DSHW-2018-004008 - 0901a0688081091b

United States Environmental Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM
1. Reason for Subrni al (Select only one )
Zip Code 84104 Country United States State Utah
Street Address 1820 S. 5200 W
City, Town, or Village Salt Lake City
Div of Waste Management
and Radiation Control
MAY - 7 2018
OMB# 2050-0024; Expires 05/31/2020
EÏI ' Obtaining or updating an EPA ID nurnber 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)
EÏI 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 LOG 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

6To

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5 9

3. Site Name
I Medline Industries 971
4. Site Location Address
Street Address 1820 S. 5200 W
City, Town, or Village Salt Lake City County Salt Lake County
State Utah Country United States Zip Code 84104
5. Site Mailing Address El Same as Location Address
6. Site Land Type
EIPrivate OCounty [Thistrict Federal rib& Municipal ['State j Other
7. North American Industry Classification System (NAICS) Code(s) for the Site (at least 5-digit codes)
A. (Primary) 423450 C.
B. D.
EPA Form 8700-12, 8700-13 A/Br 8700-23 Page of
EPA ID Number 0Ma# 2050-0024; Expires 05/3112020
8. Site Contact Information El Same as Location Address
First Name Rick Mt Last Name mcCa 1
Title Director of Operations
Street Address 1820 S. 5200 W
City, Town, or Villa e Salt Lake City
State Utah CountrY US Zip Code 84104
Email [e-mail]
Phone [phone] Fax
9. Legal Owner and Operator of the Site
A. Name of Site's Legal Owner Same as Location Address
Full Name
IMedline Indus ries
Date Becarne Owner (mm/c1d/yyyy)
1/1/2014
Owner Type _ / Private Coun [jjDistrict OFederal DTribal DMunicipal ri s t DOther
Street Address Three Lakes Drive
City, Town, or Village Northfielci
State Illinois Country United Sta es Zip Code 60093
Email [e-mail]
Phone [phone] ; Ext 1206 t Fax
Comments
B. Name of Site's Legal Operator ame as Location Address
Full Name
Medline Industries
Date Became Operator (mm/dd/yyyy)
Operator Type
rivate DCounty District Federal 0 Tribal Munidpal 0 State pother
Street Address
City, Town, or Village
State Country Zip Code
Email
Phone Ext j Fax
comments
EPA Form 8700-12, 8700.13 A/8, 8700-23 Page
D002
D001
D003
EPA ID Number 0 # 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. Ilazardous Waste Activities
Ey ots, 1. Generator of Hazardous Waste—If "Yes", mark only one of the following a, b, c
LJ a. LQG -.Generates, in any calendar month (includes quantities imported by importer site)
1,000 kg/mo (2,200 lb/rno) 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 kerno
(220 lb/mo) of acute hazardous spill cleanup material.
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/mo) of non-acute ha. ardous waste.
If "Yes" above, indicate other generator activities in 2 and 3, as applicable.
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.
3. Mixed Waste (hazardous and radioactive) Generator
[jv EjN 4. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for
these activities.
S. Receives Hazardous Waste from Off-site N
6. Recycler of Hazardous Waste
Ejj a. Recycler who stores prior to recycling
Ejj b. Recycler who does not store prior to recycling
E v ON• 7. Exempt Boiler and/or Industrial Furnace—If "Yes", mark all that apply.
L. 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. 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/13, 8700-23 3 6 Page of
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
11. Additional Regulated Waste Activities (NOTE: Refer to your State regulations to deteroiine if a separate permit is required.
A. Other Waste Activities
II 1. Transporter of Hazardous Waste—If "Yes", mark all that apply.
0 a. Transporter
jjj b. Transfer Facility (at your site)
2 Underground Injection Control
i 3. United States Importer of Hazardous Waste
i 4. Recognized Trader—If "Yes", mark all that apply.
EJ a. Importer
b. Exporter
N S. Importer/Exporter of Spent Lead-Acid Batteries (SLABS) under 40 CFR 266 Subpart G—If "Yes", mark all that apply.
a. Importer
b. porter
B. Universal Waste Activities
Ig 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 rs regulated.
a. Batteries
b. Pesticides
0 c. Mercury containing equipment
111 d. Lamps
L Other (specity)
f. Other (specify)
L g. Other (specify)
N 2 Destination Facility for Universal Waste Note; A hazardous waste permit may be required for this
activity.
C. Used Oil Activities
1 Used Oil Transporter—If "Yes", mark all that apply.
.1 a. Transporter
III b. Transfer Facility (at your site)
2 Used Oil Processor and/or Re-refiner—If "Yes", mark all that apply.
El a. Processor [jjJ _ b. Re-refiner
3. Off-Specification Used Oil Burner
DV Z N 4. Used Oil Fuel Marketer—lf "Yes", mark all that apply.
111 a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used Oìl Burner
0 b. Marketer Who First Claims.the Used Oil Meets the Specifications
EPA Form 8700-12, 8700 13 A/B, 8700-23 4 Page_ o
Ll OMB# 2050-0024; Expires 05/31/2020 EPA ID Number
7IN
13. Ep sodic Generation
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.
1. college or University
2. Teaching Hospital that is owned by or has a formal written affiliation with a college or university
3. Non-profit Institute that is owned by or has a formal written affiliation with a college or univer• -
B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories. EY V
A. Opting into or currently operating under 40 CFR 262 Subpart K for the management 0 hazardous
wastes in laboratories—lf "Yes", mark all that apply. Note: See the item-by-itern instructions for defini-
tions of types of eligible academic entities.
Are you an LQG notifying of consolidating VSQG Hazardous Waste Under the Control of the Same Person
pursuant to 40 CFR 262.17(0? If "Yes", you must fill out the Addendum for LQG Consolidation of VSCIGs
hazardous waste.
DY
LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility.
A.7 Central Accumulation Area (CAA Entire Facility
B. Expected closure date: mrn/dd/yyyy
C. Requesting new closure date: mm/dd/yyyy
D. Date closed : mm/dd/yyyy L i. in compliance with the closure performance standards 40 CFR 262.3.7(a)(8) E2. Not in compliance with the closure performance standards 40 CFR 262.17(a)(8)
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?
12. Eligible Academic Entities with Laboratories—Notification for opting into or withdrawing from managing laboratory hazardous
wastes pursuant to 40 CFR 262 Subpart K.
14. LQG Consolidalon of VSQG Hazardous Waste
15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) OR En ire Facility (required
16. Notification of Hazardous Secondary Material (HSM) Activity
A. Are you notifying u n der 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 Addendurn to the Site identification Form for Managing Hazardous Secondary Material.
NI
/ N 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
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _5 of
Printed NE:,r (First, Middle Initial as )
Rick McCall
Title
Director of Operations
%nature of le owner, o or a ized representati Date (mm/cicl/yyyy)
5/1/2018
Printed Narn
Rick McCall
irst, Middle Initial Last)
Email [e-mail]
Title
Director of Operations
Date (mrn/ddhyyy)
5/1/2018
Signature of I owner, o or or uthorized
Email [e-mail]
EPA ID Number OMB# 2050-0024; Expire 0 1/2020
18. Comments (include item number for each comment)
The facility currently has damaged and expired waste onsite that needs to be disposed of. Not all the
waste is hazardous waste, some of the waste is sharps and over the counter medications.
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 RCRA Hazardous Waste Part A permit Application, all owners and operators must sign (see 40
CFR 270.10(b) and 270.11).
EPA Forrn 8700-12, 8700-13 A/13, 8700-23 6 Page of
5/7/2018 State ot Utah Mail - One- lime EPA IL) Number

Carlee Christoffersen <[e-mail]>

One-Time EPA ID Number
1 message

Carlee Christoffersen <[e-mail]>
To: [e-mail], "Brown, Rebecca A" <[e-mail]>

Mon, May 7, 2018 at 12:11 PM
Mr. McCall,

This is to acknowledge you have filed a RCRA Subtitle C Site Identification Form requesting an EPA ID number for
a one-time/short term event for hazardous waste generated at the following address:
Medline Industries
1820 South 5200 West Salt Lake City, UT 84104
Your EPA Identification Number is UTP000001598.
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.
Because this EPA ID number is for a one-time/short term event, please let me know when the project is
complete.
If you have any questions please call me at [phone], or reply to this email.
Thank you,
Carlee Christoffersen l Environmental Program Coordinator
Phone: [phone]
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.
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