DSHW-2018-004589 - 0901a0688082616c

5/21/2018 liGRAInto Review bource Record
Div of Waste Management
and Radiation Contro)
0,4 MAY 2 1 2018
WALMART NEIGHBORHOOD 3706 WEST 9800 SOUTH - SOUTH UTR000007427 0
MARKET #5120 JORDAN (/rcrainfoprod/action/secured/handler/viev
handler/UTR000007427/N/6) 171
yrcrainfoprod/restlreport/inline-
quick-report/H_SITE_DETAIL?
p_handler_id=UTR000007427&p_activity
Review Source Record
EN-Zot -o o 4-58 9
General Information
Received Date Non-notifier Extract to Public?
05/17/2018 Yes
Accessibility Acknowledgement Flag
1. Reason for Submittal
Obtaining or updating an EPA lD number for an on-going regulated activity that will continue for a period of time. (Includes HSM
activity) [Source N]
2. Site ID
EPA ID Activity Location
UTR000007427 UT
3. Site Name
Name
WALMART NEIGHBORHOOD MARKET #5120
4. Site Location
Street Number Street 1 Street 2
3706 WEST 9800 SOUTH
Zip City, Town or Village State
84095 SOUTH JORDAN UTAH
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512112018
Country
UNITED STATES
RGRAInto Review Source Record

County
SALT LAKE

State District
5. Site Mailing Address
Street Number Street 1 Street 2
P.O. BOX 8041
Zip City, Town or Village State
72712-8041 BENTONVILLE ARKANSAS
Country
UNITED STATES
6. Site Land Type
Land Type
Private
7. North American Industry Classification System (NAICS)
Primary NAICS
452311 - WAREHOUSE CLUBS AND SUPERCENTERS
Other NAICS
8. Site Contact Person
First Name Middle Initial Last Name
ROSE ARNOLD
Title Email
SENIOR MANAGER [e-mail]
Phone Number Extension Fax
479-277-8972 479-204-9675
8a. Site Contact Address
Street Number Street 1 Street 2
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5/21/2018 KUKAInto Kewew Source Record
RO. BOX 8041
Zip City, Town or Village State
72712-8041 BENTONVILLE ARKANSAS
Country
UNITED STATES
9a. Legal Owner
Type Name Address Date
Private WAL-MART STORES INC. RO. BOX 8041, BENTONVILLE, AR 72712-8041 04/02/2003
9b. Legal Operator
Type Name Address Date
Private WAL-MART STORES INC. RO. BOX 8041, BENTONVILLE, AR 72712-8041 04/02/2003
10. Type of Federal Regulated Waste Activity
A. Hazardous Waste Activities
1. Generator of Hazardous Waste 4. Treater, Storer, or Disposer of 7. Exempt Boiler and / or Industrial
(Federal) Hazardous Waste Furnace
N - Not a Generator None Selected None Selected
Generator of Hazardous Waste 5. Receives Hazardous Waste from
(State) Off-site
7 - Closed None Selected
2-3. Other Generator Activities 6. Recycler of Hazardous Waste
None Selected None Selected
B. Waste Codes for Federally Regulated Hazardous Wastes
A. Hazardous Waste Codes (Federal)
None Selected
C. Waste Codes for State Regulated (non-Federal) Hazardous Wastes
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1. Large Quantity Handler of
Universal Waste
1. Used Oil Transporter 3. Off-Specification Used Oil
None Selected Burner
5/21/2U18 RURAInto Review Source Record
B. Hazardous Waste Codes (State)
None Selected
11. Additional Regulated Waste Activities
A. Other Waste Activities
1. Transporter of Hazardous Waste 3. United States Importer of 5. lmporter/Exporter of SLABs
None Selected Hazardous Waste None Selected
None Selected
2. Underground Injection Control 4. Recognized Trader
None Selected None Selected
B. Universal Waste Activities C. Used Oil Activities
None Selected None Selected
2. Used Oil Processor and / or Re-
2. Destination Facility for refiner 4. Used Oil Fuel Marketer
Universal Waste None Selected None Selected
None Selected
D. State Activities
Your State does not have any State defined activities.
12. Eligible Academic Entities with Laboratories
1. Opting into or currently operating under 40 CFR Part 262 Subpart K for the management of hazardous wastes in
laboratories.
2. Withdrawing from 40 CFR Part 262 Subpart K for the management of hazardous wastes in laboratories.
No
13. Episodic Generation
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5/21/2018 KCKAInto Review Source Record
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 Addendum for Episodic
Generator.
No
14. LQG Consolidation of VSQG Waste
Are you an LQG notifying of consolidating VSQG hazardous waste under the control of the same person pursuant to 40
CFR 262.17(f)?
No
15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) and Entire Facility
LQG Site Closure of a Central Accumulation Area or Facility
No
16. Notification of Hazardous Secondary Material (HSM) Activity
Are you reporting HSM activities?
No
17. Electronic Manifest Broker
Are you notifying as a person, as defined in 40 CFR 260.10, electing to use the EPA electronic manifest system to obtain,
complete, and transmit an electronic manifest under a contractual relationship with a hazardous waste generator?
No
18. Comments
Internal Comments
NOTIFICATION THAT THIS WALMART LOCATION CLOSED IN JANUARY 2018. NO LONGER GENERATING HAZARDOUS
WASTE
Public Comments
PLEASE DEACTIVATE THE EPA ID FOR THIS FACILITY. FACILITY OPERATIONS CEASED ON 1/10/2018.
19. Certification
First Name M.I. Last Name Title Date Signed
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5/21/2(.118 RGRAInto Review Source Record
First Name M.I. Last Name Title Date Signed
Rose Arnold Senior Manager 05/17/2018
Approve Make Changes
Back to Pending Submissions (/rcrainfoprod/action/secured/myrcraid/submissions/pending)
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