NCD980602163_20020815_Warren County PCB Landfill_SERB C_EPA ID Numbers for Warren Co. PCB Landfill-OCR

Pat Backus
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 20460
State of North Carolina
NCDENR-Division of Waste Management
401 Oberlin Road -Suite 150
Raleigh, NC 27605
OFFICE OF
PREVENTION, PESTICIDES AND
TOXIC SUBSTANCES
August 15 , 2002
This is to notify you that the Environmental Protection Agency has received your
request to either modify the entry or remove the facility from the PCB Activity Database
System (PADS). EPA has taken the following action (as indicated by an "X") to
respond to your request:
X The modification you requested has been made; this is your confirmation.
(Reference# 6875)
A code has been inserted in the database to indicate that your company notified
and subsequently requested withdrawal of the notification. This letter serves as
your confirmation. (Reference # ____ )
Other (explanation provided).
If you have any questions regarding the PCB Waste Handler's database, please
contact Laura Casey at [phone].
s~
,.,.
Tony Baney, Chief
Fibers & Organics Branch
Internet Address (URL) • http://www.epa.gov
Recycled/Recyclable• Printed with Vegetable Oil Based Inks on Recycled Paper (Minimum 30% Postconsumer)
J
North Carolina
Department of Environment and Natural Resources &~
Division of Waste Management
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Dexter R. Matthews, Director
June 27, 2002
Ms. Laura Casey
U.S. Environmental Protection Agency
1200 Pennsylvania Ave., NW
Washington, DC 20460-0001
Dear Ms. Casey:
_ .. ,.
,a ,,;,,, ___ _
NCDENR
Via Fax to [phone] and USPS
The Fibers and Organics Branch issued the State of North Carolina TSCA identification number
NCWO00000l 82 for the Warren County PCB Landfill (letter reference number 6875). We also
requested and received from the Hazardous Waste Section of our division a RCRA identification
number. The number issued was NCR000137802. EPA Form 8700-12 is attached as reference.
By this letter and previous fax, I am requesting that you consolidate these numbers.
If you have any questions, please contact me at [phone] ext. 308.
Sincerely,
Patricia M . Backus, P.E.
PCB Landfill Project Manager
Enclosure
cc: Jim Edwards, NCDENR -DWM
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone: [phone] \ FAX: [phone] \ Internet: www.enr.state.nc.us
AN EQUAL OPPORTUNITY\ AFFIRMATIVE ACTION EMPLOYER-50% RECYCLED/ 10% POST CONSUMER PAPER
Please print or type with ELITE type (12 characters per Inch) In the unshaded areas only
~~~f= -_ -~--: ~~-9.~ifi~~ti011 ~f •~e_gulated
tcom,1,u"' 1111• form. TIit . .. . . Waste.Act1v1+u lftformttlo" r911uHlld IIIN II ft EA~-s ·, : .... _. . . , . ~, ,...._.d lly In' (ltctlon SOIO of ~~ . _ . ~ · ,. • . . .. _ . .. • . . . . .
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1. lnstaHetlon'• EPA ID Number ,(,V•rlr r In fhuppn,prut.bolr) --:-:! -• ,. • . ,~ • II,;---.. ..,,.
Date Recelv.d
(For Offlclal Uae Only)
□ a. SubHquenfNotlftcatlon : . , :, 'C;Jnatallatlon'a EPA ID Number
lnttialNotfflcatlon (Com 1 ......... .,.1 .,; •• : · •.. : ,.1 0 I 3 1 lo j · P •-, .. m ~1 ·" ,_ . : • ,v C "-0 0 O I 7 o O :L
P e 13 L A All D f;j I L L I
111. Location of lnstallatlon {Physical •dd,.N not P.O. Box or Rout, Nuinl»r)
5IRI 1 IG, o 41 Rio AD I
I I I I I I I I I
City or Town State Zip Code -
All= IT O IN' I I I I I
COUntyCode County Name
I I wlAIR.1 R!& tJI I I ~L
IV. lnstallatlon Malllng Addreaa (SH ln1tructlon1) ~•-~ -~,:;.:
Street or P.O. Box
410 11 lo A EIR Li, IN'I R.oAt:>_ s u I lT E I 5 0 I
J
City or Town State Zip Code
I I I I
V. lnatallatlon Contact (Person to b• cont.acted ,.gard/ng wa.t• ■r:tMti•• •t •It•)
Name (u1t) (First)
81 A I e. KI v s I I I I P A r I I
Job Title Phone Number (ArN Cod• •nd Numb#j
p I c..18 IL ,-= I p R.. I O I J I 111 G-(< q I 9 -7 3 J 3 -~ 'r 9 ~
A. Contact Add,.u rr Fvr B. StrNt or P.O. Box
I I I I I I
City or Town State --. Zip Code '
I I I I I I I I I
A. Name of-ln1tal11tlon'1 L-.gill OWner · ~ -~:>.:::~--
C. A I~ 0 L. I lN A I
Street, P.O. Box, or Route Number ·;• -· ··
41 ol I Io A EIR. LI, Lvl ROAD su,ITE ISO I
City or Town ._· ·· . · '· · State Zip Code
EPA Form 8700.12 (Rev.12/99) -1of2-
,1e111 print or type with IL.ITI type (11 ohlr1ott11 par lnoh) ii the ur111\ai1i 1re11 only -----------------... ID • 111.1, )fflcltl Uat Onlw -------------~'---~'~I I I I VIII, Type of Rt;ul1ttd W11t1 Activity (M1rt ,t' In tlt1 app,op,f,ft bona. ltmr to lnlfNoflontJ J ,;_;.,:, ~.;~:. ., · · ·:.:, . <:-0•
A. Huardoua WHtt ActMtlll C. U11d 011 Man1;tmtnt Act1Vltl11
1 •. Gtntrator (Stt ln1tructlon1) 6a a. Ort1ttr thin 1000kg/mo (2,200 Iba.)
0
0 b.100 to 1000 kg/mo (220·2,200 Iba.)
c. Le11 than 100 kg/mo (220 Iba)
2. Transporter (lndlc1tt Mode In boxe1
1°5 btlow)
B a. For own waate onty
b. For commercl1I purpou1
Mod• of Transportation
~ 1.Alr
,2. Rall
3.Hlghw■y
4. Water 0 !.Other••peclfy
I I
oa. Tr11ttr, ltorer, ·011po11r (It
lnatallatlon) Hott: A permit la
required for thla activity, He
lnatructlon1.
•· Exempt Boller arid/or lnduatrtal
Fumace O a. Smelting, Mtltln;, 1nd Rtfln-
lng Fumace Exemption 0 b. Small Quantity On-Sita Bu mer
Exemption oa. Underground Injection Control
1. Und OIi Tran1porterrrran1far
Faclllty • Indicate l)'pt(t) of .
Acttvlty(IH)
B a. Tranaporttr
b. Transfer Faclltty
2. UHd 011 Proce11or/R .. ,.ftner•
tndlcatt Type(a) of Actlvlty(IH)
B a. Proceaaor
b. R .. reflntr 0 3. Of'f•Sptclncatlon UHd 011 Bumer
,&, UHd 011 Futl Marketer D a. Marketer Who t>lrtcta Shipment
of Off-Sptclflcatlon Uatd 011 to
Uatd 011 Burner D b. Marketer Who First Clalma the
Uatd 011 Metta tht
Speclflcatlona
a. Unlveraal Waste Activity
0 Large Quantity Handler of Unlvtraal W11te
IX. Description of Hazardous Wastes (U•• 1ddltlon1/ •h••ta lfn,c. ... ry} :-;;~ _;..;>:~'::.£; :·:":~u:.·: :.-
A. Listed Hazardous Wastes. (See 40 CFR 261.31 • 33; lilff lllfflVction• If you nHd lo lilt mo,. thin 12 nm cod••.)
1 2 3 4 5 e
I I I I I I I I I I I I I I I I I I
7 8 I 10 11 12
I I I I I I I I I I I I I I I
B. Characteristics of Non listed Hazardous Wastea. (M11rlc X' In th• boxe, corre•pondlng to tht ch,,.cterlatica of
nonll•t•d hu11rdou1 w111tu your lnmllatlon handle,; 8H 40 CFR Part. 261.20 • 261.24; S.• ln■tructlon• If you n11d
to 11'1 mo,. than , toxicity ch11,.cterl11tlc nm code,,)
I
(List apedflc EPA haurdoiia wute number(•) for the ToxlcltyChll1"1ct1rtstlc contaml1111nt(1)) 'E!" ·~r 'Er c::15rr,,1 I i I I I I i I I I I i I I -I ..,....I .....,....i--,-1-I
C. Other Wastes. (Stllt...,.gu/at.d or other ,nat11 ,.quiring • handler to h•v• an LD. number; SH lnatnx:tlon•.J
I,---, -, 1 ------,' I I I i2 , 1.1 1 i 1 11 i----,.. 1 ----.--r ............-41 1-11-----,-, ----.--i ............-41 I =1, =i =, I
X. Certlflcatlori
I certify under penalty of law that thla document and all attachment, were prepared under my direction or 1upervl1lon In accordance with
• 1y1tem designed to 111ure that qualified personnel properly gather and 1valuat1 the Information 1ubmltt1d. Bued on my Inquiry of
the person or p1r1on1 who manage the 1y1t1m, or thou per1on1 directly reapon1lbl1 for gathering the Information, the Information
1ubmltted i1, to th• but of my knowledge end belief, true, accurate, and complete. I am aware that there are 1lgnlflcanl penaltlH for
aubmlttlng fain Information, Including the poulblllty of fine and lmprl1onment for knowing vlolatlona.
Signature
-))ah._·~_,/ Ji1 . Jg/( C ~ -r,Name and Official Title (Type or print)
,-t:Lr,.,ic,..._ M. Ba.ck.us P,€.
N r DEJJ R. -Dw M Pt.13 LP-Pr-.: ;~tf MAA,
Date Signed
fe/4/c2-
PCB Ac.t-~vi ty ~-t-L.c..,,,c ('; (I r~j .... la.t-~d by rhe r:-; bar;$ a,-.<i Or.:i«.-•0L<::, a..--....... ct. oP EPA'.... o+r.·c.~ o-f' Pollu.+-i·~.-. Preve.r,+.'-a.Yid -ro,L,'c.s
Note: Mall completed form to the approprlile EPA Re.glonal or-State Office: {Ste S•ction IV ofth• booklet for addreuH.}
EPA Fenn 8700-12 (Rev. 12/99) -2of2-
I of3
https:/ /rtnccisland.rtpnc.epa.gov/rcrainf. .. D _ NOTIF _ ADDUPD.ASP?nxtcmd=update&source=N
Notification Form
To save history for the Installation Name or Activity Information you MUST CHANGE the Received Date.
! Source oflnfonnation: N -Notification ······················~l"' .. '> Received Date: : 6/4/200 v
I Non-notifier: r····--···----------------·--···········•·w·······················.•.·.·.·.·.·--············----··--····--····------------------------··--··----·····----···----a u Extract to Public I Send Acknowledgement: LJ
............ w····-.• .. ·· .................... ·.·•·•········ ...... w ... w ................................................................................... ,. ...................................... w..,. ...... ,. ............................... _ .. ·--~·,
i EPA ID: j NCR000137802 •·•·•1•····:::·:;;::;;:~:, ;~ .. , ~:~:~:1··:··~ci,6.666·6·g
; !
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........................................................... ___ ........................... "-............................................ ..._ ....................... , ..... ---............................................................................................................................................................................................................................................................ " .......................... ..
lNumber: CJ
! County: • WARREN-NC185 ·············0 State District:
Number: j Lili] StreetorP.O.Box: I ·--··o_·"i_~··E_·RL_·.·.··_r-N_······_ ... R_D ________ .... ·1
l Street or P.O. Box: •~ :'--•· ·_•.•.•.•_.•.•.•_.•.•.•._•.•.•._•.•.•.•_.•.•.•_·······_•.•. _____ .•_······_·······_·.·.·._·······_······_······· .... 1
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City: Zip code: I (z"'flfos·· ·······1
06/05/2002 10:24 AM
,
2 of3
! Owner
!No.: 1
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Street or P.O. Box: :···················································································'j
Name ofLegal Owner: :: STATE OF NORTH CAROLINA .............. ·.·········'l
Street or P.O. Box:
...................... ·.············.·.·.·.··.·.·.·.·.·.·.·.·.·.·.·.·.·.-.•·.·.·.•.·.·.·.·.·.··.•.··.·.·.-.···w.·.• _. .• , .......... .,
!1&1~:-i1r li!!iJ.isii.9Jljl:li~ii~~~v.~l~i:i1iiii:iijj~~Ytiti~~,iti:iiMiiMl!fflifllmG1:l1 iili~i¢i::o~i:
Type Federally Regulated
! I.Generator
!I
Stat
Regul
! 2. Transporter
~:,,:·~ Fl -~~~ -==:B_-4-2
Description: ·········· ..... ····· ..... ···· ................. ·.·.· ....... ·.·.·.·.·.··. ········································································· ..... ················0 t··········· · .... .....
i,,~ .................... , .... ,, ....................... "" ........ , .......... , .. , .. , .................... , .............. , ........ ._. .. ,....................................................... .. ........................................................................ """" .. """._ ...... " ................................................................ ,1 ...................... , .................................................... ::::::::::::::::.::--1:~ .................................. ..
Mode of Transportation: Cl Air u Rail Cl Highway u Water Other: r······· ____ ....
~ •• ._.__...........,."..,...""""""".......,.....,._" .. ..............,•----. ........ .,,......,. ...... ""••----------"" .. """"""" .... ""'" ......................... ....,.. .................... www _____ _
\ 3. Treater, Storer, Disposer
06/05/2002 10:24 AM
https://rtnccisland.rtpnc.epa.gov/rcrainf ... D _ NOTIF _ ADDUPD.ASP?nxtcmd=update&source=N
..
Description:
j 5. Other Activity(ies) 0 Underground Injection Control
r"'"'"""""'"'"'""---~-;:;:--~:"""'"'""""=--------w -------------""""'""'""·---"""""""""""""""" _______________________________ "':'.'.:'.'.'.'.'.::.
: ......................................................... , ___ ......................................................................................................................................................................... , ..... ---.. --................................ , ................................................................................................. ,. ................................................................................. ..
1. Used Oil Fuel Marketer
LJ Marketer Directs Shipment of Used Oil to Off-Specification Burner
LJ Marketer Who First Claims the Used Oil Meets the Specifications
2. Used Oil Transporter Activity [ r·· . .... ... .. ......... .......... .. . .... . . .. . .. w ·13
; ....................................................................................................................................................................................................................................................................................................... _ .... ._._ ......................................................................................................................................................................................................... ..
l-~~--~~--~~--~-:::~~::~:::_~-:~~-:~~-------------w _::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~@ __________________________________________________________________________________________ _
! 4. Off-Specification Used Oil Burner I CJ
! ................................................................................................................................................................................................... · ............................ " .................................................................................................................................................................................................................................................................................................. .
(Pc'it·LANiiFiii···REGULATEri' .. BY···rFoii\" .. EPA;·s··"c5FFici···oif".FiBERS···i···oRGANiCs" ················9
: BRANCH OF POLUTION PREVENTION & TOXICANS -(TSCA) B
URL: /Handler/HAND_ notif _ addupd.asp
3 of3 06/05/2002 10:24 AM
Please print or type with ELITE type (12 characters per inch) in the unshaded areas only Fonn ~. 0MB No. 205<>-0028 ~• 12131/02
GSA No. 0246-EPA-OT
:::-:.:.:.~~ ~Notificatlon :of ·Re ulated
EPA Form 1700-12 IHfore · :· · '·' · •·:· : ' · . ·• ·· __ g
completlng thll form. Th• . . . . . .. • • Waste Act1v1ty
Information requHted hare 11 · ft E-. A~-' . •· · ·, · · · requlrad by law (Section 3010 ol ~ . . . • . ··-. --.
. -R-~ _, ,,.,. · · •· ... _ Unlted·StatesEnvlronm,mtal Protection:A,gency . Reoowty.Aot), ·;·: ---:· .;····· •. , . ', ... ,. . -«,:: .. ,c,·"' . .
I. lnatallatlon's EPA ID Number-(Af•rlr 'X'ln th• approprl•t•'tiox.)
Q-lnltlal Notification □ B. Subsequent Notification .
(Complete ltemCJ ._ •.
II. Name of lnstallatlon_.(lnclude:comp•ny •nd spec/fit:slte narrie}
Ill. Location of Installation (Physical •ddrwu not P.O. Box or Route Niiin~r)
Street
Street (Continued)
City or Town
County Code County Name
IV. Installation MaUlng Address (See lnstructlo_n•J
Street or P .0. Box
City or Town
State Zip Code ,
State Zip Code
V. Installation Contact (Person to be contacted regarding waste actlvltlH •t •lte)
Name (La•t) (First)
Job Tltle
VI. Installation Contact Address (S.e ln•tructlon•J
A. Contact Add,.u
Location Malling B. Street or P.O. Box
City or Town
VII. Ownership (See ln•tructlons
Street, P.O. Box, or'RoutaNuinber ·,_·,
City or Town State Zip Code
Date Received
(For Official Use Only)
'' '■:iandTypi ~ t•e;•~r'l'ype -' D. C"f~:.°~~r
-~-~~-...... --~-..----.---.-L--.---.---f _..,..........,..........,...---,;,.__._~....,.......---;.--Yu No
EPA Form 8700-12 (Rev. 12199) -1of2-
FIIHH print or typo with U.IU typo (12 char1ct1r1 per Inch) In lht un1h1d1ct 1rt11 only
VIII. Type of Regulated W11te Activity (M•rlt ~ In fllt 1pp,oprl1te boMH. tt,,_, to lnnvotlona)
A. Huardoua W11te ActlvltlH
1. Generator (SH lnetructlona) D a. GrHter than 1000kg/mo (2,200 Iba.)
D b.100 to 1000 kg/mo (220-2,200 Iba.) D c. Le11 than 100 kg/mo (220 Iba)
2. Tranaporter (Indicate Mode In boxH
1-5 below) D a. For own w11t• only D b. For commercial purpoaH
Mode of Tranaportatlon
§ 1.Alr
2.Rall
3. Highway D 4. Water
D !. Other• •peclfy
D 3. Tr11ter, Storer, Dl1po11r (at
lnatallatlon) Note: A permit la
required for thla activity, 111
lnatructlona.
4. Exempt Boller arid/or lnduatrlal
Furnace D a. Smelting, Melting, and Refln•
Ing Furnace Exemption D b. Small Quantity On-Site Burner
Exemption D 5. Underground Injection Control
B. Universal Waste Activity
D Large Quantity Handler of Unlversal Waste
IX. Description of Hazardous Wastes (II•• additional •h••ts If necenary)
C. Uaed 011 Management ActlvltlH
1. Uaed OIi Tran1porter/Tran1fer
Faclllty • Indicate Type(•) of .
Actlvlty(le•)
8 a. Tranaporter
b. Transfer Faclllty
2. UHd 011 ProcHaor/Re-reftner·•
Indicate Type(a) of Actlvlty(lea) D a. Proce11or D b. Re-refiner D 3. Off-Specification Uaed 011 Burner
4. Uaed 011 Fuel Marketer D a. Marketer Who .Directs.Shipment
of Off-Specification Uaed 011 to
l,Jaed 011 Burner D b. Marketer Who First Clalma the
Used 011 Meets the
Specifications
A. Listed Hazardous Wastes. (See 40 CFR 261.31 • 33; See lnlltructlon• ff you nHd to list more than 12 waste code,.)
1 2 3 4 5 6
7 8 9 10 11 12
B. Characteristics of Non listed Hazardous Wastes. (Marie X' In the box•• corre•pondlng to the characterl,tJc, of
nonll•t•d huardou• wast•• your Installation handle•; 8H 40 CFR Parts 261.20. 261.24; S.e lnlltruction• If you need
to fist more than 4 toxicity charact•rf•tlc waste code•.)
. (Llat apeclflc EPA hazardous waste number(•) forth• Toxicity Characteristic contamln■nt(•)I
0001) 1.rlt■il• 2. Corrosive 3. RHctlve . 4.Toxlclty I 1 I I 2 I I 3 I I 4 □) □ Ch■orl•tic ,-: ~~l----,------i: ,-: ~~,----,------i: ,-: ~~l-----,--1: :: ====i ====
C. Other Wastes. (State-regul•t.d or oth•r wastH rwqulrfng • h•ndler to have an I.D. number; S.e Instruction•.)
~, I I 1· UI@ l,____,._1 1~1 II>----------,---i~I 1=· i=
X. Certification
I certify under penalty of law that thla document and ■11 attachment• were prepared under my direction or supervision In accordance with
a ayatem designed to assure that quallfled personnel properly gather and evaluate th• Information submitted. Based on my Inquiry of
the person or persona who manage the ayatem, or thoH persona directly responsible for gathering the Information, the Information
submitted la, to the best of my knowledge ■nd bellef, true, accurate, and complete. I am ■ware that there are significant pen■ltles for
submitting falH Information, lncludlng the poaaiblllty of fine and Imprisonment for knowing vlol■tlona.
Signature Name and Official Title (Type or print) Date Signed
XI. Comments
Note: Mall completed fonii to the appropriate EPA'Reglotial oi''state Office:-. ($Be -Section IV'of tfie booklet for •dd,. .. ••.)
EPA Fonn 8700-12 (Rev. 12/99) -2of2-
Please print or type with ELITE type (12 characters per inch) in the unshaded areas only Fann~. OMI No. 2050-0028 Expi,91 12131102
GSA No. 0246-EPA.OT
Q-Initial "Notification □ 8 . Sub9equenfNotlflcatlon __ : .-
-(Compl•t. /Nm CJ _ ._ · . · " --
II. Naine of lnstallatlon (lnc:lud• company •nd •~clfic •• ,,.,,;•)
Ill. Location of Installation (Phyalcal add,. .. not P.O. Bax or Rout. Number}
Street
StrNt (Continued)
City or Town
County Code County Name
IV. Installation Malllng Address (See ln•tructlon•J
Street or P .0. Box
City or Town
State Zip Code ,
State Zip Code
Date Received
(For Official Use Only)
V. Installation Contact (P•rson to be contacted regarding wane •ctlvltl .. •t •It•)
Name (L .. t) {First)
Job Title
VI. lnstallatlon Contact Address (SH ln•tructlon•J
A. Contact Addrau
Location Malling B. Street or P.O. Box
City or Town · State Zip Code
VII. Ownership (See Instructions)
Street, P.O. Box, cr·Route Number --~. '
City or Town State Zip Code
' D. CMnge of Owner
ll>dic;ator ,--..,..:.,'-,'-'=-,.---,r"-'-.,.-...-'-'=.----t
YN No
EPA Form 8700-12 (Rev. 12199) -1of2-
,ie11e print or type with ILITI type (12 ohlraottra per Inch) In the unahlc:tec:t Ire11 only
VIII. Type of Re;ulated W11te Activity (111ft ,t" In th• 1pp,opn.,. bona. lt.,_r to lnltnlotlona)
A. Haurdoua W11te Actlvltlll C. U11d 011 Management Actlvltltl
1. Generator (SH ln1tructlonI) 0 a. Gr11ter than 1000kgfmo (2,200 Iba.)
0 b.100 to 1000 kg/mo (220-2,200 Iba.) O c. Lau than 100 kg/mo (220 Iba)
2. Tranaporter (Indicate Mode In box11
1•5 below)
B a. For own w11te only
b. For commercial purpoHa
Mode of Tran1portItlon
§ 1.Alr
2.Rall
3. Highway D 4. Water D $.Other•apeclfy
0 3. TrHttr, ltorer, Dl1po11r (at
lnatallatlon) Note: A permit la
required for thla activity, Ha
lnatructlona.
4. Exempt Boller arid/or lnduatrlal
Furnace O a. Smelting, Melting, and Refln•
Ing Furnace Exemption 0 b. Small Quantity On-Site Burner
Exemption 0 5. Underground Injection Control
B. Universal Wasta Activity
D Large Quantity Handl•r of Universal Waste
IX. Description of Hazardous Wastes (UN •ddltlonal ahHt. If n,ce,..ry}
1, UHd 011 Tran1portarfTran1ftr
Faclllty • Indicate Type(a) of
Actlvlty(IH)
8 a. Transporter
b. Tranafer Faclllty
2. UHd 011 ProcHaor!Re-Nflnar•
indicate Type(I) of Actlvlty(IH)
B a. Proc:e11or
b. Re-refiner 0 3. Off-Specification Uaad 011 Burner
4. UHd 011 Fuel Marketer O a. Marketer Who .DI Neta Shipment
of Off-Specification UHd 011 to
Uaed 011 Burner 0 b. Marketer Who First Clalma the
Used OIi Meets the
Speclflcatlona
A. Listed Hazardous Wastes. (SH 40 CFR 261.31 • 33; SH lnatructlona If you nHd to I/at more than 12 wa,te codes.)
1 2 3 5 6
7 8 9 10 11 12
B. Characteristics of Non listed Hazardous Wastes. (Mart X' In th• boxes c:orre,pondlng to tht! characterl,t/~ of
nonll•ted huardou• WHtH your lnatallatlon hsndlH; $ff 40 CFR P,rt, 261.20 • 261.24; S.e lnatructlon• If you need
to I/at more than 4 toxicity characteristic waste c:odu.J
. (Llat apeclftc EPA huardoua waate number(a) for the Toxicity Chllr1ct•rletlc contamlnant(a))
0001) 1.rteil• (0002) (DOOJ) Characterletlc .,.. -..--~-..----,. .,.. -..---·..--~-· '-· -------'· .,.. -..---"'..--~~ 2. CorTOalve 3. RHctlv9 . 4.Toxlclty I 1 . I I 2 I I 3 I I .,. □ □ □ I I I '-----'---'--I ....____.
C. Other Wastes. (Stat..,..gulated or other waste• requiring• handler to have an t.D. number; S.• lnatruct/on,.J
1---------T----. I I i2 I I i I Ii I i-------.---1 ·~1 I =1 ·=,
X. Certification
I certify under penalty of law that this document and all attachments were prepared under my direction or •upervl1lon In accordance with
a system designed to 111ure that qualified personnel properly gather and evaluate the Information submitted. Based on my Inquiry of
the person or persons who menage the 1ystem, or those per1on1 directly respon•lbl1 for gathering the Information, the Information
1ubmltted la, to th, but of my knowledge and belief, true, accurate, and compl•t•. I am aware that there ■re ■lgnlflcant pen■ltlu for
•ubmlttlng false Information, Including the po11lblllty of fine and lmprl•onment for knowing vlolatlon1.
Signature Name and Official Tltle (Type or print) Date Signed
XI. Comments
Note: Mall completed form to the approprlit■ EPA Re.glonal oi'State Office: (See Ssctlori Nofthe book/st for addreua,.J
EPA Fonn 8700-12 (Rev. 12/99) -2of2-
Please print or type with ELITE type (12 characters per inch) in the unshaded areas only Fom, ~. OMI No. 2050-0028 Expn, 12131/02
GSA No. 0246-EPA-OT
,._ .. ,.._tolec:tiof,V.I.JnM)'-
Une 1"struclioftl to,·e.npletlng
El'A Form 1700-12 -llt1fore
co111pl1Ung thll form. Thi
lnform1Uon requ11t1d htrl 11
-lrtd by law (a.c:tlon l010 of ·"-~_,, "--YAdJ. .
I. lnstaHatlon'a EPA ID Number-(Marlc ,CO Jn th• approprl•te-box) -.
~ Initial Notification
11. Name of lnatallatlon (Include_ comp•ny •nd •peclfjc site n•me)
C..OUNTY
Ill. Location of Installation (Ph,-.lcal add,. .. not P.O. Bo,c or Route Nuinb.r)
Street
~ 0 4 Li fr)ER..ToWN
Street (Continued)
R. o AD
City or Town State Zip Code •
At=TON
County Code County Name
I !
IV. Installation Malling Addreaa (See ln•trucflona)
Street or P .0. Box
D ER. L ; tJ
City or Town
R. A L f: I G /4
DA I)
V. Installation Contact (Person to be contacted rwgardlng wast, ectlvltlH at alt•)
Name (Lut) (First)
8A<!...K.us PA,
TE
Date Received
(For Offlelal Use Only)
.i . 5 0
Job Title Phone Number Area Cod• and Numbe
p c.. f3 L ,-= P ,~Io J
VI. Installation Contact Address (See lnatructlon•)
8. Street or P.O. Box
City or Town State Zip Code
VII. Ownership (See Instructions)
TAT" t= L
Street, P.O. Box, or"Route Number · -~
401 0 O U I TI= iSO
City or Town State Zip Code
YN No
EPA Fonn 8700.12 (Rev. 12199) -1of2-
VIII, Typt of R1;ul1ttd W11t1 Activity (Mlrlt ~In,,,. approp,;,t, bo.tH. fltmr to lnftnletiOfll)
A. Hu1rclouI W11tt ActlvltlH C. Uatd 011 M■nagtmtnt ActlvltlH
1. , Generator (Su lnatructlona)
(sa a. Oruter than 1000kg/mo (2,200 Iba,) 0 b.100 to 1000 kg/mo (220-2,200 Iba.) O c. Leu than 100 kg/mo (220 Iba)
2. Tranaporter (Indicate Mode In boxu
1-5 below) O •· For own wute only O b. For commercial purpoaea
Mode of Tranaportatlon
§ 1. Air
_2. Rall
3.Hlghway
0 4.Water D 5.0ther-•peclfy
0 3. TrHttr, ltortr, Dl1po11r (It
lnatallatlon) Note: A permit la
required for thla activity, Ne
lnatructlona.
4. Exempt Boller ■rid/or lnduatrlal
Furnace D a. Smelting, Meltln;, and Refln•
Ing Furnace Exemption D b. Small Quantity On-Site Sumer
Exemption 0 5. Underground Injection Control
B. Universal Waite Activity
D Large Quantity Handler of Universal Waste
IX. Description of Hazardous Wastes (Use additional sheet. If n,c .. ury)
1, UHd 011 Tranaporter/Tranafer
Facility. Indicate Type(•) of
Actlvlty(lea)
B a. Tranaporter
b. Tranafer Faclllty
2. UHd 011 Proceaaor/Rt-rtftner·•
Indicate Type(•) of Actlvlty(ltl) D a.Proceaaor D b. Re-refiner D 3. Off-Specification Uatd 011 Burner
-4. Used 011 Fuel Marketer D a. Marketer Who .Olrecta Shipment
of Off-Specification UHd 011 to
Uaed 011 Burner D b. Marketer Who First Clalma the
Used 011 Metta the
Speclflcatlona
A. Listed Hazardous Wastes. (Se. 40 CFR 261.31 • 33; See inlltruction• lfyou need to I/st more than 12 wa~ codes.)
1 2 3 5 6
7 8 9 10 11 12
B. Characteristics of Nonlisted Hazardous Wastes. (Marie X' In the boxes r;crre•ponding to the characterlatiC$ of
nonll,ted hazardous waste, your Installation handles; SH 40 CFR Parts 261.20 ·• 261.24; See Instruction• If you need
to fist more than 4 toxicity characteristic wam codes.)
1. r nltabl1 0001)
I I
(List spectflc EPA hazardous w■-t• number(•) forth• Toxlclty Ctuiract,nstlc contamlnant(s)l
C. Other Wastes. (Stat-.gul•tad or other wastu requiring• handler to have an I.D. number; S.e lnatrut:tlons.)
Ee@ I 1· I I i I Ii 1-1 • I ,---1 i----,1
X. Certification
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision In accordanca with
a 1ystem designed to assure that qualified personnel properly gather and evaluate the Information submitted. Baaed on my Inquiry of
the person or persons who manage the eyat,m, or thou persons dlrectly rHponslble for gathering the Information, the Information
eubmltttd Is, to the bnt of my knowledge and belief, true, accurate, and complete. I am aware that there are elgnlflcant penaltlH for
submitting false Information, Including the poulblilty of fine and Imprisonment for knowing vlolatlons.
Signature
'4u;./ hJ .
Name and Official Title (Type or print)
· · /<:.us P, -
Date Signed
4/oL
XI. Comments
Pe/3 Act-;..,i ty 0-t-La,_nci ('; 11 r~j.,.__la..h•d by rhe ~ .. b,u;S a,,ci Or7a:.-.'L<;
~"'-i"\.Cl-> of' I=. A 1 ·c..~ o Pollut-i Preve +; a. cl 70-,1..,·c...s
Note: Mall completed form to the appropriate EPA Re-glonal oi'Stete Office: fS-i Section N of the book/at for addre .. u .)
EPA Form 8700-12 (Rev. 12/99) -2of2-
Pat Backus
From:
To:
Sent:
Subject:
"Pat Backus" <[e-mail]>
"Home" <[e-mail]>
Friday, May 31, 2002 10:57 AM
[Fwd: FW: EPA ID from TSCA]
--------Original Message --------
Subject: FW: EPA ID from TSCA
Date: Thu, 30 May 2002 14:18:26 -0700
From: "Cloonan, Jim" <Jim_ [e-mail]>
Pagel of 2
To: "Funk, John" <[e-mail]>,"Pat Backus (E-mail)"<[e-mail]>
We need to discuss this at progress meeting next week.
-----Original Message-----
From: [e-mail] [mailto:[e-mail]]
Sent: Wednesday, May 15, 2002 11:57 AM
To: [e-mail]; [e-mail]; [e-mail]; [e-mail];
[e-mail]; [e-mail]; [e-mail]
Cc: MIKE.A.KELL [e-mail]
Subject: Re: EPA ID from TSCA
WCLFTeam,
The formula for the BCD reaction that we received from the BCD Chemist will result in the treated oil being a RCRA
corrosive waste, with pH much greater than 12 for the final "liquid". We can eliminate this characteristic on site by
neutralization. I am not certain, but a fuels recovery facility may not mind a little alkalai, so than may not be a value
adding step for them. It would mean handling concentrated sulfuric acid and attendant safety concerns. We are in the
final stages of defining the "recipe" for BCD, and this will be one of the discussion points before we can finalize it.
Carl Palmer
************
In a message dated 5/15/02 11: 13: 17 AM Eastern Daylight Time, [e-mail] writes:
Subj: RE: EPA ID from TSCA
Date: 5/15/02 11 :13:17 AM Eastern Daylight Time
From: [e-mail] (Duke, Gary W.)
To: [e-mail] ('Pat Backus'), [e-mail] (Duke, Gary W), [e-mail] (Bill
Gallagher), [e-mail] (Ditcher, David), [e-mail] (Cloonan, Jim),
[e-mail] (Jones, Dennis), [e-mail] (Palmer, Carl), [e-mail] (Swanstrom,
Carl)
CC: MIKE.A.KELL [e-mail] (Kelly, Mike)
Material now scheduled to be sent off as non-haz (PCB<50 ppm) such as used
PPE, will most likely go to Waste Management landfill in Kernersville, NC .
6/2/2002
Once we actually start to generate waste they need it analyzed for
par;ameters below, some of which could result in a RCRA classification. At
,. this time I don't plan to analyze for anything else, so these are the only
things we are liekly to find.
PCB
BTEX (benzene, toluene, ethylbenzene, xylene) -these could trigger RCRA if
high enough
total (not TCLP} metals for the 8 RCRA metals -we MAY have to go back and
look at TCLP if totals seem unusually high, only TCLP results would trigger
RCRA
----Original Message----
From: Pat Backus [mailto:[e-mail]]
Sent: Wednesday, May 15, 2002 10:56 AM
To: Duke, Gary; Bill Gallagher; Ditcher, Dave; Cloonan, Jim; Jones,
Dennis; Palmer, Carl; Swanstrom, Carl
Cc: Kelly, Mike
Subject: EPA ID from TSCA
Our EPA ID number from TSCA is NCW000000182. The letter is attached.
As it states, ifwe need a RCRA ID also, we can consolidate IDs. The
only RCRA classified regulation that I can think we might have is the
BCD process product which will be sent offsite for fuel recycling.
Carl(s), do you think the flash point will be low enough to classify as
0001? If so, what will be the quantity?
Any other potential RCRA waste that would require a RCRA ID?
Thanks,
Pat
Page 2 of2
6/2/2002
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 20460
Pat Backus
State of North Carolina
NCDENR -Division of Waste Management
401 Oberlin Road -Suite 150
Raleigh, NC 27605
(7404)
OFFICE OF
PREVENTION, PESTICIDES AND
TOXIC SUBSTANCES
April 30, 2002
68 75
Subject: Notification of PCB Activity
Thank you for filing the Notification of PCB Activity form dated April 17, 2002 for
the facility location listed below:
Warren County PCB Landfill
SR 1604 -Limertown Road
Afton, NC 27589-
The Fibers and Organics Branch (FOB) of EPA's Office of Pollution Prevention and
Toxics is issuing the following TSCA identification number to the above listed
facility: NCW000000 182. This number may only be used for PCB-related activities
and may not be used for any other regulated hazardous waste activities.
If you have also applied for a Regulation (Hazardous) Waste EPA ID number under
RCRA, you may request a consolidation of your RCRA identification number and
TSCA identification number upon receipt of your RCRA EPA ID number. To do so,
FOB would require confirmation of the RCRA identification number that has been
assigned to your facility. A copy of the RCRA ID Assignment Form (8700-12A(6-90))
for your facility would be an example of acceptable documentation.
Please direct all questions and requests for consolidation to Laura Casey at
[phone].
Tony Baney, Chief
Fibers & Organics Branch
Internet Address (URL) • http://www.epa.gov
Recycled/Recyclable • Printed with Vegetable Oil Based Inks on Recycled Paper (Minimum 30% Postconsumer)
Patricia M. Backus, PE
Division of Waste Management
401 Oberlin Road, Suite 150
Raleigh, NC 27605
Phone: [phone] ext. 308
Fax: [phone]
Fax
To: Laura Casey
Fax: [phone]
Phone: [phone]
Re:
Laura,
Notification of PCB Activity
Warren Co. PCB Landfill
. .
. .
. ~ . . . . ·-. . . :-
. . . . . . .. .
6dlll I Jftf llllllli . : .-.-· ·.
NCDENR
From: Pat Backus
Pages: 2
Date: April 17, 2002
CC:
If you have any additional questions, please give me a call.
Thanks,
I
USEPA United States
Environmental Protection Agency
Washington, DC 20460
Notification of PCB Activity
Form Approved
0MB No.2070-0112
For Official Use Only
Return To:
Fibers & Organics Branch (7404)
Office of Pollution Prevention & Toxics
U.S. Environmental Protection Agency
1200 Pennsylvania Ave., N.W.
Washington, DC 20460-0001
I. Name of Facility Name of Owner Facility 2. EPA Identification Number (ifalreadyassignedunderRCRA)
Warren County PCB Landfill State of North Carolina
l3. Facility Mailing Address (Street or PO Box, City, State, & Zip Code) 4. Location of Facility (No. Street, City, State, & Zip Code)
NCDENR -Division of Waste Management
401 Oberlin Road, Suite 150
Raleigh, NC 27605
SR 1604 -Limertown Road
Afton, NC 27589
5. Installation Contact (Name and Title) 6. Type of PCB Activity (Mark 'X' in appropriate box. See Instructions.
Pat Backus, PCB Landfill Project Manager 0 A. Generator w/onsite storage facility
NCDENR -Division of Waste Management O c. Transporter ______________ _;;;;__ _______ -I
Telephone Number (Area Code and Number) D E. Approved Disposer
[phone] ext 308
7. Certification
D B. Storer (Commercial)
□ D. R&D/Treatability D F. Scrap Metal Recovery Oven/Smelter,
High Efficiency Boilers
Under civil and criminal penalties of law for the making or submission of false or fraudulent statements
or representations (18 U.S.C. 1001 and 15 U.S.C. 2615), I certify that the information contained in or
accompanying this document is true, accurate, and complete. As to the identified section(s) of this
document for which I cannot personally verify truth and accuracy, I certify as a company official having
supervisory responsibility for the persons who, acting under my direct instructions, made the verification
that this information is true, accurate, and complete.
Signature
~~hJ-~
Name and Official Title (Type of Print)
Patricia M. Backus, P.E.
NCDENR-DWM, PCB Landfill Project Manager
Paperwork Reduction Act Notice
Date Signed
4/ ,,, / o:z.,
The annual public burden for this collection of information is estimated to average 1.5 hours per
response. This estimate includes time for reading instructions, searching existing data sources,
gathering and maintaining the needed data, and completing and reviewing collection of information,
including suggestions for reducing the burden to: Director, Collection Strategies Division,
U.S. Environmental Protection Agency (mail code 2822), 1200 Pennsylvania Ave., N.W.,
Washington, D.C. 20460-0001. Include the 0MB number identified above in any correspondence.
Do not send the completed form to this address. The actual information or form should be submitted in
accordance with the instructions accompanying the form, or as specified in the corresponding regulations.
El'A Fonn 7710-53 (Rev.8//01)
l'revious editions are obsolete.
USEPA United States
Environmental Protection Agency
Washington, DC 20460
Notification of PCB Activity
Form Approved
0MB No. 2070-0112
For Official Use Only
Return To:
Fibers & Organics Branch (7404)
Office of Pollution Prevention & Toxics
U.S. Environmental Protection Agency
1200 Pennsylvania Ave., N.W.
Washington, DC 20460-0001
I. Name ofFaci1ity Name of Owner Facility 2. EPA Identification Number (ifalreadya.uigncdundc,RCRA)
Warren County PCB Landfill State of North Carolina
l3. Facility Mailing Address (Street or PO Box, City, State, & Zip Code) 4. Location of Facility (No. Street, City, State, & Zip Code)
NCDENR -Division of Waste Management
40 I Oberlin Road, Suite 150
Raleigh, NC 27605
SR 1604 -Lirnertown Road
Afton, NC 27589
5. Installation Contact (Name and Title) 6. Type of PCB Activity (Mark 'X' in appropriate box. See Instructions.
Pat Backus, PCB Landfill Project Manager 0 A. Generator wlonsite storage facility
NCDENR -Division of Waste Management D c. Transponer 1------------------'"--------1 Telephone Number (Area Code and Number) D E. Approved Disposer
[phone] ext 308
7. Certification
D B. Storer (Commercial)
□ D. R&D/Trcatabihty D F. Scrap Metal Recovery Oven/Smeller,
High Efficiency Boilers
Under civil and criminal penalties of law for the making or submission of false or fraudulent statements
or representations (18 U.S.C. 1001 and 15 U.S.C. 2615), I certify that the information contained in or
accompanying this document is true, accurate, and complete. As to the identified section(s) of this
document for which I cannot personally verify truth and accuracy, I certify as a company official having
supervisory responsibility for the persons who, acting under my direct instructions, made the verification
that this infom1ation is true, accurate, and complete.
Signature
~~h">-~
Name and Official Title (Type of Print)
Patricia M. Backus, P.E.
NCDENR-DWM, PCB Landfill Project Manager
Paperwork Reduction Act Notice
Date Signed
4/ ,1 / 0:2-
The annual public burden for this collection of information is estimated to average 1.5 hours per
response. This estimate includes time for reading instructions, searching existing data sources,
gathering and maintaining the needed data, and completing and reviewing collection of information,
including suggestions for reducing the burden to: Director, Collection Strategies Division,
U.S. Environmental Protection Agency (mail code 2822), 1200 Pennsylvania Ave., N.W.,
Washington, D.C. 20460-0001. Include the 0MB number identified above in any correspondence.
Do not send the completed form to this address. The actual information or form should be submitted in
accordance with the instructions accompanying the form, or as specified in the corresponding regulations.
D'.-'. Fom, 7il0-~., (kcv.J; '01 l
l'revious ~ition~ arc obr.olctc.
USEPA United States
Environmental Protection Agency
Washington, DC 20460
Notification of PCB Activity
Form Approved
0MB No. 2070-0112
For Official Use Only
Return To:
Fibers & Organics Branch (7404)
Office of Pollution Prevention & Toxics
U.S. Environmental Protection Agency
1200 Pennsylvania Ave., N.W.
Washington, DC 20460-0001
I. Name of Facility Name of Owner Facility 2. EPA Identification Number (ihlroodyusigncdundcrRCRA)
Warren County PCB Landfill State of North Carolina
~-Facility Mailing Address (Street or PO Box, City, State, & Zip Code) 4. Location of Facility (No. Street, City, State, & Zip Code)
NCDENR-Division of Waste Management
401 Oberlin Road, Suite 150
Raleigh, NC 27605
SR 1604 -Limertown Road
Afton, NC 27589
5. Installation Contact (Name and Title) 6. Type of PCB Activity (Mark 'X' in appropriate box. See Instructions.
Pat Backus, PCB Landfill Project Manager 0 A. Generator w/onsite storage facility
NCDENR -Division of Waste Management □ C. Transponer ------------------------t T el e phone Number (Area Code and Number) D E. Approved Disposer
[phone] ext 308
7. Certification
D B. Storer (Commercial)
□ D. R&D/Treatability D F. Scrap Metal Recovery Oven/Smelter,
High Efficiency Boilers
Under civil and criminal penalties of law for the making or submission of false or fraudulent statements
or representations (18 U.S.C. 1001 and 15 U.S.C. 2615), I certify that the information contained in or
accompanying this document is true, accurate, and complete. As to the identified section(s) of this
document for which I cannot personally verify truth and accuracy, I certify as a company official having
supervisory responsibility for the persons who, acting under my direct instructions, made the verification
that this information is true, accurate, and complete.
Signature
~~h)-~
Name and Official Title (Type of Print)
Patricia M. Backus, P.E.
NCDENR-DWM, PCB Landfill Project Manager
Paperwork Reduction Act Notice
Date Signed
1-/ ,1 I ":i.-
The annual public burden for this collection of information is estimated to average 1.5 hours per
response. This estimate includes time for reading instructions, searching existing data sources,
gathering and maintaining the needed data, and completing and reviewing collection of information,
including suggestions for reducing the burden to: Director, Collection Strategies Division,
U.S. Environmental Protection Agency (mail code 2822), 1200 Pennsylvania Ave., N.W.,
Washington, D.C. 20460-0001. Include the 0MB number identified above in any correspondence.
Do not send the completed form to this address. The actual information or form should be submitted in
accordance with the instructions accompanying the form, or as specified in the corresponding regulations.
D'A Fonn 7710-5., (k.ev.k"O\)
l're',,·iom t:idi1ion& are obsok:tc.
Notification of Regulated Waste Activity
V. Line-by-Line Instructions for Completing EPA Form
8700-12
Initial Notification
All persons submitting an initial notification must complete Items I
through X in their entirety.
Subsequent Notification
All persons submitting a subsequent notification must complete Items I, II,
IV, VI , VII, IX, and X in their entirety. Whether you must complete Items
III , V, and VIII depends on the circumstances under which you are
required to submit a subsequent notification.
General Instructions
Type or print in black ink all items except Item X, "Signature," leaving a
blank box between words. The boxes are spaced at 1 / 4" intervals which
accommodate elite type (12 characters per inch). When typing, hit the
space bar twice between characters. If you print, place each character in a
box. Abbreviate if necessary to stay within the number of boxes allowed
for each Item. If you must use additional sheets, indicate clearly the
number of the Item on EPA Form 8700-12 to which the information on the
separate sheet applies.
Item I --Installation's EPA ID Number:
Place an "X" in the appropriate box to indicate whether this is your initial
or a subsequent notification for this installation in this location. Leave the
EPA Identification Number blank if this is your initial notification for this
installation. If this is a subsequent notification, enter the EPA
Identification Number assigned to this installation in the boxes provided.
Items II and Ill --Name and Location of Installation:
Complete Items II and III. Please note that the address you give for Item
III, Location of Installation, must be a physical address, not a post office
box or route number.
Page 25
Notification of Regulated Waste Activity
County Code and Name: Give the county code, if known. If you do not
know the county code, enter the county name, from which EPA can
automatically generate the county code. If the county name is unknown,
contact the local Post Office. To obtain a list of county codes, contact the
National Technical Information Service, U.S . Department of Commerce,
Springfield, Virginia, 22161 or at [phone]. The list of codes is
contained in the Federal Information Processing Standards Publication
(FIPS PUB) number 6-3.
Note: A subsequent notification is required when the loca tion of the
installation changes.
Item IV --Installation Mailing Address:
Please enter the Installation Mailing Address. If the Mailing Address and
the Location of Installation (Item IV) are the same, you can print "Same" in
the box for Item IV.
Item V --Installation Contact:
Enter the name, title, and business telephone number of the person who
should be contacted regarding information submitted in this notification.
Note: A subsequent notification is required when the installation contact
changes.
Item VI --Installation Contact Address:
A. Code: If the contact address is the same as the location of
installation address listed in Item IV or the installation mailing
address listed in Item IV, place an "X" in the appropriate box to
indicate where the contact may be reached. If the location of
installation address, the installation mailing address, and the
installation contact address are all the same, mark the "Location"
box. If the contact address is not the same as those addresses in
either Item III or IV , place an "X" in the "Other" box and complete
Item VI.B . If an "X" is entered in either the location or mailing box,
Item VI.B. should be left blank.
B. Address: Enter the contact address only if the contact address is
different from either the location of installation address (Item IV) or
Page 26
Notification of Regulated Waste Activity
the installation mailing address (Item IV), and if Item VI.A. was
marked "Other."
Item VII -Ownership:
A. Name: Enter the name of the legal owner(s) of the installation,
including the property owner. Also enter the address and phone
number where this individual can be reached. Use the comment
section in XI or additional sheets if necessary to list more than one
owner.
B. Land Type: Using the codes listed below, indicate in VII .B. the code
which best describes the current legal status of the land on which
the installation is located:
F Federal
S State
I Indian
P Private
C County
M Municipal*
D District
0 Other
* If the Land Type is best described as Indian, County or District,
please use those codes. Otherwise, use Municipal.
C. Owner Type: Using the codes listed below, indicate in VII.C . the code
which best describes the legal status of the current owner of the
installation:
F Federal
S State
I Indian
P Private
C County
M Municipal*
D District
0 Other
* If the Owner Type is best described as Indian, County or District,
please use those codes. Otherwise, use Municipal.
Page 27
Notification of Regulated Waste Activity
D. Change of Owner Indicator: (If this is your installations initial
notification, leave Item VII.D. blank and skip to Item VIII. If this is a
subsequent notification, complete Item VII.D. as directed below.)
A subsequent notification is required when the owner of an
installation changes. The new owner must notify EPA of the change,
even if the previous owner already received an EPA Identification
Number. Because an EPA Identification Number is site-specific, the
new owner will keep the existing EPA Identification Number for that
location. If the installation moves to another location, the
owner/ operator must notify EPA of this change. In this instance, a
new EPA Identification Number will be assigned, since the
installation has changed locations.
If the owner of this installation has changed since the installation's
initial notification, place an "X" in the box marked "Yes" and enter
the date the owner changed.
If the owner of this installation has not changed since the
installation's initial notification, place an "X" in the box marked "No"
and skip to Item VIII.
If an additional owner(s) has been added or replaced since the
installation's initial notification, place an "X" in the box marked "Yes."
Use the comment section in XI to list any additional owners, the
dates they became owners, and which owner(s) (if any) they replaced.
If necessary, attach a separate sheet of paper.
Page 28
Notification of Regulated Waste Activity
Item VIII --Type of Regulated Waste Activity:
A. Hazardous Waste Activities: Mark an "X" in the appropriate box(es)
to show which hazardous waste activities are being conducted at
this installation.
1. Generator: If you generate a hazardous waste that is listed in
40 CFR 261 .31 through 261.33 or identified by one or more
hazardous waste characteristic(s) contained in 40 CFR 261.21
through 261. 24, mark an "X" in the appropriate box for the
quantity of non-acutely hazardous waste that is generated per
calendar month. The regulations for hazardous waste
generators are found in 40 CFR Part 262.
Note: If you generate acutely hazardous wastes listed in 40 CFR 261.31,
261.32 or 261.33(e), please refer to 40 CFR 261.5{e) to determine under
what circumstances you must notify EPA.
2. Hazardous Waste Transporter: If you transport hazardous
waste, indicate if it is your own hazardous waste, if you
transport it for commercial purposes, or mark both boxes if both
classifications apply. Mark an "X" in each appropriate box to
indicate the method(s) of transportation you use. Hazardous
waste transporters do not have to complete Item IX of the
notification, but must sign the certification in Item X. The
Federal regulations for hazardous waste transporters are found
in 40 CFR Part 263.
3. Treater/Storer/Disposer: If you treat, store or dispose of
regulated hazardous waste, place an "X" in this box. (Burning
hazardous wastes in boilers and industrial furnaces and storing
hazardous wastes before recycling them fall into this category as
well .) You are reminded to contact the appropriate addressee
listed for your State in Section IV.C. of this booklet to request
Part A of the RCRA Permit Application. The Federal regulations
for owners or operators of hazardous waste installations are
found in 40 CFR Parts 264, 265, and 266.
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Notification of Regulated Waste Activity
4. Exempt Boiler and/or Industrial Furnace: If you burn
hazardous wastes in a smelting, melting, or refining furnace
solely for metals recovery, as described in 40 CFR 266. 1-00(c), or
to recover economically significant amounts of precious metals,
as described in 40 CFR 266. lOO{f), mark an "X" in the box to
indicate that you qualify for the smelting, melting and refining
furnace exemption.
If you burn small quantities of hazardous waste in an on-site
boiler or industrial furnace in accordance with the conditions in
40 CFR 266.108, place an "X" in the box to indicate that you
qualify for the Small Quantity On-Site Burner Exemption.
5. Underground Injection Control: If you generate, treat, store,
or dispose of hazardous waste and there is an underground
injection well located at your installation, place an "X" in the
appropriate box. The Federal regulations for owners or
operators of underground injection wells are found in
40 CFR Part 148.
B. Universal Waste Handling Activities: Mark an "X" in the
appropriate box to indicate that universal waste handling activities
are taking place at this installation and will result in the
universal waste handler becoming a Large Quantity Handler of
Universal Waste. The Federal regulations for large quantity
handlers of universal waste are found in 40 CFR Part 273,
Subpart C.
C. Used Oil Management Activities: Mark an "X" in the appropriate
box(es) to indicate which used oil management activities are taking
place at this installation. The Federal regulations for used oil
management are found in 40 CFR Part 279.
1. Used Oil Transporter /Transfer Facility: If you transport used
oil and/or own or operate a used oil transfer facility , place an "X"
in the appropriate box(es) to indicate this used oil management
activity.
2. Used Oil Processor/Re-Refiner: If you process and/or re-
refine used oil, place an "X" in the appropriate box(es) to indicate
this used oil management activity.
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Notification of Regulated Waste Activity
3. Off-Specification Used Oil Burner: If you burn off-specification
used oil fuel, place an "X" in the box to indicate this used oil
management activity.
4. Used Oil Fuel Marketer: If you market off-specification used oil
directly to a burner, mark an "X" in box 1 a. If you a re the first
to claim the used oil meets the used oil specification established
in 40 CFR 279.11 , mark an "X" in box 1 b. If either of these
boxes is marked, you must also notify (or have previously
notified) as a used oil transporter, used oil processor/re-refiner,
or off-specification used oil fuel burner, unless you are a used oil
generator. (Used oil generators are not required to notify.)
Note: A subsequent notification is required when the type of regulated
waste activity changes.
Item IX --Description of Hazardous Wastes:
Note: Only persons involved in hazardous waste activities (Item VIII.A.}
need to complete this item. Hazardous waste transporters requesting an EPA
Identification Number do not need to complete this item, but must sign the
"Certification" in Item X.
You will need to refer to 40 CFR Part 261 in order to complete this Item.
Part 261 identifies those solid wastes that EPA defines as hazardous and
regulates under RCRA. If you need help completing this section, please
contact the appropriate addressee for your State as listed in Section IV.C.
of this booklet.
A. Listed Hazardous Wastes: If you handle hazardous wastes that are
listed in 40 CFR Part 261 , Subpart D, enter the appropriate 4-digit
code(s) in the boxes provided.
Note: If you handle more than 12 listed hazardous wastes, please continue
listing the hazardous waste codes on the extra sheet provided at the end of
this booklet. If you have more waste codes than will fit on the notification
and the additional sheet, feel free to photocopy the additional sheet and use
that as well. Attach any additional sheets to the rest of EPA Form 8700-12
before mailing it to the appropriate EPA Regional or State office.
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Notification of Regulated Waste Activity
B. Characteristic Hazardous Wastes: If you handle hazardous wastes
that a re not listed in 40 CFR Part 261, Subpart D, but do exhibit a
characteristic of hazardous waste as defined in 40 CFR Part 261 ,
Subpart C , you should describe these wastes by the EPA hazardous
waste number for the characteristic. Place an "X" in the box next to
the characteristic of the wastes that you handle. If you mark "4.
Toxicity Characteristic," please list the specific EPA hazardous waste
number(s) for the specific contaminant(s) in the box(es) provided.
Refer to Section VII to determine the appropriate hazardous waste
number(s).
Note: If you handle more than four Toxicity Characteristic (TC) hazardous
wastes, please continue listing the hazardous waste codes on the extra
sheet provided at the end of this booklet. If you have more TC waste codes
than will flt on the notification and the additional sheet, feel free to
photocopy the additional sheet and use that as well. Attach any additional
sheets to the rest of EPA Form 8 700-12 before mailing it to the appropriate
EPA Regional or State office.
C. Other Wastes: If you handle other wastes or State-regulated was tes
that have a waste code, enter the appropriate code(s) in the boxes
provided.
Item X --Certification:
This certification must be signed by the owner, operator, or an authorized
representative of your installation. An "authorized representative" is a
person responsible for the overall operation of the installation (i.e., a plant
manager or superintendent, or a person of equal responsibility). All
notifications must include this certification to be complete.
Item XI --Comments:
Use this space for any additional comments and attach additional sheets,
if necessary.
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Notification of Regulated Waste Activity
VI. Definitions
The following definitions are included to help you to understand and
complete EPA Form 8700-12:
Act or RCRA means the Solid Waste Disposal Act, as amended by the
Resource Conservation and Recovery Act of 1976, as amended by the
Hazardous and Solid Waste Amendments of 1984, 42 U.S.C. Section
6901 et seq.
Authorized Representative means the person responsible for the overall
operation of the installation or an operational unit (i.e ., part of an
installation), e.g., superintendent or plant manager, or person of
equivalent responsibility.
Boiler means an enclosed device using controlled flame combustion and
having the following characteristics:
1 . The unit has physical provisions for recovering and exporting
energy in the form of steam, heated fluids, or heated gases;
2. The unit's combustion chamber and primary energy recovery
section(s) are of integral design (i.e., they are physically formed
into one manufactured or assembled unit);
3. The unit continuously maintains an energy recovery efficiency of
at least 60 percent, calculated in terms of the recovered energy
compared with the thermal value of the fuel;
4. The unit exports and utilizes at least 7 5 percent of the recovered
energy, calculated on an annual basis (excluding recovered heat
used internally in the same unit, for example, to preheat fuel or
combustion air or drive fans or feedwater pumps); or
5. The unit is one which the Regional Administrator has
determined, on a case-by-case basis, to be a boiler, after
considering the standards in 40 CFR 260.32.
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Notification of Regulated Waste Activity
Disposal means the discharge, deposit, injection, dumping, spilling,
leaking, or placing of any solid waste or hazardous waste into or on
any land or water so that such solid waste or hazardous waste or any
constituent thereof may enter the environment or be emitted into the
air or discharged into any waters, including ground waters.
EPA Identification (ID) Number means the number assigned by EPA to
each hazardous waste generator, hazardous waste transporter, and
treatment, storage, or disposal installation; large quantity handler of
universal wastes; used oil transporter, used oil processor/re-refiner,
off-specification used oil fuel burner, and used oil fuel marketer.
Hazardous Waste means a hazardous waste as defined in 40 CFR 261.3.
Hazardous Waste Generator means any person, by site, whose act or
process produces hazardous waste identified or listed in 40 CFR Part
261.
Hazardous Waste Storage means the holding of hazardous waste for a
temporary period, at the end of which the hazardous waste is
treated, disposed of, or stored elsewhere.
Hazardous Waste Transporter means a person engaged in the off-site
transportation of hazardous waste by air, rail, highway, or water.
Hazardous Waste Treatment means any method, technique, or process,
including neutralization, designed to change the physical, chemical,
or biological character or composition of any hazardous waste so as
to neutralize such hazardous waste, or so as to recover energy or
material resources from the hazardous waste, or so as to render
such hazardous waste nonhazardous, or less hazardous; safer to
transport, store or dispose of; or amenable for recovery, amenable for
storage, or reduced in volume. Such term includes any activity or
processing designed to change the physical form or composition of
hazardous waste so as to render it nonhazardous.
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Notification of Regulated Waste Activity
Industrial Furnace means any of the following enclosed devices that are
integral components of manufacturing processes and that use
thermal treatment to accomplish recovery of materials or energy:
cement kilns; lime kilns; aggregate kilns ; phosphate kilns; coke
ovens; blast furnaces; smelting, melting and refining furnaces ;
titanium dioxide chloride process oxidation reactors; methane
reforming furnaces; pulping liquor recovery furnaces; combustion
devices used in the recovery of sulfur values from spent sulfuric acid ;
halogen acid furnaces, as defined under industrial furnace in 40 CFR
260.10; and such other devices as the Administrator may add to this
list.
Installation means the physical plant or location at which one or more of
the following regulated waste activities occurs: the generation,
transportation, treatment, storage, or disposal of hazardous wastes;
the storage of hazardous wastes before they are recycled; the
accumulation of 5,000 kg or more of universal wastes; and the
transportation (and temporary storage during transportation),
processing/re-refining, burning, or marketing of used oil. An
installation may consist of several treatment, storage, or disposal
operational units. (For entities that only transport regulated wastes,
the term installation refers to the headquarters of that entity's
operations.)
Large Quantity Handler of Universal Waste means a universal waste
handler (as defined in 40 CFR 273.6) who accumulates 5 ,000
kilograms or more total of universal waste (batteries, pesticides, or
thermostats, collectively) at any time. This designation is retained
through the end of the calendar year in which 5,000 kilograms or
more of universal wastes are accumulated.
Municipality means a city, village, town, borough, county, parish, district,
association, Indian tribe or authorized Indian tribal organization,
designated and approved management agency under Section 208 of
the Clean Water Act, or any other public body created by or under
State law and havingjurisdiction over disposal of sewage, industrial
wastes, or other wastes.
Off-Specification Used Oil Burner means an installation where used oil
not meeting the specification requirements in 40 CFR 279.11
(off-specification used oil) is burned for energy recovery in devices
identified in Section 279.61 (a).
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Notification of Regulated Waste Activity
Off-Specification Used Oil Fuel means used oil fuel that does not meet
the specification provided under 40 CFR 279.11.
On-Specification Used Oil Fuel means used oil fuel that meets the
specification provided under 40 CFR 279.11.
Operator means the person responsible for the overall operation of an
installation.
Owner means a person who owns an installation or part of an installation,
including the property owner.
Small Quantity On-Site Burner Exemption means that persons who
burn small quantities of hazardous waste in an on-site boiler or
industrial furnace, in accordance with 40 CFR 266.108, are
conditionally exempt from regulation for that activity.
Smelting, Melting, and Refining Furnace Exemption means that, under
40 CFR 266. l00(c), owners or operators of smelting, melting, and
refining furnaces that process hazardous wastes solely for metals
recovery are conditionally exempt from regulation, except for 40 CFR
266.101 and 266.112, provided they comply with limited
requirements set forth in Section 266.1 00(c). Similarly,
40 CFR 266. 1 00(f) provides that owners or operators of smelting,
melting and refining furnaces that process hazardous wastes for the
recovery of precious metals are conditionally exempt from regulation,
except for 40 CFR 266.1 12, provided they comply with limited
requirements specified in Section 266. l00(f).
Underground Injection Control means the subsurface emplacement of
fluids through a bored, drilled or driven well; or through a dug well,
where the depth of the dug well is greater than the largest surface
dimension. Underground injection wells are regulated under both
the Safe Drinking Water Act and the Resource Conservation and
Recovery Act (see 40 CFR Part 148).
Used Oil means any oil that has been refined from crude oil, or any
synthetic oil, that has been used, and as a result of such use, is
contaminated by physical or chemical impurities.
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Notification of Regulated Waste Activity
Used Oil Fuel Marketer means any person who conducts either of the
following activities:
1. Directs a shipment of off-specification used oil from their
installation to an off-specification used oil burner; or
2. First claims that used oil that is to be burned for energy
recovery meets the used oil fuel specifications set forth in 40
CFR 279.11.
Used Oil Management Activities, for the purposes of EPA Form
8700-12, include used oil transportation; used oil processing and re-
refining; burning off-specification used oil fuel; and used oil fuel
marketing.
Used Oil Processing means chemical or physical operations designed to
produce from used oil, or to make used oil more amenable for
production of, fuel oils, lubricants, or other used oil-derived
products. Processing includes, but is not limited to: blending used
oil with virgin petroleum products, blending used oils to meet the
fuel specification, filtration, simple distillation, chemical or physical
separation, and re-refining.
Used Oil Processor means an installation that processes on-or
off-specification used oil.
Used Oil Re-Refiner means an installation that produces lubricating oils
and greases, industrial fuel, asphalt extender, gasoline, and other
products from on-or off-specification used oil.
Used Oil Transfer Facility means any transportation-related facility,
including loading docks, parking areas, storage areas, and other
areas where shipments of used oil are held for more than 24 hours
during the normal course of transportation and not longer than 35
days. Transfer facilities that store used oil for more than 35 days are
subject to regulation under 40 CFR Part 279, Subpart F.
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Notification of Regulated Waste Activity
Used Oil Transporter means any person who transports used oil, any
person who collects used oil from more than one generator and
transports the collected oil, and owners and operators of used oil
transfer facilities. Used oil transporters may consolidate or aggregate
loads of used oil for purposes of transportation but, with the
following exception, may not process used oil. Used oil transporters
may conduct incidental processing operations that occur in the
normal course of used oil transportation (e.g., settling and water
separation), but that are not designed to produce (or make more
amenable for production of) used oil-derived products or used oil
fuel.
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