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Get EPA 8700-12 8700-13 A/B 8700-23 2020-2024

Name of Site s Legal Owner Owner Type B. Name of Site s Operator Type EPA Form 8700-12 8700-13 A/B 8700-23 Revised 11/2009 Page 1 of 10. OMB 2050-0024 Expires 11/30/2011 SEND COMPLETED FORM TO The Appropriate State or Regional Office. Reason for Submittal United States Environmental Protection Agency RCRA SUBTITLE C SITE IDENTIFICATION FORM Reason for Submittal To provide an Initial Notification first time submitting site identification information / to obtain an EPA ID number for this location MARK ALL BOX ES THAT APPLY To provide a Subsequent Notification to update site identification information for this location As a component of a First RCRA Hazardous Waste Part A Permit Application Site was a TSD facility and/or generator of 1 000 kg of hazardous waste 1 kg of acute hazardous waste or 100 kg of acute hazardous waste spill cleanup in one or more months of the report year or State equivalent LQG regulations Site EPA ID Number Site Name Site Location Information EPA ID Number Name Street Address City Town or Village County State Site Land Type Private NAICS Code s for the Site at least 5-digit codes A. - C. - B. - D. - Site Mailing Address District Zip Code Federal Site Contact Person Municipal Other Street or P. O. Box Tribal First Name MI Last Title Email Phone Legal Owner and Operator Ext. Fax Date Became Owner A. Type of Regulated Waste Activity at your site Mark Yes or No for all current activities as of the date submitting the form complete any additional boxes as instructed* A. Hazardous Waste Activities Complete all parts 1-7. Y N 1. Generator of Hazardous Waste If Yes mark only one of the following a b or c* a* LQG b. SQG c* CESQG Generates in any calendar month 1 000 kg/mo 2 200 lbs. /mo. or more of hazardous waste or accumulates at any time more than 1 kg/mo 2. 2 lbs. /mo of acute hazardous waste or 220 lbs. /mo of acute hazardous spill cleanup material* 100 to 1 000 kg/mo 220 2 200 lbs. /mo of nonacute hazardous waste. Less than 100 kg/mo 220 lbs. /mo of non-acute hazardous waste. 2. Transporter of Hazardous Waste If Yes mark all that apply. a* Transporter b. Transfer Facility at your site 3. Treater Storer or Disposer of waste permit is required for these activities. 4. Recycler of Hazardous Waste 5. Exempt Boiler and/or Industrial Furnace a* Small Quantity On-site Burner Exemption If Yes above indicate other generator activities. b. Smelting Melting and Refining Furnace Exemption d. Short-Term Generator generate from a short-term or onetime event and not from on-going processes. If Yes provide an explanation in the Comments section* e. United States Importer of Hazardous Waste 6. Underground Injection Control f* 7. Receives Hazardous Waste from Off-site Mixed Waste hazardous and radioactive Generator B. Universal Waste Activities Complete all parts 1-2. C. Used Oil Activities Complete all parts 1-4. 1. Large Quantity Handler of Universal Waste you accumulate 5 000 kg or more refer to your State regulations to determine what is regulated.

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