[Federal Register Volume 61, Number 120 (Thursday, June 20, 1996)]
[Proposed Rules]
[Pages 31736-31779]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-15585]




[[Page 31735]]


_______________________________________________________________________

Part IV





Environmental Protection Agency





_______________________________________________________________________



40 CFR Part 60



Standards of Performance for New Stationary Sources and Emission 
Guidelines for Existing Sources: Medical Waste Incinerators; Proposed 
Rule

Federal Register / Vol. 61, No. 120 / Thursday, June 20, 1996 / 
Proposed Rules

[[Page 31736]]



U.S. ENVIRONMENTAL PROTECTION AGENCY

40 CFR Part 60

[AD-FRL-5523-1]
RIN 2060-AC62


Standards of Performance for New Stationary Sources and Emission 
Guidelines for Existing Sources: Medical Waste Incinerators

AGENCY: Environmental Protection Agency (EPA).

ACTION: Notice of availability of supplemental information and 
reopening of public comment period.

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

SUMMARY: On February 27, 1995, EPA proposed new source performance 
standards (NSPS or standards) and emission guidelines (EG or 
guidelines) for new and existing medical waste incinerator(s) (MWI) 
that will reduce air pollution from MWI. Once implemented, these 
standards and guidelines will protect public health by reducing 
exposure to air pollution. In the proposal preamble, EPA made a 
commitment to reconsider the proposed NSPS and EG based on new 
information submitted. Today's action presents an assessment of the 
supplemental information submitted following the proposal and solicits 
public comment on this assessment. Today's action also serves to 
address comments received on the proposal and reopens the comment 
period for development of the MWI standards and guidelines.

DATES: Public Meeting.  A public meeting will be held on July 10, 1996 
beginning at 9:00 a.m. At the public meeting, EPA will review the 
contents of this notice and answer questions so that commenters can 
better prepare their written comments. See ADDRESSES below for the 
location of the meeting.
    Comments.  Comments are requested on all information associated 
with the development of MWI standards and guidelines. Written comments 
must be received on or before August 8, 1996. See ADDRESSES below.

ADDRESSES: Public Meeting.  The public meeting will take place at the 
Holiday Inn, Hotel and Suites, 625 First Street, Alexandria, Virginia, 
22314, (703) 548-6300. Persons interested in attending the meeting 
should notify Ms. Donna Collins, U.S. Environmental Protection Agency, 
Research Triangle Park, North Carolina 27711, telephone (919) 541-5578.
    Comments.  Comments should be submitted (in duplicate, if possible) 
to the following: The Air and Radiation Docket and Information Center, 
ATTN: Docket No. A-91-61, U.S. Environmental Protection Agency, 401 M 
Street, SW, Washington, DC 20460.
    Submissions containing proprietary information (Confidential 
Business Information) should be sent directly to the following address, 
not to the public docket, to ensure that proprietary information is not 
inadvertently placed in the docket: Attention: Mr. Rick Copland, c/o 
Ms. Melva Toomer, U.S. Environmental Protection Agency Confidential 
Business Manager, 411 W. Chapel Hill Street, Room 944, Durham, North 
Carolina 27701. See SUPPLEMENTARY INFORMATION for further discussion of 
confidential business information.
    Docket.  Docket No. A-91-61, containing supporting information used 
in developing the standards and guidelines, is available for public 
inspection and copying between 8:00 a.m. and 4:00 p.m. , Monday through 
Friday, at the Air and Radiation Docket and Information Center, U.S. 
Environmental Protection Agency, 401 M Street, SW, Washington, DC 
20460, telephone (202) 260-7548, fax (202) 260-4000. A reasonable fee 
may be charged for copying. See SUPPLEMENTARY INFORMATION for a list of 
documents most directly related to today's notice.

FOR FURTHER INFORMATION CONTACT: Mr. Rick Copland at (919) 541-5265 or 
Mr. Fred Porter at (919) 541-5251, Emission Standards Division (MD-13), 
U.S. Environmental Protection Agency, Research Triangle Park, North 
Carolina 27711.

SUPPLEMENTARY INFORMATION: Regulated Entities.  Entities potentially 
regulated by the standards and guidelines are those which operate 
medical waste incinerators. Regulated categories and entities include 
those listed in Table 1.

                                         Table 1.--Regulated Entities <SUP>a                                         
----------------------------------------------------------------------------------------------------------------
                          Category                                      Examples of regulated entities          
----------------------------------------------------------------------------------------------------------------
Industry....................................................  Hospitals, nursing homes, research laboratories,  
                                                               other healthcare facilities, commercial waste    
                                                               disposal companies.                              
Federal Government..........................................  Armed services, public health service, Federal    
                                                               hospitals, other Federal healthcare facilities.  
State/local/Tribal Government...............................  State/county/city hospitals and other healthcare  
                                                               facilities.                                      
----------------------------------------------------------------------------------------------------------------
<SUP>a This table is not intended to be exhaustive, but rather provides a guide for readers regarding entities likely
  to be regulated by the standards or guidelines for MWI. This table lists the types of entities that EPA is now
  aware could potentially be regulated. Other types of entities not listed in the table could also be regulated.
  To determine whether your facility is regulated by the standards or guidelines for medical waste incinerators,
  you should carefully examine the applicability criteria in sections 60.50(c) and 60.51(c) of the February 1995
  proposal and sections II(B), II(H), and II(I) of today's notice. If you have questions regarding the          
  applicability of the MWI standards and guidelines to a particular entity, consult the person listed in the    
  preceding FOR FURTHER INFORMATION CONTACT section.                                                            

    Confidential Business Information. Commenters wishing to submit 
proprietary information for consideration should clearly distinguish 
such information from other comments and clearly label it 
``Confidential Business Information.'' Information covered by such a 
claim of confidentiality will be disclosed by the EPA only to the 
extent allowed and by the procedures set forth in 40 CFR part 2. If no 
claim of confidentiality accompanies a submission when it is received, 
the submission may be made available to the public without further 
notice to the commenter.
    Documents Available Electronically. An electronic version of this 
action as well as the February 1995 Federal Register proposal notice 
are available for download from EPA's Technology Transfer Network 
(TTN), which is a network of electronic bulletin boards developed and 
operated by EPA's Office of Air Quality Planning and Standards. The TTN 
provides information and technology exchange in various areas of air 
pollution control. The service is free, except for the cost of a 
telephone call. Dial (919) 541-5742 for data transfer of up to 14,400 
bits per second. The TTN is also available on the Internet (access: 
TELNET ttnbbs.rtpnc.epa.gov). For more information on the TTN, contact 
the systems operator at (919) 541-5384.
    Documents in the Docket. The documents listed below are not 
available through the TTN, but are available through Air Docket No. A-
91-61 located at the Air and Radiation Docket and Information Center 
(see the ADDRESSES section earlier in this

[[Page 31737]]

notice). These documents provide the analyses that are summarized in 
this notice.

------------------------------------------------------------------------
         Item No.                              Title                    
------------------------------------------------------------------------
IV-A-7...................  National Dioxin Emission Estimates from      
                            Medical Waste Incinerators.                 
IV-A-8...................  Revised Economic Impacts: Existing Medical   
                            Waste Incinerators.                         
IV-A-9...................  Revised Economic Impacts: New Medical Waste  
                            Incinerators.                               
IV-B-23..................  PM MACT Floor Emission Levels for Potential  
                            Subcategories of the MWI Source Category.   
IV-B-24..................  Determination of the Maximum Achievable      
                            Control Technology (MACT) Floor for Existing
                            Medical Waste Incinerators that Incinerate  
                            General Medical Waste.                      
IV-B-25..................  Definition of Medical Waste.                 
IV-B-26..................  Operator Training and Qualification and      
                            Incinerator Inspection Requirements.        
IV-B-30..................  Approach Used to Estimate the Capital and    
                            Annual Costs for MWI Wet Scrubbers.         
IV-B-32..................  Revised Costs for Dry Injection/Fabric Filter
                            Controls for MWI.                           
IV-B-33..................  Revised Costs for Secondary Chamber Retrofits
                            for MWI.                                    
IV-B-37..................  Projections for New MWI Population.          
IV-B-38..................  Determination of the Maximum Achievable      
                            Control Technology (MACT) Floor for New     
                            Medical Waste Incinerators.                 
IV-B-39..................  Annual Costs for the Operator Training and   
                            Qualification Requirements for MWI          
                            Operators.                                  
IV-B-43..................  Alternative Methods of Medical Waste         
                            Treatment: Availability, Efficacy, Cost,    
                            State Acceptance, Owner Satisfaction,       
                            Operator Safety, and Environmental Impacts. 
IV-B-44..................  Determination of Medical Waste Incinerator   
                            (MWI) Size.                                 
IV-B-45..................  Updated Medical Waste Incinerator Data Base. 
IV-B-46..................  PM, CO, and CDD/CDF Average Emission Rates   
                            and Achievable Emission Levels for MWI with 
                            Combustion Controls.                        
IV-B-47..................  Acid Gases and Metals Typical Performance and
                            Achievable Emission Levels for Medical Waste
                            Incinerators with Good Combustion Control.  
IV-B-48..................  Wet Scrubber Performance Memorandum.         
IV-B-49..................  Dry Scrubber Performance Memorandum.         
IV-B-50..................  Cost Impacts of the Regulatory Options for   
                            New and Existing Medical Waste Incinerator  
                            (MWI).                                      
IV-B-51..................  Air Emission Impacts of the Regulatory       
                            Options for New and Existing Medical Waste  
                            Incinerators (MWI).                         
IV-B-52..................  Potential Solid Waste, Wastewater, and Energy
                            Impacts of the New Source Performance       
                            Standards and Emission Guidelines for New   
                            and Existing Medical Waste Incinerators.    
IV-B-54..................  Testing and Monitoring Options and Costs for 
                            MWI--Methodology and Assumptions.           
IV-B-56..................  Standards of Performance for Medical Waste   
                            Pyrolysis Units.                            
------------------------------------------------------------------------

    Acronyms, Abbreviations, and Measurement Units. The following list 
of acronyms, abbreviations, and measurement units is provided to aid 
the reader.

AHA.................................  American Hospital Association     
Btu.................................  British thermal unit              
Cd..................................  cadmium                           
CEMS................................  continuous emission monitoring    
                                       system(s)                        
CFR.................................  Code of Federal Regulations       
CO..................................  carbon monoxide                   
dioxin..............................  dioxins and dibenzofurans         
DI/FF...............................  dry injection/fabric filter       
dscf................................  dry standard cubic foot           
dscm................................  dry standard cubic meter          
EG..................................  emission guidelines               
EPA.................................  Environmental Protection Agency   
ft<SUP>3.................................  cubic feet                        
FTE.................................  full time equivalent              
g...................................  grams                             
gr..................................  grains                            
HCl.................................  hydrogen chloride                 
Hg..................................  mercury                           
hr..................................  hour                              
IV..................................  intravenous                       
lb..................................  pound                             
MACT................................  maximum achievable control        
                                       technology                       
m<SUP>3..................................  cubic meter                       
MW..................................  megawatt                          
MSA.................................  Metropolitan Statistical Area     
Mg..................................  megagram                          
mg..................................  milligram                         
MM..................................  million                           
MWI.................................  medical waste incinerator(s)      
MWTA................................  Medical Waste Tracking Act        
MWC.................................  municipal waste combustor         
ng..................................  nanogram                          
NO<INF>X.................................  Oxides of nitrogen                
NRDC                                  Natural Resources Defense Council 
NSPS................................  new source performance standards  
NYSDOH..............................  New York State Department of      
                                       Health                           
O<INF>2..................................  oxygen                            
Pb..................................  lead                              
PM..................................  particulate matter                
ppmdv...............................  parts per million by volume (dry  
                                       basis)                           
SO<INF>2.................................  sulfur dioxide                    
STAATT..............................  State and Territorial Association 
                                       of Alternate Treatment           
                                       Technologies                     
SWDA................................  Solid Waste Disposal Act          
TEQ.................................  Toxic Equivalency Quality (dioxin 
                                       emissions)                       
TTN.................................  Technology Transfer Network       
TCLP................................  Toxicity Characteristics Leachate 
                                       Procedure                        
yr..................................  year                              
                                                                        

    Outline of this Notice. The information in this section is 
organized as follows:

I. Introduction
    A. The Clean Air Act
    B. February 1995 Proposal
    C. New Information Since Proposal
    D. Purpose of this Supplemental Notice
    E. New Timeline for Promulgation
II. Review of New Information
    A. MWI Inventory
    1. Existing Population
    2. Future Installations
    B. Subcategorization
    C. Performance and Cost of Technology
    1. Good combustion
    2. Wet scrubbers
    3. Dry scrubbers
    D. MACT Floor
    1. Existing MWI
    2. New MWI
    E. Baseline Emissions
    F. Operator Training and Qualification
    G. Testing, Monitoring, and Inspection
    H. Definition of Medical Waste
    I. Pyrolysis Units
    J. Alternative Medical Waste Treatment Technologies
III. Regulatory Options and Impacts for Existing MWI
    A. Regulatory Options
    B. National Environmental and Cost Impacts
    1. Analytical approach
    2. Air Impacts
    3. Water and solid waste impacts
    4. Energy Impacts
    5. Cost Impacts
    C. Economic Impacts
    1. Analytical approach
    2. Industry-wide economic impacts
    3. Facility-specific economic impacts
IV. Regulatory Options and Impacts for New MWI
    A. Regulatory Options
    B. National Environmental and Cost Impacts
    1. Analytical approach
    2. Air impacts
    3. Water and solid waste impacts

[[Page 31738]]

    4. Energy Impacts
    5. Cost Impacts
    C. Economic Impacts
    1. Analytical approach
    2. Industry-wide economic impacts
    3. Facility-specific economic impacts
V. Inclinations for Final Rule

I. Introduction

A. The Clean Air Act

    The Clean Air Act amendments of 1990 added section 129, which 
includes specific requirements for solid waste combustion units. 
Section 129 requires the EPA, under section 111(b), to establish NSPS 
for new MWI and under section 111(d), to establish EG for existing MWI 
based on maximum achievable control technology (MACT). Section 129 
establishes specific criteria that must be analyzed in developing these 
standards and guidelines. In general, this involves (1) determining 
appropriate subcategories within a source category; (2) determining the 
``MACT floor'' for each subcategory; (3) assessing available air 
pollution control technology with regard to achievable emission 
limitations and costs; and (4) examining the cost, nonair-quality 
health and environmental impacts, and energy requirements associated 
with standards and guidelines more stringent than the MACT floor. 
Section 129 also directs EPA to establish operator training 
requirements for new and existing MWI as well as siting requirements 
for new MWI.
    Section 129 requires the EPA to include numerical emission 
limitations in the standards and guidelines for the following air 
pollutants: particulate matter (PM), opacity, sulfur dioxide 
(SO<INF>2), hydrogen chloride (HCl), oxides of nitrogen (NO<INF>x), 
carbon monoxide (CO), lead (Pb), cadmium (Cd), mercury (Hg), and 
dioxins and dibenzofurans (referred to in this notice as ``dioxin''). 
Section 129 requires that these emission limitations reflect the 
maximum degree of reduction in air emissions that the Administrator 
determines is achievable, taking into consideration the cost of 
achieving such emission reduction and any nonair-quality health and 
environmental impacts and energy requirements. This requirement is 
referred to as MACT.
    The MACT for new MWI may not be less stringent than the emissions 
control achieved in practice by the best controlled similar unit. The 
guidelines for existing MWI may be less stringent than the standards 
for new MWI; however, the guidelines may be no less stringent than the 
average emission limitation achieved by the best performing 12 percent 
of units in the category. These requirements that the standards and 
guidelines must be no less stringent than certain levels are referred 
to as the ``MACT floor.''
    The Clean Air Act requires EPA to consider standards and guidelines 
more stringent than the MACT floor, considering costs and other impacts 
described above. If EPA concludes that more stringent standards and/or 
guidelines are achievable considering costs and other impacts, then the 
standards and/or guidelines would be established at these more 
stringent levels (i.e., MACT would be more stringent than the MACT 
floor). The EPA may establish NSPS or EG at the MACT floor only if it 
concludes that NSPS or EG more stringent than the MACT floor are not 
achievable, considering costs and other impacts. In no case may EPA 
establish emission limitations less stringent than the MACT floor.
    Because standards and guidelines developed under Section 129 are to 
reflect the performance capabilities of air pollution control 
technology, EPA must assess air pollution control technologies and draw 
conclusions regarding their performance. This is often misunderstood 
and some assume that the regulations require the use of specific 
technology. However, the control technology used to achieve the 
standards or guidelines is not specified in the regulations. The 
regulations only include specific air pollution emission limits that a 
source (i.e., an MWI) must achieve. Any control technology that can 
comply with the final emission limits may be used.

B. February 1995 Proposal

    On February 27, 1995 (60 FR 10654), EPA published proposed NSPS and 
EG for MWI. The proposal was the result of several years of effort 
reviewing available information in light of the Clean Air Act 
requirements described above.
    During the data-gathering phase of the project, it was difficult to 
get an accurate count of MWI nationwide. In addition, it was difficult 
to find MWI with add-on air pollution control systems in place. 
Information from a few State surveys led to an estimated population of 
3,700 existing MWI.
    Subcategories were determined based on design differences among 
different types of incinerators: continuous, intermittent, and batch. 
These three design types roughly correlate to MWI size.
    A few MWI with various levels of combustion control (no add-on air 
pollution control) were tested to determine the performance of 
combustion control in reducing MWI emissions. One MWI equipped with a 
wet scrubber (add-on control) was tested to determine the performance 
capabilities of wet scrubbing systems. A few other MWI equipped with 
dry scrubbing systems (add-on control) were tested to determine the 
performance capabilities of dry scrubbing systems. These systems were 
considered typical of air pollution control systems available at the 
time, and the data indicated that dry scrubbing systems could achieve 
much lower emissions than wet scrubbing systems.
    As mentioned above, the MACT floor for new MWI is to reflect the 
emissions control achieved by the best controlled similar unit. Dry 
scrubbing systems were identified on at least one MWI in each of the 
three subcategories (continuous, intermittent, and batch). 
Consequently, the MACT floor emission levels for the proposed NSPS 
reflected the performance capabilities of dry scrubbing systems.
    For existing MWI under the emission guidelines, State regulations 
and permits were used to calculate the average emission limitation 
achieved by the best performing 12 percent of units. These results were 
then compared with the results of the emission tests on wet and dry 
scrubbing systems. This comparison led to the conclusion that the MACT 
floor for existing MWI would require the use of a dry scrubbing system, 
even for small existing batch MWI.
    Following determination of the MWI population, subcategories, 
performance of technology, and MACT floors, the Clean Air Act requires 
EPA to consider standards and guidelines that are more stringent than 
the floors. However, because the MACT floors calculated for the 
proposal were so stringent, EPA was left with few options to consider. 
Emission limits reflecting the capability of dry scrubbing systems were 
proposed for all sizes and types of new and existing MWI.
    As mentioned earlier, the proposed standards and guidelines 
included numerical emission limits reflecting the performance 
capabilities of dry scrubbing systems; however, the proposed 
regulations would not require the use of a dry scrubbing system. 
Emission limits are included in these regulations rather than control 
equipment requirements to encourage competition and further the 
development of new technologies. Any technology capable of achieving 
the emission limitations in the regulations may be used.

[[Page 31739]]

C. New Information Since Proposal

    A proposal is essentially a request for public comment on the 
information used, assumptions made, and conclusions drawn from the 
evaluation of available information. Following proposal, more than 700 
comment letters were received, some including new information and some 
indicating that commenters were in the process of gathering information 
for EPA to consider. The large amount of new information that was 
ultimately submitted addressed every aspect of the proposed standards 
and guidelines, including: the existing population of MWI, the 
performance capabilities of air pollution control systems, monitoring 
and testing, operator training, alternative medical waste treatment 
technologies, and the definition of medical waste. In almost every 
case, the new information has led to different conclusions, as outlined 
below.

D. Purpose of This Supplemental Notice

    This notice announces the availability of new information, reviews 
EPA's assessment of the new information, provides EPA's inclination as 
to how the new information might change the final standards and 
guidelines, and solicits comments on EPA's assessments and 
inclinations. This new information and these assessments are documented 
in more detail in a series of memoranda included in Air Docket No. A-
91-61. A listing of these documents can be found at the beginning of 
this notice. This action also reopens the public comment period for the 
development of standards and guidelines for MWI. Today's action serves 
not only as a review of new information and request for comment, but 
also as a response to comments on the proposed rule.
    This notice is not a reproposal. The proposal date for the MWI 
standards and guidelines remains February 27, 1995. Any MWI that has 
commenced construction after February 27, 1995, is considered a new MWI 
and will be subject to the NSPS, while any MWI that commenced 
construction on or before February 27, 1995, is considered an existing 
MWI.

E. New Timeline for Promulgation

    In 1993, the EPA, the Sierra Club, and the Natural Resources 
Defense Council (NRDC) filed a consent decree with the U.S. District 
Court for the Eastern District of New York (Nos. CV-92-2093 and CV-93-
0284) that required the EPA Administrator to sign a notice of proposed 
rulemaking no later than February 1, 1995 and a notice of final 
rulemaking no later than April 15, 1996.
    Because of the large amount of new information and conclusions 
drawn from the new information, the EPA deemed it necessary to issue 
this supplemental Federal Register notice to provide the public 
sufficient opportunity to comment on all information used by the Agency 
in developing the NSPS and EG. The Agency requested an extension of the 
April 15, 1996 court-ordered deadline, and the court order has been 
revised to require the EPA Administrator to sign a notice of final 
rulemaking no later than July 25, 1997.

II. Review of New Information

    As mentioned earlier, more than 700 comment letters were received 
following the February 27, 1995 proposal. An assessment of this 
information and some of EPA's inclinations in light of this new 
information are presented below.
    In general, the following process was used to assess the new 
information. The public comment letters were reviewed and categorized 
by area of comment. Information related to specific issues (e.g., wet 
scrubber performance) was reviewed; meetings were then held to discuss 
specific areas of comment with relatively small groups who were 
believed to have expertise in specific areas. For example, meetings 
with wet scrubber vendors were held to discuss the new information 
related to the performance capabilities of wet scrubbers. During the 
smaller meetings, additional information was received and comment was 
taken. Following the smaller meetings, EPA conducted larger public 
meetings on June 15, 1995, September 26, 1995, and February 14, 1996, 
to review the assessment of new information and take further public 
comment. This Federal Register notice provides EPA's review of all 
information received since proposal.

A. MWI Inventory

    One of the essential starting points in developing EG and NSPS is 
compiling an inventory of existing sources and projecting the number of 
new sources expected to be built in the future. The MWI inventory is 
the basis for the development of MACT floors, environmental impacts, 
cost impacts, and economic impacts. The results of these analyses are 
then used to determine MACT.
    The inventory of existing sources used in this analysis is a 
``snapshot'' of the current population of existing MWI. The inventory 
of new MWI potentially subject to the NSPS is a prediction of the 
number of MWI that will be built over the next 5 years in the absence 
of Federal regulations. The MWI inventories are not exact, but are 
representative of current and future MWI populations. Consequently, 
they are adequate to allow EPA to make informed decisions in developing 
standards and guidelines for new and existing MWI.
1. Existing Population
    To estimate the nationwide population of existing MWI at proposal, 
available State MWI inventory information was gathered. Where MWI 
information was not available for a particular State, the State's human 
population was used to estimate the MWI population. Human population 
was selected as the basis for extrapolation because it is logical that 
the amount of medical waste generated (and, therefore, the MWI 
population) would correlate with human population. This extrapolation 
was a straightforward computation with readily available data; however, 
detailed State inventory data were only available from 11 States. This 
method resulted in an estimated 3,700 MWI burning general medical 
waste.
    Following proposal, a number of comments were received regarding 
the inventory of existing MWI. Several commenters suggested that the 
population of MWI was overestimated. The American Hospital Association 
(AHA) submitted comments that included a compilation of approximately 
2,200 existing MWI.
    To compile a new EPA inventory, the AHA inventory was used as a 
starting point. Other sources of information, including State surveys 
and a data base of MWI operating permits, were also used to refine the 
inventory. Following this initial compilation, the inventory contained 
approximately 2,600 MWI. During the September 26, 1995 public meeting, 
several stakeholders voiced concern that many of the incinerators 
listed in EPA's MWI inventory had ceased operation. To address this 
concern, the Agency requested additional information to update the 
inventory. Additional information was received from State agencies, 
commercial medical waste disposal companies, and MWI vendors. Medical 
waste incinerator units were deleted or added based on the new 
information provided. Following these revisions, the final EPA 
inventory contains approximately 2,400 MWI; this inventory is located 
in the docket as item No. IV-B-45.
    The inventory also contains information such as MWI type 
(continuous/intermittent or batch fed), capacity, and location, as well 
as State

[[Page 31740]]

regulatory or permit emission limits. Every MWI in the inventory is 
assigned an MWI capacity in pounds per hour (lb/hr) or pounds per batch 
(lb/batch). Location information includes rural or urban designations 
based on Metropolitan Statistical Area (MSA) boundaries for the U.S. 
Facilities within MSA boundaries were considered urban MWI; facilities 
outside MSA boundaries were considered rural MWI. Emission limitations 
were determined by examining air quality permits, where available, or 
examining the emission limitations included in State regulations.
2. Future Installations
    Projections of new MWI were made to estimate the costs and other 
impacts associated with NSPS. To estimate the number of new MWI that 
would be subject to the NSPS, historical sales data were obtained from 
MWI vendors. For the proposal, it was estimated that, in the absence of 
Federal regulations, 700 MWI would be installed during the 5 years 
following proposal (140 MWI per year). This projection was based on 
historical sales data gathered from 1985 through 1989.
    To update the projection of new MWI that would be subject to the 
NSPS, additional data were gathered from MWI vendors following the 
proposal. Historical sales data were gathered covering years 1990 to 
1995. Based on this new data, 235 MWI are expected to be installed in 
the next 5 years in the absence of the NSPS (47 per year). This 
projection covers the years 1996 to 2000. The memorandum documenting 
the procedures used to estimate the population of new MWI is located in 
the docket as item IV-B-37.

B. Subcategorization

    Section 129 of the Clean Air Act states that the Administrator may 
distinguish among classes, types, and sizes of units within a category 
in establishing the standards and guidelines. At proposal, the Agency 
concluded the MWI population should be divided into three 
subcategories: (1) Continuous MWI, (2) intermittent MWI, and (3) batch 
MWI. While these three subcategories were based on design differences 
of the MWI, they also correlate roughly with size or MWI capacity.
    During the public comment period, a number of comments were 
received regarding subcategorization. Several commenters suggested that 
EPA subcategorize directly by MWI size. Others suggested that EPA 
subcategorize MWI based on heat input capacity. Other commenters 
suggested that the Agency set standards based on the location of MWI; 
these commenters expressed concern about the lack of medical waste 
disposal options in remote rural locations.
    Three criteria were subsequently considered in reexamining 
potential subcategories: size (capacity to burn medical waste); type 
(continuous/intermittent versus batch); and location (urban versus 
rural). The first two are clearly identified in Section 129 and have 
been used in other Federal regulations as criteria for 
subcategorization. Location, by itself, is not a valid criterion for 
subcategorization. However, in this case, it is used as a surrogate 
measure of the availability of alternative waste disposal options. 
Medical waste incinerators located in remote areas might be considered 
as a separate ``class'' of incinerator because of the limited 
availability of alternative waste disposal options in rural areas.
    As mentioned earlier, the MACT floor is the least stringent 
regulatory option allowed under the Clean Air Act. Consequently, the 
MACT floors were examined using the EPA MWI inventory for various 
potential MWI subcategories. Because PM is, by far, the most common 
type of emission limitation in State regulations and permits, the PM 
MACT floor was the focus in this analysis. Subcategories were 
established when significant differences in PM MACT floors were 
identified.
    The most common size breaks used by States in regulating MWI occur 
at 100, 200, 500, 1,000, and 2,000 lb/hr. The MACT floor emission 
levels for these size breaks were evaluated to determine appropriate 
size breaks for regulation. Significant differences in MACT floors were 
identified at 200 lb/hr and 500 lb/hr. Consequently, the three size 
ranges determined to be appropriate for the purpose of regulating MWI 
are presented in Table 2.

        Table 2.--Number of MWI and Size Ranges for Subcategories       
------------------------------------------------------------------------
                                                                  Number
           MWI subcategory                 Size range, lb/hr      of MWI
------------------------------------------------------------------------
Small................................  <ls-thn-eq>200..........    1,139
Medium...............................  >200 and <ls-thn-eq>500.      692
Large................................  >500....................      542
------------------------------------------------------------------------

    The three basic design types of MWI are continuous, intermittent, 
and batch. A distinction between continuous and intermittent MWI based 
on design type may not be appropriate because these two types of units 
are essentially identical with the exception of the ash handling 
system. Also, the information used to develop the population of 
existing MWI does not distinguish between continuous and intermittent 
MWI. Batch MWI, however, are very different from intermittent and 
continuous units. As a result, batch MWI were further examined to 
determine if the MACT floor emission levels are different than those 
for continuous and intermittent MWI within the same size range; no 
significant difference in MACT floor emission levels was found.
    The final criterion considered was location (urban vs. rural). This 
analysis focused on the small MWI because commenters were particularly 
concerned about small, rural MWI. The MACT floor emission levels for 
small urban MWI and small rural MWI, however, were found to be 
essentially the same.
    Based on the new information, the Agency is inclined to 
subcategorize the existing and new population of MWI into three 
subcategories as shown in Table 2: small (<ls-thn-eq>200 lb/hr), medium 
(>200 and <ls-thn-eq>500), and large (>500). The memorandum that 
details the procedures used to assess the subcategories is found in the 
docket as item IV-B-23. Further subcategorization may be considered in 
examining standards and guidelines more stringent than the MACT floors 
(see Sections III and IV).
    Directly related to the question of using size or burning capacity 
to subcategorize MWI, the proposal requested comment on a ``standard'' 
method of determining MWI size for the purpose of consistent, uniform, 
and equitable application of whatever standards and guidelines are 
adopted. Comments responding to this request focused on the design heat 
release rate of the MWI expressed in British thermal units per hour per 
cubic foot (Btu/hr-ft<INF>3) in the primary combustion chamber and the 
heat content of medical waste expressed in British thermal units per 
pound (Btu/lb). Most MWI manufacturers base their design capacities on 
these two factors.
    In considering and/or adopting a ``standard'' means of determining 
MWI size, EPA is not attempting to establish design requirements for 
MWI manufacturers. Instead, the only purpose of adopting a standard 
method for determining the size of MWI is to ensure that all MWI of the 
same ``size'' are subject to the same requirements.
    The design heat release rate used by most vendors of continuous and 
intermittent MWI is typically 15,000 Btu/hr-ft<INF>3. The heat content 
of medical waste can vary substantially from 1,000 Btu/lb for 
pathological waste to over 10,000 Btu/lb for waste with a high

[[Page 31741]]

plastics content. The heat content generally associated with medical 
waste for the purpose of determining nameplate capacity has been 8,500 
Btu/lb. The combination of 15,000 Btu/hr-ft<INF>3 and 8,500 Btu/lb 
results in a volumetric waste burning capacity of 1.76 lb/hr-ft<INF>3. 
The volume of the primary chamber is multiplied by 1.76 to determine 
the size of the MWI. A continuous or intermittent MWI with a primary 
chamber volume of 500 ft<INF>3 would be sized at 880 lb/hr for the 
purpose of determining regulatory requirements.
    For batch MWI, the calculation is slightly different. Batch MWI 
charge all waste to be burned when the unit is cold. No additional 
waste is added during the combustion cycle. The unit is then allowed to 
cool before ash is removed and more waste is charged. These units are 
given a designation of pounds per batch (lb/batch) rather than lb/hr 
and usually take about 12 hours to completely burn the waste. The 
density of medical waste is about 4.5 lb/ft<INF>3. Consequently, the 
combination of 4.5 lb/ft<INF>3 and 12 hours per batch yields a 
volumetric waste burning capacity of 0.375 lb/hr-ft<INF>3. The volume 
of the primary chamber would be multiplied by 0.375 to determine the 
size of the MWI. A batch MWI with a primary chamber volume of 500 
ft<INF>3 would be sized at 188 lb/hr for the purpose of determining 
regulatory requirements. A more detailed description of the MWI size 
methods described above for continuous, intermittent, and batch MWI can 
be found in the docket as item IV-B-44.
    During a meeting with MWI vendors, it was suggested that MWI size 
should be determined by the unit's operating permit rather than its 
design capacity. Many States allow MWI to meet less stringent 
requirements associated with smaller MWI as long as the MWI is subject 
to a permit condition limiting the amount of waste burned. 
Consequently, while EPA is inclined to determine MWI size by the 
criteria described above, EPA is also considering inclusion of an 
option to allow an MWI to change its size designation by operating 
under a Federally enforceable requirement limiting the amount of waste 
burned (i.e., waste feed rate--lb/hr). For example, a continuous or 
intermittent MWI with a 340 ft<INF>3 primary chamber, with a design 
capacity of about 600 lb/hr (i.e., ``large''), using the procedure 
outlined above, could be considered a ``medium'' MWI by operating under 
a Federally enforceable requirement limiting its charge rate to no more 
than 500 lb/hr. A batch MWI with a 1,000 ft<INF>3 primary chamber, with 
a design capacity of about 4,500 lb/batch or 375 lb/hr (i.e., 
``medium''), using the procedure outlined above, could be considered a 
``small'' MWI by operating under a Federally enforceable requirement 
limiting its charge rate to no more than 2,400 lb/batch (200 lb/hr).
    Finally, some commenters expressed concern about facilities 
installing multiple small MWI at one location in an effort to be 
subject to less stringent requirements. Commenters believed this should 
not be allowed. Consequently, EPA is inclined to combine the waste 
burning capacity of multiple units at one location to determine size. 
As stated above, such facilities could still operate under a Federally 
enforceable permit limiting their operating capacity to change their 
size designation.

C. Performance and Cost of Technology

    Section 129 of the Clean Air Act directs the EPA to develop 
regulations for MWI that are based on the use of MACT, which is defined 
as the maximum reduction in emissions of air pollution the EPA 
considers achievable, considering costs, environmental, and energy 
impacts. However, Section 129 also states that, for existing MWI, these 
regulations can be no less stringent than the average of the best 12 
percent of existing MWI, and for new MWI, they can be no less stringent 
than the best similar MWI. These minimum stringency requirements for 
the regulations are referred to as the ``MACT floors.'' The emission 
limits in the final regulations can be no less stringent than the 
``MACT floor'' emission levels.
    The ``MACT floors'' for the regulations are discussed in detail in 
another section of this notice. However, these ``MACT floors'' are only 
the starting point for determining MACT. Since MACT is the maximum 
reduction in air pollution emissions that is achievable, considering 
costs, environ-mental and energy impacts, if more stringent emission 
levels than the MACT floor emission levels are achievable, the EPA must 
identify these more stringent emission levels and consider them in 
selecting the MACT emission limits for MWI.
    The EPA determines whether more stringent emission levels than the 
MACT floor emission levels are achievable by identifying various air 
pollution control technologies used to reduce emissions from MWI. Next, 
the EPA gathers and analyzes data on these technologies and draws 
conclusions regarding their performance--in terms of their ability to 
reduce air pollution emissions. The EPA then is able to determine MACT 
as follows.
    After the MACT floors have been determined, the EPA can identify 
what air pollution control technologies would need to be used by MWI to 
achieve or comply with regulations based on these MACT floors. Then the 
EPA can identify those air pollution control technologies that are 
capable of achieving more stringent emission levels than the MACT 
floors. The EPA is then able to analyze and consider these more 
stringent emission levels in terms of the cost, environmental, and 
energy impacts associated with their use compared to the use of the air 
pollution control technologies that can achieve the MACT floor emission 
levels. This analysis and consideration serves as the basis for the EPA 
to determine MACT.
    All of this analysis, with its focus and discussion of air 
pollution control technology, is often misunderstood and leads some to 
assume that the regulations require the use of a specific air pollution 
control technology, which is not the case. The air pollution control 
technology used to achieve or comply with the regulations is not 
specified in the regulations. The regulations only include emission 
limits (i.e., concentration levels in the gases released to the 
atmosphere) for specific air pollutants (e.g., hydrogen chloride, lead, 
etc.) that an MWI must achieve. The decision on how to meet these 
emission limits is left to the MWI owner or operator; an MWI owner or 
operator may select any equipment or any means available to comply with 
these emission limits.
    At the time of proposal, relatively few emission test reports were 
available to the EPA from which to draw conclusions regarding the 
performance capabilities of various air pollution control systems. The 
data indicated that dry scrubbing systems could achieve much lower 
emission levels than wet scrubbing systems and that either type of 
scrubbing system could achieve much lower emission levels than 
combustion controls (i.e., good combustion) alone.
    Following proposal, a number of emission test reports were 
submitted to EPA. Many commenters believe that EPA misjudged the 
performance capabilities of various air pollution control technologies, 
especially the capabilities of wet scrubbing systems. The EPA has 
reviewed the data contained in these emission test reports and, as 
summarized below, EPA's conclusions regarding the performance 
capabilities of various air pollution control technologies have been 
revised.
    Relatively few comments were received regarding EPA's estimates of 
the costs of air pollution control technology. The majority of the

[[Page 31742]]

comments regarding cost pertained to wet scrubbing systems. The 
reassessment of costs is discussed briefly below for each control 
technology.
1. Good Combustion
    Combustion controls (i.e., good combustion) are effective in 
reducing emissions of combustion-related pollutants, such as PM, CO, 
and dioxin, but are not effective in reducing emissions of waste-
related pollutants, such as acid gases or metals. For the combustion-
related pollutants, combustion controls can be divided into two levels 
(i.e., 1-second and 2-second residence time) and the achievable 
emission levels associated with the use of each of these levels have 
been reassessed. In addition, achievable emission levels for waste-
related pollutants were also reassessed. For waste-related pollutants, 
performance between the two levels of combustion control is not 
distinguishable. The results of the reassessment of combustion control 
are shown in Table 3 and are available as item Nos. IV-B-46 and IV-B-47 
in the docket.

       Table 3.--Achievable Emission Levels For Combustion Control      
------------------------------------------------------------------------
                                                             Achievable 
                Pollutant/combustion level                    emission  
                                                               levels   
------------------------------------------------------------------------
PM, gr/dscf:                                                            
  1-sec...................................................          0.35
  2-sec...................................................          0.25
Dioxin, ng/dscm:                                                        
  1-sec...................................................      9,000   
  2-sec...................................................        800   
TEQ dioxin, ng/discm:                                                   
  1-sec...................................................        275   
  2-sec...................................................         15   
CO, ppmdv:                                                              
  1-sec...................................................        700   
  2-sec...................................................         40   
HCl, ppmdv................................................      3,100   
SO<INF>2, ppmdv................................................         55   
NO<INF>x, ppmdv................................................        250   
Pb, mg/dscm...............................................         10   
Cd, mg/dscm...............................................          4   
Hg, mg/dscm...............................................          7.5 
------------------------------------------------------------------------

    Most of the achievable emission levels associated with combustion 
control have changed little from the proposal; the exceptions are the 
achievable emission levels for dioxin and Hg. The conclusion drawn at 
proposal regarding the achievable emission level for dioxin was driven 
by two relatively high data points from two different MWI. A thorough 
review of these two MWI and the tests conducted at these two MWI raise 
numerous questions and doubts about whether good combustion was 
actually employed at these MWI during the emission tests. Consequently, 
EPA no longer considers these emission tests representative of good 
combustion.
    The situation is similar with regard to achievable Hg emission 
levels; at proposal, the conclusion regarding achievable emission level 
for Hg was driven by one very high data point. Following proposal, the 
hospital operating this MWI instituted several common waste management 
practices employed by other hospitals, and the MWI was retested by the 
EPA. The new data point is very similar to all the other data points. 
Consequently, the earlier data point is no longer considered 
representative of achievable Hg emission levels.
    While no specific comments were received regarding the cost of good 
combustion, the costs were reassessed and updated for consistent 
comparison with other costs. This information is described in more 
detail in item IV-B-33 in the docket.
2. Wet Scrubbers
    Following proposal, a number of comments were submitted to the EPA 
concerning the performance capabilities of wet scrubbing systems. Some 
commenters claimed that the wet scrubbing system tested by EPA was not 
representative of current wet scrubber technology and that the scrubber 
was not designed for high efficiency PM removal. The commenters 
submitted a number of emission test reports from wet scrubbing systems 
and urged EPA to reconsider the performance capabilities of these 
systems.
    The EPA has reviewed these emission test reports and revised its 
previous conclusions on the performance capabilities of wet scrubbing 
systems. Wet scrubbing systems are capable of achieving three different 
levels of performance, depending on their design and operation. For 
convenience, these three levels of performance have been termed low 
efficiency, moderate efficiency, and high efficiency. A summary of 
EPA's revised conclusions regarding achievable emission levels 
associated with the use of wet scrubbing systems is shown in Table 4. A 
full discussion of these revised conclusions is available as item No. 
IV-B-48 in the docket.

                             Table 4.--Achievable Emission Levels For Wet Scrubbers                             
----------------------------------------------------------------------------------------------------------------
                                                             Achievable emission levels                         
         Pollutant, units         ------------------------------------------------------------------------------
                                              Low                     Moderate                    High          
----------------------------------------------------------------------------------------------------------------
PM, gr/dscf......................  0.05.....................  0.03....................  0.015.                  
dioxin, ng/dscm..................  125......................  125.....................  125.                    
TEQ dioxin, ng/dscm..............  2.3......................  2.3.....................  2.3.                    
HCl, ppmdv.......................  15 or 99%................  15 or 99%...............  15 or 99%.              
Pb, mg/dscm......................  1.2 or 70%...............  1.2 or 70%..............  1.2 or 70%.             
Cd, mg/dscm......................  0.16 or 65%..............  0.16 or 65%.............  0.16 or 65%.            
Hg, mg/dscm......................  0.55 or 85%..............  0.55 or 85%.............  0.55 or 85%.            
----------------------------------------------------------------------------------------------------------------
Percent reflects achievable percentage reduction in emissions. No levels are shown for CO, SO<INF>2, or NO<INF>x because  
  wet scrubbers on MWI achieved no further reductions beyond good combustion for these pollutants.              

    Note that for the waste-related pollutants, the achievable emission 
levels in the table are expressed as a numerical concentration level or 
a percent reduction. The composition of the waste burned in an MWI is 
not uniform; as a result, the concentration levels of waste-related 
pollutants from an MWI varies. On occasion, however, a momentary rise 
or ``spike'' in the concentration level of a waste-related pollutant 
may occur; while a wet scrubbing or dry scrubbing system can reduce 
this concentration level considerably, the system can not necessarily 
reduce it to the concentration levels shown in the table. For this 
reason, conclusions regarding

[[Page 31743]]

achievable emission levels associated with the use of wet or dry 
scrubbing systems for waste-related pollutants must include a percent 
reduction component to accurately reflect the performance capabilities 
of wet and dry scrubbing systems.
    Also note that the EPA has no emission data upon which to assess 
the performance capabilities of wet scrubbing systems that might 
utilize activated carbon. The EPA knows of no wet scrubbing system 
currently operating on an MWI using activated carbon, although vendors 
have mentioned this technique could be done. Activated carbon used with 
a dry scrubber (discussed below) provides enhanced removal of Hg and 
dioxin. Thus, the use of activated carbon with a wet scrubbing system, 
in an appropriate manner such as a fixed bed, should achieve the same 
enhanced performance levels.
    Along with new information regarding the performance of wet 
scrubbers, EPA received new information regarding the cost of wet 
scrubbing systems. Figure 1 shows the relationship between cost and 
size of MWI for each level of wet scrubber performance. These costs are 
not substantially different from those used at proposal. The key 
difference is the distinction in costs between wet scrubbers of 
different efficiency. This information is described in more detail in 
item IV-B-30 in the docket.

BILLING CODE 6560-50-P
[GRAPHIC] [TIFF OMITTED] TP20JN96.000


BILLING CODE 6560-50-C
3. Dry Scrubbers
    Very few comments were submitted to EPA following proposal that 
questioned EPA's conclusions on the performance capabilities of dry 
scrubbing systems. These capabilities were reassessed, however, to 
consider data contained in several emission test reports submitted to 
EPA from dry scrubbing systems using activated carbon.
    The results of this reassessment of dry scrubbing system 
performance is shown in Table 5. The conclusions summarized in this 
table are similar to those at proposal. Note, however, that as 
discussed above under wet scrubbing systems, the achievable emission 
levels associated with the use of dry scrubbing systems for waste-
related pollutants are now expressed as a numerical concentration level 
or a percent reduction. A discussion of this reassessment is available 
as item No. IV-B-49 in the docket.

  Table 5.--Achievable Emission Levels For Dry Scrubbers With Activated 
                            Carbon Injection                            
------------------------------------------------------------------------
            Pollutant, units                Achievable emission levels  
------------------------------------------------------------------------
PM, gr/dscf............................  0.015.                         
dioxin, ng/dscm........................  25.                            
TEQ dioxin, ng/dscm....................  0.6.                           
HCl, ppmdv.............................  100 or 93%.                    
Pb, mg/dscm............................  0.07 or 98%.                   
Cd, mg/dscm............................  0.04 or 90%.                   
Hg, mg/dscm............................  0.55 or 85%.                   
------------------------------------------------------------------------
Percent reflects achievable percentage reduction in emissions. No levels
  are shown for CO, SO<INF>2, or NO<INF>x because dry scrubbers on MWI's achieved 
  no further reductions beyond good combustion for these pollutants.    

    While no specific comments were received regarding the cost of dry 
scrubbers, the costs were reassessed and updated for consistent 
comparison with other costs. Figure 2 shows the relationship between 
cost and size of MWI for dry scrubbing systems. This information is 
described in more detail in item IV-B-32 in the docket.

[[Page 31744]]

[GRAPHIC] [TIFF OMITTED] TP20JN96.001



BILLING CODE 6560-50-C

D. MACT Floor

1. Existing MWI
    The Clean Air Act specifies in Section 129 that the degree of 
reduction in emissions that is deemed achievable for existing MWI shall 
not be less stringent than the average emission limitation achieved by 
the best performing 12 percent of units in a category; this requirement 
is referred to as the ``MACT floor'' for existing MWI. Section 302(k) 
of the Clean Air Act defines the term ``emission limitation'' as ``a 
requirement established by the State or Administrator which limits the 
quantity, rate, or concentration of emissions of air pollutants on a 
continuous basis.''
    Air quality permits and State regulations were examined to 
determine the average emission limitations achieved by the best 
performing 12 percent of MWI in each of the three subcategories 
considered at proposal (continuous, intermittent, and batch MWI). Table 
6 presents the MACT floor emission levels identified at proposal.

                         Table 6.--Proposed MACT Floor Emission Levels For Existing MWI                         
                                                 [February 1995]                                                
----------------------------------------------------------------------------------------------------------------
                                                                                  MWI subcategory               
                        Pollutant, units                         -----------------------------------------------
                                                                       Batch       Intermittent     Continuous  
----------------------------------------------------------------------------------------------------------------
PM, gr/dscf.....................................................            0.03            0.03            0.02
CO, ppmdv.......................................................           91              90              76   
Dioxin, ng/dscm.................................................           NF              NF              NF   
HCI, ppmdv......................................................          911             115              43   
                                                                        (35%)           (92%)           (97%)   
SO<INF>2, ppmdv......................................................           NF              NF              NF   
NO<INF>X, ppmdv......................................................           NF              NF              NF   
Pb, mg/dscm.....................................................           NF              NF              NF   
Cd, mg/dscm.....................................................           NF              NF              NF   
Hg, mg/dscm.....................................................           NF              NF              NF   
----------------------------------------------------------------------------------------------------------------
NF=No Floor--the MACT floor emission levels for these pollutants reflect uncontrolled emissions. Numbers in     
  parentheses indicate percent reduction.                                                                       

    Note that the table indicates no floor for most pollutants. While a 
numerical value was calculated for each pollutant, most pollutant MACT 
floors reflected uncontrolled emissions. Nevertheless, based on 
conclusions drawn at proposal regarding performance of technology, the 
MACT floor values included in Table 6 for CO, PM, and HCl indicated, at 
proposal, that all existing MWI would need good combustion and dry 
scrubbers to meet the MACT floors for CO, PM, and HCl.
    As discussed in earlier sections, the new information submitted 
following proposal led to changes to the MWI inventory and 
subcategories. Because these factors can influence the MACT floors, a 
review of the MACT floors was conducted. Recall that the inventory 
includes emission limitations for each pollutant based on State permits 
and regulations. For each pollutant, the MWI inventory was sorted by 
subcategory

[[Page 31745]]

and then by stringency of emission limit (most stringent to least 
stringent) within each subcategory. For each pollutant, the emission 
limitations for the top 12 percent of units in each subcategory were 
averaged to determine the MACT floor emission levels. The results of 
these calculations to determine the MACT floor emission levels for 
existing MWI in each subcategory based on the new MWI inventory are 
presented in Table 7.

                          Table 7.--Revised MACT Floor Emission Levels for Existing MWI                         
----------------------------------------------------------------------------------------------------------------
                                                                                  MWI subcategory               
                        Pollutant, units                         -----------------------------------------------
                                                                       Small          Medium           Large    
----------------------------------------------------------------------------------------------------------------
PM, gr/dscf.....................................................           0.086           0.043           0.021
CO, ppmdv.......................................................         156              98              87    
Dioxin, ng/dscm.................................................          NF              NF              NF    
HCI, ppmdv......................................................          NF             589             101    
                                                                                       (57%)           (93%)    
SO<INF>2, ppmdv......................................................          NF              NF              NF    
NO<INF>X, ppmdv......................................................          NF              NF              NF    
Pb, mg/dscm.....................................................          NF              NF              NF    
Cd, mg/dscm.....................................................          NF              NF              NF    
Hg, mg/dscm.....................................................          NF              NF              NF    
----------------------------------------------------------------------------------------------------------------
NF=No Floor--the MACT floor emission levels for these pollutants reflect uncontrolled emissions. Numbers in     
  parentheses indicate percent reduction.                                                                       

    Based on the recalculated MACT floors and the new conclusions drawn 
regarding the performance capabilities of air pollution control 
technologies (Section II.C.), it appears that large MWI would have to 
use good combustion and a high efficiency wet scrubber to achieve the 
MACT floor emission levels, while a medium-sized MWI would have to 
install at least good combustion and a moderate efficiency wet 
scrubber. Dry scrubbers could also be used in conjunction with good 
combustion to meet the MACT floor emission levels for medium and large 
MWI. Available data showing the performance capabilities of good 
combustion appears to indicate that the 0.086 gr/dscf PM MACT floor for 
small MWI is not achievable with good combustion alone. However, MWI 
manufacturers have indicated they routinely guarantee achieving 0.08 
gr/dscf with good combustion. Consequently, the MACT floor for small 
MWI would require the use of good combustion practices; based on the 
claims of MWI manufacturers, add-on scrubbing systems would not be 
needed in all cases to meet the MACT floor. Regulatory options 
reflecting more stringent guidelines for existing MWI are examined in 
Section III of this notice. A memorandum that documents the procedures 
used to determine the MACT floors for existing MWI is located in the 
docket as item IV-B-24.
2. New MWI
    The Clean Air Act specifies in Section 129 that the degree of 
reduction in emissions that is deemed achievable for new MWI shall not 
be less stringent that the emissions control achieved by the best-
controlled similar unit; this requirement is referred to as the ``MACT 
floor'' for new MWI. The MACT floor emission levels identified at 
proposal for new MWI are presented in Table 8. These MACT floor values 
reflect conclusions at proposal about the performance capabilities of 
dry scrubbing systems because such systems were identified on at least 
one MWI in each subcategory and because dry scrubbing systems were 
considered capable of achieving lower emissions than wet scrubbing 
systems.

                            Table 8.--Proposed MACT Floor Emission Levels For New MWI                           
                                                 [February 1995]                                                
----------------------------------------------------------------------------------------------------------------
                                                                                  MWI subcategory               
                        Pollutant, units                         -----------------------------------------------
                                                                       Batch       Intermittent     Continuous  
----------------------------------------------------------------------------------------------------------------
PM, gr/dscf.....................................................           0.013           0.013           0.013
CO, ppmdv.......................................................          50              50              50    
Dioxin, ng/dscm.................................................       1,500             450              80    
HCl, ppmdv......................................................          42              42              42    
                                                                       (97%)           (97%)           (97%)    
SO<INF>2, ppmdv......................................................          NF              NF              NF    
NO<INF>X, ppmdv......................................................          NF              NF              NF    
Pb, mg/dscm.....................................................           0.1             0.1             0.1  
Cd, mg/dscm.....................................................           0.05            0.05            0.05 
Hg, mg/dscm.....................................................          NF              NF               0.47 
                                                                                                       (85%)    
----------------------------------------------------------------------------------------------------------------
NF=No Floor--the MACT floor emission levels for these pollutants reflect uncontrolled emissions. Numbers in     
  parentheses indicate percent reduction.                                                                       

    Again, the new information submitted following proposal led to 
changes to the MWI inventory, subcategories, and conclusions about 
performance of technology. Because these factors can influence the MACT 
floors, a review of the MACT floors was conducted. The revised 
inventory of existing MWI was examined to identify the best-controlled

[[Page 31746]]

MWI in each subcategory. The revised MACT floor emission levels for new 
MWI are shown in Table 9.

                            Table 9.--Revised MACT Floor Emission Levels For New MWI                            
----------------------------------------------------------------------------------------------------------------
                                                                                  MWI subcategory               
                        Pollutant, units                         -----------------------------------------------
                                                                       Small          Medium           Large    
----------------------------------------------------------------------------------------------------------------
PM, gr/dscf.....................................................           0.03            0.015           0.015
CO, ppmdv.......................................................          40              40              40    
Dioxin, ng/dscm.................................................         125             125              25    
HCl, ppmdv......................................................          15              15              15    
                                                                       (99%)           (99%)           (99%)    
SO<INF>2, ppmdv......................................................          NF              NF              NF    
NO<INF>x, ppmdv......................................................          NF              NF              NF    
Pb, mg/dscm.....................................................           1.2             0.07            0.07 
                                                                       (70%)           (98%)           (98%)    
Cd, mg/dscm.....................................................           0.16            0.04            0.04 
                                                                       (65%)           (90%)           (90%)    
Hg, mg/dscm.....................................................           0.55            0.55            0.55 
                                                                       (85%)           (85%)           (85%)    
----------------------------------------------------------------------------------------------------------------
NF=No Floor--the MACT floor emission levels for these pollutants reflect uncontrolled emissions. Numbers in     
  parentheses indicate percent reduction.                                                                       

    The small MWI subcategory consists of MWI operating at a throughput 
of 200 pounds per hour (lb/hr) or less of medical waste. The MACT floor 
for new small MWI consists of the emission levels that are achievable 
with good combustion and a moderate efficiency wet scrubber. The MACT 
floor is based on these emissions levels because small existing MWI 
equipped with this air pollution control have been identified. No small 
existing MWI have been identified with high-efficiency wet scrubbers or 
dry scrubbers.
    The medium MWI category consists of MWI operating at a throughput 
of greater than 200 lb/hr and less than or equal to 500 lb/hr of 
medical waste. The MACT floor for new medium-sized MWI is based on 
emission levels that are achievable with good combustion and a 
combination of two control technologies, the high efficiency wet 
scrubber and the dry injection/fabric filter (DI/FF) dry scrubber 
system without carbon. At least one existing MWI in the medium 
subcategory is controlled with a high efficiency wet scrubber and 
another is equipped with a DI/FF system without carbon. The MACT floor 
is based on both of these technologies (i.e., a combined dry/wet 
scrubber system) because the wet scrubber achieves the lowest dioxin, 
HCl, and Hg emissions, but the DI/FF without carbon injection achieves 
the lowest Pb and Cd emissions. While no combined dry/wet scrubber 
systems were identified on medium MWI, several such systems are 
currently in operation on large MWI, as mentioned below. In addition, 
as also mentioned below, spray dryer/fabric filter systems could also 
meet the MACT floor emission levels for medium-sized MWI.
    The large MWI subcategory consists of all MWI operating at a 
throughput of greater than 500 lb/hr of medical waste. As with the MACT 
floor for new medium MWI, the MACT floor for new large MWI is based on 
the emission levels that are achievable with good combustion and a 
combination of two control technologies, the high efficiency wet 
scrubber and the DI/FF dry scrubber system with carbon. Several 
existing facilities in the large category currently control emissions 
with a combined dry/wet system. In addition, one existing MWI equipped 
with a spray dryer/fabric filter system with carbon was tested during 
the EPA testing program and this test demonstrated that this scrubbing 
technology could also meet the MACT floor emission levels presented in 
Table 9.
    Regulatory options reflecting more stringent standards for new MWI 
are examined in Section IV of this notice. A memorandum that documents 
the procedures used to determine the MACT floors for new MWI is located 
in the docket as item IV-B-38.

E. Baseline Emissions

    To estimate the environmental impacts of the standards and 
guidelines for MWI, an estimate of baseline emissions must be made 
(i.e., emissions in the absence of Federal regulations). In the 
February 1995 proposal, baseline emissions were estimated for PM, CO, 
dioxin, HCl, SO<INF>2, NO<INF>x, Pb, Cd, and Hg. When this estimate was 
developed, very little information was available regarding the actual 
number of MWI and the level of air pollution control associated with 
each. The emission estimate was derived from an estimated 3,700 MWI 
assumed to be operating with little, if any, air pollution control.
    As discussed in previous sections, new information has led to new 
conclusions about the MWI inventory, performance of technology, and 
control levels associated with each existing MWI. As a result, revised 
estimates of baseline emissions from existing MWI have been calculated 
and are presented in Table 10.

          Table 10.--Annual Baseline Emissions For Existing MWI         
------------------------------------------------------------------------
                                                              Baseline  
                     Pollutant, units                         emissions 
------------------------------------------------------------------------
PM, Mg/yr.................................................         940  
CO, Mg/yr.................................................         460  
Dioxin g/yr...............................................       7,200  
Dioxin g TEQ/yr...........................................         150  
HCl, Mg/yr................................................       5,700  
SO<INF>2, Mg/yr................................................         250  
NO<INF>x, Mg/yr................................................       1,200  
Pb, Mg/yr.................................................          11  
Cd, Mg/yr.................................................           1.2
Hg, Mg/yr.................................................          15  
------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1. To convert g/yr to lb/yr,  
  divided by 453.6.                                                     

    The results of these emission estimates are significantly lower 
than estimates developed at proposal. For example, the estimate of 
baseline emissions of dioxin toxic equivalency (TEQ) was 5,100 grams 
per year (g/yr) at proposal; the current estimate is 150 g/yr. At 
proposal, the estimate of Hg emissions from existing MWI was 64.6 tons 
per year (tons/yr); the current estimate is 16.0 tons/yr.
    The primary reason for the lower baseline emission estimate is the 
much greater level of emission control found

[[Page 31747]]

at existing MWI than was assumed at proposal. Comment is requested on 
the methodology and assumptions used to estimate baseline emissions 
from existing MWI. Where information on specific air pollution control 
equipment was not available, EPA used State regulatory emission limits 
to predict the type of air pollution control equipment installed on 
each existing MWI. Information is requested which would more accurately 
reflect the actual air pollution control equipment installed on each 
existing MWI. In addition, emission factors for each type of air 
pollution control equipment were developed based on compliance test 
reports. Comment is requested on whether these emission factors reflect 
actual air emissions from these control devices over the life of the 
equipment.
    At proposal, baseline emissions were also estimated for new MWI in 
the fifth year after adoption of the NSPS. These estimates were based 
on a projected number of new MWI and their associated emission controls 
that would be installed in the five years following promulgation of the 
standards. As with the estimation of baseline emissions for existing 
MWI, the estimate of baseline emissions for new MWI has also changed 
significantly. This change is due primarily to the lower projected 
number of new MWI and the emission control level associated with each 
MWI. The revised baseline emissions estimates for new MWI are presented 
in Table 11.

            Table 11.--Annual Baseline Emissions For New MWI            
------------------------------------------------------------------------
                                                              Baseline  
                     Pollutant, units                         emissions 
------------------------------------------------------------------------
PM, Mg/yr.................................................        28    
CO, Mg/yr.................................................        14    
Dioxin g/yr...............................................        47    
Dioxin g TEQ/yr...........................................         1.1  
HCl, Mg/yr................................................        64    
SO<INF>2, Mg/yr................................................        28    
NO<INF>x, Mg/yr................................................       130    
Pb, Mg/yr.................................................         0.39 
Cd, Mg/yr.................................................         0.051
Hg, Mg/yr.................................................         0.21 
------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1.                            
To convert g/y to 1b/yr, divided by 453.6.                              

    The memoranda documenting these revised estimates of baseline 
emissions from new and existing MWI can be found in the docket as items 
IV-B-51 and IV-A-6.

F. Operator Training and Qualification

    The proposed standards and guidelines included operator training 
and qualification requirements for each MWI operator. These operator 
training and qualification requirements included completion of (1) 24 
hours of classroom instruction, (2) 4 hours of hands-on training, (3) 
an examination developed and administered by the course instructor, and 
(4) a handbook or other documentation covering the subjects presented 
during the course. The instructor of the operator training course was 
not to be employed by the owner or operator of the facility. To obtain 
qualification, an operator was to complete the training course and have 
either a minimum level of experience or satisfy comparable or more 
stringent criteria established by a national professional organization. 
The proposed standards and guidelines also required the owner or 
operator of the facility to develop and annually update a site-specific 
operating manual. This manual would summarize regulations, operating 
procedures, and reporting and recordkeeping requirements in accordance 
with the proposed standards and guidelines. The proposal required that 
each MWI be operated by a trained and qualified operator or by an 
individual under the direct supervision of a trained and qualified 
operator. The trained and qualified operator would have to be on duty 
and at the facility at all times while the incinerator is in operation.
    Many comments were received on the proposed operator training and 
qualification requirements. The majority of the public comments on 
operator training and qualification were related to the third party 
training requirement and to the duration that operators must be present 
while the MWI is burning waste. Many commenters stated that the EPA 
should allow facilities the option of providing training by in-house 
personnel because the facility's own personnel would be most familiar 
with the operation and maintenance of the incinerator. The commenters 
indicated that smaller facilities that do not have the personnel could 
use the services of trainers and inspectors that are not affiliated 
with the facility.
    Many commenters stated that the amount of time that the operator 
was required to be present was excessive. Under the proposal, the 
operator would have to be on-duty and at the facility during the time 
that the combustion air blowers are operating. Several commenters 
suggested that this would require operators to be at the incinerator 
even when waste was not being burned. Several commenters also suggested 
that the trained and qualified operator should be easily accessible 
(either at the facility or on-call) while the incinerator is operating.
    The EPA is inclined to adopt the operator training and 
qualification requirements briefly summarized below and discussed in 
greater length in document number IV-B-26, which is available in the 
Docket. Cost estimates for operator training and qualification are 
documented in item IV-B-39.
    The owner or operator of an MWI would be responsible for ensuring 
that one or more operators at the facility are qualified. Operator 
training may be obtained through a State-approved program or by 
completing a training course with (1) 24 hours of classroom 
instruction, (2) an examination designed and administered by the course 
instructor, and (3) reference material distributed to the attendees 
covering course topics.
    Operators may obtain qualification by completing a training course 
and having one of the following levels of experience: (1) at least 6-
months' experience as an MWI operator, (2) at least 6-months' 
experience as the direct supervisor of a qualified MWI operator, or (3) 
completion of at least two burn cycles under the observation of two 
qualified operators. To maintain qualification, the operator would be 
required to complete and pass an annual review or refresher course of 
at least 4 hours.
    A fully trained and qualified operator would have to be easily 
accessible, either at the facility or on-call at all times while the 
incinerator is in operation. The trained and qualified operator may 
operate the MWI directly or be the direct supervisor of one or more 
individuals that charge waste, remove ash, etc. As proposed, the 
emission guidelines for existing MWI would require that, 1 year after 
approval of the State plan, MWI must be operated by a trained and 
qualified operator.

G. Testing, Monitoring, and Inspection

    Section 129(c) of the Clean Air Act requires the EPA to develop 
regulations that include monitoring and testing requirements. The 
purpose of these requirements is to allow the EPA to determine whether 
a source is operating in compliance with the regulations.
    As mentioned earlier, at proposal relatively few emission test 
reports were available to EPA to judge the performance of air pollution 
control technologies. These test reports were the result of EPA 
emission testing at several MWI. For a variety of reasons, EPA gathered 
data during these emission tests using three, 4-hour test runs. The 
results of the three test runs were then averaged at each MWI to 
calculate a measured emission level. This calculated emission level 
represented an

[[Page 31748]]

average emission value over the 12-hour period (i.e., three, 4-hour 
runs).
    As a result, EPA's assessments of the performance capabilities of 
air pollution control technologies and conclusions regarding the 
appropriate emission limits to include in the proposed regulations were 
based on the measured performance of technology averaged over a 12-hour 
period. Emission levels, however, tend to fluctuate somewhat as part of 
normal operation. Consequently, during short periods of time, emission 
levels may occasionally be greater or lower than the average emission 
level over a 12 hour period.
    In developing a regulation based on the performance of a particular 
technology, the level of performance demanded by the regulation must be 
consistent with the level of performance that technology can achieve. 
The period of time over which emissions are measured and then averaged 
to determine compliance with the regulation, therefore, must correspond 
to the period of time over which emission levels were measured and 
averaged in determining the emission limits included in the regulation. 
If this is not the case, a regulation could include emission limits 
that a technology can achieve if emissions are averaged over a 
relatively long period of time, but not if emissions are averaged over 
a much shorter period of time. For this reason, the proposed regulation 
required emission testing to determine compliance by averaging the 
results of three, 4-hour test runs, consistent with the procedures 
followed in gathering the emission data used to establish the emission 
limits included in the regulation.
    Many comments were received regarding this proposed requirement to 
determine compliance using three, 4-hour test runs. These commenters 
noted that a 4-hour test run was much longer than the more conventional 
test run of about 1-hour; additionally, many hospitals and healthcare 
facilities would normally not have sufficient waste on hand to 
accommodate three, 4-hour test runs. Finally, several commenters stated 
that the proposed emission testing requirements would substantially 
increase the costs associated with emission testing. Consequently, 
these commenters urged EPA to revise the emission testing requirements 
and adopt the more conventional approach of relying on test runs of 
about an hour in length.
    As mentioned earlier, more than two dozen test reports were 
submitted to EPA following the proposal, and these test reports now 
form the basis for revised conclusions regarding the performance 
capabilities of technology and the emission limits these technologies 
can achieve. The EPA test methods were used to perform the emission 
testing summarized in these reports. These methods include procedures 
that require the collection of a sufficient sample to accurately 
measure emission levels. For most air pollutants, this sample generally 
corresponds to a test run of about an hour. The revised conclusions 
discussed earlier, therefore, regarding the performance capabilities of 
emission control technologies and the emission limits these 
technologies can achieve, are based (for the most part) on emission 
test data generated by averaging the results of three test runs of 
about an hour each (i.e., a 3-hour test).
    For this reason, the EPA is inclined to state in the final 
regulations adopted for MWI that EPA test methods be followed when 
performing any emission testing required to determine compliance with 
the regulations. This requirement will ensure that compliance testing 
follows the same procedures used to generate the emission data upon 
which the emission limits in the final regulation were based. In most 
cases, three test runs of about an hour each would be necessary to 
determine compliance with the final regulations.
    An exception to this requirement is emission testing to measure 
dioxin emissions. The procedures in the EPA test method to ensure 
sufficient sample is gathered to accurately measure dioxin emissions 
frequently leads to test runs longer than 1 hour. Whatever the length 
of the emission test, however, the emission testing procedures included 
in the EPA test method for measuring dioxin emissions were followed in 
the emission test reports submitted to EPA following proposal. As 
discussed earlier, these emission test reports serve as the basis for 
the dioxin emission limits included in the final regulations and, as a 
result, the length of testing necessary to determine compliance will 
automatically be consistent with the length of testing used to 
determine the emission limits included in the regulations.
    The proposed regulations also would have required annual emission 
testing to determine compliance. While some commenters supported 
emission testing annually or even more frequently (such as every 6 
months), a number of commenters believed that annual testing would be 
unnecessary or that testing should be required no more than every 5 
years. Commenters felt that the requirements for inspections, 
monitoring, and operator training are sufficient and much less 
expensive than annual emission testing.
    Other commenters suggested that the annual emission testing 
requirement be replaced with a requirement for annual equipment 
inspection/maintenance to ensure that burner settings, air flow rates, 
and other operation parameters are properly adjusted. While the 
proposal includes a requirement for annual equipment inspection and 
maintenance, this requirement would have applied only to existing MWI 
until air pollution control equipment had been installed and the MWI 
was in compliance with all the emission limits in the regulations. The 
purpose of the proposed annual equipment inspection and maintenance 
requirements was to ensure that the MWI was in good working order and 
physically capable of operating as well as it could operate until 
compliance with the emission limits was demonstrated. A MWI in poor 
operating condition will likely have higher emissions than a MWI in 
good operating condition.
    While some commenters stated inspections are not necessary and 
others suggested that EPA should let the States decide whether 
inspections are necessary, most commenters were generally supportive of 
annual inspection and maintenance requirements. Several commenters also 
stated that biannual inspections would not be unreasonable. Many of the 
commenters supportive of inspection requirements, however, suggested 
that the requirement for a ``third party'' inspection be deleted. These 
commenters stated in-house personnel are more familiar with the details 
and operating intricacies of the equipment installed at their sites. In 
addition, serious liability concerns could arise from injury or damage 
caused by ``third party'' inspection or maintenance. At this point, EPA 
is inclined to include inspection and maintenance requirements wherever 
annual stack testing is not required (see document IV-B-26 in the 
docket for a description of injection/maintenance requirements). The 
inspection would not have to be conducted by a third party.
    The proposal also included various monitoring requirements, 
requiring the use of continuous emission monitoring systems (CEMS) for 
some pollutants and the monitoring of operating parameters for other 
pollutants. Some commenters supported the proposed requirements for CO, 
opacity, and oxygen (O<INF>2) CEMS. Another commenter suggested that 
the requirements should be extended to require CEMS for Hg, HCl, and 
PM; the commenter suggested that such instruments are available. On the 
other

[[Page 31749]]

hand, several other commenters objected to the CEMS requirements in the 
proposed rule. These commenters stated that CEMS are not justified, 
especially for small MWI, because they are too expensive. These 
commenters believe that monitoring operating parameters is a sufficient 
substitute for CEMS once compliance has been demonstrated by an initial 
emission test.
    The monitoring requirements in the proposal for monitoring 
operating parameters were structured around the use of dry scrubber 
systems. Those who commented on these specific requirements generally 
agreed that monitoring of these operating parameters was appropriate 
for dry scrubbing systems.
    No monitoring requirements were included for monitoring operating 
parameters for wet scrubbing systems. The EPA solicited information 
regarding an appropriate set of operating parameters for wet scrubbing 
systems. The EPA was inclined and is still inclined to include specific 
operating parameter monitoring requirements in the final regulations 
for wet scrubbing systems as well as for dry scrubbing systems. To 
accommodate MWI using an air pollution control system other than a dry 
or wet scrubbing system, EPA is inclined to include provisions in the 
final regulations for petitioning the Administrator to monitor specific 
operating parameters associated with the other air pollution control 
system.
    A number of commenters responded to EPA's request for suggestions 
of monitoring requirements for operating parameters suitable for wet 
scrubbing systems. Suggested parameters included pressure drop across 
the system, liquor flow rate, flue gas temperature, liquor pH, and 
horsepower or amperage. While EPA is inclined to include the same 
requirements in the final regulations for monitoring operating 
parameters for dry scrubbing systems as proposed, EPA is inclined to 
include requirements in the final regulations for monitoring the 
following operating parameters for wet scrubbing systems: scrubber exit 
temperature, scrubber liquor pH, scrubber liquor flow rate, and energy 
input to the scrubber (e.g., pressure drop or horsepower).
    To consider the comments outlined above regarding the frequency of 
emission testing and the proposed inspection and monitoring 
requirements, a matrix of options was developed. This matrix of options 
and their annual costs are summarized in Table 12. Each cell or box in 
this table represents a combination of emission testing and monitoring 
requirements (some combinations also include inspection requirements). 
The range in the costs shown in each cell is a reflection of how the 
cost of emission testing and monitoring is likely to vary depending on 
the emission limits included in the final regulation (i.e., whether the 
emission limits are based on the use of good combustion alone or good 
combustion and wet or dry scrubbing). These costs vary somewhat because 
the operating parameters monitored in each case would be somewhat 
different.

                             Table 12.--Monitoring/Testing Options and Annual Costs                             
                                                 [Thousand $/yr]                                                
----------------------------------------------------------------------------------------------------------------
                                                                                  Testing options               
                                                                 -----------------------------------------------
                       Monitoring options                         A  Initial and    B  Initial     C  Substitute
                                                                   repeat stack   stack testing;  stack testing;
                                                                      testing       inspection      inspection  
----------------------------------------------------------------------------------------------------------------
1--CO CEMS (App F); Opacity CEM (no App F); Operating Parameters         110-119         100-104          99-102
2--Opacity and CO CEMS (no App F); Operating Parameters.........          96-104           85-89           83-86
3--Opacity CEMS (no App. F); Operating Parameters...............           37-46           27-31           26-29
4--Operating Parameters; Quarterly Method 9.....................           10-15          7.5-11         5.8-8.8
----------------------------------------------------------------------------------------------------------------

    Table 12 presents the 12 possible combinations of three emission 
testing options and four monitoring options that the EPA is considering 
including in the final regulations. A more detailed explanation of 
these emission testing and monitoring options, as well as their costs, 
is available in the docket as item IV-B-54. The following discussion, 
however, briefly outlines the essential requirements of each of the 
monitoring and emission testing options.
    Monitoring Option 1 requires a CO CEMS with Appendix F requirements 
(Appendix F requirements ensure the data generated is reliable), an 
opacity CEMS without Appendix F requirements, and operating parameter 
monitoring requirements for the MWI and, if applicable, for the air 
pollution control device. Because the use of Appendix F is required 
under this option, the CO CEMS would be used for direct enforcement of 
the CO emission limit. The opacity CEMS without Appendix F requirements 
would simply provide an indication of opacity and would not be used for 
direct enforcement of the opacity limit. Routine opacity testing with 
Reference Method 9 is included in Monitoring Option 1 to compensate for 
not including Appendix F requirements on the opacity CEMS.
    Monitoring Option 2 is the same as Monitoring Option 1, except that 
it would not include Appendix F requirements for the CO CEMS, which 
would reduce costs. Without Appendix F requirements, the CO CEMS would 
provide an indication of CO emissions and would not be used for direct 
enforcement of the CO emission limit. Emission testing for CO is 
included in Monitoring Option 2 to compensate for excluding Appendix F 
requirements on the CO CEMS. An opacity CEMS and operating parameter 
monitoring would be required as in Monitoring Option 1.
    Monitoring Option 3 is the same as Monitoring Option 2, except 
that, instead of the more expensive CO CEMS, stack emission testing for 
CO would be required. An opacity CEMS and operating parameter 
monitoring would be required as in Monitoring Options 1 and 2.
    Monitoring Option 4 would require no CEMS. Instead, it would rely 
on manual emission test methods (including more frequent Method 9 
opacity tests) and operating parameter monitoring.
    For each of these monitoring options, three emission testing 
options have been developed. Emission testing Option A would require 
initial and annual/skip tests. With the annual/skip test requirement, 
emission tests would be required for the first 3 years. If these tests 
show that the facility was in compliance each of these 3 years, then 
subsequent testing would be done every third year. Emission testing 
Option A,

[[Page 31750]]

under all four monitoring options, would require an initial stack test 
for all pollutants. Annual or skip emission testing under Monitoring 
Options 1, 2, and 3 would also require emission testing of all 
pollutants. However, annual or skip emission testing under Monitoring 
Option 4 would only require emission testing of a few key or critical 
pollutants (i.e., only those necessary to gain a good indication that 
the air pollution control system is operating properly).
    Emission testing Option B would require an initial emission test 
for all pollutants, but would not require annual emission tests. In 
lieu of annual or skip emission testing, MWI inspection/maintenance 
would be required. This inspection/maintenance would be required 
annually under Monitoring Options 1 and 2; however, it would be 
required quarterly under Monitoring Options 3 and 4, where no CO CEMS 
is required. The inspection/maintenance could be done by in-house 
personnel. With regard to any necessary repairs arising from the 
inspection/maintenance, the owner or operator of the MWI would be 
required to contact the State (or local, if delegated by the State) air 
pollution control agency and negotiate a date, within 10 operating days 
following the date of the inspection/maintenance, by which the repairs 
must be completed.
    Emission testing Option C would permit substitute emission testing. 
A substitute emission test is an emission test conducted on another, 
but identical MWI. An MWI would be required to petition the State (or 
local, if delegated by the State) air pollution control agency for 
approval, however, and the ``burden of proof'' would be on the MWI to 
demonstrate to the satisfaction of the agency that the substitute 
emission test is on an identical MWI. In addition, an initial emission 
test for Hg would be required; this test would ensure that appropriate 
measures for managing the mercury content of the waste are utilized 
(e.g., material separation, material purchasing, etc.). Inspection/
maintenance requirements would be the same as under Emission Testing 
Option B.
    The most direct means of ensuring compliance with emission limits 
included in regulations is the use of CEMS. As a matter of policy, the 
first and foremost option considered by EPA is to require the use of 
CEMS in regulations to demonstrate and ensure compliance on a 
continuous basis with the regulations. Only when the impacts of 
including such requirements are considered unreasonable, does the EPA 
consider other options.
    For MWI, it appears that almost all of the emission testing and 
monitoring options under consideration cost more than the emission 
control system that would be installed to meet the emission limits in 
the regulations; in some cases, the emission testing and monitoring 
requirements could cost twice as much as the emission control system. 
Consequently, the Agency is inclined to include the emission testing 
and monitoring requirements under Monitoring Option 4 in the final 
regulations to minimize costs. Where the regulations are based on good 
combustion and wet and/or dry scrubbing systems, the EPA is inclined to 
require Monitoring Option 4 with Emission Testing Option A; where the 
regulations are based, in part, on the use of good combustion alone, 
the EPA is inclined to require Monitoring Option 4 with Emission 
Testing Option B.
    The appropriate choice of emission testing and monitoring 
requirements (as well as inspection/maintenance requirements) is an 
area in which the EPA specifically solicits comments. Many of the MWI 
visited or inspected by the EPA in the course of gathering data and 
information often appeared poorly maintained and operated. Inadequate 
maintenance and/or operation can cause even the best equipment to 
perform poorly and result in excess emissions. The inspection/
maintenance and operator training requirements included in the final 
regulations are expected to address this problem in a satisfactory 
manner; however, the EPA is interested in whether others feel the 
inspection/maintenance requirements and operator training requirements 
should be supplemented with more extensive emission testing and/or 
monitoring requirements.
    In addition, CEMS vendors have expressed concern with the costs 
developed by EPA for the various CEMS and operating parameter 
monitoring requirements. In particular, they believe the costs of CEMS 
are much lower than those estimated by EPA. As mentioned, a detailed 
breakdown of the EPA estimates of the costs of these requirements is 
available in the docket as item IV-B-54. The EPA solicits comments on 
these costs and if costs are indeed much lower than estimated, EPA may 
consider more comprehensive monitoring requirements in the final rule. 
Finally, even if the costs remain similar to those previously 
estimated, the EPA is considering more comprehensive emission testing 
and monitoring requirements (including CEMS) for large MWI that burn 
medical waste generated offsite (i.e., generated at another location 
than that of the MWI).

Definition of Medical Waste

    Section 129 of the Clean Air Act directs the EPA to adopt 
regulations for solid waste incineration units that combust (1) 
municipal waste; (2) hospital, medical, and infectious waste; (3) 
commercial or industrial waste; and (4) all other solid waste. The 
regulations limiting air emissions from solid waste incineration units 
combusting municipal waste (otherwise known as municipal waste 
combustor(s) or MWC) were promulgated on December 19, 1995 (60 FR 
65387). In developing regulations to limit air emissions from solid 
waste incineration units combusting hospital, medical, and infectious 
waste (otherwise known as medical waste incinerator(s) or MWI), medical 
waste was defined as any solid waste that is generated in the 
diagnosis, treatment, or immunization of human beings or animals, in 
research pertaining thereto, or in the production or testing of 
biologicals.
    Section 129(g)(6) states that the term ``medical waste'' shall have 
the meaning ``established by the Administrator pursuant to the Solid 
Waste Disposal Act'' (SWDA). For the proposed air emission standards 
and guidelines for MWI, EPA adopted the definition of ``medical waste'' 
from solid waste regulations codified in 40 CFR part 259, subpart B 
because this definition was ``established by the Administrator pursuant 
to the [SWDA],'' as amended by the Medical Waste Tracking Act (MWTA). 
However, 40 CFR part 259 has since been withdrawn. Consequently, there 
is no definition of medical waste which has been ``established by the 
Administrator pursuant to the [SWDA],'' and EPA now has the flexibility 
to examine and consider other definitions of medical waste. While EPA 
is inclined to adopt a specific definition described below, EPA is 
considering all of the definitions discussed in this section as well as 
the proposed definition and solicits comment on the merits of each 
definition discussed as well as other definitions EPA should consider.
    During the public comment period, the majority of the comments on 
the definition of medical waste stated that the proposed definition was 
too broad and that it should be narrowed. Several commenters stated 
that this definition would aggravate an already confusing situation, 
where the public distinction between the terms medical waste and 
infectious waste has become blurred and in most cases lost; these terms 
are often used synonymously in public discourse.

[[Page 31751]]

    These commenters believed that a broad definition of medical waste 
in the regulations for MWI would have the undesirable impact of 
fostering and encouraging the use and adoption of this definition in 
other areas and by other regulatory authorities. They suggested that as 
this definition becomes more widespread and adopted by others, 
healthcare facilities would eventually be forced to handle most, if not 
all, medical waste as infectious waste--whether it was burned in an 
incinerator or not.
    These commenters stated the proposed definition of medical waste, 
because of the loss of public distinction between this term and the 
term infectious waste, and the resulting impact of eventually forcing 
healthcare facilities to treat most waste as infectious waste, would 
lead to a massive increase in the volume of infectious waste. This 
increase would, in turn, lead to a major increase in the costs of 
disposal of waste from hospitals, since most waste would have to be 
handled as infectious waste.
    These commenters stated that, as in implementing the MWTA, 
healthcare facilities should be viewed as generating two waste streams: 
a medical waste stream, which is usually defined by the potential for 
disease transmission and requires special handling; and a noninfectious 
waste or ``healthcare trash'' waste stream, which has no potential for 
infection and is treated and handled as municipal waste. These 
commenters urged EPA to narrow the definition of medical waste used in 
the MWI regulations to one of infectious waste, analogous to the term 
``regulated medical waste'' adopted in regulations resulting from the 
MWTA.
    In most--if not all--cases, these commenters indicated that, where 
healthcare facilities operate medical waste incinerators, they burn 
infectious medical waste or a mixture of infectious medical waste and 
noninfectious waste (i.e., healthcare trash). These commenters stated 
that there were very few, if any, medical waste incinerators operated 
by healthcare facilities that burned only noninfectious waste or 
healthcare trash.
    Consequently, by defining medical waste narrowly, in a manner 
consistent with infectious or regulated medical waste, and by applying 
the regulations to incinerators that burn this waste or any mixture of 
this waste and other waste, the EPA could achieve the objective, which 
is regulating air pollution from medical waste incinerators at 
healthcare facilities; this objective would be achieved without adding 
to the confusion or leading to the serious impacts outlined above.
    These commenters further stated the proposed definition of medical 
waste would subject MWC, which burn general nonregulated and 
noninfectious waste from hospitals, to the same requirements as those 
proposed for MWI. Consequently, even if healthcare facilities were not 
eventually forced to handle most waste as infectious waste (because MWC 
that burn general nonregulated and noninfectious waste from hospitals 
would be subject to the MWI regulations) this broad definition would 
result in higher disposal costs for healthcare facilities which send 
their general nonregulated and noninfectious waste to MWC for disposal.
    Some commenters, on the other hand, support the proposed broad 
definition of medical waste. These commenters pointed out that there is 
little difference in the air emissions created by burning infectious 
medical waste (e.g., regulated medical waste or ``red bag'' waste) and 
by burning noninfectious waste (e.g., nonregulated medical waste or 
healthcare trash). As a result, the regulations should apply to the 
burning of all medical waste, as EPA proposed. These commenters believe 
that EPA's use of the broad definition of medical waste, solely for the 
purpose of defining what type of incinerator the regulations apply to, 
does not imply that more waste or that all medical waste will be 
considered infectious waste. Merely requiring that incinerators that 
burn medical waste must limit air pollution will not require all 
healthcare facilities to handle all their medical waste as infectious 
waste.
    In fact, these commenters indicated that many healthcare facilities 
today routinely separate their waste into two types: infectious waste 
(``red bag'') and noninfectious waste (``black bag''). Numerous items 
of waste from healthcare facilities are not, nor need not be considered 
infectious waste. On the other hand, many healthcare facilities today 
do little to separate their waste streams; most waste is handled and 
treated as infectious waste. If waste disposal costs were of paramount 
concern to healthcare facilities, those that do little separation today 
could reduce their present waste disposal costs by more carefully 
segregating their waste into infectious and noninfectious waste streams 
and properly disposing of these two waste streams.
    Finally, several commenters questioned whether animal carcasses and 
pathological waste should be included in the definition of medical 
waste. These commenters were uncertain as to whether pathological waste 
incinerators were to be regulated as MWI or separately. These 
commenters requested clarification of this situation and urged EPA to 
regulate pathological wastes separately from medical waste.
    Similarly, several commenters questioned whether ``out-of-date'' or 
``off-spec'' drugs, or radio-active type medical wastes, should be 
included in the definition of medical waste. These commenters requested 
special treatment for these types of wastes, similar to that proposed 
for pathological wastes.
    The EPA did not intend to add or contribute to the confusion that 
presently exists in the public discourse regarding the distinction or 
lack of distinction between the terms medical waste, regulated medical 
waste, and infectious medical waste. In fact, the EPA would like to 
state very clearly that numerous items within the medical waste stream 
are noninfectious and need not be treated as infectious. In fact, the 
majority of items in the medical waste stream are noninfectious, and in 
terms of percentages, most authorities conclude that only 10 to 15 
percent of the items in the medical waste stream are infectious, or 
potentially infectious, and warrant special treatment or handling.
    In considering the public comments, an interesting and unanimous 
agreement emerges, even if it is not stated as such. All of the 
commenters seem to agree that healthcare facilities can be viewed as 
generating two waste streams: an infectious medical waste stream and a 
noninfectious healthcare trash, or ``municipal waste'' type, waste 
stream. The challenge for EPA, therefore, is to reconcile the agreement 
in this area with the requirement of the Clean Air Act to develop 
regulations for incinerators burning hospital, medical, and infectious 
waste.
    The Clean Air Act requires EPA to develop regulations for the 
burning of medical waste; but it also requires EPA to develop 
regulations for the burning of municipal waste. In fact, EPA adopted 
regulations limiting air pollution from the burning of municipal waste 
on December 19, 1995 (60 FR 65387). As a result, if healthcare 
facilities are viewed as generating two types of waste streams, an 
infectious waste stream and a municipal waste stream, then the burning 
of the municipal waste stream is already covered by regulations.
    The definition of municipal waste included in the regulations 
covering the burning of municipal waste states:

    Municipal solid waste * * * means household, commercial/retail, 
and/or institutional waste * * * Commercial/retail waste includes 
material discarded by stores,

[[Page 31752]]

offices, restaurants * * * Institutional waste includes materials 
discarded by schools, nonmedical waste discarded by hospitals, * * * 
and material discarded by other similar establishments or 
facilities.

    The regulations cover the burning of municipal waste discarded from 
offices and institutions. Hospitals are cited as an example of an 
institution and clinics and nursing homes are considered ``similar 
establishment(s)''. Offices include doctors' offices, dentists' 
offices, etc. Consequently, noninfectious, municipal-type waste 
discarded from healthcare facilities is considered part of the 
municipal waste stream and is covered by the regulations adopted for 
the burning of municipal waste.
    The remaining need, therefore, is to regulate the burning of the 
infectious waste stream discarded from healthcare facilities, which can 
be achieved by redefining medical waste in terms of infectious or 
potentially infectious materials. Thus, the EPA is inclined to narrow 
the applicability of the proposed regulations by adopting a definition 
of medical waste that focuses on that portion of the overall medical 
waste stream that is generally considered infectious or potentially 
infectious.
    Given the confusion and number of varying definitions of medical 
waste, regulated medical waste, infectious waste, etc., at the Federal 
and State level, and within the healthcare community, transportation 
sector, etc., EPA does not intend to add to this confusion by creating 
another definition. As a result, EPA is inclined to adopt a definition 
of medical waste, for the MWI regulations, from among those already in 
use.
    As mentioned, numerous definitions are currently in use, such as 
the definition of infectious waste created by the U.S. Department of 
Transportation, the definition of regulated medical waste created by 
EPA, as well as other definitions created by other regulatory agencies 
and national associations, such as the Occupational Safety and Health 
Administration, the New York State Department of Health, the American 
Hospital Association, etc. While these are just a few of the agencies 
or associations that have developed definitions of medical waste that 
are currently in use, they are the ones most often cited or suggested 
in the public comments. Each of these definitions are slightly 
different, but all focus on infectious or potentially infectious 
medical waste. These definitions are discussed in more detail in 
document number IV-B-25, available in the Docket.
    For the most part, infectious or potentially infectious wastes are 
defined through the use of categories or classes of wastes. The classes 
of wastes most commonly used include:
    1. Cultures and stocks of infectious agents;
    2. Human pathological wastes;
    3. Human blood and blood products;
    4. Used sharps;
    5. Animal wastes;
    6. Isolation wastes; and
    7. Unused sharps.
    These seven waste classes are commonly used by various agencies and 
associations as the basis for defining medical wastes. However, while 
the classes of wastes included in two different definitions may be 
identical, the specific items included under each class and the 
definitions for these items may be very different. Each agency or 
association has developed different language to define each of these 
waste classes in a way that best serves their purposes. For example, 
some definitions include intravenous (IV) bags under class 3 wastes, 
while others do not.
    It appears that adoption of any one of these definitions or any 
definition at all will be controversial. No uniform or widespread 
agreement on a definition exists, and for each commenter who argued 
strongly for adoption of one particular definition, another commenter 
argued equally strongly for adoption of a different one.
    Of all these definitions, EPA is inclined to adopt the New York 
State Department of Health (NYSDOH) definition, which is one of the 
more recently developed definitions for use in the MWI air pollution 
emission regulations. This definition was subjected to intense 
discussion, consideration, and review within the medical and healthcare 
community. Because it was adopted fairly recently, this definition also 
benefits from the various controversies and discussions generated by 
adoption of earlier definitions by other agencies and associations. 
Further, this definition seems to be among the more comprehensive ones 
in terms of identifying and defining the various classes of infectious 
or potentially infectious medical waste mentioned above.
    The NYSDOH definition includes six of the seven waste classes; 
isolation wastes (class 6) are not listed as a separate category. The 
definitions used for waste classes 1, 2, 4, and 7 are similar to those 
used by the MWTA definition. As with the AHA definition, the NYSDOH 
definition differs from the MWTA definition in the specifics of class 3 
wastes. Class 3 waste under the NYSDOH definition does not include 
items caked with dried blood or IV bags. These wastes are included in 
the MWTA definition of class 3 waste. The definitions for class 5 waste 
only includes wastes from animals exposed to infectious agents during 
research, the production of biologicals, or the testing of 
pharmaceuticals. Pathological waste from veterinary facilities is 
excluded from the MWTA definition. The NYSDOH defines class 5 wastes as 
wastes from animals known to be contaminated with infectious agents or 
from animals inoculated during research, the production of biologicals, 
or pharmaceutical testing. Unlike the MWTA definition, the NYSDOH 
definition seems to include some wastes (from animals contaminated with 
infectious agents) generated by general veterinary practices. The 
specifics of this definition are included in item IV-J-078 in the 
docket).
    Also, as stated at proposal, the EPA is inclined to exclude 
crematories and incinerators used solely for burning pathological waste 
(human or animal remains and tissues) from the medical waste 
incinerator regulation. However, MWI that burn animal and pathological 
waste co-mingled with other classes of medical waste would be subject 
to the regulation. Because MWI that burn mixtures of medical and 
pathological (or animal) waste would be covered by the regulation, it 
is necessary to include a description of pathological and animal waste 
in the definition of medical waste. Human pathological waste and animal 
waste are included in the NYSDOH definition of medical waste.
    In addition, the EPA is inclined to exclude from the regulation 
incinerators used solely for burning ``off-spec'' or ``out of date'' 
drugs or pharmaceuticals, as well as incinerators used solely for 
burning radio-active type medical wastes. In other words, as several 
comments suggested, the EPA is inclined to treat these wastes in a 
manner similar to pathological waste.
    While EPA is inclined to exclude these types of wastes from the 
regulation for MWI, this exclusion does not mean that EPA will not 
develop regulations which will cover these wastes. The Clean Air Act 
clearly directs the EPA to develop regulations to cover burning of 
these wastes. Thus, this inclination to exclude them is only to 
temporarily defer regulation.
    The Clean Air Act directs the EPA to develop regulations for all 
solid waste incinerators, and burning these wastes will be covered by 
regulations developed within the next few years. The Clean Air Act also 
directs the EPA to announce a schedule for development

[[Page 31753]]

of these other regulations, and the EPA has announced these regulations 
will be developed by the year 2000.

I. Pyrolysis Units

    Incineration is only one of several medical waste treatment 
technologies. Other treatment technologies, such as autoclaves, 
microwaves, and chemical treatment, where there is clearly no 
combustion occurring, are referred to in this notice as ``alternative 
technologies'' and are discussed further in Section II.J. These 
``alternative technologies'' clearly are not subject to MWI 
regulations. On the other hand, some medical waste treatment 
technologies employ plasma or gasification processes (i.e., pyrolysis). 
Because it appears that at least some combustion is taking place in 
these devices, EPA considered these pyrolysis technologies covered by 
the proposed MWI regulations.
    Comments from the vendors of pyrolysis technologies indicated they 
believed they could easily meet the emission limitations included in 
the proposed MWI standards and guidelines. However, they believed that 
their processes are unique enough to warrant a separate category for 
regulation. The vendors were particularly concerned that the proposed 
compliance and monitoring requirements for MWI do not apply to 
pyrolysis technologies. The proposal, therefore, requested comment on 
whether pyrolysis units should be regulated as MWI or as a separate 
source category.
    Numerous comments and suggestions were received following proposal 
from vendors of pyrolysis treatment technologies. Based on these 
comments and suggestions, a draft regulation for pyrolysis treatment 
technologies has been developed and is available in the docket as item 
IV-B-56. This draft regulatory text is incomplete at this time. It 
includes placeholders and requests for information where such 
information is lacking. Comments are requested to help EPA fill in this 
missing information.
    A separate regulation for pyrolysis treatment technologies would 
look very similar to the MWI regulation in that it would contain 
definitions, emissions limitations, monitoring and testing requirements 
to demonstrate compliance, and reporting and recordkeeping 
requirements. It would differ from the MWI regulations in that some 
definitions would be different, the emission limitations would, in many 
cases, be more stringent than the MWI regulations, and the monitoring 
and testing requirements would reflect the operating parameters that 
are unique to pyrolysis systems.
    The EPA is inclined to adopt separate regulations for pyrolysis 
treatment technologies. The EPA specifically requests comment on the 
merits of continued development of separate regulations for pyrolysis 
systems. These systems appear to be very different than incinerators. 
Because they are emerging technologies, however, the normal process of 
determining a MACT floor and MACT for these systems is not possible at 
this time. In fact, because they appear to be inherently clean 
technologies, regulation of these systems may not be warranted at this 
time.

J. Alternative Medical Waste Treatment Technologies

    In the proposal, it was estimated that many owners of existing 
onsite MWI would discontinue use of their existing MWI in favor of less 
expensive medical waste disposal options to avoid the high cost of add-
on air pollution control equipment. In addition, many facilities that 
would have chosen to purchase a new onsite MWI were estimated to be 
likely to choose some other method of waste disposal. This phenomenon 
was labeled as ``switching'' in the proposal, and it has already 
occurred in a few States that have adopted stringent MWI regulations in 
the past few years.
    Next to onsite incineration, the two most common methods of medical 
waste disposal are (1) offsite contract disposal, which usually 
involves larger, commercial incinerators dedicated to medical waste and 
(2) onsite alternative medical waste treatment technologies, which 
include steam autoclaving, chemical treatment, and microwave 
irradiation. Because the MWI regulation may encourage switching and the 
use of onsite alternatives, the possible impacts of other waste 
disposal methods were assessed. Although autoclaves, chemical treatment 
systems, and microwave systems are not covered by the MWI standards and 
guidelines, commercial medical waste incinerators would be subject to 
the MWI standards and guidelines.
    Following proposal, new data on commercial disposal facilities 
throughout the U.S. were obtained. Information on the costs of 
commercial disposal for medical waste generators in both urban and 
rural locations was obtained. Also, information on the environmental 
impacts of increased transportation of medical waste was developed. 
This new information pertaining to commercial disposal was factored 
into the economic and environmental impacts analyses presented in 
Sections III and IV of this notice. The remainder of this section will 
focus on information relating to nonincineration alternative 
technologies (i.e., autoclaves, chemical treatment, microwave 
irradiation, etc.).
    During the public comment period following proposal, several 
concerns were raised regarding the availability, effectiveness, costs, 
and environmental impacts of onsite alternative treatment technologies. 
Concerns were also raised regarding alternative technology operator 
safety and State acceptance of alternative technologies. Because of the 
concerns raised during the public comment period, the Agency has 
examined the available information on the effects that switching from 
onsite incineration to alternative technologies could have on medical 
waste generators and the environment.
    Following proposal, a great deal of information on alternative 
technologies was received. This information was compiled and is 
presented in document No. IV-B-43. The material presented in document 
IV-B-43 should not be considered an in-depth study of alternative 
technologies. Instead, it is a review of the available information. 
Based on this information, there appears to be no significant or 
substantial adverse economic, environmental, or health and safety 
issues associated with the increased use of these nonincineration 
alternative medical waste treatment technologies.
    The most widely used nonincineration alternative technologies are 
autoclaves, chemical treatment systems, and microwave systems. In 
autoclaves, the effects of heat from saturated steam and increased 
pressure are used to decontaminate the medical waste. In chemical 
treatment systems, an antimicrobial chemical, such as sodium 
hypochlorite, chlorine dioxide, or peracetic acid, is used to 
decontaminate the waste. In microwave technologies, medical waste is 
wetted and heated to decontaminating temperatures with microwave 
irradiation.
    Most alternative technologies are equipped with a shredder or 
grinder that is used to reduce the volume of the waste by up to 80 
percent and render the waste unrecognizable. In some alternative 
technologies, the waste is compacted, and the waste volume is reduced 
by 50 percent. With most alternative technologies, the mass of the 
waste is not reduced due to the entrainment of liquids that are added 
during treatment.
    Because shredding or grinding pathological and animal waste may 
present aesthetically unacceptable

[[Page 31754]]

results, most alternative technologies are not suitable treatment 
methods for these types of waste. Also, alternative technologies are 
usually unable to effectively treat chemotherapy, hazardous, or low-
level radioactive wastes. The total waste stream at a typical hospital 
contains less than 3 percent by weight of pathological, animal, 
chemotherapy, hazardous, and low level radioactive wastes. Facilities 
using alternative technologies usually package this portion of the 
waste and send it to a commercial disposal facility.
    The efficacy of autoclave, microwave, and other thermal treatment 
technologies depends primarily on the treatment time and temperature. 
The efficacy of chemical treatment systems depends on the treatment 
time and the chemical concentration. The most widely used criteria for 
determining the efficacy of an alternative technology in 
decontaminating the waste was developed by the State and Territorial 
Association of Alternate Treatment Technologies (STAATT). The STAATT 
criteria recommends, as a safe and satisfactory level of medical waste 
treatment, the inactivation of vegetative bacteria, fungi, lipophilic/
hydrophilic viruses, and mycobacteria at a 6 Log<INF>10 reduction or 
greater and the inactivation of Bacillus subtilis or Bacillus 
stearothermophilus at a 4 Log<INF>10 or greater. Efficacy test reports 
indicate that autoclave systems, chemical treatment systems, and 
microwave systems can meet and exceed the STAATT efficacy criteria. 
Therefore, the most widely used alternative treatment technologies seem 
to be effective methods of decontaminating medical waste.
    In most States, alternative technologies must undergo an approval 
or permitting process before they can be installed in the State. As 
long as the technology can demonstrate that it meets the State's 
efficacy requirements, which are usually similar to, if not the same 
as, the STAATT criteria, the technology can be installed, unless the 
State determines that the technology is unacceptable for some other 
reason. The State approval or permitting process usually takes less 
than a year. Many alternative technology vendors have gained approval 
of their systems in a number of States so that less time will be 
required for review of the technology by State regulatory agencies 
before the system is installed.
    There are some 20 vendors of alternative technologies (i.e. 
autoclaves, chemical treatment systems, and microwave systems) that 
have a considerable number of installations. These vendors, when 
combined, have about 150 years of experience in the medical waste 
business. Some of these vendors have more than 15 years of experience 
alone. These vendors are responsible for approximately 975 alternative 
technology installations, which range in capacity from 12 to 8,000 
pounds of medical waste treated per hour. An additional 17 alternative 
technology vendors were identified with systems that are under 
development and are expected to appear on the market in the near 
future.
    Alternative technologies seem to be available, and many vendors 
have been in the medical waste business for many years. With the number 
of vendors that have alternative technologies under development, the 
alternatives industry appears to be growing. Alternative technology 
vendors claim they will be able to meet any increased demand for onsite 
alternative systems due to switching.
    The results from reports on the air emissions from autoclaves show 
that there are some emissions of volatile organics from autoclaves. 
However, the test reports also show that the emissions of Pb, Cd, Hg, 
HCl, and PM from autoclaves are insignificant when compared to 
emissions of the same pollutants from MWI. No information on dioxin 
emissions from autoclaves was available. The available data on the air 
emissions from autoclaves shows that these emissions are more organic 
than the acid gas and metal emissions from MWI. Furthermore, it appears 
that on a pound of pollutant per pound of waste basis, far less total 
emissions are produced from treating medical waste in an autoclave than 
from burning waste in an MWI.
    No data is available on the air emissions from chemical treatment 
systems and microwave systems. However, some States require chemical 
treatment systems to obtain air permits. The emissions from microwave 
systems are likely to be similar to those from an autoclave since lower 
temperatures are used during microwaving and the only component added 
is water.
    Based on the information received, there does not appear to be any 
water pollution from the liquid effluents of autoclaves and chemical 
treatment systems and no liquid effluent from microwave treatment 
systems. The results of Toxicity Characteristics Leachate Procedure 
(TCLP) tests conducted on waste treated in an autoclave and a chemical 
treatment system were far below the regulatory threshold for metals and 
organics. Since the only component added to waste that is treated in a 
microwave system is water, the TCLP tests conducted on microwaved waste 
should produce similar results to those of autoclaved waste.
    The annualized price per pound of medical waste treatment with an 
alternative technology is comparable to the price per pound associated 
with other methods of medical waste treatment and disposal. For 
facilities that wish to treat their medical waste onsite with an 
alternative technology, but do not have the capital to purchase an 
alternative system, options for leasing or renting an alternative 
technology are available. According to alternative technology vendors, 
leasing onsite medical waste treatment technologies is a common 
practice. Most lease agreements are available either through the 
alternative vendor directly or through a third party leasing company.
    The results from a survey of hospitals that are currently using 
autoclaves, chemical treatment systems, and microwave systems indicate 
that these hospitals are pleased with the operation of their 
alternative medical waste treatment systems. The hospitals indicated 
that problems with shredder jams are rare and that odors are minimal 
with the alternative systems. The surveyed hospitals reported that the 
alternative technologies are cost effective and easy to operate. The 
hospitals also indicated that the waste treated in their alternative 
systems is readily accepted at local landfills. Further, the hospitals 
indicated that they would recommend their alternative technology as a 
method of medical waste treatment.
    The potential hazards associated with medical waste treatment arise 
primarily from the presence and handling of infectious waste. 
Therefore, the potential hazards of medical waste treatment are similar 
for operators of all medical waste treatment technologies, including 
MWI. Few, if any, additional hazards are associated with alternative 
technologies that have not already been associated with medical waste 
incineration.

III. Regulatory Options and Impacts for Existing MWI

    As discussed earlier, the MACT ``floor'' defines the least 
stringent emission guidelines the EPA may adopt for existing MWI. 
However, as also discussed earlier, the Clean Air Act requires the EPA 
to examine alternative emission guidelines (i.e., regulatory options) 
more stringent than the MACT floor. The EPA must consider the cost, 
environmental, and energy impacts of these regulatory options and 
select one that reflects the maximum reduction in

[[Page 31755]]

emissions that EPA determines is achievable (i.e., MACT).
    At proposal, the EPA concluded all existing MWI would need good 
combustion and dry scrubbers to meet the MACT floors for CO, PM, and 
HCl. Consequently, EPA was left to consider only two regulatory options 
for MACT. The first regulatory option reflected the floor (i.e., 
emission limitations achievable with good combustion and dry 
scrubbers). The second reflected emission limitations achievable with 
good combustion and dry scrubbers with activated carbon injection. 
Based on the cost, environmental, and energy impacts of the second 
regulatory option relative to the first option, EPA selected the second 
option as MACT. Consequently, EPA proposed emission guidelines for 
existing MWI based on the use of good combustion and dry scrubbers with 
activated carbon injection.
    As discussed earlier in this notice, EPA received numerous comments 
containing substantial new information following proposal. Based on 
this information, new conclusions concerning the MWI inventory, MWI 
subcategories, performance of emission control technologies, MACT 
floors, and monitoring and testing options have been reached. As a 
result, EPA now believes there are several new regulatory options that 
merit consideration in selecting MACT for existing MWI. The following 
sections summarize these new regulatory options and the EPA's initial 
assessment of their merits.

A. Regulatory Options

    As discussed earlier, new MACT floor emission levels were developed 
for small, medium, and large MWI. To assess the impacts of regulatory 
options, EPA must first consider what emission control technology(s) 
existing MWI may need to meet regulations based on these floor emission 
limits. The floor for small existing MWI appears to require good 
combustion; add-on wet scrubbing systems would not be necessary to meet 
the MACT floor. For medium existing MWI, the MACT floor appears to 
require good combustion and a moderate efficiency wet scrubber. The 
MACT floor for large existing MWI appears to require good combustion 
and a high efficiency wet scrubber.
    Having identified these control technologies, the EPA is now able 
to review the performance capabilities of other emission control 
technologies and identify those that are capable of achieving even 
greater emission reductions. This review enables EPA to identify 
regulatory options more stringent than the floor that could be selected 
as MACT.
    For small existing MWI, as mentioned above, good combustion is the 
emission control technology most MWI would probably need to meet the 
MACT floor emission levels. Therefore, this technology serves as the 
basis for the first regulatory option for the MACT emission guidelines 
for small existing MWI. Based on the performance capabilities of 
various emission control technologies, however, using low efficiency 
wet scrubbing systems in addition to good combustion could achieve 
greater emission reductions. This combination would achieve further 
emission reductions in PM and dioxins, as well as HCl, Pb, Hg, and Cd. 
Therefore, these controls used together are a possible option beyond 
the MACT floor emission levels for small existing MWI.
    As discussed earlier in Section II.B., the availability of 
alternatives for the treatment and disposal of medical waste is 
generally more limited in rural areas than in urban areas. Therefore, 
the potential impact of MACT regulations on small existing MWI may be 
greater in rural than in urban areas. This concern was expressed in 
many comments EPA received following proposal. As also discussed 
earlier in Section II.B., section 129 of the Clean Air Act permits EPA 
to subcategorize the MACT emission guidelines by class, consequently, 
subcategorizing small existing MWI into rural and urban classes was 
examined. In terms of the MACT floor emission limits, however, 
subcategorizing small existing MWI into rural and urban classes made no 
difference--the MACT floor emission limits are the same. As a result, 
for purposes of the MACT floor, there is no merit to subcategorizing 
small existing MWI into rural and urban classes.
    Although subcategorizing based on location was rejected for 
purposes of the MACT floor, it was considered again in identifying 
regulatory options more stringent than the MACT floor. Thus, the 
regulatory option of MACT emission guidelines for small existing MWI 
based on the use of good combustion and low efficiency wet scrubbing 
systems was subdivided to create two options. The first regulatory 
option beyond the MACT floor is to base the MACT guidelines for small 
existing MWI located in rural areas on good combustion only, as 
required by the MACT floor, but to base MACT guidelines for small 
existing MWI located in urban areas on good combustion and low 
efficiency wet scrubbing systems. If this option were selected as the 
basis for the final MACT emission guidelines, the emission limits for 
small existing MWI located in rural areas would be different than the 
emission limits for small existing MWI located in urban areas.
    As discussed in Section II.B., location, by itself, is not a valid 
criterion for subcategorization under the Clean Air Act. In addition, 
use of location as surrogate measure of the availability of technology 
may not be a valid criterion for subcategorization either. There may be 
statutory limitations to this approach. As a result, the previous 
discussion regarding differences in regulatory requirements based on 
the location of an MWI may not be allowed under the Clean Air Act, and 
EPA specifically requests comment on the validity of this approach. As 
discussed later in Section V., one of the options EPA is considering 
would reflect good combustion and wet scrubbers on all small existing 
MWI except where an individual MWI could meet certain ``criteria,'' in 
which case the individual MWI would be subject to emission limits based 
on good combustion alone. Consequently, in addition to seeking comment 
on the validity of identifying urban and rural MWI as separate 
``classes,'' EPA also requests comment on other criteria that could be 
used to make distinctions in regulatory requirements.
    A third regulatory option is MACT emission guidelines for small 
existing MWI located in both rural and urban areas based on good 
combustion and low efficiency wet scrubbing systems. In other words, no 
difference in the MACT emission limits between small existing MWI 
located in rural or urban areas would exist. This third option would 
achieve greater emission reductions than the second option.
    Beyond these three regulatory options (i.e., the MACT floor option 
and the two options more stringent than the floor), a review of the 
performance capabilities of various emission control technologies 
readily identifies a fourth regulatory option for small existing MWI. 
This regulatory option is to base the MACT emission guidelines for 
small existing MWI on the use of good combustion and moderate 
efficiency wet scrubbing systems. This regulatory option would further 
reduce PM emissions, however, it would not achieve further reductions 
in emissions of other pollutants. As summarized earlier, moderate and 
high efficiency wet scrubbing systems do not appear to achieve greater 
emission reductions of dioxins, acid gases (e.g., HCl), or the metals 
(i.e., Hg, Pb, or Cd) than low efficiency wet scrubbing systems.

[[Page 31756]]

    Option 4 could also be subdivided into two options: (1) MACT 
emission guidelines for small existing MWI in rural areas based on good 
combustion and low efficiency wet scrubbing systems; and MACT 
guidelines for small existing MWI in urban areas based on good 
combustion and moderate efficiency wet scrubbing systems and (2) MACT 
emission guidelines for small existing MWI in both rural and urban 
areas based on good combustion and moderate efficiency wet scrubbing 
systems. However, the cost difference between using a low efficiency 
wet scrubbing system or a moderate efficiency wet scrubbing system is 
not as great as that between using a low efficiency wet scrubbing 
system or not using a wet scrubbing system at all. Consequently, at 
this point, to limit the number of regulatory options under 
consideration, the EPA has chosen not to further subdivide this 
regulatory option.
    Reviewing the performance capabilities of emission control 
technologies identifies a fifth regulatory option for small existing 
MWI. This option is to base the MACT emission guidelines for small 
existing MWI on the use of good combustion and high efficiency wet 
scrubbing systems. This would further reduce PM emissions, but as 
outlined above, would not further reduce emissions of other air 
pollutants such as dioxins, acid gases (e.g., HCl), or the metals 
(i.e., Pb, Hg, Cd).
    A sixth regulatory option for small existing MWI also is apparent. 
This option is to base the MACT emission guidelines for small existing 
MWI on the use of good combustion and dry scrubbing systems with 
activated carbon injection. This possibility would further reduce 
emissions of Pb, Cd, and dioxins, but would not further reduce 
emissions of other air pollutants. Dry scrubbing systems, however, 
generally cost about one and a half times what high-efficiency wet 
scrubbing systems cost to operate annually, and the overall difference 
in the emissions control performance between the two systems is 
relatively small. Therefore, at this point, to limit the total number 
of regulatory options under consideration, the EPA has chosen not to 
include this sixth regulatory option for small existing MWI.
    For medium existing MWI, as discussed earlier, the use of good 
combustion and moderate efficiency wet scrubbing systems appears to be 
necessary to meet the MACT floor emission limits. This option, 
therefore, is the first regulatory option for medium existing MWI. The 
second regulatory option is to base the emission guidelines on good 
combustion and high efficiency wet scrubbing systems.
    Finally, for large existing MWI, as discussed earlier, the use of 
good combustion and high efficiency wet scrubbing systems appears to be 
necessary to meet the MACT floor emission limits. Thus, the EPA is not 
inclined at this point to consider other regulatory options for large 
existing MWI.
    As mentioned above, a review of the performance capabilities of 
emission control technologies indicates that dry scrubbing systems can 
reduce emissions of some pollutants (i.e., Pb, Cd, and dioxins) greater 
than high-efficiency wet scrubbing systems. Additional regulatory 
options for both medium and large existing MWI could be structured, 
therefore, around the use of dry scrubbing systems. However, as also 
mentioned above, the cost of these systems is much higher than that of 
high-efficiency wet scrubbing systems and the overall difference in 
emission control performance is relatively small. For existing MWI 
already equipped with wet scrubbers, replacing a wet scrubber with a 
dry scrubber would be exorbitantly expensive. As a result, at this 
point, the EPA has chosen not to develop additional regulatory options 
for medium and large existing MWI based on the use of dry scrubbing 
systems to keep the total number of regulatory options under 
consideration to a manageable number.
    The regulatory options outlined above are compiled in Table 13. 
This table summarizes the technology basis for the regulatory options 
for the various MACT emission guidelines the EPA believes merit 
consideration as MACT for existing MWI. This table is constructed only 
to organize and structure an analysis of the cost, environmental, and 
energy impacts associated with the various MACT emission guidelines in 
order to consider these impacts in selecting MACT for existing MWI. In 
reviewing this table, therefore, there are several important points to 
keep in mind.

                            Table 13.--Level of Air Pollution Control Associated With Each Regulatory Option for Existing MWI                           
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                    Regulatory options                                                  
            MWI size             -----------------------------------------------------------------------------------------------------------------------
                                           1                   2                   3                   4                   5                   6        
--------------------------------------------------------------------------------------------------------------------------------------------------------
Small <ls-thn-eq>200 lb/hr......  Good combustion...  Good combustion on  Good combustion     Good combustion     Good combustion     Good combustion   
                                                       rural; Good         and low             and moderate        and moderate        and high         
                                                       combustion and      efficiency wet      efficiency wet      efficiency wet      efficiency wet   
                                                       low efficiency      scrubber.           scrubber.           scrubber.           scrubber.        
                                                       wet scrubber on                                                                                  
                                                       urban.                                                                                           
Medium 201-500 lb/hr............  Good combustion     Good combustion     Good combustion     Good combustion     Good combustion     Good combustion   
                                   and moderate        and moderate        and moderate        and moderate        and high            and high         
                                   efficiency wet      efficiency wet      efficiency wet      efficiency wet      efficiency wet      efficiency wet   
                                   scrubber.           scrubber.           scubber.            scrubber.           scrubber.           scrubber.        
Large 500 lb/hr.................  Good combustion     Good combustion     Good combustion     Good combustion     Good combustion     Good combustion   
                                   and high            and high            and high            and high            and high            and high         
                                   efficiency wet      efficiency wet      efficiency wet      efficiency wet      efficiency wet      efficiency wet   
                                   scrubber.           scrubber.           scubber.            scrubber.           scrubber.           scrubber.        
--------------------------------------------------------------------------------------------------------------------------------------------------------

    First, the MACT emission guidelines for existing MWI will not 
include requirements to use a specific emission control system or 
technology; the MACT emission guidelines will only include emission 
limits, which may be met by any means or by using any control system or 
technology the owner or operator of the MWI decides to use to meet 
these emission limits. Second, to the extent possible (i.e., within the 
constraints imposed by Section 129 of the Clean Air Act), the EPA plans 
to adopt emission limits in the MACT emission guidelines that can be 
met through the use of several emission control systems or 
technologies. Consequently, where not constrained by

[[Page 31757]]

the Clean Air Act, the actual emission limits associated with some of 
the regulatory options shown in Table 13 have been selected at a level 
designed to encourage or permit the use of both wet and dry scrubbing 
control systems, as outlined below.
    The emission limits associated with each of the regulatory options 
for small, medium, and large existing MWI are presented in Table 14.

                                        Table 14.--Emission Limitations Associated With Each Regulatory Option for Small, Medium, and Large Existing MWI                                        
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                    Regulatory                                                                                                                                                  
        Pollutant, units              options       Small MWI's      Medium MWI's       Large MWI's                                                                                             
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                           1       2 (rural)      2 (urban)........  3................  4 and 5.........  6...............  1-4.............  5 and 6.........  1-6             
                                                                                                                                                                                                
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
PM, gr/dscf.....................           0.086           0.086  0.05.............  0.05.............  0.03............  0.015...........  0.03............  0.015...........  0.015.          
CO, ppmdv.......................          40              40      40...............  40...............  40..............  40..............  40..............  40..............  40.             
CDD/CDF, ng/dscm................         800             800      125..............  125..............  125.............  125.............  125.............  125.............  125.            
TEQ CDD/CDF, ng/dscm............          15              15      2.3..............  2.3..............  2.3.............  2.3.............  2.3.............  2.3.............  2.3.            
HCI, ppmdv......................       3,100           3,100      100 or 93%.......  100 or 93%.......  100 or 93%......  100 or 93%......  100 or 93%......  100 or 93%......  100 or 93%.     
SO<INF>2, ppmdv......................          55              55      55...............  55...............  55..............  55..............  55..............  55..............  55.             
NO<INF>x, ppmdv......................         250             250      250..............  250..............  250.............  250.............  250.............  250.............  250.            
Pb, mg/dscm.....................          10              10      1.2 or 70%.......  1.2 or 70%.......  1.2 or 70%......  1.2 or 70%......  1.2 or 70%......  1.2 or 70%......  1.2 or 70%.     
Cd, mg/dscm.....................           4               4      0.16 or 65%......  0.16 or 65%......  0.16 or 65%.....  0.16 or 65%.....  0.16 or 65%.....  0.16 or 65%.....  0.16 or 65%.    
HG, mg/dscm.....................           7.5             7.5    0.55 or 85%......  0.55 or 85%......  0.55 or 85%.....  0.55 or 85%.....  0.55 or 85%.....  0.55 or 85%.....  0.55 or 85%.    
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    Regulatory Option 1 in Table 14 reflects the performance of the 
emission control system or technology needed to meet the MACT floor. 
For small existing MWI, Regulatory Option 1 reflects emission limits 
based on good combustion. For medium existing MWI, Regulatory Option 1 
reflects emission limits based on good combustion and moderate 
efficiency wet scrubbers, except for HCl (discussed below). For large 
existing MWI, Regulatory Option 1 reflects emission limits based on 
good combustion and high efficiency wet scrubbers, except for HCl 
(discussed below).
    Dry scrubbers with activated carbon injection can achieve the 
emission limits associated with moderate or high efficiency wet 
scrubbers, with the exception of HCl. While dry scrubbers cannot reduce 
HCl emissions to the same levels as wet scrubbers, dry scrubbers can 
achieve the MACT floor emission level for HCl. Consequently, Regulatory 
Option 1 reflects the HCl emission limit achievable with a dry scrubber 
for both medium and large existing MWI. Both technologies (wet or dry 
scrubber) are capable of achieving the emission limits shown for 
Regulatory Option 1.
    Regulatory Option 2 is the same as Regulatory Option 1 for medium 
and large existing MWI. Small existing MWI located in urban areas would 
be required to meet emission limits associated with good combustion and 
low efficiency wet scrubbers. Small existing MWI located in rural areas 
would remain subject to the same emission limits as Regulatory Option 1 
(based on good combustion). Regulatory Option 3 would establish 
emission limits for all small existing MWI (urban and rural) based on 
good combustion and low efficiency wet scrubbers. Regulatory Option 4 
would establish emission limits for all small existing MWI based on 
good combustion and moderate efficiency wet scrubbers. Requirements for 
medium and large existing MWI would remain the same under Regulatory 
Options 1, 2, 3, and 4. As discussed above, HCl emission limits in all 
cases would allow the use of dry scrubbers.
    Regulatory Option 5 would establish emission limits for small 
existing MWI based on good combustion and moderate efficiency wet 
scrubbers; medium existing MWI based on good combustion and high 
efficiency wet scrubbers; and large existing MWI based on good 
combustion and high efficiency wet scrubbers. The sixth and final 
regulatory option would require all existing MWI to meet emission 
limitations associated with good combustion and high efficiency wet 
scrubbers. As discussed above, the HCl emission limit under Regulatory 
Options 5 and 6 would allow the use of dry scrubbing systems.

B. National Environmental and Cost Impacts

    This section presents a summary of the air, water, solid waste, 
energy, and cost impacts of the six regulatory options described above 
for existing MWI. Economic impacts are discussed in Section III.C. All 
impacts are nationwide impacts resulting from the implementation of the 
emission guidelines on existing MWI.
1. Analytical Approach
    As discussed at proposal and within this notice, healthcare 
facilities may choose from among a number of alternatives for treatment 
and disposal of their medical wastes; however, these alternatives are 
generally more limited for healthcare facilities located in rural areas 
than for those in urban areas. In fact, as stated at proposal, most 
estimates are that less than half of hospitals today currently operate 
onsite medical waste incinerators. The clear trend over the past 
several years has been for more and more hospitals to turn to the use 
of alternative onsite medical waste treatment technologies or 
commercial offsite treatment and disposal services. Consequently, even 
fewer hospitals are now likely to operate onsite medical waste 
incinerators.
    More than half of existing hospitals today, therefore, have chosen 
to use other means of treatment and disposal of their medical waste 
than operation of an onsite incinerator. This is a clear

[[Page 31758]]

indication that alternatives to the use of onsite incinerators exist 
and that they are readily available in many cases. (Although as 
mentioned above, these alternatives--particularly the availability and 
competitive cost of offsite commercial treatment and disposal 
services--tend to be more limited in rural areas than in urban areas). 
For other healthcare facilities, such as nursing homes, outpatient 
clinics, doctors and dentists offices, etc., only very few facilities 
currently operate onsite medical waste incinerators. Therefore, for 
these types of healthcare facilities, the percentage of such facilities 
using alternative means of treatment and disposal of medical waste--
particularly commercial treatment and disposal services--is much 
higher, probably higher than 95 percent. This high percentage is 
further confirmation of the availability of alternatives to onsite 
incinerators for the treatment and disposal of medical waste.
    A very likely reaction and outcome associated with the adoption of 
MACT emission guidelines for existing MWI, therefore, is an increase in 
the use of these alternatives by healthcare facilities for treatment 
and disposal of medical waste. The EPA's objective is not to encourage 
the use of alternatives or to discourage the continued use of onsite 
medical waste incinerators; the EPA's objective is to adopt MACT 
emission guidelines for existing MWI that fulfill the requirements of 
Section 129 of the Clean Air Act. In doing so, however, one outcome 
associated with adoption of these MACT emission guidelines is likely to 
be an increase in the use of alternatives and a decrease in the 
continued use of onsite medical waste incinerators. Consequently, EPA 
should acknowledge and incorporate this outcome into the analyses of 
the cost, environmental, and energy impacts associated with the MACT 
emission guidelines.
    In these analyses of the cost, environmental, and energy impacts, 
the selection of an alternative form of medical waste treatment and 
disposal by a healthcare facility, rather than the operation of an 
onsite medical waste incinerator and purchase the emission control 
technology necessary to meet the MACT emission limits, is referred to 
as ``switching''. Switching was incorporated in the analyses at 
proposal and was the basis for the conclusion at proposal that adoption 
of the proposed MACT emission guidelines could lead to as many as 80 
percent of healthcare facilities with MWI to choose an alternative 
means of medical waste treatment and disposal over continued operation 
of their MWI. Although switching was not EPA's objective, it was a 
potential outcome of the regulations that EPA believed should be 
acknowledged, considered, and discussed at proposal.
    Switching has also been incorporated into the new analyses of the 
cost, environmental, and energy impacts associated with the six new 
regulatory options. The new analyses, however, incorporate three 
scenarios; one scenario that ignores switching and two scenarios that 
consider switching. Scenario A assumes that each existing MWI remains 
in operation and complies with the appropriate regulatory option (i.e., 
no switching). This scenario results in the highest costs because it 
assumes no existing MWI will switch to a less expensive waste disposal 
method. This scenario is clearly unrealistic and grossly overstates the 
national costs associated with MACT emission guidelines. It should not 
be viewed as representative or even close to representative of the 
impacts associated with the MACT emission guidelines. This scenario is 
so misleading that the EPA considered not including it in the analysis; 
some may take it out of context and use it as representative, when it 
is in no way representative of the impacts of the MACT emission 
guidelines. The EPA finally decided to include this scenario in the 
analysis only because some may ask ``what if * * *?'' and the EPA 
wanted to be in a position to answer such questions.
    Switching Scenarios B and C are much more realistic and more 
representative of the cost, environmental, and energy impacts 
associated with the MACT emission guidelines for existing MWI. Only 
these scenarios merit serious review and consideration in gauging the 
potential impacts associated with the MACT emission guidelines. Both 
Scenarios B and C assume switching occurs when the cost associated with 
purchasing and installing the air pollution control technology or 
system necessary to comply with the MACT emission guideline (i.e., a 
regulatory option) is greater than the cost of choosing an alternative 
means of treatment and disposal.
    The difference in Scenarios B and C is the assumption of how much 
separation of the medical waste stream into an infectious medical waste 
stream and a noninfectious medical waste stream currently occurs at 
healthcare facilities that today operate a medical waste incinerator. 
Some have stated that, for the most part, hospitals that are currently 
operating onsite medical waste incinerators practice little separation 
of medical waste into infectious and noninfectious waste; generally all 
the waste at the facility is incinerated.
    Based on estimates in the literature that only 10 to 15 percent of 
medical waste is potentially infectious and the remaining 85 to 90 
percent is noninfectious, Scenario B assumes that only 15 percent of 
the waste currently being burned at a healthcare facility operating an 
onsite medical waste incinerator is potentially infectious medical 
waste. The 85 percent noninfectious waste is municipal waste that needs 
no special handling, treatment, transportation, or disposal. It can be 
sent to a municipal landfill or municipal combustor for disposal. Thus, 
under Scenario B, when choosing an alternative to continued operation 
of an onsite medical waste incinerator, in response to adoption of MACT 
emission guidelines, a healthcare facility need only choose an 
alternative form of medical waste treatment and disposal for 15 percent 
of the waste stream currently burned onsite and may send the remaining 
85 percent to a municipal landfill. In other words, if a hospital is 
burning 100 pounds of waste, Scenario B assumes 85 pounds are 
noninfectious and 15 pounds are potentially infectious. This scenario 
results in the lowest costs because 85 percent of the waste is disposed 
at the relatively inexpensive cost of municipal waste disposal.
    On the other hand, it is unlikely that all healthcare facilities 
that currently operate an MWI will be able to or will decide to 
segregate the waste stream currently being burned in their incinerator. 
If a hospital is already separating medical waste into infectious and 
noninfectious waste streams, for example, this hospital would be unable 
to separate the waste stream any further. In other words, if a hospital 
is burning 100 pounds of waste, Scenario C assumes all 100 pounds are 
potentially infectious. Scenario C, therefore, assumes that all medical 
waste being burned at a healthcare facility currently operating a 
medical waste incinerator is potentially infectious medical waste and 
must be treated and disposed of accordingly. As a result, Scenario C 
leads to higher costs than Scenario B.
    For the purposes of determining impacts of the emission guidelines 
under switching Scenarios B and C, the MWI inventory was separated into 
commercial (offsite) incinerators and onsite incinerators used to burn 
healthcare waste. The commercial incinerators were not subjected to the 
switching analyses under Scenarios B and C because switching to an

[[Page 31759]]

alternative method of waste disposal (e.g., commercial disposal) is not 
feasible for commercial facilities. An assumption was made that 
commercial facilities would add on the control associated with the 
emission guidelines. Only the onsite MWI in the inventory were subject 
to the switching analyses under Scenarios B and C.
    Scenarios B and C represent the likely range of impacts associated 
with the MACT emission guidelines for existing MWI. The actual impacts 
of a MACT emission guideline (i.e., a regulatory option) is most likely 
to fall somewhere within the range represented by Scenarios B and C.
2. Air Impacts
    As outlined above, the impacts associated with six MACT emission 
guidelines or regulatory options, under three scenarios reflecting 
switching, have been assessed. Baseline emissions (i.e., emissions 
today in the absence of adoption of the MACT emission guidelines) and 
emissions under each MACT emission guideline or regulatory option are 
summarized in Tables 15, 16, and 17. Emissions under Scenario A (no 
switching) are summarized in Table 15; emissions under Scenario B 
(switching with waste separation) are summarized in Table 16; and 
emissions under Scenario C (switching without waste separation) are 
summarized in Table 17.

      Table 15.--Baseline Emissions Compared With Emissions After Implementation of the Emission Guidelines     
                                                  [Scenario A]                                                  
                                                 [Metric Units]                                                 
----------------------------------------------------------------------------------------------------------------
                                                                    Regulatory options                          
      Pollutant, units         Baseline  -----------------------------------------------------------------------
                                               1           2           3           4           5           6    
----------------------------------------------------------------------------------------------------------------
PM, Mg/yr...................      940         190         160         140         120         110         100   
CO, Mg/yr...................      460         120         120         120         120         120         120   
CDD/CDF, g/yr...............    7,200         420         360         300         300         300         300   
TEQ CDD/CDF, g/yr...........      150           9.4         8.2         7.1         7.1         7.1         7.1 
HCl, Mg/yr..................    5,700         880         490          86          86          86          86   
SO<INF>2 Mg/yr...................      250         250         250         250         250         250         250   
NO<INF>X, Mg/yr..................    1,200       1,200       1,200       1,200       1,200       1,200       1,200   
Pb, Mg/yr...................       11           3.3         2.7         2.1         2.1         2.1         2.1 
Cd, Mg/yr...................        1.2         0.42        0.36        0.29        0.29        0.29        0.29
Hg, Mg/yr...................       15           1.4         1.2         1.1         1.1         1.1         1.1 
----------------------------------------------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1. To convert g/yr to lb/yr, divide by 453.6                          


      Table 16.--Baseline Emissions Compared with Emissions After Implementation of the Emission Guidelines     
                                                  [Scenario B]                                                  
                                                 [Metric Units]                                                 
----------------------------------------------------------------------------------------------------------------
                                                                    Regulatory options                          
      Pollutant, units         Baseline  -----------------------------------------------------------------------
                                               1           2           3           4           5           6    
----------------------------------------------------------------------------------------------------------------
PM, Mg/yr...................      940          91          78          67          67          65          65   
CO, Mg/yr...................      460          83          83          82          82          81          81   
CDD/CDF, g/yr...............    7,200         240         220         210         210         200         200   
TEQ CDD/CDF, g/yr...........      150           5.5         5.1         4.8         4.8         4.7         4.7 
HCl, Mg/yr..................    5,700         310         180          77          77          77          77   
SO<INF>2, Mg/yr..................      250         180         170         170         170         170         170   
NO<INF>X, Mg/yr..................    1,200         830         820         810         810         810         810   
Pb, Mg/yr...................       11           1.7         1.5         1.3         1.3         1.3         1.3 
Cd, Mg/yr...................        1.2         0.23        0.20        0.18        0.18        0.18        0.18
Hg, Mg/yr...................       15           0.87        0.81        0.76        0.76        0.75        0.75
----------------------------------------------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1. To convert g/yr to lb/yr, divide by 453.6                          


      Table 17.--Baseline Emissions Compared With Emissions After Implementation of the Emission Guidelines     
                                                  [Scenario C]                                                  
                                                 [Metric Units]                                                 
----------------------------------------------------------------------------------------------------------------
                                                                    Regulatory options                          
      Pollutant, units         Baseline  -----------------------------------------------------------------------
                                               1           2           3           4           5           6    
----------------------------------------------------------------------------------------------------------------
PM, Mg/yr...................      940         170         140         110         110         100         100   
CO, Mg/yr...................      460         120         120         120         120         120         120   
CDD/CDF, g/yr...............    7,200         400         350         300         300         300         300   
TEQ CDD/CDF, g/yr...........      150           9.0         8.0         7.1         7.1         7.1         7.1 
HCl, Mg/yr..................    5,700         740         410          86          86          86          86   
SO<INF>2, Mg/yr..................      250         250         250         250         250         250         250   
NO<INF>X, Mg/yr..................    1,200       1,200       1,200       1,200       1,200       1,200       1,200   
Pb, Mg/yr...................       11           3.1         2.6         2.1         2.1         2.1         2.1 
Cd, Mg/yr...................        1.2         0.40        0.34        0.29        0.29        0.29        0.29
Hg, Mg/yr...................       15           1.3         1.2         1.1         1.1         1.1         1.1 
----------------------------------------------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1. To convert g/yr to lb/yr, divide by 453.6.                         


[[Page 31760]]


    As discussed in previous sections, new information has led to new 
conclusions about the MWI inventory, performance of technology, and 
control levels associated with each existing MWI. As a result, revised 
estimates of annual baseline emissions and emissions under each 
regulatory option are significantly lower than estimates developed at 
proposal. There are two primary reasons for the lower emission 
estimates. First, existing MWI are equipped with better emission 
control than was assumed at proposal. Second, many more MWI were 
assumed to exist at proposal than in the current inventory.
3. Water and Solid Waste Impacts
    Estimates of wastewater impacts were developed for only Regulatory 
Option 6, Scenario A, which reflects all existing MWI equipped with wet 
scrubbers in the absence of switching. Assessing these impacts under 
Scenario A without any consideration of the effect of switching grossly 
overstates the magnitude of these impacts. Under Scenarios B and C more 
than half of the existing MWI are expected to switch, resulting in 
significantly lower impacts. This approach of estimating and 
summarizing impacts under Scenario A, at this point, was taken as a 
matter of expediency to share new information and provide an 
opportunity for public comment.
    Under Scenario A and Regulatory Option 6, 198 million gallons of 
additional wastewater would be generated annually by existing MWI as a 
result of the MACT emission guideline. This amount is the equivalent of 
wastewater produced annually by four large hospitals. Therefore, when 
considering the wastewater produced annually at healthcare facilities 
nationwide, the increase in wastewater resulting from the 
implementation of the MACT emission guidelines for existing MWI is 
insignificant.
    With regard to solid waste impacts, about 767 million Mg (846 
million tons) of medical waste are burned annually in existing MWI 
producing about 76,700 Mg/yr (84,600 tons/yr) of solid waste (bottom 
ash) disposed of in landfills. To estimate the solid waste impacts for 
the MACT emission guidelines, impacts were developed only for 
Regulatory Option 6, Scenario B. This option is associated with the 
most switching and the most separation of waste for disposal in 
municipal landfills and, thus, produces the greatest estimated impact.
    Under Regulatory Option 6, Scenario B, 210,000 Mg/yr (231,000 tons/
yr) of additional solid waste would result from the adoption of the 
MACT emission guideline. Compared to municipal waste, which is disposed 
in landfills at an annual rate of over 91 million Mg/yr (100 million 
tons/yr), this increase from the implementation of the MACT emission 
guideline for existing MWI is insignificant.
4. Energy Impacts
    The emission control technologies used by existing MWI to comply 
with the MACT emission limits consume energy. Estimates of energy 
impact were developed for Regulatory Option 6, Scenario A. Under 
Scenarios B and C, which include switching, it is not clear whether 
overall national energy consumption would increase, decrease, or remain 
the same. Alternatives to incineration require energy to operate, 
however, information is not available to estimate whether these 
alternatives use more or less energy than MWI.
    The energy impacts associated with the MACT emission guidelines 
could include additional auxiliary fuel (natural gas) for combustion 
controls and additional electrical energy for operation of the add-on 
control devices, such as wet scrubbers and dry scrubbers. Regulatory 
Option 6, Scenario A, could increase total national usage of natural 
gas for combustion controls by about 16.6 million cubic meters per year 
(MMm\3\/yr) (586 million cubic feet per year [10\6\ ft\3\/yr]). Total 
national usage of electrical energy for the operation of add-on control 
devices could increase by about 259,000 megawatt hours per year (MW-hr/
yr) (883 billion British thermal units per year [10\9\ Btu/yr]). Once 
again, compared to the amount of energy used by healthcare facilities 
such as hospitals (approximately 2,460 MMm\3\/yr of natural gas and 
23.2 million MW-hr/yr of electricity) the increase in energy usage that 
results from implementation of the MACT emission guideline for existing 
MWI is insignificant.
5. Cost Impacts
    The cost impacts on individual healthcare facilities that currently 
operate an MWI vary depending on the MACT emission guideline or 
regulatory option; the actual cost to purchase and install any 
additional air pollution control equipment; the cost of alternative 
means of treatment and disposal where they are located; and other 
factors, such as liability issues related to disposal and State and 
local medical waste treatment and disposal requirements. In general, 
facilities with smaller MWI will have a greater incentive to use 
alternative means of treatment and disposal because their onsite 
incineration cost (per pound of waste burned) will be higher.
    Large healthcare facilities with larger amounts of waste to be 
treated or healthcare facilities that serve as regional treatment 
centers for waste generated at other healthcare facilities in the area 
may have some cost advantages compared to smaller facilities. Due to 
economies of scale, their cost of burning waste may be lower (i.e., 
dollars per pound burned), and they may have already installed some air 
pollution control equipment. These facilities may only have to upgrade 
this equipment to comply with the MACT emission guideline rather than 
purchase and install a complete air pollution control system.
    Table 18 contains the estimated increase in national annual costs 
associated with each of the MACT emission guidelines or regulatory 
options under Scenario A (no switching), Scenario B (switching with 
separation of waste), and Scenario C (switching with no separation of 
waste). As discussed earlier, Scenario A is unrealistic and grossly 
overstates the national cost impacts. The costs associated with the 
MACT emission guidelines under Scenarios B and C represent the likely 
range of national cost impacts, and only these costs merit serious 
consideration and review.

          Table 18.--Costs of the Regulatory Options of the Emission Guidelines [Scenarios A, B, and C]         
                                                 [Million $year]                                                
----------------------------------------------------------------------------------------------------------------
                                                                          Regulatory options                    
                      Scenario                       -----------------------------------------------------------
                                                          1         2         3         4         5         6   
----------------------------------------------------------------------------------------------------------------
A...................................................    120       145       173       181       190       201   
B...................................................     57.0      57.1      57.4      57.4      57.7      57.7 
C...................................................    108       113       118       119       122       123   
----------------------------------------------------------------------------------------------------------------


[[Page 31761]]


    The nationwide annual costs presented in Table 18, excluding 
Scenario A, range from $57 million/yr for Regulatory Option 1 and 
Scenario B to $123 million/yr for Regulatory Option 6 and Scenario C. 
These nationwide annual costs are significantly lower than the $351 
million/yr estimated for the proposed emission guidelines. The primary 
reason for the difference in the proposed and the current nationwide 
annual cost estimates is the greater level of emissions control found 
at existing MWI than was assumed at proposal. The costs of upgrading 
from the current level of control now known to be on existing MWI are 
far less than the costs of upgrading from the mere \1/4\ sec combustion 
controls assumed to be on most MWI at proposal. Also, the annual cost 
of the MACT emission levels discussed in this notice is significantly 
less than the proposed MACT emission level (DI/FF with activated 
carbon). Another reason for the difference is that the number of MWI 
assumed to exist at proposal was much greater than the number of MWI in 
the current inventory. For example, the cost estimates at proposal were 
based on an estimated 3,700 MWI; currently, there are approximately 
2,400 MWI in the inventory.

C. Economic Impacts

    Section III.B.1 described assumptions pertaining to three analysis 
scenarios: no switching, switching with waste segregation, and 
switching with no waste segregation. Section III.B.5 presented annual 
cost estimates that have been developed for each of the six regulatory 
options. This section incorporates these assumptions and cost data to 
estimate potential economic impacts that might result from 
implementation of these regulatory options.
    The goal of the economic impact analysis is to estimate the market 
response of affected industries to the emission guidelines and to 
identify any adverse impacts that may occur as a result of the 
regulation. Industries that operate onsite waste incinerators 
(hospitals, nursing homes, research labs, and commercial waste 
incinerators) and those that utilize offsite medical waste incinerators 
(hospitals, nursing homes, medical/dental laboratories, funeral homes, 
physicians' offices, dentist offices, outpatient care, freestanding 
blood banks, fire and rescue operations, and correctional facilities) 
will potentially be affected by the regulation. Industrywide impacts, 
including changes in market price, output or production, revenues, and 
employment for the affected industries are estimated for each 
regulatory option assuming the three switching scenarios. Facility-
specific impacts are estimated for hospitals of varying sizes, 
ownerships, and operating characteristics; nursing homes; commercial 
research labs; and commercial waste incineration based on engineering 
model plant cost estimates under each of the three switching scenarios.
1. Analytical Approach
    The analytical approach to estimate industrywide and facility 
specific economic impacts and evaluate the economic feasibility of 
switching are briefly described. For a more detailed description refer 
to docket item IV-A-8. Prices are stated at 1993 levels.
    The average price changes anticipated to occur in each industry 
sector for each of the regulatory options are estimated by comparing 
the annual control cost estimates to annual revenues for each affected 
industry. This calculation provides an indication of the magnitude of a 
price change that would occur for each industry sector to fully recover 
its annual control costs. The resulting cost-to-revenue ratio 
represents the price increase necessary on average for firms in the 
industry to recover the increased cost of environmental controls. 
Percent changes in output or production are estimated using the price 
impact estimate and a high and low estimate of the price elasticity of 
demand. Resulting changes in revenues are estimated based upon the 
estimated changes in price and output for an industry. Employment or 
labor market impacts result from decreases in the output for an 
industry and are assumed to be proportional to the estimated decrease 
in output for each industry.
    Facility-specific economic impacts are estimated by using model 
plant information under the three switching scenarios. The assumption 
of no switching (Scenario A) represents the highest cost and economic 
impact scenario for most affected industries, while the assumption of 
switching with waste segregation (Scenario B) represents the lowest 
cost and economic impact scenario for most of the affected industries. 
As previously stated, EPA considers Scenario A to be an unlikely 
scenario; therefore, the economic impacts presented under Scenarios B 
and C should be regarded as the impacts most likely to occur.
2. Industry-Wide Economic Impacts
    Industry-wide impacts include estimates of the change in market 
price for the services provided by the affected industries, the change 
in market output or production, the change in industry revenue, and the 
impact on affected labor markets in terms of full time equivalent 
workers lost. These impacts are summarized in Tables 19 and 20.

     Table 19.--Medical Waste Incineration Industry-Wide Price Impacts--Existing Sources Percent Increase <SUP>a     
                                                  [In percent]                                                  
----------------------------------------------------------------------------------------------------------------
                                                                         Range for regulatory options 1-6       
                                                                 -----------------------------------------------
                                                                                    Scenario B      Scenario C  
                            Industry                              Scenario A  No  Switching with  Switching with
                                                                     switching         waste         no waste   
                                                                                    segregation     segregation 
----------------------------------------------------------------------------------------------------------------
Hospitals.......................................................       0.03-0.05            0.01       0.02-0.03
Nursing homes...................................................       0.03-0.04            0.01       0.02-0.03
Laboratories:                                                                                                   
    Research....................................................       0.08-0.13            0.04       0.07-0.08
    Medical/dental..............................................               0               0               0
Funeral homes...................................................               0               0               0
Physicians' offices.............................................               0               0               0
Dentists' offices and clinics...................................               0               0               0
Outpatient care.................................................               0               0               0
Freestanding blood banks........................................               0               0               0
Fire and rescue operations......................................               0               0               0
Correctional facilities.........................................               0               0               0

[[Page 31762]]

                                                                                                                
Commercial incineration.........................................             2.6             2.6             2.6
----------------------------------------------------------------------------------------------------------------
<SUP>a The price increase percentages reported represent the price increase necessary to recover annualized emission 
  control costs for each industry.                                                                              



  Table 20.--Medical Waste Incineration Industry-Wide Output, Employment and Revenue Impacts--Existing Sources  
----------------------------------------------------------------------------------------------------------------
                                                                         Range for regulatory options 1-6       
                                                                 -----------------------------------------------
                                                                                    Scenario B      Scenario C  
                            Industry                              Scenario A  No  Switching with  Switching with
                                                                     switching         waste         no waste   
                                                                                    segregation     segregation 
----------------------------------------------------------------------------------------------------------------
Hospitals:                                                                                                      
    Output decrease (%).........................................          0-0.02               0          0-0.01
    Employment decrease (FTE's).................................           0-647           0-174           0-388
    Revenue increase or (decrease) (%)..........................       0.02-0.05            0.01       0.02-0.03
Nursing homes:                                                                                                  
    Output decrease (%).........................................       0.01-0.03          0-0.01       0.01-0.02
    Employment decrease (FTE's).................................         139-484          63-130         126-290
    Revenue increase or (decrease) (%)..........................       0.01-0.03          0-0.01       0.01-0.02
Laboratories:                                                                                                   
    Research:                                                                                                   
        Output decrease (%).....................................       0.08-0.18       0.04-0.05       0.07-0.11
        Employment decrease (FTE's).............................         124-281           56-76         112-169
        Revenue increase or (decrease) (%)......................        (0.04)-0        (0.01)-0        (0.03)-0
    Medical/dental:                                                                                             
        Output decrease (%).....................................               0               0               0
        Employment decrease (FTE's).............................             2-3             2-3             2-3
        Revenue increase or (decrease) (%)......................               0               0               0
Funeral homes:                                                                                                  
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................               0               0               0
Physicians' offices:                                                                                            
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................             0-1             0-1             0-1
    Revenue increase or (decrease) (%)..........................               0               0               0
Dentists' offices and clinics:                                                                                  
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               1               1               1
    Revenue increase or (decrease) (%)..........................               0               0               0
Outpatient care:                                                                                                
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................             0-1             0-1             0-1
    Revenue increase or (decrease) (%)..........................               0               0               0
Freestanding blood banks:                                                                                       
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................               0               0               0
Fire and rescue operations:                                                                                     
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................               0               0               0
Correctional facilities:                                                                                        
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................               0               0               0
----------------------------------------------------------------------------------------------------------------
Output decreases and full time equivalents (FTE's) employment losses as a result of the regulation are shown in 
  this table. Revenue increases and decreases are presented with decreases noted in brackets.                   


[[Page 31763]]


    As shown in Table 19, industries that generate medical waste (i.e., 
hospitals, nursing homes, etc.) are expected to experience average 
price increases in the range of 0.00 to 0.13 percent, depending on the 
industry, regulatory option, and scenario. Table 20 shows that these 
industries are expected to experience output and employment impacts in 
the range of 0.00 to 0.18 percent. In addition, the revenue impacts for 
these industries are expected to range from an increase of 0.05 percent 
to a decrease of 0.04 percent. An increase in industry revenue is 
expected in cases where the price elasticity of demand for an 
industry's product is less than one. A price elasticity of less than 
one indicates that the percentage decrease in output will be less than 
the percentage increase in price. Since total revenue is a product of 
price and output, a less than proportional change in output compared to 
price means that total revenue should increase.
    The following example illustrates how the above price impacts could 
be interpreted for the hospital industry. Table 19 shows that for 
hospitals, 0.03 percent is estimated as the price increase necessary to 
recover annual control costs assuming Regulatory Option 6, the most 
stringent regulatory option, and Scenario C, switching with no waste 
segregation. This change in price can be expressed in terms of the 
increased cost of hospitalization due to the regulation. The 1993 
estimate of adjusted patient days nationwide totals 304,500,000 days. 
This estimate of adjusted patient-days is based on a combined estimate 
of in-patient and out-patient days at hospitals. Calculating the ratio 
of annual control cost ($86,167,082) to the number of adjusted patient 
days provides an estimate of $0.28/day. Therefore, the average price 
increase that an individual would experience for each hospital patient-
day is expected to equal 28 cents.
    Table 19 also shows that the average price impact for the 
commercial medical waste incinerator industry is approximately a 2.6 
percent increase in price. Cost and economic impact estimates are the 
same for the commercial MWI industry regardless of the regulatory 
option analyzed because all six regulatory options specify identical 
regulatory requirements for large MWI. Average industrywide output, 
employment, and revenue impacts were not estimated for this sector 
because data such as price elasticity estimates and employment levels 
were not available.
3. Facility-Specific Economic Impacts
    Facility-specific impacts were also estimated for the affected 
industries. These estimates, presented in Tables 21 and 22, were 
calculated for the three switching scenarios. A cost as a percent of 
revenue ratio was calculated to provide an indication of the magnitude 
of the impact of the regulation on an uncontrolled facility in each 
industry sector. This calculation was then compared to the industrywide 
price impact to determine if the facility's impacts differ 
significantly from the average industrywide impacts (i.e., if there is 
greater than a 1 percent difference).

   Table 21.--Medical Waste Incineration Per Facility Impacts Assuming No Switching and Onsite Incineration--   
                     Existing Sources Annualized Control Cost as a Percent of Revenue/Budget                    
                                                  [In percent]                                                  
----------------------------------------------------------------------------------------------------------------
                                                                          Scenario A--No switching              
                                                           -----------------------------------------------------
                         Industry                                                  Option                       
                                                           -----------------------------------------------------
                                                               1        2        3        4        5        6   
----------------------------------------------------------------------------------------------------------------
Hospitals--Short-term, excluding psychiatric:                                                                   
Federal Government:                                                                                             
  Small:                                                                                                        
    Urban.................................................     0.09     0.37     0.37     0.41     0.41     0.46
    Rural.................................................     0.09     0.09     0.37     0.41     0.41     0.46
  Medium..................................................     0.20     0.20     0.20     0.20     0.22     0.22
  Large...................................................     0.13     0.13     0.13     0.13     0.13     0.13
State Government:                                                                                               
  Small:                                                                                                        
    Urban.................................................     0.20     0.80     0.80     0.87     0.87     0.99
    Rural.................................................     0.20     0.20     0.80     0.87     0.87     0.99
  Medium..................................................     0.21     0.21     0.21     0.21     0.23     0.23
  Large...................................................     0.07     0.07     0.07     0.07     0.07     0.07
Local Government:                                                                                               
  Small:                                                                                                        
    Urban.................................................     0.31     1.24     1.24     1.36     1.36     1.53
    Rural.................................................     0.31     0.31     1.24     1.36     1.36     1.53
  Medium..................................................     0.32     0.32     0.32     0.32     0.36     0.36
  Large...................................................     0.10     0.10     0.10     0.10     0.10     0.10
Not-for-profit:                                                                                                 
  Small:                                                                                                        
    Urban.................................................     0.21     0.84     0.84     0.92     0.92     1.04
    Rural.................................................     0.21     0.21     0.84     0.92     0.92     1.04
  Medium..................................................     0.23     0.23     0.23     0.23     0.26     0.26
  Large...................................................     0.11     0.11     0.11     0.11     0.11     0.11
For-profit:                                                                                                     
  Small:                                                                                                        
    Urban.................................................     0.23     0.95     0.95     1.04     1.04     1.18
    Rural.................................................     0.23     0.23     0.95     1.04     1.04     1.18
  Medium..................................................     0.25     0.25     0.25     0.25     0.25     0.28
  Large...................................................     0.14     0.14     0.14     0.14     0.14     0.14

[[Page 31764]]

                                                                                                                
Hospitals--Psychiatric, short-term and long-term:                                                               
  Small:                                                                                                        
    Urban.................................................     0.32     1.30     1.30     1.43     1.43     1.62
    Rural.................................................     0.32     0.31     1.30     1.43     1.43     1.62
  Medium..................................................     0.57     0.57     0.57     0.57     0.64     0.64
  Large...................................................     0.46     0.46     0.46     0.46     0.46     0.46
Nursing homes:                                                                                                  
  Tax-paying:                                                                                                   
    Urban.................................................     0.35     1.41     1.41     1.55     1.55     1.75
    Rural.................................................     0.35     0.35     1.41     1.55     1.55     1.75
  Tax-exempt:                                                                                                   
    Urban.................................................     0.36     1.45     1.45     1.59     1.59     1.79
    Rural.................................................     0.36     0.36     1.45     1.59     1.59     1.79
Commercial research labs:                                                                                       
  Tax-paying..............................................     0.40     0.40     0.40     0.40     0.46     0.46
  Tax-exempt..............................................     0.40     0.40     0.40     0.40     0.46     0.46
Commercial incineration facilities........................     8.02     8.02     8.02     8.02     8.02     8.02
----------------------------------------------------------------------------------------------------------------



   table 22.--Medical Waste Incineration Per Facility Impacts Assuming  
Switching From Onsite Incineration To Commercial Disposal Alternatives--
     Alternative Waste Disposal Cost As A Percent Of Revenue/Budget     
                              [In percent]                              
------------------------------------------------------------------------
                                            Scenario B      Scenario C  
                                          Switching with     Switching  
                Industry                       waste       without waste
                                            segregation     segregation 
------------------------------------------------------------------------
Hospitals--Short-term, excluding                                        
 psychiatric:                                                           
Federal Government:                                                     
  Small:                                                                
    Urban...............................            0.03            0.10
    Rural...............................            0.03            0.17
  Medium:                                                               
    Urban...............................            0.05            0.17
    Rural...............................            0.05            0.27
  Large:                                                                
    Urban...............................            0.08            0.29
    Rural...............................            0.09            0.47
State Government:                                                       
  Small:                                                                
    Urban...............................            0.06            0.22
    Rural...............................            0.06            0.36
  Medium:                                                               
    Urban...............................            0.05            0.18
    Rural...............................            0.05            0.29
  Large:                                                                
    Urban...............................            0.05            0.16
    Rural...............................            0.05            0.27
Local Government:                                                       
  Small:                                                                
    Urban...............................            0.09            0.34
    Rural...............................            0.10            0.56
  Medium:                                                               
    Urban...............................            0.07            0.27
    Rural...............................            0.08            0.44
  Large:                                                                
    Urban...............................            0.06            0.22
    Rural...............................            0.06            0.36
Not-for-profit:                                                         
  Small:                                                                
    Urban...............................            0.06            0.23
    Rural...............................            0.07            0.38
  Medium:                                                               
    Urban...............................            0.05            0.20
    Rural...............................            0.06            0.32

[[Page 31765]]

                                                                        
  Large:                                                                
    Urban...............................            0.07            0.25
    Rural...............................            0.07            0.41
For-profit:                                                             
  Small:                                                                
    Urban...............................            0.07            0.26
    Rural...............................            0.08            0.43
  Medium:                                                               
    Urban...............................            0.06            0.21
    Rural...............................            0.06            0.34
  Large:                                                                
    Urban...............................            0.09            0.32
    Rural...............................            0.09            0.52
Hospitals--Psychiatric, short-term and                                  
 long-term:                                                             
  Small:                                                                
    Urban...............................            0.10            0.36
    Rural...............................            0.11            0.59
  Medium:                                                               
    Urban...............................            0.13            0.48
    Rural...............................            0.14            0.78
  Large:                                                                
    Urban...............................            0.29            1.05
    Rural...............................            0.31            1.70
Nursing homes:                                                          
  Tax-paying:                                                           
    Urban...............................            0.11            0.39
    Rural...............................            0.11            0.64
  Tax-exempt:                                                           
    Urban...............................            0.11            0.40
    Rural...............................            0.12            0.65
Commercial research labs:                                               
  Tax-paying:                                                           
    Urban...............................            0.09            0.34
    Rural...............................            0.10            0.56
  Tax-exempt:                                                           
    Urban...............................            0.09            0.34
    Rural...............................            0.10            0.56
------------------------------------------------------------------------


    Tables 21 and 22 show that facilities with onsite MWI that are 
currently uncontrolled may experience impacts ranging from 0.03 to 1.79 
percent, depending on the industry, regulatory option, and scenario. A 
comparison of the economic impacts expected to occur under the three 
switching scenarios, presented in Tables 21 and 22, indicates that the 
option of switching will be attractive to some facilities currently 
operating an onsite incinerator. For many of the uncontrolled model 
facilities, the economic impacts of switching to an alternative method 
of waste disposal are much lower than the economic impacts of choosing 
to install emission control equipment. The decision to switch to an 
alternative should preclude any facilities from experiencing a 
significant economic impact. These results support EPA's assertion that 
implementation of the regulation will likely result in either Scenarios 
B or C and that the costs and economic impacts of Scenario A are 
unlikely to occur.
    Table 23 shows the impacts that would be incurred by medical waste 
generators that currently use an offsite medical waste incineration 
service. These impacts range from 0.00 to 0.02 percent and are 
considered negligible impacts. These results indicate that the 
incremental cost for the vast majority of medical waste generators are 
expected to be small.

  Table 23.--Medical Waste Incineration Per Facility Impacts For Firms  
  That Utilize Offsite Waste Incineration--Existing Sources Incremental 
               Annual Cost as a Percent of Revenue/Budget               
                              [In percent]                              
------------------------------------------------------------------------
                                                            Incremental 
                                                          annual cost as
                        Industry                           a percent of 
                                                              revenue   
------------------------------------------------------------------------
Hospitals:                                                              
    <50 Beds............................................          0-0.01
    50-99 Beds..........................................          0-0.01
    100-299 Beds........................................          0-0.01
    300 + Beds..........................................          0-0.01
Nursing homes:                                                          
  0-19 Employees:                                                       
    Tax-paying..........................................               0
    Tax-exempt..........................................               0

[[Page 31766]]

                                                                        
  20-99 Employees:                                                      
    Tax-paying..........................................               0
    Tax-exempt..........................................               0
  100 + Employees:                                                      
    Tax-exempt..........................................               0
    Tax-paying..........................................               0
Commercial research labs:                                               
  Tax-paying:                                                           
    0-19 Employees......................................               0
    20-99 Employees.....................................               0
    100 + Employees.....................................               0
  Tax-exempt............................................               0
Outpatient care clinics:                                                
  Physicians' clinics (Amb. Care)                                       
    Tax-paying..........................................               0
    Tax-exempt..........................................               0
  Freestanding kidney dialy-sis facilities:                             
    Tax-paying..........................................               0
    Tax-exempt..........................................          0-0.01
Physicians' offices.....................................               0
Dentists' offices and clinics:                                          
    Offices.............................................               0
    Clinics.............................................  ..............
      Tax-paying........................................               0
      Tax-exempt........................................               0
Medical & dental labs:                                                  
    Medical.............................................          0-0.01
    Dental..............................................          0-0.01
Freestanding blood banks................................          0-0.02
Funeral homes...........................................               0
Fire & Rescue...........................................               0
Corrections:                                                            
    Federal Government..................................               0
    State Government....................................               0
    Local Government....................................               0
------------------------------------------------------------------------



    Table 22 also presents price impact estimates for the commercial 
medical waste incinerator sector. The analysis shows that uncontrolled 
medical waste incinerators required to meet any of the regulatory 
options would need to increase their prices by approximately 8 percent 
in order to recoup their control costs. Several factors indicate that 
it is unlikely these particular facilities would be able to increase 
the price of their service by 8 percent.
    An examination of the MWI inventory indicates that a majority of 
facilities the commercial MWI sector have already implemented controls 
that would enable them to meet the requirements of any of the six 
regulatory options. Only a small number of facilities in this sector 
would be ``uncontrolled'' in the baseline and would, therefore, incur 
the majority of the costs estimated for this sector. This distribution 
suggests that commercial MWI that must install emission control 
equipment will not be able to freely increase their prices due to 
competition from already controlled commercial MWI. As indicated in the 
industrywide impact calculations, the average industrywide price 
increase is expected to be approximately 3 percent. Therefore, 
commercial MWI having to incur regulatory costs will most likely be 
forced to absorb some portion of their cost increase instead of passing 
the increase to their customers.
    Another factor indicating the likely possibility that these 
commercial MWI would be required to absorb some portion of their cost 
increases is based on model plant capacity information. Many MWI are 
operating below full capacity, indicating that medical waste 
incinerator operators with excess capacity will act as a competitive 
force to keep incineration prices from rising.
    One advantage that commercial MWI operators will experience due to 
the regulation will be increasing demand for commercial incineration 
service. Table 22 presents impact information under the assumption that 
some facilities with onsite incinerators will choose to switch to a 
lower cost alternative for medical waste disposal rather than install 
emission control equipment to meet the requirements of the regulation. 
Some facilities will probably choose one of these lower cost options, 
which in many cases may be to switch to commercial incineration. If 
implementation of the regulation will have such an effect, demand for 
commercial incineration should increase and commercial MWI operators 
should be able to offset some of their absorbed cost increases due to 
increased demands for their service.
    Another consideration regarding the current state of the commercial 
MWI industry is that the small number of uncontrolled commercial MWI 
may currently be enjoying a cost advantage compared to the majority of 
controlled firms in the industry. Commercial MWI facilities that 
currently operate with emission control equipment presumably operate at 
a higher cost per unit than uncontrolled facilities. If the majority of 
the facilities in this industry are controlled and are able to charge 
prices that enable them to recapture their costs and earn reasonable 
profits, then uncontrolled facilities that are probably operating at a 
lower cost are likely to be enjoying profits exceeding the levels 
earned by the controlled facilities in the industry.
    Based on these explanations, EPA estimates that the price of 
commercial incineration is likely to increase by an average of 
approximately 2.6 percent. Some uncontrolled facilities in this 
industry may need to absorb some of their cost increases due to 
implementation of this regulation. However, due to factors such as 
increased demand for commercial incineration and possible cost 
advantages currently enjoyed by these facilities, the cost of the 
regulation should be achievable.
    This economic impact section examines possible economic impacts 
that may occur in industries that will be directly affected by this 
regulation. Therefore, the analysis includes an examination of 
industries that generate medical waste or dispose medical waste. 
Secondary impacts such as subsequent impacts on air pollution device 
vendors and MWI vendors are not estimated due to data limitations. Air 
pollution device vendors are expected to experience an increase in 
demand for their products due to the regulation. This regulation is 
also expected to increase demand for commercial MWI services. However, 
due to economies of scale, this regulation is expected to shift demand 
from smaller incinerators to larger incinerators. Therefore, small MWI 
vendors may be adversely affected by the regulation. Lack of data on 
the above effects prevents quantification of the economic impacts on 
these secondary sectors.

IV. Regulatory Options and Impacts for New MWI

    As discussed earlier, the MACT ``floor'' defines the least 
stringent emission standards the EPA may adopt for new MWI. However, as 
also discussed earlier, the Clean Air Act requires EPA to examine 
alternative emission standards (i.e., regulatory options) more 
stringent than the MACT floor. The EPA must consider the cost, 
environmental, and energy impacts of these regulatory options and 
select one that reflects the maximum reduction in emissions that EPA 
determines is achievable (i.e., MACT).
    At proposal, the EPA concluded all new MWI would need good 
combustion and dry scrubbers to meet the MACT floors for CO, PM, and 
HCl. Consequently, EPA was left to consider only two regulatory options 
for MACT. The first regulatory option reflected the floor (i.e., 
emission limitations achievable with good combustion and dry 
scrubbers). The second reflected emission limitations achievable with 
good combustion and dry scrubbers with activated carbon injection. 
Based on the cost, environmental, and energy impacts of the second 
regulatory option

[[Page 31767]]

relative to the first option, EPA selected the second option as MACT. 
Consequently, EPA proposed emission standards for new MWI based on the 
use of good combustion and dry scrubbers with activated carbon 
injection.
    As discussed earlier in this notice, EPA received numerous comments 
containing substantial new information following the proposal. Based on 
this new information, new conclusions concerning the MWI inventory, MWI 
subcategories, performance of emission control technologies, MACT 
floors, and monitoring and testing options have been reached. As a 
result, EPA now believes there are several new regulatory options that 
merit consideration in selecting MACT for new MWI. The following 
sections summarize these new regulatory options and the EPA's initial 
assessment of their merits.

A. Regulatory Options

    As discussed earlier, new MACT floor emission levels were developed 
for small, medium, and large MWI. To assess the impacts of regulatory 
options, EPA must first consider what emission control technology(s) 
new MWI may need to meet regulations based on these floor emission 
limits. The floor for small new MWI appears to require good combustion 
and moderate efficiency wet scrubbers. For medium new MWI, the MACT 
floor appears to require good combustion and a combined wet/dry 
scrubbing system without activated carbon injection. The MACT floor for 
large new MWI appears to require good combustion and a combined wet/dry 
scrubbing system with activated carbon injection.
    Having identified these control technologies, the EPA is now able 
to review the performance capabilities of other control technologies 
and to identify those technologies capable of achieving even greater 
emission reductions. This review enables EPA to identify regulatory 
options more stringent than the floor that could be selected as MACT.
    For small new MWI, as mentioned above, good combustion and a 
moderate efficiency wet scrubber system are the emission control 
technologies most MWI would probably need to meet the MACT floor 
emission levels. Therefore, these technologies serve as the basis for 
the first regulatory option for the MACT emission standards for small 
new MWI. A review of the performance capabilities of various emission 
control technologies summarized earlier readily identifies a second 
option for small new MWI. This option is to base the MACT emission 
standards for small new MWI on the use of good combustion and high 
efficiency wet scrubbing systems. This would achieve further reductions 
in PM emissions, but it would not further reduce other pollutants. As 
summarized earlier, high efficiency wet scrubbing systems do not appear 
to achieve greater reductions in emissions of dioxins, acid gases 
(e.g., HCl), or metals (i.e., Hg, Pb, or Cd) than do moderate 
efficiency wet scrubbing systems.
    Reviewing the performance capabilities of emission control 
technologies also identifies a third option for small new MWI. This 
regulatory option is to base the MACT emission standards for small new 
MWI on the use of good combustion and a combined dry/wet scrubbing 
system with activated carbon injection. This alternative would further 
reduce emissions of Pb, Cd, and dioxins, but would not further reduce 
emissions of other air pollutants. The combined system, however, 
generally costs about two and a half times what high-efficiency wet 
scrubbing systems cost to operate annually, and the overall difference 
in the emissions control performance between the two systems is 
relatively small. As a result, at this point, to limit and manage the 
total number of regulatory options under consideration, the EPA has 
chosen not to include this third regulatory option for small new MWI.
    For medium new MWI, as discussed earlier, the use of good 
combustion and a combined wet/dry scrubbing system without activated 
carbon injection appears to be necessary to meet the MACT floor 
emission limits. Therefore, this option is the first regulatory option 
for medium new MWI. The second regulatory option is to base the 
emission standards for medium new MWI on good combustion and a combined 
wet/dry scrubbing system with activated carbon injection.
    Finally, for large new MWI, as discussed earlier, the use of good 
combustion and a combined wet/dry scrubbing system with activated 
carbon injection appears necessary to meet the MACT floor emission 
limits. Because no other air pollution control technologies have been 
identified that can achieve more stringent emission limits, the EPA is 
not inclined at this point to consider other regulatory options for 
large new MWI.
    The regulatory options outlined above are combined in Table 24. 
This table summarizes the technology basis for the regulatory options 
for the various MACT standards the EPA believes merit consideration as 
MACT for new MWI. This table is constructed only to organize and 
structure an analysis of the cost, environmental, and energy impacts 
associated with the various MACT standards in order to consider these 
impacts in selecting MACT for new MWI. As mentioned earlier, the MACT 
standards for new MWI will not include requirements to use a specific 
emission control system or technology; the MACT standards will only 
include emission limits, which may be met by any means or by using any 
control system or technology the owner or operator of the MWI decides 
to use to meet these emission limits.

          Table 24.--Level of Air Pollution Control Associated with Each Regulatory Option for New MWI          
----------------------------------------------------------------------------------------------------------------
                                                                  Regulatory options                            
              MWI size              ----------------------------------------------------------------------------
                                                 1                         2                        3           
----------------------------------------------------------------------------------------------------------------
Small <ls-thn-eq>200 lb/hr.........  Good combustion and       Good combustion and       Good combustion and    
                                      moderate efficiency wet   moderate efficiency wet   high efficiency wet   
                                      scrubber.                 scrubber.                 scrubber.             
Medium 201-500 lb/hr...............  Good combustion, dry      Good combustion, dry      Good combustion, dry   
                                      injection/fabric filter   injection/fabric filter   injection/fabric      
                                      system, and high          system with carbon, and   filter system with    
                                      efficiency wet scrubber.  high efficiency wet       carbon, and high      
                                                                scrubber.                 efficiency wet        
                                                                                          scrubber.             
Large >500 lb/hr...................  Good combustion, dry      Good combustion, dry      Good combustion, dry   
                                      injection/fabric filter   injection/fabric filter   injection/fabric      
                                      system with carbon, and   system with carbon, and   filter system with    
                                      high efficiency wet       high efficiency wet       carbon, and high      
                                      scrubber.                 scrubber.                 efficency wet         
                                                                                          scrubber.             
----------------------------------------------------------------------------------------------------------------

    The emission limits associated with each of the regulatory options 
for small, medium, and large new MWI are presented in Table 25.

[[Page 31768]]



                       Table 25.--Emission Limitations Associated With Each Regulatory Option for Small, Medium, and Large New MWI                      
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                        
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                    1 and 2...............  3.....................  1.....................  2 and 3..............  1-3                  
                                                                                                                                                        
-----------------------------------                                                                                                                     
PM, gr/dscf.......................  0.03..................  0.015.................  0.015.................  0.015................  0.015                
CO, ppmdv.........................  40....................  40....................  40....................  40...................  40                   
CDD/CDF, ng/dscm..................  125...................  125...................  125...................  25...................  25                   
TEQ CDD/CDF, ng/dscm..............  2.3...................  2.3...................  2.3...................  0.6..................  0.6                  
HCl, ppmdv........................  15 or 99%.............  15 or 99%.............  15 or 99%.............  15 or 99%............  15 or 99%            
SO<INF>2, ppmdv........................  55....................  55....................  55....................  55...................  55                   
NO<INF>x, ppmdv........................  250...................  250...................  250...................  250..................  250                  
Pb, mg/dscm.......................  1.2 or 70%............  1.2 or 70%............  0.07 or 98%...........  0.07 or 98%..........  0.07 or 98%          
Cd, mg/dscm.......................  0.16 or 65%...........  0.16 or 65%...........  0.04 or 90%...........  0.04 or 90%..........  0.04 or 90%          
Hg, mg/dscm.......................  0.55 or 85%...........  0.55 or 85%...........  0.55 or 85%...........  0.55 or 85%..........  0.55 or 85%          
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Regulatory Option 1 in Table 25 reflects the performance of the 
emission control system or technology needed to meet the MACT floor. 
For small new MWI, Regulatory Option 1 reflects emission limits based 
on good combustion and moderate efficiency wet scrubbers. For medium 
new MWI, Regulatory Option 1 reflects emission limits based on good 
combustion and a combined wet/dry scrubbing system without carbon. For 
large new MWI, Regulatory Option 1 reflects emission limits based on 
good combustion and a combined wet/dry scrubbing system with activated 
carbon injection.
    Regulatory Option 1 does not reflect the most stringent emission 
limits achievable for all subcategories. Consequently, the Clean Air 
Act requires EPA to examine the costs and other impacts of regulatory 
options more stringent than Regulatory Option 1. Each regulatory option 
examined reflects slightly more stringent emission standards.
    Regulatory Option 2 is the same as Regulatory Option 1 for small 
and large MWI. Medium MWI would be required to meet emission limits 
associated with good combustion and a combined wet/dry scrubbing system 
with activated carbon injection. Regulatory Option 3 would establish 
emission limits for small MWI based on good combustion and high 
efficiency wet scrubbers. Requirements for medium and large MWI would 
remain the same under Regulatory Option 3 as under Regulatory Option 2.

B. National Environmental and Cost Impacts

    This section presents a summary of the air, water, solid waste, 
energy, and cost impacts of the three regulatory options for new MWI. 
Economic impacts are discussed in Section IV.C. All impacts are 
nationwide resulting from the implementation of the new source 
performance standards for new MWI.
1. Analytical Approach
    As discussed at proposal and within this notice, healthcare 
facilities may choose from among a number of alternatives for treatment 
and disposal of their medical wastes; however, these alternatives are 
generally more limited for healthcare facilities located in rural areas 
than for those located in urban areas. In fact, as stated at proposal, 
most estimates are that less than half of hospitals today currently 
operate onsite medical waste incinerators. The clear trend over the 
past several years has been for more and more hospitals to turn to the 
use of alternative onsite medical waste treatment technologies or 
commercial offsite treatment and disposal services. Consequently, even 
fewer hospitals are now likely to operate onsite medical waste 
incinerators.
    More than half of existing hospitals today, therefore, have chosen 
to use other means of treatment and disposal of their medical waste 
than operation of an onsite incinerator. This is a clear indication 
that alternatives to the use of onsite incinerators exist and that they 
are readily available in many cases (although as mentioned above, these 
alternatives--particularly the availability and competitive cost of 
offsite commercial treatment and disposal services--tend to be more 
limited in rural areas than in urban areas). For other healthcare 
facilities, such as nursing homes, outpatient clinics, doctors and 
dentists offices, etc., only very few facilities currently operate 
onsite medical waste incinerators. Therefore, for these types of 
healthcare facilities, the percentage of such facilities using 
alternative means of treatment and disposal of medical waste--
particularly commercial treatment and disposal services--is much 
higher, probably higher than 95 percent. This high percentage is 
further confirmation of the availability of alternatives to onsite 
incinerators for the treatment and disposal of medical waste.
    A very likely reaction and outcome associated with the adoption of 
MACT standards for new MWI, therefore, is an increase in the use of 
these alternatives by healthcare facilities for treatment and disposal 
of medical waste. The EPA's objective is not to encourage the use of 
alternatives or to discourage the use of onsite medical waste 
incinerators; EPA's objective is to adopt MACT emission standards for 
new MWI that fulfill the requirements of Section 129 of the Clean Air 
Act. In doing so, however, one outcome associated with adoption of 
these MACT standards is likely to be an increase in the use of 
alternatives and a decrease in the use of onsite medical waste 
incinerators. Consequently, EPA should acknowledge and incorporate this 
outcome into the analyses of the cost, environmental, and energy 
impacts associated with the MACT emission standards.
    In these analyses of the cost, environmental, and energy impacts, 
the selection of an alternative form of medical waste treatment and 
disposal by a healthcare facility, rather than the purchase of an 
onsite medical waste incinerator and the emission control technology 
necessary to meet the MACT emission limits, is referred to as 
``switching''. Switching was incorporated in the analyses at proposal 
and was the basis for the conclusion at proposal that adoption of the 
proposed MACT emission standards could lead to as many as 80 percent of 
healthcare facilities to choose an alternative means of medical waste 
treatment and disposal over the purchase of an MWI. Although switching 
was not EPA's objective, it was a potential outcome of the regulations 
that EPA believed should be

[[Page 31769]]

acknowledged, considered, and discussed at proposal.
    Switching has also been incorporated into the new analyses of the 
cost, environmental, and energy impacts associated with the three new 
regulatory options. The new analyses, however, incorporate three 
scenarios: one scenario that ignores switching and two scenarios that 
consider switching. Scenario A assumes that each new MWI will be 
installed and will comply with the appropriate regulatory option (i.e., 
no switching). This scenario results in the highest costs because it 
assumes no potential new MWI owner will switch to a less expensive 
waste disposal method. This scenario is clearly unrealistic and grossly 
overstates the national costs associated with MACT emission standards. 
It should not be viewed as representative or even close to 
representative of the impacts associated with the MACT emission 
standards. This scenario is so misleading that EPA considered not 
including it in the analysis; some may take it out of context and use 
it as representative, when it is in no way representative of the 
impacts of the MACT emission standards. The EPA finally decided to 
include this scenario in the analysis only because some may ask ``what 
if * * *?'' and the EPA wanted to be in a position to answer such 
questions.
    Switching Scenarios B and C are much more realistic and more 
representative of the cost, environmental, and energy impacts 
associated with the MACT emission standards for new MWI. Only these 
scenarios merit serious review and consideration in gauging the 
potential impacts associated with the MACT emission standards. Both 
Scenarios B and C assume switching occurs when the cost associated with 
purchasing and installing the air pollution control technology or 
system necessary to comply with the MACT emission standard (i.e., a 
regulatory option) is greater than the cost of choosing an alternative 
means of treatment and disposal.
    The difference in Scenarios B and C is the assumption of how much 
separation of the medical waste stream into an infectious medical waste 
stream and a noninfectious medical waste stream currently occurs at 
healthcare facilities that today operate a medical waste incinerator. 
Some have stated that, for the most part, hospitals that are currently 
operating onsite medical waste incinerators practice little separation 
of medical waste into infectious and noninfectious waste; generally all 
the medical waste at the facility is incinerated.
    Based on estimates in the literature that only 10 to 15 percent of 
medical waste is potentially infectious and the remaining 85 to 90 
percent is noninfectious, Scenario B assumes that only 15 percent of 
the waste currently being burned at a healthcare facility operating an 
onsite medical waste incinerator is potentially infectious medical 
waste. The 85 percent noninfectious waste is municipal waste that needs 
no special handling, treatment, transportation, or disposal. It can be 
sent to a municipal landfill or municipal combustor for disposal. Thus, 
under Scenario B, when choosing an alternative to an onsite medical 
waste incinerator, in response to adoption of MACT emission standards, 
a healthcare facility need only chose an alternative form of medical 
waste treatment and disposal for 15 percent of the waste stream 
currently burned onsite and may send the remaining 85 percent to a 
municipal landfill. In other words, if a hospital plans to burn 100 
pounds of waste, Scenario B assumes 85 pounds are noninfectious and 15 
pounds are potentially infectious. This scenario results in the lowest 
costs because 85 percent of the waste is disposed at the relatively 
inexpensive cost of municipal waste disposal.
    On the other hand, it is unlikely that all healthcare facilities 
that consider purchasing an MWI will be able to or will decide to 
segregate the waste stream to be burned in the incinerator. If a 
hospital already separates medical waste into infectious and 
noninfectious waste streams, for example, this hospital would be unable 
to separate the waste stream any further. In other words, if a hospital 
plans to burn 100 pounds of waste, Scenario C assumes all 100 pounds 
are potentially infectious. Scenario C, therefore, assumes that all 
medical waste to be burned at a healthcare facility that purchases a 
medical waste incinerator is potentially infectious medical waste and 
must be treated and disposed of accordingly. As a result, Scenario C 
leads to higher costs than Scenario B.
    For the purposes of determining impacts of the emission standards 
under switching Scenarios B and C, new commercial (offsite) 
incinerators and onsite incinerators used to burn healthcare waste were 
treated separately. The commercial incinerators were not subjected to 
the switching analyses under Scenarios B and C because switching to an 
alternative method of waste disposal (e.g., commercial disposal) is not 
feasible for commercial facilities. An assumption was made that 
commercial facilities would add on the control associated with the 
emission standards. Only the new onsite MWI were subject to the 
switching analyses under Scenarios B and C. On the other hand, a 
commercial waste disposal company does have the option of purchasing an 
alternative technology (e.g., autoclave or microwave) rather than 
installing a new MWI. Consequently, while switching was not included in 
this analysis for commercial MWI, it is an option that could result in 
lower costs.
    Scenarios B and C represent the likely range of impacts associated 
with the MACT emission standards for new MWI. The actual impacts of a 
MACT emission standard (i.e., a regulatory option) is most likely to 
fall somewhere within the range represented by Scenarios B and C.
2. Air Impacts
    As outlined above, the impacts associated with three MACT emission 
standards or regulatory options, under three scenarios reflecting 
switching, have been assessed. Baseline emissions (i.e., emissions in 
the absence of adoption of the MACT emission standards) and emissions 
under each MACT emission standard or regulatory option are summarized 
in Tables 26, 27, and 28. Emissions under Scenario A (no switching) are 
summarized in Table 26; emissions under Scenario B (switching with 
waste separation) are summarized in Table 27; and emissions under 
Scenario C (switching without waste separation) are summarized in Table 
28.

    Table 26.--Baseline Emissions Compared with Emissions in the Fifth Year After Implementation of the NSPS    
                                                  [Scenario A]                                                  
                                                 [Metric Units]                                                 
----------------------------------------------------------------------------------------------------------------
                                                                                   Regulatory Options           
                    Pollutant, units                        Baseline   -----------------------------------------
                                                                              1             2             3     
----------------------------------------------------------------------------------------------------------------
PM, Mg/yr..............................................         28               2.7           2.7           2.3

[[Page 31770]]

                                                                                                                
CO, Mg/yr..............................................         14                14            14            14
CDD/CDF, g/yr..........................................         47                12           7.2           7.2
TEQ CDD/CDF, g/yr......................................          1.1            0.28          0.17          0.17
HC1, Mg/yr.............................................         64               3.1           3.1           3.1
SO<INF>2, Mg/yr.............................................         28                28            28            28
NO<INF>x, Mg/yr.............................................        130               130           130           130
Pb, Mg/yr..............................................          0.39           0.02          0.02          0.02
Cd, Mg/yr..............................................          0.001    3.5 x 10<SUP>-3    3.5 x 10<SUP>-3    3.5 x 10<SUP>-3
Hg, Mg/yr..............................................          0.21           0.12          0.12          0.12
----------------------------------------------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1. To convert g/yr to lb/yr, divide by 453.6.                         



  Table 27.--Baseline Emissions Compared With Emissions in the Fifth Year After Implementation of the Emission  
                                                   Guidelines                                                   
                                                  [Scenario B]                                                  
                                                 [Metric Units]                                                 
----------------------------------------------------------------------------------------------------------------
                                                                         Regulatory options                     
          Pollutant, units             Baseline   --------------------------------------------------------------
                                                            1                    2                    3         
----------------------------------------------------------------------------------------------------------------
PM, Mg/yr..........................        28      2.1                  2.1                  2.1                
CO, Mg/yr..........................        14      6.5                  6.5                  6.5                
CDD/CDF, g/yr......................        47      5.9                  5.9                  5.9                
TEQ CDD/CDF, g/yr..................         1.1    0.14                 0.14                 0.14               
HC1, Mg/yr.........................        64      1.5                  1.5                  1.5                
SO<INF>2, Mg/yr.........................        28      14                   14                   14                 
NO<INF>x, Mg/yr.........................       130      65                   65                   65                 
Pb, Mg/yr..........................         0.39   0.031                0.031                0.031              
Cd, Mg/yr..........................         0.051  4.6 x 10<SUP>-3           4.6 x 10<SUP>-3           4.6 x 10<SUP>-3         
Hg, Mg/yr..........................         0.21   0.056                0.056                0.056              
----------------------------------------------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1 To convert g/yr to lb/yr, divide by 453.6.                          


    Table 28.--Baseline Emissions Compared With Emissions in the Fifth Year After Implementation of the NSPS    
                                                  [Scenario C]                                                  
                                                 [Metric Units]                                                 
----------------------------------------------------------------------------------------------------------------
                                                                         Regulatory options                     
          Pollutant, units             Baseline   --------------------------------------------------------------
                                                            1                    2                    3         
----------------------------------------------------------------------------------------------------------------
PM, Mg/yr..........................        28      4.1                  4.1                  4.1                
CO, Mg/yr..........................        14      14                   14                   14                 
CDD/CDF, g/yr......................        47      12                   12                   12                 
TEQ CDD/CDF, g/yr..................         1.1    0.28                 0.28                 0.28               
HC1, Mg/yr.........................        64      3.1                  3.1                  3.1                
SO<INF>2, Mg/yr.........................        28      28                   28                   28                 
NO<INF>x, Mg/yr.........................       130      130                  130                  130                
Pb, Mg/yr..........................         0.39   0.06                 0.06                 0.06               
Cd, Mg/yr..........................         0.051  8.9 x 10<SUP>-3           8.9 x 10<SUP>-3           8.9 x 10<SUP>-3         
Hg, Mg/yr..........................         0.21   0.12                 0.12                 0.12               
----------------------------------------------------------------------------------------------------------------
To convert Mg/yr to ton/yr, multiply by 1.1 To convert g/yr to lb/yr, divide by 453.6.                          

    As discussed in previous sections, new information has led to new 
conclusions about the MWI inventory, performance of technology, and 
control levels associated with each new MWI. As a result, revised 
estimates of annual baseline emissions and emissions under each 
regulatory option are significantly lower than estimates developed at 
proposal. There are two primary reasons for the lower emission 
estimates. First, a greater level of emission control is expected at 
new MWI than was assumed at proposal. Second, more MWI were projected 
to be built at proposal than current estimates.
3. Water and Solid Waste Impacts
    Estimates of wastewater impacts were developed for only Regulatory 
Option 3, Scenario A, which reflects all new MWI equipped with wet 
scrubbers in the

[[Page 31771]]

absence of switching. Assessing these impacts under Scenario A without 
any consideration of the effect of switching grossly overstates the 
magnitude of these impacts. Under Scenarios B and C more than half of 
the new MWI are expected not to be built, resulting in significantly 
lower impacts. This approach of estimating and summarizing impacts 
under Scenario A, at this point, was taken as a matter of expediency to 
share new information and provide an opportunity for public comment.
    Under Regulatory Option 3, Scenario A, 3.3 million gallons of 
additional wastewater would be generated in the fifth year by MWI as a 
result of the NSPS. This amount is the equivalent of wastewater 
produced annually by one small hospital. Therefore, when considering 
the wastewater produced annually at healthcare facilities nationwide, 
the increase in wastewater resulting from the implementation of the 
MACT emission standards for new MWI is insignificant.
    With regard to solid waste impacts, about 88,800 Mg (97,900 tons) 
of medical waste would be burned in the fifth year in new MWI in the 
absence of Federal regulations, producing about 8,880 Mg/yr (9,790 
tons/yr) of solid waste (bottom ash) disposed of in landfills. To 
determine the solid waste impacts for the NSPS, impacts were developed 
for Regulatory Option 3, Scenario B. This option is associated with the 
most switching and the most separation of waste for disposal in 
municipal landfills and thus, produces the greatest estimated impact.
    Under Regulatory Option 3, Scenario B, 43,600 Mg/yr (48,000 tons/
yr) of additional solid waste would result from the adoption of the 
NSPS. However, compared to municipal waste, which is disposed in 
landfills at an annual rate of over 91 million Mg/yr (100 million tons/
yr), the increase in solid waste from the implementation of the MWI 
standards is insignificant.
4. Energy Impacts
    The emission control technologies used by new MWI to comply with 
the MACT emission limits consume energy. Estimates of energy impact 
were developed for Regulatory Option 3, Scenario A. Under Scenarios B 
and C, which include switching, it is not clear whether overall 
national energy consumption would increase, decrease, or remain the 
same. Alternatives to incineration require energy to operate; however, 
information is not available to estimate whether these alternatives use 
more or less energy than MWI.
    The energy impacts associated with the MACT emission standards 
could include additional auxiliary fuel (natural gas) for combustion 
controls and additional electrical energy for operation of the add-on 
control devices, such as wet scrubbers and dry scrubbers. It was 
assumed that all new MWI would be installed with combustion controls in 
the absence of the NSPS in order to meet State regulations for new MWI. 
Therefore, there is no increase in the total national usage of natural 
gas for combustion controls under Regulatory Option 3, Scenario A. 
Total national usage of electrical energy for the operation of add-on 
control devices would increase by about 9,800 megawatt hours per year 
(MW-hr/yr) (33.4 billion British thermal units per year (10\9\ Btu/
yr)). Once again, compared to the amount of energy used by health care 
facilities such as hospitals (approximately 2,460 MMm\3\/yr of natural 
gas and 23.2 million MW-hr/yr of electricity) the increase in energy 
usage that results from implementation of the MWI emission standards is 
insignificant.
5. Cost Impacts
    The cost impacts on individual healthcare facilities that consider 
purchasing an MWI vary depending on the MACT emission standard or 
regulatory option; the actual cost to purchase and install any 
additional air pollution control equipment; the cost of alternative 
means of treatment and disposal where they are located; and other 
factors, such as liability issues related to disposal and State and 
local medical waste treatment and disposal requirements. In general, 
facilities considering purchasing smaller MWI will have a greater 
incentive to use alternative means of treatment and disposal because 
their onsite incineration cost (per pound of waste burned) will be 
higher.
    Large healthcare facilities with larger amounts of waste to be 
treated or healthcare facilities that serve as regional treatment 
centers for waste generated at other healthcare facilities in the area 
may have some cost advantages compared to smaller facilities. Due to 
economies of scale, their cost of burning waste may be lower (i.e., 
dollars per pound burned), even after purchasing and installing a 
complete air pollution control system to comply with the emission 
standards.
    Table 29 contains the estimated increase in national annual costs 
associated with each of the MACT emission standards or regulatory 
options under Scenario A (no switching), Scenario B (switching with 
separation of waste), and Scenario C (switching with no separation of 
waste). As discussed earlier, Scenario A is unrealistic and grossly 
overstates the national cost impacts. The costs associated with the 
MACT emission standards under Scenarios B and C represent the likely 
range of national cost impacts and only these costs merit serious 
consideration and review.

         Table 29.--Costs of the Regulatory Options of the NSPS         
                         [Scenarios A, B, and C]                        
                            [Million $/year]                            
------------------------------------------------------------------------
                                                   Regulatory options   
                   Scenario                   --------------------------
                                                  1        2        3   
------------------------------------------------------------------------
A............................................     32.3     32.8     33.7
B............................................     10.8     10.8     10.8
C............................................     24.0     24.0     24.0
------------------------------------------------------------------------

    The nationwide annual costs presented in Table 29, excluding 
Scenario A, range from $10.8 million/yr for the regulatory options 
under Scenario B to $24.0 million/yr for the regulatory options under 
Scenario C. These nationwide annual costs are significantly lower than 
the $74.5 million/yr estimated for the proposed emission standards. The 
difference in the proposed and the current nationwide annual cost 
estimates can be attributed to the difference in the number of new MWI 
that were predicted to be installed at proposal and the current 
estimate of the number of new MWI. For example, at proposal it was 
estimated that approximately 700 new MWI would be installed by the 
fifth year after adoption of the emission standards. It is now 
estimated that approximately 235 new MWI will be installed by the fifth 
year after adoption of the standards.

C. Economic Impacts

    Section IV.B.1 described assumptions pertaining to three analysis 
scenarios: no switching, switching with waste segregation, and 
switching with no waste segregation. Section IV.B.5 presented annual 
cost estimates that have been developed for each of the six regulatory 
options. This section incorporates these assumptions and cost data to 
estimate potential economic impacts that might result from 
implementation of these regulatory options.
    The goal of the economic impact analysis is to estimate the market 
response of affected industries to the emission guidelines and to 
identify any adverse impacts that may occur as a result of the 
regulation. Industries that

[[Page 31772]]

operate onsite waste incinerators (hospitals, nursing homes, research 
labs, and commercial waste incinerators) and those that utilize offsite 
medical waste incinerators (hospitals, nursing homes, medical/dental 
laboratories, funeral homes, physicians' offices, dentist offices, 
outpatient care, freestanding blood banks, fire and rescue operations, 
and correctional facilities) will potentially be affected by the 
regulation. Industrywide impacts, including changes in market price, 
output or production, revenues, and employment for the affected 
industries, are estimated for each regulatory option assuming the three 
switching scenarios. Facility-specific impacts are estimated for 
hospitals of varying sizes, ownerships, and operating characteristics; 
nursing homes; commercial research labs; and commercial waste 
incineration based on engineering model plant cost estimates under each 
of the three switching scenarios.
1. Analytical Approach
    The analytical approach to estimate industrywide and facility 
specific economic impacts and evaluate the economic feasibility of 
switching are briefly described. For a more detailed description refer 
to docket item IV-A-9. Prices are stated at 1993 levels.
    Economic impacts for new MWI are calculated under several 
assumptions. First, the costs that are used to estimate the economic 
impacts of the NSPS include control costs from both the EG and NSPS. 
This approach is used to account for market adjustments (e.g., price, 
etc.) that would have had to occur under implementation of the EG 
first. This approach allows for the establishment of a future baseline 
scenario. Second, due to lack of information, revenue data for each of 
the affected industries were not adjusted for growth during the 5 year 
time period.
    The average price changes anticipated to occur in each industry 
sector for each of the regulatory options are estimated by comparing 
the annual control cost estimates to annual revenues for each affected 
industry. This calculation provides an indication of the magnitude of a 
price change that would occur for each industry sector to fully recover 
its annual control costs. The resulting cost-to-revenue ratio 
represents the price increase necessary on average for firms in the 
industry to recover the increased cost of environmental controls. 
Percent changes in output or production are estimated using the price 
impact estimate and a high and low estimate of the price elasticity of 
demand. Resulting changes in revenues are estimated based upon the 
estimated changes in price and output for an industry. Employment or 
labor market impacts result from decreases in the output for an 
industry and are assumed to be proportional to the estimated decrease 
in output for each industry.
    Facility-specific economic impacts are estimated by using model 
plant information under the three switching scenarios. The assumption 
of no switching (Scenario A) represents the highest cost and economic 
impact scenario for most affected industries, while the assumption of 
switching with waste segregation (Scenario B) represents the lowest 
cost and economic impact scenario for most of the affected industries. 
As previously stated, EPA considers Scenario A to be an unlikely 
scenario; therefore, the economic impacts presented under Scenarios B 
and C should be regarded as the impacts most likely to occur.
2. Industry-Wide Economic Impacts
    Industry-wide impacts include estimates of the change in market 
price for the services provided by the affected industries, the change 
in market output or production, the change in industry revenue, and the 
impact on affected labor markets in terms of full time equivalent 
workers lost. These impacts are summarized in Tables 30 and 31.

 Table 30.--Medical Waste Incineration Industry-Wide Price Impacts--New 
                        Sources Percent Increase                        
                               [Percent]<SUP>a                               
------------------------------------------------------------------------
                                   Range for regulatory options 1-6     
                             -------------------------------------------
                                              Scenario B     Scenario C 
          Industry             Scenario A     Switching      Switching  
                              No switching    with waste   with no waste
                                             segregation    segregation 
------------------------------------------------------------------------
Hospitals...................          0.05           0.01           0.03
Nursing homes...............          0.05           0.01           0.03
Laboratories:                                                           
    Research................     0.15-0.16           0.04           0.09
    Medical/dental..........  ............           0              0   
Funeral homes...............          0              0              0   
Physicians' offices.........          0              0              0   
Dentists' offices and                                                   
 clinics....................          0              0              0   
Outpatient care.............          0              0              0   
Freestanding blood banks....          0.01           0.01           0.01
Fire and rescue operations..          0              0              0   
Correctional facilities.....          0              0              0   
Commercial incineration.....          3.8            3.8            3.8 
------------------------------------------------------------------------
<SUP>aThe price increase percentages reported represent the price increase   
  necessary to recover annualized emission control costs for each       
  industry.                                                             


[[Page 31773]]



     Table 31.--Medical Waste Incineration Industry-Wide Output, Employment and Revenue Impacts--New Sources    
----------------------------------------------------------------------------------------------------------------
                                                                         Range for regulatory options 1-6       
                                                                 -----------------------------------------------
                                                                                    Scenario B      Scenario C  
                            Industry                               Scenario A No  Switching with  Switching with
                                                                     switching         waste         no waste   
                                                                                    segregation     segregation 
----------------------------------------------------------------------------------------------------------------
Hospitals:                                                                                                      
    Output decrease (%).........................................          0-0.02          0-0.01          0-0.01
    Employment decrease (FTE's).................................           0-767           0-200           0-457
    Revenue increase or (decrease) (%)..........................       0.02-0.05            0.01       0.02-0.03
Nursing homes:                                                                                                  
    Output decrease (%).........................................       0.02-0.04            0.01       0.01-0.02
    Employment decrease (FTE's).................................         260-574          74-150         168-342
    Revenue increase or (decrease) (%)..........................       0.03-0.04          0-0.01       0.01-0.02
Laboratories:                                                                                                   
  Research:                                                                                                     
    Output decrease (%).........................................       0.15-0.21       0.04-0.06       0.09-0.13
    Employment decrease (FTE's).................................         231-333           65-87         149-199
    Revenue increase or (decrease) (%)..........................        (0.05)-0        (0.01)-0        (0.03)-0
  Medical/dental:                                                                                               
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................             3-5             3-5             3-5
    Revenue increase or (decrease) (%)..........................               0               0               0
Funeral homes:                                                                                                  
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................               0               0               0
Physicians' offices:                                                                                            
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................             0-2             0-2             0-2
    Revenue increase or (decrease) (%)..........................               0               0               0
Dentists' offices and clinics:                                                                                  
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................             1-2             1-2             1-2
    Revenue increase or (decrease) (%)..........................               0               0               0
Outpatient care:                                                                                                
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................             0-1             0-1             0-1
    Revenue increase or (decrease) (%)..........................               0               0               0
Freestanding blood banks:                                                                                       
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................          0-0.01          0-0.01          0-0.01
Fire and rescue operations:                                                                                     
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................               0               0               0
Correctional facilities:                                                                                        
    Output decrease (%).........................................               0               0               0
    Employment decrease (FTE's).................................               0               0               0
    Revenue increase or (decrease) (%)..........................               0               0               0
----------------------------------------------------------------------------------------------------------------
Output decreases and full time equivalents (FTE's) employment losses as a result of the regulation are shown in 
  this table. Revenue increases and decreases are presented with decreases noted in brackets.                   

    As shown in Table 30, industries that generate medical waste (i.e., 
hospitals, nursing homes, etc.) are expected to experience average 
price increases in the range of 0.00 to 0.16 percent, depending on the 
industry, regulatory option, and scenario. Table 31 shows that these 
industries are expected to experience output and employment impacts in 
the range of 0.00 to 0.21 percent. In addition, the revenue impacts for 
these industries are expected to range from an increase of 0.05 percent 
to a decrease of 0.05 percent. An increase in industry revenue is 
expected in cases where the price elasticity of demand for an 
industry's product is less than one. A price elasticity of less than 
one indicates that the percentage decrease in output will be less than 
the percentage increase in price. Since total revenue is a product of 
price and output, a less than proportional change in output compared to 
price means that total revenue should increase.
    The following example illustrates how the above price impacts could 
be interpreted for the hospital industry. Table 30 shows that for 
hospitals, 0.03 percent is estimated as the price increase necessary to 
recover annual control costs assuming Regulatory Option 3, the most 
stringent regulatory option, and Scenario C, switching with no waste 
segregation. This change in price can be expressed in terms of the 
increased cost of hospitalization due to the regulation. The 1993 
estimate of adjusted patient days nationwide totals 304,500,000 days. 
This estimate of adjusted patient-days is based on a

[[Page 31774]]

combined estimate of in-patient and out-patient days at hospitals. The 
total annual control cost for the EG and NSPS for hospitals required to 
comply with regulatory option 3 is estimated as $101,652,807. Assuming 
that the ratio of adjusted patient-days to revenue does not 
significantly change over time, the expected average price increase for 
each hospital patient-day is expected to equal 33 cents.
    Table 30 also shows that the average price impact for the 
commercial medical waste incinerator industry is approximately a 3.8 
percent increase in price. Cost and economic impact estimates are the 
same for the commercial MWI industry regardless of the regulatory 
option analyzed because all three regulatory options specify identical 
regulatory requirements for large MWI. Average industrywide output, 
employment, and revenue impacts were not estimated for this sector 
because data such as price elasticity estimates and employment levels 
were not available.
3. Facility-Specific Economic Impacts
    Facility-specific impacts were also estimated for the affected 
industries. These estimates, presented in Tables 32 and 33, were 
calculated for the three switching scenarios. A cost as a percent of 
revenue ratio was calculated to provide an indication of the magnitude 
of the impact of the regulation on an uncontrolled facility in each 
industry sector. This calculation was then compared to the industrywide 
price impact to determine if the facility's impacts differ 
significantly from the average industrywide impacts (i.e., if there is 
greater than a 1 percent difference).

 Table 32.--Medical Waste Incineration Per Facility Impacts Assuming No 
 Switching and Onsite Incineration--New Sources Annualized Control Cost 
                     as a Percent of Revenue Budget                     
                                [Percent]                               
------------------------------------------------------------------------
                Industry                  Option 1   Option 2   Option 3
------------------------------------------------------------------------
Hospitals--Short term, excluding                                        
 psychiatric:                                                           
Federal Government                                                      
  Small                                                                 
    Urban..............................       0.36       0.36       0.41
    Rural..............................       0.36       0.36       0.41
  Medium...............................       0.33       0.49       0.49
  Large................................       0.16       0.16       0.16
State Government                                                        
  Small                                                                 
    Urban..............................       0.76       0.76       0.88
  Rural                                       0.76       0.76       0.88
  Medium...............................       0.35       0.51       0.51
  Large................................       0.09       0.09       0.09
Local Government                                                        
  Small                                                                 
    Urban..............................       1.18       1.18       1.36
    Rural..............................       1.18       1.18       1.36
  Medium...............................       0.53       0.78       0.78
  Large................................       0.12       0.12       0.12
Not-for-profit                                                          
  Small                                                                 
    Urban..............................       0.80       0.80       0.93
    Rural..............................       0.80       0.80       0.93
  Medium...............................       0.39       0.58       0.58
  Large................................       0.14       0.14       0.14
For-profit                                                              
  Small                                                                 
    Urban..............................       0.91       0.91       1.04
    Rural..............................       0.91       0.91       1.04
  Medium...............................       0.41       0.61       0.61
  Large................................       0.17       0.17       0.17
Hospitals--Psychiatric, short term and                                  
 long term:                                                             
  Small                                                                 
    Urban..............................       1.25       1.25       1.44
    Rural..............................       1.25       1.25       1.44
  Medium...............................       0.95       1.40       1.40
  Large................................       0.56       0.56       0.56
Nursing Homes:                                                          
  Tax-Paying                                                            
    Urban..............................       1.35       1.35       1.56
    Rural..............................       1.35       1.35       1.56
  Tax-exempt                                                            
    Urban..............................       1.39       1.39       1.59
    Rural..............................       1.39       1.39       1.59
Commercial research labs:                                               
    Tax-paying.........................       0.68       1.00       1.00
    Tax-exempt.........................       0.68       1.00       1.00
Commercial Incineration Facilities.....      11.82      11.82      11.82
------------------------------------------------------------------------


[[Page 31775]]



   Table 33.--Medical Waste Incineration Per Facility Impacts Assuming  
 Switching From Onsite Incineration To Commercial Disposal Alternatives 
     Alternative Waste Disposal Cost as a Percent of Revenue Budget     
                                [Percent]                               
------------------------------------------------------------------------
                                            Scenario B      Scenario C  
                                          Switching with     Switching  
                Industry                       waste       without waste
                                            segregation     segregation 
------------------------------------------------------------------------
Hospitals--Short-term, excluding                                        
 psychiatric:                                                           
Federal Government:                                                     
  Small                                                                 
    Urban...............................            0.03            0.10
    Rural...............................            0.03            0.17
  Medium                                                                
    Urban...............................            0.05            0.17
    Rural...............................            0.05            0.27
  Large                                                                 
    Urban...............................            0.08            0.29
    Rural...............................            0.09            0.47
State Government:                                                       
  Small                                                                 
    Urban...............................            0.06            0.22
    Rural...............................            0.06            0.36
  Medium                                                                
    Urban...............................            0.05            0.18
    Rural...............................            0.05            0.29
  Large                                                                 
    Urban...............................            0.05            0.16
    Rural...............................            0.05            0.27
Local Government:                                                       
  Small                                                                 
    Urban...............................            0.09            0.34
    Rural...............................            0.10            0.56
  Medium                                                                
    Urban...............................            0.07            0.27
    Rural...............................            0.08            0.44
  Large                                                                 
    Urban...............................            0.06            0.22
    Rural...............................            0.06            0.36
Not-for-profit:                                                         
  Small                                                                 
    Urban...............................            0.06            0.23
    Rural...............................            0.07            0.38
  Medium                                                                
    Urban...............................            0.05            0.20
    Rural...............................            0.06            0.32
  Large                                                                 
    Urban...............................            0.07            0.25
    Rural...............................            0.07            0.41
For-profit:                                                             
  Small                                                                 
    Urban...............................            0.07            0.26
    Rural...............................            0.08            0.43
  Medium                                                                
    Urban...............................            0.06            0.21
    Rural...............................            0.06            0.34
  Large                                                                 
    Urban...............................            0.09            0.32
    Rural...............................            0.09            0.52
Hospitals--Psychiatric, short-term and                                  
 long-term:                                                             
  Small                                                                 
    Urban...............................            0.10            0.36
    Rural...............................            0.11            0.59
  Medium                                                                
    Urban...............................            0.13            0.48
    Rural...............................            0.14            0.78
  Large                                                                 
    Urban...............................            0.29            1.05
    Rural...............................            0.31            1.70
Nursing homes:                                                          
  Tax-paying                                                            
    Urban...............................            0.11            0.39
    Rural...............................            0.11            0.64
  Tax-exempt                                                            
    Urban...............................            0.11            0.40

[[Page 31776]]

                                                                        
    Rural...............................            0.12            0.65
Commercial research labs:                                               
  Tax-paying                                                            
    Urban...............................            0.09            0.34
    Rural...............................            0.10            0.56
  Tax-exempt                                                            
    Urban...............................            0.09            0.34
    Rural...............................            0.10            0.56
------------------------------------------------------------------------


    Tables 32 and 33 show that facilities with onsite MWI that are 
currently uncontrolled may experience impacts ranging from 0.03 to 1.59 
percent, depending on the industry, regulatory option, and scenario. A 
comparison of the economic impacts expected to occur under the three 
switching scenarios, presented in Tables 32 and 33, indicates that the 
option of switching will be attractive to some facilities that might 
have considered operating an onsite incinerator in the absence of this 
regulation. For many of these facilities, the economic impacts of 
switching to an alternative method of waste disposal are much lower 
than the economic impacts of choosing to install emission control 
equipment. The decision to switch to an alternative method of medical 
waste disposal should preclude any facilities from experiencing a 
significant economic impact. These results support EPA's assertion that 
implementation of the regulation will likely result in either Scenarios 
B or C and that the costs and economic impacts of Scenario A are 
unlikely to occur.
    Table 34 shows the impacts that would be incurred by medical waste 
generators that currently use an offsite medical waste incineration 
service. These impacts range from 0.00 to 0.02 percent and are 
considered negligible impacts. These results indicate that the 
incremental cost for the vast majority of medical waste generators are 
expected to be small.

  Table 34.--Medical Waste Incineration Per Facility Impacts for Firms  
 That Utilize Offsite Waste Incineration--New Sources Incremental Annual
                   Cost as a Percent of Revenue/Budget                  
                                [Percent]                               
------------------------------------------------------------------------
                                                             Incremental
                                                             annual cost
                          Industry                               as a   
                                                              percent of
                                                               revenue  
------------------------------------------------------------------------
Hospitals:                                                              
    <50 Beds...............................................       0-0.01
    50-99 Beds.............................................       0-0.01
    100-299 Beds...........................................       0-0.01
    300 + Beds.............................................       0-0.01
Nursing homes:                                                          
  0-19 Employees                                                        
    Tax-paying.............................................            0
    Tax-exempt.............................................            0
  20-99 Employees                                                       
    Tax-paying.............................................       0-0.01
    Tax-exempt.............................................       0-0.01
  100 + Employees                                                       
    Tax-paying.............................................            0
    Tax-exempt.............................................            0
Commercial research labs:                                               
  Tax-paying                                                            
    0-19 Employees.........................................            0
    20-99 Employees........................................            0
    100 + Employees........................................            0
    Tax-exempt.............................................            0
Outpatient care clinics:                                                
  Physicians' clinics (Amb. Care)                                       
    Tax-paying.............................................       0-0.01
    Tax-exempt.............................................       0-0.01
Freestanding kidney dialysis facilities                                 
    Tax-paying.............................................       0-0.01
    Tax-exempt.............................................       0-0.01
Physicians' offices........................................            0
Dentists' offices and clinics:                                          
    Offices................................................            0
  Clinics                                                               
    Tax-paying.............................................            0
    Tax-exempt.............................................            0
Medical & dental labs:                                                  
    Medical................................................       0-0.01
    Dental.................................................       0-0.01
Freestanding blood banks...................................    0.01-0.02
Funeral homes..............................................            0
Fire & Rescue..............................................            0
Corrections:                                                            
    Federal Government.....................................            0
    State Government.......................................            0
    Local Government.......................................            0
------------------------------------------------------------------------

    Table 33 also presents price impact estimates for the commercial 
medical waste incinerator sector. The analysis shows that a new medical 
waste incinerator required to meet any of the regulatory options would 
need to increase its prices by approximately 11.82 percent in order to 
recoup its control costs. The large difference between the facility-
specific price increase compared to the industry-wide price increase 
(3.8 percent) for this industry suggests that it is unlikely that a new 
commercial MWI would be able to increase the price of its service by 
11.82 percent.
    Although a ``switching'' analysis was not developed for the 
commercial MWI sector, recent trends in the medical waste treatment and 
disposal industry suggest that the concept of switching may also be 
applicable to the commercial MWI sector. A company in this industry 
that might have decided to open a new incinerator may reconsider the 
option of opening an alternative

[[Page 31777]]

technology, such as autoclaving. These alternative technologies will 
seem more attractive from a cost perspective due to the requirements 
that regulation places on new MWI. Therefore, some companies in this 
industry will have an incentive to choose to open an alternative 
treatment unit, such as an autoclave unit. Some companies in the 
medical waste treatment and disposal industry have already begun to 
make these ``switching'' decisions. Since companies in this industry 
have demonstrated the ability to operate various types of medical waste 
treatment and disposal units, the option of ``switching'' should be 
seen as a viable alternative for commercial MWI operators.
    This economic impact section examines possible economic impacts 
that may occur in industries that will be directly affected by this 
regulation. Therefore, the analysis includes an examination of 
industries that generate medical waste or dispose medical waste. 
Secondary impacts such as subsequent impacts on air pollution device 
vendors and MWI vendors are not estimated due to data limitations. Air 
pollution device vendors are expected to experience an increase in 
demand for their products due to the regulation. This regulation is 
also expected to increase demand for commercial MWI services. However, 
due to economies of scale, this regulation is expected to shift demand 
from smaller incinerators to larger incinerators. Therefore, small MWI 
vendors may be adversely affected by the regulation. Lack of data on 
the above effects prevents quantification of the economic impacts on 
these secondary sectors.

V. Inclinations for Final Rule

    At various points throughout this notice, EPA has indicated 
``inclinations'' regarding the final regulations for MWI, based on the 
new information and revised analyses now available. For example, as 
discussed in Section II of this notice, EPA is inclined to: 
subcategorize MWI by size rather than by type, where judged appropriate 
in the final regulations; adopt the NYSDOH definition of medical waste 
for the purpose of determining what incinerators the final regulations 
apply to; determine compliance with the final regulations using 
parameter monitoring and routine inspection/maintenance rather than 
CEMS; defer to the States the judgement of what constitutes an 
acceptable operator training program; and develop a separate regulation 
for medical waste ``pyrolysis'' units. In this final section, EPA 
inclinations regarding the regulatory options outlined earlier are 
discussed.
    A note of caution should be observed and kept in mind by the 
reader, however, with regard to these EPA inclinations. These 
``inclinations'' should not be viewed as final or, for that matter, 
even tentative EPA decisions. All options discussed in this notice and 
any additional options which may arise from further public comment will 
be considered in developing the final standards and guidelines for MWI. 
The primary purpose of these inclinations is to solicit public comment.
    It is also important to reiterate some additional points. First, as 
mentioned earlier, all of the information and analyses reviewed in this 
notice, particularly the discussions below with their focus on air 
pollution control technology, are often misunderstood and lead some to 
assume that the final regulations will require the use of a specific 
air pollution control technology--this is not the case. The final 
regulations must be based upon the performance capabilities of air 
pollution control technology; as a result, EPA assesses air pollution 
control technologies and draws conclusions regarding their performance 
capabilities. These conclusions regarding performance capabilities take 
the form of emission limits which could be achieved through the use of 
the various air pollution control technologies. This approach permits 
EPA to identify and consider the different options for the regulations, 
in terms of emission limits.
    The final regulations will not require use of any specific air 
pollution control technology. The final regulations will include 
emission limits (i.e., concentration levels in the gases released to 
the atmosphere) for specific air pollutants (e.g., hydrogen chloride, 
lead, etc.) that an MWI must achieve. The decision on how to meet these 
emission limits is left to the MWI owner or operator; an owner or 
operator may select any equipment or any means available to comply with 
these emission limits.
    Second, as also mentioned earlier, Section 129 of the Clean Air Act 
directs EPA to develop regulations for MWI which are based on maximum 
achievable control technology (MACT). Section 129 defines MACT as the 
maximum reduction in emissions which is achievable, considering cost, 
environmental, and energy impacts. Section 129 also states, however, 
that for new MWI MACT can be no less stringent than the best similar 
MWI and for existing MWI MACT can be no less stringent than the best 12 
percent of existing MWI. These minimum stringency requirements for the 
standards (new MWI) and the guidelines (existing MWI) are referred to 
as the MACT ``floors.'' The emission limits in the final regulations 
can be no less stringent than the MACT floor emission limits.
    Finally, the MACT floors are only the starting point for 
determining MACT. Since MACT is the maximum reduction in air pollution 
emissions that is achievable, considering cost, environmental, and 
energy impacts, if more stringent emission limits than the MACT floor 
are achievable, EPA must identify these more stringent emission limits 
and consider them in selecting the MACT emission limits for the final 
regulations.

A. New MWI

    As discussed in Section IV, the MACT floor for large new MWI 
appears to require the use of good combustion and a combined dry/wet 
scrubber with activated carbon. There is no air pollution control 
technology which could achieve lower emissions than this system. 
Consequently, EPA is inclined to establish emission limitations for 
large new MWI based on good combustion and a combined dry/wet scrubber 
system with activated carbon (i.e., the MACT floor).
    For medium new MWI, the MACT floor appears to require the use of 
good combustion and a combined dry/wet scrubber system without 
activated carbon. In this case, one regulatory option more stringent 
than the MACT floor would reflect the addition of activated carbon to 
the combined dry/wet scrubber system. On a national basis, because of 
switching to the use of alternative means of medical waste disposal, 
the addition of activated carbon results in a negligible cost increase. 
Where a typical medium new MWI was constructed, the addition of 
activated carbon would reduce emissions of dioxin and would increase 
air pollution control costs by less than 4 percent. As a result, EPA is 
inclined to establish emission limitations for medium new MWI based on 
good combustion and a combined dry/wet scrubber system with activated 
carbon (i.e., more stringent than the MACT floor).
    For small new MWI, four small existing MWI have been identified 
which currently operate with good combustion and moderate efficiency 
wet scrubbers; therefore, the MACT floor appears to require the use of 
good combustion and a moderate efficiency wet scrubber. Consideration 
of the impact of this MACT floor indicates that few new small MWI are 
likely to be

[[Page 31778]]

constructed due to the substantial increase in the cost of a new small 
MWI as a result of the moderate efficiency wet scrubber and the 
availability of switching to an alternative means of medical waste 
disposal.
    One regulatory option more stringent than this MACT floor would 
reflect the use of good combustion and a high efficiency wet scrubber. 
Consideration of this option indicates that the nationwide impacts 
would be negligible, primarily because few new small MWI would be 
constructed (i.e., because of switching to alternative means of medical 
waste disposal). Where a typical new small MWI was constructed, 
however, the high efficiency wet scrubber would only reduce PM 
emissions by a small amount and would increase air pollution control 
costs by about 15 percent. As a result, EPA is inclined to establish 
emission limitations for small new MWI based on the use of good 
combustion and a moderate efficiency wet scrubber (i.e., the MACT 
floor).

B. Existing MWI

    As discussed in Section III, the MACT floor for large existing MWI 
appears to require the use of good combustion and a high efficiency wet 
scrubber. One regulatory option more stringent than this MACT floor is 
the use of dry scrubbers with activated carbon. However, a dry scrubber 
typically costs much more than a high efficiency wet scrubber, and a 
dry scrubber with activated carbon would result in only a very small 
additional reduction in dioxin, Pb, and Cd emissions. For large 
existing MWI already equipped with wet scrubbers, replacing a wet 
scrubber with a dry scrubber would be exorbitantly expensive. As a 
result, EPA is inclined to establish emission limitations for large 
existing MWI based on the use of good combustion and a high efficiency 
wet scrubber (i.e., the MACT floor). As discussed in Section III, these 
emission limitations could also be achieved using a dry scrubber with 
activated carbon.
    For medium existing MWI, the MACT floor appears to require the use 
of good combustion and a moderate efficiency wet scrubber. One 
regulatory option more stringent than this MACT floor would reflect the 
use of good combustion and a high efficiency wet scrubber. On a nation-
wide basis, while this more stringent option would result in a 
relatively small cost increase, it would also result in only a small 
decrease in PM emissions. For a typical medium MWI that installed or 
upgraded an existing wet scrubber to a high efficiency wet scrubber, 
air pollution control costs would increase by about 15 to 25 percent. 
As a result, EPA is inclined to establish emission limitations for 
medium existing MWI based on the use of good combustion and a moderate 
efficiency wet scrubber (i.e., the MACT floor). As mentioned above and 
in Section III, these emission limitations could also be achieved using 
a dry scrubber with activated carbon.
    For small existing MWI, the MACT floor appears to require the use 
of good combustion; add-on air pollution control would not be needed to 
meet the MACT floor. One regulatory option more stringent than this 
MACT floor would reflect the use of good combustion and a low 
efficiency wet scrubber. Consideration of this option, as well as other 
options outlined below, is the subject of the remainder of this 
section. At this point, EPA has no inclination, but solicits comment on 
the options available.
    If the guidelines for small existing MWI were established based on 
the use of good combustion and wet scrubbing, the analysis indicates 
that almost all healthcare facilities operating small MWI would switch 
to the use of alternative means of medical waste disposal. From a 
national perspective, this would minimize emissions of PM, dioxin, acid 
gases, and metals from small existing MWI at a relatively low cost 
because of switching. For most healthcare facilities using small 
existing MWI, the cost of switching to the use of alternative means of 
medical waste disposal would be negligible. On this basis, one might 
argue that EPA should establish emission guidelines for small existing 
MWI based on the use of good combustion and wet scrubbers.
    On the other hand, if a healthcare facility chooses to install a 
wet scrubbing system on its small existing MWI, the cost of waste 
disposal at this facility would more than double and the emission 
reduction achieved would be relatively small. The wet scrubber-based 
option would effectively preclude continued use of the MWI, whereas 
guidelines based on the use of good combustion alone would permit many 
healthcare facilities with small MWI to continue to use these MWI, 
preserving incineration as a viable medical waste disposal option for 
these healthcare facilities. On this basis, one might argue that EPA 
should establish emission guidelines for small existing MWI based on 
the use of good combustion alone.
    As mentioned earlier in this notice, some commenters expressed 
concern about the availability and/or the cost of alternative means of 
medical waste disposal to healthcare facilities located in remote or 
rural locations. In this case, the conclusion that costs would be 
negligible because of switching would be incorrect, and such a facility 
could be faced with adverse impacts. The availability and/or cost of 
alternative means of medical waste disposal in urban areas, however, 
does not appear to be an issue. Competition among commercial medical 
waste disposal services, formation of healthcare facilities into groups 
for the purpose of leading commercial disposal services to bid for 
waste disposal contracts, as well as other forms of cooperation among 
healthcare facilities in urban areas appears to ensure that alternative 
means of medical waste disposal are readily available at reasonable 
costs to healthcare facilities in urban areas.
    This consideration of the potential difference in the availability 
and/or cost of alternative means of medical waste disposal to 
healthcare facilities located in rural or urban areas leads to 
additional regulatory options. Small existing MWI could be 
subcategorized into those located in urban areas and those located in 
rural areas.
    As mentioned, the MACT floor for small existing MWI only appears to 
require the use of good combustion; it does not appear to require the 
use of good combustion and a wet scrubber. The guideline for small 
existing MWI located in urban areas could be based on the use of good 
combustion and a low efficiency wet scrubber (i.e, beyond the MACT 
floor). The guideline for small existing MWI located in rural areas, 
however, could be based on the use of good combustion alone (i.e., the 
MACT floor). On the other hand, the guideline for small existing MWI 
located in rural areas could be based on the use of good combustion and 
low efficiency wet scrubbers (i.e., beyond the MACT floor), but 
permit--on a case by case basis--a healthcare facility which met 
certain criteria to comply with a guideline based on the use of good 
combustion alone (i.e., the MACT floor).
    These options of differing requirements for small existing MWI in 
urban and rural areas were examined in a broad sense under Regulatory 
Option 2, which would establish emission limitations based on good 
combustion alone in rural areas, but establish emission limitations 
based on good combustion and wet scrubbers in urban areas. The 
difference between these two options is that the second option would 
establish a set of criteria (much more comprehensive than simply 
``rural location'') to permit a small existing MWI in a rural location 
to comply with requirements based on the use of good combustion alone.

[[Page 31779]]

    The attractiveness of this second option is that it would appear to 
minimize emissions from small existing MWI (urban or rural) while 
providing relief--on a case by case basis--for those few small MWI 
located in rural areas where the impacts of compliance might be 
particularly severe due to the limited availability of alternative 
means of medical waste disposal. The EPA, therefore, solicits comment 
on the following options:
    (1) Guidelines for small existing MWI located in both urban and 
rural areas based on the use of good combustion alone;
    (2) Guidelines for small existing MWI located in urban areas based 
on the use of good combustion and wet scrubbing, and guidelines for 
small existing MWI located in rural areas based on the use of good 
combustion alone;
    (3) Guidelines for small existing MWI located in urban and rural 
areas based on the use of good combustion and wet scrubbers, but with 
the guidelines permitting small existing MWI located in rural areas to 
meet requirements based on the use of good combustion alone, provided 
these MWI meet certain criteria; and
    (4) Guidelines for small existing MWI in both urban and rural areas 
based on the use of good combustion and wet scrubbers.
    As mentioned above, EPA has no inclination with regard to the 
guidelines for small existing MWI. Each of the options outlined above 
merits serious consideration. Since the option outlined above with 
criteria for small existing MWI located in rural areas to meet 
requirements--on a case by case basis--based on the use of good 
combustion alone would seem to achieve the environmental benefits, but 
avoid the cost impacts, of the most stringent option, EPA specifically 
solicits comment on what the criteria associated with this option might 
be.
    For example, these criteria might include: location with respect to 
an Metropolitan Statistical Area [MSA] (i.e., either outside an MSA or 
more than a specified number of miles from an MSA); location with 
respect to a commercial waste disposal company or a vendor of 
alternative treatment technology; some other measure of the lack of 
alternative disposal options; some measure of economic impact of 
switching waste disposal methods or some other reason why switching 
would not be possible; etc. The criteria could also be structured to 
allow good combustion alone only where a healthcare facility generates 
less than some very small amount of medical waste on a daily or weekly 
basis.

List of Subjects in 40 CFR Part 60

    Air pollution control, New source performance standards, Emission 
guidelines, Medical waste incinerators.

    Dated: June 12, 1996.
Mary D. Nichols,
Assistant Administrator for Air and Radiation.
[FR Doc. 96-15585 Filed 6-19-96; 8:45 am]
BILLING CODE 6560-50-P