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Home My WebLink AboutDSHW-2018-003314 - 0901a068807ec4981. Reason for Submittal (Select only one.) Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of time. (Includes HSM activity) Submitting as a component of the Hazardous Waste Report for (Reporting Year) 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 reporting year (or State equivalent LQG regulations) E Notifying that regulated activity is no longer occurring at this Site n Obtaining or updating an EPA ID number for conducting Electronic Manifest Broker activities ri Submitting a new or revised Part A Form D314W --Zo 18 -Oo33 I Div of Waste Management and Rad:ation Control APR 1 0 2018 ONAB# 2050-0024; Expires 05/31/2020 United States Environmental Protection Agency RCRA SUBTITLE C SITE IDENTIFICATION FORM 2. Site EPA ID Number tit o o o O 1 o_ F 3. Site Name 4. Site Location Address Street Address i 7 7 9 frv, S. City, Town, or Village e y County ..._. be, r State (/( +4k, 1,, country 0 A Zip Code ,eititie I 5. Site Mailing Address IZ Same as Location Address Street Address City, Town, or Village State Country Zip Code 6. Site Land Type Private ElCounty IDDistrict El Federal [Tribal El Municipal []State ri Other 7. North American Industry Classification System (NAICS) Code(s) for the Site (at least 5-digit codes) A. (Primary) 3 ), 5-4i 1 c. B. 3 I I t 11 D. D EPA Form 8700-12, 8700-13 A/B, 8700-23 Page± of EPA ID Number OMB# 2050-0024; Expires 05/31/2020 8. Site Contact information ci4Same as Location Address MI Last Name 5cii rvi col s k i First Name n da Title c I'CO /-S, 7i.- Street Address City, Town, or Village State Country Zip Code Email --t 5c_. k 1+14_11 i Phone eat, .(::,..).?, tio3, Ext Fax 9. Legal Owner and Operator of the Site A. Name of Site's Legal Owner El Same as Location Address Full Name ' - Cor f, Date Became Owner (mm/dd/YYM C.5a10 //a0R, Owner 4priyate Type County E District 0 Federal IIITribal DMunicipal • State pother Street Address 5.9. c-vo r /ce City, Town, or Village iv e vv, State iv,, yer k Country t4 A Zip Code f 0 Email Phone Ext Fax Comments B. Name of Site's Legal Operator El Same as Location Address Full Name A i ,, fa/ctwilci ("olio Date Became Operator (mm/dd,/yyyy) Operator Type qrivate ElCounty District Dederal • Tribal •Municipal [State pother Street Address City, Town, or Village State Country Zip Code Email Phone Ext Fax Comments EPA Form 8700-12, 8700-13 A/B, 8700-23 Page EPA ID Number OMB# 2050-0024; Expires 05131/2020 10. 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 R'• N 1. Generator of Hazardous Waste—If "Yes", mark only one of the following—a, b, c : a. LQG -Generates, in any calendar month (includes quantities imported by irnporter site) 1,000 kg/mo (2,200 lb/mo) or more of non-acute hazardous waste; or - Generates, in any calendar month, or accumulates at any time, more than 1 kg/mo (2.2 lb/mo) of acute hazardous waste; or - Generates, in any calendar month or accumulates at any time, more than 100 kg/mo (220 lb/mo) of acute hazardous spill cleanup material, gi b. SQG 100 to 1,000 kg/mo (220-2,200 lb/mo) of non-acute hazardous waste and no more than 1 kg (2.2 lb) of acute hazardous waste and no more than 100 kg (220 lb) of any acute hazardous spill cleanup material. c. VSQG Less than or equal to 100 kg/mo (220 lb/rno) of non-acute hazardous waste. If "Yes" above, ind cate other generator activities in 2 and 3, as applicable. JY 0 N 2. Short-Term Generator (generates from a short-term or one-time event and not from on-going processes). If "Yes", provide an explanation in the Comments section. Dv N 3. Mixed Waste (hazardous and radioactive) Generator Dy ViN 4. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for these activities. DY N 5. Receives Hazardous Waste from Off-site Ea, a N 6. Recycler of Hazardous Waste 0 a. Recycler who stores prior to recycling 0 _b. Recycler who does not store prior to recycling y M N 7. Exempt Boiler and/or Industrial Furnace—If "Yes", mark all that apply. LJ a. Small Quantity On-site Burner Exemption El b. Smelting, Melting, and Refining Furnace Exemption B. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes handled at your site. List them in the order they are presented in the regulations (e.g. 0001., D003, F007, U1.12). Use an additional page if more spaces are needed. C. Waste Codes for State Regulated (non-Federal) Hazardous Wastes. Please list the waste codes of the State hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if more spaces are needed. EPA Form 8700-12, 8700-13 A/B, 8700-23 Page 3 of 7 EPA ID Number OMB# 2050-0024; Expires 05/31/2020 11. Additional Regulated Waste Activities (NOTE: Refer to your State regulations to determine if a separate permit is required.) A. Other Waste Activities ay NN 1. Transporter of Hazardous Waste—If "Yes", mark all that apply. 0 —a. Transporter 0 b. Transfer Facility (at your site) JJv N 2 Underground Injection Control Y 3. United States Importer of Hazardous Waste Hy Fl N 4 Recognized Trader—If "Yes", mark all that apply. 0 a. Importer LJ b. Exporter 0 y [Xi N 5. Importer/Exporter of Spent Lead-Acid Batteries (5LABs) under 40 CFR 266 Subpart G—If "Yes", mark all that apply. a. Importer b. Exporter B. Universal Waste Activities Y N 1. Large Quantity Handler of Universal Waste (you accumulate 5,000 kg or more) - If "Yes" mark all that apply. Note: Refer to your State regulations to determine what is regulated. 0 a. Batteries b. Pesticides c. Mercury containing equipment 0 d. Lamps E e. Other (specify) II f. Other (specify) ' fJ g. Other (specify) 0 It [A N 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this activity. C. Used Oil Activities JJ y 0 N 1. Used Oil Transporter—lf "Yes", mark all that apply. 1:1 a. Transporter • b. Transfer Facility (at your site) 0 y Ei N 2. Used Oil Processor and/or Re-refiner—If "Yes", mark all that apply. a. Processor 0 b. Re-refiner Ely El N 3 Off-Specification Used Oil Burner 1py 41 N 4. Used Oil Fuel Marketer—lf "Yes", mark all that apply. — LT a. Marketer Who Directs Shipment of Off-Specification U-sed Oil to Off-Specification Used Oil Burner 0 b. Marketer Who First Claims the Used Oil Meets the Specifications EPA Form 8700-12, 8700-13 A/B, 8700-23 Page tl of 7 Are you an LQG notifying of consolidating VSQG Hazardous Waste Under the Control of the Same Person pursuant to 40 CFR 262.17(f)? if "Yes", you must fill out the Addendum for LQG Consolidation of VSQGs hazardous waste. EY [71 EPA ID Number OMB# 2050-0024; Expires 05/31/2020 12. Eligible Academic Entities with Laboratories—Notification for opting into or withdrawing from managing laboratory hazardous wastes pursuant to 40 CFR 262 Subpart K. Y [7,1N A. Opting into or currently operating under 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories—lf "Yes", mark all that apply. Note: See the item-by-item instructions for defini- tions of types of eligible academic entities. El 1. College or University II 2. Teaching Hospital that is owned by or has a formal written affiliation with a college or university 0 3. Non-profit Institute that is owned by or has a formal written affiliation with a college or univer- D N B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories. 13. Ep sodic Generation 011 Are you an SQG or VSQG generating hazardous waste from a planned or unplanned episodic event, lasting no more than 60 days, that moves you to a higher generator category. If "Yes", you must fill out the Ad- dendum for Episodic Generator. 14. LQG Consolidation of VSQG Hazardous Waste 15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) OR Entire Facility (required) DY EN LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility. A.LJ Central Accumulation Area (CAA) CI Entire Facility B. Expected closure date: mm/c1d/yyyy C. Requesting new closure date: mm/dd,/yyyy D. Date closed : mm/cld/yyyy III 1.. In compliance with the closure performance standards 40 CFR 262.17(a)(8) • 2. Not in compliance with the closure performance standards 40 CFR 262.17(a)(8) 16. Notification of Hazardous Secondary Material (HSM) Activity El? NN A. Are you notifying under 40 CFR 260.42 that you will begin managing, are managing, or will stop manag- ing hazardous secondary material under 40 CFR 260.30, 40 CFR 261.4(a)(23), (24), or (27)? If "Yes", you must fill out the Addendum to the Site Identification Form for Managing Hazardous Secondary Material. Efr V1N B. Are you notifying under 40 CFR 260.43(a)(4)(iii) that the product of your recycling process has levels of hazardous constituents that are not comparable to or unable to be compared to a legitimate product or intermediate but that the recycling is still legitimate? If "Yes", you may provide explanation in Comments section. You must also document that your recycling is still legitimate and maintain that documentation on site. 17. Electronic Manifest Broker LJYN Are you notifying as a person, as defined in 40 CFR 260.10, electing to use the EPA electronic manifest sys- tern to obtain, complete, and transmit an electronic manifest under a contractual relationship with a haz- ardous waste generator? EPA Form 8700-12, 8700-13 A/B, 8700-23 7 Page _ of _ EPA ID Number OMB# 2050-0024; Expires 05/3112020 Signature of legal owner, operator or authorized representative Printed Name (First, Middle Initial Last) Jot / 5c4,1 44“4 Date (mm/dcljyyyy) 471100/ AC)/(3 Title 614 S-ip ec Email , t 5 in Signature of legal owner, operator or authorized representative Date (mm/dd/yyyy) Printed Name (First, Middle Initial Last) Email Title 18. Comments (include item number for each cornment) 19. Certification I certify under penalty of law that this document and all attachments were prepared under my direction or su- pervision 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 gath- ering 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 fines and imprisonment for knowing violations. Note: For the KRA Hazardous Waste Part A permit Application, all owners and operators must sign (see 40 CFR 270.10(b) and 270.11). EPA Form 8700-12, 8700-13 A/13, 8700-23 Page of 7 EPA ID Number OMB# 2050-0024; Expires 05/31/2020 ADDENDUM TO THE SITE IDENTIFICATION FORM: EPISODIC GENERATOR ONLY fill out this form if: • You are an SQG or VSQG generating hazardous waste from a planned or unplanned episodic event, lasting no more then 60 days, that moves the generator to a higher generator category pursuant to 40 CFR 262 Subpart L. Note: Only one planned and one unplanned episodic event are allowed within one year; otherwise, you must follow the requirements of the higher generator category. Use additional pages if more space is needed. Episodic Event 1. Planned shutdowns 2. Unplanned DAccidental spills .41 ' roduction process upsets • Excess chemical inventory removal ElTank cleanouts • Short-term construction or demolition III Product recalls ElEquipment maintenance during plant 0"Acts of nature" (Tornado, hurricane, flood, etc.) pother •Other 3. Emergency Contact Phone (ea /• Vq, ,27./? 4. Emergency Contact Name or.,1 n .5,&,, 77,o( d 5c, 5. Beginning Date If- /0/R4:)/44.) mm/dd/yrly) 6. End Date 111301d20/6 (mm/dd/yyyy) Waste 1 7. Waste Description Pi ivio 6/ye..)",,q I--? CpI , 8. Estimated Quantity (in pounds) (9'e), lao 9. Federal and/or State Hazardous Waste Codes DO/o0-' Waste 2 7. Waste Description 8. Estimated Quantity (in pounds) 9. Federal and/or State Hazardous Waste Codes Waste 3 7. Waste Description 8. Estimated Quantity (in pounds) 9. Federal and/or State Hazardous Waste Codes EPA Form 8700-12, 8700-13 A/13; 8700-23 Page 7 of 7 4/1U/2018 State ot Utah Mail - EI-1; IL) Number Carlee Christoffersen <cchristoffersen@utah.gov> EPA ID Number 1 message Carlee Christoffersen <cchristoffersen@utah.gov> To: Todd Schmanski <tschmanski@balchem.com> Hi Todd, Tue, Apr 10, 2018 at 4:35 PM This is to acknowledge you have filed a RCRA Subtitle C Site Identification Form for waste generated at the following address: BALCHEM ALBION CENTRAL WAREHOUSE 1774 WEST 2800 SOUTH OGDEN, UTAH 84401 The EPA Identification Number for this site is UTR000014258. The EPA Number must be included on all shipping manifests for transporting hazardous wastes; on all Biennial Reports that some generators of hazardous waste must file with the State of Utah, and other hazardous waste management reports and documents required under the Utah Solid and Hazardous Waste Act and the Utah Administrative Code. The EPA Number is site specific. If your company changes physical locations, it is your responsibility, as a generator, to notify the state and apply for a new EPA ID Number. You can submit a new form to update information regarding your site at any time. If you would like to arrange a compliance assistance visit to discuss waste management practices, please contact Deborah Ng at 801-536-0218. For questions regarding your EPA ID number or site status please call Carlee Christoffersen at (801) 536-0233 or reply to this email. Thank you, Carlee Christoffersen l Environmental Program Coordinator Phone: 801.536.0233 utAti ;.)EPAA•rmu•i: -ld prrol p • o ViAs-r7 I A r ENT kAi.41ATICIN Statements made in this email do not constitute the official position of the Director of the Division of Waste Management and Radiation Control. If you desire a statement of the Division Director's position, please submit a written request to Director, Division of Waste Management and Radiation Control, P.O. Box 144880, Salt Lake City, Utah 84114-4880, including copies of documents relevant to your request. httns.//mailmnnnIA.nnni/mailhi/0/711i=2Rik=AlAr145Ari2attisvAr=HcMSiMti7nRY An RNipw=nt&spamh=spnt&th=1R2h1h:13f5)7169A7Rsiml=1A7h1h:115)71A9A7