DSHW-2025-001047

UTAIIEPARTM ENT OF ENVIRCIMENTAL OUALITY
DIVISION OF SOLID AND HMARDOUS WASTE
Dennls R. Downs. Dlrector
SQG Program
P. O Box 1/14880
salt Lake city, UT 84114-4880
(801)-538-6170
HAZARDOUS WASTE GENERATOR EVALUATION FORM
FacllitvName: fn+ Ar f Gq S EPAID NumberU-Tb {'q QOl Z tl L-J
Street Address,'3 L{ i'5 S 1o o tdc Ity suq 7tp Code:
County:3L Gontact Persont [3i tt frhnso n Phone Number: 2S 8 i' 5O rl
Generator Status: L6 SA. g
-
Number of Employeest 3 5 Date of vrslt: 6^L3 '- ci 8 Oloo
lnspectors, l{o P Kt Por^) E as
Other Personnel:
WASTE STREAM / GENERATION PROCESS GENERATION RATE
PER MONTH
HAZARDOUS
WASTE CODE
PROPERLY
MANAGED ?
Lrn',e- S iu ry.l / pll lL,q Sq )t, ooo ^a?n r\,o n-L Y-a-S
Qoes -to tje*{€-en Z {*'rto/1, #d
\Jl.x) t^.)Tr€c, *wr+^,t I
t$oYU- tA \z rr#
&, -? {^.J,lA t i ri"
Total Quantity of Hazardous
Waste Generated per Month:
8,@o*
P*\ A.-nl ,.r*lr71
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:
NaffiB, Printed:
Signature:
Title:
INSPECTOR:
Name, Print
Date:
Signature;
ult,
Page 2 of 6
(Examole) XYZ ee Trainin L
Date: April 9, 1997
Time: 10:00 am to 1l:00 am
Discussion lead by: John Doe, Health and Safety Coordinator
Topics discussed
I. 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."
I 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 problem.
m. Other topics as discussed.
a.
b.
Employee Name (Please Print)
1.
2.
3.
Ilmployee Signature
6THIS IS ONLY AN EXAMPLE AND MUST BE ADAPTED SPECIFICALLY TO
YOUR FACILMY AND TRAINING FORMAT.
\
OK 1.
Page 3 of 6
SMALL QUANTITY GENERATOR
COMPLIANCE EVALUATION FORM
Items that are marked "NO" on the line in the left-hand column are not in compliance with the Utah Solid and
Hazardous Waste Regulations and require your immediate attention. ltems marked "OK" meet the minimum requirements of the
regulations. hems marked "NA" do not appty to your facility.
H315.5.2 DETEBMINATION OF WHETHER A WASTE IS HAZARDOUS
ACTION NEEDED:
.xffi1l',X?sfff,;ilRo
ff''^
Otcq
Cc
ffi
86w
b.
R315-3 NOTIFICATION AND EPA HAZARDOUS WASTE IDENTIFICATION NUMBEHS:
lf you generate between 100 and 1000 Kgs (220-2200 pounds) of hazardous waste per month or up to 1 Kg ol acutely
hazardous wasle, you are classified as a Small Ouantity Generator (SOG), and you must notify the Executive Secretary ol
the Utah Solid and Hazardous Waste Control Board and obtain an EPA lD number. This is accomplished by notitying 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 ror management to
a lransporter or to a trealment, storage and disposal facility (TSDF) that has an EPA lD Number.
ACTION NEEDED:
R3.I5.5.4 MANIFESTS
Only use approved manilest lorm 87OO-22 and 8700-22A when otfering hazardous wastes for transport to a TSDF or use the
manifest ol the state thal the TSDF is located in, if required by that state.
Designate anolher lacility or instrucl a transporter to return wasles if they are undeliverable.
Fill out all applicable seclions of the manifest.
Use a conlraclual disposal agreement only il a generation rate is less than 1000 Kg/month (SQG or less).
Keep copies of conlractual agreements lor three years after service ends.
ACTION NEEDED:
3.
a.
b.
c.
d.
e.
4.H315.5.5 RECORD KEEPINGa. Keep copies of manifests lor three years.b. Keep all records, including determination ol generation rales, wasto characterization documentation, disposition, etc., lor three
years.
ACTION NEEDED:
Wu'u H315.5.7 EXCEPTION REPORTING
lf TSDF does not return generators' copy of manifest within
and a copy of the manifest to the Executive Secretary of the
ACTION NEEDED:
60 days, a generator must submit a letter stating so
Utah Solid and Hazardous Waste Control Board.
R315.5.9 PACKAGING, LABELING, MARKING AND PLACARDING
Package, Label and mark wasle in accordance with DOT 49 CFR prior to shipment.
ACTION NEEDED:
Ot< z.15tr a
b.
^J4NA
*0{^s
lrI-A s.AJ& h
c.
d.
e.
f.
R315.5.10 ACCUMULATION TIME
Do not store hazardous wastss for longer ihan 180 days, or 270 days if applicable, without a permit.
Do not exceed 6000 Kg ol hazardous wasles slored at your lacility at any time.
Mark the dale the accumulation period began on each container of hazardous wastes. Satellite accumulalion containers are
the exception.
Label each tank and container with lhe woTdS "HAZARDOUS WASTE" while it is being used to accumulale hazardous wastes.
Designate and authorize an €mergency coordinator(s) who is(are) readily available by some means at all times.
Post the following inlormation next lo each telephone at lhe lacility: Name and telephone number of lhe emergency
coordinator(s) location(s) of lire exinguishers, spill conlrol equipment and lire alarms, telephone number of the local fire
department (or equivalent emergency response lor facility).
Ensure that all employees are familiar whh hazardous waste handling and emergency procedures.
The emergency coordinator musl respond appropriately to emergencies thal have the potential of involving hazardous waste(s).
ACTION NEEDED:
Page 4 of 6
These are only examples that will help you comp$.with the regulations, you must ADAPT the following information
for and make it specific to YOUR facility.
SEE #lOe
Tod ay' s date
Letters to: Your
Your
Your
Hospital
local Police Department
local FiIe Department
Dear sir or Madame,
In accordance with 40 CFR 265 Subpart C, we are requirecl to notify you that we generate hazarclous waste(s). The
waste(s) that we generate is (are)...examples might be; paint wastes, paint sludges, Methyl Ethyl Ketone, Acetone,
other solvents, acids, bases, Iisted wastes, etc.
We make every effort to properly manage our waste, but in the event of an emergency we may require your assistance.
In the event of an unforseen emergency, would you be able to respond?
Your Name and Title
ABC Company
#7 e ancl 7f
I€ IN CASE OF EMERGENCY DIAL 91 1Ig EMERGENCY COORDINATOR IS CARL CAREFUL-
EXT. 2536[S FIRE EXTINGUISHERS' LOCATION MARKED ON
WALLrS SPILL CONTROL EQUIPMENT LOCATED AT TIME
CLOCK
UNIYERSAL WASTE,
MERCURY.CONTAINING
LAMPS
date
8t(re
6t( s.
6td-. a.
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O urAH DrvrsroN oFSoLrD O
AND HAZARDOUS WASTE
SMALL QUANTITY GENERATOB
COMPLIANCE EVALUATION FORM
Page 5 of 6
sPrLL FESPONSE TTHESE HULES AHE FOUND lN H31s-s)
Take appropriate aqtion to minimize thr€als lo human health and the environment by notilying the Utah Slat€ Department of
Environmental Quality at [phone] or 1€00-572-6400 ( 24 hour number) if more than 1 Kg ol acutely hazardous wasle
or 100 Kg of hazardous wast€ or material which when spilled becomes hazardous waste. is spilled as specilied in 40 CFR
261.33(e). Notify the National Response Center when applcable and provide the appropriate information, fsted in R315-9(c), in
the spill report.
ACTION NEEDED:
usE AND MANAGEMENT OF CONTAINERS CTHESE BULES ABE FOUND lN 40 CFH 26s SUBPAHT l)
HoH Hazardous Wasles in containers that are in good condilion.
Store hazardous wastes in containers that ar€ compatible with lhe waste.
Keep hazardous wasl€ containers in a completely cbsed condition, ercept when adding or removing wast€s.
Do not open. handle or store containers of hazardous wasle in a mann€r which may cause a release.
lnspect conlainers of hazardous waste at leasl weekly to look {or signs ol leakage or deterioration. A bg should be kept.
Do not store lncompatible hazardous wastes in the same contain€r.
Do not slore hazardous wasles ln containers that previously heH an incompatible material without cleaning it first.
Separate incompaible hazardous $/asl€s by means ol a dike, berm or other melhod.
ACTION NEEDED:
PREPABEDNESS AND PREVENTION TTHESE HULES AHE FOUND tN 40 CFR 26s SUBPABT C)
You must op€rato yourlaciEty in such a mannerthat MINIMZES the possibi[ty ol lire. explosion or any unplanned release.
You must havE the {olbwing preparedness and prevenlion equipment unless the wast€s' you stor€s do not pose lhe hazards
that the equipment is designed to respond to: lnternal communicalions or alarm capable of inslruction, such as an intercom; A
device capable ol summoning outside €m€rg€ncy assislance (such as a direct alarm lo the fire depanmenl or a telephone);
portable fire eAinguishers; wat€r al adequate pr€ssur€ and rrobme to supply fire fighting needs; Ahrms and communir=lion
devices accessible to personnel where they are handfing hazardous wast€s.
You musl maintain and t€sl where necessary all communication syslems; fire. spill response, decontamination and protective
equipment.
You must maintain aisle space lo allow unobstrucl€d movem€nt ol personnel and emergency equipment
Make arrangements with bcal lire, polce and hospitals to respond to em€rg€ncy situations at your lacifily. Maintain
documentation ol nolification letlers, responses or lack ol responses lrom these agencies.
Document refusals by authorities lo em€rgency arrangements.
ACTION NEEDED:
LAND DISPoSAL RESTRICTIoNS (LDR) CIHESE BULES ARE FoUND lN 40 cFR 268.7(a)(a))
ll you tr€at your hazardous wast€s to renderthem non-Land Disposal Restricted. you must develop and {olbw a wrinen waste
analysis phn. This waste analysis plan musl be based on a laboralory anatysis of the waste. and must conlain all necessary
elemenls, including frequency. The waste anatysis plan must be submitted to lh€ Executive Secretary of the Ulah SoH and
Hazardous Waste Control Board at l€ast 30 days priorto tr€alm€nt.
Maintain an assessment of LDR status on file lor each hazardous wast€ gen€rat€d al tho facifity.
A notice and certificalion that each waste ls. either not hnd disposal restricted, or il h is restricled. that it is hnd disposable after
treatm€nt, must accompany €ach manifested shipment of hazardous waste.
Maintain all LDR Documentation for {ive y€ars after the waste is shipped otf site.
ACTION NEEDED:
8315-15 UNMERSAL WASTES, FLUORESCENT LIGHT TUBES
Fhrorescenl tght tub€s must be recycled or disposed of hazardous wasta. Any broken tubes must be managed as a hazardous
waste. but can sill be recycled. Do nol dispose ol tubes in the regular trash or in the dumpster.
Label ehher th€ waste lub€s or container holding the tub€s as 'UNIVERSAL WASTE- MERCURY CONTAININGLAMPS-.
ACTION NEEDED:
R315.5.13 EXPORTS OF HAZABDOUS WASTE
R315.5.14 IMPORTS OF HAZAHDOUS WASTE
usE AND MANAGEMENT OF TANK SYSTEMS TTHESE FULES AHE FOUND tN 40 CFB 26s2O1 SUBPART J)
d.
c.
d.
e.
t
11.
a.
b
c.
d
12.
a.
b.
13.
a
14.
a.
15.
16.OTHER ACTIONS NEEDED:
Page e ,f iI
CONTAINER MANAGEMENT LOG
Date
If any columns are marked
NO,rvhat was done to bring the
conrainer into compliance?
Are hazardous
waste containers
closed and are all
bungs and bung
rings secure?
Are all
Hazardous
waste
containers in
good
condition?
Is accumulation
date marked on all
hazardous waste
containers and is
that date less than
180 old ?
Are containers
labeled with the
words
,,HAZARDOUS
WASTE''?
Inspectors
Name