DSHW-2018-006230 - 0901a06880868eca

OK Ce 07cti JUN 1 8 2018
OMB# 2050-0024; Expires 05/31/2020
United States Environmental Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM
Div of Waste Management
and Radiation Control
1. Reason for Submittal (Select only one.) S - -OOC3o
Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of
bite. (Includes HSM activity) El Submitting as a component of the Hazardous Waste Report for (Reporting Year) 0 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)
0 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
LL -r o o o o o o 3
3. Site Name
4. Site Location Address
Street Address
City, Town, or Village % p C . County
State Country (..)S A Zip Code rti/ 6/
5. Site Mailing Address Same as Location Address
Street Address
City, Town, or Village
State Country Zip Code
6. Site Land Type
DPrivate County ['District Federal rlbal unicipal S e 0 Other
7. North American Industry Classification System (NAICS) Code(s) for the Site (at least 5-digit codes)
A. (Primary) 1 VA-144! 0 Z. ili C.
B. frfittf_ 11): 2.4.23 D. D
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
8. Site Contact information r?Si Same as Location Address
First Name Ai ets nAl Last Name 0 el ers
Title i
Street Address
City, Town, or Village
State Country Zip Code
Email cf rcc,rs Q. xrr.c '
Phone — 7 2 76 Ext Fax _
1 Legal Owner and Operator of the Site
A. Name of Site's Le al Owner
IDSame as Location Address
Full Name
1..) 5 60Litif,4~4.: 2 idn A1-4fc.oul Pcyrit
Date Became Owner (mm/dd/yyyy)
Owner Type
j3r1yate Co nty District Federal ElTribal DMunicipal State DOther
Street Address 1 ' 1310A 1
City, Town, or Village
State 1)1— country ‘,/g A Zip Code 1-141 6 7
Email
Phone Ext Fax
Comments
B. Name of Site's Legal Operator 0 Same as Location Address
Full Na e Date Became Operator (mm/dd/yyyy)
\ / I / z oo 9
Operator 1Priyate
Type
lcountv District ofederat EiTribal unicipal 0 State DOther
Street Address 61 ‘2... c;Afi iti, 5 (.; cee4,‘.. G C CO 11/
City, Town, or Village
State Country 0 E, A Zip Code VII )
Email
Phone Ext Fax
Comments
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page_
Dôo
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 ID Number OMB# 2050-0024; Expires 05/3112020
10. Type of Regulated Waste Activity (at your site)
Mark "Yes" or "No" for ail current activities las of the date submitting the form); complete any additional boxes as Instructed.
A. Hazardous Waste Activities
gy Q N L. Generator of Hazardous Waste—If "Yes", mark only one of the following—a, b, c
D a. LQG -Generates, in arty 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 arty calendar month, or accumulates at any time, more than 1 kg/mo
(2.2 tb/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.
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.
N c. VSQG Less than or equal to 100 kg/mo (220 lb/mo) of non-acute hazardous waste.
lf "Yes" above indicate other generator activities in 2 and 3, as applicable.
NY ON 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. D ON 3. Mixed Waste (hazardous and radioactive) Generator ny NN 4. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for these activities.
Ely Ed N 5. Receives Hazardous Waste from Off-site
Fly El N 6. Recyder of Hazardous Waste ..
a. Recycler who stores prior to recycling
0 b. Recycler who does not store prior to recycling
Dy EIN 7 Exempt Boiler and/or Industrial Furnace—If "Yes", mark all that apply.
El a. Small Quantity On-site Burner Exemption
0 b. Smelting, Melting, and Refining Furnace Exemption
O. 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. 0001, 0003, F007, W.12). Use an
additional page If more spaces are needed.
EPA Form 8700-12, $700-13 A/B, 8700-23 Page _ 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
Oy INN 1. Transporter of Hazardous Waste—If "Yes", mark all that apply.
ID a. Transporter
El b. Transfer Facility (at your site)
Dy 0 N 2. Underground injection Control
Ely EN 3. United States Importer of Hazardous Waste
fly 13N 4. Recognized Trader—If "Yes", mark all that apply.
II a. Importer
121 _ b. Exporter
y EIN 5. lmporter/Exporter of Spent Lead-Acid Batteries (SLABs) under 40 CFR 266 Subpart G—If "Yes", mark all that apply.
0 a. Importer
El b. Exporter
B. Universal Waste Activities D y VI 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 is regulated.
0 a. Batteries
111 b. Pesticides
p c. Mercury containing equipment
121 cl. Lamps
0 e. Other (specify)
0 f. Other {specify)
El g. Other (specify)
El [1(1 N 2. Destination Facilityfor Universal Waste Note: A hazardous waste permit may be required for this
activity.
C. Used Oil Activities liy 0 N 1. Used Oil Transporter—If "Yes", mark all that apply,
0 a. Transporter
El b. Transfer Facility (at your site)
Ely El N 2. Used Oil Processor and/or Re-refiner—If "Yes", mark all that apply.
0 a. Processor
0 b. Re-refiner
ill y la N S. Off-Specification Used Oil Burner
Ely igN 4. Used Oil Fuel Marketer—If "Yes", mark all that apply. .. 0 a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used 011 Burner
II b. Marketer Who First Claims the Used Oil Meets the Specifications
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page_ of _
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
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.
13. Episodic Genieration
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.
12. Eligible Academic Entities with Laboratories—Notification for opting into or withdrawing from managing laboratory hazardous
wastes pursuant to 40 CFR 262 Subpart K.
Dy 51.N
—
A. Opting Into or currently operating under 40 CFR 262 Subpart K for the management of hazardous
wastes in laboratories—if "Yes", mark all that apply. Note: See the item-by-item instructions for defini-
tions of types of eligible academic entities.
0 L. College or University
0 2. Teaching Hospital that is awned by or has a formal written affiliation with a college or university
111 3. Non-profit Institute that is owned by or has a formal written affiliation with a college or univer-
Ely EiN B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories.
14. LQG Consolidation of VSQG Hazardous Waste
15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) OR Entire Facility (required)
Dr 0 N LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility.
AO Central Accumulation Area (CAA) a: Entire Facility
B. Expected closure date: mm/dd/yyyy
C. Requesting new closure date: mm/c1d/yyyy
D. Date closed : mm/cid/yyyy El1. In compliance with the closure performance standards 40 CFR 262.17(08)
li2. Not In compliance with the closure performance standards 40 CFR 262.17(a)(8)
16. Notification of Hazardous Secondary Material (HSM) Activity DY 02 N 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 260.301 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.
DY D B. Are you notifying under 40 CFR 260.43(0(4)00 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 rnaintain that documentation on
site.
17. Electronic Manifest Broker ryal

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_ of_
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
18. Comments (include item number for each comment)
Oiie friL tra4-iclq.cLw D kact- orn ovtaj,i
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 of •ow r, oper tor or authorized representative Date (nm/cid/NNW)
Printed Name (First, Midd e Initial I.ast) ilaiVel. ? ctct
Tit?
v,vit 4.4,114.Lf Sct,4. `1144,407 cm-
Email A k r 05c4 e..1.6.0kel to...
Signature of legal owner, operator or authorized representative Date (mm/dd/yyyy)
Printed Name (First, Middle Initial Last) Title
Email
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _
Ei/ZWZO18 State ot Utah Mail - One- I ime EIJA IL) Number
Carlee Christoffersen <[e-mail]>
One-Time EPA ID Number
1 message

N
Carlee Christoffersen <[e-mail]>
To: Alex Rogers <[e-mail]>
Alex,

Tue, Jun 26, 2018 at 9:39 AM
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:
Zion National Park Lodge 1 Zion Lodge
Springdale, UT 84767
Your EPA Identification Number is UTP000001603.
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]
Ali F:‘,00.1 Ott
WASTE MANAGENIEKT
8, 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 84114-4880, including copies of documents relevant to your
request.
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