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Home My WebLink AboutDSHW-2016-008565 - 0901a0688061f515OMB#: 2050-0024 Expires 12/31/2015 Of/ */-■?-iw Div of Waste Management and Radiation PnntrnlSEND THE COMPLETED FORM TO: The Appropriate State or Regional Office United States Environmental Protection Agency RCRA SUBTITLE C SITE IDENTIFICATION FORM FEE 2 3 [m) iw*0 1. Reason for Submittal MARK ALL BOX(ES) THAT APPLY Reason for Submittal: G To provide initial notification (to obtain an EPA ID Number for hazardous waste, universal waste, or used oil activities). H To provide subsequent notification (to update site identification information). G As a component of a First RCRA Hazardous Waste Part A Permit Application. 0 As a component of a Revised RCRA Hazardous Waste Part A Permit Application (Amendment #). 8 As a component of the Hazardous Waste Report (If marked, see sub-bullet below) H 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 report year (or State equivalent LQG regulations) 2. Site EPA ID Number EPA ID Number: UTD009081357 3. Site Name Name: ATK LAUNCH SYSTEMS INC. - PROMONTORY 4. Site Location information Street Address:9160 N. HWY 83 City, Town, or Village: BRIGHAM CITY State: UT Country: us County: BOX ELDER Zip Code: 84302- 5. Site Land Type [^Private [] County [] District □ Federal [] Tribal □ Municipal [] State [] Other 6. NAICS Code(s) for the Site (at least 5-digit codes) 336414 C. B.336415 D. 7. Site Mailing Address Street or P.O. Box:PO BOX 707 M/S 301 City, Town, or Village: BRIGHAM CITY State: UT Country: US Zip Code: 84302- 8. Site Contact Person First Name: BLAIR Ml: G Last:PALMER Title: ENVIRONMENTAL ENGINEER Street or P.O. Box: PO BOX 707 M/S 301 City, Town, or Village: BRIGHAM CITY State: UT Country:US Zip Code: 843 02- EmaM. BLAIR.PALMER@ORBITALATK.COM Phone:(435)863-2430 Ext:Fax: (435)863-4037 9. Legal Owner and Operator of the Site A Name of Site's Legal Owner: ORBITAL ATK Date Became 02/09/2015 Owner: Owner Type:Private []County Q District [] Federal []Tribal □Municipal □ State □Other Street or P.O. Box: 45101 WARP DRIVE City, Town, or Village: DULLES State: VA Country: US B. Name of Site's Operator: ATK LAUNCH SYSTEMS, INC Phone:(703)406-5000 Zip Code: 20166- Date Became 04/20/2001 Operator: Operator Type:H Private □ County □ District □ Federal □Tribal □Municipal □ State □ Other EPA Form 8700-12, 8700-13 A/B, 8700-23 (Revised 12/2012 )Page 1 of fL EPA ID Number UTD009081357 OMB#: 2050-0024 Expires 12/31/2015 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;Complete all parts for Items 1 through 7. Y £T] | 1. Generator of Hazardous Waste If "Yes'' mark only one of the following - a, b, or c. jX] a. LQG: Generates, in any calendar month, 1,000 kg/mo (2,200 lbs./mo.) or more of hazardous waste; or Generates, in any calendar month, or accumulates at any time, more than 1 kg/mo (2.2 lbs./mo) of acute hazardous waste; or Generates, in any calendar month, or accumulates at any time, more than 100 kg/mo (220 lbs./mo) of acute hazardous spill cleanup material. Y E N Q 2. Transporter of Hazardous Waste If “Yes”, mark all that apply. m Transporter EH Transfer Facility Y S N EH 3. Treater, Storer, or Disposer of Hazardous Waste (at your site) Note: A hazardous waste permit is required for these activities □ b. SQG: 100 to 1,000 kg/mo (220 - 2,200 lbs.) of non-acute hazardous waste | | c. CESQG: Less than 100 kg/mo (220 lbs./mo) of non-acute hazardous waste yd m YEH NE 4. Recycler of Hazardous Waste (at your site) Note: A hazardous waste permit may be required for this activity. 5. Exempt Boiler and/or Industrial Furnace If “Yes” above, indicate other generator activities. Y| | n[X~| d- Short-Term Generator (generate from a short-term or one time event and not from on-going processes). If “Yes”, provide an explanation in the Comments section. YEH nE e. YD NS f- United States Importer of Hazardous Waste Mixed Waste (hazardous and radioactive) Generator | | a. Small Quantity On-site Burner Exemption | | b. Smelting, Melting, Refining Furnace Exemption Y EH N E 6. Underground Injection Control Y E N EH 7. Receives Hazardous Waste from Off-site B. Universal Waste Activities Complete all parts 1 - 2.C. Used Oil Activities -Complete all parts 1-4. Yl—I NfXl "*■ Large Quantity Handler of Universal Waste (you ■—■ '—‘ accumulate 5,000 KG or more) [refer to your State regulations to determine what is regulated]. Indicate types of universal waste managed at your site. If "Yes”, mark all that apply. Mahaae or Accumulate a. Batteries b. Pesticides c. Mercury containing equipment d. Lamps e. Other ____________________ f. Other ____________________ g. Other ____________________ □□□□□□□ Y| | NpC~| 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this activity. Y| | n|X| 1. Used Oil Transporter If "Yes’, mark all that apply. | | a. Transporter | | b. Transfer Facility YEH N0 2. Used Oil Processor and/or Re-refiner - if "Yes", mark all that apply. □ □ a. Processor b. Re-refiner Y| | Nfx| 3. Off-Specification Used Oil Burner yEH N [X] 4. Used Oil Fuel Marketer If "Yes", mark all that apply. I I 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 (Revised 12/2012 )Page 2 of EPA ID No. UTD009081357 OMB#: 2050-0024 Expires 12/31/2015 D. Eligible Academic Entities with Laboratories—Notification for opting into or withdrawing from managing laboratory hazardous wastes pursuant to 40 CFR Part 262 Subpart K ❖ You must check with your State to determine if you are eligible to manage laboratory hazardous wastes pursuant to 40 CFR Part 262 Subpart K [] 1. Opting into or currently operating under 40 CFR Part 262 Subpart K for the management of hazardous wastes in laboratories See the item-by-item instructions for definitions of types of eligible academic entities. Mark all that apply: [] a. College or University []b. Teaching Hospital that is owned by or has a formal written affiliation agreement with a college or university Qc. Non-profit Institute that is owned by or has a formal written affiliation agreement with a college or university [] 2. Withdrawing from 40 CFR Part 262 Subpart K for the management of hazardous wastes in laboratories 11. Description of Hazardous Wastes A. 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 D003 D005 D006 D007 DO 08 D009 D010 D011 D018 D019 D021 D022 D028 D030 D035 D036 D038 D039 D040 D042 F001 F002 F003 F005 K044 P022 P029 P030 P048 P077 P104 P105 P106 U002 U011 U031 U041 U048 U056 U069 U080 U088 U102 U103 U105 U106 U112 U122 U138 U154 U159 U161 U188 U220 U2!!3 U226 U239 B. Waste Codes for State-Regulated (i.e., non-Federal) Hazardous Wastes. Please list the waste codes of the State-Regulated 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 (Revised 12/2012 Page 3 of iL EPAID No. UTD009081357 OMB#: 2050-0024 Expires 12/31/2015 12. Notification of Hazardous Secondary Material (HSM) Activity yd m Are you notifying under 40 CFR 260.42 that you will begin managing, are managing, or will stop managing hazardous secondary material under 40 CFR 261.2(a)(2)(ii), 40 CFR 261.4(a)(23), (24), or (25)? If “Yes”, you must fill out the Addendum to the Site Identification Form: Notification for Managing Hazardous Secondary Material. 13. Comments BLAIR.PALMER@ORBITALATK.COM 14. Certification. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision 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 gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are signifigant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. For the RCRA Hazardous Waste Part A Permit Application, all owner(s) and operator(s) must sign (see 40 CFR 270.10(b) and 270.11). Signature of owner, operator, or an authorized representative b erp/'—~ Name and Official Title (type or print)D. Date Signed (mm-dd-yyyy) GEORGE E GOOCH 02/22/2016 MANAGER, ENVIRONMENTAL SERVICES EPA Form 8700-12, 8700-13 A/B, 8700-23 (Revised 12/2012 )Page 4 of ^4