DSHW-2024-006816

UTAH DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF SOLID AND HMARDOUS WASTE
Dennis R. Downs. Director
SQG Program
P. O Box 144880
Salt Lake City, UT 841 14-4880
(801)-538-6170
HAZARDOUS WASTE GENERATOR EVALUATION FORM
Faclllty l,tame' PAID Numb", Uf 0 153 abl Yl}j
street*0r""",23 "(oC;/v rro"oo"rWcounty:s^lt 0i'l i)tgt-73a5
Generator Status^:C E 5 A G Number^of Emplqyees Date or visit= o<f, b , [111
rnspectors, E0@ + (oh 'P;"r"..
Other Personnel:
WASTE STREAM / GENERATION PROCESS GENERATION RATE
PER MONTH
HAZARDOUS
WASTE CODE
PROPERLY
MANAGED ?
Lq,b gga., st<-S
Total Quantity of Hazardous
Waste Generated per Month:
RESPONSE NECESSARY:
COMMENTS:
YES RESPONSE DUE BY:
This compliance evaluation notes areas where your hazardous waste management practices may not meet the
regulatory requirements of the Utah Solid and Hazardous Waste Management Rules. lf a "Response Due Date' is
indicated, you must take the actions, summarized in this audit, in order to come into compliance and NOTIFY THIS
OFFICE lN WRITING by the indicated date. Please be advised, that if we do not receive written documentation of
these corrective actions by the response due date, you may be subject to further regulatory action, including
administrative penalties. Please include your EPA number with your correspondence.
lf you have further questions, or would like to discuss these issues with the inspectors or their supervisor, you may
contact them during business hours at [phone]. ltems that must be submitted may be mailed to the address at
the top of this page.
RECEIVED BY:INSPECTOR:
Name, Printe*Name, Printed
Signatuyfi,Signature:
Title:Title:
^J
Date:,?Date:
3
Page 2 of 6
(Example)
Date: April 9, 1997
Time: 10:00 am to 11:00 am
Discussion lead by: John Doe, Health and Safety Coordinator
Topics discussed
Hazardous Waste Accumulation Time
a. Do not store hazardous wastes for longer than 180 days on site.
b. Label each container or tank with the words "Hazardous Waste."
tr. Use and Management of Containers
a. Maintain a log weekly on the hazardous waste containers, are the containers closed,
labeled, dated and in good condition. If not, please contact the emergency coordinator in order to
rectiff the problern
Itr. Other topics as discussed.
a.
b.
Employee Name (Please Print)
1.
2.
3.
Employee Signature
TSTHIS IS ONLY AN EXAMPLE AND MUST BE ADAPTED SPECIF'ICALLY TO
YOUR FACILITY AND TRAINING FORMAT.
UTAH DIVISION OF SOLID
AND HAZARDOUS WASTE
SMALL QUANTITY GENERATOR
COMPLIANCE EVALUATION FORM
Page 3 of 6
hems that are marked "NO" on the line in the left-hand column are not in compliance wilh the Utah Solid and
Hazardous Waste Regulations and require your immediate attention. ltems marked "OK" meet the minimum requirements of the
regulations. ltems marked "NA' do not apply to your facility.
1. R315-5.2 DETERMINATION OF WHETHER A WASTE IS HAZARDOUS
ACTION NEEDED:
o^ z.R315-3 NOTIFICATION AND EPA HAZARDOUS WASTE IDENTIFICATION NUMBERS:
lf you generate between 100 and 1000 Kgs (220-2200 pounds) of hazardous waste per month or up to 't Kg of acutely
hazardous waste, you are classified as a Small Quantity Generator (SOG), and you must notify the Executive Secretary of
the Utah Solid and Hazardous Waste Control Board and obtain an EPA lD number. This is accomplished by notifying the Utah
Division of Solid and Hazardous Waste.
lf you are a small quantity generator, you must obtain an EPA lD Number in order to otfer hazardous waste for management to
a transporter or to a treatment, storage and disposal facility (TSDF) that has an EPA lD Number.
ACTION NEEDED:
O(3 R315.5.4 MANIFESTS
Only use approved manifest lorm 8700-22 and 87OO-22A when otfering hazardous wastes for transport to a TSDF or use the
manilest of the state that the TSDF is located in, il required by that state.
Designate another facility or instruct a transporter 1o return wastes if they are undeliverable.
Fillout all applicable sections of the manifest.
Use a contractual disposal agreement only if a generalion rate is less than 1000 Kg/month (SQG or less).
Keep copies of contractual agreements for three years after service ends.
ACTION NEEDED:
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4.R315.5.5 RECORD KEEPING
Keep copies of manifests for three years.
Keep all records, including determination of generation rates, waste characterization documentation, disposition, etc., for three
years.
ACTION NEEDED:
R315.5.7 EXCEPTION REPORTING
lf TSDF does not return generators'copy of manifest within 60 days, a generator must submit a letter stating so
and a copy of the manifest to the Executive Secretary of the Utah Solid and Hazardous Waste Control Board.
ACTION NEEDED:
R315.5.9 PACKAGING, LABELING, MARKING AND PLACARDING
Package, Label and mark waste in accordance with DOT 49 CFR prior to shipment.
ACTION NEEDED:
R315.5.10 ACCUMULATION TIME
Do not store hazardous wastes for longer than 180 days, or 270 days if applicable, without a permit.
Do not exceed 6000 Kg of hazardous wastes stored at your facility at any time.
Mark the date the accumulation period began on each container of hazardous wastes. Satellhe accumulation containers are
the exception.
Label each tank and container with the woTdS "HAZARDOUS WASTE" while it is being used to accumulate hazardous wastes.
Designate and authorize an emergency coordinator(s) who is(are) readity available by some means at all times.
Post the tollowing information next to each telephone at the facility: Name and telephone number of the emergency
coordinator(s) location(s) of lire extinguishers, spill control equipment and fire alarms, telephone number ol the local fire
department (or equivalent emergency response for facility).
Ensure that all employees are familiar with hazardous waste handling and emergency procedures.
The emergency coordinator must respond appropriately to emergencies that have the potential of involving hazardous waste(s).
ACTION NEEDED:
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These are only examples that will help you comply with the regulations, you must ADAPT the following information
for and make it specific to YOUR facility.
SEE #10e
Today?s date
Letters to: Your Hospital
Your local Police Department
Your local Fire Department
Dear sir or Madame,
In accordance with 40 CFR 265 Subpart C, we are required to notif,i you that we generate hazardous waste(s). The
waste(s) that we generate is (are)...examp1es might be; paint wastes, paint sludges, Methyl Ethyl Ketone, Acetone,
other solvents, acids, bases, listed wastes, etc.
We make every effort to properly nxmage our waste, but in the event of an emergency we may require your assistance.
In the ovent of an unforseen emergency, you may be required to respond.
Your Name and Title
ABC Company
#7 e and 7f
[s IN CASE OF EMERGENCY DIAL 91 1!a EMERGENCY COORDINATOR IS CARL CAREFUL.
EXT. 2536ns FIRE EXTINGUISHERS' LOCATION MARKED ON
WALLra SPILL CONTROL EQUIPMENT LOCATED AT TIME
CLOCK
UNIYERSAL WASTE
MERCURY.CONTAINING
LAMPS
date
8.
UTAH DIVISION OF SOLID
AND HAZARDOUS WASTE
SMALL QUANTITY GENERATOR
COMPLIANCE EVALUATION FORM
Page 5 of 6
sPrLL RESPONSE (THESE RULES ARE FOUND rN R31s-e)
Take appropriate action to minimize threats to human health and the environment by notifying the Utah Siate Department of
Environmental Quality at [phone] or 1-800-572-6400 ( 24 hour number) if more than 1 Kg of acutely hazardous waste
or 100 Kg of hazardous waste or material which when spilled becomes hazardous waste, is spilled as specified in 40 CFR
261 .33(e). Notify the National Response Center when applicable and provide the appropriate information, listed in R315-9(c), in
the spillreport.
ACTION NEEDED:
usE AND MANAGEMENT OF CONTATNERS (THESE RULES ARE FOUND lN 40 CFR 265 SUBPART D
Hold Hazardous Wastes in containers that are in good condition.
Store hazardous wastes in containers that are compatible with the waste.
Keep hazardous waste containers in a completely closed condition, except when adding or removing wastes.
Do not open, handle or store containers of hazardous waste in a manner which may cause a release.
lnspect containers of hazardous waste at least weekly to look lor signs of leakage or deterioration. A log should be kept.
Do not store incompatible hazardous wastes in the same container.
Do not store hazardous wastes in containers that previously held an incompatible material without cleaning it first.
Separate incompatible hazardous wastes by means of a dike, berm or other method.
ACTION NEEDED:
PREPAREDNESS AND PREVENTION (THESE RULES ARE FOUND lN 40 CFR 265 SUBPART C)
You must operate your facility in such a manner that MINIMIZES the possibility of fire, explosion or any unplanned release.
You must have the following preparedness and prevention equipment unless the wastes' you stores do not pose the hazards
that the equipment is designed to respond to: lnternal communications or alarm capable of instruction, such as an intercom; A
device capable of summoning outside emergency assistance (such as a direct alarm to the fire department or a telephone);
portable fire extinguishers; water at adequate pressure and volume to supply fire fighting needs; Alarms and communication
devices accessible to personnel where they are handling hazardous wastes.
You must maintain and test where necessary all communication systems; fire, spill response, decontamination and protective
equipment.
You must maintain aisle space to allow unobstructed movement of personnel and emergency equipment
Make arrangements with local fire, police and hospitals to respond to emergency situations at your facility. Maintain
documentation ol notilication letters, responses or lack ol responses from these agencies.
Document refusals by authorities to emergency arrangements.
ACTION NEEDED:
LAND DISPOSAL RESTRICTIONS (LDR) (THESE RULES ARE FOUND IN 40 CFR 268.7(a)(4))
lf you treat your hazardous wastes to render them non-Land Disposal Restricted, you must develop and follow a written waste
analysis plan. This waste analysis plan must be based on a laboratory analysis of the waste, and must contain all necessary
elements, including frequency. The waste analysis plan must be submitted to the Executive Secretary of the Utah Solid and
Hazardous Waste Control Board at least 30 days prior to treatment.
Maintain an assessment of LDR status on file for each hazardous waste generated at the facillty.
A notice and certification that each waste is, either not land disposal restricted, or if it is restricted, that it is land disposable after
treatment, must accompany each manifested shipment of hazardous waste.
Maintain all LDR Documentation {or live years after the waste is shipped off site.
ACTION NEEDED:
R315.16 UNIVERSAL WASTES, FLUORESCENT LIGHT TUBES
Fluorescent light tubes must be recycled or disposed of hazardous waste. Any broken tubes must be managed as a hazardous
waste, but can still be recycled. Do not dispose of tubes in the regular trash or in the dumpster.
Label either the waste tubes or container holding the tubes as "UNIVERSAL WASTE- MERCURY CONTAININGLAMPS".
ACTION NEEDED:
R315.5.13 EXPORTS OF HAZARDOUS WASTE
R315.5.14 IMPORTS OF HAZARDOUS WASTE
usE AND MANAGEMENT OF TANK SYSTEMS (THESE RULES ABE FOUND lN 40 CFR 26s.2O1SUBPART J)
OTHER ACTIONS NEEDED:
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CONTAINER MANAGEMENT LOG
Date Inspectors
Name
Are containers
labeled with the
words
*HAZARDOUS
WASTE"T
Is accumulation
date marked on all
hazudous waste
containers and is
that date less than
180 old ?
Are hazwdous
waste containers
closed and are all
bungs and bung
rings secure?
Are all
Hazardous
waste
containers in
good
condition?
If any columns are marked
No,what was done to bring the
container into compliance?
Yes No Yes No Yes No Yes No
MANIFEST MANAGE,MENT LOG
Date Manifest
number
Total
Pounds of
Hazardous
Waste
(convert all
amounts to
pounds)
Generator copy
of manifest
signed by
transporter and
representative
from our
company
Land
Disposal
Restriction
certffication
(LDR) with
matching
manifest
number
Signed
copy from
disposal
facility
mailed
back to us
within 60
days
Are these
three
forms
stapled
together ?
If any columns are
marked NO, what is
being done to bring
manifest file into
compliance?
Total
Pounds
Yes No Yes No Yes No Yes No