DSHW-2018-004984 - 0901a06880839eac

Div of M•r'agerrent
and Rao.at.on Control
MAY 3 1 2C18
cmAB# 2050-0024; Expires 05/31 21fg1:15f11911—
tZe
United States Environmental Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM
1. Reason for Submittal (Select only one.)
el Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of
time. (Includes HSM activity) CI 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)
111 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
Lt. o o o O o
3. Site Name
Prime Machine (Keene Coatings)
4. Site Location Address
Street Address 4170 West 2100 South
City, Town, or Village Salt Lake City County Salt Lake
State UT Country USA Zip Code 84120
5. Site Mailing Address El Same as Location Address
Street Address
City, Town, or Village
State Country Zip Code
6. Site Land Type
V Private County District Federal [Tribal Municipal State Other
7. North American Industry Classification System (NAICS) Code(s) for the Site (at least 5-digit codes)
A. (Primary) 332710 C.
B. D.
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page 1 of 6
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
8. Site Contact Information El Same as Location Address
First Name Val MI Last Name Ossmen
Title Vice President
Street Address
City, Town, or Village
State Country Zip Code
Email [e-mail]
Phone [phone] Ext Fax
9. Legal Owner and Operator of the Site
A. Name of Site's Legal Owner 0 Same as Location Address
Full Name
Keene Coatings
Date Became Owner (mm/dd/yyyy)
2/1 /2018
Owner Type arivate ['County District ['Municipal State Other II Federal II Tribal
Street Address
City, Town, or Village
State Country Zip Code
Email
Phone Ext Fax
Comments
B. Name of Site's Legal Operator EJ Sarne as Location Address
Full Name
Keene Coatings
Date Became Operator (mm/dd/yyyy) 2/1 /2018
Operator Type ariyate County District ['Federal Tribal State Municipal Other 111
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 I of 2,1
D008 D002
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
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
EY N 1. Generator of Hazardous Waste—lf "Yes", mark only one of the following—a, b, c
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 tirne, 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.
6/
0 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 hazardous waste.
If "Yes" above indicate other generator activities in 2 and 3, as applicable.
Ely . 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. Ely 0 N 3. Mixed Waste (hazardous and radioactive) Generator
I:lv 2 N 4. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for these activities.
y v N S. Receives Hazardous Waste from Off-site
0 y El N 6 Recycler of Hazardous Waste
0 a. Recycler who stores prior to recycling
0 b. Recycler who does not store prior to recycling CI N 7 Exempt Boiler and/or Industrial Furnace—lf "Yes", mark all that apply.
a. Small Quantity On-site Burner Exemption
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 I of
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
y v N 1. Transporter of Hazardous Waste—If "Yes", rnark all that apply.
fJ a. Transporter
b. Transfer Facility (at your site)
0 y
y
0
V
N 2 Underground Injection Control
N 3. United States Importer of Hazardous Waste
Dy 6/N 4 Recognized Trader—If "Yes", mark all that apply.
a. Importer
IJ b. Exporter
IJ y ve N 5 that
Importer/Exporter of Spent Lead-Acid Batteries (SLABs) under 40 CFR 266 Subpart G—If "Yes", mark all
apply.
a. Importer
0 b. Exporter
B. Universal Waste Activities
Illy 2N 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.
a. Batteries
0 b. Pesticides
0 c. Mercury containing equipment
d. Lamps
111 e. Other (specify)
f. Other (specify)
g. Other (specify)
Y V N 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this
activity.
C. Used Oil Activities
y E1 N 1, Used Oil Transporter—If "Yes", mark all that apply.
0 a. Transporter
b. Transfer Facility (at your site)
Dy El N 2 Used Oil Processor and/or Re-refiner—If "Yes", mark all that apply.
a. Processor
0 b. Re-refiner
y el N 3. Off-Specification Used Oil Burner
y V N 4. Used Oil Fuel Marketer—lf "Yes", mark all that apply.
fJ 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
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page of ___6
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.
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.
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.
CY 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 itern-by-item instructions for defini-
tions of types of eligible academic entities.
1. College or University
0 2. Teaching Hospital that is owned by or has a formal written affiliation with a college or university
II 3. Non-profit Institute that is owned by or has a formal written affiliation with a college or univer-
y 4/ N B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories.
13. Episodic Generation
EY 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
EY N 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)
OY El N LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility.
AO Central Accumulation Area (CAA) CI Entire Facility
B. Expected closure date: mrn/dd/yyyy
C. Requesting new closure date: mm/dd/yyyy
D. LJ1.
0
Date closed : mm/dd/yyyy
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
17. Electronic Manifest Broker
DY N 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 5 of 6
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
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 comment)
Hazardous waste generation is from a one time event from the stripping of lead based paint from
machinery. Prime Machine is the generator and Keene Coatings is the site operator and owner.
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).
Signature I al ow , operator or authorized representative Date (mm/dd/yyyy)
5/30/18
Printed Name(lirst, Middle Initial Last)
Shelby M hreve
Title
Project Manager
Email [e-mail]
EPA Form 8700-12, 8700-13 A/B, 8700-23 6 6 Page of _
5/31/2U16 State ot Utah Mail - One I ime EPA IL) Number

Carlee Christoffersen <cchristoffersen©utah.gov>

One Time EPA ID Number
1 message

Carlee Christoffersen <[e-mail]>
To: Josh Greenwood <[e-mail]>
Josh,

Thu, May 31, 2018 at 2:45 PM
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:
Prime Machine (Keene Coatings)
4170 West 2100 South Salt Lake City, UT 84120
Your EPA Identification Number is UTP000001601.
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 I Environmental Program Coordinator
Phone: [phone]
;At!
WASTE MANAGEMENT
RADIATION CONTROL
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 841.14-4880, including copies of documents relevant to your
request.
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