DSHW-2018-003359 - 0901a068807f03bf

County Tooele City, Town, or Village Erda
State Utah Zip Code 84074 Country USA
Street Address 5800 North Highway 36
Div of Waste rviagerrcnt
and Rathabon Contol
APR 1 0 2018
OMB# 2050-0024; Expires 05/31/2020
United States Environmental Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM

1. Reason for Submittal (Select only one.) 5F0/4- 6- 0033 59
Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of
time. (Includes HSM activity)
0 Submitting as a component of the Hazardous Waste Report for (Reporting Year)
jJ 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)
• Notifying that regulated activity is no longer occurring at this Site
• Obtaining or updating an EPA ID number for conducting Electronic Manifest Broker activities
• Submitting a new or revised Part A Form
2. Site EPA ID Number
UTP 0000 101 65

3. Site Name
Pacific West LLC
4. Site Location Address
5. Site Mailing Address El Same as Location Address
Street Address 1515 West 2200 South, Suite C
City, Town, or Village Salt Lake City
State Utah Country USA Zip Code 84119
6. Site Land Type
Orivate Ejcounty aistrict Federal Eirribal Municipal State Other
7. North American Industry Classification System (NAICS) Code(s) for the Site (at least 5-digit codes)
A. (Primary) 237990 C.
B. D.
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _
UTR 000 010 16 5

EPA ID Number OMB# 2050-0024; Expires 05/31/2020
8. Site Contact Information ElSame as Location Address
First Name Levi MI Last Name Pratt
Title Environmental Manager
Street Address 1515 West 2200 South, Suite C
City, Town, or Village Salt Lake City
State Utah Country USA Zip Code 84119
Email [e-mail]
Phone [phone] Ext Fax [phone]
9. Legal Owner and Operator of the Site
A. Name of Site's Legal Owner 0 Same as Location Address
Full Name Pacific West LLC Date Became Owner (mm/dd/yyyy) 05/01/1995
Owner Type
,Z)rivate ounty District ¡jjjjjFederal [Tribal Municipal State Other
Street Address 1515 West 2200 South, Suite C
City, Town, or Village Salt Lake City
State Utah Country USA Zip Code 84119
Email [e-mail]
Phone [phone] Ext Fax [phone]
Comments
B. Name of Site's Legal Operator 11 Same as Location Address
Full Name Pacific West LLC Date Became Operator (mm/dd/yyyy) 05/01/1995
Operator Type
•3rivate County District Federal ETribal Municipal State Other
Street Address 1515 West 2200 South, Suite C
City, Town, or Village Salt Lake City
State Utah Country USA Zip Code 84119
Email [e-mail]
Phone [phone] Ext Fax [phone]
Comments
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _
UTR 00 0 010 1 65

OMB# 2050-0024; Expires 05/31/2020 EPA ID Number
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
lit 4/ N 1. Generator of Hazardous Waste—If "Yes", mark only one of the following—a, b, c
fjjjjjJ a. LQG -Generates, in any calendar month (includes quantities imported by importer 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.
LJ 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.
LJ c. VSQG Less than or equal to 100 kg/mo (220 lb/mo) of non-acute hazardous waste.
If "Yes" above, indicate other generator activities in 2 and 3, as applicable.
Efr ,, N 2. Short-Term
processes).
Generator (generates from a short-term or one-time event and not from on-going
If "Yes", provide an explanation in the Comments section. Ely ,„ N 3. Mixed Waste (hazardous and radioactive) Generator
Ely V N 4. Treater, these activities. Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for
Dy v N 5. Receives Hazardous Waste from Off-site
ly piN 6. Recycler of Hazardous Waste
El a. Recycler who stores prior to recycling
b. Recycler who does not store prior to recycling Ey s/ N 7 Exempt Boiler and/or Industrial Furnace—If "Yes", mark all that apply.
LJ a. Small Quantity On-site Burner Exemption
LJ 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. D001, D003, F007, U112). 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 _ of _
u -1- gl o C...) 0 0 i 0 1 (.p s OMB# 2050-0024; Expires 05/31/2020 EPA ID Number
11. Additional Regulated Waste Activities (NOTE: Refer to your State regulations to determine if a separate permit is required.)
A. Other Waste Activities
s/ y N 1. Transporter of Hazardous Waste—If "Yes", mark all that apply.
V a. Transporter
111 b. Transfer Facility (at your site)
ny Fil N 2 Underground Injection Control
D s N 3. United States Importer of Hazardous Waste
Fly pi N 4. Recognized Trader—if "Yes", mark all that apply.
LEa. Importer
LIb. Exporter
LJ y Noo N 5 Importer/Exporter of Spent Lead-Acid Batteries (SLABs) under 40 CFR 266 Subpart G—If "Yes", mark all that apply.
a. Importer
b. Exporter
B. Universal Waste Activities
py 0 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.
111 a. Batteries
b. Pesticides
11 c. Mercury containing equipment
d. Lamps
e. Other (specify) Lr- f. Other (specify)
LJ g. Other (specify)
ON 2 Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this
activity.
C. Used Oil Activities 7y jjj] N 1. Used Oil Transporter—If "Yes", mark all that apply.
El a. Transporter
r--, b. Transfer Facility (at your site)
y El N 2. Used Oil Processor and/or Re-refiner—if "Yes", mark all that apply.
V a. Processor
111 b. Re-refiner
y ,./ N 3. Off-Specification Used Oil Burner
2 y 111 N 4. Used Oil Fuel Marketer—If "Yes", mark all that apply. , 11./..] a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used Oil Burner
LJ b. Marketer Who First Claims the Used Oil Meets the Specifications
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _
UTR 000 01 016 5

EPA ID Number OMB# 2050-0024; Expires 05/31/2020
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.
El E1N
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.
Eit oN
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 V N 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.
111 1. College or University
III 2. Teaching Hospital that is owned by or has a formal written affiliation with a college or university
EI 3. Non-profit Institute that is owned by or has a formal written affiliation with a college or univer-
D, EN B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories.
13. Episodic Generation
ElY 2 N 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 DY ON 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.

15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) OR Entire Facility (required) D ... N LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility. ,
AO Central Accumulation Area (CAA) CllEntire Facility
B. Expected closure date: mm/dd/yyyy
C. Requesting new closure date: mm/dd/yyyy
D. Date closed : mm/dd/yyyy EI1.
jj2.
In compliance with the closure performance standards 40 CFR 262.17(a)(8)
Not in compliance with the closure performance standards 40 CFR 262.17(a)(8)
16. Notification of Hazardous Secondary Material (HSM) Activity
1.7. Electronic Manifest Broker
EIY EN Are you notifying as a person, as defined in 40 CFR 260.10, electing to use the EPA electronic manifest sys-
tem 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 Page _ of _
UTR 000 010 1 6 5

EPA ID Number OMB# 2050-0024; Expires 05/31/2020
nature of legal owner, operator or a th ed_representative
Printed Name (First, Middle initial Last)
"
Email \1/414,1? S:CxC—Wek k k ,
Signature of legal owner, operator or authorized representative Date (mm/dd/yyyy)

Printed Name (First, Middle Initial Last) Title

Email

Date (mm/ddi /yyyy)
i o
Title
cA c);
18. Comments (include item number for each comment)
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. l am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations. Note: For the RCRA Hazardous Waste Part A permit Application, all owners and operators must sign (see 40
CFR 270.10(b) and 270.11).
EPA Form 870042, 870013 A/B, 8700-23 Page — of —