DSHW-2018-007982 - 0901a068808a5cf6

State NC Zip Code 28117 Country USA
Street Address 1000 LOWES BLVD., MAIL STOP A3WLP
City, Town, or Village MOORESVILLE
Div of Waste Management
and Radiation Control
-V—HtA/-2081-00752— JUL 2 5 2018
orm# 2050-0024; Expires 05/31/2020
United States Environmental Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM

1. Reason for Submittal (Select only one.)
Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of
time. (Includes HSM activity)
EJ Submitting as a component of the Hazardous Waste Report for (Reporting Year)
ljjjjjl 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)
fJ Notifying that regulated activity is no longer occurring at this Site
IJ 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
u.• -r- g o o o o o (I) i s g
3. Site Name
LOWE'S OF RIVERDALE, UT #1080
4. Site Location Address
Street Address 4155 RIVERDALE RD
City, Town, or Village RIVERDALE CountY WEBER
State UT Country USA Zip Code 84405
5. Site Mailing Address 0 Same as Location Address
6. Site Land Type
X Private County District Federal ElTribal Municipal State Other
7. North American Industry Classification System (NAICS) Code(s) for the Site (at least 5-digit codes)
A. (Primary) 444110 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 0 Same as Location Address
First Name BOBBI MI Last Name TENBORG
Title ENVIRONMENTAL COMPLIANCE SUPERVISOR
Street Address 1000 LOWES BLVD., MAIL STOP A3WLP
City, Town, or Village MOORESVILLE
State N C Country USA Zip Code 28117
Email [e-mail]
Phone [phone] Ext Fax [phone]
9. Legal Owner and Operator of the Site
A. Name of Site's Legal Owner CI Same as Location Address
Full Name
LOWE'S HOME CENTERS, LLC
Date Became Owner (mm/dd/yyyy)
01/22/2001
Owner Type
D'rivate County District Federal Tribal Municipal State Other
Street Address 1605 CURTIS BRIDGE RD.
City, Town, or Village WILKESBORO
State N C Country USA Zip Code 28697
Email [e-mail]
Phone [phone] Ext Fax [phone]
Comments
B. Name of Site's Legal Operator D Same as Location Address
Full Name
LOWE'S HOME CENTERS, LLC
Date Became Operator (mm/dd/yyyy)
01/22/2001
Operator Type
ZPrivate County District Federal Tribal Municipal State Other
Street Address 1605 CURTIS BRIDGE RD.
City, Town, or Village WILKESBORO
State NC Country USA Zip Code 28697
Email BOBBI.L.TENBORG@LOWES COM
Phone [phone] Ext Fax [phone]
Comments
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page 2 of 6
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
Ely N 1. Generator of Hazardous Waste—If "Yes", mark only one of the following—a, b, c
ljjl 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 lb/mo) of acute hazardous spill cleanup material.
X 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.
Ll 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 EIN 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 EIN 3. Mixed Waste (hazardous and radioactive) Generator y LIN 4. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for these activities.
Ely EIN 5. Receives Hazardous Waste from Off-site
Dy x N 6. Recycler of Hazardous Waste
111 a. Recycler who stores prior to recycling
LI b. Recycler who does not store prior to recycling
Dv X N 7. Exempt Boiler and/or Industrial Furnace—If "Yes", mark all that apply.
Ll a. Small Quantity On-site Burner Exemption
Ll 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.
D001 D002 0005 D006 D007 D008 D009
D011 D016 D018 D035 U154
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 6
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 x N 1. Transporter of Hazardous Waste—If "Yes", mark all that apply.
a. Transporter
b. Transfer Facility (at your site)
a X
y x
N
N
2 Underground Injection Control
3. United States Importer of Hazardous Waste
ny Fq N 4 Recognized Trader—If "Yes", mark all that apply.
a. Importer 11111 b. Exporter
y x 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
y x 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.
LJ a. Batteries
LJ b. Pesticides
LJ c. Mercury containing equipment
LJ d. Lamps
e. Other (specify)
f. Other (specify) Ei g. Other (specify) DY X N 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this
activity.
C. Used Oil Activities
:y x N 1. Used Oil Transporter—If "Yes", mark all that apply.
LJ a. Transporter
jjjjjj b. Transfer Facility (at your site)
y x N 2 Used Oil Processor and/or Re-refiner—If "Yes", mark all that apply.
LJ a. Processor
LJ b. Re-refiner
y x N 3. Off-Specification Used Oil Burner
Dv X N 4. Used Oil Fuel Marketer—If "Yes", mark all that apply.
a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used Oil Burner
LJ 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
12. Eligible Academic Entities with Laboratories—Notification for opting into or withdrawing from managing laboratory hazardous
wastes pursuant to 40 CFR 262 Subpart K.
aEl 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 a 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-
Dy X N B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories.
13. Episodic Generation

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

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) DY X N LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility.
A. Central Accumulation Area (CAA) 0 Entire Facility
B. Expected closure date: mm/dd/yyyy
C. Requesting new closure date: mm/dd/yyyy
D. Date closed : mm/dd/yyyy
Ll1. In compliance with the closure performance standards 40 CFR 262.17(a)(8)
Ll2. Not in compliance with the closure performance standards 40 CFR 262.17(a)(8)
16. Notification of Hazardous Secondary Material (HSM) Activity
Eti X 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 260.30, 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.
D X N 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.
17. Electronic Manifest Broker ry LIN

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
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).
Sigr e of legal o ner)operator or authorized representative
\
Date (mm/dd/yyyy)
06/29/2018
Printed Name (First, Middle lni ast)
BOBBI TENBORG
Title ENVIRONMENTAL COMPLIANCE
SUPERVISOR
Email [e-mail]
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 6 6 Page of