OMB #: 2050-0024 Expires 12-31-88 United States Environmental Protection Agency 1987 Hazardous Waste Generation and Shipment Report (PACKAGE A) FORMS One report package must be completed for every site receiving this mailing: Complete Package A 1987 Hazardous Waste Generation and Shipment Report - if, in 1987, hazardous wastes were not managed at this site, as defined in the box on page 1 of the instructions booklet. Complete Package B - 1987 Hazardous Waste Generation and Management Report - if, in 1987, hazardous wastes were managed at this site, as defined in the box on page 1 of the instructions booklet. Submission of the appropriate Report package fulfills 1987 RCRA Annual/Biennial Report requirements. Form 8700-13A (5-80) (Rev. 11-85) Revised (12-87) ------- OMB#: 2050-0024 Expires 12-31-88 BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME EPA ID NO. I I I I FORM 1C U.S. ENVIRONMENTAL PROTECTION AGENCY 1987 Hazardous Waste Generation and Shipment Report IDENTIFICATION AND CERTIFICATION WHO MUST COMPLETE THIS FORM? Form 1C must be completed by every site that received this package. INSTRUCTIONS: Please read the detailed instructions beginning on page 8 of the 1987 Hazardous Waste Generation and Shipment Report Instructions booklet before completing this form. Complete Sections I through IV and Sections VI through IX immediately. Complete Section V, certification, after you have finished the full report package. SEC. I. Site name and physical location which may differ from the mailing address. Complete items A through G. Mark [X] for items A, B, C, D, F, and G if same as label; if different, enter corrections, if label is absent, enter information. A. Site/company name Same as label fj B. EPA ID No. Same as label fj C. Address number and street name of physical location - if not known, enter Industrial park, building name or other physical location description Same as label F 3. City, town, village, etc. Same as label fj E. County F. State Same as label G. Zip Code Same as label fj I I I SEC. Mailing address of site. Mark [X] for A, B, C, and D if same as label; if different, enter corrections. A. Number and street name of mailing address Same as label [H B. City, town, village, elc. Same as label Q C. State Same as label D. Zip Code Same as label I I I I—I SEC. Ill,I Name, title, and telephone number of the person who should be contacted if questions arise regarding this report. A. Please print: Last name First name M.I. B. Title C. Telephone Extension I I I I SEC. IV. Enter the Standard Industrial Classification (SIC) Code that describes the principal products, group of products, produced or distributed, or the services rendered at the site's physical location. Enter more than one SIC Code only if no one industry description includes the combined activities of the site. SIC codes are listed beginning on page 1 of the 1987 Hazardous Waste Generation, Shipment and Management Report Codebook. I I I I I I I I I I I I I I I SEC V. I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I bejieve that the submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. A. Please print: Last name First name M.I. Title B. Signature Date of signature Mo. Day Yr. Page 1 of. EPA Form 8700 - 13A (5-80) (Rev. 11-85) Revised (12-87) OVER ---> ------- FORM 1C Does this site's EPA ID authorize hazardous waste generation? j—| NO » SKIP TO SECTION VII. j~] YES • Did this site generate any hazardous waste during 1987? r—i YES . READ DETAILED INSTRUCTION ON PAGE 9 OF THE 1987 HAZARDOUS WASTE GENERATION AND SHIPMENT REPORT INSTRUCTIONS BOOKLET FOR ACUTE AND ACCUMULATION LIMITS. MARK {£] NEXT TO THE HAZARDOUS WASTE GENERATION QUANTITY CATEGORY THAT APPLIED TO THIS SITE DURING 1987. fj Category 1: More than 10OOkg (2,200 Ib) in one or more months Q Category 2: More than 100 kg (220 Ib) but no more than 1000 kg (2,200 Ib) in any single month Q Category 3: No more than 100 kg (220 Ib) in any single month Q Mark El if this site changed from Category 1 to Category 2 or 3 due to waste minimization activity conducted during 1986 or 1987. Q NO . CONTINUE BELOW. MARK CB NEXT TO ALL THAT APPLY. Q Generated, excluded or delisted wastes Q Generated hazardous waste prior to 1987 but do not expect to generate in the future - MARKS] FOR REASON IN ONE BOX BELOW fj Waste was from one-time event(s) (e.g. spills, remedial actions, etc.) Q] Waste minimization activity undertaken during 1986 or 1987 Q Out of business [3 Generated hazardous waste prior to 1987 and expect to generate in the future Q Never generated before but expect to generate in the future fj Never generated and do rot expect to generate in the future - MARK [XJ FOR REASON IN ONE BOX BELOW L~] Protective notifier only fj Misunderstood the requirements Q Notified to secure transportation services rj Other EXPLAIN REASON FOR GENERATOR NOTIFICATION IN COMMENTS SuiP' IDoes tnis site have RCRA Interim Status or a RCRA permit to treat, store, or dispose hazardous waste? r—] NO SKIP TO SECTION VIII r—•| YES Did the site treat, store, or dispose (T/S/D) hazardous waste in RCRA-regulated units during 1987? Q YES > SKIP TO SECTION VIII Q NO . CONTINUE BELOW, MARK Kl NEXT TO ALL THAT APPLY f~) T/S/D excluded waste during 1987 Q T/S/D hazardous waste in exempt units during 1987 Q T/S/D hazardous waste prior to 1987 but did not T/S/D waste during 1987. MARK Kl IN ONE BOX BELOW [] T/S/D will resume in the future fj Have notified of planned closure Q Site is in closure or post closure fj Never T/S/D hazardous waste prior to 1987 but: MARK Kl IN ONE BOX BELOW fj Expect to T/S/D hazardous waste in the future fj Do not expect to T/S/D hazardous waste in trie future - EXPLAIN REASON FOR INTERIM STATUS OR PERMIT IN COMMENTS VIII. Do you wish to withdraw this site's generator notification or EPA Part A permit application? Withdraw generator notification Q Yes fj No Withdraw Part A permit application Q yes D No SEC. IX. Does this site have an area not requiring a RCRA Part A or Part B permit that is used exclusively for the short term accumulation of hazardous waste? CD NO r~I YES DOES THE AREA HAVE: Containers r~I No r~I Yes ENTER THE NUMBER OF TANKS AND THEIR TOTAL CAPACITY IN GALLONS. Tanks i—i No i—i Yes . i , , i I ,,,,,,,, I L—' "—' I I I I Number I I I [ I I I ! I I Gallon capacity Comments: Page 2 of ------- BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL jg& •*)*, ORENTER: § ** \ SITE NAME I t*W*7 * EPAIDNO. 1 i i i i ... ^zay 198 , , i FORM GS U.S. ENVIRONMENTAL PROTECTION AGENCY 7 Hazardous Waste Generation and Shipment Report WASTE GENERATION AND SHIPMENT WHO MUST COMPLETE THIS FORM? Form GS must be completed by every site that generated hazardous waste on site or shipped hazardous waste off site during 1987. Mark H if you are not required to complete Form GS. INSTRUCTIONS: Please read the detailed instructions beginning on page 12 of the 1987 Hazardous Waste Generation and Shipment Report Instructions booklet before completing this form. Make and complete a photocopy of this form for each hazardous waste generated on site or shipped off site during 1987. Complete Sections 1 through IV. Throughout this form enter "DK" if the information requested is not known or is not available; enter "MA" if the information requested is not applicable. Sec. 1 A. Waste description 1 1 Instruction Page 12 B. EPA hazardous waste code Page 12 1 1 1 1 1 1 1 1 1 1 III C. State hazardous waste code Page 13 I I 1 I 1 I 1 t 1 1 1 1 1 1 1 i i i i i i i i i i i i D. SIC code E. Source code F. Waste form code Page 13 1 1 1 1 1 Page 13 1 1 1 Page 13 1 1 1 Sec. IA. Organics B. Water C. T II 1 Instruction Page 14 Page 15 P High | | High | | K Low | | Low | | L Test | | Note | | Note | | r. G. pH H. Flashpoint I. ( • Page 18 Page 18 1 Hiflh 1 1 I.I 1 High 1 1 1 1 °F Hta Low 1 1 1. ( | Low | | | | °F Lou Note | | Note | | Tes Sec. 1 A. 1986 quantity hazardous waste generated Jj^J Instruction Page 20 1 I 1 t I I 1 I I I E. Quantity hazardous waste on site on January 1, 1987 Page 21 1 1 1 1 1 1 1 1 1 I Dial Solids D. Suspended Solids E. BTU 'age 15 Page 15 Page 18 tah I I High 1 1 High 1 1 1 1 1 1 owll Low 1 1 Lowllllll tote | | Note | | UOM | | Note L Cyanides J. Halogens K. Radioactive 'age 19 Page 20 Page 20 h | | High | | Yes \~\ I [ | Low | | No | 1 t | | Note | | Note | | Note | | Page 20 Page 1 1 1 1 1 1 1 1 1 1 II G. Waste minimization results | Page 13 | | F. Toxic Metals Page 18 Note | | Metal High Low Test 1. 1 1 1 I — 1 1 — 1 1 — 1 J 2. 1 1 1 | | | | | | _l 3. 1 1 1 | | | | | | 4. 1 1 1 | | | | | | 5.1 1 I LJ LJ LJ 6. 1 1 1 | || || | D. Density 21 Page 21 ' 1 ' • 1 1 ' fj" Ibs/gal rjsg F. Quantity hazardous waste remaining on site on December 31, 1987 Page2t 1 1 1 1 1 1 1 1 1 1 Sec. 1 A. EPA ID No. of facility to which waste was shipped IV | Instruction Page 22 1 1 1 1 1 1 1 1 1 1 1 1 1 B. Number of C. Transport D. Off-site T/S/D/H code shipments mode Page 22 Page 22 Page 72. 1 1 1 1 II 1 1 1 1 1 1 1 1 E. Total quantity shipped Page 22 1 1 1 1 1 1 1 1 1 1 Comments: Page of ------- BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME EPA ID NO. FORM Ol U.S. ENVIRONMENTAL PROTECTION AGENCY 1987 Hazardous Waste Generation and Shipment Report OFF-SITE IDENTIFICATION WHO MUST COMPLETE THIS FORM? D INSTRUCTIONS: Form Ol must be completed by every site that shipped hazardous waste off site and every site that received hazardous waste from off site during 1987. Mark [X] if you are not required to complete Form Ol. Please read the detailed instructions beginning on page 23 of the 1987 Hazardous Waste Generation and Shipment Report Instructions booklet before completing this form. Complete A through E for each off-site installation to which you shipped waste or from which you received waste during 1987. Complete A through Dfor every transporter you used during the reporting year. Throughout this form enter "DK" if the information requested is not known or is not available; enter "NA" if the information requested is not applicable. Make and complete additional copies of this form if you need to identify more than four off-site installations or transporters. Site A. EPA ID No. of off-site installation or transporter •j Instruction page 23 ill! C. Site type code Page 24 u I I I I f I ! D. Site relationship code Page 24 U Site A. EPA ID No. of off-site installation or transporter 2 Instruction page 23 I I C. Site type code Page 24 U I I I I I I D. Site relationship code Page 24 U Site I A. EPA ID No. of off-site installation or transporter 3 I Instruction page 23 I II I ! I I I I C. Site type code Page 24 LJ D. Site relationship code Page 24 LJ Site A. EPA ID No. of off-site installation or transporter 4 Instruction page 23 I I C. Site type code Page 24 U I I I I I 1 D. Site relationship code Page 24 U 3. Name of off-site installation or transporter Page 23 E. Address of off-site installation Page 24 Street Zip nay State I | I Code I | | I I — I I I I I B. Name of off-site installation or transporter Page 23 E. Address of off-site installation Page 24 Street . . Zip rity Slate I | I Code I I I I - I ! I ! I B- Name of off-site installation or transporter Page 23 E. Address of off-site installation Page 24 Street . i Zip ray State I I I Code f 1 I I — I I I I I B. Name of off-site installation or transporter Page 23 E. Address, of off-site installation Page 24 Street 1 Zip nty State ! 1 1 Code | | | | j - | III Comments: Page. of ------- BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME EPA ID NO. I I I I I I I I FORM WM U.S. ENVIRONMENTAL PROTECTION AGENCY 1987 Hazardous Waste Generation and Shipment Report WASTE MINIMIZATION PARTI WHO MUST COMPLETE THIS FORM? INSTRUCTIONS: Form WM Part I, describing efforts undertaken to implement waste minimization programs, must be completed by all generators required to file an Annual/Biennial Report. This requirement was established in response to statutory provisions included in the Hazardous and Solid Waste Amendments of 1984 (HSWA). NOTE: Generators shipping hazardous waste off site are required to certify, on Item 16 of the Uniform Hazardous Waste Manifest, that they have a program in place to reduce, to the degree determined economically practicable, the volume and toxicity of hazardous waste generated. A similar certification must also be made by generators who have obtained a RCRA treatment, storage, or disposal permit. Consistent with these certification requirements, generators must report, on Form WM Part I, the efforts undertaken to implement waste minimization programs. Please read the detailed instructions on page 25 of the 1987 Hazardous Waste Generation and Shipment Report Instructions booklet before completing this form. Answer questions 1 through 10. Throughout this form enter "DK" if the information requested is not known or is not available; enter "MA" if the information requested is not applicable. Did this site create or expand a source reduction and recycling program? 1987 1986 Yes No Yes No Create Expand D D D D Prior Years Yes No D D D D Did this site have a written policy or statement that outlined goals, objectives and methods for source reduction and recycling of hazardous waste? 1987 1986 Prior Years Yes No D D D D D What was the dollar amount of capital expenditures (plant and equipment) and operating costs devoted to source reduction and recycling of hazardous waste? ENTER ZERO (0) IF NONE. 1987 1986 PriorYears Capital expenditures $ $ $ Operating costs $. $. $. Did this site have an employee training program or provide incentives (bonuses, awards, personal recognition, etc.) to identify and implement source reduction and recycling opportunities and activities? 1987 1986 PriorYears Yes No Yes No Yes No Training Incentives D D D D D D D D Page of OVER—> ------- FORM WM - PART I 5. Did this site conduct a source reduction and/or recycling opportunity assessment or audit? Note: an opportunity assessment or audit is a procedure that identifies practices that can be implemented to reduce the generation of hazardous waste or the quantity which must subsequently be treated, stored or disposed. 1987 1986 Prior Years Yes No Yes No Yes No Site-Wide D D D D Process-Specific EH EH EH EH 6. Did this site identify or implement new SOURCE REDUCTION opportunities to reduce the volume and/or toxicity of hazardous waste generated at this site? 1987 1986 Prior Years Yes No Yes No Yes No identify D D EH EH EH EH Implement EH D D EH D EH 7. What factors have delayed or prevented implementation of SOURCE REDUCTION opportunities. MARK [X] NEXT TO ALL THAT APPLY. Q] a. Insufficient capital to install new source reduction equipment or implement new source reduction practices. Q b. Lack of technical information on source reduction techniques, applicable to my specific production processes. I I c. Source reduction is not economically feasible: cost savings in waste management or production will not recover the capital investment. Q] d. Concern that product quality may decline as a result of source reduction. Q] e. Technical limitations of the production processes. [~| f. Permitting burdens. O 9- Other (SPECIFY) 8. Did this site identify or implement new RECYCLING opportunities to reduce the volume and/or toxicity of hazardous waste generated at this site or subsequently treated, stored, or disposed of on site or off site? 1987 1986 Prior Years Yes No Yes No Yes No identify D D EH EH EH EH Implement EH EH EH EH EH EH Page of ------- FORM WM - PART I EPA ID NO. I I I l I I 9. 10. What factors have delayed or prevented implementation of on-site or off-site RECYCLING opportunities. MARK | NEXT TO ALL THAT APPLY. D a a a a a a a a. b. c. d. e. f. g- h. k. I. Insufficient capital to install new recycling equipment or implement new recycling practices. Lack of technical information on recycling techniques applicable to this site's specific production processes. Recycling is not economically feasible: cost savings in waste management or production will not recover the capital investment. Concern that product quality may decline as a result of recycling. Requirements to manifest wastes inhibit shipments off site for recycling. Financial liability provisions inhibit shipments off site for recycling. Technical limitations of product processes inhibit shipments off site for recycling. Technical limitations of production processes inhibit on-site recycling. Permitting burdens inhibit recycling. Lack of permitted off-site recycling facilities. Unable to identify a market for recyclable materials. Other (SPECIFY) Has this site requested or received technical information or financial assistance on source reduction and/or recycling practices from any of the following sources? MARK B NEXT TO ALL THAT APPLY. 1987 Technical Financial 1986 Technical Financial Prior Years Technical Financial a. b. c. d. e. f. g- h. Local government State government Federal government Trade associations Educational institutions Suppliers Other parts of your firm Other firms/consultants No request made D D D D D D D D D D Other (conferences, literature, [_J etc.) D D D D D D D D D D D D D D D D D D D D D D D Comments: Page of ------- BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION LABEL OR ENTER: SITE NAME EPA ID NO. FORM WM U.S. ENVIRONMENTAL PROTECTION AGENCY 1987 Hazardous Waste Generation and Shipment Report WASTE MINIMIZATION PART II WHO MUST COMPLETE THIS FORM? Form WM Part II must be completed only by generators that engaged in an activity during 1987 that resulted in waste minimization. Waste minimization means: (1) reduction in the volume and/or toxicity of hazardous waste generated as a result of source reduction; and/or, (2) reduction in the volume and/or toxicity of hazardous waste subsequently treated, stored, or disposed as a result of on-site or off-site recycling. Mark E| and do not complete this form if no waste minimization results were achieved during 1987. INSTRUCTIONS: Please read the detailed instructions beginning on page 26 of the 1987 Hazardous Waste Generation and Shipment Report Instructions booklet before completing this form. Make and complete a photocopy of this form for each hazardous waste minimized in 1987. Complete Sections I through IV. Throughout this form enter "DK" if the information requested is not known or is not available; enter "NA" if the information requested is not applicable. Sec. A. EPA hazardous waste code Instruction Page 27 1 1 1 III I 1 1 III B. State hazardous waste code Page 27 i i i i i C. Product or service description Page 27 ' 0. Product or service SIC code Page 27 , , I E. Waste form code Page 27 F. UOM Page 28 U G. Density Page 28 H. Source description: Page 28 I. Source code Page 28 gal sg SeC. 1 A. 1986 quantity generated II 1 Instruction Page 29 I I I I I I B. 1987 quantity generated Page 29 I I I I I I I I C. Production ratio Page 29 D. Toxicity change code Page 31 U E. Waste minimization: recycling Page 31 Code 1. U 2. U Quantity recycled I I I I I I I I I F. Waste minimization: source reduction Page 32 Code 1.LJ 2. U 3.IJ Quantity prevented I I 1 I I 1 I 1 I I Sec. 1 A. Narrative description of waste minimization project or activity and results achieved III 1 Instruction Page 39 Page of OVER— > ------- FORM WM - PART II Sec. IV. Instructions: Answer questions 1 through 4. Mark ED next to the effects produced by the source reduction and/or recycling activity reported on this form in Sections I through III. 1. What effect did this site's source reduction and/or recycling activity have on the quantity of water effluent produced by hazardous waste generation processes during 1987? Q a. Increase in the quantity of water effluent Q] b. Decrease in the quantity of water effluent Q c. No effect on the quantity of water effluent | | d. Don't know 2. What effect did this site's source reduction and/or recycling activity have on the toxicity of water effluent produced by hazardous waste generation processes during 1987? Q a. Increase in the concentration of hazardous constituents Q b. Decrease in the concentration of hazardous constituents Q c. No effect on the concentration of hazardous constituents Q d. Don't know 3. What effect did this site's source reduction and/or recycling activity have on the quantity of air emissions produced by hazardous waste generation processes during 1987? | | a. Increase in the quantity of air emissions Q b. Decrease in the quantity of air emissions Q c. No effect on the quantity of air emissions Q d. Don't know 4. What effect did this site's source reduction and/or recycling activity have on the toxicity of the air emissions produced by hazardous waste generation processes during 1987? Q a. Increase in the concentration of hazardous constituents Q b. Decrease in the concentration of hazardous constituents Q c. No effect on the concentration of hazardous constituents I I d. Don't know Comments: Page of ------- |