703 303^7?) &EPA United States Environmental Protection Agency October 2003 2003 Hazardous Waste Report Instructions and Forms EPA Form 8700-13 A/B (OMB #2050-0024; Expires October 31, 2005) XXXX ------- Office of Solid Waste (5301W) Washington, DC 20460 2003 Hazardous Waste Report Instructions and Forms This is an ongoing information collection from hazardous waste generators and hazardous waste treatment, storage or disposal facilities. This collection is done on a two-year cycle as required by Sections 3002 and 3004 of the Resource Conservation and Recovery Act (RCRA). The information is collected via a mechanism known as the Hazardous Waste Report for the required reporting year [EPA Form 8700-13 A/B](also known as the Biennial Report) Both RCRA Sections 3002 and 3004 require EPA to establish standards for recordkeeping and reporting of hazardou; waste. Section 3002 applies to hazardous waste generators and Section 3004 applies to hazardous waste treatment storage, and disposal facilities. The implementing regulations are found at 40 CFR Parts 262,40(b) and (d), 262.41(a)(l)-(5), (a)(8), and (b); 264.75(a)-(e) and (j); 265.75(a)-(e) and (j); and 270.30(1)(9). This is mandatory reporting by the respondents. The respondents' submissions (reports) describe each generated hazardous waste, the activity by which they generated the waste, and the waste quantity; the reports also list the management method by which each waste is treated, recycled, or disposed and the quantity managed. There are a number of uses of Biennial Report data. EPA uses Biennial Report data for planning and developing regulations, compliance monitoring, and enforcement. Also, Biennial Report data allows the Agency to determine whether its regulations are having the desired effect on the generation and management of hazardous waste. For example, Biennial Report data provides information on whether waste management has shifted from one method of disposal to another. Some State uses of Report data include support of planning, fee assessment, compliance monitoring, and enforcement. Some businesses consider some of their hazardous waste information to be Confidential Business Information (CB1). A business may, if it desires, protect its Biennial Report information from public disclosure by asserting a claim of confidentiality covering all or part of its information. When a claim is made EPA will treat the information in accordance with the confidentiality regulations in 40 CFR Part 2, Subpart B. EPA also ensures that the information collection procedures comply with the Privacy Act of 1974 and OMB Circular 108. Estimated Burden: The total annual public reporting and recordkeeping burden for this collection of information is estimated to average 19.35 hours per response. The annual reporting burden is estimated to average 16.87 hours per response including time for reviewing instructions, gathering data, completing and reviewing the forms, and submitting the report. The annual recordkeeping requirement is estimated to. average 2.48 hours per respondent including the time for filing and storing the Biennial Report submission for three years. To comment on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including the use of automated collection techniques, EPA has established a public docket for this ICR under Docket ID Number RCRA-2002-0024, which is available for public viewing at the RCRA Docket in the EPA Docket Center (EPA/DC), EPA West, Room B102, 1301 Constitution Avc., NW, Washington, DC. The EPA Docket Center Public Reading Room is open from 8:30 a.m. to 4:30 p.m., Monday through Friday, excluding legal holidays. The telephone number for the Reading Room is (202) 566-1744, and the telephone number for the RCRA Docket is (202) 566-0270. An electronic version of the public docket is available through EPA Dockets (EDOCKET) at - http://www.epa.gov/edocket Use EDOCKET to submit or view public comments, access the index listing of the contents of the public docket, and to access those documents in the public docket that are available electronically. Once in the system, select "search," then key in the docket ID number identified above. Also, you can send comments to the Office oi Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, N W, Washington, DC 20503, Attention: Desk Office for EPA. Please include the EPA Docket ID Number RCRA-2002-0024 and OMB Control Number 2050-0024 in any correspondence. ------- PURPOSE OF THE 2003 HAZARDOUS WASTE REPORT The U.S. Environmental Protection Agency's (EPA) mission to protect human health and the environment includes the responsibility to effectively manage, with the States, the nation's hazardous waste. As part of this task, the EPA and the States collect and maintain information about the generation, management, and final disposition of the nation's hazardous waste regulated by the Resource Conservation and Recovery Act (RCRA). The EPA prepared this booklet for hazardous waste generators and for facilities that treat, store, or dispose hazardous waste to report their hazardous waste activities for calendar year 2003. The information collected will: • Provide the EPA and the States with an understanding of hazardous waste generation and management in the United States. • Help the EPA measure the quality of the environment, such as monitoring industry compliance with the regulations and evaluating waste minimization efforts taken by industry. • Be summarized and communicated to the public, primarily through publication of the 2003 National Biennial RCRA Hazardous Waste Report. The data you provide will be entered into a computer database by the State or the EPA Regional Office to which you return your Hazardous Waste Report. After review to ensure the quality of the data, EPA will create a national database for this information. Your efforts in carefully filling out all the report forms are appreciated. IMPORTANT Before completing the 2003 Hazardous Waste Report forms, please carefully read the instructions in this booklet. EPA has made changes to the previous version of this booklet. IF YOU NEED ASSISTANCE To obtain assistance in filling out the 2003 Hazardous Waste Report forms, please call the EPA RCRA, Superfund & EPCRA Call Center at 1-800-424-9346 (703-412-9810 in the Washington, D.C., metropolitan area). The Call Center operates Monday through Friday from 9:00 a.m. to 5:00 p.m. (Eastern Standard Time); the Call Center is closed on Federal holidays. In addition to calling the Call Center, you may need to contact your State Office. Some States' reporting requirements differ from the Federal requirements. The list of State and Regional Office addresses, contact names, telephone numbers, and email addresses is on the Internet at - http://www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm ------- SITES THAT SHOULD NOT FILE THE HAZARDOUS WASTE REPORT Do not file the 2003 Hazardous Waste Report if, during 2003, your site was not a RCRA Large Quantity Generator (your site did not meet any of the LQG criteria in the box above) AND did not treat, store, or dispose of RCRA hazardous wastes on site. If you are not required to report, you should notify us if your hazardous waste generator status has changed; please fill out the RCRA Subtitle C Site Identification Form and submit it to your State Office. See page 7 for instructions on filling out the Site Identification Form. Mark the box for Subsequent Notification of Regulated Waste Activity in Item 1 - Reason for Submittal. Do not file the 2003 Hazardous Waste Report if, during 2003, all of your hazardous waste was exported directly out of the United States to a foreign country. An Annual Report must be filed in this case as required under 40 CFR 262.56. STATE-SPECIFIC REQUIREMENTS States may impose reporting requirements above and beyond the Federal requirements. If your State does so, it will attach information to (or delete information from) this booklet. Alternatively, some States use a modified version of this report or their own instructions and forms for fulfilling the reporting requirements. Please contact your State Office about state-specific requirements. See the Contacts list on the Internet at - http://www.epa.gov/epaoswer/hazwaste/data^r03/forms.htm IV ------- 2003 HAZARDOUS WASTE REPORT TABLE OF CONTENTS PURPOSE OF THE 2003 HAZARDOUS WASTE REPORT i WHO MUST FILE THE 2003 HAZARDOUS WASTE REPORT iii SITES REQUIRED TO FILE THE HAZARDOUS WASTE REPORT iii SITES THAT SHOULD NOT FILE THE HAZARDOUS WASTE REPORT iv STATE-SPECIFIC REQUIREMENTS iv INSTRUCTIONS FOR FILING THE 2003 HAZARDOUS WASTE REPORT 1 INTRODUCTION 1 Authority 1 Overview of the 2003 Hazardous Waste Report 1 CHANGES TO THE 2003 HAZARDOUS WASTE REPORT 2 WHICH FORMS TO SUBMIT AND WHAT TO REPORT 2 FILLING OUT THE FORMS 3 RCRA, Superfund & EPCRA Call Center 3 Copies of Hazardous Waste Report Instructions and Forms 4 Documents Helpful in Filling Out the Forms 4 Site Identification Labels 4 Code Lists 4 Skip Instructions 4 Notes 4 Right Justification of Quantities 5 Comments Section of Forms 5 Page Numbering of Forms 5 Photocopies of Forms 5 Electronic Reporting 5 Confidential Business Information (CBI) 6 WHEN AND WHERE TO FILE 6 INSTRUCTIONS FOR FILLING OUT THE RCRA SUBTITLE C SITE IDENTIFICATION (SITE ID) FORM 7 WHO MUST SUBMIT THIS FORM 7 PURPOSE OF THIS FORM 7 HOW TO FILL OUT THIS FORM 7 ITEM-BY-ITEM INSTRUCTIONS 9 INSTRUCTIONS FOR FILLING OUT FORM GM - WASTE GENERATION AND MANAGEMENT 17 WHO MUST SUBMIT THIS FORM 17 PURPOSE OF THIS FORM 17 HOW TO FILL OUT THIS FORM 17 WASTES TO BE REPORTED 17 WASTES NOT TO BE REPORTED 18 HOW TO REPORT SIMILAR WASTES ON ONE FORM GM 19 ITEM-BY-ITEM INSTRUCTIONS 20 ------- INSTRUCTIONS (Continued) CHANGES IN THE 2003 HAZARDOUS WASTE REPORT EPA made significant modifications to the Hazardous Waste Report for the 2001 submission based on a lengthy study of the information needs of EPA and State hazardous waste programs. Those changes were made to improve the consistency, accuracy, and reliability of the data. EPA has made a few more changes in this 2003 report based on the previous study. These modifications include: • Site ID Form Items - You must complete the entire RCRA Subtitle C Site Identification Form. This will update your record for all of your site's current regulated activities and related site information. You will report your current Hazardous Waste Generator status as of the date of submitting your 2003 Hazardous Waste Report; see Item 10.A.1 - Generator of Hazardous Waste. • Deletion of the "RCRA radioactive mixed" (mixed waste) box on Form GM (Sec. 1 .F) and on Form WR (H). You will, however, mark "Yes" on the Site Identification Form for Item 10.A. 1 .e - Mixed Waste Generator if your site generates this waste. • Addition of Source codes for foreign countries of origin for hazardous waste that is imported into the United States. This is reported on Form GM. In Section 1, Box D. WHICH FORMS TO SUBMIT AND WHAT TO REPORT The 2003 Hazardous Waste Report contains the following four forms: Site ID Form A site required to file the 2003 Hazardous Waste Report must submit the RCRA Subtitle C Site ID Form (Site ID Form) as a component of the Report. You will report your current Hazardous Waste Generator status as of the date of submitting your 2003 Hazardous Waste Report on the Site Identification Form in Item 1 O.A.I - Generator of Hazardous Waste. Your status may have changed since 2003 Instructions for the Site ID Form begin on page 7. Form GM A site required to file the 2003 Hazardous Waste Report must submit Form GM for all hazardous waste that was used to determine the site's generator status. Hazardous waste must be reported if it was: • Generated and accumulated on site and subsequently managed on site or shipped off site in 2003; or • Generated and accumulated on site in 2003 but not managed on site or shipped off site until after 2003; or • Generated and accumulated on site prior to 2003 but either managed on site or shipped off site in 2003; or • Imported from a foreign country in 2003. ------- INSTRUCTIONS (Continued) Examples of RCRA hazardous wastes to be reported include those that were: • Generated on site from a production process, service activity, or routine cleanup; • Generated from equipment decommissioning, spill cleanup, or remedial cleanup activity; • Shipped off site, including hazardous waste that was received from off site (reported on the Waste Received from Off Site Form (Form WR)) and subsequently shipped off site without being treated or recycled on site; « Removed from on-site storage for treating, recycling, or disposing on site or shipped off site. • Derived from the management of non-hazardous waste; or • Derived from the on-site treatment (including reclamation), disposal, or recycling of previously existing hazardous waste (as a residual). DO NOT submit a Form GM for any hazardous waste shipped directly to a foreign country. An Annual Report must be filed in this case as required under 40 CFR 262.56. Instructions for Form GM begin on page 17. Form WR A site required to file the 2003 Hazardous Waste Report must submit Form WR if, during 2003, it received RCRA hazardous waste from off site and managed the waste on site (including subsequent transfer off-site). Instructions for Form WR begin on page 26. Form OI A site must complete Form OI only if the site's State requires it. Instructions for Form OI are on the back of the form. FILLING OUT THE FORMS RCRA, SUPERFUND & EPCRA CALL CENTER To obtain assistance in filling out the 2003 Hazardous Waste Report forms, please call the EPA's RCRA, Superfund & EPCRA Call Center at 1-800-424-9346 (703-412-9810 in the Washington, D.C., metropolitan area). The Call Center operates Monday through Friday from 9:00 a.m. to 5:00 p.m. (Eastern Standard Time), and is closed on Federal holidays. In addition to calling the Call Center, you may want to contact your State or EPA Regional Office. Some States' reporting requirements differ from the Federal requirements. The list of contact addresses, contact names, telephone numbers, and email addresses is on the Internet at - http://www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm ------- INSTRUCTIONS (Continued) COPIES OF HAZARDOUS WASTE REPORT INSTRUCTIONS AND FORMS Additional copies of 2003 Hazardous Waste Report instructions and forms can be obtained from the contact provided for your State. If your State uses the EPA's version of the instructions and forms, you can download the booklet from the Internet at - http://www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm DOCUMENTS HELPFUL IN FILLING OUT THE FORMS To prepare the 2003 Hazardous Waste Report, you should consult your records on quantities and types of hazardous waste that your site generated, managed, shipped, or received in 2003. Some records that may be helpful are: Hazardous waste manifest forms; Hazardous Waste Report forms submitted in previous years; Records of quantities of hazardous waste generated or accumulated on site; Results of laboratory analyses of your wastes; Contracts or agreements with off-site facilities managing your wastes; and Copies of permits for on-site waste management systems. SITE IDENTIFICATION LABELS If you received pre-printed site identification labels with your 2003 Hazardous Waste Report instructions and forms booklet, please review the labels to verify that the information is accurate and mark any changes directly on the labels. Attach one label to each form in the Hazardous Waste Report. If you did not receive labels with your booklet, enter the site name and EPA Identification Number on each form in the space provided for the label (i.e., the top left-hand corner of the form). Before making copies of the forms in order to complete them, be sure that you have either attached a pre-printed label to each form or, if you did not receive labels, that you have entered the site's name and EPA Identification Number in the top left-hand corner of each form. CODE LISTS This symbol denotes references to the page numbers of relevant code lists. Please use only the codes included in the instructions or in the lists of codes that begin on page 49. Please minimize the use of "Other" and "Unknown" codes. If you do use an "Other" or "Unknown" code, please provide an explanation in the Comments section of the form. SKIP INSTRUCTIONS This symbol denotes directions to skip to the next appropriate section or box to be completed, given certain responses to some questions. NOTES This symbol denotes explanatory text or definitions of terms used in the instructions. ------- INSTRUCTIONS (Continued) RIGHT JUSTIFICATION OF QUANTITIES Right justify all quantities reported on the forms. For example, enter a quantity of 12,000 tons on the form as: I I I I I H|2|0|0|0| _ LOJ Enter a quantity of 29,599.5 tons as: _LJ_2_L9J_51919J L.5J COMMENTS SECTION OF FORMS Use the Comments section at the bottom of the forms to clarify or continue any entry. For each comment, reference the section number and box letter of the entry that is being continued. For example, if a hazardous waste generated on site has six EPA hazardous waste codes, enter the first five in Section 1, Box B of Form GM. Enter the sixth waste code in the Comments section and cross-reference Section 1, BoxB: "Sec. 1, Box B, continued: D001." PAGE NUMBERING OF FORMS When you have filled out all the appropriate forms in your Hazardous Waste Report submission, number the pages (each piece of paper is a page) consecutively throughout your submission. Do not number each set of forms separately, but rather number each page sequentially. The individual page number and the total number of pages in your submission should appear at the bottom of each page (e.g., Page 1 of 7, Page 2 of 7). If it is necessary to continue information from one form onto another page, make additional copies of the form and number the additional pages with the same page number as the first page, followed by a letter (e.g., page 27, page 27a; page 28, page 28a, 28b). When continuing information on a supplemental page, enter only the information that is being continued. PHOTOCOPIES OF FORMS A single copy of each form is included in this booklet. Photocopy as many forms as you need to complete your Hazardous Waste Report. Make copies after you have attached the pre-printed site identification label or entered the site name and EPA Identification Number in the top left-hand comer of the form, but before you begin filling out the form. After you have finished filling out the forms, photocopy the entire Hazardous Waste Report and keep a copy for a period of at least three years from the due date of the report as required by 40 CFR 262.40(b). ELECTRONIC REPORTING The EPA encourages electronic reporting of Hazardous Waste Reports. To obtain instructions on how to file electronically, contact your State or EPA Regional Office. ------- INSTRUCTIONS (Continued) CONFIDENTIAL BUSINESS INFORMATION (CBI) You may not withhold information from the Administrator of the EPA because it is confidential. However, when the Administrator is requested to consider information confidential, it must be treated according to the EPA regulations contained in Title 40 of the CFR, Part 2, Subpart B. These regulations provide that a business may, if it desires, assert a claim of business confidentiality covering all or part of the information furnished to the EPA. 40 CFR 2.203(b) explains how to assert a claim. The EPA will treat information covered by such a claim in accordance with the procedures set forth in Subpart B. If someone requests release of information covered by a claim of confidentiality, or if the EPA otherwise decides to make a determination as to whether such information is entitled to confidential treatment, the EPA will notify the business. The EPA will not disclose information as to when a claim of confidentiality has been made except to the extent of and in accordance with 40 CFR Part 2, Subpart B. However, if the business does not claim confidentiality when it furnishes the information, the EPA may make the information available to the public without notice to the business. WHEN AND WHERE TO SEND YOUR COMPLETED REPORT The 2003 Hazardous Waste Report is due to your State or Regional Office by March 1, 2004. Return your completed Hazardous Waste Report to the address listed for your State or Regional contact. See the additional information sent to you with this booklet. An updated listing of State and EPA Regional mailing addresses, contact names, telephone numbers, and email addresses is maintained at - www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm If you need more time to fill out the 2003 Hazardous Waste Report, contact your State or Regional Office as soon as possible for specific instructions. IF YOU NEED ASSISTANCE To obtain assistance in filling out the 2003 Hazardous Waste Report forms, please call the EPA's RCRA, Superrund & EPCRA Call Center at 1-800-424-9346 (703-418-9810 in the Washington, D.C., metropolitan area). The Call Center operates Monday through Friday from 9:00 a.m. to 6:00 p.m. (Eastern Standard Time), and is closed on Federal holidays. This booklet and other related information is on the Internet at - http://www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm In addition to calling the Call Center, you may want to contact your State or Regional Office. Some States' reporting requirements differ from the Federal requirements. The list of State and Regional Office addresses, contact names, telephone numbers, and email addresses is on the Internet at - http://www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm ------- Instructions for Filling Out the RCRA Subtitle C Site Identification (Site ID) Form WHO MUST SUBMIT THIS FORM All sites required to submit any of the following must submit the RCRA Subtitle C Site Identification (Site ID) Form: Initial Notification of Regulated Waste Activity Subsequent Notification of Regulated Waste Activity First RCRA Hazardous Waste Part A Permit Application Revised RCRA Hazardous Waste Part A Permit Application Hazardous Waste Report You must complete all the items on the Site ID Form. PURPOSE OF THIS FORM For purposes of the Notification of Regulated Waste Activity, the Site ID Form provides site-specific information about a facility for obtaining an EPA Identification Number and submitting Initial Notification of Regulated Waste Activity. For purposes of a Subsequent Notification of Regulated Waste Activity, the Site ID Form provides updated site-specific information for those items that have changed at your site and verifies the information for those items that remain unchanged. For the purposes of the RCRA Hazardous Waste Part A Permit Application and the Hazardous Waste Report, you must also complete the Site ID Form to update your site information. HOW TO FILL OUT THIS FORM Please complete all of the Site ID Form items. • Item 1 - your reason for submitting the form (In this case, As a component of the Hazardous Waste Report. If your status or other Site ID Form information has changed, also mark Subsequent Notification of Regulated Waste Activity.) • Item 2 - your site's EPA Identification Number; • Item 3 - the name of your site; • Item 4 - the physical location of your site; • Item 5 - the land type of your site; • Item 6 - the North American Industry Classification System (NAICS) code(s) for your site; • Item 7 - the mailing address for your site; • Item 8 - name and phone number of a contact person at your site; ------- Site ID Form (Continued) • Item 9 - names of the operator and the legal owner(s) of your site; • Item 10 - your site's regulated waste activities (enter all that apply); • Item 11 - the description of hazardous waste if you handle any; • Item 12 - additional comments on Items 1 through 11; and • Item 13 - certification that the information you provided throughout the form is truthful, accurate and complete. Type or print in black ink all items except the Signature box in Item 13. Enter your site's EPA ID Number in the top left-hand corner on the second and third pages of the form; for Initial Notification for this site, leave the EPA Identification Number blank. Use Item 12 - Comments to clarify or provide additional information for any entry. When entering information in the comments section, enter the item number and box letter to which the comment refers. If you must use additional sheets for comments, enter your site's EPA ID number in the top left-hand corner of each sheet. ------- Site ID Form (Continued) ITEM-BY-ITEM INSTRUCTIONS Item 1 -- Reason for Submlttal: Reason for Submittal: Place an "X" in the appropriate box to indicate whether this form is your Initial Notification of Regulated Waste Activity (to obtain an EPA Identification Number); a Subsequent Notification of Regulated Waste Activity (to update your site identification information); a component of a First or a Revised Hazardous Waste Part A Permit Application; or a component of the Hazardous Waste Report. • For Initial Notification of Regulated Waste Activity to provide site identification information and obtain an EPA Identification Number for hazardous waste, universal waste, or used oil activities. If your waste activity is regulated under Subtitle C of the Resource Conservation and Recovery Act (RCRA) and the rules promulgated pursuant to the Act (specifically 40 CFR Parts 260-299), you must submit this form to notify the appropriate State or EPA Regional Office of your regulated waste activities and obtain an EPA Identification Number. • For Subsequent Notification of Regulated Waste Activity to update site identification information. You must use this form to submit a subsequent notification if your site already has an EPA Identification Number and you wish to change information (e.g., generator status, new site contact person, new owner, new mailing address, new regulated waste activity, etc.). » As a component of a First RCRA Hazardous Waste Part A Permit Application. If your site is planning to treat, store, or dispose of hazardous waste on site in a unit that is not exempt from obtaining a hazardous waste permit, you must submit this form as part of the Part A Permit Application. Also, if the activity at this site (treatment, storage, or disposal) became newly regulated under RCRA Subtitle C and the rules promulgated pursuant to the Act (specifically 40 CFR Parts 260-299), you must submit this form as part of the Part A Permit Application. • As a component of a Revised RCRA Hazardous Waste Part A Permit Application. If you must submit a revised Part A Permit Application to reflect changes that have occurred at your site, you must submit this form as part of your revised Part A Permit Application. Examples of site changes requiring a revised Part A Permit Application include managing new wastes not identified in the first submission of the form or changes to existing waste treatment processes. When submitting a revised Part A Permit Application, please include the Amendment number in the appropriate space. • As a component of the Hazardous Waste Report. If you are required to submit a Hazardous Waste Report indicating the amount of hazardous waste you generate, treat, recycle, dispose, ship off site, or receive from off site, you must fill out this form. You will report your current Hazardous Waste Generator status as of the date of submitting the Site Identification Form in Item 10.A.1 - Generator of Hazardous Waste. Your status may have changed since your last submission (except for Initial Notification of Regulated Waste Activity). ------- Site ID Form (Continued) Item 2 -- Site EPA ID Number: Provide your EPA Identification Number in Item 2 for this site. Also, be sure to include your EPA Identification Number at the top of pages 2 and 3 of the form (as well as on any attachments to the Site ID Form). If this is your Initial Notification for this site, leave the EPA Identification Number blank and proceed to Item 3. Items 3 and 4 - Site Name and Location: Provide the legal name of your site and a complete location address. Please note that the address you give for Item 4, Site Location, must be a physical address, not a post office box or route number. A new EPA Identification Number is required if you change the location of your site. Item 5 -- Site Land Type: Place an "X" in the box that best describes the land type of your site. Select only one type: Private, County, District, Federal, Indian, Municipal, State, or Other. If your site's Land Type could be described as Municipal and as County, as District, or as Indian, do not mark Municipal. Instead choose the other appropriate code; you may explain this in Item 12 - Comments. Item 6 •• North American Industry Classification System (NAICS) Code(s): Box A must be completed. Completing Boxes B-D is recommended, if applicable. Box A Provide the North American Industry Classification System (NAICS) code that best describes your site's primary business production process for your products or services. Use the six (6) digit code (most specific description) if available for your business; if not, use the five (5) digit code; do not enter any four (4) or less digit code. Boxes B - D List other NAICS codes that describe the primary business production processes for your site. Use the 6 or 5 digit codes that apply to your site. Check with your accounting or business staff to determine your NAICS code(s); the NAICS code is used in tax reporting and other business reports. A list of the codes can be found on the Internet at - http://www.epa.gov/epaoswer/hazwaste/data/br03/forms.htm You can obtain additional information about NAICS codes from the Internet at - http://www.census.gov/epcd/naics02/ 10 ------- Site ID Form (Continued) Item 7 - Site Mailing Address: Please enter the Site Mailing Address. If the mailing address and the Location of Site (Item 4) are the same, you can enter "Same as Item 4" in the box for Item 7. Item 8 - Site Contact Person: Enter the name, business telephone number, and extension of the individual who should be contacted regarding the information submitted in the Site ID Form. You may also enter an email address; if you want to be contacted by fax, enter that number in Item 12 - Comments. A Subsequent Notification is recommended when the Site Contact Person changes. Do not enter other contact persons here; if there are other persons who may be contacted about this submission, list them and their other contact information in Item 12. An example would be a contact specifically for the Hazardous Waste Report. Note that the Facility Permit Contact information for the RCRA Hazardous Waste Part A Permit Application is entered in Items 1 and 2 of the Hazardous Waste Permit Information Form. It is assumed that the Site Contact Person will receive mail at the Site Mailing Address provided in Item 7. If this is not the case, please provide the mailing address for the Site Contact Person in Item 12 - Comments. Item 9 -- Operator and Legal Owner of the Site: This section should be used to indicate all the operators and owners of this site. Please review these definitions: Operator - The person responsible for the overall operation of a RCRA site. Note: This is the legal entity which controls the RCRA site operation rather than the plant or site manager. This is usually a company or business name, not an individual. See Person. Owner - The person who owns a RCRA site or part of a RCRA site. Note: This includes the property owner. This may be an individual, company, or business name. See Person. Person - An individual, trust, firm, joint stock company, Federal Agency, corporation (including a government corporation), partnership, association, State, municipality, commission, political subdivision of a State, or any interstate body. A. Name of Site's Operator: Provide the name of your site's operator. Date Became an Operator: Indicate the date on which the above entity became the operator of your site. Enter dates as in this example: For April 22,1995, enter 04/22/1995. Operator Type: Place an "X" in the box that best describes the operator type of your site. Select only one type: Private, County, District, Federal, Indian, Municipal, State, or Other. If your site's Operator Type could be described as Municipal and as County, as District, or as Indian, do not mark Municipal. Instead choose the other appropriate code; you may explain this in Item 12 - Comments. Use the Comments section in Item 12 to list any additional operators, their names, the dates they 11 ------- Site ID Form (Continued) In addition to the above, mark "Yes" or "No" for the other hazardous waste activities listed below that may occur at this site. Complete l.d and e, and 2 through 6. d. United States Importer of Hazardous Waste Mark "Yes" if you import hazardous waste from a foreign country into the United States. Refer to 40 CFR 262.60 for additional information. e. Mixed Waste Generator Mark "Yes" if you are a generator of mixed waste (waste that is both hazardous and radioactive). RCRA defines "mixed waste" as waste that contains both hazardous waste and source, special nuclear, or by-product material subject to the Atomic Energy Act (AEA), RCRA section 1004(41), 42 U.S.C. 6903 (63 FR 17414; April 9,1998). See the definitions on pages 39,42, and 43. 2. Transporter of Hazardous Waste: Mark "Yes" if you transport hazardous waste within the United States. The Federal regulations for hazardous waste transporters are found in 40 CFR Part 263. 3. Treater, Storer, or Disposer of Hazardous Waste: If you treat, store, or dispose of hazardous waste, mark "Yes". A RCRA Hazardous Waste Permit is required for this activity. Contact the appropriate office for your State for more information. The Federal regulations for operators and owners of permitted treatment, storage, and disposal facilities (TSDFs) are found in 40 CFR Parts 264, 265, 266, and 270. If your site is a destination facility for universal wastes in addition to being a treatment, storage, or disposal facility for other RCRA hazardous wastes, mark both this box and Box B.2 below. Recycler of Hazardous Waste: If you recycle regulated hazardous wastes (recyclable materials), mark "Yes". The Federal regulations for operators and owners of sites that recycle hazardous waste are found in 40 CFR 261.6. You also may be subject to other Federal and State regulations; in some cases a permit is required. If your site, in addition to being a recycling site for hazardous waste, is a treater, storer, or disposer of hazardous waste, mark both this box and Box A.3 above. If your site is a destination facility for universal wastes in addition to being a recycling site for other RCRA hazardous wastes, mark both this box and Box B.2 below. Exempt Boiler and/or Industrial Furnace: If you mark "Yes", mark each that applies. a. 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, mark "Yes" to indicate that you qualify for the Small Quantity On-Site Burner Exemption. b. If you process hazardous wastes in a smelting, melting, or refining furnace solely for 14 ------- Site ID Form (Continued) metals recovery, as described in 40 CFR 266.100(d), or to recover economically significant amounts of precious metals, as described in 40 CFR 266.100(g), or if you process hazardous wastes in a lead recovery furnace to recover lead, as described in 40 CFR 266.100(h), place an "X" in the box to indicate that you qualify for the Smelting, Melting, and Refining Furnace Exemption. 6. Underground Injection Control: If you generate, treat, store, or dispose of hazardous waste and there is an underground injection well located at your site, mark "Yes". The Federal regulations for operators or owners of underground injection wells are found in 40 CFR Part 148. In addition to the above, mark "Yes" or "No" for the other regulated waste activities listed below that may occur at this site. Complete Items B and C. B. Universal Waste Activities: Refer to your State-specific requirements and definitions for universal waste. Also, refer to 40 CFR 261.9 and 40 CFR Part 273 for the Federal regulations covering universal waste. Complete 1 and 2. 1. Large Quantity Handler of Universal Waste (LQHUW): You are an LQHUW if you accumulate a total of 5,000 kg or more of any universal wastes (calculated collectively) at any time. If "Yes", place an "X" in the appropriate box(es) to indicate the type(s) of universal wastes you generate and/or accumulate at your site. If your State has additional universal wastes, indicate what they are and place an "X" in the corresponding box(es). 2. Destination Facility: Mark "Yes" if you treat, dispose of, or recycle universal wastes on site. A hazardous waste permit is required if you treat or dispose of universal wastes; a permit may be required if you recycle universal wastes. If your site, in addition to being a destination facility for universal wastes, is also a treatment, storage, or disposal facility for RCRA hazardous wastes, mark both this box and Box A.3 above. In addition, if your site recycles RCRA hazardous wastes, mark both this box and Box A.4 above. Used Oil Activities: Mark the appropriate box(es) to indicate which used oil management activities are taking place at this site. The Federal regulations for used oil management are found in 40 CFR Part 279. Complete 1 through 4. 1, Used Oil Transporter: If you transport used oil and/or own or operate a used oil transfer facility, mark "Yes" and 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, mark "Yes" and place an "X" in the appropriate box(es) to indicate this used oil management activity. 3. Off-Specification Used Oil Burner: If you burn off-specification used oil fuel, mark "Yes" to indicate this used oil management activity. 4. Used Oil Fuel Marketer: Mark "Yes" if you market used oil fuel. If you market off- 15 ------- FORM GM (Continued) • Generated and accumulated on site in 2003 but not managed on site or shipped off site until after 2003; or • Generated and accumulated on site prior to 2003 but either managed on site or shipped off site in 2003; or • Imported from a foreign country in 2003. Examples of RCRA hazardous wastes to be reported include those that were: • Generated on site from a production process, service activity, or routine cleanup. • Generated from equipment decommissioning, spill cleanup, or remedial cleanup activity. • Removed from on-site storage. • Derived from the management of non-hazardous waste. • Derived from the on-site treatment (including reclamation), disposal, or recycling of previously existing hazardous waste (as a residual). • Shipped off site, including hazardous waste that was received from off site (reported on the Waste Received from Off Site Form (Form WR)) and subsequently shipped off site without being treated or recycled on site. Radioactive wastes mixed with RCRA hazardous wastes should also be reported; be sure to mark "Yes" on the Site Identification Form in Item lO.A.l.e. See the definitions on pages 39,42, and 43 and see the special instructions on page 46. Hazardous wastes regulated only by your State should be reported if required by your State. WASTES NOT TO BE REPORTED RCRA hazardous wastes exported directly to a foreign country should not be reported on Form GM. Rather, hazardous waste exports should be reported on the Annual Report required under 40 CFR 262.56. In addition, materials and wastes identified at 40 CFR 261.4(a) and (b) and 261.5(c) should not be reported on Form GM. Section 261.4(a) and (b) identify materials and solid wastes that do not quality as solid or hazardous wastes, respectively. Section 261.5(c) identifies hazardous wastes that should not be included in a site's generator status determination, even if these hazardous wastes were generated at the site. Following are the materials and wastes addressed under 40 CFR 261.4(a) and (b) and 261.5(c), which should not be reported on Form GM; • Materials which are excluded from being a solid waste, e.g., any mixture of domestic sewage and other wastes that passes through a sewer system to a publicly owned treatment works (unless they are stored or treated in regulated units prior to being discharged). (40CFR261.4(a)) • Solid wastes that are excluded from being hazardous waste, e.g., petroleum-contaminated media and debris that fail the test for the toxicity characteristic (Waste Codes D018 18 ------- FORM GM (Continued) through D043 only) and are subject to the corrective action regulations under 40 CFR Part 280. (40CFR261.4(b)) • Waste exempt from regulation because the waste has not exited the raw material storage or production unit yet, as specified in 261.4(c). (40 CFR 261.5(c)(l)) • Hazardous waste that has been collected as a sample(s) for the purpose of determining its characteristic or composition, as specified in 261.4(d). (40 CFR 261.5(c)(l)) • Sample(s) undergoing treatability studies, as specified in 261.4(e). (40 CFR 261.5(c)(l)) • Sample(s) undergoing treatability studies at the laboratory or testing facility, as specified in261.4(i). (40CFR261.5(c)(l)) • Hazardous waste that is a specified recyclable material such as ethyl alcohol or scrap metal, as specified in 261.6(a)(3). (40 CFR 261.5(c)(l)) • A residue of hazardous waste in an empty container or in an inner liner removed from an empty container, as specified in 261.7(a)(l). (40 CFR 261.5(c)(l)) • PCB wastes regulated under the Toxic Substance Control Act, as specified in 261.8, unless mixed with a hazardous waste. (40 CFR 261.5(c)(l)) • Wastes managed immediately upon generation only in on-site elementary neutralization units, wastewater treatment units, or totally enclosed treatment facilities as defined in 40 CFR 260.10. (40 CFR 261.5(c)(2)) Any hazardous waste residues generated from these units, however, must be reported on Form GM. • Wastes recycled, without prior storage, only in an on-site process subject to regulation under 40 CFR 261.6(c)(2). (40 CFR 261.5(c)(3)) • Used oil that is recycled and is also a hazardous waste solely because it exhibits a hazardous waste characteristic and is managed under 40 CFR Part 279. (40 CFR 261.5(c)(4)) • Spent lead-acid batteries managed under the requirements of 40 CFR Part 266, Subpart G, which includes persons who reclaim spent lead-acid batteries that are recyclable materials; persons who generate, transport, or collect spent batteries; persons who regenerate spent batteries; or persons who store them (other than spent batteries that are to be regenerated). (40 CFR 261.5(c)(5)) Any hazardous wastes generated during battery reclamation, however, must be reported on Form GM. • Universal wastes managed under 40 CFR 261.9 and 40 CFR Part 273. (40 CFR 261.5(c)(6)) HOW TO REPORT SIMILAR WASTES ON FORM GM Generally, a Form GM should be completed for each generated RCRA hazardous waste. Contact your State about combining and reporting similar hazardous wastes on Form GM. 19 ------- FORM GM (Continued) ITEM-BY-ITEM INSTRUCTIONS Section 1: Waste Characteristics Section 1 requests information on each RCRA hazardous waste that, in 2003, was generated and accumulated on site; managed on site; and/or shipped off site. Boxes B, D, F, and G must be completed. Boxes A and E request non-mandatory information. Box A: Waste description Provide a short narrative description of the waste, such as: • General type; • Source; • Type of hazard; and • Generic chemical name or primary hazardous constituents. Example: "Ignitable spent solvent from degreasing operation in tool production; mixture of mineral spirits and kerosene." In the example, note that the general type (spent solvent), source (degreasing operation in tool production), type of hazard (ignitability), and generic chemical names (mineral spirits and kerosene) have all been cited. Box B: EPA hazardous waste code Enter the four-character EPA hazardous waste code(s) that applies to the waste reported in Box A. EPA hazardous waste codes are listed beginning on page 49. If you need room for additional codes, list the codes in the Comments section and cross-reference Section 1, Box B. If fewer than five EPA hazardous waste codes are applicable, enter "NA" in the remaining spaces. If the waste is regulated only by your State, enter "NA" in Box B and report the State hazardous waste codes in Box C. EPA Hazardous Waste Codes, page 49. Box C: State hazardous waste code Enter the State hazardous waste code(s) that applies to the waste reported in Box A, if: • Your State regulates hazardous wastes not regulated as RCRA hazardous wastes and requires these wastes to be reported in the 2003 Hazardous Waste Report; or • Your State uses a hazardous waste code system other than the EPA hazardous waste codes that applies to the waste described in Box A. Otherwise, leave Box C blank. If you need space for additional State hazardous waste codes, list the codes in the Comments section and cross-reference Section 1, Box C. 20 ------- FORM GM (Continued) Box D: Source and Management Method code Enter the Source code that best describes how the hazardous waste reported in Box A originated. If the hazardous waste was mixed with other non-hazardous materials, report the Source code for only the hazardous waste portion. Source codes, page 51. If the Source code is G25 - Hazardous waste management, you also need to provide the Management Method code. Source code G25 indicates that this waste was generated from a hazardous waste management system described on a separate Form GM or Form WR. Enter the same Management Method code that is listed on the matching Form GM - Section 2, or on the matching Form WR - Box H, linking this waste with the on-site process that created it. Provide the Management Method code if you selected Source code G25. See page 55. Reporting hazardous waste imported from a foreign country - Review the Special Instructions for Wastes received from foreign countries on page 47. Provide the appropriate Source code for hazardous waste imported from a foreign country if your site is the U.S. Importer. Also, mark "Yes" on the Site ID Form, Item lO.A.l.d. - United States Importer of Hazardous Waste. Box E: Form code Review the Form codes beginning on page 53 and enter the code that best corresponds to the physical form or chemical composition of the hazardous waste reported in Box A. Note: The Form codes have been revised to provide a simpler coding structure. Form codes, page 53. 21 ------- FORM GM (Continued) BoxF: Quantity generated in 2003 Enter the total quantity of the hazardous waste described in Box A that was generated during 2003. Right justify the quantity entry. Report the UOM and density for this quantity in Box G. Box G: UOM and Density Enter the unit of measure (UOM) code for the quantity you reported in Box F. Report the quantity in one of the units of measure listed below. If you select a volumetric measure (gallons, liters, or cubic yards), you must also report the density of the waste. Code Unit of Measure 1 Pounds 2 Short tons (2,000 pounds) 3 Kilograms 4 Metric tonnes (1,000 kilograms) 5 Gallons 6 Liters 7 Cubic yards Weight and Volume Conversions 1 kilogram (kg) 1 short ton 1 metric tonne 1 metric tonne = 2.2046 pounds (Ib) = 2,000 Ib = 1,000 kg = 1.1023 short tons 1 cubic meter (m) = 1.3079 cubic yards 1 cubic yard (yd) = 27 cubic feet (ft) 1 liter (1) = 0.2642 gallons (gal) Skip to Section 2 if you selected code 1,2, 3, or 4. Continue to Density if you selected code 5, 6, or 7. Report the density only if you entered code 5, 6, or 7 for the unit of measure. Provide the density in either pounds per gallon (Ibs/gal) or specific gravity (sg) and mark the appropriate box to indicate which measure was used. Section 2: On-site Generation and Management of Hazardous Waste During 2003 All boxes in this section are mandatory. For each on-site RCRA-regulated management system, you must report the Management Method and quantity treated, disposed, or recycled on site during 2003. Was any of this waste managed on site? Mark "Yes" or "No" to indicate if the site did any of the following to the waste reported in Box A: treat on site; dispose on site; recycle on site. If you marked "Yes," complete the blocks for On-site Process Systems below. Skip to Section 3 if you marked "No." Continue to On-site Process System 1 if you marked "Yes." 22 ------- FORM GM (Continued) On-site Process Systems 1 and 2: On-site Management Method Classify the process system (see definition on page 40) with a Management Method code that best identifies the final substantive purpose/operation it performs. Space is provided to report up to two different Management Methods. If you did not use a second on-site process system to manage the waste, enter "NA" in the space for reporting the Management Method code under On- site Process System 2. Management Method codes, page 55. The space provided for the second on-site process system should be used only in the special case of management of the same waste on site by more than one process system during 2003. Use the second on-site process system only when: • A waste is managed in one process system for part of a year and in another process system for the rest of the year; or • A waste is managed by two different process systems at the same time (i.e., management of the waste is split between parallel process systems). If more than two on-site process systems meet one of the above conditions, you need not complete the entire form again. Simply attach a second copy of Form GM, leaving blank all entries except Section 2 for on-site process systems. Note in the Comments section of each page: "Sec. 2, on-site process system type continued on supplemental page." (Refer to page 5 for instructions on page numbering of supplemental pages.) The space provided for the second on-site process system should not be used to report the following: • The on-site management of the treatment residual generated from management of the waste by the first Management Method (on-site management of treatment residuals should be reported on a separate Form GM); or • To report treatment in a series of process units (see definition on page 40). Report only process systems, not process units. Quantity treated, disposed, or recycled on site in 2003 Enter the quantity of hazardous waste described in Section 1 that was treated, disposed, or recycled by the reported on-site process management method during 2003. Enter the quantity in the same unit of measure reported in Section 1, BoxH. Example: A firm generated 100 tons of F002 solvent waste in 2003. Eighty (80) tons were recycled for reuse in a batch distillation process system, generating 5 tons of still bottoms. The remaining 20 tons were burned in an industrial boiler. 23 ------- FORM GM (Continued) Under On-site Process System 1, the site enters the Management Method code for distillation (H020) and a quantity of 80 tons. Under On-site Process System 2, the site enters the Management Method code for energy recovery of liquids (H050) and a quantity of 20 tons. The 5 tons of still bottoms should be reported on a separate Form GM. Section 3: Off-site Shipment of Hazardous Waste This section requests information on the off-site shipment of hazardous waste. Boxes B and D are mandatory for such off-site shipment. Boxes A and C request non-mandatory information. Do report shipments of previously generated hazardous wastes stored until 2003. Do report waste shipped via transfer facility. Do not report shipments of decharacterized wastes. Space is provided to report shipments of the waste to three different off-site facilities. If the waste you reported in Section 1 was shipped to more than three off-site facilities during 2003, you need not complete the entire form again. Simply attach a second copy of Form GM, leaving blank all entries except Section 3, Boxes B, C, and D. Note in the Comments section of each page: "Sec. 3, Box B continued on supplemental page." (Refer to page 5 for instructions on page numbering of supplemental pages.) Box A: Was any of this waste shipped off site in 2003 for treatment, disposal, or recycling? Mark "Yes" or "No" to indicate if any of the waste described in Section 1 was shipped off site for treatment, disposal, or recycling during 2003. While responding to Box A is not mandatory, providing information for waste shipped off site is required. This Form GM is complete if you marked "No" in Box A. Continue to Box B if you marked "Yes" in Box A. Box B: EPA ID No. of facility to which waste was shipped Enter the 12-digit EPA Identification Number of the facility to which the waste was shipped. DO NOT create a GM Form for hazardous waste shipped directly to a foreign country from this site. You must complete an Annual Report as required under 40 CFR 262.56, no later than March 1 of each year. Box C: Off-site Management Method code shipped to Review the Management Method codes beginning on page 55. Enter the Management Method code that best describes the way in which the waste was managed at the initial receiving facility reported in Box B. 24 ------- FORM GM (Continued) Management Method codes, page 55. Box D: Total quantity shipped in 2003 Enter the total quantity of the waste shipped to the off-site facility during 2003. Report the quantity in the same unit of measure entered in Section 1, Box G. Shipment quantities should equal the total quantity recorded on Uniform Hazardous Waste Manifests for this site during 2003, unless there were rejections or other complications. The quantity shipped may not necessarily equal the quantity generated (e.g., because some waste is on site). 25 ------- INSTRUCTIONS FOR FILLING OUT FORM WR - WASTE RECEIVED FROM OFF SITE WHO MUST SUBMIT THIS FORM A site required to file the 2003 Hazardous Waste Report must submit this form if, during 2003, it received RCRA hazardous waste from off site. PURPOSE OF THIS FORM Form WR identifies hazardous wastes that were received from other hazardous waste sites and the method(s) used to manage them. Form WR is divided into three identical parts (i.e., waste blocks), labeled Waste 1, Waste 2, and Waste 3, that collect information on the quantities and characteristics of each hazardous waste received from an off-site source during 2003 and managed on site. HOW TO FILL OUT THIS FORM You may report waste received from more than one off-site handler on the same page of the form. A separate waste block must be filled out for each hazardous waste received from each off-site handler. Hazardous waste from the same off-site handler may be aggregated as long as a single Form code describes the physical form or chemical composition, and all of the waste is managed in a single process system (i.e., same Management Method code). If your site received more than three RCRA hazardous wastes from off-site handlers during 2003, photocopy and fill out additional copies of this form. Prior to photocopying, place the pre-printed site identification label in the top left-hand corner of the form or, if you did not receive pre-printed labels, enter the site name and EPA Identification Number in the space provided. Use the Comments section at the end of the form to clarify any entry (e.g., "Other" responses) or to continue any entry. When entering information in the Comments section, cross-reference the waste block and box letter to which the comment refers. 26 ------- FORM WR (Continued) ITEM-BY-ITEM INSTRUCTIONS For each waste reported, Boxes B, D, E, F, and H must be filled out. Box A: Description of hazardous waste Provide a short narrative description of the waste, such as: • General type; • Source; • Type of hazard; and • Generic chemical name or primary hazardous constituents. Example: "Ignitable spent solvent used as a degreaser in tool production; mixture of mineral spirits and kerosene." In the example, note that the general type (spent solvent), source (degreaser in tool production), type of hazard (ignitability), and generic chemical names (mineral spirits and kerosene) have all been cited. Box B: EPA hazardous waste code Enter the EPA hazardous waste code(s) that applies to the waste reported in Box A. If you need room for additional codes, list the codes in the Comments section and cross-reference the applicable waste block number (e.g., Waste 1) and Box B. If fewer than four EPA hazardous waste codes are applicable, enter "NA" in the remaining spaces. If the waste is regulated only by your State, enter "NA" in Box B and report the State hazardous waste codes in Box C. EPA Hazardous Waste Codes, page 49. Box C: State hazardous waste code Enter the State hazardous waste code(s) that applies to the waste reported in Box A, if: • Your State regulates hazardous wastes not regulated as RCRA hazardous wastes, and requires these wastes to be reported in the 2003 Hazardous Waste Report; or • Your State uses a hazardous waste code system other than the EPA hazardous waste codes that applies to the waste described in Box A. Otherwise, leave Box C blank. If you need space for additional State hazardous waste codes, list the codes in the Comments section and cross-reference the applicable waste block number (e.g., Waste l)andBoxC. 27 ------- FORM WR (Continued) Box D: Off-site handler EPA ID number Enter the 12-digit EPA Identification Number of the off-site handler from which the waste was received. If the site does not have an EPA Identification Number, it may be a CESQG or foreign country. Refer to the Special Instructions in this booklet for instructions on how to complete Box D for these off-site handlers. If the waste reported under Waste 2 is received from the same off-site handler as the waste reported under Waste 1, mark the box to indicate that the EPA ID number is the same as the one reported in Waste 1; if Waste 3 is received from the same off-site handler as Waste 2, mark the box to indicate that the EPA ID number is the same as the one reported under Waste 2. Refer to the Special Instructions for reporting wastes received from CESQGs on page 46 and for reporting wastes received from foreign countries on page 47. Box E: Quantity received in 2003 Report the total quantity of the hazardous waste reported in Box A that was received from the off- site handler reported in Box D during 2003. If more than one shipment of this waste was received from the same off-site handler, add the quantities and report only the sum. Report the unit of measure and density in Box F. Box F: UOM and Density Enter the unit of measure (UOM) code for the quantity you reported in Box E. Report quantities in one of the units of measure listed below. If you select a volumetric measure (gallons, liters, or cubic yards), you must also report the density of the waste. Code Unit of Measure 1 Pounds 2 Short tons (2,000 pounds) 3 Kilograms 4 Metric tonnes (1,000 kilograms) 5 Gallons 6 Liters 7 Cubic yards Weight and Volume Conversions 1 kilogram (kg) 1 short ton 1 metric tonne 1 metric tonne = 2.2046 pounds (Ib) = 2,000 Ib = 1,000 kg = 1.1023 short tons 1 cubic meter (m) = 1.3079 cubic yards 1 cubic yard (yd) = 27 cubic feet (ft) 1 liter (1) = 0.2642 gallons (gal) Skip to Box'G if you entered code 1,2, 3, or 4. Continue to Density if you entered code 5, 6, or 7. Complete density only if you entered code 5,6, or 7 as a unit of measure. Provide the density in either pounds per gallon (Ibs/gal) or specific gravity (sg) and mark the appropriate box to indicate which measure was used. 28 ------- FORM WR (Continued) Box G: Form code Review the Form codes beginning on page 53 and enter the code that best corresponds to the physical form or chemical composition of the hazardous waste reported in Box A. Note: The Form codes have been revised to provide a simpler coding structure. Form codes, page 53. Box H: Management Method code Enter the code that describes the type of process system (see definition on page 40) in which the waste was managed. Management Method codes, page 55. 29 ------- THIS PAGE INTENTIONALLY LEFT BLANK 32 ------- EXCLUDED WASTES This section presents a partial list of excluded materials and wastes. This list includes materials excluded from the definition of solid waste in 40 CFR 261.4(a) and solid wastes excluded from the definition of hazardous waste in 40 CFR 261.4(b). In addition, it also includes specific solid waste samples that are excluded from the definition of hazardous waste in 40 CFR 261.4(d)-(f). Finally, this list includes specific hazardous wastes, as described in 40 CFR 261.4(c), that are exempted from certain RCRA Subtitle C regulations. Agricultural Waste Fertilizer §26i.4(b)(2) Analytical Samples §261. 4(d) Arsenic Treated Wood and Wood Products §261.4(b)(9) Cement Kiln Dust §261.4(b)(8) Coking By-products §261.4(a)(10) Comparable/Syn gas Fuels §261.4(a)(16) Domestic Sewage §261.4(a)(l) Dredged Material §261.4(g) Drilling Fluid §261.4(b)(5) Excluded Scrap Metal Being Recycled §261.4(a)(13) Exported Wastes §262.56 Fossil Fuel Emission Control Waste §261.4(b)(4) Household Waste HTMR Condenser Residue §261.4(aXH) In situ Mining Materials §261.4(a)(5) Irrigation Return Flows §261.4(a)(3) Kraft Mill Steam Stripper Conden sates §261.4(a)(15) Leachate §261.4(b)(15) Mining and Mineral Process Wastes §261.4(b)(7) Mining Overburden §261.4(b)(3) Nuclear Material §261.4(a)(4) Oil Filters §261.4(b)(13) Petrochemical Recovered Oil §261.4(a)(18) Petroleum-contaminated Media and Debris §261.4(b)(10) Petroleum Refining §261.4(a)(12) Pulping Liquor §261.4(a)(6) Refrigerants §261.4(b)(12) Secondary Materials Returned to Original Process §261.4(a)(8) Secondary Materials from Mineral Processing §261.4(a)(17) Shredded Circuit Boards Being Recycled §261.4(a)(14) Spent Caustics from Petroleum Refining §261.4(a)(19) Spent Wood Preserving Solutions and Wastewaters §261.4(a)(9) Sulfuric Acid §261.4(a)(7) Treatability Study Samples §261.4(e) Treatability Studies at Laboratories and Testing Facilities §261,4(f) Trivalent Chromium Waste §261.4(b)(6) Used Oil Distillation Bottoms §261.4(b)(14) Wastes Generated in Storage Tanks, Transport Vehicles, Pipelines, or Manufacturing Process Units §261.4(c) Wastewater Point Source Discharge §261.4(a)(2) 33 ------- THIS PAGE INTENTIONALLY LEFT BLANK 34 ------- DEFINITIONS This section contains definitions of terms helpful for completing the Hazardous Waste Report. For terms defined in the Code of Federal Regulations (CFR), the appropriate citation is provided. Accumulation Act or RCRA Acute Hazardous Waste Authorized Representative Authorized State Boiler A site that does not hold RCRA Interim Status or a RCRA permit may accumulate hazardous waste for a short period of time before shipping it off site. The waste must be accumulated in either tanks or containers; it may not be accumulated in surface impoundments. Generators of more than 1,000 kg (2,200 Ibs) of hazardous waste per month may accumulate their waste for up to 90 days before shipping it off site. Generators of 100 kg (220 Ibs) to 1,000 kg (2,200 Ibs) of hazardous waste per month may accumulate their waste for up to 180 days before shipping it off site. If the nearest treatment, storage, disposal, or recycling facility to which they can send their waste is more than 200 miles away, they may accumulate their waste for 270 days. See 40 CFR 262.34. 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. Any hazardous waste with an EPA hazardous waste code beginning with the letter "P" (40 CFR 261.33(e)) or any of the following "F" codes: F020, F021, F022, F023, F026, and F027 (40 CFR 261.31). These wastes are subject to stringent quantity standards for accumulation and generation (40 CFR 261.5(e)). The person responsible for the overall operation of the site or an operational unit (i.e., part of a site), e.g., superintendent or plant manager, or person of equivalent responsibility. A State that has obtained authorization from the EPA to direct its own RCRA program. 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; 35 ------- DEFINITIONS (Continued) By-product Material Code of Federal Regulations (CFR) Conditionally Exempt Small Quantity Generator (CESQG) of Hazardous Waste Confidential Business Information (CBI) Dellsted Wastes 4. The unit exports and utilizes at least 75 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 For purposes of the Hazardous Waste Report, a by-product material is (1) any radioactive material (except special nuclear material) yielded in or made radioactive by exposure to the radiation incident to the process of producing or utilizing special nuclear material; and (2) the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its source material content (defined in the Atomic Energy Act of 1954). Codification of the general and permanent rules published in the Federal Register by the Executive departments and agencies of the Federal Government. The Code is divided into 50 titles which represent broad areas subject to Federal regulation. Each title is divided into chapters that usually bear the name of the issuing agency. Each chapter is further subdivided into parts covering specific regulatory areas. The CFR title applicable for the Hazardous Waste Report is "40," as in "40 CFR 262.34." A generator that meets the following criteria: In every month during the year, the site did all of the following: 1. Generated no more than 100 kg (220 Ibs.) of RCRA hazardous waste in a calendar month; and 2. Generated, in a calendar month, or accumulated at any time, no more than 1 kg (2.2 Ibs.) of acute hazardous waste, and no more than 100 kg (220 Ibs.) of material from the cleanup of a spill of acute hazardous waste; and 3. Accumulated, at any time, no more than 1,000 kg (2,200 Ibs.) of hazardous waste. Information a facility does not wish to make available to the general public for competitive business reasons. Confidential Business Information (CBI) may be claimed for certain information in your report. A claim may be made in accordance with 40 CFR Part 2, Subpart B, Site-specific wastes excluded from regulation under 40 CFR 260.20 and 260.22. A waste at a particular generating site may be excluded by petitioning the EPA Administrator for a regulatory amendment. These wastes are listed in Appendix IX of 40 CFR Part 261. 36 ------- DEFINITIONS (Continued) Disposal Environmental Protection Agency (EPA) EPA Identification (ID) Number Excluded Wastes Hazardous Waste Hazardous Waste Generator Hazardous Waste Number or Code, EPA Hazardous Waste Storage Hazardous Waste Transporter Hazardous Waste Treatment 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, also called U.S. EPA, means the United States Environmental Protection Agency. Some State environmental authorities may be called the EPA also, as in "Illinois EPA." The number assigned by the EPA to each hazardous waste generator, hazardous waste transporter, and treatment, storage, or disposal facility; United States importer of hazardous waste; mixed waste (hazardous and radioactive) generator; recycler of hazardous waste; exempt boiler and/or industrial furnace burning or processing hazardous waste; large quantity handler of or destination facility for universal wastes; disposer of hazardous waste with an underground injection permit; used oil transporter, used oil processor/re-refiner, off-specification used oil fuel burner, used oil fuel marketer; or site undergoing corrective action. Wastes excluded from the definition of solid or hazardous waste under 40 CFR 261.3 and 261.4. See page 33 for a partial listing. A hazardous waste as defined in 40 CFR 261.3. Any person, by site, whose act or process produces hazardous waste identified or listed in 40 CFR Part 261. The number (or code) assigned by the EPA to each hazardous waste listed in 40 CFR Part 261, Subpart D and to each characteristic identified in 40 CFR Part 261, Subpart C. The codes consist of one letter (D, F, P, U, or K) and three numbers. The list of EPA hazardous waste codes begins on page 49. The holding of hazardous waste for a temporary period, at the end of which the hazardous waste is treated, disposed of, or stored elsewhere. A person engaged in the off-site transportation of hazardous waste by air, rail, highway, or water. 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. 37 ------- DEFINITIONS (Continued) Incineration Industrial Furnace Interim (Permit) Status Large Quantity Generator (LQG) of Hazardous Waste Large Quantity Handler of Universal Waste Management, or Hazardous Waste Management Burning of certain types of solid, liquid, or gaseous materials; or a treatment technology involving destruction of waste by controlled burning at high temperatures (e.g., burning sludge to remove the water and reduce the remaining residues to a safe, non-burnable ash that can be disposed safely on land, in some waters, or in underground locations). 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. Period during which the operator/owner of an existing TSD facility is treated as having been issued a RCRA permit even though he/she has not yet received a final determination. An existing facility should have automatically qualified for interim status if the operator/owner filed both timely "notification" and the first part (Part A) of the RCRA permit application. Interim status continues until a final determination is made to issue or deny the permit. Operator/owner of new facilities cannot by definition qualify for interim status; rather, they need a RCRA permit prior to beginning construction of a hazardous waste management facility. A generator that meets any of the following criteria: 1. Generates, in a calendar month, 1,000 kg (2,200 Ibs.) or more of RCRA hazardous waste, during one or more months in a year; or 2. Generates, in a calendar month, or accumulates at any time, more than 1 kg (2.2 Ibs.) of RCRA acute hazardous waste; or 3. Generates, in a calendar month, or accumulates at any time, more than 100 kg (220 Ibs.) of spill cleanup material contaminated with RCRA acute hazardous waste. A universal waste handler (as defined in 40 CFR 273.9) who accumulates a total of 5,000 kilograms or more of universal wastes (batteries, pesticides, thermostats, or lamps - calculated 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. Systematic control of the collection, source separation, storage, transportation, processing, treatment, recovery, or disposal of hazardous waste (40 CFR 260.10). 38 ------- DEFINITIONS (Continued) Manifest, Uniform Hazardous Waste Mixed Waste Municipality Off-site Facility Off-Specification Used Oil Burner Off-Specification Used Oil Fuel On-site Facility On-Specification Used Oil Fuel Operator Owner Person The shipped document EPA form 8700-22 and, if necessary, Form 8700- 22A, originated and signed by a generator in accordance with the instructions included in the appendix to 40 CFR Part 262. The "cradle- to-grave" paperwork must accompany a shipment of hazardous waste as it moves from the generator to the transporter and eventually to the hazardous waste management facility. Waste that contains both hazardous and source, special nuclear, or by- product material subject to the Atomic Energy Act (AEA), RCRA section 1004(41), 42 U.S.C. 6903 (63 FR 17414; April 9, 1998). 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 having jurisdiction over disposal of sewage, industrial wastes, or other wastes. A hazardous waste treatment, storage, disposal, or recycling area located at a place away from the generating site. A site 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). Used oil fuel that does not meet the specification provided under 40 CFR 279.11. A hazardous waste treatment, storage, disposal, or recycling area located on the generating site. Used oil fuel that meets the specification provided under 40 CFR 279.11. The person responsible for the overall operation of a RCRA site. Note: This is the legal entity which controls the RCRA site operation rather than the plant or site manager. This is usually a company or business name, not an individual. See Person. The person who owns a RCRA site or part of a RCRA site. Note: This includes the property owner. This may be an individual, company, or business name. See Person. An individual, trust, firm, joint stock company, Federal Agency, corporation (including a government corporation), partnership, association, State, municipality, commission, political subdivision of a State, or any interstate body. 39 ------- DEFINITIONS (Continued) Process System Process Unit Resource Conservation and Recovery Act (RCRA) RCRA Interim (Permit) Status RCRA Permit For purposes of the Hazardous Waste Report, a process system refers to one or more units used together to treat, recover, or dispose of a hazardous waste. The process system begins at the unit where the hazardous waste first enters and consists of all other treatment, recovery, or disposal units downstream from the point of entry. Note that storage is not considered a process system, except for storage at a bulking and re-shipping facility (H141). Classify each process system with a Management Method code that best identifies the final substantive purpose/operation it performs. For example, a process system to remove dissolved metals from wastewater prior to shipping the sludge off site typically includes equalization, pH adjustment, chemical precipitation, flocculation, clarification/settling, and dewatering of the sludge removed from the bottom of the clarifier. The chemical precipitation process best identifies the primary purpose of this treatment system - to remove metals from the wastewater. If this wastewater treatment system is RCRA-regulated, it would be reported as H077 (chemical precipitation). If the sludge will be disposed at the reporting site in a landfill, the code will be H132 (landfill) and will need to be reported on a separate GM Form because it is a residual from a treatment process. However, this process is exempt if the treated water flows to a POTW or a NPDES outfall with no RCRA-regulated storage or treatment units in the system, and should not be reported. A listing of Management Method codes begins on page 55. For purposes of the Hazardous Waste Report, a process unit refers to a single type of treatment (e.g., tank, distillation column, surface impoundment) in which hazardous waste is treated, disposed, or recycled. The Solid Waste Disposal Act as amended by the Resource Conservation and Recovery Act (RCRA) (40 CFR 270.2). It is the Federal statute that regulates the generation, treatment, storage, disposal, recycling, and/or transportation of solid and hazardous waste. Refer to "Interim (Permit) Status" definition on page 38. A complete RCRA permit is comprised of an operating permit for hazardous waste treatment, storage, and disposal, and a corrective action permit addressing releases from solid waste management unit (SWMUs). To apply for a permit, a site must file a two-part application (Part A and Part B). A facility is not considered to have a complete RCRA permit until both parts have been issued. 40 ------- DEFINITIONS (Continued) RCRA Subtitle C Site (RCRA Site or Site) Recycling Residual Sludge The physical plant or location at which one or more of the following regulated waste activities occurs: the generation, transportation, treatment, storage, or disposal of hazardous wastes; recycling of hazardous wastes; United States importer of hazardous waste; mixed waste (hazardous and radioactive) generator; exempt boiler and/or industrial furnace burning or processing hazardous waste; large quantity handler of or destination facility for universal wastes; disposing hazardous waste with an underground injection permit; the transportation (and temporary storage during transportation), processing/re-refining, burning, or marketing of used oil; or undergoing corrective action. A site may consist of several treatment, storage, or disposal operational units. For entities that only transport regulated wastes, the term site refers to the headquarters of that entity's operations. Use, reuse, or reclamation of a material (40 CFR 261.1 (c)(7)). "Reclamation" is the processing or regeneration of a material to recover a usable product (e.g., recovery of lead values from spent batteries, regeneration of spent solvents) (40 CFR 261.1(c)(4)). A material is "used or reused" if it is either: (1) employed as an ingredient (including use as an intermediate) in an industrial process to make a product (e.g., distillation bottoms from one process used as feedstock in another process) (40 CFR 261.1(c)(5)). However, a material will not satisfy this condition if distinct components of the material are recovered as separate end products (as when metals are recovered from metal-containing secondary materials); or (2) employed in a particular function or application as an effective substitute for a commercial product (e.g., spent pickle liquor used as phosphorous precipitant and sludge conditioner in wastewater treatment). A hazardous waste derived from the treatment, disposal, or recycling of a previously existing hazardous waste (e.g., the sludge remaining after initial wastewater treatment). Any solid, semi-solid, or liquid waste generated from a municipal, commercial, or industrial wastewater treatment plant, water supply treatment plant, or air pollution control facility exclusive of the treated effluent from a wastewater treatment plant (40 CFR 260.10). 41 ------- DEFINITIONS (Continued) Small Quantity Generator (SQG) of Hazardous Waste Small Quantity On-Site Burner Exemption Smelting, Melting, and Refining Furnace Exemption Solid Waste Source Material A generator that meets all the following criteria: 1. Generates, in a calendar month, more than 100 kg (220 Ibs.) but less than 1,000 kg (2,200 Ibs.) of RCRA hazardous waste, during one or more months in a year; and 2. Generates, in a calendar month, or accumulates at any time, no more than 1 kg (2.2 Ibs.) of acute hazardous waste and no more than 100 kg (220 Ibs.) of material from the cleanup of a spill of acute hazardous waste. OR, your site is a Small Quantity Generator if the site: 1. Meets all other criteria for a Conditionally Exempt Small Quantity Generator, but 2. Accumulates, at any time, more than 1,000 kg (2,200 Ibs.) of hazardous waste. The 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. Under 40 CFR 266.100(c), operators or owners 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 266.100(c). Similarly, 40 CFR 266.100(0 provides that operators or owners of smelting, melting and refining furnaces that process hazardous wastes for the recovery of precious metals are conditionally exempt from regulation, except for 40 CFR 266.112, provided they comply with limited requirements specified in Section 266.100(0. Any garbage, refuse, or sludge, or other materials not excluded under 40 CFR 261.4(a). Exclusions include, for example, domestic sewage and any mixture of other wastes that pass through a sewer system to a publicly owned treatment works (POTWs); industrial wastewater discharges that are point source discharges subject to regulation under the Clean Water Act; irrigation return flows; nuclear materials defined by the Atomic Energy Act; and in situ mining materials (see also page 33). Wastewaters being collected, stored, or treated before discharge and sludges generated by wastewater treatment are not excluded. The EPA defines hazardous waste as a subset of solid waste. As defined by the Atomic Energy Act of 1954: (1) Uranium, thorium, or any other material determined by the Commission pursuant to the provisions of Section 2091 of this title to be source material; or (2) ores containing one or more of the foregoing materials in such concentration as the Commission may by regulation determine from time to time. 42 ------- DEFINITIONS (Continued) Special Nuclear Material Superfund Surface Impoundment Transfer Facility Underground Injection Control Unit United States Importer Universal Waste Used Oil As defined by the Atomic Energy Act of 1954: (1) plutonium, uranium enriched in the isotope 233 or in the isotope 235, and any other material which the Commission, pursuant to the provisions of Section 2071 of this title, determines to be special nuclear material, but does not include source material; or (2) any material artificially enriched by any of the foregoing, but does not include source material. The program operated under the legislative authority of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the Superfund Amendments and Reauthorization Act (SARA) that funds and carries out the solid waste emergency response and long-term remedial activities of the EPA. A natural topographic depression, man-made excavation, or diked area formed primarily from earthen materials (though it may be lined with man-made materials) that is designed to accumulate liquid wastes or wastes containing free liquids, and that is not an injection well (40 CFR 260.10). Any transportation-related facility including loading docks, parking areas, storage areas, and other similar areas where shipments of hazardous waste are held during the normal course of transportation (40 CFR 260.10). 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). Refer to "Process Unit" definition on page 40. Any person who imports hazardous waste from a foreign country into the United States. This does not include hazardous waste shipped from a foreign Department of Defense site, Maquiladora, United States territory or protectorate. Any of the following hazardous wastes that are managed under the universal waste requirements of 40 CFR Part 273: batteries, pesticides, thermostats, and lamps. 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. 43 ------- DEFINITIONS (Continued) Used Oil Fuel Marketer Used Oil Management Activities Used Oil Processing Used Oil Processor Used Oil Re-Refiner Used Oil Transfer Facility Used Oil Transporter Any person who conducts either of the following activities: 1. Directs a shipment of off-specification used oil from their site to an off-specification used oil burner; or 2. First claims that used oil that is to be burned for energy recovery meets the used oil fuel specifications set forth in 40 CFR 279.11. For the purposes of the Site Identification Form, includes used oil transportation; used oil processing and re-refining; burning off- specification used oil fuel; and used oil fuel marketing. 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. A site that processes on- or off-specification used oil. A site that produces lubricating oils and greases, industrial fuel, asphalt extender, gasoline, and other products from on- or off-specification used oil. 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. Any person who transports used oil, any person who collects used oil from more than one generator and transports the collected oil, and operators and owners 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. 44 ------- SPECIAL INSTRUCTIONS These instructions explain how to complete the 2003 Hazardous Waste Report for wastes and sites with unique regulatory or reporting requirements. Asbestos, PCBs, waste oils Groundwater contaminated by leachate Lab packs In most cases, do not report asbestos, PCBs, and waste oils. However, you must report them if any of the following conditions exist: (1) If your State specifically requires that these wastes be reported; (2) If a listed RCRA hazardous waste (i.e., EPA hazardous waste code that begins with "F," "K," "P," or "U") is mixed with asbestos, PCBs, or waste oil, in which case the entire mixture is a hazardous waste; or (3) If the waste possesses one or more of the characteristics that result in assigning EPA hazardous waste code beginning with "D." (This does not apply to used oil that is recycled as explained below.) Do not report "used oil that is recycled and is also a hazardous waste solely because it exhibits a hazardous characteristic (criterion 3 above). Used oil that is recycled includes any used oil which is reused, following its original use, for any purpose (including the purpose for which the oil was originally used). Such term includes, but is not limited to, oil which is re-refined, reclaimed, burned for energy recovery, or reprocessed." (40CFR261.6(a)(4)) Groundwater contaminated by RCRA hazardous waste leachate is not considered a solid waste and is, therefore, not classified as a hazardous waste. However, because hazardous waste is "contained in" the groundwater, it must be treated "as if it were a RCRA hazardous waste. When reporting groundwater contaminated by leachate in the 2003 Hazardous Waste Report, observe the following conventions: (1) Do not report generation quantities for contaminated groundwater. Enter "NA" in Form GM, Section 1, Box G. Explain in the Comments section that it is groundwater, not a hazardous waste, that was generated on site. (2) Do report quantities managed on site (Form GM, Section 2, On- site Process Systems 1 and 2); quantities shipped off site for management (Form GM, Section 3); and quantities received from off site and managed on site (Form WR, Box E). The following rules apply to the reporting of lab pack wastes in the 2003 Hazardous Waste Report: (1) You may aggregate lab pack wastes if they have the same Form code. However, you must report them as separate wastes under the following conditions: • If they contain RCRA acute hazardous wastes (i.e., EPA hazardous waste codes F020, F021, F022, F023, F026, F027, 45 ------- SPECIAL INSTRUCTIONS (Continued) and all "P" waste codes). Report separately from lab packs containing other RCRA hazardous wastes (all other EPA hazardous waste codes). • If they are managed differently from each other. For example, report lab packs shipped to landfills separately from those incinerated. (2) Enter a Form code (see page 53) indicating lab packs (i.e., W001 or W004) on Form GM, in Section 1, Box E or on Form WR in Box G. These Form codes are to be used with any lab pack, whether the wastes are gaseous, liquid, solid, or sludge. (3) It is not necessary to report every EPA hazardous waste code included in a batch of lab packs. Record one, or a few predominant, EPA hazardous waste codes in Section 1, Box B of Form GM, or Box B of Form WR. If there are many EPA hazardous waste codes associated with the batch of lab packs, enter "LABP" in the first four-character field in Section 1, Box B of Form GM, or Box B of Form WR; then enter "NA" in the remaining spaces for the EPA hazardous waste codes. (4) When reporting quantities for lab packs: • Include the weight of the containers if they are disposed (e.g., landfilled) or treated (e.g., incinerated) with the waste. • Exclude the weight of the containers if the waste is removed from the containers before treatment or disposal. By themselves, source material, special nuclear material, or by-product materials (See Definitions section beginning on page 35), as defined by the Atomic Energy Act of 1954 and amended by 42 U.S.C. 2011 et. seq., are not classified as hazardous wastes under RCRA. However, if these materials are mixed with a RCRA hazardous waste, the material is controlled under RCRA regulation, as well as under the Atomic Energy Act (DOE, NRC, and EPA) regulations, and is to be reported in the 2003 Hazardous Waste Report. Waste management facilities sometimes receive hazardous wastes from large numbers of Conditionally Exempt Small Quantity Generators (CESQGs) or other sites that do not have RCRA EPA Identification Numbers. To minimize the response burden for filling out the Form WR for these wastes, you may aggregate the wastes across generating sites, in accordance with these guidelines: RCRA-radioactive mixed wastes Wastes received from Conditionally Exempt Small Quantity Generators (CESQGs) (1) All the wastes must have the same EPA hazardous waste code (Box B), State hazardous waste code (Box C), Form code (Box G), and Management Method code (Box H). 46 ------- SPECIAL INSTRUCTIONS (Continued) Wastes received from foreign countries (2) Wastes received from different States must be reported separately. For the off-site handler EPA ID number (Box D), the entry should include the two-letter postal code of the originating State, followed by the letters "CESQG." For example, wastes received from several CESQGs in the State of Alaska (AK) that share a common EPA hazardous waste code, State hazardous waste code, Form code, RCRA radioactive mixed code, and Management Method code could be aggregated in a single waste block of Form WR (e.g., Waste 1). In Box D, the off-site handler EPA ID number is entered as "AKCESQG." Note: This method of completing Box D can also be used for CESQG waste that is not aggregated. Reporting on Form GM - If your site was the generator of record and was the U.S. Importer for hazardous waste received from a foreign country (other than a foreign Department of Defense site, Maquiladora, U.S. territory or protectorate), complete a Form GM. Enter the appropriate code in Section 1, Box D - Source code from the list of codes G63 through G75 - Hazardous waste received from [name of foreign country]. Include the Import Notification and other foreign generator information in Comments. Also, mark "Yes" on the Site ID Form, Item 10. A.I, Box d - United States Importer of Hazardous Waste. Report on Form OI the name and address of all foreign generators if this form is required by your State. Reporting on Form WR - If your site received hazardous waste directly from a generator in a foreign country (other than a foreign Department of Defense site, Maquiladora, U.S. territory or protectorate), complete a Form WR for the waste treated, recovered, or disposed at your site. This waste was not shipped to your site by a U.S. Importer. Report the code "FC" followed by the name of the foreign country in Box D - Off Site Handler EPA ID number. Include the Import Notification and other foreign generator information in Comments. Report on Form 01 the name and address of all foreign generators if this form is required by your State. 47 ------- THIS PAGE INTENTIONALLY LEFT BLANK 48 ------- EPA HAZARDOUS WASTE CODES A list of all the hazardous waste codes is shown below. See the regulations for details. CHARACTERISTICS OF HAZARDOUS WASTE (SEE 40 CFR 261.24) - DXXX HAZARDOUS WASTE FROM NONSPECIFIC SOURCES (SEE 40 CFR 261.31) - FXXX HAZARDOUS WASTE FROM SPECIFIC SOURCES (SEE 40 CFR 261.32) - KXXX DISCARDED COMMERCIAL CHEMICAL PRODUCTS, OFF-SPECIFICATION SPECIES, CONTAINER RESIDUALS, AND SPILL RESIDUES THEREOF-ACUTE HAZARDOUS WASTE (SEE 40 CFR 261.33 FOR AN ALPHABETIZED LISTING) - PXXX DISCARDED COMMERCIAL CHEMICAL PRODUCTS, OFF-SPECIFICATION SPECIES, CONTAINER RESIDUES, AND SPILL RESIDUES THEREOF - TOXIC WASTES (SEE 40 CFR 261.33 FOR AN ALPHABETIZED LISTING) - UXXX D001 D002 D003 D004 D005 D006 D007 D008 D009 D010 D011 D012 D013 D014 D015 D016 D017 D018 D019 D020 D021 D022 D023 D024 D025 D026 D027 D028 D029 D030 D031 D032 D033 D034 D035 D036 D037 D038 D039 D040 D041 D042 D043 F001 F002 F003 F004 F005 F006 F007 F008 F009 F010 F011 F012 F019 F020 F021 F022 F023 F024 F025 F026 F027 F028 F032 F034 F035 F037 F038 F039 K001 K002 K003 K004 K005 K006 K007 K008 K009 K010 K011 K013 K014 K015 K016 K017 K018 K019 K020 K021 K022 K023 K024 K025 K026 K027 K028 K029 K030 K031 K032 K033 K034 K035 K036 K037 K038 K039 K040 K041 K042 K043 K044 K045 K046 K047 K048 K049 K050 K051 K052 K060 K061 K062 K064 K065 K066 K069 K071 K073 K083 K084 K085 K086 K087 K088 K090 K091 K093 K094 K095 K096 K097 K098 K099 K100 K100 K101 K102 K103 K104 K105 K106 K107 K108 K109 K110 K111 K112 K113 K114 K115 K116 K117 K118 K123 K124 K125 K126 K131 K132 K136 K140 K141 K142 K143 K144 K145 K147 K148 K149 K150 K151 K156 K157 K158 K159 K161 K169 K170 K171 K172 K174 K175 K176 K177 K178 P001 P002 POOS P004 POOS P006 P007 POOS P009 P010 P011 P012 P013 P014 P015 P016 P017 P018 P020 P021 P022 P023 P024 P026 P027 P028 P029 P030 P031 P033 P034 P036 P037 P038 P039 P040 P041 P042 P043 P044 P045 P046 P047 P048 P049 P050 P051 P054 P056 P057 P058 P059 P060 P062 P063 P064 P065 P066 P067 P068 P069 P070 P071 P072 P073 P074 P075 P076 P077 P078 P081 P082 P084 P085 P087 P088 P089 P092 P093 P094 P095 P096 P097 P098 P099 P101 P102 P103 P104 P105 P106 P107 P108 P109 P110 P111 P112 P113 P114 P115 P116 P118 P119 P120 P121 P122 P123 P127 P128 P185 P188 P189 P190 P191 P192 P194 P196 P197 P198 P199 P201 P202 P203 P204 P205 U001 U002 U003 U004 U005 U006 U007 U008 U009 U010 U011 U012 U014 U015 U016 U017 U018 U019 U020 U021 U022 U023 U024 U025 U026 U027 U028 U029 U030 U031 U032 U033 U034 U035 U036 U037 U038 U039 U041 U042 U043 U044 U045 U046 U047 U048 U049 U050 U051 U052 U053 U055 U056 U057 U058 U059 U060 U061 U062 U063 U064 U066 U067 U068 U069 U070 U071 U072 U073 U074 U075 U076 U077 U078 U079 U080 U081 U082 U083 U084 U085 U086 U087 U088 U089 U090 U091 U092 U093 U094 U095 U096 U097 U098 U099 U101 U102 U103 U105 U106 U107 U108 U109 U110 U111 U112 U113 U114 U115 U116 U117 U118 U119 U120 U121 U122 U123 U124 U125 U126 U127 U128 U129 U130 U131 U132 U133 U134 U135 U136 U137 U138 U140 U141 U142 U143 U144 U145 U146 U147 U148 U149 U150 U151 U152 U153 U154 U155 U156 U157 U158 U159 U160 U161 U162 U163 U164 U165 U166 U167 U168 U169 U170 U171 U172 U173 U174 U176 U177 U178 U179 U180 U181 U182 U183 U184 U185 U186 U187 U188 U189 U190 U191 U192 U193 U194 U196 U197 U200 U201 U202 U203 U204 U205 U206 U207 U208 U209 U210 U211 U213 U214 U215 U216 U217 U218 U219 U220 U221 U222 U223 U225 U226 U227 U228 U234 U235 U236 U237 U238 U239 U240 U243 U244 U246 U247 U248 U249 U271 U278 U279 U280 U328 U353 U359 U364 U367 U372 U373 U387 U389 U394 U395 U404 U408 U409 U410 U411 49 ------- THIS PAGE INTENTIONALLY LEFT BLANK 50 ------- SOURCE CODES Source codes describe the type of process or activity (i.e., source) from which a hazardous waste was generated. Review the groups and pick the appropriate code. Code Source Code Group Wastes from Ongoing Production and Service Processes (waste from general day to day manufacturing, production, or maintenance activities) ___^______ G01 Dip, flush or spray rinsing (using solvents to clean or prepare parts or assemblies for further processing - i.e. painting or assembly) G02 Stripping and acid or caustic cleaning (using caustics to remove coatings or layers from parts or assemblies) G03 Plating and phosphating (electro- or non-electroplating or phosphating) G04 Etching (using caustics or other methods to remove layers or partial layers) G05 Metal forming and treatment (pickling, heat treating, punching, bending, annealing, grinding, hardening, etc.) G06 Painting and coating (manufacturing, building, or maintenance) G07 Product and by-product processing (direct flow of wastes from chemical manufacturing or processing, etc.) G08 Removal of spent process liquids or catalysts (bulk removal of wastes from chemical manufacturing or processing, etc.) . G09 Other production or service-related processes from which the waste is a direct outflow or result (specify in comments) Other Intermittent Events or Processes Gil Discarding off-specification or out-of-date chemicals or products (unused chemicals or products - corresponds to P and U hazardous waste codes) G12 Lagoon or sediment dragout and leachate collection (large scale operations in open pits, ponds, or lagoons) G13 Cleaning out process equipment (periodic sludge or residual removal from enclosed processes including internal scrubbing or cleaning) G14 Removal of tank sludge, sediments, or slag (periodic sludge or residual removal from storage tanks including internal scrubbing or cleaning) G15 Process equipment change-out or discontinuation of equipment use (final materials and residuals removal including cleaning) G16 Oil changes and filter or battery replacement (automotive, machinery, etc) G19 Other one-time or intermittent processes (specify in comments) Pollution Control and Waste Management Process Residuals G21 Air pollution control devices (baghouse dust or ash from stack scrubbers or precipitators; vapor collection, etc.) G22 Laboratory analytical wastes (used chemicals from laboratory operations) G23 Wastewater treatment (sludge, filter cake, etc., including wastes from treatment before discharge by NPDES or POTW or by UIC disposal) G24 Solvent or product distillation or recovery (sludge, waste solvent, bottoms, from recovery/recycling of used product) G25 Hazardous waste management - indicate management method (for residuals from regulated hazardous waste treatment processes - enter the related H code) nazaiuuus waste iicauiiciiijJiuoca&ca - cmci me iciaicu n muc; Leachate collection (from landfill operations or other land units) Hazardous residual from treatment or recovery of universal waste G26 G27 51 ------- SOURCE CODES (Continued) G31 G32 G33 G39 Accidental contamination of products, materials, or containers (other than Gl 1) Cleanup of spill residues (infrequent, not routine) Leak collection and floor sweeping (ongoing, routine) Other cleanup of current contamination (specify in comments) Spills and Accidental Releases Remediation of Past Contamination G41 G42 G43 G44 G45 G49 Closure of hazardous waste management unit under RCRA Corrective action at a solid waste management unit under RCRA Remedial action or emergency response under Superfund State program or voluntary cleanup Underground storage tank cleanup Other remediation (specify in comments) Waste Not Physically Generated On Site G61 Hazardous waste received from off site for storage/bulking and transfer off site for treatment or disposal For codes G63- G75 Hazardous waste received from a foreign country (other than a foreign Department of Defense site, Maquiladora, U.S. territory or protectorate). This site was the generator of record and is the U.S. Importer. Enter the appropriate code from the list_b_ejow - G63 Hazardous waste received from Antarctica G64 Hazardous waste received from Aruba G65 Hazardous waste received from Bahamas G66 Hazardous waste received from Belgium G67 Hazardous waste received from Brazil G68 Hazardous waste received from Canada G69 Hazardous waste received from Holland G70 Hazardous waste received from Malaysia G71 Hazardous waste received from Mexico G72 Hazardous waste received from New Zealand G73 Hazardous waste received from Taiwan G74 Hazardous waste received from Venezuela G75 Hazardous waste received from other foreign country - see Comments for country name 52 ------- FORM CODES Form codes describe the general physical and chemical characteristics of a hazardous waste. Review the groups and pick the appropriate code. Code Form Code Group Mixed Media/Debris/Devices - Waste that is a mixture of organic and inorganic wastes, liquid and solid wastes, or devices that are not easily categorized W001 W002 W004 W301 W309 W310 W320 W512 W801 Lab packs from any source not containing acute hazardous waste Contaminated debris: paper, clothing, rags, wood, empty fiber or plastic containers, glass, piping, other solids (usually from construction, demolition, cleaning, or remediation) Lab packs from any source containing acute hazardous waste Contaminated soil (usually from spill clean up, demolition, or remediation); see also W512 Batteries, battery parts, cores, casings (lead-acid or other types) Filters, solid adsorbents, ion exchange resins and spent carbon (usually from production, intermittent processes, or remediation) Electrical devices (lamps, fluorescent lamps, or thermostats usually containing mercury; CRTs containing lead; etc) Sediment or lagoon dragout, drilling or other muds (wet or muddy soils); see also W301 Compressed gases of any type Inorganic Liquids - Waste that is primarily inorganic and highly fluid (e.g., aqueous), with low suspended inorganic solids and low organic content W101 W103 W105 W107 WHO W113 W117 W119 Very dilute aqueous waste containing more than 99% water (land disposal restriction defined wastewater that is not exempt under NPDES or POTW discharge) Spent concentrated acid (5% or more) Acidic aqueous wastes less than 5% acid (diluted but pH <2) Aqueous waste containing cyanides (generally caustic) Caustic aqueous waste without cyanides (pH >12.5) Other aqueous waste or wastewaters (fluid but not sludge) Waste liquid mercury (metallic) Other inorganic liquid (specify in comments) Organic Liquids - Waste that is primarily organic and is highly fluid, with low inorganic solids content and low-to-moderate water content W200 W202 W203 W204 W205 W206 W209 W210 W211 W219 Still bottoms in liquid form (fluid but not sludge) Concentrated halogenated (e.g., chlorinated) solvent Concentrated non-halogenated (e.g., non-chlorinated) solvent Concentrated halogenated/ non-halogenated solvent mixture Oil-water emulsion or mixture (fluid but not sludge) Waste oil Paint, ink, lacquer, or varnish (fluid - not dried out or sludge) Reactive or polymerizable organic liquids and adhesives (fluid but not sludge) Paint thinner or petroleum distillates Other organic liquid (specify in comments) 53 ------- FORM CODES (Continued) Code Form Code Group Inorganic Solids - Waste that is primarily inorganic and solid, with low organic content and low-to-moderate water content; notpumpable W303 W304 W307 W312 W316 W319 Ash (from any type of burning of hazardous waste) Slags, drosses, and other solid thermal residues Metal scale, filings and scrap (including metal drums) Cyanide or metal cyanide bearing solids, salts or chemicals Metal salts or chemicals not containing cyanides Other inorganic solids (specify in comments) Organic Solids - Waste that is primarily organic and solid, with low-to-moderate inorganic content and water content; not pumpable W401 W403 W405 W409 Pesticide solids (used or discarded - not contaminated soils - W301) Solid resins, plastics or polymerized organics Explosives or reactive organic solids Other organic solids (specify in comments) Inorganic Sludges - Waste that is primarily inorganic, with moderate-to-high water content and low organic content; mostly pumpable W501 W503 W504 W505 W506 W519 Lime and/or metal hydroxide sludges and solids with no cyanides (not contaminated muds - W512) Gypsum sludges from wastewater treatment or air pollution control Other sludges from wastewater treatment or air pollution control Metal bearing sludges (including plating sludge) not containing cyanides Cyanide-bearing sludges (not contaminated soils - W512) Other inorganic sludges (not contaminated muds - W512; specify in comments) Organic Sludges - Waste that is primarily organic with low-to-moderate inorganic solids content and water content; pumpable W603 W604 W606 W609 Oily sludge (not contaminated muds - W512) Paint or ink sludges, still bottoms in sludge form (not contaminated muds - W5 12) Resins, tars, polymer or tarry sludge (not contaminated muds - W5 1 2) Other organic sludge (specify in comments) 54 ------- MANAGEMENT METHOD CODES Management Method codes describe the type of hazardous waste management system used to treat, recover, or dispose a hazardous waste. Select the final substantive method used. Review the groups and pick the appropriate code. Code Management Method Code Group Reclamation and Recovery H010 Metals recovery including retorting, smelting, chemical, etc. H020 Solvents recovery (distillation, extraction, etc) H039 Other recovery or reclamation for reuse including acid regeneration, organics recovery, etc. (specify in comments) H050 Energy recovery at this site - used as fuel (includes on-site fuel blending before energy recovery; report only this code) H061 Fuel blending prior to energy recovery at another site (waste generated either on site or received from off site) Destruction or Treatment Prior to Disposal at Another Site H040 Incineration - thermal destruction other than use as a fuel (includes any preparation prior to burning) H071 Chemical reduction with or without precipitation (includes any preparation or final processes for consolidation of residuals) H073 Cyanide destruction with or without precipitation (includes any preparation or final processes for consolidation of residuals) H075 Chemical oxidation (includes any preparation or final processes for consolidation of residuals) H076 Wet air oxidation (includes any preparation or final processes for consolidation of residuals) H077 Other chemical precipitation with or without pre-treatment (includes processes for consolidation of residuals) H081 Biological treatment with or without precipitation (includes any preparation or final processes for consolidation of residuals) H082 Adsorption (as the major component of treatment) H083 Air or steam stripping (as the major component of treatment) H101 Sludge treatment and/or dewatering (as the major component of treatment; not H071-H075, H077>orH082) H103 Absorption (as the major component of treatment) Stabilization or chemical fixation prior to disposal at another site (as the major component of treatment; not H071-H075, H077, or H082) Hill H112 Macro-encapsulation prior to disposal at another site (as the major component of treatment; not reportable as H071-H075, H077, or H082) H121 Neutralization only (no other treatment) i>ieuiraiizauon oniy ino otner treatment,; Evaporation (as the major component of treatment; not reportable as H071-H083) Settling or clarification (as the major component of treatment; not reportable as H Phase separation (as the major component of treatment; not reportable as H071-H H122 H123 asH071-H083) iy Ui maimvauuii ^as iuc uiajui ^miipuuciu ui ucaimciii, iim icpmiauic an xi\j i1- juaa^ separation (as the major component of treatment; not reportable as H071-H083) Other treatment (specify in comments; not reportable as H071-H124) H124 H129 55 ------- MANAGEMENT METHOD CODES (Continued) Code Management Method Code Group Disposal H131 Land treatment or application (to include any prior treatment and/or stabilization) H132 Landfill or surface impoundment that will be closed as landfill (to include prior treatment and/or stabilization) H134 Deepwell or underground injection (with or without treatment; this waste was counted as hazardous waste) H135 Discharge to sewer/POTW or NPDES (with prior storage - with or without treatment) Transfer Off Site H141 The site receiving this waste stored/bulked and transferred the waste with no treatment or recovery (H010-H129), fuel blending (H061), or disposal (H131-H135) at that receiving site. Do not use this code on Form GM in Section 1- Box D or in Section 2. 56 ------- 2003 HAZARDOUS WASTE REPORT FORMS READ ALL INSTRUCTIONS BEFORE COMPLETING THE FORMS 57 ------- THIS PAGE INTENTIONALLY LEFT BLANK ------- OMB#: 2050-0024 Expires 10/31/2005 SEND COMPLETED FORM TO: The Appropriate State or EPA Regional Office. 1 . Reason for Submittal (See instructions on page 9) MARK ALL BOX(ES) THAT APPLY 2. Site EPA ID Number ( page 10) 3. Site Name (page 10) 4. Site Location Information (page 10) 5. Site Land Type (page 10) 6. North American Industry Classification System (NAICS) Code(s) for the Site (page 10) 7. Site Mailing Address (page 11) 8. Site Contact Person (page 11) 9. Operator and Legal Owner of the Site (pages 11 and 12) United States Environmental Protection Age RCRA SUBTITLE C SITE IDENTIFICATION jncy FORM Reason for Submittal: G To provide Initial Notification of Regulated Waste Activity (to obtain an EPA ID Number for hazardous waste, universal waste, or used oil activities) G To provide Subsequent Notification of Regulated Waste Activity (to update site identification information) Q As a component of a First RCRA Hazardous Waste Part A Permit Application G As a component of a Revised RCRA Hazardous Waste Part A Permit Application (Amendment # ) Q As a component of the Hazardous Waste Report EPA ID Number i i i i i i i i i i i i i Name: Street Address: City, Town, or Village: State County Name: Zip C »: lode: Site Land Type: G Private G County G District G Federal G Indian G Municipal G State G Other A. B. C. D. k Street or P. O. Box: City, Town, or Village: State: Country: Zip C First Name: Ml: Last Phone Number: Extension: Ema A. Name of Site's Operator: Date :ode: Name: I address: Became Operator (mm/dd/yyyy): Operator Type: G Private G County G District G Federal G Indian G Municipal G State G Other B. Name of Site's Legal Owner: Date Became Owner (mm/dd/yyyy): Owner Type: Q Private Q County G District G Federal Q Indian Q Municipal Q State Q Other EPA Form 8700-13 A/B (Revised 10/2003) Page 1 of 3 ------- THIS PAGE INTENTIONALLY LEFT BLANK ------- EPA ID NO: I I I I L_L J I OMB#: 2050-0024 Expires 10/31/2005 9. Legal Owner (Continued) Address Street or P. O. Box; City, Town, or Village: State: Country: Zip Code: 10. Type of Regulated Waste Activity Mark "Yes" or "No" for all activities; complete any additional boxes as instructed. (See instructions on pages 12 to 16.) A. Hazardous Waste Activities Complete all parts for 1 through 6. YQNQ 1. Generator of Hazardous Waste If "Yes", choose only one of the following - a, b, or c. Q a. LOG: Greater than 1,000 kg/mo (2,200 Ibs./mo.) of non-acute hazardous waste; or a b. SQG: 100 to 1,000 kg/mo (220-2,200 lbs./mo.) of non-acute hazardous waste; or Q c. CESQG: Less than 100 kg/mo (220 IbsVmo.) of non-acute hazardous waste In addition, indicate other generator activities. Y Q N Q d. United States Importer of Hazardous Waste Y Q N Q e. Mixed Waste (hazardous and radioactive) Generator YQNQ 2. Transporter of Hazardous Waste YQNQ 3. Treater, Storer, or Disposer of Hazardous Waste (at your site) Note: A hazardous waste permit is required for this activity. YQNQ 4. Recycler of Hazardous Waste (at your site) YQNQ 5. Exempt Boiler and/or Industrial Furnace If "Yes", mark each that applies. Q a. Small Quantity On-site Burner Exemption Q b. Smelting, Melting, and Refining Furnace Exemption YQNQ 6. Underground Injection Control B. Universal Waste Activities Y Q N Q1. Large Quantity Handler of Universal Waste (accumulate 5,000 kg or more) [refer to your State regulations to determine what is regulated]. Indicate types of universal waste generated and/or accumulated at your site. If "Yes", mark all boxes that apply: Generate Accumulate a. Batteries b. Pesticides c. Thermostats d. Lamps e. Other (specify) f. Other (specify) g. Other (specify) Q Q Q Q Q Q Q Q Q Q Q Q Q Q Y Q N Q 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this activity. C. Used Oil Activities Mark all boxes that apply. Y Q N Q1. Used Oil Transporter If "Yes", mark each that applies. Q a. Transporter Q b. Transfer Facility Y Q N Q 2. Used Oil Processor and/or Re-refiner If "Yes", mark each that applies. Q a. Processor Q b. Re-refiner Y Q N Q 3. Off-Specification Used Oil Burner Y Q N Q 4. Used Oil Fuel Marketer If "Yes", mark each that applies. Q a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used Oil Burner Q b. Marketer Who First Claims the Used Oil Meets the Specifications EPA Form 8700-13 A/B (Revised 10/2003) Page 2 of 3 ------- THIS PAGE INTENTIONALLY LEFT BLANK ------- EPA ID NO: L OMB#: 2050-0024 Expires 10/31/2005 11. Description of Hazardous Wastes (See instructions on page 16.) A. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes handled at your site. List their, in the order they are presented in the regulations (e.g., D001, D003, F007, U112). Use an additional page if more spaces are needed. B. Waste Codes for State-Regulated (i.e., non-Federal) Hazardous Wastes. Please list the waste codes of the State-regulated hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if more spaces are needed for waste codes. 12. Comments (See instructions on page 16.) 13. Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. (See instructions on page 16.) Signature of operator, owner, or an authorized representative Name and Official Title (type or print) Date Signed (mm/dd/yyyy) EPA Form 8700-13 A/B (Revised 10/2003) Page 3 of 3 ------- THIS PAGE INTENTIONALLY LEFT BLANK ------- BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME: EPA ID NO: FORM GM OMB#: 2050-0024 Expires 10/31/2005 U.S. ENVIRONMENTAL PROTECTION AGENCY 2003 Hazardous Waste Report WASTE GENERATION AND MANAGEMENT Instructions: Please see the detailed instructions on pages 17 to 25 of this booklet before completing this form. Sec. 1 A. Waste description B. EPA hazardous waste code C. State hazardous waste code D. Source code Management Method code for Source code G25 LH. E. Form code F. Quantity generated in 2003 LJ G. UOM LJ Density D Ibs/gal a sg Sec. 2 Was any of this waste managed on site? (pages a 1 Yes (CONTINUE TOON-SITE PROCESS SYSTEM 1) a 2 No (SKIP TO SEC. 3) ON-SITE PROCESS SYSTEM 1 On-site Management Method code IHI | | | Quantity treated, disposed, or recycled on site in 2003 ON-SITE PROCESS SYSTEM 2 On-site Management Method code Quantity treated, disposed, or recycled on site in 2003 Sec. 3 A. Was any of this waste shipped off site in 2003 for treatment, disposal, or recycling? (pages 25 and 26) a 1 Yes (CONTINUE TO BOX B) a 2 No (FORM IS COMPLETE) Sitel B. EPA ID No. of facility to which waste was shipped C. Off-site Management Method code Shipped to D. Total quantity shipped in 2003 I I I I I I I I I l LJ Site 2 B. EPA ID No. of facility to which waste was shipped C. Off-site Management Method code Shipped to D. Total quantity shipped in 2003 I I I I I I I I I I LJ SiteS B. EPA ID No. of facility to which waste was shipped C. Off-site Management Method code Shipped to D. Total quantity shipped in 2003 Comments: EPA Form 8700-13 A/B (Revised 10/2003) Page _ of _ ------- THIS PAGE INTENTIONALLY LEFT BLANK ------- BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME: EPA ID NO: FORM WR OMB#: 2050-0024 Expires 10/31/2005 U.S. ENVIRONMENTAL PROTECTION AGENCY 2003 Hazardous Waste Report WASTE RECEIVED FROM OFF SITE Instructions: Please see the detailed instructions on pages 26 to 29 of this booklet before completing this form. Waste 1 A. Description of hazardous waste B. EPA hazardous waste code C. State hazardous waste code D. Off-site handler EPA ID number E. Quantity received in 2003 F. UOM Density a 1 ibs/gal a 2 sg G. Form code H. Management Method code IHI I I i Waste 2 A. Description of hazardous waste B. EPA hazardous waste code C. State hazardous waste code D. Off-site handler EPA ID number D Mark if same as in Waste 1 E. Quantity received in 2003 LJ F. UOM Density LJ I I I. D 1 Ibs/gal D 2 sg G. Form code iwi I H. Management Method code IHI I I I Waste 3 A. Description of hazardous waste B. EPA hazardous waste code C, State hazardous waste code D. Off-site handler EPA ID number n Mark if same as in Waste 2 E. Quantity received in 2003 F. UOM Density n 11bs/gal D 2 sg G. Form code H. Management Method code Comments: EPA Form 8700-13 A/B (Revised 10/2003) Page _ of _ ------- THIS PAGE INTENTIONALLY LEFT BLANK ------- BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME: EPA ID NO: I I I FORM Ol OMB#: 2050-0024 Expires 10/31/2005 U.S. ENVIRONMENTAL PROTECTION AGENCY 2003 Hazardous Waste Report OFF-SITE IDENTIFICATION Instructions: Please read the detailed instructions on the reverse side before completing this form. Sitel A. EPA ID No. of off-site installation or transporter B. Name of off-site installation or transporter C. Handler type (MARK ALL THAT APPLY) a Generator D Transporter n TSDR facility __ D. Address of off-site installation Street City State Zip Site 2 A. EPA ID No. of off-site installation or transporter B. Name of off-site installation or transporter C. Handler type (MARK ALL THAT APPLY) a Generator n Transporter a TSDR facility D. Address of off-site installation Street City State iii Zip i i i | i Site3 A. EPA ID No. of off-site installation or transporter B. Name of off-site installation or transporter C. Handler type (MARK ALL THAT APPLY) D Generator n Transporter n TSDR facility D. Address of off-site installation Street City State Zip Site 4 A. EPA ID No. of off-site installation or transporter B. Name of off-site installation or transporter C. Handler type (MARK ALL THAT APPLY) a Generator a Transporter D TSDR facility D. Address of off-site installation Street City State Zip i Comments: EPA Form 8700-13 A/B (Revised 10/2003) Page _ of _ ------- INSTRUCTIONS FOR FILLING OUT FORM 01 - OFF-SITE IDENTIFICATION WHO MUST SUBMIT THIS FORM Sites required to file the 2003 Hazardous Waste Report must submit Form Ol if: • Form Ol is required by your State; AND • The site received hazardous waste from off site or sent hazardous waste off site during 2003. PURPOSE OF THIS FORM Form 01 documents the names and addresses of off-site installations and transporters. HOW TO FILL OUT THIS FORM Form Ol is divided into five identical parts. You must fill out one part for each off-site installation to which you shipped hazardous waste, each off-site installation from which you received hazardous waste, and each transporter you used to ship hazardous waste during 2003. If these off-site installations and transporters total more than four, you must photocopy and complete additional copies of the form. Prior to photocopying, place the pre-printed site identification label in the top left-hand corner of the form or, if you did not receive pre- printed labels, enter the site name and EPA Identification Number In this space. Use the Comments section at the end of the form to clarify any entry (e.g., "Other" responses) or to continue any entry. When entering Information in the Comments section, cross-reference the site number and box letter to which the comment refers. ITEM-BY-ITEM INSTRUCTIONS Complete Boxes A through D for each off-site Installation to which you shipped hazardous waste and each off-site installation from which you received hazardous waste during 2003. Complete Boxes A through C for each transporter you used during the year (address in Box D is not required for transporters). Box A: EPA ID No. of off-site installation or transporter Enter the 12-dlgit EPA ID number of the off-site installation to which you shipped hazardous waste or from which you received hazardous waste. Or, enter the EPA ID number of the transporter who shipped hazardous waste to or from your site. Each EPA ID Number should appear only once. If the off-site installation or transporter did not have an EPA ID number during 2003, enter "NA" in Box A and note the reason in the Comments section. Box B: Name of off-site installation or transporter Enter the name of the off-site installation or transporter reported in Box A. Box C: Handler type Mark all boxes that apply to the handler type (i.e., generator, transporter, or treatment, storage, or disposal (TSD) facility) of the off-site installation or transporter reported in Box A. Box D: Address of off-site installation Enter the address of the off-site installation reported in Box A. If the EPA ID number reported in Box A refers to a transporter, enter "NA" in Box D. ------- ------- 2003 Hazardous Waste Report Instructions and Forms EPA Form 8700-13 A/B Dave Levy EPA Office of Solid Waste 703-308-8479 ------- |