DSHW-2018-006226 - 0901a06880868ec6

Div of Waste Manager, •
and Radiation Contic.„
APR i 8 2818
OMB# 2050-0024; Expires 05/31/2020 0/z t
United States Environmental Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM
Zip Code 84104 State Utah Country USA
Street Address 3110 West California Ave., Suite D
City, Town, or Village Salt Lake City
1. Reason for Submittal (Select only one.)
g 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)
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 spili cleanup in one or more months of the reporting year
(or State equivalent LOG regulations)
E Notifying that regulated activity is no longer occurring at this Site
1 Obtaining or updating an EPA ID number for conducting Electronic Manifest Broker activities
Il Submitting a new or revised Part A Form
2. Site EPA 10 Number
0 0 0 0 0 9 6 3 9
3. Site Name
E.T. Technologies, inc.
4. Site Location Address
Street Address 3110 West California Ave., Suite D
City, Town, or Village Salt Lake City County Salt Lake
State Utah Country USA Zip Code 84104
S. Site Mailing Address El Same as location Address
6. Site Land Type
Drivate ['County ElDistrict oFederal [Tribal Municipal OState Other
7. North American Industry Classification System (NAICS) Code(s) for the Site (at leait 5-digit codes)
A. (Primary) 562910
_
c.
B. D.
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page 1 of 6
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8. Site Contact information 0 Same as Location Address
First Name Greg mi Last Narne Neville
Title Regional Manager
Street Address 3110 West California Ave., Suite D
City, Town, or Village Salt Lake City
State Utah Country USA Zip Code 84104
Email gneville©ettechnologies.net
Phone [phone] Ext Fax [phone]
9. Legal Owner and Operator of the Site
A. Name of Site's Legal Owner Same as Location Address
Full Name
Jemco
Date Became Owner fmm/dd/PITI)
1/1/2005
Owner Type
„.D,riyate OCounty District Federal Tribal Elvlunicipal ljJState Other
Street Address 9061 Santa Monica Boulevard
City, Town, or Village Los Angeles
State CA country USA Zip Code 90069
Email
Phone [phone] Ext Fax
Comments
S. Name of Site's Legal Operator Same as Location Address
Full Name
E.T. Technologies, Inc
Date Became Operator (mm/dd/wri)
1/1/2005
Operator Type
ariyate ljJcounty District El Federal Tribal Municipal State Other
Street Address 3110 West California Ave., Suite D
City, Town, or Village Salt Lake City
State Utah Country USA Zit) Code 84104
Email [e-mail]
Phone [phone] Ext Fax [phone]
Comments
EPA Form 8700-12, 8700-13 A/B, 8700-23 page 2 of 6
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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
[--1( ZN 1. Generator of Hazardous Waste—If "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 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 Iblmo) of acute hazardous spill cleanup material.
b. SQG 100 to 1,000 kg/mo (220-2,200 Ib/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.
Lit 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 irw 2 and 3, as applicable.
Eli w 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. Dt 1 N 3. Mixed Waste (hazardous and radioactive) Generator
IF ON 14. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for thew activities.
5, Receives Hazardous Waste from Off-site Ely i N
DY i N 6. Recycler of Hazardous Waste
a. Recycler who stores prior to recycling
f:} b. Recycler who does not store prior to recycling
Oy i 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 , 3 of 6
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11. Additional Regulated Waste Activities (NOTE: Refer to your State regulations to determine if a separate permit is required.)
A. Other Waste Activities
Ely EIIII N 1. Transporter of Hazardous Waste—If "Yes", mark all that apply.
IN a. Transporter
Lj b. Transfer Fadlity (at your site)
Dy is N 2 Underground Injection Control
Dv , N 3. United States Importer of Hazardous Waste
ny I71 N 4. Recognized Trader—If "Yes", mark all that apply.
Lj a. Importer
E b. Exporter
y i N 5. Importer/Exporter of Spent Lead-Acid Batteries (SLABs) under 40 CFR 266 Subpart G—If "Yes", mark all that apply. Lj a. Importer Lj b. Exporter
B. Universal Waste Activities
Lj y ,/ 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 deterrnine what is regulated.
Lj a. Batteries
0 b. Pesticides
fJ c. Mercury containing equipment
d. Lamps
e. Other (specify)
f. Other (specify)
0 g. Other (specify)
EyLj N 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this
activity.
C. Used Oil Activities
ZY 0 N 1 Used Oil Transporter—If "Yes", mark all that apply.
./ a. Transporter
11 b. Transfer Facility (at your site)
E:I y v N 2. Used Oil Processor and/or Re-refiner—lf "Yes", mark all that apply.
a. Processor
0 b. Re-refiner
D y / N 3. Off-Specification Used Oil Burner
Lj y ,./ N 4. Used Oil Fuel Marketer—lf "Yes', mark all that apply. , 0 a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used Oil Burner E b. Marketer Who First Clairns the Used Oil Meets the Specifications
EPA Form 8700-12, 8700-1.3 A/B, 8700-23 page 4 of 6
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ZN 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.
DY ZN
12. Eligible Academic Entities with Laboratories—Notification for opting into or withdrawing from managing laboratory hazardous
wastes pursuant to 40 CFR 262 Subpart K.
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.
1. College or University
2. Teaching Hospital that is owned by or has 3 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-
y i N B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories.
13. Ep sock Generation
t:11 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 Consolidaron of VSQG Hazardous Waste Eli ON 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 VSQGs
hazardous waste.

15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) OR Entire Facility (required)
jv V N LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility.
A Central Accumulation Area (CAA) Entire Facility
B. Expected closure date: mm/dd/InfYy
C. Requesting new closure date: mrn/dd/WYY
D. Date closed : mm/dd/yyyy
1. 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
Ds( EIN 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?

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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. 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).
Email
Signature of legl owner, opepator o authori!Aldepresentative ,4 / A
Printed Name (First, Middle lniLíal Last)
Date (mm/dd/yyyy)
Title
Signature of legal owner, operator or authorized representative Date (mm/dd/yyyy)
Printed Name (First, Middle Initial Last)
Email
Title
OMB# 2050-0024: Expires 05(3112020 EPA ID Number