MISSOURI DEPARTMENT OF NATURAL RESOURCES WASTE MANAGEMENT PROGRAM NOTIFICATION OF REGULATED WASTE ACTIVITY

All new and reactivating registrations require an initial registration fee. Registrations without the correct fee will not be processed. Checks should be made out to the Missouri Department of Natural Resources Hazardous Waste Program. The fee is not required if only updating information to an existing and active registration. Form must be completed in its entirety, or it will be returned. Instructions are at the end of this form. Completed form with an original ink signature should be sent to:

Waste Management Program P.O. Box 176 Jefferson City, MO 65102-0176

or Waste Management Program 1730 E. Elm StreetJefferson City, MO 65101-4130

Registration Fee Schedule

LQG = $500 SQG = $150 CESQG = $150 For Office Use Only 1. TYPE OF NOTIFICATION

A. NEW NOTIFICATION

B. SUBSEQUENT NOTIFICATION

EPA ID NUMBER

MISSOURI ID NUMBER

2. NAME OF HANDLER (BUSINESS NAME, SITE NAME OR D.B.A)

3. LOCATION OF HANDLER (PHYSICAL ADDRESS WHERE WASTE IS LOCATED)STREET

CITY

STATE

ZIP CODE + 4

COUNTY NAME

SAME AS SITE 4. MAILING ADDRESSSTREET

CITY

STATE

ZIP CODE + 4

BILLING ADDRESS: SAME AS MAILING

STREET

CITY

STATE

ZIP CODE + 4

5. HANDLER CONTACT ADDRESS SAME AS SITE ADDRESS SAME AS MAILING FIRST NAME MIDDLE NAME LAST NAME

TITLE TELEPHONE NUMBER WITH AREA CODE EXTENSION

ADDRESS

CITY STATE ZIP CODE + 4

EMAIL ADDRESS

MO 780-1164 (03-19)

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MO 780-1164 (03-19)

6. NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM (NAICS) CODE(S)Visit census.gov/eos/www/naics for NAICS code list.

7. OWNERSHIPNote: Make copies of this section for multiple ownerships.

NAME OF HANDLER’S LEGAL OWNER (OPERATOR)

STREET, P.O. BOX OR ROUTE NUMBER

CITY

STATE

ZIP CODE + 4

TELEPHONE NUMBER WITH AREA CODE

EXTENSION

DATE BECAME OWNER (MM/DD/YYYY)

INSTALLATION OWNER TYPE - MARK ONE PRIVATE COUNTY DISTRICT FEDERAL TRIBAL MUNICIPAL STATE HOSPITAL OTHER

NAME OF PROPERTY’S LEGAL OWNER SAME AS HLO

STREET, P.O. BOX OR ROUTE NUMBER

CITY

STATE

ZIP CODE + 4

TELEPHONE NUMBER WITH AREA CODE

EXTENSION

DATE BECAME OWNER (MM/DD/YYYY)

PROPERTY OWNER TYPE (MARK ONE) PRIVATE COUNTY DISTRICT FEDERAL TRIBAL MUNICIPAL STATE HOSPITAL OTHER

8. TYPE OF REGULATED WASTE ACTIVITYA. HAZARDOUS WASTE ACTIVITIES Y N

1. Generator of hazardous waste (If Yes, choose only one and you must enter at least one waste code in section XI).a. LQG: Greater than 1,000kg (2,220 lbs.) of non-acute hazardous waste or 1kg (2.2 lbs.) of acute hazardous waste

in a calendar month. ($500 if fee required).b. SQG: Generate 100 to 1,000kg (220-2,220 lbs.) of non-acute hazardous waste at any one time. ($150 if fee

required).c. CESQG: Generate less than 100kg (220 lbs.) of hazardous waste in a calendar month and never accumulate 100kg

(220 lbs.) or more of hazardous waste at any one time. ($150 if fee required). Y N

2. Episodic LQG event (see instructions) Date of Episodic Event (MM/DD/YYYY) ____/____/________

Y N 3. United States importer of hazardous waste.

Y N 4. Mixed waste (hazardous and radioactive) generator.

Y N 5. Transporter of hazardous waste (If Yes, mark all that apply).

a. Transporter.b. Transfer Facility (at your site).

Y N 6. Treater, storer or disposer of hazardous waste (at your site).

Note: A hazardous waste permit is required for this activity.Check N if you just store your waste within the allowable timeframes prior to shipping off-site for disposal.

Y N 7. Recycler of hazardous waste (at your site) (If Yes, you must choose only one).Note: A hazardous waste permit may be required for this activity.

a. Recycler who stores waste prior to recyclingb. Recycler who does not store prior to recycling

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Y N 8. Exempt boiler or industrial furnace. (If Yes, mark all that apply)

a. Small quantity on-site burner exemption.b. Smelting, melting and refining furnace exemption.

Y N 9. Underground injection control.

Y N 10. Receives hazardous waste from off-site.

Y N 11. Precious metals reclamation.

Y N 12. Recognized Trader (If Yes, mark all that apply).

a. Importerb. Exporter

Y N 13. Importer/Exporter of Spent Lead-Acid Batteries (SLABS) under 40 CFR Part 266 Subpart G (If Yes, mark all

that apply).a. Importerb. Exporter

B. UNIVERSAL WASTE ACTIVITIES Y N

1. Large quantity handler of universal waste (accumulate 5,000kg or more). [Refer to Missouri regulations todetermine what is regulated.] Indicate types of universal waste managed or accumulated at your site. (If Yes,mark all that apply)

a. Batteriesb. Lampsc. Pesticidesd. Thermostats

Y N 2. Destination facility for universal waste. Note: A hazardous waste permit may be required for this activity.

C. USED OIL ACTIVITIES Y N

1. Used oil transporter (If Yes, mark all that apply)a. Transporterb. Transfer facility

Y N 2. Used oil processor or re-refiner (If Yes, mark all that apply)

a. Processorb. Re-refine

Y N 3. Off-specification used oil burner

Y N 4. Used oil fuel marketer (If Yes, mark all that apply)

a. Marketer who directs shipment of off-specification used oil to off-specification used oil burner.b. Marketer who first claims the used oil meets the specifications.

D. ELIGIBLE ACADEMIC ENTITIES WITH LABORATORIES Y N

1. Opting into or currently operating under 40 CFR 262 subpart K (If Yes, mark all that apply)a. College or Universityb. Teaching Hospital that is owned by or has a formal written affiliation with a college or universityc. Non-profit Institute that is owned by or has a formal written affiliation with a college or university

Y N 2. Withdrawing from 40CFR 262 subpart K

E. NOTIFICATION OF MANAGEMENT OF HAZARDOUS SECONDARY MATERIAL Y N

1. Notifying under 40 CFR 260.42 that management of hazardous secondary material under 40 CFR 260.30, 40CFR 261.4(a)(23), (24), or (27) is beginning, continuing or stopping (If Yes, the Notification of Hazardous SecondaryMaterial Activity must be completed).

MO 780-1164 (03-19) 3

Y N 2. Notifying under 40 CFR 260.43(a)(4)(iii) that legitimate recycling is being conducted at your site. You may

include details in the comment section of this form. Documentation must be maintained on-site.

F. E-MANIFEST ACTIVITIES

Y N 1. Broker

2. Receiver

3. Transporter

4. Generator

9. DESCRIPTION OF REGULATED WASTE ACTIVITY (USE ADDITIONAL SHEETS IF NECESSARY) Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the federal hazardous wastes handled at your site. Use an additional page if more spaces are needed for waste codes.

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10. COMMENTS

11. CERTIFICATIONI certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment.

SIGNATURE (ORIGINAL INK REQUIRED)

NAME AND OFFICIAL TITLE (TYPE OR PRINT)

DATE SIGNED

MO 780-1164 (03-19)

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Notification of Regulated Waste Activity Instructions

Note: All new registrations and reactivations require an initial registration fee as stated in 10 CSR 25.12.010(1)(E). Registrations without this fee will not be processed. The fee is not required if you are only updating information to an existing, active registration.

ITEM 1 - TYPE OF NOTIFICATION A. New Notification: Check this box if this is the first notification for the handler named in Section II of the form.

B. Subsequent Notification: If you are filing a subsequent notification enter your EPA ID number and MO ID number in the space provided. Note: When the owner of a facility changes, the new owner must notify the department of the change, even if the previous owner already received an EPA ID number. Because the EPA ID number is 'site-specific,' the new owner will keep the existing ID number. If the facility moves to another location, the owner/operator must notify the department of this change. In this instance a new EPA ID number will be assigned, since the facility has changed locations. The same is true of a Missouri Generator ID number as for an EPA ID number.

ITEMS 2 AND 3 - NAME AND LOCATION OF HANDLER Complete Items 2 and 3. Note: The address you give for Item 3, "Location of the Handler," must be a physical address or directional description (example: number of miles from a known junction, not a post office box or route number.)

County Name: Enter the county name for the site. If the county name is unknown, contact the local post office.

ITEM 4 - MAILING ADDRESS Enter the installation mailing address. This is the address all correspondence will be sent to. If the mailing address and the location of the installation (Item 3) are the same, you can check the "SAME AS SITE" box for Item 4.

Billing Address: Enter the address to which you would like invoices to be mailed. If this address is the same as the mailing address (Item 4), check the “SAME AS MAILING” box.

ITEM 5 - HANDLER CONTACT Enter the name, address, title, email address and business telephone number with area code of the person who should be contacted regarding information submitted on this form.

ITEM 6 - NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM, or NAICS, CODE(S) Provide the North American Industry Classification System code that best describes your site's primary business production process for your products or services. Use the six digit code (most specific description) if available for your business; if not, use the five digit code; do not enter any codes with four or fewer digits. If more than one code applies, please list those additional codes as well.

You can obtain North American Industry Classification System codes online at census.gov/eos/www/naics and at some libraries.

ITEM 7 – OWNERSHIP Name of Handler's Legal Owner (Business Owner): Enter the name of the legal owner(s) of the installation. Also enter the address and phone number where this individual can be reached. Make copies of this section for multiple ownerships.

Date Became Owner: Enter the date the named entity became the owner of the business operating at this site.

Handler Owner Type: Check the box that best describes the legal status of the current business owner of the facility. (Note: The ownership code for hospitals may only be used if a facility is licensed under Chapter 197 of the RSMO.)

Name of the Property's Legal Owner: Enter the name of the legal owner(s) of the property. Also enter the address and phone number where this individual can be reached. Make copies of this section for multiple ownerships. If the property owner and the handler’s legal owner (Item VI.A.) are the same, check the “SAME AS HLO” box.

Date Became Owner: Enter the date the named entity purchased the property at this site. If you checked the “SAME AS HLO” box you must still enter a date if the purchase of the property did not coincide with the date you became owner of the business operating at the site.

Property Owner Type: Check the box that best describes the legal status of the current owner of the property.

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Notification of Regulated Waste Activity Instructions (continued)

ITEM 8 - TYPE OF REGULATED WASTE ACTIVITY

Every Item that has a Yes and No box to check must have one of those boxes checked.

A. Hazardous Waste Activities:

1. Generator of hazardous waste: If you generate a hazardous waste that is identified by characteristic or listed in 40 CFRPart 261 check the appropriate box for the quantity of non-acute hazardous waste that would indicate the highest generationper month or accumulation at any one time. If you generate acutely hazardous waste, please refer to 40 CFR Part 262 and10 CSR 25-5 for further information.

If “Yes”, check the “Y” box and only one of the following – a, b, or c. Otherwise, check the “N” box.

a. LQG: Large Quantity GeneratorGenerate greater than 1000 kg (2200 lbs) of non-acute hazardous waste or 1 kg (2.2 lbs) of acute hazardous waste in acalendar month.

b. SQG: Small Quantity GeneratorGenerates over 100 kg (220 lbs) and up to 1000 kg (2200 lbs) of non-acute hazardous waste at any one time.

c. CESQG: Conditionally Exempt Small Quantity GeneratorGenerate less than or equal to 100 kg (220 lbs) of non-acute hazardous waste and less than or equal to 1 kg (2.2 lbs) ofacute hazardous waste in a calendar month, and never accumulate those amounts at any one time.

2. Episodic LQG Event: Check “Y” if you are currently registered as a SQG and have had a one-time large quantityhazardous waste generation event. The date of the hazardous waste generation must be entered in the space provided onthe form. The additional information required of the episodic event notification must be included in the comment section or ina cover letter accompanying this form. Otherwise, check “N”.

3. United States Importer of Hazardous Waste: Check “Y” if you import hazardous waste from a foreign country into theUnited States. Refer to 40 CFR 262.260 for additional information. Otherwise, check “N”.

4. Mixed Waste Generator: Check “Y” if you are a generator of mixed waste (waste that is both hazardous and radioactive).RCRA defines 'mixed waste' as waste that contains both hazardous waste and source, special nuclear, or by-productmaterial subject to the Atomic Energy Act, or AEA, RCRA section 1004(41), 42 U.S.C 6903 (63 FR 17414; April 9, 1998).Otherwise, check “N”.

5. Transporter of Hazardous Waste: Check “Y” if you transport hazardous waste within the United States and mark all thatapply. Otherwise, check “N”.

a. Transport: Mark if you transport hazardous waste within the United States. The federal regulations for hazardouswaste transporters are found in 40 CFR Part 263.

b. Transfer facility: Mark if you hold manifested hazardous waste(s) at your site for a period of 10 days or less while thewaste is in transit. The federal regulations for hazardous waste transfer facilities are found in 40 CFR Part 263.12.

6. Treater/Storer/Disposer: If you treat, store or dispose of regulated hazardous waste at your site, check “Y”. A hazardouswaste permit is required for this activity. The federal regulations for hazardous waste facility owners/operators are found in40 CFR Part 264 and 265; the state regulations are found in 10 CSR 25-7. Otherwise, check “N”. Storing your own wastewithin allowable timeframes prior to shipping the waste off-site does not constitute the kind of storage that would require youto check “Y”, so “N” is the appropriate box to check.

7. Recycler of Hazardous Waste: Check “Y” if you recycle regulated waste (recyclable materials) and mark the subsequentbox to indicate if you store or do not store the waste prior to the recycling. The federal regulations for owners or operators ofsites that recycle hazardous waste are found in 40 CFR 261.6. A hazardous waste permit may be required for this activity.You may also be subject to other federal and state regulations. Otherwise, check “N”.

a. Mark if you store the waste prior to recycling.b. Mark if you do not store the waste prior to recycling.

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Notification of Regulated Waste Activity Instructions (continued)

ITEM 8 - TYPE OF REGULATED WASTE ACTIVITY (continued)

8. Exempt Boiler or Industrial Furnace: Check “Y” if a and/or b apply, and check the appropriate box(es). Otherwise, check“N”.

a. You burn small quantities of hazardous waste in an on-site boiler or industrial furnace in accordance with the conditionsin 40 CFR 266.108, check the box to indicate that you qualify for the small quantity on-site burner exception.

b. You process hazardous wastes in a smelting, melting or refining furnace solely for metals recovery, as described in 40CFR 266.100(d), or to recover economically significant amounts of precious metals, as described in 40 CFR266.100(g), or if you process hazardous wastes in a lead recovery furnace to recover lead, as described in 40 CFR266.100(h), check the box to indicate that you qualify for the smelting, melting and refining furnace exception.

9 Underground Injection Control: Check “Y” if you generate, treat, store or dispose of hazardous waste and there is an underground injection well located at your site, check the box. The federal regulations for owners or operators of underground injections wells are found in 40 CFR Part 148. Otherwise, check “N”.

10. Receives Hazardous Waste from Off-site: Check “Y” if you received hazardous waste from another site, whether thiswaste was received as a commercial transaction or waste received from a restricted group of off-site generators. Otherwise,check “N”. Please note that “Receives Hazardous Waste from Off-site” does not apply to transfer facilities.

11. Precious Metals Reclamation: Check “Y” if you will be performing precious metals reclamation at your site. Otherwise,check “N”.

12. Recognized Trader: Check “Y” if you are a recognized trader, defined in 40 CFR 260.10 as a person domiciled in Missouri,who acts to arrange and facilitate transboundary movements of wastes destined for recovery or disposal operations, eitherby purchasing from and subsequently selling to United States and foreign facilities, or by acting under arrangements with aUnited States waste facility to arrange for the export or import of the waste. Otherwise, check “N”. Mark all that apply.

a. Importerb. Exporter

13. Importer/Exporter of Spent Lead-Acid Batteries (SLABS) under 40 CFR Part 266 Subpart G: Check “Y” if you are animporter or exporter of spent lead-acid batteries (SLABs) being managed domestically under 40 CFR 266 Subpart G toobtain an EPA Identification number (see 40 CFR 266.80(a)(6), (8)-(10). Otherwise, check “N”. Mark all that apply.

a. Importerb. Exporter

B. Universal Waste Activities: Refer to 10 CSR 25-16.273 requirements and definitions for universal waste. Also refer to 40CFR 261.9 and 40 CFR Part 273 for the federal regulations covering universal waste.

1. Large Quantity Handler of Universal Waste, or LQHUW: Check “Y” if you accumulate a total of 5,000 kg or more of anyuniversal wastes (calculated collectively) at any time. Check the appropriate boxes to indicate the types of universal wastesyou generate and/or accumulate at your site. Otherwise, check “N”. Mark all that apply.

2. Destination Facility: Check “Y” if you treat, dispose of, or recycle universal wastes on site. A hazardous waste permit isrequired if you treat or dispose of universal wastes; a permit may be required if you recycle universal waste. Otherwise,check “N”.

C. Used Oil Management Activities: Check the appropriate boxes to indicate which used oil fuel activities are taking place at thisinstallation. The federal regulations for used oil management are found in 40 CFR Part 279; the state regulations are found in 10CSR 25-11.

1. Used Oil Transporter/Transfer Facility: Check “Y” If you transport used oil, or if the site you are registering is a used oiltransfer facility. Otherwise check “N”. Mark all that apply.

2. Used Oil Processor/Re-refiner: Check “Y” If you are processing or re-refining used oil at the facility which you areregistering. Otherwise check “N”. Mark all that apply.

3. Off-Specification Used Oil Burner: Check “Y” if you burn used oil fuel. Otherwise, check “N”.

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Notification of Regulated Waste Activity Instructions (continued)

ITEM 8 - TYPE OF REGULATED WASTE ACTIVITY (continued)

4. Used Oil Marketer: Check “Y” if you market used oil fuel. Otherwise, check “N”. Mark all that apply.

D. Eligible Academic Entities with Laboratories:

Subpart K is an optional alternative set of requirements for eligible academic entities with laboratories. Certain generators (i.e.,eligible academic entities as defined in 40 CFR 262.200) are eligible to operate under Subpart K for management of theirhazardous wastes in laboratories in lieu of 40 CFR 262.15 (or 40 CFR 262.14 for CESQGs). Eligible academic entities withlaboratories that generate hazardous waste that elect to opt into Subpart K, are currently operating under Subpart K, orsubsequently withdraw from Subpart K must complete this section to meet the notification requirements of this subpart. Refer to40 CFR 262.203 and 40 CFR 262.204.

1. Check “Y” if you are an eligible academic entity and elect to opt into or are currently operating under 40 CFR Part 262,Subpart K for the hazardous wastes generated in your laboratories. Otherwise, check “N”. Mark all that apply.

a. College or Universityb. Teaching Hospital that is owned by or has a formal written affiliation agreement with a college or universityc. Non-profit Institute that is owned by or has a formal written affiliation agreement with a college or university

Check “Y” if you have previously elected to opt into 40 CFR Part 262, Subpart K and are now withdrawing from participation in this optional set of alternative requirements for hazardous waste generation in laboratories. Withdrawing generators will automatically revert to regulation under 40CFR 262.15 requirements (or 40CFR 262.14 for CESQGs). If you mark “Y” for this box, please include comments in item X – Comments that explain your reasons for withdrawing from Subpart K. Otherwise, check “N”.

E. Notification of Hazardous Secondary Material Activity:

1. Check “Y” if you are notifying under 40CFR 260.42 that you will begin managing, are still managing, or will stop managing hazardous secondary material under 40 CFR 260.30, 40 CFR 261.4(a)(23), (24), or (27). Checking “Y” requires that Addendum A be completed. Otherwise, check “N”.

2. Check “Y” if you are submitting a legitimate recycling notification under 40CFR 260.43(a)(4)(iii). Recycling of hazardous secondary materials for the purpose of the exclusions or exemptions from hazardous waste regulations must be legitimate. You must notify EPA if the product of your recycling process has levels of hazardous constituents that are not comparable to a legitimate product or intermediate, but the recycling is still legitimate. The recycling can be shown to be legitimate based on lack of exposure from toxics in the product, lack of the bioavailability of the toxics in the product, or other relevant considerations that show the recycled product does not contain levels of hazardous constituents that pose a significant human health or environmental risk. Documentation of legitimacy must be maintained on-site for three years. Provide additional information regarding your recycling in item X – Comments. Otherwise, check “N”. Notification is not required if the product of the recycling process in comparable to a legitimate product or intermediate per 40 CFR 260.43(a)(4)(i) or (ii).

F. E-Manifest Activities:

1. Electronic Manifest Broker: Check “Y” if you are a person as defined in 40 CFR 260.10 that elects to use the electronic manifest system to obtain, complete and transmit an electronic manifest format supplied by the EPA electronic manifest system under a contractual relationship with a hazardous waste generator. Otherwise, check “N”.

2. Receiver – State Regulated Wastes: Check “Y” if the only waste that you receive at your site is waste where another state requires the generator of that waste to ship it using a hazardous waste manifest. Otherwise, check “N”.

3. Transporter – State Regulated Wastes: Check “Y” if you are obtaining an ID number so that you can be listed as a transporter on a hazardous waste manifest where the waste being shipped does not require you to have a Missouri Hazardous Waste Transporter License, but another state requires the waste to be shipped on a hazardous waste manifest. Otherwise, check “N”. You must check “N” if you have a Missouri Hazardous Waste Transporter License.

4. Generator – State Regulated Wastes: Check “Y” if the only waste that you are shipping on a hazardous waste manifest is a waste that Missouri does not consider to be a hazardous waste and are shipping it to a receiving facility in a state that requires the waste to be shipped on a hazardous waste manifest. Otherwise, check “N”. You must check “N” if you are registered as a hazardous waste generator.

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Notification of Regulated Waste Activity Instructions (continued)

ITEM 9 - DESCRIPTION OF REGULATED WASTE ACTIVITY Only persons involved in hazardous waste activity (Item 8.A.1 & Item 8.A.11) need to complete this item. Transporters requesting an EPA identification number do not need to complete this item, but must mark A.2 and sign the 'Certification' in Item XI. You will need to refer to 40 CFR Part 261 and 10 CSR 25-4 in order to complete this section. Part 261 identifies those wastes EPA defines as hazardous. If you need help in completing this section, please contact the Waste Management Program.

Waste Codes for Federally Regulated Hazardous Wastes: If you handle hazardous wastes described in 40 CFR Part 261, enter the appropriate 4-digit code(s) in the boxes provided.

ITEM 10 – COMMENTS Use this section as needed to provide additional information. You may attach additional sheets if needed.

ITEM 11 – CERTIFICATION This certification must be signed by the owner, operator or an authorized representative of your installation. An 'authorized representative' is a person responsible for the overall operation of the facility (e.g., a plant manager or superintendent or a person of equal responsibility). All notifications must include the certification to be complete.

Mail completed forms and registration fee, if applicable, to:

Missouri Department of Natural Resources or Waste Management Program P.O. Box 176 Jefferson City, MO 65102-0176

Missouri Department of Natural Resources Waste Management Program 1730 E. Elm St. Jefferson City, MO 65101-4130

DEFINITIONS The following definitions are included to help you to understand and complete the Notification Form:

ACT or RCRA means the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act of 1976, as amended by the Hazardous and Solid Waste Amendments of 1984, 42 U.S.C. Section 6901 et seq.

Authorized Representative means the person responsible for the overall operation of an installation or an operational unit (i.e., part of a facility). An authorized representative could be a superintendent or plant manager, or person of equivalent responsibility.

Boiler means an enclosed device using controlled flame combustion and having the following characteristics:

1. The unit has physical provisions for recovering and exporting energy in the form of steam, heated fluids or heated gases.2. The unit's combustion chamber and primary energy recovery section(s) are of integral design (e.g., they are physically

formed into one manufactured or assembled unit).3. The unit continuously maintains an energy recovery efficiency of at least 60 percent, calculated in terms of the recovered

energy compared with the thermal value of the fuel.4. The unit exports and uses at least 75 percent of the recovered energy, calculated on an annual basis (excluding recovered

heat used internally in the same unit, for example, to preheat fuel or combustion air or drive fans or feedwater pumps).5. The unit is one that the regional administrator has determined on a case-by-case basis, to be a boiler after considering the

standards in 40 CFR 260.32.

Burner means the owner or operator of any boiler or industrial furnace that burns hazardous waste fuel for energy recovery and that is not regulated as a RCRA hazardous waste incinerator.

Disposal means the discharge, deposit, injection, dumping, spilling, leaking or placing of any solid waste or hazardous waste into or on any land or water so that such solid waste or hazardous waste or any constituent thereof may enter the environment or be emitted into the air or discharged into any waters, including ground waters.

E-Manifest means the EPA system in which all hazardous waste manifests are entered.

EPA Identification (ID) Number means the number assigned by EPA to each hazardous waste generator, hazardous waste transporter, and treatment, storage or disposal installation; large quantity handler of universal wastes; used oil transporter, used oil processor/re-refiner, off-specification used oil fuel burner and used oil fuel marketer.

Generator means any person, by site, whose act or process produces hazardous waste identified or listed in 40 CFR Part 261.

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Notification of Regulated Waste Activity Instructions (continued)

DEFINITIONS (continued)

Hazardous Secondary Material means a secondary material (e.g., spent material, by-product, or sludge) that, when discarded, would be identified as hazardous waste under 40 CFR Part 261.

Hazardous Waste means a hazardous waste as defined in 40 CFR 261.3.

Industrial Furnace means any of the following enclosed devices that are integral components of manufacturing processes and that use controlled flame combustion to accomplish recovery of materials or energy: cement kilns, lime kilns, aggregate kilns (including asphalt kilns), phosphate kilns, coke ovens, blast furnaces, smelting, melting and refining furnaces, titanium dioxide chloride process oxidation reactors, methane reforming furnaces, pulping liquor recovery furnaces, combustion devices used in the recovery of sulfur values from spent sulfuric acid and other devices as the administrator may add to this list.

Installation means all contiguous land, structures, other appurtenances and improvements on the land, used for treating, storing or disposing of hazardous waste. An installation may consist of several treatment, storage or disposal operational units. (For entities that only transport regulated wastes, the term installation refers to the headquarters of that entity's operations.)

Large Quantity Universal Waste Handler means a universal waste handler who accumulates 5,000 kilograms or more of universal waste (batteries, pesticides, or thermostats, calculated collectively) at any time.

Municipality means a city, village, town, borough, county, parish, district, association, Indian tribe or authorized Indian tribal organization, designated and approved management agency under Section 208 of the Clean Water Act, or any other public body created by or under state law and having jurisdiction over disposal of sewage, industrial wastes or other wastes.

Off-Specification Used Oil Fuel means used oil fuel that does not meet the specification provided under 40 CFR 279.11.

On-Specification Used Oil Fuel means used oil fuel that meets the specification provided under 40 CFR 279.11.

Operator means the person responsible for the overall operation of an installation.

Owner means a person who owns an installation or part of an installation, including the property owner.

Precious Metals Reclamation means recycling and recovery of precious metals (i.e., gold, silver, platinum, palladium, iridium, osmium, rhodium, and ruthenium) from hazardous waste.

Storage means the holding of hazardous waste for a temporary period, at the end of which the hazardous waste is treated, disposed of, or stored elsewhere.

Transportation means the movement of hazardous waste by air, rail, highway or water.

Transporter means a person engaged in the off-site transportation of hazardous waste by air, rail, highway or water.

Treatment means any method, technique or process, including neutralization, designed to change the physical, chemical or biological character or composition of any hazardous waste to neutralize such waste, or to recover energy or material resources from the waste, or to render such waste nonhazardous or less hazardous so it is safer to transport, store or dispose of, or amenable for recovery, amenable for storage or reduced in volume. This includes any activity or processing designed to change the physical form or composition of hazardous waste so as to render it nonhazardous.

Universal Waste means batteries as described in 40 CFR 273.2, pesticides as described in 40 CFR 273.3 as modified by paragraph (2)(A)3. 10 CSR 25-16, mercury switches as described in subparagraph (2)(A)4.A. 10 CSR 25-16, thermostats as described in 40 CFR 273.4, as incorporated in 10 CSR 25-16, mercury containing thermometers and manometers as described in subparagraph (2)(A)4.B. 10 CSR 25-16 and mercury containing lamps as described in subparagraph (2)(A)4.C. 10 CSR 25-16.

Used Oil means any oil that has been refined from crude oil, or any synthetic oil, that has been used and as a result of such use, is contaminated by physical or chemical impurities.

Used Oil Fuel means any used oil burned (or destined to be burned) for energy recovery including any fuel produced from used oil by processing, blending or other treatment and that does not contain hazardous waste (other than that generated by a conditionally exempt small quantity generator and exempt from regulation as hazardous waste under provisions of 40 CFR 261.5). Used oil fuel

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Notification of Regulated Waste Activity Instructions (continued)

DEFINITIONS (continued)

may itself exhibit a characteristic of hazardous waste and remain subject to regulation as used oil fuel provided it is not mixed with hazardous waste.

Used Oil Processing means chemical or physical operations designed to produce from used oil, or to make used oil more amenable for production of, fuel oils, lubricants or other used oil derived products. Processing includes, but is not limited to: blending used oil with virgin petroleum products, blending used oils to meet the fuel specification, filtration, simple distillation, chemical or physical separation, and re-refining.

Used Oil Processor means an installation that processes on- or off-specification used oil.

Used Oil Re-refiner means an installation that produces lubricating oils and greases, industrial fuel, asphalt extender, gasoline and other products from on- or off-specification used oil.

Utility Boiler means a boiler that is used to produce electricity, steam or heated or cooled air or other gases or fluids for sale.

Waste Fuel means hazardous waste fuel or off-specification used oil fuel.

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ADDENDUM OF THE NOTIFICATION OF REGULATED WASTE ACTIVITY: NOTIFICATION OF HAZARDOUS SECONDARY MATERIAL ACTIVITY

Only complete this form if you answered "YES" to item 8.E.1., which would indicate that you are going to be managing excluded hazardous secondary material (HSM) under 40 CFR 261.2(30), 261.4(a)(23), (24), or (27); or have stopped managing excluded HSM in compliance with the exclusion(s) and do not expect to manage any amount of excluded HSM under the exclusion(s) for at least one year.

Note: This form is not intended for the re-notifications due by March 1 of each even-numbered year as required by 40 CFR 260.42. Persons who must meet this notification requirement will do so when they complete the federal Hazardous Waste Report (biennial report) on the federal form.

1. REASON FOR NOTIFICATION (include dates where requested)

Facility will begin managing excluded HSM as of ___________(mm/dd/yyyy).

Facility has stopped managing excluded HSM as of ___________(mm/dd/yyyy).

2. DESCRIPTION OF EXCLUDED HSM ACTIVITY. Enter the appropriate codes and quantities, in short tons, to describe yourexcluded HSM activity only (do not include any information regarding your hazardous wastes).

A. Facility Code B. Waste Code(s)for HSM

C. Estimate Short Tonsof excluded HSM tobe managed annually

D. Actual Short Tons ofexcluded HSM thatwas managed duringthe most recent odd-numbered year

E. Land-based UnitCode

F. Comments

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Notification of Hazardous Secondary Material Activity Instructions

This addendum must be completed if you answered “Yes” to Item 8.E.1. of the Notification of Regulated Waste Activity. This would indicate that you are going to manage excluded hazardous secondary material (HSM) under 40 CFR 260.30, 40 CFR 261.4(a)(23), (24), or (27); or have stopped managing excluded HSM in compliance with the exclusion(s) and do not expect to manage any amount of excluded HSM under the exclusion(s) for at least one year.

NOTE: This form is not intended for the re-notifications due by March 1 of each even-numbered year, as required by 40 CFR 260.42. Persons who must meet this notification requirement will do so when they complete the federal Hazardous Waste Report (biennial report) on the federal form.

1. Reason for Notification: Check the box that states the reason why you are submitting this notification. Mark only one.a. Facility will begin managing excluded HSM.

i. You must notify prior to operating under the exclusion.ii. The date when this activity will begin is required.

b. Facility has stopped managing excluded HSM. The date the activity stopped is required. You must notify within 30 days of when you stopped managing hazardous secondary material. You are considered to have stopped managing if:(1) you stop managing HSM completely (e.g., you cease operations); (2) you choose to manage the HSM as a hazardous waste; (3) you undergo closure and request release from financial assurance per 40 CFR 261.143(h) or 40 CFR 264.143; or (4) you temporarily suspend management of HSM for at least one year.

2. Description of Excluded HSM Activity: Enter the appropriate codes and quantities that describe your excluded HSM activity (do not include any information regarding your hazardous wastes).

a. Facility Code: Enter the appropriate 2-digit code(s) that describes your facility. If more than one code applies, enter each code on a separate row. Each hazardous secondary material should be reported by facility code. These codes will be found at the end of the instructions to this addendum.

b. Waste Code(s) for HSM: Enter the appropriate 4-digit hazardous waste code(s) that would apply to your hazardous secondary material if you managed it as a hazardous waste.

c. Estimate Short Tons of Excluded HSM to be Managed Annually: Enter your estimated quantity (using short tons) of hazardous secondary material you expect to manage annually. Convert all quantities to short tons (1 ton = 2000 pounds) and round to the nearest ton.

d. Actual Short Tons of Excluded HSM Managed During the Most Recent Odd-Numbered Year: Report the quantity (using short tons) of each hazardous secondary material you actually managed during the most recent odd-numbered year. Enter “0” if this is your notification that you are beginning to manage HSM.

e. Land-based Unit Code: Enter the 2-digit code that best describes the land-based unit you use or will use to manage the hazardous secondary material. If you do not use any land-based units, enter “NA”. If you use the code “OT” (Other), please describe your land based unit in the comment section.

f. Comments: Use this space to list additional waste codes that do not fit in the space provided or to describe the “Other” land-based unit code.

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HAZARDOUS SECONDARY MATERIAL (HSM) FACILITY CODES Under Generator Exclusion ((40 CFR 261.4(a)(23)) Code Facility Code Description 01 HSM Generator reclaiming HSM “on‐site”: This code applies if you generate and reclaim hazardous secondary

material at your generating facility. 02 HSM Generator transferring HSM to reclaimer within the “same company”: This code applies if you generate

hazardous secondary material and send the material for reclamation to a different facility that is either controlled by you or controlled by the same person that controls your generating facility.

03 Reclaimer receiving HSM from HSM generator within the “same company”: This code applies if you receive and reclaim hazardous secondary material from a different facility that either controls you or is controlled by the same person that controls you.

04 Tolling Contractor reclaiming HSM pursuant to a tolling contract: This code applies if you are a tolling contractor that reclaims hazardous secondary material pursuant to a written contract with a toll manufacturer.

05 Toll Manufacturer managing HSM pursuant to a tolling contract: This code applies if you generate and send hazardous secondary material for reclamation to a tolling contractor pursuant to a written contract.

Verified Recycler Exclusion (40 CFR 261.4(a)(24)) Code Facility Code Description 06 HSM Generator transferring HSM off‐site to a domestic reclamation facility: This code applies if you generate and

send hazardous secondary material for reclamation to an off‐site domestic reclamation facility. 07 Permitted Reclaimer receiving HSM from off‐site: This code applies if you have a RCRA Part B permit, or operate

under interim status standards, and reclaim hazardous secondary material received from an off‐site HSM generator or other facility. (If you do not have a RCRA Part B permit and are not operating under interim status standards and instead, have obtained a variance to receive HSM under this exclusion, use code 17 below.)

08 Permitted Intermediate facility: This code applies if you have a RCRA Part B permit, or operate under interim status standards, and receive hazardous secondary material from an off‐site hazardous secondary material generator or another domestic facility and you store it for more than ten days. This code does not apply if you generate or reclaim the hazardous secondary material. (If you do not have a RCRA Part B permit and are not operating under interim status standards and instead, have obtained a variance to receive hazardous secondary material under this exclusion, use code 18 below.)

Imports (40 CFR 261.4(a)(24)) Code Facility Code Description 09 [Reserved] 10 HSM Generator importing HSM from a foreign country to send to recycling: This code applies if you import

hazardous secondary material from a foreign country and send the material for reclamation to a permitted or verified recycling facility.

11 HSM Generator AND Permitted Reclaimer of imported HSM: This code applies if you import hazardous secondary material from a foreign country and reclaim the material at your facility under a RCRA Part B permit or under interim status standards. (If you do not have a RCRA permit and are not operating under interim status standards and, instead have obtained a variance to receive HSM under this exclusion, use code 18 below).

Non-waste Determinations and Solid Waste Variances (40 CFR 260.30) Code Facility Description Code 14 Variance for Materials that are Accumulated Speculatively: This code applies if you operate under an approved

variance from EPA or your State for materials that are accumulated speculatively without sufficient amounts being recycled (see 40 CFR 260.31(a)).

Code Facility Description Code 15 Variance for Materials that are Reclaimed and then Reused within the Original Production Process: This code

applies if you operate under an approved variance from EPA or your State for materials that are reclaimed and then reused as feedstock within the original production process in which the materials were generated (see 40 CFR 260.31(b)).

16 Variance for Materials that are Partially‐Reclaimed: This code applies if you operate under an approved variance from EPA or your State for materials that have been partially‐reclaimed; but, must be reclaimed further before recovery is completed if the partial reclamation has produced a commodity‐like material (see 40 CFR 260.31(c)).

17 Variance for HSM transferred for reclamation and managed at a verified reclamation facility: This code applies if you operate under an approved variance from EPA or your State for hazardous secondary materials that are transferred to you for reclamation under 40 CFR 261.4(a)(24) (see 40 CFR 260.31(d)). (If you have not obtained a variance to receive hazardous secondary material under this exclusion and, instead, have a RCRA Part B permit or operate under interim status standards, use code 07 above.)

18 Variance for HSM transferred and managed at a verified intermediate facility: This code applies if you operate under an approved variance from EPA or your State for hazardous secondary materials that are transferred to you for storage greater than 10 days under 40 CFR 261.4(a)(24) (see 40 CFR 260.31(d)). (If you have not obtained a variance to receive hazardous secondary material under this exclusion and, instead, have a RCRA Part B permit or operate under interim status standards as an intermediate facility, use code 08 above.)

19 Variance for HSM imported AND managed at a verified reclamation facility: This code applies if you operate under an approved variance from EPA or your State for hazardous secondary materials that are imported to you for reclamation at your site under 40 CFR 261.4(a)(24) (see 40 CFR 260.31(d)). (If you have not obtained a

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variance to receive hazardous secondary material under this exclusion and, instead, have a RCRA Part B permit or operate under interim status standards, use code 07 above.)

20 Non‐waste determination for HSM reclaimed in a continuous industrial process: This code applies if you operate under an approved non‐waste determination from EPA or your State for hazardous secondary material, which is reclaimed in a continuous industrial process (see 40 CFR 260.34(b)).

21 Non‐waste determination for HSM that are indistinguishable from a product or intermediate: This code applies if you operate under an approved non‐waste determination from EPA or your State for hazardous secondary materials, which is indistinguishable in all relevant aspects from a product or intermediate (see 40 CFR 260.34 (c)).

HAZARDOUS SECONDARY MATERIAL (HSM) LAND-BASED UNIT CODES Code Land-based Unit Code Description NA Do not use land‐based units to manage hazardous secondary material SI Use surface impoundment(s) to manage hazardous secondary material. A surface impoundment is a natural

topographic depression, man‐made excavation or diked area formed primarily of earthen materials (although it may be lined with man‐made materials), which is designed to hold an accumulation of liquid hazardous secondary materials or materials containing free liquids and which is not an injection well.

PL Use pile(s) to manage hazardous secondary material. Pile means any non‐containerized accumulation of solid, non‐flowing hazardous secondary material that is used for storage and is not a containment building.

OT Use other land‐based unit(s) to manage hazardous secondary material. Use Comments area to describe. MO 780-1164 (03-19)

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