DSHW-2018-007998 - 0901a068808a5efc

OMB# 2050-0024; Expires 05/31/2020 OIL- GO-
United States Environmental Protection Agency
RCRA SUBTITLE C SITE IDENTIFICATION FORM
Div of Waste Management
and Radiation Control
JUL 2 5 2018
1. Reason for Submittal (Select only one.) D504-20(6 -00
Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of
time. (Includes HSM activity)
fl Submitting as a component of the Hazardous Waste Report for (Reporting Year)
fl 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)
jjjj Notifying that regulated activity is no longer occurring at this Site
Obtaining or updating an EPA ID number for conducting Electronic Manifest Broker activities
fl Submitting a new or revised Part A Form
2. Site EPA ID Number
o o o
3. Site Name
LOWE'S OF RIVERTON, UT #2296
4. Site Location Address
Street Address 12462 S. CREEK MEADOW ROAD
City, Town, or Village RIVERTON County SALT LAKE
State UT Country USA Zip Code 84065
5. Site Mailing Address fl Same as Location Address
Street Address 1000 LOWES BLVD., MAIL STOP A3WLP
City, Town, or Village MOORESVILLE
State N C Country USA Zip Code 28117
6. Site Land Type
X Private County District Federal ElTribal fl 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. D
EPA Form 8700-12, 8700-13 A/B, 8700-23 1 f 6 Page o
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
8. Site Contact Information 11 Same as Location Address
11 Same as Location Address
9. Legal Owner and Operator of the Site
A. Name of Site's Legal Owner
11 Same as Location Address B. Name of Site's Legal Operator
Page 2 of 6 EPA Form 8700-12, 8700-13 A/B, 8700-23
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 NC Country USA Zip Code 28117
Email [e-mail]
Phone [phone] Ext Fax [phone]
Full Name
LOWE'S HOME CENTERS, LLC
Date Became Owner (mm/dd/yyyy)
10/28/2006
Owner Type
>rivate 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
Full Name
LOWE'S HOME CENTERS, LLC
Date Became Operator (mm/dd/yyyy)
10/28/2006
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 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
X Y N 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 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.
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.
Y X N 2. Short-Term
processes).
Generator (generates from a short-term or one-time event and not from on-going
If "Yes", provide an explanation in the Comments section.
Y X N 3. Mixed Waste (hazardous and radioactive) Generator
Y X N these 4. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for activities.
y x N 5. Receives Hazardous Waste from Off-site
Ly x N 6. Recycler of Hazardous Waste
a. Recycler who stores prior to recycling
b. Recycler who does not store prior to recycling
Y X N 7 Exempt Boiler and/or Industrial Furnace—If "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.
D001 D002 D005 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 3 6 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
Y X N 1. Transporter of Hazardous Waste—If "Yes", mark all that apply.
JjjjjjjJ a. Transporter
111 b. Transfer Facility (at your site)
Y X N 2 Underground Injection Control
ljjjjjjv x N 3. United States Importer of Hazardous Waste
ny Fl N 4 Recognized Trader—If "Yes", mark all that apply.
a. Importer
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.
a. Importer
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.
a. Batteries
b. Pesticides
c. Mercury containing equipment
d. Lamps
e. Other (specify)
f. Other (specify)
g. Other (specify)
Y X N 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this
activity.
C. Used Oil Activities
Ey X N 1. Used Oil Transporter—If "Yes", mark all that apply.
LI a. Transporter
b. Transfer Facility (at your site)
y x N 2 Used Oil Processor and/or Re-refiner—If "Yes", mark all that apply.
a. Processor
b. Re-refiner
y x N 3 Off-Specification Used Oil Burner
y 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
b. Marketer Who First Claims the Used Oil Meets the Specifications
EPA Form 8700-12, 8700-13 A/B, 8700-23 Page 4 of 6
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.
Y X 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-
y x N B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories.
13. Episodic Generation
EIY E N Are you an SQG or VSQG generating hazardous waste from a planned or unplanned episodic event, lasting
no more than 60 days, that moves you to a higher generator category. If "Yes", you must fill out the Ad-
dendum for Episodic Generator.

14. LQG Consolidation of VSQG Hazardous Waste Ely il N Are you an LQG notifying of consolidating VSQG Hazardous Waste Under the Control of the Same Person
pursuant to 40 CFR 262.17(f)? If "Yes", you must fill out the Addendum for LQG Consolidation of VSQGs
hazardous waste.

15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) OR Entire Facility (required)
Y X N LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility.
Afjj Central Accumulation Area (CAA) EJI Entire Facility
B. Expected closure date: mm/dd/yyyy
C. Requesting new closure date: mm/dd/yyyy
D. Date closed : mm/dd/yyyy
Ejjl 1. In compliance with the closure performance standards 40 CFR 262.17(a)(8)
fjJ2. Not in compliance with the closure performance standards 40 CFR 262.17(a)(8)
16. Notification of Hazardous Secondary Material (HSM) Activity
Efr 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.
Efr 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
DY E N Are you notifying as a person, as defined in 40 CFR 260.10, electing to use the EPA electronic manifest sys-
tem to obtain, complete, and transmit an electronic manifest under a contractual relationship with a haz-
ardous waste generator?

EPA Form 8700-12, 8700-13 A/B, 8700-23 Page 5 of 6
EPA ID Number OMB# 2050-0024; Expires 05/31/2020
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).
Sign e of legal er, operator ..fav4;\
LSTIAL6)/
or authorized representative Date (mm/dd/yyyy)
06/29/2018
Printed Name (First, Middle Itial
BOBBI TENBORG
Last) 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
8/9/2018 State of Utah Mail - Utah EPA ID Numbers
Carlee Christoffersen <[e-mail]>

Utah EPA ID Numbers
1 message

Carlee Christoffersen <[e-mail]> Thu, Aug 9, 2018 at 4:10 PM
To: [e-mail]
Ms. Tenborg,
This is to acknowledge you have filed a RCRA Subtitle C Site Identification Form for waste generated at several Lowe's
locations in the State of Utah. The EPA Identification Numbers for these sites are:
UTR000000166* LOWE'S OF LAYMN UT #15
UTR000000182* LOWE'S OF OREM UT #178
UTR000006189* LOWES OF RIVERDALE UT #1080
UTR000014415 LOWE'S OF WEST BOUNTIFUL UT #2662
UTR000014407 LOWE'S OF VERNAL UT #2834
UTR000014423 LOWE'S OF SANDY UT #2606
UTR000014431 LOWE'S OF LOGAN UT #1501
UTR000014449 LOWE'S OF WEST JORDAN UT #1613
UTR000014456 LOWE'S OF SALT LAKE CITY UT #2275
UTR000014464 LOWE'S OF LEHI UT #2293
UTR000014472 LOWE'S OF RIVERTON UT #2296
UTR000014480 LOWE'S OF CLINTON UT #2845
UTR000014498 LOWE'S OF OGDEN UT #2858
*indicates locations with existing ID numbers - site information was updated.
The EPA Numbers 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.
The EPA Numbers are site specific. If any site changes physical locations, it is your responsibility, as a generator, to
notify the state and aPply for a new EPA ID Number. You can submit a new form to update information regarding your
sites at any time.
If you would like to arrange a compliance assistance visit to discuss waste management practices, please contact
Deborah Ng at 801-536-0218.
For questions regarding your EPA ID number or site status please call Carlee Christoffersen at [phone] or reply to
this email.
Thank you,
Carlee Christoffersen l Environmental Program Coordinator
Phone: [phone]
UTAH DtPARDIENT of
ENVII4OFCMN"A"L_ QUAL111,
WASTE MANAGEMENT
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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