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Norman H. Bangerter
Governor
Suzanne Dandoy, M.D., M.P.H.
Executive Diree0or
Kenneth L Alkema
Director
DEPARTMENT OF HEALTH
DMSION OF EI\NIRONMENTAL HEALTH
Bureau of Solid & Hazardous Waste
288 North 1460 West, P.O. Box 16690
Salt Lake City, Utah 841 16-0690
[phone]
June 6, I 989
Sorenco A. Sorenson Company
2323 South hlest Temple
South Salt Lake, Utah 84115
Attn: Chri s ltloore, President
Oear Mr. Moore:
This is to acknowledge that you have filed a Notification of
Hazardous tdaste Activity.
Your EPA Identification Number is: UT0153967435.
The EPA Identification Number must be included on all shipping
manifests for transporting hazardous wastes; on all Biennial Reports
that 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 Solid and
Hazardous Waste Management Regulations (UH[I'IMR).
If you have any questions please contact Oelene Thomas at 538-6170.
/QdJnM
Brent C. Brad ford
Executi ve Sec reta ry
Utah Solid and Hazardous Wastes
Commi ttee
cc : Steve Burkett, U. S. Envi ronmenta J
Region VIII
Sincerely,
Protecti on AgercV,
united statss E$ifnt*:ffi,
r6it6"dtion
Aeency
\9EPA Notification of Hazardous Waste Activity
Please refer to the lnstructions for
F ilinq Notification before comoletinq
thrs form. The informatton requestedhere is required by law (Section
3Ol O of the Resource Conservation
and Recovery Act).
Comments
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lnstallation's EPA lD Number Approved
Data Receiv€d(yr. mo. daf)
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Streer or Route Number
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Citv or Town State ZIP Code
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6 S o u T +-l S A L 'r L A K €L 14 T I +I (
Name and Title llast. first. and iob title)Phone Nurnber brea code and number)
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2 It 0 o R E C il R 7 s P R E s n
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A. Name of lnstallation's Lesal Owner B. Tvoe of Ownershio lenter code)
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R s o f?E tv S o t\D E \/u L o P m E t\i d
I P
Vl. Tvoe of Reoulated Waste Activitv lMark'X' in the aoorooriate boxes. Reler to instructions.l
A. Hazardous Wastc Activitv B. Urcd Oil Fuol Activitics
E[ r a. Generator tr lb. Less than 1,0@ kg./mo.
E z. Transporter
fl g. Treater/Storer,/Disposer
fJ c. Underground lnjection
D S. Market or Burn Hazardous Wasra Fuel
(enter 'X' and mark appropriate boxes below)
D .. Generator Marketing to Burner
E u. other Marketer
[ .. Burner
C O. Off-Specification Used Oil Fuel
(enter 'X' and mar* appropriate boxes belowl
E .. Generator Marketing to Burner
D u. Other Marketer
fl .. Burner
I Z. Specification Used Oil Fuel Marke ter (or On site Eurner)
Who First Claims tho Oil Meets the Specification
Vl I . Wasta Fuel Burning: Type of Combustion Device lcntor 'x' in all apgropriatc boxes to indicatc typc ol combustion dcvica(s) in
which hazardous wasta luel or oll-specification uscd oil luel is burncd. See instructions lor definitions ol combustion devices.)
E e. utitity Boiter E A. lndustrial Boiler fJ c. lndustrial Furnace
Vlll. Mode of Transportalion (transoorters onlv - enter'X' in the aporooriate boxbs)
I e. nir f, B. Rait I c. Highway E o. water E e. other (specu)
Mark 'X' in lhe apptopriate box lo indicate whothsr this is your installation's tirst norirication of hazardous waste activity o. a subsequent
notification. ll this is not your first notilication, onter your installation's EPA lD Number in the space provided below.
[( n. First Notification tr B. Subsequent Notificataon (complete item C)
mber
t
Please print or type with ELITE type (12 charactars per inchl in rhe unshaded areaE only
Form Approvcd. OMB No. 2O5O-@28. Expires 9-30-88.
GSI No. O246-EPA-O|
tlsirL-'
EPA Form 87OO-12 (Rev. 11-851 Previous edirion is obsol€te.Continuo on revoruo
lD - For Official Use Only
escnDtron ol H azardous wastes conttnued trom tront
A. Hazardour Wa.t6. from Nonspecilic Sources. Enter the four-digir number lrom 40 CFR Part 26'l .31 for each lisled hazardous waste
from nonspecilic sources your installatlon hanoies. Use additional sheets il necessary.
B, Hrzardour Wartcr lrom Specilic Sourcer. Enter the four-digit number from 40 CFR Pan 261 .32 for each lisred hazardous wasre lrom
speciric sourco! your installation handlss. Uge additional Eheers i, noces&ary.
C. Commcrcirl Chemical Prcduct Hrrrrdour Wrtcr. Enter the four-digir number hom 40 CFR Part 26t.33 lor each chemical substancs
your installation handles which may bc a hazardous waste. Use additionEl sheels il necsssary.
D. Li.t d ln; ,ctiour W.d... Enter thc lour-digit number lrom & CFn Part 261.34 for cach hazardouE woste from hospitals, veterinary hos-
pitsls, or medical and resoarch laboratori$ your installation handlss. Uge addirional shcets il n€cassary.
E. Charactcristicr ol Nonlirtod Hazardour Wrrto. Mark 'X' in th. boros corresponding to the characeristics of nonlistod hazardous wastos
your installarion handles. (See ,00 CFA Parts 261.21 - 261.24)
I . lgnitable
(DOO| )
XI. Certification
I certify under penalty of law that I have personally examined and am familiar with the inlormation submitted in
this and all attached documents. and that based on my inquiry of those individuals immediately responsible for
obtaining the inf ormation, I believe that the submitted inlormation is true, accurate, and complete. I am aware that
there arg significant penahies for submittingtalse information. including the possihility of line and imprisonment.
Signat Name and Official Title (type or print)
c H (r sTo pH Et? 14oo R E
Date Signed
67F/57
1 1 -85) Revorsc }2K E ST- D EruT