United States	Office of Solid Waste
Environmental Protection	(5301)
Agency	Washington, DC 20460	November 1993
Solid Waste
<&EPA RCRA Part A Permit Application
EPA Form 8700-23 (Rev. 11/30/93) Previous editions are obsolete.

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United States Environmental Protection Agency
Washington, D.C. 20460
RCRA Part A Permit Application
Forms and Instructions
Enclosed is the application form and instructions for a Federal permit to
treat, store, or dispose of hazardous waste.
The Resource Conservation and Recovery Act (RCRA) requires anyone
who owns or operates a facility where hazardous waste is treated, stored,
or disposed to have a permit. RCRA establishes a procedure for
obtaining interim status which allows existing facilities to continue
operating until a final hazardous waste permit is issued. In order to
obtain interim status, existing facilities must complete a two step
process. The first step is the submittal of a Notification of Regulated
Waste Activity form. You will need to submit this form in order to obtain
an EPA RCRA Identification Number. If you need a Notification form,
please contact the appropriate State Office (see Table 1) or the EPA
Regional Office which serves your area (see Table 2).
The second step is to submit the permit application form included in this
package. If you do not file a Notification form and complete the permit
application by the deadline specified on page 5 of these instructions, you
will be required by law to halt your operations until a permit is issued.
There are two parts to a RCRA permit application — Part A and Part B.
Part A is included in this package. Part B of the RCRA permit
application contains detailed, site-specific information. Part B of the
permit application may be submitted voluntarily, however, you are not
required to submit it until it is requested by EPA or an authorized State.
You will then have up to six months to submit that part of the
application.
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RCRA Part A Permit Application
State governments may be authorized by EPA to administer hazardous
waste management programs in lieu of the Federal RCRA program. You
should contact your State hazardous waste management agency to
determine whether your State is authorized (see Table 1). If so, you will
need to comply with the specific permit application requirements of that
State.
The enclosed instructions show the specific steps on how to apply for a
RCRA permit. If after reading the instructions you have any questions
regarding the permit application process, please contact the EPA
Regional Office in your area for assistance (see Table 2).
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RCRA Part A Permit Application
I.	Who Must File a RCRA Permit Application
The Resource Conservation and Recovery Act of 1976 (RCRA), as
amended, requires each person owning or operating a facility for the
treatment, storage, or disposal of hazardous waste to have a permit. This
includes individuals, trusts, firms, joint stock companies, corporations
(including government corporations), partnerships, associations, State,
municipalities, commissions, interstate bodies, Indian tribes (or an
authorized Indian tribe organization), and Federal Agencies. If you treat,
store, or dispose of hazardous waste without obtaining a permit, you
may be subject to a civil or criminal penalty.
II.	How to Determine if You Handle Hazardous Waste
OFF-SITE FACILITIES. Owners and operators of off-site treatment,
storage, or disposal facilities are encouraged to obtain waste information
from the generators they serve. If the generators will not supply this
information, you are still responsible for determining if you handle a
hazardous waste and should follow the procedures below for on-site
facilities.
ON-SITE FACILITIES. Solid waste generators who treat, store, or
dispose of their own waste on-site should follow the following procedures
for determining if their waste is a hazardous waste. This determination is
made as follows:
1.	First, determine if the solid waste handled is excluded from
regulation as a hazardous waste. The list of exclusions can be
found in the regulation titled "Identification and Listing of
Hazardous Waste," 40 CFR Sections 261.4 and 261.5. If the solid
waste handled is excluded, a RCRA hazardous waste permit is not
needed to treat, store, or dispose of these wastes.
2.	If the solid waste handled is not excluded by Sections 261.4 or
261.5, determine if the waste is listed in Subpart D of Lists of
Hazardous Wastes. Persons owning or operating facilities where
listed hazardous waste is treated, stored, or disposed are subject to
regulation and must file a RCRA permit application.
3.	If the waste handled is not listed in Subpart D of Lists of
Hazardous Wastes, the waste may still be hazardous because it
possesses certain characteristics or contains certain contaminants.
These characteristics and contaminants are contained in
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RCRA Part A Permit Application
Subpart C of "Identification and Listing of Hazardous Waste." A
determination that a waste possesses these characteristics or
contaminants may be made either based on:
(a) Your knowledge of the hazard characteristic of the waste in light
of the materials or the processes used; or (b) The results of testing
the waste according to the methods in Subpart C of "Identification
and Listing of Hazardous Waste."
Certain persons who handle hazardous waste are not required to obtain
a RCRA permit. They are:
1.	Generators who accumulate their own hazardous waste on-site for
less than 90 days as provided in 40 CFR 262.34;
2.	Farmers who dispose of hazardous waste pesticides from their own
use as provided in 40 CFR 262.70; and
3.	Owners and operators of totally enclosed treatment facilities as
defined in 40 CFR 260.10.
III. What Information Should be Filed and When
There are two parts to the RCRA permit application — Part A and Part B.
Part A defines the processes to be used for treatment, storage, and
disposal of hazardous wastes; the design capacity of such processes; and
the specific hazardous wastes to be handled at a facility. Part B requires
detailed site specific information such as geologic, hydrologic, and
engineering data. 40 CFR Section 270, Subpart B, specifies the
information that will be required from hazardous waste management
facilities in Part B of the permit application.
A. Operation During Interim Status
As provided in 40 CFR 270.13, Part A of the application defines the
processes to be used for treatment, storage, and disposal of hazardous
wastes; the design capacity of such processes; and the specific
hazardous wastes to be handled at a facility during the interim status
period. Once Part A is submitted to EPA, changes in the hazardous
wastes handled, changes in design of facilities, changes in processes,
and changes in ownership or operational control at a facility during the
interim status period may only be made in accordance with the
procedures in 40 CFR 270.72. Changes in design capacity and changes
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RCRA Part A Permit Application
in processes require prior EPA approval. Changes in the quantity of
waste currently specified on the Part A can be made without submitting
a revised Part A, provided the quantity does not exceed the design
capacities of the processes specified in Part A of the permit application.
Failure to furnish all information required to process a permit
application is grounds for termination of interim status.
B.	How Many Applications Should be Filed
You need submit only one RCRA permit application (Part A and Part B)
per site or location, provided that you describe all of the activities at that
site or location. If you conduct hazardous waste activity(ies) at more
than one site or location, you must submit a separate application for
each site or location.
C.	Where to File
The application forms should be mailed to the EPA Regional Office whose
Region includes the State in which the facility is located (see Table 2).
If the State in which the facility is located administers a Federal permit
program under which you need a permit, you should contact the
appropriate State agency for the correct forms (see Table 1). Your EPA
Regional Office (Table 2) can tell you to whom to apply and can provide
the appropriate address and phone number.
D.	When to File
As required by 40 CFR 270.1(b), the deadlines for filing applications are
as follows:
•	Existing facility: six months following publication of
regulations listing hazardous wastes.
•	New facility: 180 days before commencing physical
construction.
IV. Confidential Information
All information submitted in this form will be subject to public
disclosure, to the extent provided by the Freedom of Information Act, 5
U.S.C. Section 552, and EPA's Business Confidentiality Regulations, 40
CFR Part 2 and 40 CFR 270.12. Claims of confidentiality for the name
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RCRA Part A Permit Application
and address of any permit applicant or permittee will be denied. Persons
filing this form may make claims of confidentiality for certain
information. Such claims must be clearly indicated by submitting an
attachment listing the specific information for which confidential
treatment is requested at the time of filing. This attachment must
include a written substantiation of the claim for confidentiality, that
answers the following questions:
1.	Which sections of the Part A form contain the information you
claim is entitled to confidential treatment?
2.	For how long is confidential treatment desired for the information?
3.	What measures have you taken to guard against undesired
disclosure of the information to others?
4.	To what extent has the information been disclosed to others, and
what precautions have been taken in connection with that
disclosure?
5.	Has EPA or any other Federal agency made a pertinent
confidentiality determination? If so, include a copy of such
determination or reference to it, if available.
6.	Will disclosure of the information be likely to result in substantial
harmful effects on your competitive position? If so, what would
those harmful effects be and why should they be viewed as
substantial? Explain the causal relationship between disclosure
and the harmful effects.
Information covered by a confidentiality claim and the above
substantiation will be disclosed by EPA only to the extent and by means
of the procedures set forth in 40 CFR Part 2 and 40 CFR 270.12.
If no claim of confidentiality or no substantiation accompanies the
information when it is submitted, EPA may make the information
available to the public without further notice to the submitter.
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RCRA Part A Permit Application
Table 1
Alphabetized State Listing of Contacts for
Obtaining and Submitting the Part A Permit
Alabama
Obtain information or forms from, and mail
completed forms to:
Land Division
Alabama Department of
Environmental Management
1751 Cong. Wm. L. Dickinson Drive
Montgomery, Alabama 36130
(205)	271-7730
Alaska
Obtain information or forms from:
Department of Environmental Conservation
410 Willoughby Avenue
Suite 105
Juneau, Alaska 99801 -1795
(907) 465-5150
Mail completed forms to:
U.S. EPA Region 10
Waste Management Branch, HW-105
1200 Sixth Avenue
Seattle, Washington 98101
(206)	553-0151
American Samoa
Obtain information or forms from, and mail
completed forms to:
U.S. EPA Region 9
Hazardous Waste Management Division
75 Hawthorne Street, H-2-3
San Francisco, California 94105
(415) 744-2098
Arizona
Obtain information or forms from, and mail
completed forms to:
Office of Waste Programs
Arizona Department of
Environmental Quality
3033 N. Central Avenue
Phoenix, Arizona 85012
(602) 207-4146
Arkansas
Obtain information or forms from, and mail
completed forms to:
Arkansas Department of Pollution
Control and Ecology
8001 National Drive
P.O. Box 8913
Little Rock, Arkansas 72219-8913
(501) 562-7444
California
Obtain information or forms Jfom:
CA Region 1
Department of Toxic Substances Control
10151 Croydon Way, Suite 3
Sacramento, CA 95827
(916) 255-3618
CA Region 2
Department of Toxic Substances Control
700 Heinz Avenue, Suite 200
Berkeley, CA 94710
(510) 540-3966
CA Region 3
Department of Toxic Substances Control
1011 North Granview Avenue
Glendale, CA 91201
(818) 551-2830
CA Region 4
Department of Toxic Substances Control
245 W. Broadway, Suite 350
Long Beach, CA 90802
(310) 590-4968
Mail completed forms to:
U.S. EPA Region 9
Hazardous Waste Management Division
75 Hawthorne Street, H-3-4
San Francisco, California 94105
(415) 744-2074
Colorado
Obtain information or forms from, and mail
completed forms to:
Colorado Department of Health
4300 Cheny Creek Drive, South
HMWMD-HWC-B2
Denver, Colorado 80222-1530
(303) 692-3300
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RCRA Part A Permit Application
Table 1 (continued)
Connecticut
Obtain information or forms from, and mail
completed forms to:
Hazardous Material Management Unit
Department of Environmental Protection
State Office Building
165 Capitol Avenue
Hartford, Connecticut 06106
(203) 566-4869
Delaware
Obtain information or forms from, and mail
completed forms to:
Delaware Department of Natural Resources
and Environmental Control
Division of Air and Waste Management
Hazardous Waste Management Branch
P.O. Box 1401, 89 Kings Highway
Dover, Delaware 19903
(302) 739-3689
(302) 739-3672
Send courtesy copy to:
U.S. EPA Region 3
RCRA Programs Branch (3 HW50)
841 Chestnut Street
Philadelphia, PA 19107
(215} 597-8116 (PA. DC)
(215) 597-3884 (VA, WV, MD, DE)
District of Columbia
Obtain information or forms from, and mail
completed forms to:
Department of Consumer and
Regulatory Affairs
Environmental Regulation Administration
Hazardous Waste Branch
2100 Martin Luther King Jr. Ave. S.E.
Washington, D.C. 20020
(202) 404-1167
Send courtesy copy to:
U.S. EPA Region 3
RCRA Programs Branch (3 HW50)
841 Chestnut Street
Philadelphia, PA 19107
(215) 597-8116 (PA, DC)
(215) 597-3884 (VA. WV, MD, DE)
Florida
Obtain information or forms from, and mail
completed forms to:
Hazardous Waste Regulation Section
Department of Environmental Regulation
Twin Towers Office Building
2600 Blair Stone Road
Tallahassee, Florida 32399-2400
(904) 488-0300
Georgia
Obtain information or forms from, and mail
completed forms to:
Land Protection Branch
Indusrial and Hazardous
Waste Management Program
1154 East Tower
205 Butler Street, S.E.
Atlanta, Georgia 30334
(404) 656-7802
Guam
Obtain information or forms from, and mail
completed forms to:
Guam Environmental Protection Agency
Harmon Plaza
Complex Unit B-107
103 Orjas Street
Harmon, Guam 96911
Hawaii
Obtain information from:
Hawaii Department of Health
Solid and Hazardous Waste Branch
Five Waterfront Plaza, Suite 250
500 Ala Moana Boulevard
Honolulu, Hawaii 96813
Obtain forms from and mail
completed forms to:
U.S. EPA Region 9
Hazardous Waste Management Division
Attn: Stan Brown, H-2-3
75 Hawthorne Street
San Francisco, California 94105
(415) 744-2098
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RCRA Part A Permit Application
Table 1 (continued)
Idaho
Obtain in formation or forms from, and. mail
completed forms to:
Department of Environmental Quality
1410 N. Hilton, Third Floor
Boise, Idaho 83706
(208) 334-5879
Illinois
Obtain information or forms from, and mail
completed forms to:
Illinois Environmental Protection Agency
Division of Land Pollution Control
2200 Churchill Road
Springfield, Illinois 62706
(217) 785-8452
Indiana
Obtain information or forms from, and mail
completed forms to:
Indiana Department of
Environmental Management
105 S. Meridian Street
P.O. Box 6015
Indianapolis, Indiana 46225
(317) 232-3242
Iowa
Obtain information or forms from, and mail
completed forms to:
U.S. EPA Region 7
RCRA Branch, Permitting Section
Attn: WSTM/RCRA/PRMT
726 Minnesota Avenue
Kansas City, Kansas 66101
(913) 551-7646
Kansas
Obtain information or forms from, and mail
completed forms to:
Department of Health and Environment
Attn: Hazardous Waste Section
Forbes Field, Building 740
Topeka, Kansas 66620
(913) 296-1600
Kentucky
Obtain information or forms from, and mail
completed forms to:
Division of Waste Management
Department of Environmental Protection
Cabinet for Natural Resources
and Environmental Protection
Fort Boone Plaza, Building No. 2
14 Reilly Road
Frankfort, Kentucky 40601
(502) 564-6716
Louisiana
Obtain information or forms from, and mail
completed forms to:
Louisiana Department of
Environmental Quality
Department of Solid and Hazardous Waste
P.O. Box 82178
Baton Rouge, Louisiana 70884-2178
(504) 765-0332
Maine
Obtain information or forms from, and mail
completed forms to:
Bureau of Oil and Hazardous
Materials Control
Department of Environmental Protection
State House Station #17
Augusta, Maine 04333
(207)289-2651
Maryland
Obtain information or forms from, and mail
completed forms to:
Maryland Department of the Environment
Waste Management Administration
Hazardous Waste Program
2500 Broening Highway
Baltimore, Maryland 21224
(410) 631-3343
(410) 631-3344
Send courtesy copy to:
U.S. EPA Region 3
RCRA Programs Branch (3 HW50)
841 Chestnut Street
Philadelphia, PA 19107
(215) 597-8116 (PA. DC)
(215) 597-3884 (VA, WV, MD, DE)
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RCRA Part A Permit Application
Table 1 (continued)
Massachusetts
Obtain information or forma from, and mail
completed forms to:
Division of Solid and Hazardous Waste
Massachusetts Department of
Environmental Protection
One Winter Street, 5th Floor
Boston, Massachusetts 02108
(617) 292-5851
Michigan
Obtain information or forms from, and mail
completed forms to:
Waste Management Division
Michigan Department of Natural Resources
Box 30241
Lansing, Michigan 48909
(5171 373-2730
Minnesota
Obtain information or forms from. and mail
completed forms to:
Solid and Hazardous Waste Division
Minnesota Pollution Control Agency
520 Lafayette Road, North
St. Paul, Minnesota 55155
(612) 297-8330
Mississippi
Obtain information or forms from, and mail
completed forms to:
Department of Environmental Quality
P.O. Box 10385
Attn: Jerry Banks
Jackson, Mississippi 39289-0385
(601) 961-5171
Missouri
Obtain information or forms from, and mail
completed forms to:
Waste Management t'rogram
Department of Natural Resource
Jefferson Building
205 Jefferson Street (13/14 floor)
P.O. Box 176
Jefferson City, Missouri 65102
(314) 751-3176
Montana
Obtain information or forms from, and mail
completed forms to:
Solid and Hazardous Waste Bureau
Department of Health and
Environmental Sciences
Cogswell Building
Helena, Montana 59620
(406) 444-1430
Nebraska
Obtain information or forms from, and mail
completed forms to:
Hazardous Waste Management Section
Department of Environmental Quality
State House Station
P.O. Box 98922
Lincoln, Nebraska 68509 8922
(402) 471-2186
Nevada
Obtain information or forms from, and mail
completed forms to:
Waste Management Program
Division of Environmental Protection
333 West Nye Lane
Carson City, Nevada 89710
(702) 687-5872
New Hampshire
Obtain information or forms from, and mail
completed forms to:
Division of Public Health Services
Office of Waste Management
Bureau of Hazardous Waste
Classification & Manifests
Department of Health and Welfare
Health and Welfare Building
6 Hazen Drive
Concord. New Hampshire 03301
(603) 271-2900
New Jersey
Obtain information from:
New Jersey Department of
Environmental Protection 8i Energy
Attn: Environmental Regulation
Bureau of Hazardous Waste Engineering
33 Arctic Parkway, CN-421
Trenton, New Jersey 08625
(609) 292-9880
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RCRA Part A Permit Application
Table 1 (continued)
Obtain forms from and mail
completed forms to:
U.S. EPA Region 2
Air and Waste Management Division
Hazardous Waste Facilities Branch
26 Federal Plaza, Room 1037
New York, NY 10278
(212) 264-0504
New Mexico
Obtain information or forms from:
Hazardous Waste Bureau
525 Camlno De Loss Marquez
Sante Fe, New Mexico 87501
(505) 827-4358
Mail completed forms to:
U.S. EPA Region 6
Hazardous Waste Management Division
First Interstate Bank Tower
1445 Ross Avenue, Suite 1200
Dallas, TX 75202-2733
(214) 655-8451
New York
Obtain information from:
NY Regions 1-5:
New York Department of
Environmental Conservation
Division of Hazardous Waste
Substances Regulation
Bureau of Eastern Hazardous
Waste Programs
P.O. Box 7252
Albany, NY 12233-7252
(518) 457-9257
NY Regions 6-9:
New York Department of
Environmental Conservation
Division of Hazardous Waste
Substances Regulation
Bureau of Western Hazardous
Waste Programs
P.O. Box 7251
Albany, NY 12233-7251
(518) 457-9236
Obtainforms from and mall completedforms
to:
U.S. EPA Region 2
Air and Waste Management Division
Hazardous Waste Facilities Branch
26 Federal Plaza, Room 1037
New York, NY 10278
(212) 264-0504
North Carolina
Obtain information or forms from, and mail
completed forms to:
Solid and Hazardous Waste
Management Branch
Division of Health Services
Department of Human Resources
P.O. Box 27687
Raleigh, North Carolina 27611-7687
(919) 733-2178
North Dakota
Obtain information or forms from, and mail
completed forms to:
Division of Waste Management
Department of Health and
Consolidated Laboratories
1200 Missouri Avenue
P.O. Box 5520
Bismarck, North Dakota 58502-5520
(701) 221-5166
Northern Mariana Islands
Obtain information or forms from, and mail
completed forms to:
U.S. EPA Region 9
Hazardous Waste Management Division
Attn: Stan Brown, H-2-3
75 Hawthorne Street
San Francisco, California 94105
(415) 744-2098
Ohio
Obtain information or forms from, and mail
completed forms to:
Ohio Environmental Protection Aency
1800 WaterMark Drive
Columbus, Ohio 43215
(614) 644-2977
Oklahoma
Obtain information or forms from:
Department of Environmental Quality
Hazardous Waste Management Service
1000 Northeast 10th Street
Oklahoma City, Oklahoma 73117-1212
(405) 271-5338
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RCRA Part A Permit Application
Table 1 (continued)
Mail completed forms to:
U.S. EPA Region 6
Hazardous Waste Management Division
First Interstate Bank Tower
1445 Ross Avenue, Suite 1200
Dallas, TX 75202-2733
(214)	655-8541
Oregon
Obtain information or forms from, and mail
completed forms to:
Oregon Department of
Environmental Quality
Hazardous Waste Operations
811 Southwest 6th Avenue
Portland, Oregon 97204
(503) 229-5356
Pennsylvania
Obtain information or forms from, and mail
completed forms to:
Pennsylvania Department of
Environmental Resources
Bureau of Waste Management
Market Street State Office Building
400 Market Street, 14 th Floor
Harrisburg, Pennsylvania 17105-8471
(717) 787-6239
Send courtesy copy to:
U.S. EPA Region 3
RCRA Programs Branch (3 HW50)
841 Chestnut Street
Philadelphia, PA 19107
(215)	597-8116 (PA, DC)
(215) 597-3884 (VA, WV, MD, DE)
Puerto Rico
Obtain information from:
Puerto Rico Environmental Quality Board
Land Pollution Control Area
Inspection, Monitoring and Surveillance
P.O. Box 11488
Santuree, Puerto Rico 00910-1488
(809) 722-0439
Obtain forms from, and mall
completed forms to:
U.S. EPA Region 2
Air and Waste Management Division
Hazardous Waste Facilities Branch
26 Federal Plaza, Room 1037
New York, New York 10278
(212) 264-0504
Rhode Island
Obtain information or forms from, and mail
completed forms to:
Solid Waste Management Program
Department of Environmental Management
204 Canon Building 75 Davis Street
Providence, Rhode Island 02908
(401) 277-2797
South Carolina
Obtain information or forms from, and mail
completed forms to:
Bureau of Solid and Hazardous
Waste Management
Department of Health and Environmental
Control
2600 Bull Street
Columbia, South Carolina 29201
(803) 734-4711
South Dakota
Obtain Information or forms from, and mail
completed forms to:
Department of Environment and
Natural Resources
Office of Waste Management
319 Coteau
c/o 500 E. Capital Avenue
Pierre, South Dakota 57501-5070
(605) 773-3153
Tennessee
Obtain information or forms from, and mail
completed forms to:
Division of Solid Waste Management
Tennessee Department of Public Health
401 Church Street
LNC Tower, 5th Floor
Nashville, Tennessee 37243-1535
(615) 532-0780
Texas
Obtain information or forms from, and mail
completed forms to:
Industrial and Hazardous Waste Division
Waste Evaluation Section
P.O. Box 13087, Capitol Station
Austin, Texas 78711-3087
(512) 908-6832
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RCRA Part A Permit Application
Table 1 (continued)
Utah
Obtain information or forms from, and mail
completed forms to:
Division of Solid an Hazardous Waste
Department of Environmental Quality
P.O. Box 144880
Salt Lake City, Utah 84114-4880
(801)	538-6170
Vermont
Obtain information or forms from, and mail
completed forms to:
Waste Management Division
Agency of Environmental Conservation
103 South Main Street
Waterbuiy, Vermont 05676
(802)	241-3888
Virgin Islands
Obtain information from:
Virgin Islands Department of
Planning and Natural Resources
Division of Environmental Protection
179 Altona and Welgunst
St. Hiomas, Virgin Islands 00801
(809) 774-3320
Obtain forms from and mail
completed forms to:
U.S. EPA Region 2
Air and Waste Management Division
Hazardous Waste Facilities Branch
26 Federal Plaza, Room 1037
New York, New York 10278
(212) 264-0504
Virginia
Obtain information or forms from, and mail
completed forms to:
Virginia Department of Waste Management
Monroe Building, 11th Floor
101 North 14th Street
Richmond, Virginia 23219
(804) 225-2863
Send courtesy copy to:
U.S. EPA Region 3
RCRA Programs Branch (3 HW50)
841 Chestnut Street
Philadelphia, PA 19107
(215) 597-8116 (PA, DC)
(215) 597-3884 (VA. WV, MD, DE)
Washington
Obtain information or forms from:
Department of Ecology
P.O. Box 47658
Olympia, Washington 98504-7658
(206) 459-6316
Mail completed forms to:
U.S. EPA Region 10
Waste Management Branch, HW-105
1200 Sixth Avenue
Seattle, WA 98101
West Virginia
Obtain information or forms from, and mail
completed forms to:
Department of Commerce, Labor, and
Environmental Protection
Division of Environmental Protection
Office of Waste Management
1356 Hansford Street
Charleston, West Virginia 25301
(304) 558-5393
Send courtesy copy to:
U.S. EPA Region 3
RCRA Programs Branch (3 HW50)
841 Chestnut Street
Philadelphia, PA 19107
(215) 597-8116 (PA, DC)
(215) 597-3884 (VA, WV, MD, DE)
Wisconsin
Obtain information or forms from, and mail
completed forms to:
Bureau of Solid Waste
Department of Natural Resources
P.O. Box 7921
Madison, Wisconsin 53707
(608) 266-1327
Wyoming
Obtain information or forms from, and mail
completed forms to:
U.S. EPA Region 8
Hazardous Waste Management
Division (8HWM-ON)
999 18th Street, Suite 500
Denver, Colorado 80202-2405
(303) 294-1361
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RCRA Part A Permit Application
Table 2
U.S. EPA Regional Contacts for the Part A Permit Application
U.S. EPA Region 1
RCRA Support Section
JFK Federal Building
Boston, MA 02203-2211
(617) 573-5750
Connecticut, Maine,
Massachusetts, New Hampshire,
Rhode Island, Vermont
U.S. EPA Region 2
Air and Waste Management Division
Hazardous Waste Facilities Branch
26 Federal Plaza, Room 1037
New York, NY 10278
(212) 264-0504
New Jersey, New York, Puerto
Rico, Virgin Islands
U.S. EPA Region 3
RCRA Programs Branch (3 HW50)
841 Chestnut Street
Philadelphia, PA 19107
(215) 597-8116 (PA, DC)
(215) 597-3884 (VA, WV, DE, MD)
Delaware, District of Columbia,
Maryland, Pennsylvania, Virginia,
West Virginia
U.S. EPA Region 4
Hazardous Waste Management Division
RCRA Permitting Section
345 Courtland Street, NE
Atlanta, GA 30365
(404) 347-3433
Alabama, Florida, Georgia,
Kentucky, Mississippi, North
Carolina, South Carolina,
Tennessee
U.S. EPA Region 5
RCRA Activities
P.O. Box A3587
Chicago, IL 60690
(call State offices)
Illtnois, Indiana, Michigan,
Minnesota, Ohio, Wisconsin
U.S. EPA Region 6
Hazardous Waste Management Division
First Interstate Bank Tower
1445 Ross Avenue, Suite 1200
Dallas, TX 75202-2733
(214) 655-8541
Arkansas, Louisiana, New Mexico,
Oklahoma, Texas
U.S. EPA Region 7
RCRA Branch, Permitting Section
726 Minnesota Avenue
Attn: WSTM/RCRA/PRMT
Kansas City, KS 66101
(913) 551-7654
Iowa, Kansas, Missouri, Nebraska
U.S. EPA Region 8
Hazardous Waste Management Division
999 18th Street, Suite 500
Denver, CO 80202-2405
(303) 294-1361
Colorado, Montana, North Dakota,
South Dakota, Utah, Wyoming
U.S. EPA Region 9
Hazardous Waste Management Division
Attn: Stan Brown, H-2-3
75 Hawthorne Street
San Francisco, CA 94105
(415) 744-2098
Arizona, California, Hawaii,
Nevada, American Samoa, Guam,
Northern Mariana Islands
U.S. EPA Region lO
Waste Management Branch, HW-105
1200 Sixth Avenue
Seattle, WA 98101
(206) 553-0151
Alaska, Idaho, Oregon,
Washington
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RCRA Part A Permit Application
V. Part A - Line-By-Line Instructions
This form must be completed by all applicants.
Please type or print in the unshaded area only leaving a blank box
between words. The boxes are spaced at 1 /4" intervals which
accommodate elite type (12 characters per inch). When typing, hit the
space bar twice between characters. If you print, place each character in
a box. Abbreviate if necessary to stay within the number of boxes
allowed for each item. If you must use additional sheets, indicate clearly
the number of the Item on the form to which the information on the
separate sheet applies.
Unless otherwise specified in the instructions to the form, each item
must be answered. To indicate that each item has been considered, enter
"NA" for not applicable if a particular item does not fit the circumstances
or characteristics of your facility or activity.
If you have previously submitted information to EPA or to an approved
State agency which answers a question, you may either repeat the
information in the space provided or attach a copy of the previous
submission. Some items in the form require narrative explanation. If
more space is necessary to answer a question, attach a separate sheet
entitled "Additional Information."
Note: When submitting a revised application, applicants must resubmit
in their entirety each item on the application for which changes are
requested. In addition, Items I, II, III, VI, VII, VIII and XVIII must be
completed. All other sections may be left blank.
Estimated Burden: Public reporting burden for this collection of
information is estimated to be 51.5 hours, including time for reviewing
instructions, searching existing data sources, gathering and main-
taining the data needed, and completing and reviewing the collection
of information. Send comments regarding the burden estimate or any
other aspect of this collection of information, including suggestions for
reducing this burden, to Chief, Information Policy Branch, 2136, U.S.
Environmental Protection Agency, 401 M St., S.W., Washington, D.C.
20460; and to the Paperwork Reduction Project (2050-0034), Office of
Management and Budget, Washington, D.C. 20503.
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RCRA Part A Permit Application
Item I - ID Number(s):
A.	First Part A Submission: Place an "X" in this box if this is the
facility's first Part A submission under a current or previous
ownership.
B.	Part A Amendment: Place an "X" in this box if this is an
amendment to a prior Part A application for this facility. Enter the
amendment number, if known.
C.	EPA ID Number: Space is provided on Form A for insertion of your
EPA Identification Number. If you have an existing facility, enter
your Identification Number. If you don't know your EPA
Identification Number, please contact your EPA Regional Office (see
Table 2), which will provide you with your number, or send you an
application (Notification of Regulated Waste Activity (EPA Form
8700-12)) to apply for an EPA Identification Number. If your facility
is new (not yet constructed) or you do not have an Identification
Number, leave this item blank.
D.	Secondary ID Number: Enter any non-EPA ID number that your
facility has been issued. For example, for wastes regulated by a
State or local authority, give the ID number that the other
authority issued.
Item II - Name of Facility:
Enter the facility's official or legal name. Do not use a colloquial name.
Item III - Facility Location:
A. Location: Give the address or location of the facility identified in
Item II of this form. Please note that the address you give for
Item III must be a physical address, not a post office box or route
number. If the facility lacks a street name give the most accurate
alternative geographic information (e.g., section number or quarter
section number from county records or at intersection of Rts. 425
and 22).
County Name and Code: Give the county code, if known. If you do
not know the county code, enter the county, township, borough,
parish, or other local government entity name, from which EPA can
automatically generate the county code. To obtain a list of county
Page 16

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RCRA Part A Permit Application
codes, contact the National Technical Information Service, U.S.
Department of Commerce, Springfield, Virginia, 22161 or at (703)
487-4650. The list of codes is contained in the Federal Information
Processing Standards Publication (FIPS PUB) number 6-3.
B. Land Type: Using the codes listed below, indicate in III. B. the
code which best describes the current legal status of the land on
which the facility is located:
F =
Federal
S =
= State
I
= Indian
P =
Private
C =
County
M =
Municipal*
D =
District
0 =
Other
*Note: If the Land Type is best described as Indian, County or
District, please use those codes. Otherwise, use Municipal
C.	Geographic Location: Enter the latitude and longitude of the
facility in degrees, minutes, and seconds. For larger facilities, enter
the latitude and longitude at the approximate mid-point of the
facility. You may use the map you provide for Item XV to determine
latitude and longitude. Latitude and longitude information is also
available from Regional Offices of the U.S. Department of Interior,
Geological Survey, and from State Natural Resource or
Environmental Agencies.
D.	Facility Existence Date: Enter the appropriate date that applies
to your facility from the following:
1.	The date that hazardous waste operations at the facility
commenced:
2.	The date construction on the facility commenced; or
3.	The date operation is expected to begin.
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RCRA Part A Permit Application
Item IV - Facility Mailing Address:
Please enter the Facility Mailing Address. If the Mailing Address and the
Facility Location (Item III) are the same, you can print "same" in the
space for Item IV.
Item V - Facility Contact:
Give the name, title, and work telephone number of a person who is
thoroughly familiar with the operation of the facility and with the facts
reported in this application and who can be contacted by reviewing
offices if necessary.
Item VI - Facility Contact Address:
A.	Code: If the contact address is the same as the facility location
address listed in Item III or the facility mailing address listed in
Item IV, place an "X" in the appropriate box to indicate where the
contact may be reached. If the facility location address, the facility
mailing address, and the facility contact address are all the same,
mark the "Location" box. If the contact is not the same as those
addresses in either Item III or IV, place an "X" in the "Other" box
and complete Item VLB. If an "X" is entered, in either the location
or mailing box, Item VLB. should be left blank.
B.	Address: Enter the facility contact address only if the contact
address is different from either the facility location address
(Item III) or the facility mailing address (Item IV) and Item VI .A. was
left blank.
Item VII - Operator Information:
A. Name: Give the name, as it is legally referred to, of the person,
firm, public organization, or any other entity which operates the
facility described in this application. This may or may not be the
same name as the facility. The operator of the facility is the legal
entity which controls the facility's operation rather than the plant
or site manager. Do not use a colloquial name. Also enter the
telephone number and address where the operator can be
contacted.
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RCRA Part A Permit Application
B. Operator Type: Using the codes listed below, indicate in VII.B. the
code which best describes the legal status of the current operator
of the facility:
F =
Federal
S =
State
I
Indian
P =
Private
C =
County
M =
Municipal*
D =
District
0 =
Other
*Note: If the Operator Type is best described as Indian, County or
District, please use those codes. Otherwise, use Municipal.
C. Operator Indicator: (If this is your installations first Part A
application leave VII.C. blank and skip to Item VIII. If this is a
subsequent Part A application, complete Item VII.C. as directed
below.)
If the operator of this facility has changed since the facility's
previous Part A was submitted, place an "X" in the box marked
'Yes" and enter the date the operator changed.
If the operator of this facility has not changed since the facility's
previous Part A was submitted, place an "X" in the box marked
"No" and skip to Item VIII.
If any additional operators have been added or replaced since the
facility's previous Part A was submitted, place an "X" in the box
marked 'Yes." Use the comment section in XIX to list any
additional operators, the dates they became operators, and which
operator(s) (if any) they replaced. If necessary attach a separate
sheet of paper.
Item VIII - Facility Owner:
A. Name: Enter the name of the legal owner(s) of the installation,
including the property owner. Also enter the address and phone
number where this individual can be reached. Use the comment
section or additional sheets if necessary to list more than one
owner.
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RCRA Part A Permit Application
B. Owner Type: Using the codes listed below, indicate in VIII.B. the
code which best describes the legal status of the current owner of
the facility:
F =
Federal
S =
= State
I
Indian
P =
= Private
C =
= County
M =
Municipal
D =
District
O =
Other
*Note: If the Operator Type is best described as Indian, County or
District, please use those codes. Otherwise, use Municipal
C. Owner Indicator: (If this is your installations first Part A
application, leave VIII. C. blank and skip to Item IX. If this is a
subsequent Part A application, complete Item VIII.C. as directed
below.)
If the owner of this facility has changed since the facility's previous
Part A was submitted, place an "X" in the box marked 'Yes" and
enter the date the owner changed.
If the owner of this facility has not changed since the facility's
previous Part A was submitted, place an "X" in the box marked
"No" and skip to Item IX.
If any additional owners have been added or replaced since the
facility's previous Part A was submitted, place an "X" in the box
marked 'Yes." Use the comment section in XIX to list any
additional owner(s), the dates they became owners, and which
owner(s) (if any) they replaced. If necessary attach a separate sheet
of paper.
Item IX - SIC Codes:
List, in descending order of significance, the four digit standard
industrial classification (SIC) codes which best describe your facility in
terms of the principal products or services you produce or provide. Also,
specify each classification in words. These classifications may differ from
the SIC codes describing the operation generating the hazardous wastes.
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RCRA Part A Permit Application
SIC code numbers are descriptions which may be found in the Standard
Industrial Classification Manual prepared by the Executive Office of the
President, Office of Management and Budget, which is available from the
Government Printing Office, Washington, D.C. Use the current edition of
the manual. If you have any questions concerning the appropriate SIC
code for your facility, contact your EPA Regional office (see Table 2).
Item X • Existing Environmental Permits:
A.	Permit Type: Using the codes listed below, enter a letter on the
form for all other environmental permits the facility has received, or
for which the facility has filed an application, even if the permit has
not yet been received.
N = NPDES (National Pollutant Discharge Elimination System,
Clean Water Act)
P = PSD (Prevention of Significant Deterioration, Clean Air Act)
R = RCRA (Resource Conservation and Recovery Act)
U = UIC (Underground Injection Control, Safe Drinking
Water Act)
F = EPA 404 (Dredge or Fill Permits under Section 404 of the
Clean Water Act)
E = Other relevant environmental permits. List any other
relevant Federal (e.g., permits under the Ocean Dumping
Act), State (e.g., State permits for new air emission
sources in nonattainment areas under Part D of the Clean
Air Act or State permits under Section 404 of the Clean
Water Act), or local environmental permits or applications.
B.	Permit Number: Give the number of each presently effective
permit issued to the facility for each program, or if you have
previously filed an application, but have not yet received a permit,
give the number of the application. If you have more than one
currently effective permit for your facility under a particular permit
program, you may list additional permit numbers on a separate
sheet of paper.
C.	Description: Use the space provided for any additional
information identifying or describing the permits.
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RCRA Part A Permit Application
Item XI - Nature of Business:
Briefly describe the nature of your business (e.g., products produced or
services provided). If more space is needed, please attach additional
sheets.
Item XII - Process Codes and Design Capacities:
The information in Item XII describes all the processes that will be used
to treat, store, or dispose of hazardous waste at the facility. The design
capacity of each process must be provided as part of the description. The
design capacity of injection wells and landfills at existing facilities should
be measured as the remaining, unused capacity. Tank storage should
refer to each tank, not each tank farm. Please indicate the location of
each process listed in Item XII on either the map provided for Item XV or
the photographs provided for Item XVII. Use the line number from Item
XII to indicate where the process(es) are located. See the form for the
detailed instructions to Item XII.
Note: Process codes T80-T93 are designated for Boilers and Industrial
Furnaces (BIFs) as regulated under 40 CFR Part 266, Subpart H.
Item XIII - Other Processes:
Use this space to describe other processes that did not have a specific
process code listed in Item XII .A. of the form. Follow the instructions in
Item XII.A. on the form for other process codes (i.e., D99, S99, T04, and
X99 process codes).
Item XIV - Description of Hazardous Wastes:
The information in Item XIV describes all the hazardous waste that will
be treated, stored, or disposed at the facility. In addition, the processes
that will be used to treat, store, or dispose of each waste and the
estimated annual quantity of each waste must be provided. See the form
for the detailed instructions to Item XTV.
Item XV - Map:
Provide a topographic map or maps of the area extending to at least one
mile beyond the property boundaries of the facility. The map must
clearly show the following:
Page 22

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RCRA Part A Permit Application
•	The legal boundaries of the facility;
•	The location and serial number of each of your existing and
proposed intake and discharge structures;
•	All hazardous waste management facilities;
•	Location of all processes listed in Items XII and XIII identified
by process code;
•	Each well where you inject fluids underground; and
•	All springs and surface water bodies in the area, plus all
drinking water wells within 1/4 mile of the facility which are
identified in the public record or otherwise known to you.
If an intake or discharge structure, hazardous waste disposal site, or
injection well associated with the facility is located more than one mile
from the plant, include it on the map, if possible. If not, attach
additional sheets describing the location of the structure, disposal site,
or well, and identify the U.S. Geological Survey (or other) maps
corresponding to the location.
On each map, include the map scale, a meridian arrow showing north,
and latitude and longitude at the nearest whole second. On all maps of
rivers, show the direction of the current, and in tidal waters, show the
directions of the ebb and flow tides. Use a 7-1/2 minute series map
published by the U.S. Geological Survey, which may be obtained through
the U.S. Geological Survey Office listed below. If a 7-1/2 minute series
map has not been published for your facility site, then you may use a 15
minute series map from the U.S. Geological Survey. If neither a 7-1/2
nor 15 minute series map has been published for your facility site, use a
plant map or other appropriate map. and include all the requested
information; in this case, briefly describe land uses in the map area (e.g.,
residential, commercial).
You may trace your map from a geological survey chart, or other map
meeting the above specifications. If you do, your map should bear a note
showing the number or title of the map or chart it was traced from.
Include the names of nearby towns, water bodies, and other prominent
points.
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RCRA Part A Permit Application
To obtain map indexes contact one of the following Earth Science
Information Centers (ESIC):
Anchorage - ESIC
4230 University Dr., Rm. 101
Anchorage, AK 99508-4664
(907) 786-7011
Fairbanks - ESIC
Box 12, New Federal Building
101 Twelfth Avenue
Fairbanks, AK 99701
(907) 456-0244
Lakewood - ESIC
Box 25046, MS 504
Denver Federal Center
Denver, CO 80225
(303) 236-5829
Menlo Park - ESIC
Room 3128, Building 3, MS 532
345 Middlefield Road
Menlo Park, CA 94025
(415) 329-4390
Reston - ESIC
507 National Center
Reston, VA 22092
(703) 648-6045
Rolla - ESIC
1400 Independence Road, MS 231
Rolla, MO 65401
(314) 341-0851
Item XVI - Facility Drawing:
Salt Lake City - ESIC
8105 Federal Building
125 S. State Street
Salt Lake City, UT 84138
(801) 524-5652
Sioux Falls - ESIC
EROS Data Center
Sioux Falls, SD 57198-0001
(605) 594-6151
TDD (605) 594-6933
Spokane - ESIC
U.S. Post Office Building, Room
135
West 904 Riverside Avenue
Spokane, WA 99201-1088
(509) 353-2524
TDD (509) 353-3235
Stennis Space Center - ESIC
Building 3101
Stennis Space Center, MS 39529
(601) 688-3541
Washington, D.C. - ESIC
Department of the Interior
Building
18th & C Streets, NW, Room 2650
Washington, D.C. 20240
(202) 208-4047
All existing facilities must include a drawing showing the general layout
of the facility. This drawing should be approximately to scale and fit on
an 8 1/2" x 11" sheet of paper. This drawing should show the following:
1.	The property boundaries of the facility;
2.	The areas occupied by all storage, treatment, or disposal operations
that will be used during interim status;
Page 24

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RCRA Part A Permit Application
3.	The name of each operation (e.g.. multiple hearth incinerator, drum
storage area, etc.);
4.	Areas of past storage, treatment, or disposal operations;
5.	Areas of future storage, treatment, or disposal operations; and
6.	The approximate dimensions of the property boundaries and all
storage, treatment, and disposal areas. (Note: where applicable, use
the process codes listed in Items XII and XIII to indicate the
location of all storage, treatment, and disposal areas.)
New facilities do not have to complete Item XVI.
Item XVII - Photographs:
All existing facilities must include photographs that clearly delineate all
existing structures, all existing areas for storing, treating, or disposing of
hazardous waste; and all known sites of future storage, treatment, or
disposal operations. Photographs may be color or black and white,
ground-level or aerial. Indicate the date the photograph was taken on the
back of each photograph. Use the process codes listed in Items XII and
XIII to indicate the location of all storage, treatment, and disposal areas.
Item XVIII - Certification(s):
All facility owners must sign Item XVIII. If the facility will be operated by
someone other than the owner, then the operator must also sign Item
XVIII. Federal regulations require the certification to be signed as
follows:
A.	For a corporation, by a principal executive officer at least the level
of vice president;
B.	For a partnership or sole proprietorship, by a general partner or
the proprietor, respectively; or
C.	For a municipality, State, Federal, or other public facility, by either
a principal executive officer or ranking elected official.
The Resource Conservation and Recovery Act provides for severe
penalties for submitting false information on this application form.
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RCRA Part A Permit Application
Section 3008(d) of the Resource Conservation and Recovery Act provides
that "Any person who knowingly makes any false statement or
representation in any application, ...shall, upon conviction be subject to
a fine of not more than $25,000 for each day of violation, or to
imprisonment not to exceed one year, or both."
Page 26

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Please print or type with ELITE type (12 characters per inch) in the unshaded areas only
Form Approved, OMB No. 2050-0034 Expires 9-30-96
GSA No. 0248-EPA-OT
For EPA Regional
Use Only
Pate Received
Month
Day Year
oEPA
United States Environmental Protection Agency
Washington, DC 20460
Hazardous Waste Permit
Application
Part A
(Read the Instructions before starting)
I. Installation's EPA ID Number (Mark 'X' In the appropriate box)
o
First Part A Submission

Part A Amendment #_
C. Installation's EPA ID Number
D. Secondary ID Number (If applicable)
tl. Name of Facility
III. Facility Location (Physical address not P.O. Box or Route Number)
A. Street






























Street (Continued)






























City or Town
State
Zip Code

























—




Cou
T
rrtyC
ffeXNffl
ode
r

County Name





















































B.I
Land Type
C. Geographic Location
D. Facility Existence Date
(Enter coda)

LATITUDE (Degrees, Minutes, & Seconds)
LONGITUDE (Degrees, Minutes & Seconds)

Month
Day

Year

























IV. Facility Mailing Address
Street or P.O. Box























Clt
y or Town
State
Zip Code




















n t i
_L_
_L
V. Facility Contact (Person to be contacted regarding waste activities at facility)
Name (Last)
(First)
Job Title
Phone Number (Area Code and Number)
VI. Facility Contact Address (See instructions)
A. Contact Address
Location Mailing Ottw
B. Street or P.O. Box
City or Town
EPA Form 8700-23 (Rev. 11-30-93) Previous edition is obsolete. -1 of 7 ¦

-------
Please print or type with ELITE type (12 characters per inch) in the unshaded areas only
EPA I.D. Number (Enter from page 1)
Form Approved. OMB No. 2050-0034 Expires 9-30-96
GSA NO. 0248-EPA-OT
VII. Operator Information (See instructions)
Name of Operator
Secondary ID Number (Enter from page 1)
Street or P.O. Box
City or Town
Phone Number (Area Code and Number)
VIH. Facility Owner (See Instructions)
Phone Number (Area Code and Numbet)










, .. .-


















stn
tetoi
rP.O
.Bo
*













































City
rorl
fowr







Sta
te
Zl
PCo
Kfe




















1










—




State
ZIP Code
B. Operator Type
C- Change of Operator
Indicator
Date Changed
Month Day Year
C. Change of Owner
Indicator
Data Changed
Month Day Year
B. Owner Type
IX. SIC Codes (4-digit, in order of significance)
Primary
(Descriptor})
(Description)
(Description)
(Description)
X. Other Environ mental Permits (See Instructions)
A. Permit Type
(Enter code)
B. Permit Number


C. Description

















	









































































	










































EPA Form flTOO-23 (Rev. 11 -30-93) Previous edition Is obsolete. - 2 of 7 ¦

-------
Please print or type with ELITE type (12 characters per inch) in the unshaded areas only
EPA I.D. Number (Enter from page 1)
Form Approved, OMB No. 2050-0034 Expires 9-30-96
GSA No. 0248-EPA-OT
Secondary ID Number (Enter from page 1)
XI. Nature of Business (Provide a brief description)
Ml. Proceee Code* end Design Capacities
PROCESS CODE - Enter the code from the list of process codes below that best describes each process to be used at the facility.
	r codes. If more lines ere needed, attsch a separate meet of paper with the additional
, 099, S99, T04 and X99), describe the process (including Its design capacity) In the space
with the additional
mi
;£|a|
c.
Thirteen lines are provided tor entering codea.
Information, For "other" processes (I.e.,
provided In Item XIH.
PROCESS DESIGN CAPACITY - For each code entered In column A, enter the capacity of the process.
1.	AMOUNT -Enter the amount. In a case where design capacity Is not applicable (auch as in a elosura/poat-doaura orenforcement
action) enter the total amount of waate for that process.
2.	UNIT OF MEASURE - Foreach amount entered In column 8(1), enterthe code from the (1st of unit meaaure codes below that describes
the unit of measure used. Only the units of measure that are Hated below should be ueed.
PROCESS TOTAL NUMBER OF UNITS • Enter the total number of unite ueed with the corresponding process code.
PROCESS
CODE
PROCESS
APPROPRIATE UNITS OF
MEASURE FOR PROCESS
DESIGN CAPACITY
Disposal;
D79 Underground Injection
D00 Landfill
081 Land Treatment
D82 Ocean Disposal
093 Surface Impoundment
099 Other Dlapoaal
Storage:
501	Container
(Barrel, Drum, Etc.)
502	Tank
503	Waate Pile
504	Surface Impoundment
505	Drip Pad
506	Containment
Building-Storage
S99 Other Storage
Treatment:
T01 Tank
T02 Surface Impoundment
T03 Incinerator
T04 Other Treatment
no
TBI
T82
T83
T84
TBS
T96
Boiler
Cement Kiln
Lime Kiln
Aggregate Kiln
Phosphate Kiln
Coke Oven
Blaat Furnace
}
Gallons; Liters; Gallons Per Day;
or Liters Per Day
Acre-feet or Hectare-meter
Acres or Hectares
Gallone Per Day r Liters Per Day
Gallons or Liters
Any Unit of Measure Listed Below
Gallons or Liters
Gallona or Liters
Cubic Yards or Cubic Meters
Gallons or Liters
Gallons or Liters
Cubic Yards or Cubic Meters
Any Unit of Meaaure Listed Below
Gallona Per Day or Liters Per Day
Gallona Per Day or Liters Per Day
Short Tons Per Hour; Metric Tons
Per Hour; Gallons Per Hour; Liters
Per Hour; or Btu's Per Hour
Gallona Per Day; Liters Per Day;
Pounda Per Hour; Short Tons Per
Hour; Kllograma Per Hour; Metric
Tons Per Day; Metric Tons Per
Hour; Short Tons Per Day; or
Btu's Per Hour
Gallona or Liters
Gallona Per Day; Lltera Per Day;
Pounda Per Hour; Short Tons Per
Hour; Kllograma Per Hour; Metric
Tons Per Day; Metric Tons Per
Hour; Short Tone Per Day; or
Btu'a Per Hour
PROCESS
CODE
PROCESS
APPROPRIATE UNITS OF
MEASURE FOR PROCESS
DESIGN CAPACITY
T87 Smelting, Melting,
Or Refining Furnace
T88 Titanium Dioxide
Chloride Process
Oxidation Reactor
T89 Methane Reforming
Furnace
T90 Pulping Liquor
Recovery Furnace
T91 Combustion Device
Used In The Recovery
Of Sulfur Values From
Spent Sulfuric Acid
T92 Halogen Acid Fumacaa
T93 Other Induatrlal
Furnaces Listed In
40 CFR §260.10
T94 Containment
Building-Treatment
Miscellaneous (Subpart X);
X01 Open Burning/Open
Detonation
X02 Mechanical Proceaalng
X03 Thermal Unit
X04 Geologic Repository
X99 Other Subpart X
Gallona Per Day; Liters Per
Day; Pounda Per Hour; Short
Tone Per Hour; Kllograma
Per Hour; Metric Tone Per
Day; Metric Tone Per Hour;
Short Tone Per Day; or Btu'a
Per Hour
Cubic Yarda or Cubic Meters
Aay Unit of Meaaure Uated
Below
Short Tone Per Hour; Metric
Tone Per Hour; Short Tone
Per Day; Metric Tona Per Dey;
Pounds Per Hour; or
Kllograma Per Hour
Gallons Per Day; Lltera Per
Day; Pounda Per Hour; Short
Tona Per Hour; Kllograma Per
Hour, Metric Tona Per Day;
Metric Tona Per Hour; Short
Tona Per Day; or Btu'a Per
Hour
Cubic Yarda or Cubic Meters
Any Unit of Meaaure Uated
Bellow
UNIT OF
MEASURE
UNIT OF
MEASURE
CODE
Gallona....	
Gallona Per Hour.
Gallone Per Day...
Lltera	
Liters Per Hour	
Lltera Per Dey
,Q
,.E
, U
,.L
, H
..V
UNIT OF
MEASURE
UNIT OF
MEASURE
CODE
Short Tona Per Hour	......... 0
Metric Tona Per Hour	W
Short Tona Per Dey		N
Metric Tone Per Day......		S
Pounda Par Hour	J
Kllograma Per Hour......	... R
UNIT OF
MEASURE
UNIT OF
MEASURE
CODE
Cubic Yarda.
Cubic Metera.
Acrea.......	
Acre-feet
Hectares.
Y
...C
...B

Hectare-meter	......		 F
Btu'e Per Hour	/
EPA Form 8700-23 (Rev. 11-30-93) Previous edition is obsolete. - 3 of 7 •

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Please print or type with ELITE type (12 characters per inch) in the unshaded areas only
EPA I.D. Number (Enter from page 1)
Form Approved, OMB No. 2050-0034 Expires 9-30-96
GSA No. 0248-EPA&T
Secondary ID Number (Enter from page 1)
Xlt.Process Codes and Design Capabilities (Continued)
EXAMPLE FOR COMPLETING ITEM XII (Shown In line number X-1 below): A facility has a storage tank, which can hold 533.788
gallons.
Une
Number
A. Process
Code
(From Hit tbeval
B. PROCESS DESIGN CAPACITY
C. Process
Total
Number
Of Units
For Official
Use Only
1. Amount (Spteify)
2. Unit Of
Measure
(Entof cod*)
X
1
S
0
2
5 3 3.78 8
G
0 0 1







1













2













3
--

	










4









5

—

•







6
7
















8


	









1
1
9
0
1

—
¦


















	






1
2
¦






1
3












NOTE: If you need to list more than 13 process codes, attach an additional sheetfs) with the Information In the same format as
above. Number the lines sequentially, taking Into account any lines that will be used tor "other" processes (l.e., D99, S99, T04 and
X99) In Item XIII.			
XIII. Other Processes (Follow Instructions from Item XII for D99, S99, T04 and X99 process codes)
Line
Number
(Enlar #¦ in
magw/Xtt}
A. Process
Code
(From UttMbove)
B. PROCESS DESIGN CAPACITY
C. Process
Total
Number
Of Units
D. Description Of Process
1. Amount (Sptdfy)
2. Unit Of
Measure
(Entareode)
X
1
T
0
4



ln-sltu Vitrification

1








2









3










4

1





EPA Form 8700-23 (Rev. 11-30-93) Previous edition Is obsolete. - 4 of 7 ¦

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Form Approved, OMB No. 2050-0034 Expires 9-30-96
Please print or type with ELITE type (12 characters per inch) in the unshaded areas only		ssa no. 0248-£pa-qt
EPA I.O. Number (Enter from page 1)	Secondary 10 Number (Enter from page 1)
XIV. Description of Hazardous Wastes
A.	EPA HAZARDOUS WASTE NUMBER • Enter the four-digit number from 40 CFR, Part 261 Subpart 0 of each fisted hazardous waste
you will handle. For hazardous wastes which an not Hated in 40 CFR, Part 391 Subpart D, enter the four-digit number(s) from 40
CFR, Part 261 Subpart C that deecribes the characteristics andfor the toxic contamlnimts of those hazardoua wastes.
B.	ESTIMATED ANNUAL QUANTITY * For each listed waste entered In column A estimate the quantity of that waste that wilt be
handled on an annual basis. For each characteristic or toxic contaminant entered in column A estimate the total annual quantity
of all the non-listed wastefs) that will be handled which possess that characteristic or contaminant
C UNIT OF MEASURE -For each quantity entered In column B enter the unit of measure code. Units of meaeure which must be used
and the appropriate codes ate:
ENGLISH UNIT OF MEASURE
CODE
METRIC UNIT OF MEASURE
CODE
POUNDS
P
KILOGRAMS
K
TONS
T
METRIC TONS
M
if facility records use any other unit of measure for quantity, the units of measure must be converted Into one of the required units
of measure taking Into account the appropriate density or specific gravity of the waste.
D. PROCESSES
1.	PROCESS CODES:
For listed hazardous waste: For eachMated hazardous waste entered in column A select thecodefs) from the list of process
codes contained In Item XII A. on page 3 to indicate how the waste will be stored, treated, and/or disposed of at the facility.
For non-listed hazardous waste: For each characteristic or toxic contaminant entered in column A, select the code(s) from
the list of process codee contained In item XII A. on page 3 to Indicate all the processes that will be used to store, treat, and/
or dispose of all the non-tlsted hazardous waetee that poeeees that characteristic or toxic contaminant.
NOTE: THREE SPACES ARE PROVIDED FOR ENTERING PROCESS COOES. IF MORE ARE NEEDED:
1.	Enter the first two aa described above.
2.	Enter "000" In the extreme right box of item XIV-D(1).
3.	Enter In the apace provided on page 7, Item XIV-E, the line number and the additional cotSefa).
2.	PROCESS DESCRIPTION: if a codeianot listed for a process that wiilbe uaed, describe the process In the apace provided
on the form (0.(2)).
NOTE: HAZARDOUS WASTES DESCRIBED B Y MORE THAN ONE EPA HAZARDOUS WASTE NUMBER - Hazardous
wastes that can be described by more than one EPA Hazardous Wast* Number shall be described on the form as fotlowa:
1.	Select one of the EPA Hazardous Waste Numbers and enter It In column A. On the same line complete columns
B, C and D by estimating the total armuafquantltyofthe waateand describing all the processes to be used to treat,
store, and/or dispose of the waste.
2.	In column A of the next line enter the other EPA Hazardous Waate Number that can be used to describe the waste.
In column D(2) on that line enter "Included with above" and make no other entries on that line.
3.	Repeat step 2 tor each EPA Hazardous Waste Number that cm be used to describe the hazardous waste.
EXAMPLE FOR COMPLETING ITEMXIV(shown in line m/mfcera X-1, X-2, X-3, andX-4 below)-A facility wilt treat anddlspote of
an estimated 900 pounds par year of chrome shavinga from leather tanning and finishing operation. in addition, the facility will treat
and dispose of three non-listed wastes. Two wastes are corrosive only and there will be an estimated200pounds per year of each waste.
The other waste Is corrosive and ignitable and there wlHbe an estimated 100 pounda per year of that waste. Treatment will be in an
Incinerator and disposal will bain a landfill.
Line
Number
A. EPA
HAZARD
WASTE NO.
(Enter code)
B. ESTIMATED
ANNUAL
QUANTITY OF
WASTE
C.UMTOF
MEASURE
(Enter
code)
D. PROCESS
(1) PROCESS CODES (Enter code)
(2) PROCESS DESCRIPTION
(It a code la not entered In 0(1))
X
1
K
0
5
4
900
P
T
0
3
D
ii*
0




X
2
D
0
0
2
400
P
7
Wi
3
D

0




X
3
0
0
0
1
100
P
T
0
3
0
ill:
0




*
4
0
0
0
2












EPA Form 8700-23 (Rev. 11 -30-93) Previous edition Is obsolete. - 5 of 7 -

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Please print or type with ELITE type (12 characters per inch) in the unshaded areas only
EPA I.D. Number (Enter from page 1)
Form Approved, OMB No. 2050-0034 Expires 9-30-96
QSA No. 0248-EPA-OT
Secondary ID Number (Enter from page 1)
XIV. Description of Hazardous Wastes (Continued)
Line
Number
A. EPA
HAZARDOUS
WASTE NO.
(Enter code)
B. ESTIMATED
ANNUAL
QUANTITY OF
WASTE
C. UNIT OF
MEASURE
(Enter
code)
0. PROCESSES
(1) PROCESS COOES (Enter code)
fit) PROCESS DESCRIPTION
(It a code le not entered In D(1))

1

















2

















3

















4

















5

















6

















7

















8

















9
















1
0
















1
1
















1
2
















1
3
















1
4
















1
5
















1
6
















1
7
















1
8
















1
9
















2
0
















2
1
















2
2
















2
3
















2
4
















2
5
















2
6
















2
7
















2
8
















2
9
















3
0
















3
1
















3
2
















3
3
















EPA Form 8700-23 (Rev. 11-30-93) Previous edition Is obsolete. - 6 of 7 ¦

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Please print or type with ELITE type (12 characters per inch) in the unshaded areas only
Form Appiovad, OUB No. 2050-0034 Expires 9-30-96
GSA No. 0243-EPA-OT
EPA 1.0. Number (Enter from page 1)
Secondary ID Number (Enter from page 1)
Attach to this application a topographic map, or other equivalent map, of the area extending to at least one mile beyond property
boundaries. The map must show the outline of the facility, the location of each of its existing and proposed Intake and discharge
structures, each of Its hazardous waste treatment, storage, or disposal facilities, and each well where It Injects fluids underground.
Include all springs, rivers and other surface water bodies In this map area. See Instructions tor precise requirements.
XVI. Facility Drawing
All existing facilities must Include a scale drawing of the facility (see Instructions for more detail).
XVII. Photographs
All existing facilities must Include photographs (aerial or ground-level) that clearly delineate all existing structures; existing storage,
treatment and disposal areas; and sites of future storage, treatment or disposal areas (see Instructions for more detail).
XVIII. Certiflcation(s)
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.
Owner Signature
Date Signed
Name and Official Title (Type or print)
Owner Signature
Date Signed
Name and Official Title (Type or print)
Operator Signature
Date Signed
Name and Official Title (Type or print)
Operator Signature
Date Signed
Name and Official Title (Type or print)
XIX. Comments
s Note: Mail completed form to the appropriate EPA Regional or State Office. (Refer to Instructions for more Information)
j	if;	¦'>; »¦!	x ffHStli:'''	'ft! BIH imilii!!!!.^^^^!;!	Si' UK* '	^					 						 	S		:V:
EPA Form 8700-23 (Rev. 11-30-93) Previous edition is obsolete.
- 7 of 7 -

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Notes

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