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. ------- 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. Pag«1 ------- 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). Page 2 ------- 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 Page 3 ------- 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 Page 4 ------- 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 Page 5 ------- 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. Page 6 ------- 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 Pag* 7 ------- 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 Pag* 8 ------- 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) Page 9 ------- 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 Page 10 ------- 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 Pag* 11 ------- 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 Page 12 ------- 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 Pag«13 ------- 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 Page 14 ------- 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. Page 15 ------- 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 ------- 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. Page 17 ------- 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. Page 18 ------- 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. Page 19 ------- 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. Page 20 ------- 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. Page 21 ------- 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 ------- 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. Page 23 ------- 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 ------- 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. Page 25 ------- 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 ------- 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 • ------- 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 ¦ ------- 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 - ------- 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 ¦ ------- 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 - ------- Notes ------- |