DSHW-2018-008706 - 0901a068808c6b8c

9/6/2018
"
RCRAlnfo Review Source Record
Div of Waste Management
and Radiation Control
Review Source Record 0~ tl1
AUG 2 8 2018
TPl/w-2/Jf8-(})870b
General Information
Received Date
08/28/2018
1. Reason for Submittal
Non-notifier Extract to Public?
Yes
Acknowledgement Flag
Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of time.
(Includes HSM activity) [~ource N]
2. Site ID
EPAID
UTROOOO 14548
3. Site Name
Name
Activity Location
UT
CVS Pharmacy #10927
4. Site Location
Street
Number
1982
Zip
84075
Street 1
West 1700 South
City; Town or Village
Syracuse
Street 2
State
UTAH
Country
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UNITED STATES
County State District
DAVIS
5. Site Mailing Address
Street Street 1 Street 2
Number CVS Drive MC2340
1
Zip City, Town or Village State
02895 Woonsocket RHODE ISLAND
Country
UNITED STATES
6. Site Land Type
Land Type
Private
7. North American Industry Classification System (NAICS)
Primary NAICS
446110 - PHARMACIES AND DRUG STORES
Other NAICS
8. Site Contact Person
First Name Middle Initial Last Name
Nicole Wilkinson
Title Email
Director, Corporate Environmental [e-mail]
Phone Number Extension Fax
401-770-1500
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8a. Site Contact Address
Street Street 1 Street 2
Number CVS Drive MC2340
1
Zip City, Town or Village State
02895 Woonsocket RHODE ISLAND
Country
UNITED STATES
9a. Legal Owner
Type Name Address Date
Private Utah CVS Pharmacy, L.L.C. 1 CVS Drive, Woonsocket, RI 02895 09/07/2016
9b. Legal Operator
Type Name Address Date
Private Utah CVS Pharmacy, L.L.C. 1 CVS Drive, Woonsocket, RI 02895 01/28/2018
10. Type of Federal Regulated Waste Activity
A. Hazardous Waste Activities
1. Generator of Hazardous 4. Treater, Storer, or Disposer 7. Exempt Boiler and / or
Waste (Federal) of Hazardous Waste Industrial Furnace
3 - Very Small Quantity None Selected None Selected
Generator
Generator of Hazardous Waste 5. Receives Hazardous Waste
(State) from Off-site
F - Same as federally defined None Selected
2-3. Other Generator Activities 6. Recycler of Hazardous
None Selected
Waste
None Selected
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B. Waste Codes for Federally Regulated Hazardous Wastes
A. Hazardous Waste Codes (Federal)
D-Codes:
D001 D002 D007 D010
P-Codes:
P001 P075
U-Codes:
U002 U129 U205
C. Waste Codes for State Regulated (non-Federal) Hazardous Wastes
B. Hazardous Waste Codes (State)
None Selected
11. Additional Regulated Waste Activities
A. Other Waste Activities
1. Transporter of Hazardous
Waste
None Selected
2. Underground Injection
Control
None Selected
3. United States Importer of
Hazardous Waste
None Selected
4. Recognized Trader
None Selected
5. Importer/Exporter of SLABs
None Selected
B. Universal Waste Activities C. Used Oil Activities
1. Large Quantity Handler 1. Used Oil Transporter 3. Off-Specification Used Oil
of Universal Waste None Selected Burner
None Selected None Selected
2. Used Oil Processor and / or
2. Destination Facility for Re-refiner 4. Used Oil Fuel Marketer
Universal Waste None Selected None Selected
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None Selected
D. State Activities
Your State does not have any State defined activities.
12. Eligible Academic Entities with Laboratories
1. Opting into or currently operating under 40 CFR Part 262 Subpart K for the management of hazardous
wastes in laboratories.
2. Withdrawing from 40 CFR Part 262 Subpart K for the management of hazardous wastes in laboratories.
No
13. Episodic Generation
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? lf "Yes", you must fill out
the Addendum for Episodic Generator.
No
14. LQG Consolidation of VSQG Waste
Are you an LQG notifying of consolidating VSQG hazardous waste under the control of the same person
pursuant to 40 CFR 262.17(f)?
No
15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) and Entire Facility
LQG Closure is not applicable when creating a new handler.
16. Notification of Hazardous Secondary Material (HSM) Activity
Are you reporting HSM activities?
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No
17. Electronic Manifest Broker
Are you notifying as a person, as defined in 40 CFR 260.10, electing to use the EPA electronic manifest
system to obtain, complete, and transmit an electronic manifest under a contractual relationship with a
hazardous waste generator?
No
18. Comments
Internal Comments
Public Comments
19. Certification
First Name M.I. Last Name Title Date Signed
John Koning Verisk 3E 08/28/2018
Approve Make Changes

Back to Pending Submissions (ftcrainfoprod/action/secured/myrcraid/submissions/pending)
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9/6/2U18 state ot Utah Mail - EPA lu Number

Carlee Christoffersen <[e-mail]>

EPA ID Number
1 message

Carlee Christoffersen <[e-mail]>
To: [e-mail]
Nicole,

Thu, Sep 6, 2018 at 5:24 PM
This is to acknowledge you have filed a RCRA Subtitle C Site Identification Form for waste generated at the following
address:
US PHARMACY #10927
1982 WEST 1.700 SOUTH
SYRACUSE, UT 84075
The EPA Identification Number for this site is UTR000014548.
The EPA Number 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 Number is site specific. If your company 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 site 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]
U I AH DiPA.4 t.
ANNIPNro ,a4l•
T.T.: MANAGEMENT
RA.OlATION 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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