1,000 kg (2,200 lbs.) of RCRA hazardous waste; and

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

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

OR , a site is a Small Quantity Generator if the site: 1. Meets 1) and 3) of the Conditionally Exempt Small Quantity Generator criteria (see definition), but

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

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

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

Solid Waste Any garbage, refuse, or sludge, or other materials not excluded under 40 CFR 261.4(a). Exclusions include, for example, domestic sewage and any mixture of other wastes that pass through a sewer system to a publicly owned treatment works (POTWs); industrial wastewater discharges that are

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

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

p ursuant to the provisions of Section 2091 of this title to be source material; or (2) ores containing one or more of the foregoing materials in such concentration as the Commission may by regulation determine from time to time.

### Definitions (continued)



### 46 Special Nuclear Material As defined by the Atomic Energy Act of 1954: (1) plutonium, uranium enriched in the isotope 233 or in the isotope 235, and any other material which the Nuclear Regulatory Commissi on, pursuant to the provisions o f Section 2071 of this title, determines to be special nuclear material, but does not include source material; or (2) any material artificially enriched by any of the foregoing, but does not include source material.

Subpart K An alternative set of generator requirements for managing laboratory hazardous waste at eligible academic en tities. Generators that are eligible academic entities with laboratories may elect to opt into 40 CFR Part 262 Subpart K and manage their la b oratory hazardous waste under Subpart K in lieu of 40 CFR 262.34(c) (or 40 CFR 261.5 for CESQGs). In order fo r eligible academic entities (see definition) to opt into Subpart K o r subsequently withdraw from Subpart K, they must use the Site ID Form to notify the appropriate State or EPA Regional Office. Refer to 40 CF R 262.203 and 262.204. Note: You must check with your State to determine if you are eligible to manage laboratory hazardous waste pursuant to 40 CFR Part 262 Subpart K and for any state-specific requirements.

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

p rovided certain requirements are met.

Transfer Facility Any transportation-related facility including loading docks, parking areas, storage areas, and other similar areas where shipments of hazardous waste are held for 10 days or less during the normal course of transportation (40 CFR 260.10 and 40 CFR 263.12).

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

Underground Injection Control The subsurface emplacement of fluids through a bored, drilled or driven well; or through a dug well, where the depth of the dug well is greater than the largest surface dimension. Unde rground injection wells are regulated under both the Safe Drinking Water Act and the Resource Conservation an d Recovery Act (see 40 CFR Part 148).

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

### Definitions (continued)



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

Used Oil Any oil that has been refined from crud e oil, or any synthetic oil, that has b een used, and as a result of such use, is contaminated by physical o r chemical impurities.

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

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

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

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

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

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

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

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

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

### 48 

## EPA HAZARDOUS WASTE CODES

A list of all the hazardous waste codes is show n below. See the regulations for details.

CHARACTERISTICS OF HAZARDOUS WASTE (SEE 40 CFR 261.24) – DXXX

HAZARDOUS WASTE FROM NON-SPECIFIC SOURCES (SEE 40 CFR 261.31) – FXXX

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

DISCARDED COMMERCIAL CHEMICAL PRODUCTS, OFF-SPECIFICATION SP ECIES, CONTAINER RESIDUES, AND SPILL RESIDUES THEREOF – TOXIC WASTES (SEE 40 CFR 261.33) - UXXX

D001 D002 D003 D004 D005 D006 D007 D008 D009 D010 D011 D012 D013 D014 D015 D016 D017 D018 D019 D020 D021 D022 D023 D024 D025 D026 D027 D028 D029 D030 D031 D032 D033 D034 D035 D036 D037 D038 D039 D040 D041 D042 D043 F001 F002 F003 F004 F005 F006 F007 F008 F009 F010 F011 F012 F019 F020 F021 F022 F023 F024 F025 F026 F027 F028 F032 F034 F035 F037 F038 F039 K001 K002 K003 K004 K005 K006 K007 K008 K009 K010 K011 K013 K014 K015 K016 K017 K018 K019 K020 K021 K022 K023 K024 K025 K026 K027 K028 K029 K030 K031 K032 K033 K034 K035 K036 K037 K038 K039 K040 K041 K042 K043 K044 K045 K046 K047 K048 K049 K050 K051 K052 K060 K061 K062 K069 K071 K073 K083 K084 K085 K086 K087 K088 K093 K094 K095 K096 K097 K098 K099 K100 K100 K101 K102 K103 K104 K105 K106 K107 K108 K109 K110 K111 K112 K113 K114 K115 K116 K117 K118 K123 K124 K125 K126 K131 K132 K136 K141 K142 K143 K144 K145 K147 K148 K149 K150 K151 K156 K157 K158 K159 K161 K169 K170 K171 K172 K174 K175 K176 K177 K178 K181 P001 P002 P003 P004 P005 P006 P007 P008 P009 P010 P011 P012 P013 P014 P015 P016 P017 P018 P020 P021 P022 P023 P024 P026 P027 P028 P029 P030 P031 P033 P034 P036 P037 P038 P039 P040 P041 P042 P043 P044 P045 P046 P047 P048 P049 P050 P051 P054 P056 P057 P058 P059 P060 P062 P063 P064 P065 P066 P067 P068 P069 P070 P071 P072 P073 P074 P075 P076 P077 P078 P081 P082 P084 P085 P087 P088 P089 P092 P093 P094 P095 P096 P097 P098 P099 P101 P102 P103 P104 P105 P106 P108 P109 P110 P111 P112 P113 P114 P115 P116 P118 P119 P120 P121 P122 P123 P127 P128 P185 P188 P189 P190 P191 P192 P194 P196 P197 P198 P199 P201 P202 P203 P204 P205 U001 U002 U003 U004 U005 U006 U007 U008 U009 U010 U011 U012 U014 U015 U016 U017 U018 U019 U020 U021 U022 U023 U024 U025 U026 U027 U028 U029 U030 U031 U032 U033 U034 U035 U036 U037 U038 U039 U041 U042 U043 U044 U045 U046 U047 U048 U049 U050 U051 U052 U053 U055 U056 U057 U058 U059 U060 U061 U062 U063 U064 U066 U067 U068 U069 U070 U071 U072 U073 U074 U075 U076 U077 U078 U079 U080 U081 U082 U083 U084 U085 U086 U087 U088 U089 U090 U091 U092 U093 U094 U095 U096 U097 U098 U099 U101 U102 U103 U105 U106 U107 U108 U109 U110 U111 U112 U113 U114 U115 U116 U117 U118 U119 U120 U121 U122 U123 U124 U125 U126 U127 U128 U129 U130 U131 U132 U133 U134 U135 U136 U137 U138 U140 U141 U142 U143 U144 U145 U146 U147 U148 U149 U150 U151 U152 U153 U154 U155 U156 U157 U158 U159 U160 U161 U162 U163 U164 U165 U166 U167 U168 U169 U170 U171 U172 U173 U174 U176 U177 U178 U179 U180 U181 U182 U183 U184 U185 U186 U187 U188 U189 U190 U191 U192 U193 U194 U196 U197 U200 U201 U202 U203 U204 U205 U206 U207 U208 U209 U210 U211 U213 U214 U215 U216 U217 U218 U219 U220 U221 U222 U223 U225 U226 U227 U228 U234 U235 U236 U237 U238 U239 U240 U243 U244 U246 U247 U248 U249 U271 U278 U279 U280 U328 U353 U359 U364 U367 U372 U373 U387 U389 U394 U395 U404 U409 U410 U411

### 49 

## HSM FACILITY CODES

Facility codes describe the specific regulation a facili ty uses to manage its hazardous secondary material (HSM) and the type of activity the facility performs under that regulation (e.g., generator, reclaimer). Review the groups and pick the appropriate code. If more than one facility code applies to you, enter each code on a separate row under Item 2 of the Addendum to the Site ID Form.

Under Control of the Generator Exclusion (40 CFR 261.2(a)(2)(ii) or 261.4(a)(23)) Code Facility Code Description

01 HSM Generator reclaiming HSM “on-site” : This code applies if you ge nerate and recl aim hazardous secondary material at your generating facility. See also paragraph (1) in the Federal definition of “Hazardous secondary material generated and reclaimed under the control of the generator” in 40 CFR Part 260.10

02 HSM Generator transferring HSM to r eclaimer within the “same company”: This code applies if you generate hazardous secondary material and send th e material for reclamation to a different facility that is either controlled by you or controlled by th e same person that controls your generating facility. See also paragraph (2) in the Federal definition of “Hazardous secondary material generated and reclaimed under the control of the generator” in 40 CFR Part 260.10

.

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

you receive and reclaim hazardous second ary material from a different fac ility that either controls you or is controlled by the same person that controls you. See also paragraph (2) in the Federal definition of “Hazardous secondary material generated and reclaimed under the control of the generator” in 40 CFR Part 260.10.

04 Tolling Contractor reclaiming HSM pursuant to a tolling contract: This code applies if you are a tolling contractor that reclaims h azardous secondary materi al pursuant to a written contract with a toll manufacturer. See also paragraph (3) in the Federal definition of “Hazardous secondary material generated and reclaimed under the control of the generator” in 40 CFR Part 260.10.

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

contract. See also paragraph (3) in the Federal definition of “Hazardous secondary material generated and reclaimed under the control of the generator” in 40 CFR Part 260.10.

Transfer-based Exclusion (40 CFR 261.4(a)(24)) Code Facility Code Description

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

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

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

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

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

10 HSM Generator importing HSM from a foreign entity to send to another domestic reclamation facility: This code applies if you import hazardous second ary material from a foreign entity and send the material for reclamation to a domestic reclamation facility.

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

### 50 

## HSM LAND-BASED UNIT CODES

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

Code Land-based Unit Code Description

NA Do not use land-based units to manage hazardous secondary material.

SI Use surface impoundment(s) to manage hazardous secondary material. A surface impoundment is a natural topographic depression, man-made ex cavation or diked area formed primarily of earthen materials (although it may be lined with ma n-made materials), which is designed to hold an accumulation of liquid hazardous secondary materials or materials containing free liquids and which is not an injection well.

PL Use pile(s) to manage hazardous secondary ma terial. Pile means any non-containerized accumulation of solid, nonflowing hazardous secondary material that is used for storage and is not a containment building.

OT Use other land-based unit(s) to manage hazardous secondary material.

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SEND COMPLETED FORM TO: The Appropriate State or Regional Office. 

### United States Environmental Protection Agency RCRA SUBTITLE C SITE IDENTIFICATION FORM

1. Reason for Submittal

MARK ALL BOX(ES) THAT APPLY Reason for Submittal: To provide an Initial Notification (first time submitting site iden tification information / to obtain an EPA ID number for this location) To provide a Subsequent Notification (to update site identification information for this location) As a component of a Firs t RCRA Hazardous Waste Part A Permit Application As a component of a Revised RCRA Hazardous Wa ste Part A Permit Application (Amendment # )

As a component of the Hazardous Waste Report (If marked, see sub-bullet below)

Site was a TSD facility and/or generator of > 1,000 kg of hazardous waste, >1 kg of acute hazardous waste, or >100 kg of acute hazardous waste spill cleanup in one or more months of the report year (or Stat e equivalent L QG regulations)

2. Site EPA ID Number EPA ID Number

3. Site Name Name: -

4. Site Location Information Street Address:

City, Town, or Village: County:

State: Country: Zip Code:

5. Site Land Type Private County District Federal Tribal Municipal State Other

6. NAICS Code(s) for the Site (at least 5-digit codes) A. - C. -

B. - D. -

7. Site Mailing Address Street or P.O. Box:

City, Town, or Village:

State: Country: Zip Code:

8. Site Contact Person First Name: MI: Last:

Title:

Street or P.O. Box:

City, Town or Village:

State: Country: Zip Code:

Email:

Phone: Ext.: Fax:

9. Legal Owner and Operator of the Site A. Name of Site’s Legal Owner: Date Became Owner:

Owner Type: Private County District Federal Tribal Municipal State Other

Street or P.O. Box:

City, Town, or Village: Phone:

State: Country: Zip Code:

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

Type: Private County District Federal Tribal Municipal State Other

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10. Type of Regulated Waste Activity (at your site) Mark “Yes” or “No” for all current activities (as of the date s ubmitting the form); complete any additional boxes as instructed.

A. Hazardous Waste Activities ; Complete all parts 1-10.

Y N 1. Generator of Hazardous Waste If “Yes”, mark only one of the following – a, b, or c. Y N 5. Transporter of Hazardous Waste If “Yes”, mark all that apply.

a. LQG: Generates, in any calendar month, 1,000 kg/mo (2,200 lbs./mo.) or more of hazardous waste; or Generates, in any calendar month, or accumulates at any time, more than 1 kg/mo (2.2 lbs./mo) of acute hazardous waste;

or Generates, in an y calendar month, or accumulates at any time, more than 100 kg/mo (220 lbs./mo) of acute hazardous spill cleanup material. a. Transporter

b. Transfer Facility (at your site)

Y N 6. Treater, Storer, or Disposer of Hazardous Waste Note: A hazardous waste Part B permit is required for these activities.

Y N 7. Recycler of Hazardous Waste

b. SQG: 100 to 1,000 kg/mo (220 – 2,200 lbs./mo) of nonacute hazardous waste. c. CESQG: Less than 100 kg/mo (220 lbs./mo) of non-acute hazardous waste. Y N 8. Exempt Boiler and/or Industrial Furnace If “Yes”, mark all that apply. If “Yes” above, indicate other generator activities in 2-4. a. Small Quantity On-site Burner Exemption

Y N 2. Short-Term Generator (generate from a short-term or one-time event and not from on-going processes). If “Y es”, provide an explanation in the Comments section. b. Smelting, Melting, and Refining Furnace Exemption

Y N 3. United States Importer of Hazardous Waste Y N 9. Underground Injection Control

Y N 4. Mixed Waste (hazardous and radioactive) Generator Y N 10. Receives Hazardous Waste from Off-site

B. Universal Waste Activities ; Complete all parts 1-2. C. Used Oil Activities; Complete all parts 1-4.

Y N 1. Large Quantity Handler of Un iversal Waste (you accumulate 5,000 kg or more) [refer to your State regulations to determine what is regulated]. Indicate types of universal waste managed at your site. If “Yes”, mark all that apply. Y N 1. Used Oil Transporter If “Yes”, mark all that apply.

a. Transporter

b. Transfer Facility (at your site)

a. Batteries

b. Pesticides

c. Mercury containing equipment

d. Lamps

e. Other (specify)

f. Other (specify)

g. Other (specify) Y N 2. Used Oil Processor and/or Re-refiner If “Yes”, mark all that apply.

a. Processor

b. Re-refiner

Y N 3. Off-Specification Used Oil Burner

Y N 4. Used Oil Fuel Marketer If “Yes”, mark all that apply.

Y N 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this activity. a. Marketer Who Directs Shipment of OffSpecification Used Oil to OffSpecification Used Oil Burner b. Marketer Who First Claims the Used Oil Meets the Specifications

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D. Eligible Academic Entities with Laboratories—Notification for opting into or wit hdrawing from managing laboratory hazardous was tes pursuant to 40 CFR Part 262 Subpart K

 You can ONLY Opt into Subpart K if:

• you are at least one of the following: a college or university; a teaching hospital that is owned by or has a formal affiliati on agreement with a college or university; or a non-profit research institute that is owned by or has a fo rmal affiliation agr eement with a college or university; AND

• you have checked with your State to determine if 40 CFR Part 262 Subpa rt K is effective in your state

Y N N 1. Opting into or currently operating under 40 CFR Part 262 Subpart K for the management of hazard ous wastes in laboratories See the item-by-item instructions for definitions of type s of eligible academic entities. Mark all that apply:

a. College or University

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

c. Non-profit Institute that is owned by or has a formal written affiliation agreement with a college or university

Y N N 2. Withdrawing from 40 CFR Part 262 Subpart K for th e management of hazardous wastes in laboratories

11. Description of Hazardous Waste

A. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of th e Federal hazardous wastes handle d at your site . List them in the order they are presented in the regulations (e.g., D001, D003, F007, U112). Use an additio nal page if more spaces are n eeded.

B. Waste Codes for State-Regulated (i.e., non-Federal) Hazardous Wastes. Please list the waste codes of the Stat e-Regulated hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if more spaces are needed.

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12. Notification of Hazardous Secondary Material (HSM) Activity

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

If “Yes”, you must fill out the Addendum to th e Site Identification Form: Notification for Managing H azardous Secondary Material.

13. Comments

14. Certification. I certify under penalty of law that this document and all attachments we re prepared under my directi on or supervision in accord ance with a system designed to assure that qua lified 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 re sponsible for gathering the info rmation, the information submitte d is, to the best of my knowledge and belief, true, accurate, and co mplete. I am aware that there are sign ificant penalties for submitting false infor mation, including the possibility of fines and imprisonment for knowing violations. For the RCRA Hazardous Waste Part A Permit Application, all owne r(s) and operator(s) must sign (see 40 CFR 270.10(b) and 270.11).

Signature of legal owner, operator, or an authorized representative Name and Official Title (type or print) Date Signed (mm/dd/yyyy)

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### ADDENDUM TO THE SITE IDENTIFICATION FORM:

NOTIFICATION OF HAZARDOUS SECONDARY MATERIAL ACTIVITY

ONLY fill out this form if :

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

 You are or will be managing excluded HSM in compliance with 40 CFR 261.2(a)(2)( ii), 261.4(a)(23), (24), or (25) (or state equiv alent) or you have stopped managing excluded HSM in compliance with the exclusi on(s) and do not expect to mana ge any amount of excluded HSM u nder the exclusion(s) for at least one year. Do not include any information regarding your hazardous waste activ ities in th is sectio n.

1. Indicate reason for notification. Include dates where requested.

Facility will begin managing excluded HSM as of _____________ (mm/dd/yyyy).

Facility is still managing excluded HSM/re-notifying as required by March 1 of each even-numbered year.

Facility has stopped managing excluded HSM as of ____________ (mm/dd/yyyy) and is notifying as required.

2. Description of excluded HSM activity. Please list the appropriate codes and quantities in short tons to describe your excluded HSM activity ONLY (do not include any information regarding your hazardous wa stes). Use additional pages if more space is needed.

a. Facility code (answer using codes listed in the Code List section of the instructions) b. Waste code(s) for HSM c. Estimated short tons of excluded HSM to be managed annually d. Actual short tons of excluded HSM that was managed duringthe most recent oddnumbered year e. Land-based unit code (answer using codes listed in the Code List section of the instructions)

3. Facility has financial assurance pursuant to 40 CFR 261.4(a)(24)(vi). (Financial assurance is required for reclaimers and intermediate facilities managing excluded HSM under 40 CFR 261.4(a)(24) and (25))

Y N Does this facility have fina ncial assurance pursuant to 40 CFR 261.4(a)(24)(vi)?

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### 57 EPA ID Number OMB#: 2050-0024 ; Ex p ires xx/xx/xxxx

United States Environmental Protection Agency 

## HARDOUS WASTE PERMIT INFORMATION FORM

1. Facility Permit Contact First Name: MI: Last Name:

Contact Title:

Phone: Ext.: Email:

2. Facility Permit Contact Mailing Address Street or P.O. Box:

City, Town, or Village:

State:

Country: Zip Code:

3. Operator Mailing Address and Telephone Number Street or P.O. Box:

City, Town, or Village:

State: Phone:

Country: Zip Code:

4. Facility Existence Date Facility Existence Date (mm/dd/yyyy):

5. Other Environmental Permits

A. Facility Type (Enter code) B. Permit Number C. Description

6. Nature of Business:

### 58 EPA ID Number OMB#: 2050-0024 ; Ex p ires xx/xx/xxxx 7. Process Codes and Design Capacities – Ente r information in the Section on Form Page 3

A. PROCESS CODE – Enter the code from the list of process codes below that best describes each process to be used at the facility. If more li nes are needed, attach a separate sheet of paper with the additional info rmation. For “other” processes (i.e., D99, S99, T04 and X99), describe the process (including its design capacity) in the space provided in Item 8.

B. PROCESS DESIGN CAPACITY – For each code entered in Item 7.A; enter the capacity of the process.

1. AMOUNT – Enter the amount. In a case where design capacity is not applicable (such as in a closure/post-closure or enforcement actio n) enter the total amount of waste for that process. 2. UNIT OF MEASURE – For each amount entered in Item 7.B(1), enter the code in Item 7.B(2) from the list of unit of measure codes below that describes the unit of measure used. Select only from the units of measure in this list.

C. PROCESS TOTAL NUMBER OF UNITS – Enter the total number of units for each corresponding process code.

Process Code Process Appropriate Unit of Measure for Process Design Capacity Process Code Process Appropriate Unit of Measure for Process

Design Capacity Disposal Treatment (Continued) (for T81 – T94) D79 Underground Injection Well Disposal Gallons; Liters; Gallons Pe r Day; or Liters Per Day T81 Cement Kiln Gallons Per Day; Liters Per Day; Pounds Per Hour; Short Tons Per Hour; Kilograms Per Hour; Metric Tons Per Day; Metric Tons Per Hour; Short Tons Per Day; BTU Per Hour; Liters Per Hour; Kilograms Per Hour; or Million BTU Per Hour D80 Landfill Acre-feet; Hectares-meter; Acres; Cubic Meters; Hectares; Cubic Yards T82 Lime Kiln

D81 Land Treatment Acres or Hectares T83 Aggregate Kiln D82 Ocean Disposal Gallons Per Day or Liters Per Day T84 Phosphate Kiln

D83 Surface Impoundment Disposal Gallons; Liters; Cubic Meters; or Cubic Yards T85 Coke Oven

D99 Other Disposal Any Unit of Meas ure Listed Below T86 Blast Furnace Storage T87 Smelting, Melting, or Refining Furnace S01 Container Gallons; Liters; Cubic Meters; or Cubic Yards T88 Titanium Dioxide Chloride Oxidation Reactor S02 Tank Storage Gallons; Liters; Cubic Meters; or Cubic Yards T89 Methane Reforming Furnace S03 Waste Pile Cubic Yards or Cubic Meters T90 Pulping Liquor Recovery Furnace S04 Surface Impoundment Gallons; Liters; Cubic Meters; or Cubic Yards T91 Combustion Device Used in the Recovery of Sulfur Values from Spent Sulfuric Acid S05 Drip Pad Gallons; Liters; Cubic Meters; Hectares; or Cubic Yards T92 Halogen Acid Furnaces S06 Containment Building Storage Cubic Yards or Cubic Meters T93 Other Industrial Furnaces Listed in 40 CFR 260.10

S99 Other Storage Any Unit of Measure Listed Below T94 Containment Building Treatment Cubic Yards; Cubic Meters; Short Tons Per Hour; Gallons Per Hour; Liters Per Hour; BTU Per Hour; Pounds Per Hour; Short Tons Per Day; Kilograms Per Hour; Metric Tons Per Day; Gallons Per Day; Liters Per Day; Metric Tons Per Hour; or Million BTU Per Hour Treatment

T01 Tank Treatment Gallons Per Day; Liters Per Day

T02 Surface Impoundment Gallons Per Day; Liters Per Day

T03 Incinerator Short Tons Per Hour; Metric Tons Per Hour; Gallons Per Hour; Liters Per Hour; BTUs Per Hour; Pounds Per Hour; Short Tons Per Day; Kilograms Per Hour; Gallons Per Day; Metric Tons Per Hour; or Million BTU Per Hour Miscellaneous (Subpart X)

X01 Open Burning/Open Detonation Any Unit of Measure Listed Below

X02 Mechanical Processing Short Tons Per Hour; Metric Tons Per Hour; Short Tons Per Day; Metric Tons Per Day; Pounds Per Hour; Kilograms Per Hour; Gallons Per Hour; Liters Per Hour; or Gallons Per Day T04 Other Treatment Gallons Per Da y; Liters Per Day; Pounds Per Hour; Short Tons Per Hour; Kilograms Per Hour; Metric Tons Per Day; Short Tons Per Day; BTUs Per Hour; Gallons Per Day; Liters Per Hour; or Million BTU Per Hour X03 Thermal Unit Gallons Per Day; Liters Per Day; Pounds Per Hour; Short Tons Per Hour; Kilograms Per Hour; Metric Tons Per Day; Metric Tons Per Hour; Short Tons Per Day; BTU Per Hour; or Million BTU Per Hour T80 Boiler Gallons; Liters; Ga llons Per Hour; Liters Per Hour; BTUs Per Hour; or Million BTU Per Hour

### 59 X04 Geologic Repository Cubic Yards; Cubic Meters; Acre-feet; Hectare-meter; Gallons; or Liters

X99 Other Subpart X Any Unit of Measure Listed Below Unit of Measure Unit of Measure Code Gallons ................................................. G Gallons Per Hour ................................. E Gallons Per Day ................................... U Liters ..................................................... L Liters Per Hour ..................................... H Liters Per Day ...................................... V Unit of Measure Unit of Measure Code Short Tons Per Hour ................................ D Short Tons Per Day .................................. N Metric Tons Per Hour .............................. W Metric Tons Per Day ................................. S Pounds Per Hour ...................................... J Kilograms Per Hour.................................. X Million BTU Per Hour ............................... X Unit of Measure Unit of Measure Code Cubic Yards ......................................... Cubic Meters ........................................ Acres .................................................... Acre-feet ............................................... Hectares ............................................... Hectare-meter ...................................... BTU Per Hour .......................................

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7. Process Codes and Design Capacities (Continued)

EXAMPLE FOR COMPLETING Item 7 (shown in line number X-1 below): A facility has a storage tank, which can hold 533.788 gallons.

Line Number A. Process Code (From list above) B. PROCESS DESIGN CAPACITY C. Process Total Number of Units For Official Use Only (1) Amount (Specify) (2) Unit of Measure

X 1 S 0 2 533.788 G 001

1

2

3

4

5

6

7

8

9

1 0

1 1

1 2

1 3

Note: If you need to list more than 13 process codes, attach an additional sheet(s) with the information in the same format as above. Number the line sequentia lly, taking into account any lines th at will be used for “other” pro cess (i.e., D99, S99, T04, and X99 ) in Item 8.

8. Other Processes (Follow instructions from Item 7 for D99, S99, T04, and X99 process codes)

Line Number (Enter #s in sequence with Item 7) A. Process Code (From list above) B. PROCESS DESIGN CAPACITY C. Process Total Number of Units For Official Use Only (1) Amount (Specify) (2) Unit of Measure

X 2 T 0 4 100.00 U 001

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9. Description of Hazardous Wastes - Enter Information in the Sections on Form Page 5

A. EPA HAZARDOUS WASTE NUMBER – Enter the four-digit number from 40 CFR, Part 261 Subpart D of each listed hazardous waste you will handle. For hazardous wastes which are not listed in 40 CFR, Part 261 Subpart D, enter the four-digit number(s) from 40 CFR Pa rt 261, Subpart C that describes the characteristics and/or the toxic contaminants of those hazardous wastes.

B. ESTIMATED ANNUAL QUANTITY – For each listed waste entered in Item 9.A, estimate the quantity of that waste that will be handled on an annual basis. For each char acteristic or toxic contaminant entered in Item 9.A, estimate the total annual quantity of all the non-listed waste(s) that will be handled which possess that characteristic or contaminant.

C. UNIT OF MEASURE – For each quantity entered in Item 9.B, ente r the unit of measure code. Units of measure which must be used and the appropriate codes are:

ENGLISH UNIT OF MEASURE CODE METRIC UNIT OF MEASURE CODE

POUNDS P KILOGRAMS K

TONS T METRIC TONS M

If facility records use any other unit of measure for quantity, th e units of measure must be conv erted into one of the required units of measure, taking into account the appropria te density or specific gravity of the waste.

D. PROCESSES

1. PROCESS CODES:

For listed hazardous wast e: For each listed hazardous wast e entered in Item 9.A, select the code(s) from the list of process codes contained in Items 7.A and 8.A on page 3 to indi cate all the processes that will be used to store, treat, and/or dispose of all listed hazardous wastes.

For non-listed waste: For each characteristic or toxic contaminant entered in Item 9.A, select the code(s) from the list of process codes contained in Items 7.A and 8.A on page 3 to indi cate all the processes that will be used to store, treat, and/or dispose of all the non-liste d hazardous wastes that possess that ch aracteristic or toxic contaminant.

NOTE: THREE SPACES ARE PROVIDED FOR ENTE RING PROCESS CODES. IF MORE ARE NEEDED:

1. Enter the first two as described above. 2. Enter “000” in the extreme right box of Item 9.D(1). 3. Use additional sheet, enter line number from previous sheet, and enter additional code(s) in Item 9.E.

2. PROCESS DESCRIPTION: If code is not lis ted for a process that will be used, d escribe the process in Item 9.D(2) or in Item 9.E(2).

NOTE: HAZARDOUS WASTES DESCRIBED BY MORE TH AN ONE EPA HAZARDOUS WA STE NUMBER – Hazardous wastes that can be described by more than one EPA Hazardous Waste Number sh all be described on the form as follows:

1. Select one of the EPA Hazardous Waste Numbers and enter it in Item 9.A. On the same line complete Items 9.B, 9.C, and 9.D by estimating the total annual quantity of the wast e and describing all the process es to be used to store, treat, and/or dispose of the waste.

2. In Item 9.A of the next line enter the other EPA Hazardous Waste Number that can be used to describe the waste. In Item 9.D.2 on that line enter “included with above” and make no other entries on that line. 3. Repeat step 2 for each EPA Hazardous Waste Number that can be used to describe th e hazardous waste.

EXAMPLE FOR COMPLETING Item 9 (shown in line numbers X-1, X-2, X-3, and X-4 below) – A facility will treat and dispose of an estimated 900 pounds per year of chrome shavings from leather ta nning and finishing operations. In addition, the facility will treat and dispose of three non-listed wastes. Two wastes are corrosive only and there wi ll be an estimated 200 pounds per year of ea ch waste. The other waste is corrosive and ignitable and there will be an estimated 100 pounds per year of that waste. Treatment will be in an incinerator and disposal will be in a landfill.

Line Number A. EPA Hazardous Waste No. (Enter code) B. Estimated Annual Qty of Waste C. Unit of Measure (Enter code) D. PROCESSES

(1) PROCESS CODES (Enter Code) (2) PROCESS DESCRIPTION (If code is not entered in 9.D(1))

X 1 K 0 5 4 900 P T 0 3 D 8 0

X 2 D 0 0 2 400 P T 0 3 D 8 0

X 3 D 0 0 1 100 P T 0 3 D 8 0

### 62 X 4 D 0 0 2 Included With Above

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9. Description of Hazardous Wastes (Continued. Use additional sheet(s) as necessary; number pages as 5a, etc.)

Line Number A. EPA Hazardous Waste No. (Enter code) B. Estimated Annual Qty of Waste C. Unit of Measure (Enter code) D. PROCESSES

(1) PROCESS CODES (Enter Code) (2) PROCESS DESCRIPTION (If code is not entered in 9.D(1))

1

2

3

4

5

6

7

8

9

1 0

1 1

1 2

1 3

1 4

1 5

1 6

1 7

1 8

1 9

2 0

2 1

2 2

2 3

2 4

2 5

2 6

2 7

2 8

2 9

3 0

3 1

3 2

3 3

3 4

### 64 3 5

3 6

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9. Description of Hazardous Wastes (Continued. Use additional sheet(s) as necessary; number pages as 5a, etc.)

Line Number A. EPA Hazardous Waste No. (Enter code) B. Estimated Annual Qty of Waste C. Unit of Measure (Enter code) D. PROCESSES

(1) PROCESS CODES (Enter Code) (2) PROCESS DESCRIPTION (If code is not entered in 9.D.1)

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10. Map Attach to this application a topographical map, or other equiva lent map, of the area extending to at least one mile beyond pro perty boundaries. The map must show the outlin e of the facility, the location of each of its existing intake and discharge structure s, each of its hazardous waste treatment, storage, or dis posal facilities, and each well where it in jects fluids underground. Include all spr ing, rivers, and other surface water bodies in this map area. See instructions for precise requirements. 11. Facility Drawing All existing facilities must include a scale drawing of the facility (see instructions for more detail). 12. Photographs All existing facilities must include photographs (aerial or gro und-level) that clearly delineate all existing structures; exis ting storage, treatment, and disposal areas; and sites of fu ture storage, treatment, or disposal ar eas (see instructions for more detail).

13. Comments

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