DSHW-1991-001661 - 0901a0688013d13c

.(•'
y HERCULES
DSHW TN
1991.30304
i^ ••; J Hisrcules Aerospace Connpany
— Missiles, Ordnance and Space Group
••^): 2 7 /99j Bacchus Works
Magna, Utah 84044-0098
-A.-.'.::''--' ••!••--•:• ••'"• [phone]
November 8, 1991
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Dennis R. Downs, Director
Bureau of Solid and Hazardous Waste
Division of Environmental Health
288 North 1460 West
P.O. Box 16690
Salt Lake City, Utah 84116-0690
RE: Notification of Hazardous Waste Activity for Bishop's Storehouse
groundwater Momtoring Well
Dear Mr. Downs:
Attached is a Notification of Hazardous Waste Activity form. A new
groundwater monitoring well will be located at the "Bishop's Storehouse" site,
located at 3648 S.7200 W. The purge water fi-om the well will be the only
hazardous waste generated.
If you require any additional information please contact John Waugaman at
251-3302.
Sincerely,
E. R. Anderson, Manager
Environmental Engineering
and Compliance
ERA/JLWaugaman/sjw/BSPSTRHS.NOT
Attachment
cc: T. J. Winder
G. E. Gooch
S. J. Storrud
5111 NW
X1P2
X1P2
BW-1000'689 (Rev 2/88)
Please print or type with ELITE tyce (12 ch^Bers per inen) in the unshaded areas only Form Acprovea. OMB No. 2050-0023. BxDires 10-3C-i1
GSAfJo. 02-IS-EP.^-aT
United States Environmental Protection Agency
Washington. DC 20460
Notification of Hazardous Waste Activity
For Official Use Only
Please refer to the Instructions for
Filing Notification Dsfcre compietina
this term. The information requesrsa
here is reouired by law (Section 3010
of ttie Resource Conservation snd
Recovery Act).
Comments
Installation's EPA ID Number Approved
T.'A I C i
Date Received
(yr. mo. day)
. Name of nstai at on -J-S'^w*^^i^;-f»shJ.t'^>i''^"^^-^-i'i^^,-=*^''fr^^
b I li 0 S E
"• '"staiiation Mailing Address .'^mmssmmri^^^^ms^^mmmmmm^m
Street or P.O. Bex
OL XI I
City or Town State ZIP Code
M N 4 I 0
111. Location of Installation
Street or Route Number
4 I 8 2 ! 0 I (3
ZIP Code
Name and Title (last, first, and job title)
Phone Number
(area code and number)
A. Name of Installation's Legal Owner
Jl ^ H H I
B. Type of Ownership
(enter cade)
VI. Type of Regulated Waste Activity (Mark 'X' in ttie appropriate boxes. Refer to instructions.i "'jgg
A. Hazardous Waste Activitv B. Used Oil Fuel Activities
13 la.Generator El lb. Less than 1.CC0 i<gTno.
m 2. Transporter
C 3 Treater/Storer/Disposer
D 4. Underground Injection
n 5. Market or Burn Hazardous Waste Fuel
fenrer 'X' and mark appropriate boxes below)
• a. Generator Marketing to Burner
Q b. Other Marketer
n c. Burner
G'6. Off-Specificaticn Used Oil Fuel
• a. Gsnerator Marketing to Burner
Q b. Other Marketer
• c. Burner
D 7. Specification Used Oil Fuel Marketer (or On site Burner)
Who First Claims the Oil Meeis the Specification
Vll. Waste Fuel Burning: Type of Combustion Device (enter 'X' in all appropriate boxes to indicate type of combustion device(s)
in which hazardous waste fuel or oft-specification used oil fuel is burned. See instructions for definitions of combustion devices.)
C A. Utility Boiler C 3. Industrial Boiler C C. Ind'JStrial F'jrrace
VIII. Mode of Transportation (transporters only - enter 'X' in the appropriate box(es)
r A. Air O 3. Ran Z C, hic.nv/av LZ D. :V5te'- !Z E. C:he.- /scec:'
IX. First or Subsequent Notification -S^^
Mark 'X' in the apprcDnate oox to indicate .vhether this .3 /our installation s first notification of hazaraous 'waste activl^y or a suDsecuent
notification. If this is not your first notification, enter ycur :nstailation's EPA ID Number in the space provided below.
'irst Nctificaticn C 3. Suoseauen; 'Jctificaticn
(comolete ite^. C'l
l.nstail-itions EPA .D "i
EPA Form 5700-12 iHev. l0-53i Previou ; icition u ccr^.ete ^cr- -ue cn rever'^.e
X. Description of Hazardous Wastes (continued fram front)
A. Hazardous Wastes from Nonsp«elflc Sourc«s. Enter the tour-digit numtier from 40 CFR Part 261.31 for each listed hazardous waste
trom nonspecific sources your insteillation handles. Usa additional sheets if necessary.
F
1
0 0 1
7
2
F 0 0 2
8
••
.3 • •
F 0 0 3
9
4
F 0 0 5
10
5
11
5
12
B. Hazardou* Wastes from Speciflc Sources. Enter the four-digit number from 40 CFH Part 261.32 for each listed hazardous wasie
from specific sources your installation handles. Use additional sheets if necessary. .• • • • •
13
19
25
14
20
26
15
21
27
16
22
28
17
23
29
18
24
30
C. Commercial Chemical Product Hazardous Wastes. Enter the tour-digit number 40 CFR Part 261.33 for each chemical substance
your installation handles which may tM hazardous waste. Use additional sheets it necessary.
(TCA)31
U 2 2 6
37
43
(DCE)32
U 0 7
38
44
(TCE)33
U 2 2
39
45
34
40
46
35
41
47
36
42
48
D. Usted Infectlaus Wastes. Enter the four-digit number 40 CFR Part 261.34 for each hazardous waste from hospitals, vetennary hospitals.
or medical and research laboratories your installation handles. Use additional sheets if necessary.
49 50 51 52 53 54
E. Characteristics ot Nonllsted Hazardous Wastas. Mar^ 'X' in the txsxes corresponding to the charetctenstcs of nonlisted hazardous
wastes your installation handles. (See 40 CFR Parts 261.21 - 26t.24) ,
D 1. Ignitable
(D(XI1)
D 2. Con-osive
(D002)
3. Reactive
(D003)
D 4. Toxic
(DOOO)
I certify under penslty oflaw that I have personally examined and am familiar with the Information submitted In this
and all attached documents, and that based on my Inquiry ot those Individuals Immediately responsible for
obtaining the Information, I believe that the submitted Information Is true, accurate, and complete. I am aware
that there are significant penalties for submitting false Information, Including the possibility of fine and
Imprisonment.
Signature Name and Official Title (type or pnnt)
E. R. Anderson, Manager
Environmental Engineering/Compllanc
Date Signed
///z^/i I
Esitimated burden: Public reponing burden for this collection of Information Is estimated to be 3 tiours, Including time far
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of Information. Send camments regarding the burden estimate or any other aspect of this collection
of Information, Including suggestions for reducing this burden, to Chief. Information Policy Branch, PM-223, U.S.
Environmental Protection Agency, 401M St., S. W., Washington, D. C. 20460; and to the Office ot Information and Regulatory
Affairs, Office of Management and Budget, Washington, D.C. 20503.
EPA Form 8700-12 (Rev. 10-881 Previous edition is obsolete.