DSHW-2018-005178 - 0901a0688083e86c

WASTE },IANAGg'iIENT
$ RADIATION CONTROL
INSPECTION REPORT FOR:
DATE OF INSPECTION:
FACILITY ADDRESS:
FACILITY COUNTY:
FACILITY CONTACT:
EPA ID #:
CURRENT NOTIFICATION:
TYPE OF INSPECTION:
PARTICIPANTS:
TIME IN/TIME OUT
REPORT PREPARED BY:
WEATHER CONDITIONS:
APPLICABLE REQUIREMENTS :
FACILITY DESCRIPTION:
HAZARDOUS WASTE INSPECTION REPORT
Ogden Regional Medical Center
April 18,2018
5475 South 500 East
Ogden, Utah 84405
Weber
Daniel North, Director - Environmental Services
(8Or) 419-2019
uTD988078846
LQG
CEI
Daniel North, Ogden Regional
Alex Pashley, DWMRC
Jon Parry, DWMRC
0900 hrs - 1300 hrs
Jon Parry
Partly Cloudy, -39oF
R315 of the Utah Administrative Code
Ogden Regional Medical Center is a 300,000 square feet, 160 bed hospital, which employs about
900 people.
Ogden Regional Medical Center was originally founded September 18,1946 under the name of
St. Benedict's Hospital and moved to its present location in 1977 .
The facility is situated on flat terrain in a commercial area. No surface waste was observed
proximate to the hospital.
CREDENTIALS, PURPOSE AND SCOPE:
Inspectors presented their credentials to Daniel North and explained that the purpose of the
inspection was to determine if the facility was in compliance with applicable hazardous waste
management rules. The scope of the inspection would include a review of required paperwork
and a tour of waste generation and management areas.
MANAGEMENT ACTIVITIES :
ogden Regional generates hazardous waste at the following locations:
o Pharmaceutical waste in hospital rooms, where it managed in satellite containers at the
nursing stations associated with the ward,o Pharmaceutical waste in the pharmacy, where it is managed in satellite containers,o Solvent and formalin waste in the histology lab where it is managed in satellite containers
prior to transfer to the histology's central accumulation area, ando In the maintenance area, where the hospital generates universal waste bulbs and batteries.
and small quantities of used oil.o Electronic waste from old computers and electronics discarded from the hospital
Pharmaceutical wastes are placed in ten gallon satellite containers (designated as p.U.D.
containers), and are transferred to the hospitals central accumulation area when full. Full
containers consist primarily of pharmaceutical packaging materials with small amounts of
pharmaceuticals.
Solvent and formalin waste from the histology lab are collected in satellite containers and then
transferred to histology's 90 day central accumulation area when full.
Universal wastes are collected in the hospital's maintenance area where they are managed prior
to offsite shipment.
Electronic wastes are collected and stored in the hospitals central accumulation area before beine
shipped offsite to be recycled.
NARRATIVE:
Inspectors met Mr. North in his office where they conducted the paperwork review. Inspectors
reviewed the facility's manifests, Personnel Training Plan, Contingency plan and preparedness
and prevention procedures.
The facility's manifests were found to be in good order. The facility's Personnel Training plan
is computer based and was determined to be adequate.
lnspectors noted deficiencies in the Contingency Plan. Inspector's provided the facility with
updated inspection checklists which they are using to correct the deficiencies in the plan. The
hospital will also use them to update the plan to include a quick reference guide. A May 10,
2018 email from the facility indicates that they are making good progress on the update.
Preparedness and prevention measures were deemed to be adequate.
Subsequent to the paperwork review the inspectors visited the facility's pharmacy. No issuers
were noted in the pharmacY.
Inspectors visited a nursing station where they noted an open satellite container. Mr. North
promptly closed the container and stated that training would be conducted on the importance of
keeping hazardous waste management containers closed except when adding or removing waste.
Inspectors visited the hospital's maintenance area and noted open, unlabeled universal waste
containers. Mr. North has indicated that they have addressed the universal waste issue in his
email.
Inspectors visited the facility central accumulation area and noted that inspections and logs were
not being consistently conducted or documented. Containers in the area were stacked such that
labels were hard to read. Mr. North has indicated that problems in the central accumulation area
have been address.
Inspectors observed the central accumulation area for the histology lab and noted two fifty-five
gallon drums that were over the ninety day accumulation time limit. Inspectors told Mr. North
that this was a major concern and that he should ship the drums offsite as soon as possible. Mr.
North has submitted a manifest indicating that this has been done.
After visiting the histology CAA inspectors visited the lab to determine why the drums were still
on-site. Inspectors explained to the lab personnel that they need to inspect their 90 day
accumulation drums weekly and ship them offsite prior to exceeding the limit. Histology lab
personnel said that they would be more mindful of time frame and inspection requirements.
COMPLIANCE STATUS: (also see attached checklist)
The following compliance issues were noted:
1. Two drums over the 90 day limit. These have since been shipped offsite.
2. Weekly inspections and documentation. Inspections are now being conducted and
documented.
3. Deficiency's with the Contingency Plan. The facility is in the process of updating their
plan to address the deficiency's and QRG requirements.
4. Open containers in a nursing area. Additional training will be provided regarding the
necessity of closing satellite containers.
ISSUES:
None noted
INSPBCTOR SIGNATURE:DATE
5475 South 500 East - Google Maps https://www.google.com/m apslplacel54T5+South+500+East,+Washington+Terrace,+UT+8...
tmaqery o2018 DigitalGlobe, state ofutah, u.s. Geological survey, usDA Farm ServiceAgency, Map data @2018 Google
2 of2 511612018, 1:15 PM
Y/ASTE MANAGgMEHT
& FADIATION COHTROI
INSPECTION ITEM CITATION ..COMMENTS
Waste Determination:
l. Has the generator determined
lvhether his,trer solid waste is a
hazardous waste?
2. Has a waste determination been done
for each rvaste stream?
F.3r5-262
R3 I 5-262-l I
R3 I 5-261 -3
40 cFR 262 I I
40 cFR 261 3
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3. Has the generator notified of
regulated activity and obtained an
EPA ID# in accordance rvith the
requirements of Section 3010 of
RCRA?
R3 I s-262- I 0(a)( I )(iii)(c
R3 l5-262-l 8(a)
40CFR262. l0(!XIXiiiXC)
40 CFR 262 I E(a)
'1 €l
Manifest:
l. Is the generator using a Uniform
Ilazardous Waste Manifsst for its
shipments of hazardous waste?
2. Did the generator designate a facility
permitted to handle its waste?
3. Was an alternate facility designated?
4. Did the generator use the correct
manifest?
R3 I 5-262-20(a)(l )
40 CIR 252.20(aXl)
R3 l5-262-20(b)
40 clR262.2oo)
R3 I 5-262-20(c)
R3l5-262-20(aXl)
40 CFR 262.20(aXl
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Wanifest requirements for the Generatorl
l. Did the generator sign the manifest
certification by hand?
2. Did the generator obtain a handrvritten
signature from the initial transporter and
the date ofacceptance?
3. Did the generator retain a copy ofthe
manifest in accordance rvith
R3 I 5-262-40(a)?
R3 I 5-262-23(a)( l)
a0 cFR 262.23(aXI)
R3rs-262-23(a)(2)
40 C[R 262.23(aX2
R3 I s-262-23(a)(3)
40 cFR 252.23(.)(3
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Recordkeeping:
l. Is the generator maintaining signed
copies of the hazardous lvaste manifest
for three years?
R3 I 5-262-40(a)
40CFR 262.40(a i2\
2. Is the generator maintaining copies
of each Biennial Report and all
Exception Reports for a period of at
least three years?
R3 I 5-262-40(b)
40 cFR262.40(b)7es
Site Name:
r.;ffi: o€J*'P..did^14 I
EPA ID:Date:
7 - rD /8
\?fanuary 2018 Inspector's Initials Page I of2
Site Name:EPA ID:Date:
3. Is the facility maintaining records
suflicient to determine quantities anddisposition ofhazardous waste or otherdeterminations, test results, or waste
analyses made in accordance with
R3l5-262-l l(f) for a period ofat leasr
three years from the date oflast shipment?
R3 l5-262-40(c)
{o CFR 262.10(c)l"t
Biennial Reporting
Has the generator submitted complete
Biennial Report(s)?
R3l5-262-4r
40 cFR 262.41
7er
Exception Reporting
Has the generator been required to
qrepa.le an Exception Report, if yes
describe the circumstances?
R.3t5-262-42
40cFR262.42
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Packaging, Labeling, Marking, andPlacarding
l. Is the generator packaging his/her
hazardous waste in the appropriate
DOT shipping containers?
2. Are containers labeled and marked in
accordance with appropriate DOT
shipping requirements prior to shipping?
3. Is the generator providing or
offering appropriate placarding to
the initial transporter when
initiating his/her shipment? I
R3 l5-262-30
40 cFR 262.30
R3ts-262-31&
R3t5-262-32
10CFR262-tr &262.t2
R3 l5-262-33
40 cFR262.33
"14(
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Accumulation Times
(See Satellite, 90 Day and Tank
Checklists as applicable)
F(3l5-262-17(a)
Arso see checldists for:
Personne.l Training,
Preparedness & Prevention,
Contingency Plan & Emergency
Procedures and Manifest
Comments:
|anuary 2018
Inspectoy's Initials Page2of 2
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IVASTE HANA6EMENT
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Hazardous Waste Inspection
Manifest Checklist
7
RequirementS ManifestS Reviewed
Manifest Number (box 4)#D1\42c;15 6io4 Lo t'44 heq/ :* q /v 'r> oq4st) h<
Generator EPA ID#
Appendix to R3l5-262 (box l)-pA 5w o72 o14
Generator information:
Mailing Address (box 5)
Phone Number
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Transporter #l information:
Company Name (box 6)
EPA ID# (box 6)OVL
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Transporter #2 information:
Company Name (box 7)
EPA ID# (box 7)/vlh
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Desienated Facility information:
Name and Address (box 8)
tsPA ID# (box 8)
Phone Number (box 8)
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Waste Shipnine reouirements:
DOT Description (Including proper
name, I{azard class, and ID #) (box 9b)
(box 9a "X" if hazardous materials)
Containers: No & I'ype (box l0)
Total Quantitl' (box I l)
unit- wt/vol (box 12)
Waste Codes (box l3)
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Special Handline Instructions
(box l4)gw I-D - Ot'//ot-r_
Manifest Certifi cations:
Generator's Signature (boxl5)
International Shipments (box l6)
Transporter's Signature (box l7 )
Discrepancy IndicatioB!0oxj8)
Hazardous Waste Report Management
Method Codes (box l9)
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Facility Signature (box 20)- ov,- 11v - b^tL - el'//
Final Observations and Comments:
Common container codes: DM - metal drum\barrel; DF - fiberbarrel; TT - cargo tank; TC - tank car; Of - Ournp tmct<; Ctvl - metatbox\carton (includes roll-offs) Common Units of Measure: G - gallons; P - pounds; T -tons; Y- cubic yards)
January 20 I 8 Page I of I Inspectors tnitiaL. flf
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WASTE tq,qHAGEMENl
A RADIATIOI{ CONTROL
Hazardous Waste Inspection
Satellite Accumulation Checklist
<55 gallons
INSP,ECTION..ITEM CITATION :r: ,' ,.COMMENTS
Is the satellite accumulation area at or near the
point ofgeneration?
R3 l5-262-15(a)7es
Is the satellite area under the control ofthe
operator ofthe process generating the rvaste?R3 I 5-262-1 5(a)Ll oc
Does the generator have the accumulation
container labeled rvith the rvords "hazardous
n aste"?R3 I 5-262-l 5(a)(5)(i)&--
The generator can not store more than 55
gallons ofhazardous rvaste or I quart of
acutely hazardous waste at the satellite
accumulation area.
R3l5-262-15(a)OL
Are the containers in good condition, and
being managed in a rvay so it does not leak
or soill?
R3 I s-262-l s(a)(l )4n{
Is the hazardous waste stored in containers thal
are conrpatible with the rvaste?R3l5-262-15(a)(2)1e!
Is the accumulation container being
maintained in a closed condition except
rvhen rvaste is being added or removed, or
rvhen temporary venting is necessary for
proper operation ofequipment or to prevent
dangerous situations such as pressure
buildup?
R3 l5-262-1 5(a)(4)
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no l,.z.L ta.'^ a4!1:; r'o^' e (
D5:-'--- st'q L- l'( ' k- *'l
fl.J Z k> tF- + ro-^r-i o
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Does the generator have the accumulation
containers marked with an indication of the
hazards of its contents?
R3 I 5-262-l s(a)(5)(ii)0(-
Is the generator conectly labeling and moving
hazardous waste, in excess ofthe 55 gallon or
I quart limits, to a 90-day storage area w'ithin
72 hours of exceedine the limit?
R3l5-262-ls(a)(6 )(i)
Januarv 20 I 8 Page I of I lnspectors Initials
IVASTE HA}IAGEI,lEI.i1r pADtaTtoH couTEt]:.
EPA #:
Hazardous Waste Inspection
90 Day Storage Site
>55 gallons
Site:Date:
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INSPECTION ITEM CITATION COMMENTS
|. Is the container labeled u'ith the
rvords "Hazardous Waste"?
2. Is the container marked or labeled
u'ith an indication ofthe hazards of
the contents?
3. Is the date upon rvhich accurnulation
began clearly marked and visibly for
inspection?
4. Is that date <= 90 days old?
R3 I s-262- I 7(a)(s)(i)(A)
R3ls-262-17(aX5XiXB)
R3 I s-262- l7(a)(s)(i)(c)
R3ts-262-17(a)
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4. Is there a Preparedness and Prevention
I'lan for this site or the facility as a rvhole,
including this site? (see separate Check l,ist)
R3 ls-262-17(aX6)
R3 I 5-262-250 thru 256 \ut
5. Operated to minimize chance of Spill or Fire?
6. Spill and Fire control equipment?
7. Emergency colnmunication device: Internal?
Emergency communication device: External?
Sufflcient Aisle and Access soace?
R3
R3
R3
R3
R3
s-262-251
s-262-2s2(c)
s-262-252(a)
s-262-2s2(b)
5-262-2ss
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8. Is there a Contingency Plan for this site or
the facility as a u'hole, including this site?
(see separate Check List)
9. a. Description ofactions that should be taken?
b. Name & Phone # for Eniergency Coordinator?
c. Primary and altemate evacuation routes?
d. List of emergency equipment & location?
R3 I 5-262-l 7(a)(6)
R3 I 5-262-260 thru 265
R3t5-262-261(a)
R3 l5-262-261 (d)
R3ls-262-261(0
R3ls-262-26t(e)
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Ilave personnel at this site Successfully
completed up to date Personnel Training on
I{zW Handling & Fire & Spill Response?
Is the training documented?
(see separate Check I-ist)
R3l5-262-17(a)(7)(i)
R3ts-262-t7 (a)(7)(v)
u84
Are the containers accumulating and holding
hazardous rvaste in good condition?
Are they compatible lvith the HzW in them?
R3 I s-262- I 7(a)(l)(ii)
P.3t5-262-17(aXlXiii)
"l ev
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Is the generator maintaining his,trer containers
in a closed condition except rvhen adding or
removins rvaste from the container?
R3 I s-262-1 7(a)( I )(iv)(A t/Ptoi lr(-, Lil-rvc!-e-'\ )t
Containers holding hazardous waste must not
be opened, handled and/or stored in a manner
uhich could cause it to leak.
R3 I s-262- I 7(a)( I )(iv)(B d-
Is the generator inspecting his/her containers
at least rveekly, and do the inspections look for
leaks, deterioration, and any factor that may
cause a release ofhazardous rvaste?
R3 l5-262-17(a)(l)(v)L".t[ J.,r-*f-
No ignitable or reactive HzW rvithin 50 feet of
the facility's property line.R3 I 5-262- I 7(a)( I )(vi)(A Dt-
January 2018 Page I of I lnspectors Initiafs - \?
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IVAS'E HANAG€}'A}JT!. RADIATION CONTFOL
site: O^ J--- t"ZtU' "--- I EPA #:
U
Hazardous Waste Inspection
Personnel Training Checklist
INSPECTION IIEM CITATION COMMENTS
Facility personnel must successfully complete
classroom instruction, online training or on-
the-job training rvhich teaches them to
perform theirjobs, such that the facility is
operated in compliance rvith the applicable
hazardous waste management requirements.
R3 I s-262- l 7(a)(7)(i)(A)
40CFR262. 1 7(a)(7XD(A)
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Is the program directed by a person trained in
hazardous waste management procedures?
R3 I 5-262- I 7(a)(7XiXB)
40 CF R262. | 7 (a'X 7X i XB )ii.,-,^ f |\ Sl-.e--^. (-t-tca 1
g;rr- t. rr-
Does the training teach facility personnel
hazardous rvaste management and contingency
plan implementation procedures?
R3 l5-262- I 7(a)(7XiXB)
40CFR262. 1 7(a)(?XiXB)14
Does the training program include, at a
minimum, the follorving, rvhere applicable:
L l)roccdures for using, inspecting, repairing.
and replacing facility emergency equipment;
2. Key parameters for automatic waste cut-off
systems;
3. Communications or alarm systems;
4. Response to fires or explosions;
5. Response to groundrvater
contamination incidents;
6. Shutdoun ofoperations; and
R3t 5-262- r7 (a)(7XiXC)
40CFR262 I7(a)(7XD(c)
R3 1 5 -2€:2- t7 (a)(7 XiXCX I )
40cF-R262 I 7(a)(TXiXCX I )
R3 | s -262- t7 (a)(7 X iXCX2)
40CFR262 I 7(a{7XiXCX2)
R3 | 5 -262- t1 (a){1X D(cX3 )
40CFR262 I7(aXTXiXCX3)
R3 | 5 -262- t7 (a\7 X iXcX4)
40CFR262. I 7(aN7XD(cX4)
R3t5-262-17(a\7XiXCX5)
40CI]R262. I 7(a\TXiXCXs)
R3rs-2€t2-t7(a)(7XiXCX6)
40CFR262. I 7(a[7XiXcX6)
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Have facility personnel successfu lly completed
the personnel training program r'l'ithin six
months of the date of their emolovment or
assignment to the facility?
R3 l5-262- 17(aXTXii)
40 CF R2 62. | 7 (a) (7)(i i)
tl ny 2- ,^*^-b i
Do the facility personnel receive an annual
revierv oftheir initial trainins?
R3r5-262-r7(aXTXiii)
40CFR262.ri (a)(7)(iii)lut
January 2018 Paee I of2 Inspectors lnitials
Site:EPA #:
Hazardous Waste Inspection
Personnel Training Checktist
Date:
maintain the following documents at the
facility:,-,t..I€ioUliiits Fr each position at the facitity
relatebto{naddous waste management, and
the name of the employee filling each job;
The owner/operator of theEci@iGi
listed
3. A written description of the type and
amount ofboth introductory and continuing
training that will be given to the employeeJ
listed in #1, and;
4. Records that document that employees have
the training orjob experience required byparagraphs 265.16 (a), (b), and (c).
R3 I 5-262-17(a)(7)(iv)
R3 I s-262- I (a)(fi iv)(A)
l(a[7)(iv[A)
ls-262-l(a[7[iv[B)
l(a[fiiv[B)
R3 I s-262- t (a)(TXivXc)
l7(a[7)(iv{c)
R3Is-262-I{a)(7XwXD)
.l(a[7[iv{D)
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144
Are training records maintained at the
for current employees and for at least three
years for employees that have left the
company?
ts-262-r7(a)(7)(v)
January 2018 Page2 of 2 Inspectors r^tti^k-W
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Y/AST€ HAtr46€'lENIl: Ri DtATt6! COItFOi
Site:EPA #:
Contingency Plan and Emergency Procedures Checklist
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Note: this checklist is applicable to LQGS and to HSM handlers (except where indicated) who accumulate >6,000 kg (-13'228 lbs)
INSPECTION ITEM CITATION COMMENTS
General Reouirements:
fr""e cop66-e"n distrlbuted to all local police and
fire departments, hospitals, and State and local
emergency response teams that may be called upon
for assistance?
{3 1 s-262- I 7(a)(6) (LQG)
\3ts-262-262(a) (LQG)
{3 I 5-26 I -420(c)(2) (HSLt)
Content ofthe Continsencv Plan:
I . Does the contingency plan describe the
actions faciliry- personnel rvill take to minimize the
hazard to human health or the environment when
responding to fires, explosions, or any unplanned
sudden or non-sudden release ofhazardous rvaste?
2. Does the contingency plan describe
arrangements agreed to by local policc and fire
departments, hospitals, contractors, and State and
local emergency response teams?
3. Does the contingency plan list the names"
addresses, and phone numbers (oftice and
home) ofprimary and all other persons
qualified to act as emergenc)' coordinator?
4. I)oes thc contingenc) plan include a list of dC
a t I c m e r ge n c 1 eq u i p rn e n t -a t t h c fac i I i tv ? -I-fi-dTl sr---:---+-must be kcpt up-to-date. and include tlte location
and a physical description ofeach item on the list,
and a briefoutline ofthe equipment's capability.
5. Does the contingency plan include an
evacuation plan for the fqqjlly? This plan must.#inclucle a descrFtlon ofsignal(s) to bc used to
begin an evacuation, evacuation routes, and
alternate evacuation routes.
R}t5-262-261(a) (LQG)
R3 l s-261-420(bXl ) (HSM.)
R3t5-262-261(c) (LQG)
R3 1 s-26 l -420(bX3 ) (Hs;[f)
P.sts-262-261(d) (LQG)
R3 l s-26 l -420(bX4) (dsn4
R3ts-262-261(e) (LQG)
R3 l s-26 l -420(bxs) (Hsi.1)
R3 r s-262-26r(0 (LQG)
R3 l s-261 -420(bx6) (HSM)
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Ifthe facility first became subject to these
provisions after May 30, 20 I 7, or has otherwise
amended its contingency plan, has it developed and
submitted a quick reference guide ofthe
contingency plan to local emergency responders in
R3l5-262-26tcri[-5n-miZile.a-iAlocalemergency
resDonse teams that could be called for assistance?
R3ts-262-262(b) (LQG)
Not required - HSM
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Ifthe facility has a quick reference guide for its
contingency plan, does it have the follorving
required elements?:
l. Types/names of haz rvastes and the associated
hazard for each haz rvaste present at an) one time
(e.g., toxic paint wastes, spent ignitable solvent,
etc. )
2. Estimated maximum amount of each haz waste
that may be present at any one time
3. Identification of any haz wastes for ufiich
exposure rvould require unique/special treatment by
medical or hospital staff
4. Map of the facility shorving where haz rvastes are
generated, accumulated and treated. and routes for
accessing these lvastes
5. Street map ofthe facility in relation to
sunounding businesses, schools and residential areas
for the purpose ofgetting to it and/or evacuating
citizens and workers.
6. Locations ofwater supply (fire hydrant, flow rate)
7. Identified on-site notification systems (alarms)
8 Name of emergency coordinator and '7124-hour
emergencv phone number
This section not
applicable for HSltl
hnndling
R3 | 5 -262 -2 62(b)(t ) (LQ c )
R3 | s -262 -262(b)(2) ( LQ G)
R3 | s -262 -262(b)(3) ( L Q c)
R3 | s -262-262(b)(4) ( L Q G )
R3 | s -2 62 -2 62(b)(s) ( LQG)
R3 | s -262 -262(b)(6) ( LQ G)
R3 | s -2 62 -2 62 (b) (7 ) (L Q G )
R3 | 5 -262-262(bX8) (rQc)
January 201 8 Page I of3 Inspectors Initials
Site:EPA #:
Contingency Plan and Emergency procedures Checklist
rs Gxcept where indicated) who
Date:
*
INSPECTION ITEM accumutate >6,000 kg (-l J,22B tbs.CITATION COMMENTSDoes the facility have a leasl one emDlovee
on-site or on-call at all time who is qualified toact as the emergency coordinator?
Does the conlingency plan include procedureslor activation ofthe internal alarm 6y theemergency coordinator?
Does the contingency plan include provisionstbr notifying the appropriate Stale and\or localresponse agencies?
lR3ts-262-264 (LQG)
lR3 | 5 -261 -420(e) (Hsrvt)
R3 1 s -2 62-26 s (a)(t) (L eG)R3 | 5 -26 t - 420(fx I xi) (r/st1)
R3 | 5 -262 -26 s (a) (2) (L e c)
R3 1 5 -26 t - 420(0( I xii) (11S,t4
uPd"'t{
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Does the contingency plan outline theproccdure(s) that the emergency coordinatorrvill follow to immediately identify thecnaracter, source, amount, and extent ofreleased material?
R3rs-262-26s(b) (LQC)
R3r5-26r-420(DQ) (HSM
iJoes tne contlngency plan include procedures
for the emergency coordinator to follorv inorder to assess possible hazards to human
health or the environment?
R31s-262-265(c) (LeG)
R3 | 5 -26 | - 420(0(3 ) (HSn4
If it is determined that the incident could
threaten human health or the environment.
outside the facility, the emergency coordinator
must notify the appropriate local, State andFederal agencies. Does the contingency planincludc provisions for notifying theappropriate agencies? Do the notification
measures include information to be reported(name and telephone # ofreponer, name and
address of facility, name and quantitv ofmaterial(s) involved, extent ofinjuries, andpossibi lity of exposure outside the facility),and identify the National Response Centeiand the State as parties to be notified?
R3rs-262-26s(d) (LQG)
R3 I 5-261 -420( Dg) (HSLO
Does the plan include procedures to prevenl
the spread of the incident to other haiardouswaste/material at the facilitv?
R3ts-262-265(e) (LeG)
R3 | s -2 6 | - 420( fx5 ) (Hs,4 1)d-'
Are measures included to monitor for leaks.
pressure buildup, gas generation, or ruptures invalves, pipes, or other equipment, when it isnecessary to shut-down operations as a
response to an incident?
R3ts-262-265(f) (LQG)
R3 | s -2 6 | - 420 (f)(6) (H S M Av2'--
uu€s rne conltngency plan provide procedures lolollow to manage the hazardous waste/material
generated as a result ofan incident?
R3t5-262-265(d (LQG)
R3 | 5 -2 6 t - 420 (f) (7 ) (HS M u, \ "qc\-
W
f o|lowtng lmplementation of the continsencvplan, are provisions included to ensure t"hat in
the affected area(s):
l. No waste that may be incompatible with the
re^leased material is treated, stored, or disposedof until the cleanup is complete.
2. That all equipment listed in the contingencyplan is cleaned and fit for use prior to
resuming activities at the facilitv.
R3 | s -2 62 -2 6 s (h)(r) (L Q G)
R3 | 5 -26 r - 420(0(8)(D (HSn4
R3 | s -2 62 -26 s (h) (2) (L Q G)
R3 l 5-26 I -420(0(8xii) (Hs,t4)
January 2018 Page 2 of 3 Inspectors Initials
Site:EPA #:
Contingency Plqn and Emergency Procedures Checklist
nate: t/ ' l8'18
Note: this checklist is applicable to LQGb and to HSM handlers (exceptwhere indicatd) who accumulate >6,Un kg F13,228 lbs.)
A l( ,/ Pd41c1- i"^ "l-r4 e
The contingency plan must include
provisions for recording the incident
requiring implementation of the
contingency plan and specifying
information that will be recorded and
reported. The requirements are as follows:
l. Will a written report on the incident be
provided to the Utah State Department of
Environmental Quality within l5 days?
2. The following information needs to be
recorded and reported:
a) The name, address, and telephone # ofthe
owner/operator;
b) The name address, and telephone # ofthe
facility;
c) Date, time, and type of incident;
d) Name and quantity of material(s) involved;
e) Extent of injury, if any;
f) An assessment of the actual or potential
hazard to human health or the environment;
and
g) An estimate of the quantity and disposition
ofrecovered material(s) that rosulted from the
incident.
rs-262-26s(i) (LQG)
R3 l s -26 r -420(fX9) (HSi.f)
rs-262-26s(i) (LQG)
R3 | 5 -2 6 | - 420 (f)(9) (H S 14)
5-262-265(iX l) $ru (iX7 ) (IpG)
R3r5-261420(fX9Xi)
HSM Only: Are all employees thoroughly
familiar with proper waste handling and
emergency procedures relevant to their
responsibilities during normal facility
operations and emergencies?
R3l5-261-420(e\ @sM)
January 2018 Page 3 of3 Inspectors Initials
!.".y,.." site: C6d**.. k6'u* \ EPArD:,fri1"9'#J
Preparedness and Prevention checklist
,*.1"r','^*3X1".11'-1"
oate 4 -/E-/ g
::INSPECTION..ITEM .CITATION
.
.COMMENTS
Is the facility maintained and operated to
minimize the possibility of a fire, explosion, or
any unplanned sudden or non-sudden release
ofhazardous rvaste or hazardous rvaste
constifuents?
R315-262-2st (LQG)
R3 r s-262-16(bX8Xi) (soc)
R3l5-261-410(a) (flSM)1lt
The facility must be equipped with items (l)-
(4), identified belorv, unless it can be shown
that hazardous rvaste managed at the site
rvould not require the particular kind of
equipment specified.
l. Does the facility have an internal
communications or alarm system capable of
providing immediate emergency instruction to
its personnel?
2. Does the facility have a device capable of
summoning external emergency assistance to
the facility (phone or trvo-rvay radio)?
3. Does the facility have portable
extinguishers, fire control equipment
(including special extinguishing equipment
necessary for their facility), spill control
equipment, and decontamination equipment?
4. Does the facility have rvater at adequate
volune and pressure to supply rvater hoses, or
foam producing equipment, or automatic
sprinklers. or water spray systems?
R3ts-262-252 (LQG)
R3 l s-262-16(bX8Xii) (Soc)
R3l5-261-410(b) (ffsn4
Rjts-262-2s2(a) (LQG\
R3 l s-262-16(bXsXiiXA) (soc)
R3r 5-261 -4rO(bXl) (Hsn4)
R31s-262-2s2(b) (LQG)
R3 l s-262- l 6(bXsXiiXB) (soc)
R3 ls-26r-4 l0(b)(2) (HSM
R315-262-2s2(c) (LQC)
R3 l s-262- | 6(bXsXiiXc) (soc)
R3l s-26r-4l0(bx3) (//s: ./)
R31s-262-2s2(d) (LQG)
R3 l s-262- l6(bXsXiiXD) (s0ct)
R3 r s-261-410(b)(4) (ttstd)
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Are facility communications or alarm systems,
fire protection equipment, spill control
equipment, and decontamination equipment
tested and maintained to assure its proper
operation in time of an emergency?
R3rs-262-2s3 (LQG)
R3 r s-262-16(bX8Xiii) (sOG)
R3 I 5-26 l-4 I 0(c) (I/S,11)c{--
Do facility personnel have immediate access to
an internal alarm or emergency
communication device, either directly through
visual or voice contact, rvhile managing
hazardous rvaste?
R3ts-262-2s4(a) (LQG)
R3 I 5-262- I 6(bX8XivXA) (sOG)
R3 l 5-26 r -4 l O(dX l ) (HSil)'("\
Is there everjust one employee on the
premises while the facility is operating? If
yes, does that person have immediate access to
device capable of summoning extemal
emergency assistance?
R3rs-262-2s4(b) (LQG)
R3 1 5-262- I 6(bX8)(iv)(B) (sQG)
R3 1 s-26 1 -4 r 0(d)(2) (HS M
I
lAe --L \. S {
o^Q
Jan 2018 Page 1 of2 Inspector's Initials
Site:EPA ID:
Preparedness and prevention Checklist
Date
Is aisle space maintained to allow theunobstructed movement of emergency
personnel or equipment (unless aisle space isnot needed for any ofthese purposes)f
R3ts-262-2ss (LQG)
R3 I s-262- l6(bXsXv) (sQc)
ts-261-arc@) (HSM)
The facility must arrange the following typesol agreements or arrangements with lo;ai'organizations (as appropriate):
L Has the facility made or attempted to makeanangements to familiarize local police, firedepartments, and emergency response teamswtth the layout of the facility, character of thehazardous waste(s) managed, locations wheretacttlty personnel normally work, location ofIacltlry entrances and possible evacuation
routes?
2. Has the facility designated primary
emergency authority to a specific police or fireoepartment, when more than one police or firedepartment might respond in the event of anemergency?
3. Have agreements with State emergencyresponse teams, emergency responses
contractors, and equipment suppliers been
4. Have arrangements been made tofamiliarize local hospitals with the properties
or nlvardous waste handled at the facility andthe types ofinjuries or illnesses which couldresult from fires, explosions, or releases at thefaciliw?
R3ts-262-2s6(a) (LeG)
R3 I s-262- I 6(bX8[vi[A) (sec)
R3 I s-26 t-4 l0(f)( l) (HSr1)
R3 | 5 -2 62 -2 s 6(aX2) (L ec)y | :-?92- t 6(bxs)(vi)(e)(r) (,sQc)
R3 I s-26 t -4 I 0(D( I Xi) (Fsn4
Rs | 5 -262 -2 s 6(a)(3) (Le G)
R3 I s-262- I 6(bXsXviXnXrrr) (.sQc)
R3 I s-26 t -4 r 0(D( | xii) (Hsn4
R3 | s -262-2 s 6(a)(t) (Le G)
R3 | 5-262- t 6(bxs)(vi)(A)(r) (spc)
R3 | s-26 r 4 l 0(0(| xiii) (tsli1)
R3 | s -262 -2 s 6 (a)e) (L e G)
R3 I s-262- l 6(bX8{vi)(A)(rr) (sec)
R3 l s-26 I -4 I 0(0( I Xiv) (rs./i.d
Ifany State or local authorities have declinedto enter into such arrangements, has thefhcility documented the refusal in theoperating recor.d?
R3ts-262-2s6(b) (LQG)
R3I s-262- I6(bx8)(vi)(n) (spc)
R3 r s-26 l -4 l0(f)(2) (HS M)
rr\o {*l"tr lc
Ian 2018 Page 2 of2 ^pInspector'slnitials
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5t21120',!8 State of Utah Mail - Hazardous Waste Corrections ORMC
Jon Parry <[e-mail]>
6 messages
Daniel.North@mountainstarhealth,com <[e-mail]>
To: [e-mail]
Hey Jon,
Thu, May 10,2018 at 11:30 AM
I have worked my way through the list of corrections you left me with. All have been completed aside from our crash cart information
that we are working to get ufOated. The following is a list of the conections and updates we have made thus far:
. Working w1h our Emergency Preparedness Coordinator, we have now included maps that clearly mark the hazardous
waste generator locations irounO the facility, a quick reference guide, and a full list of our spill cart materials. Still working on
crash cart info as well as a list of all emergency equipment found throughout the facility, along with its respective location and
physical description.
. Our lab manager has created an inspection log that is currently hanging inside the container holding the waste barrels for
histology. Inspections have already begun.
. An inspection log has been created and is currently hanging in our 90 day haz waste holding area.
. plant Operations has carefully labeled all used light bulb and battery containers with "Universal Waste" stickers as well as
the nature of the hazard.
. Education is being provided as to the importance of keeping all P.U.D containers firmly closed throughout the facility
. The',Red" unlabeled sharps container left in our 90 day holding area was determined to not be biohazardous and has since been
picked up by Waste Management.
. p.U.D containers have been reorganized so labels and dates are clearly visible. Start dates are not being issued until the container
comes down to the 90 day holding area.
Let me know if there is anything else I should be including. Thanks Jon.
(l have tried to attach the iictures you requested as well but for some reason emailing them from my phone is not working. l'll send as
soon as I get them through)
Dan North
Director of Environmental Services
Ogden Regional Medical Center
5475 South 500 East
Ogden, UT 84405
[phone]
Jon Parry <[e-mail]>
To: [e-mail]
Hi Dan.
Thanks for the updates. Have you had the 2 drums over the 90 day limit shipped from the site yet?
Thu, May 10,2018 at 11:57 AM
https://mail.google.com/mail/u lQl?ui=2&ik=del ea970eb&jsver=GAFHaMvshdw.en.&cbl=gmail_fe_l80506.06j7&view=pt&search=inbox&th=1 634b8224948b03a6
512112018 State of Utah Mail - Hazardous Waste Corrections ORMC
Jon
lQuoted text hiddenl
Jon G. Parry P.G. - Environmental Scientist
Hazardous Waste Management Section
Phone: [phone] (office) | 801.536.0222 (fax) | Website
D;
Statements made in this e-mail do not constitute the official position of the Director of the Division of Waste Management and
Radiation Control. lf you desire a statement of the Director's position, please submit a written request to the Director, Division of WasteManagement and Radiation Control, P.O. Box 144880, Salt Lake City, Utah 841144880, including copies of documents relevant to your
request.
Emails to and from this email address may be considered public records and thus subject to lJtah GMMA requirements.
[e-mail] <[e-mail]> Thu, May 10,2}1|gat 12:0g pM
To: [e-mail]
Yes those drums have been picked up. Sorry I forgot to include that
Dan North
Director of Environmental Services
Ogden Regional Medical Center
5475 South 500 East
Ogden, UT 84405
(801)-47s-2o7e
From: Jon Parry <[e-mail]>
Sent: Thursday, May L0,2OL8 LL:58 AM
To: North Da niel <Daniel.North @ Mountainstarhealth.com>
Subject: {EXTERNAL} Re: Hazardous Waste Corrections ORMC
lQuoted text hiddenl
[Quoted text hidden]
lQuoted text hiddenl
tl
Statements made in this e-mail do not constitute the ofiicial position of the Director of the Division of Waste Management and
Radiation Control. lf you desire a statement of the Director's position, please submit a written request to the Director, Division of
Waste Management and Radiation Control, P.O. Box 1/14880, Salt Lake City, Utah 841144880, including copies of documents
relevant to your request.
Emails to and from this email addrcss may be considered public records and thus subject to Uah GRAMA requirements.
httpsJ/mail.google.com/mail/u/0/?ui=2&ik=delea970eb&jsver=GAFHaMvshdw.en.&cbl=gmail_fe_180506.06j7&view=pt&search=inbox&th=1634b8224948b03a6
5t21t2018 State of Utah Mail - Hazardous Waste Corrections ORMC
Jon Parry <[e-mail]>
To: Daniel. [e-mail]
Can you send me a copy of the manifest, please.
lQuoted text hiddenl
lQuoted text hiddenl
Ot
Thu, May 10,2018at12:17 PM
Statements made in this e-mail do not constitute the ofiicial position of the Director of the Division of Waste Management and
Radiation Control. lf you desire a statement of the Director's position, please submit a written request to the 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.
Emails to and from this emai! address may be ansidered pubtic records and thus subiect to Utah GRAMA requirements'
[e-mail] <[e-mail]> Thu, May 10' 2018 at 1:06 PM
To: [e-mail]
Yes I will reach out to our Histology department to get a copy, and l'll send ASAP.
Dan North
Director of Environmental Services
Ogden Regional Medical Center
5475 South 500 East
Ogden, UT 84405
(801)-47s-207s
From: Jon Parry <[e-mail]>
Sent: Thursday, May 10, 2018 12:18 PM
To: North Daniel <Daniel. North@ Mountainstarhea lth.com>
Subiect: {EXTERNAL} Re: Re:Hazardous Waste Corrections ORMC
[Quoted text hiddenl
Jon Parry <[e-mail]>
To: [e-mail]
Thank you Dan.
lQuoted text hiddenl
[Quoted text hidden]
i'{
*t
Thu, May 10,2018 at 1:23 PM
Statements made in this e-mail do not constitute the ofiicial position of the Director of the Division of Waste Management and
Radiation Control. lf you desire a statement of the Director's position, please submit a written request to the 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.
Emails to and from this email addre,ss may 6e ansidered public records and thus subject to Uah GMMA requirements.
https://mail.google.com/mail/u/0/?ui=2&ik=delea970eb&jsver=GAFHaMvshdw.en.&cbl=gmail_fe_180506.06j7&view=pt&search=inbox&th=1634b8224948b03a8
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OMB# 2050-0024; Explres 05131 12020
United States Envi ron menta I Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM {*ffi
1, Reason for Submlttal {Select only one.)
2. Site
3. Site Name
5. Site Malllng Address
6. Slte
n Obtaining or updating an EPA lD number for an on-going regulated activity that will continue for a period of
time. (lncludes HSM activity)
m Submitting as a component of the Hazardous Waste Report tor 2017 (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 reportlng year
(or State equivalent LQG regulations)
E
E Notifuing that regulated activitv is no longer occurring at this Site
n tb"t"rt .^.rtd.r'"t .*PA lD number for conducting Electronic Manifest Broker activities
t Submitting a new or revised Part A Form
EPA lD Number
U T D 9 8 8 0 7 8 8 4 6
Ogden Reglonal Medical Genter
Locatlon Address
Street Address 5475 South 500 East
City, Town, or Village Ogden County Weber
state uT CountrY United States Zip Code 84405
Same as Location Address
t*", ^ddt"*
City, Town, or Village
State Country Zip Code
Land Type
f]co"nty;p,'ot,.i,t [reoerat f[rribal [ruunicipat [st.te f]ott'"'
7. North American Industry Classiflcatlon System (NAlCSl Code(s) for the Slte (at least S'dlglt codes)
A.(Primary) 62211 c.
B.D.
EPA Form 8700-72,8700-13 A/8, 8700-23 Page I ofj
EPA lD Number U rlolelE I 0l7l8l8 4 o OMB# 2050-0024: Explres 05131 12020
First Name Daniel Mt I Last Name NOrth
Tifle Director of Envlronmental Services
Street Address 5475 South 500 East
Clty, Town, orVillage Ogden
state uT Country United States Zip Code 8/1405
Email [e-mail]
Phone [phone] Ext Fax
8. Slte Contact Informatlon
9. legal Owner and Operator of th€ Slte
A. Name of Site's Legal Owner
8. Name of Site's Legal Operator
I s.r" as Location Address
fJ ,rr" as Location Address
fl t.r" as Location Address
Full Name
Northern Utah Healthcare, DBA Ogden Regional
Date Became Owner (mm/ddlVVWl
111t1994
OwnerType
ftrivate flcornty floirtri.t lreoerat flrriu"t [uunicipat Istute [otn",
Street Address 5475 South 500 East
Clty, Town, orVillage Ogden
state uT Country United States lZip Code 84405
Emall
Phone [phone] lext Fax
Comments
Full Name
Ogden Regional Medical Center
Date Became Operator (mm/ddlyyyy)
1t1t1994
Operator Type
ftrivate [cornty f]oittrict [reoerat flrriuut [Municipat !strt" f]otn.t
Street Address 5475 South 500 East
City, Town, or Village Ogden
State UT country United States lZip Code 84405
Email
Phone [phone] lExt Fax
Comments
EPA Form 8700-12, 8700-13 A/8, 8700-23 eage 2 ofj
U T D 9 8t8 0 7 8 8 4 6EPA lD Number
10. Type of Regulated Waste Actlvlty (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. Haardous Waste Actlvltles
1. G"r*"t* "f Hazardous waste-lf eYes", mark only one of the followinS-a, b, cZ' l-lu
V a. LQG -Generates, in any calendar month (lncludes quantltles lmported by importer slte)
1,000 kg/mo (2,200 lb/mo) or more of non-acute hazardous waste; or
- G.n"rii"r, in iny catenOar 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 tlme, more than 100 kg/mo
(220 lb/mo) of acute hazardous splll cleanup material'
n b.sQG lfi) to 1,000 kglmo 1220-2,200 lb/mo) of non-acute hazardous waste and no more than
1 kg (2.2 lbl ofacute haaardous waste and no more than 100 kg (220 lb) of any acute
hazardous spill cleanup material.
n I c. VSaG I Less than or equal to 100 kg/mo (220 lb/mo) of non'acute hazardous waste'
l-Jl-l
tf '^f"y' iUou", indlcate other generator actlvltles in 2 and 3, as applicable'
lE*2. Short-Term Generator (generates from a short-term or one'time event and not from on-going
processes). lf "Yes", provlde an explanation ln
4t [*3. Mlxed Waste (hazardous and radloactive) Generator
I' El*A hazardous waste Part B permit ls required for
these activitles.
lv Mn 5. Recelves Hazardous Waste from Off'site
lv Mn 6. Recycler of Hazardous Waste
a. Recycler who stores prior to recycling
b. Recycler who does not store prior to recycling
I' El*?lt.tpt B"il"t *,d/or Industrial Furnace-lf "Yes", mark all that apply'
n a. Small Quantity On-site Burner Exemption
n b. Smelting, Meltlng, and Reflning Furnace Exemptlon
B. Waste Codes for Federally Regulated .Hazardous Wastes. Please llst 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. Dfl)1, D003, F007, U112)' Use an
additional page if more spaces are needed.
OMB# 2050-0024; Explres A5131 lzO2O
v122 D001 D009 P001 u188 D011 Pl88
u122 D007 D010 P075 D001 D022 u010
D001 Dotl D011 Pl88 D001 D024 u058
D001 U18E D022 uot0 D009 P001 ut88
D008 D001 D024 u058 D010 P075 u154
c. waste codes for state Regulated (non-Federal) Hazardous wastes. Please list the waste codes of the State hazardous
wastes handled at your slte, List them in the order they are presented in the regulations. Use an additional page if more
spaces are needed.
EPA Form 87W-L2,8700-13 A,/8, 8700-23 Page 3 of6
U T D 9 I 8 7 I I 4 6EPA lD Number OMB# 2O5O-O024; Explres 05131 l2O2O
u. Addltlonal Regulated waste Actlvltles (NOTE: Refer to your State regulatlons to determine lf a separate permit ls required.)
A. Other Waste Actlvltles
It Z*X. Transporter of Hazardous Waste-lf 'Yes", mark all that apply.
!a. Transporter
n b. Transfer Facillty (at your slte)
v llln 2. Underground Injection Control
vEru 3. United States lmporter of Hazardous Waste
-lv 17ru 4. Recognized Trader-lf "Yes", mark all that apply.
n a. lmporter
n b. ExporterI'El'5.. lmporter/Exporter of Spent Lead-Acid Batteries (SLABs) under 40 CFR 266 Subpart G*lf ' Yes", mark allthat apply.l a. lmporter
n b. Exporter
B. Unlversal Waste Activitles
Zt ['1. Large Quantlty Handler of Universal Waste (you accumulate 5.000 kg or more) - lf "Yes" mark all that
apply. Note: Refer to your State regulations to determine what is reguibted.
E a. Batteries
u b, Pesticides
n c. Mercury containing equipment
n d. Lamps
U e. Other (specify)!f. Other (speclfy)I g. Other (specify)
I'M*2, Destination Facllity for Unlversal Waste Note: A hazardous waste permlt may be requlred for this
activity.
C. Used OllActlvitles
ft Et 1. Used Oil Transporter-lf "Yes", mark all that apply.
l a. Transporter
!b. Transfer Facility (at your site)
I' l7l*2. Used Oll Processor and/or Re-refiner-lf "Yes", mark all that apply,
n a. Processor
n b. Re-refiner
I'Et 3. Off-Speclfication Used Oil Burner
lv En 4. Used Oll Fuel Marketer-lf "Yes", mark all that apply.
l_t a. Marketer Who Directs Shlpment of Off-Specification Used Oil to Off-Specification Used Oil Burner
n b. Ma*eter Who Fint Claims the Used Oil Meets the Specifications
EPA Form 8700-12,8700-13 A/8, 8700-23 eage 4 ofj
U T D 9 I 8 0 7 I I 4EPA ID NuMbcr OMB# 2050-0024; Expires 05131/2020
12. Ellglble Academlc Enfltles wlth Laboratorier-Notification for opting into or withdrawing from managing laboratory hazardous
wastes pursuant to 40 CFR 262 Subpart K.
lv lljru @operatingunder40cFR262SubpartKforthemanagementofhazardous
wastes ln laboratorles-lf "Yes", r.iL rll that apply. Note: See the item-by-ltem instructlons for defini-
tions of Wpes of eliglble academic entities.t 1. College or UniversitYt2. Teachlng Hospltal that is owned by or has a formal written affiliation with a college or university
n 3. Non-profit Institute that is owned by or has a formal,written affiliatlon with a college or univer-
&[*" tnan.rgerent of hazardous wastes in laboratories.
16. Notiflcatlon of llazardous Secondary Materlal (HSM) ActlvlW
Are you an SQG or VSQG generatlng hazardous waste from a planned or unplanned episodlc event' lastlng
no more than 60 days, ttrai mov., io, to a higher generator category' lf qfes", you must fill out the Ad'
dendum for Eplsodlc Generator.
LQG Consolldatlon of vSqG Hazardous wast€
Are you an LQG notifying of consolldatlng VSQG Hazardous Waste Under the Control of the Same Person
pursuant to 40 cFR 262'1740t lf "Yes", yiu must flll out the Addendum for LQG consolidation of vSQGs
Notiflcatlon of teG Slte Closure for a Central Accumulatlon Area (cAA) (optlonal) oRtntlre Faclllty (requlred)
LQ6 Site Closure of a central Accumulation Area (cAA) or Entlre Faclllty.
central Accumulation Area (cAA) d lt Entire pacility
B. Expected closure date: ---_-- mm/dd/yyyy
C. Requestlng new closure datel
--
mm/dd/Wyy
D. Date closed : mm/dd/YYYY
1. In compliance with the closure performance standards a0 cFR 262.17(ax8)
2. Not in compllance with the closure performance standards a0 cFR 262.17{ax8)
DM*A. Are you notifying under 40 CFR 260.42 that you will begin managing, are managing, or wlll stop manag-
ing hazardous ,".ondrry material under 40 CFR 260.30, 40 CFR 251.4(aX23l, (24), or l27l? lf "Yes", you
must fill out the Addendum to the site ldentification Form for Managing Hazardous Secondary Material.
lE'#
B. Are you notifying under 40 cFR 260.43(ax4xlii) that the product of your recycllng process has levels of
hazardous constituents that are not comparable to or unable to be compared to a legitlmate product or
intermediate but that the recycling is still legitimate? lf "Yes", you may provide explanation In Comments
section. you must also docunrent ihat your recycllng ls still legitlmate and malntaln that documentation on
site.
Are you notifying as a person, as defined in 40 CFR 260,10, electing to use the EPA electronlc manifest sys'
tem to obtaln, complete, and transmit an electronic manifest under a contractual relationship with a haz-
EPA Form 8700-12, 8700-13 A/8, 8700-23 Page 5 of 6
EPA lD Number U T D 9 I I 0 7 8 I 4 6 OMB# 2050-0024; Expires 05/31/2020
18. Comments (include item number for each comment)
19. Certlflcatlon t certlfy under penalty of law that thls 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 dlrectly responsible for gath-
ering the informatlon, the information submitted is, to the best of my knowledge and bellef, true, accurate, and complete. I am
aware that there are slgniflcant penalties for submittlng false information, includin6 the possibillty of fines and imprlsonment for
knowing vlolations. Note: For the RCRA Hazardous Waste Part A permlt Applicatlon, all owners and operator must sltn (see rO
CFR 270.10(b) and 270.111.
Signature of legal owner, operator or authorized representative Date (mm/dd/yyW)
Printed Name (First, Middle Inltlal Last)Title
Email
Date (mm/ddlyyW)
Printed Name (Flrst,
Daniell North
Title
Dlrector of Envlronmental Servlces
[e-mail]
EPA Form E700-t2,8700-13 A/8, 8700-23 Page 6 of 6
EPA lD Number U T D 9 B I 0 7 I 8 4 5 OMB# 2050-0024; Explres 05131 12020
United States Environmental Protection Agency
HAZARDOUS WASTE REPORT 2017 (reportlne cycle)
WASTE GENERATION AND MANAGEMENT (GM) FORM
{&}
1. Waste Characterlstics
2, On-slte Generatlon and Management of Hazardous Waste
A. Waste Description Formaldehyde
B, EPA Hazardous Waste Code(s)u122
C. State Hazardous Waste Codets)
D. Source Code Gl1 Management Method Code (Source Code G25 only)
F. Waste Minimization Code AE. FormCode 219
6. Quantity 2,623.76 UOM Density @ los/gat ! ss
Was any of this waste that was generated at this faclllty treated, disposed, andlor recycled on-site? lf yes'
contlnue to On'site Process System 1.
fv Eln
Process System 1 Management Method Code QuantitY
Process System 2 Management Method Code QuantitY
off-slte Shlpment of Hazardous Waste
A. Was any of thls waste that was generated at this facllity shipped off-slte for treatment, disposal, or recy-
cling? lf yes, continue to Site X.
D. Total QuantitY ShiPPedB. EPA lD of facility to whlch waste was shipped
D, Total Quantlty ShiPPedB. EPA lD of facility to whlch waste was shipped
D. Total Quantity ShippedB. EPA lD of facility to which waste was shipped
EPA Form 8700-12, 8700-13 AlB, 87W'23 Page _ of-
EPA lD Number u T D 9 8 I n 7 X 8 4 6 OMB# 2050-0024; Explre s 05131 1202A
United States Environmental Protection Agency
HAZARDOUS WASTE REPORT 2017 (reporting cycte)
WASTE GENERATION AND MANAGEMENT (GM) FORM
iffi
1. Waste Characterlstlcs
A. Waste Description Shandon Xylene Subsfltute
B. EPA Hazardous Waste Code(s)D001
c. state Hazardous waste code(s)
D. Source Code G15 Management Method Code (Source Code G25 only)
E. FormCode 203 F. Waste Minimization Code A
G. Quantity 2,602.08 UOM Density Etusleat Ise
2. On-site Generation and Management of Hazardous Waste
lv En Was any of thls waste that,was generated at thls facility treated, disposed, and/or recycled on-slte? lf yes,
continue to On-slte Process System 1.
Process System 1 Management Method Code Quantity
Process Swtem 2 Management Method Code Quantity
3. Off-slte Shlpment of Hazardous Waste
4, Comments
EIv fll A. Was any of thls waste that was generated at this facility shipped off-site for treatment, dlsposal, or recy-
cling? lf yes, contlnue to Site 1.
Site 1
8. EPA lD of facility to which waste was shipped C. Management Method Code D, Total Quantity Shipped
NVD980895338 H141 2,602.08
Slte 2
B. EPA lD of facility to which waste was shipped C. Management Method Code D. Total Quantity Shipped
Site 3
B. EPA lD of faciliW to which waste was shipped C. Management Method Code D. Total Quantlty Shipped
EPA Form 8700-12, 8700-13 A/8,87OO-23 Page _ of _
EPA lD Number U T D 9 8 8 0 7 I 8 4 6 OM B# 2050-0024; Expires 05131 12020
Un ited States Environ m enta I Protecti on Age ncy
HAZARDOUS WASTE REPORT 2017 (reportine cycle)
WASTE GENERATION AND MANAGEMENT (GM) FORM
{ffi
1. Waste Characteristlcs
A. Waste Description UsEd Lead Aprons
B. EPA Hazardous Waste code(s)D008
C. State Hazardous Waste Code(sl
D. Source Code G11 Management Method Code (Source Code G25 only)
E. Form Code 307 F. Waste Minimlzation Code A
G. Quantl$ 75.00 UOM Density Eltus/eat E sg
2. On-slte Generatlon and Management of Hazardous waste
Dv En Was any of thls waste that was generated at thls faclllty treated, dlsposed, and/or recycled on'site? lf yes,
continue to On-site Process System 1.
Process System I Management Method Code Quantity
Process System 2 Management Method Code QuantitY
3. off-slte Shipment of Hazardous Waste
4. Comments
BY En A. Was any of this waste tiat was generated at this facility shipped off-slte for treatment, disposal, or recy-
cling? lf yes, continue to Site 1.
Site I
B. EPA lD of facillty to whlch waste was shlpped C. Management Method Code D. Total Quantity ShlPPeo
NVD980895338 Hl41 75.00
Site 2
L EPA lD of faclllty to which waste was shipped C. Management Method Code D. Total Quantity ShiPPed
Site 3
8. EPA lD of facility to which waste was shlpped C. Management Method Code D. Total Quantlty Shipped
EPA Form 8700-12, 8700-X3 A/8, 8700-23 Page- of-
EPA lD Number U T D 9 I I 0 7 B I 4 6 OMB# 2050-0024; Expires 05/31/2020
United States Environmental Protection Agency
HAZARDOUS WASTE REPORT 2017 (reportinscycle)
WASTE GENERATION AND MANAGEMENT (GM) FORM ffi
1. Waste Characterlstlcs
A. Waste Description Oxldlzer Solld and Llquld Chemlcals 5.'l - Lab Pack
B. EPA Hazardous Waste Code(s)D001 D011
D007
C. State Hazardous Waste Code(s)
D. Source Code Gll Management Method Code (Source Code G25 only)
E. Form Code 001 F. Waste Minimization Code A
G. Quantity 9.00 UOM Density E tus/eat EIss
2, On-site Generatlon and Management of Hazardous Waste
Jv En Was any of thls waste that was generated at this facility treated, disposed, and/or recycled on'slte? lf yes,
contlnue to On-slte Process System X.
Process System 1 Management Method Code Quantlty
Process System 2 Management Method Code Quantlry
3. Off-site Shlpment of Hazardous Waste
4. Comments
Ev Ew A. Was any of thls.waste that was generated at thls facility shipped off-site for treatment, disposal, or recy-
cling? lf yes, continue to Site 1,
Site 1
B. EPA lD of faciliW to whlch waste was shipped C. Management Method Code D. Total Quantity Shipped
NVD980895338 H070 9.00
Site 2
B. EPA lD of facillty to whlch waste was shipped C. Management Method Code D. Total Quantity Shipped
Site 3
B. EPA lD of facility to whlch waste was shipped C. Management Method Code D. Total Quantity Shipped
EPA Form 8700-12, 8700-13 A/8, 8700-23 Page _ of -
EPA ID Number U T D 9 8 I 0 7 I I 4 5 OMB# 2050-0024; Expires 05131 12020
United States Environmental Protection Agency
HAZARDOUS WASTE REPORT 2017 (reporting cycle)
WASTE GENERATION AND MANAGEMENT {GM) FORM
{ffi
1. Waste Characterlstlcs
A. Waste Description Polson Solld Ghemlcals 6.1 . Lab Pack
B. EPA Hazardous Waste Code(s)u188
C. State Hazardous Waste Code(s)
D. Source Code Gl1 Management Method Code (Source Code G25 only)
E. Form Code 409 F. Waste Minimization Code A
G. Quantity 7.00 UOM Density Eltus/eat E se
2. On-slte Generatlon and Management of Hazardous Waste
flv EIru Was any of thls waste that was generated at this facility treated, disposed, and/or recycled on-slte? lf yes,
continue to On-slte Process System 1.
Process System 1 Management Method Code Quantity
Process System 2 Management Method Code Quantity
3. Off-slte Shlpment of Hazardous Waste
4. Comments
Elv En A. Was any of thls waste that was generated at this facility shlpped off-site for treatment, dlsposal, or recy-
cling? lfyes, continue to Site 1.
Site 1
B. EPA lD of facility to whlch waste was shlpped C. Management Method Code D. Total Quantity Shipped
NVD980895338 H141 7.00
Site 2
B. EPA lD of facili{ to which waste was shipped C. Management Method Code D. Total Quantity Shipped
Site 3
B. EPA lD of facility to which waste was shipped C. Management Method Code D. Total Quantity Shipped
EPA Form 8700-!2,8700-13 A/8, 8700-23 Page_ of_
EPA lD Number u T D 9 I I 0 7 8 I 4 6 OMB# 205G0024; Expires OSl31l202O
United States Environmental Protection Agency
HAZARDOUS WASTE REPORT 2017 (reportins cycle)
WASTE GENERATION AND MANAGEMENT (GM} FORM
{,ffi
1. Waste Characterlstlcs
2. On-slte Generatlon and Management of Hazardous Waste
3. Off-slte Shlpment of Hazardous Waste
4. Comments
A. Waste Description Waste Pharmaceuticals - D-Listed, U-Llsted, P.Llsted RCRA Hazardous
B. EPA Hazardous Waste Code(s)D001 D010 DO22 P001 Pl88 u058
D009 D011 0024 P075 u010 ul88
C. State Hazardous Waste Code(s)
D. Source Code G09 Management Method Code (Source Code G25 only)
E. Form Code 005 F, Waste Minimization Code A
6. Quantity 665.00 UOM Density EJtus/gat flse
f,v En Was any of thls waste that was generated at thls facllity treated, disposed, and/or recycled on-site? lf yes,
continue to On-site Process System 1.
Process System 1 Manatement Method Code Quantity
Process System 2 Management Method Code Quantity
Elv trru A. Was any of this waste that was generated at thls faclllty shlpped off-site for treatment, dlsposal, or recY-
cllng? lfyes, continue to Site 1.
Site 1
B. EPA lD of facility to which waste was shipped C. Management Method Code D. Total Quantity Shipped
NVD980895338 H141 665.00
Site 2
B. EPA lD of facility to which waste was shipped C. Management Method Code D, Total Quantity Shipped
Slte 3
B. EPA lD of facility to which waste was shipped C, Management Method Code D. Total Quantlty Shipped
EPA Form 8700-12, 8700-13 Al8,87OO-23 Page _ of_
EPA lD Number U T D 9 I 8 0 7 I I 4 6 OMB# 2050-0024; Expires 05t3't 12020
United States Environmental protection Agency
HAZARDOUS WASTE REPORT 2017 (reportingcycle)
WASTE GENERATION AND MANAGEMENT (GM) FORM
rffi
1. Waste Characterlstlcs
A. Waste Description Flammable Liquids 3 - Lab pack
B. EPA Hazardous Waste Code(s)D00l u154
u002
C. State Hazardous Waste Code(sl
D. Source Code Gl 1 Mana8ement Method Code (Source Code GZ5 only)
E. Form Code 001 F. Waste Minimization Code A
G. Quantity 4.00 UOM Density E tus/gat I sg
2. On-site Generation and Management of Harardous Wastefv En Was any of this waste that was generated at this facility treated, disposed, and/or recycled on-slte? lf yes,
continue to On-slte Process System t.
Process System 1 Management Method Code Quantity
Process System 2 Manag€ment Method Code Quantity
3. Off-site Shlpment of Hazardous Waste
4. Comments
EJv Eru A. Was any of this waste that was generated at this facility shipped off-site for treatment, disposal, or recy-
cling? lf yes, continue to Site l.
Site 1
B. EPA lD of facility to which waste was shipped C. Management Method Code D. Total Quantity Shipped
NVD980895338 H141 4.00
Site 2
B. EPA lD of facility to which waste was shipped C. Management Method Code D. Total Quantity Shipped
Site 3
B. EPA lD of facility to whlch waste was shipped C. Management Method Code D. Total Quantity Shipped
EPA Form 8700-t2,8700-13 A/8, 8700-23 Page_ of_
U T D 9 I I 0 7 I I 4 5 OMB# 2050-0024; Expires OSl3'l l2O2O
EPA lD Number
United States Envi ron menta I Protection Agency
HAZARDOUS WASTE REPORT 2017 (reportinecycle)
WASTE GENERATION AND MANAGEMENT (GM) FORM
A. Waste Descrlption Wagte AeroEols and Inhalers
B. EPA Hazardous Waste Code(s)
C. State Hazardous Waste Code(s)
Management Method Code (source Code G25 only)
F. Waste Minimization Code A
On-slte Generatlon and Management of Hazardous waste
Was any of this waste tnat was generated at thls facllity treated, disposed, andlor recycled on-site? lf yes'
continue to On-slte Process System 1.
Off-slte Shlpment of Hazardous Waste
A. Was any of this waste that was generated at this faciliw shipped off-site for treatment, disposal, or resy-
cling? lf yes, continue to Site 1.
B. EPA lD of faclllty to whlch waste was shlpped
C. Management Method CodeB. EPA lD of facility to which waste was shipped
D. Total Quantlty ShlPPedC. Management Method CodeB. EPA lD of faclli$ to which waste was shipped
EPA Form 8700-12,8700-13 A/8, 8700'23 Page _ of-