DSHW-2025-001401

Norman H. Bangerter
t]tlrr,rno r
Suzanne Dandoy, 11 D. Itl.P.H
Execg1r.e [)ir.,( t()r
Kenneth L. Alkema
I )l rt'r'tor
DEPARTMENT OF HEALTH
DIVISION OF ENIVIRONMENTAL HEALTH
Bureau of Solid & Hazardous Waste
288 North 1 460 West. P O Box 16690
Salt Lake Crty, Utah 841 16-0690
iB01 ) 538-6170
Janua ry I 8, I 990
Rubber Eng i neeri ng
3459 South 700 hlest
Salt Lake City, Utah 84II9
Attn: Tom Dawson
Dea r Mr . Daws on :
This is to acknowledge that you
Not i f i cat i on of Ha za rdous Wa ste
have fi led a SubseguentActivity.
Your EPA Identification Number is UT00209.l0519.
The EPA Identjfication Number must be 'included on all shipping
manjfests 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 [daste Act
and the Utah Solid and Hazardous Waste Management Regulations
( UHTJMR ) .
If you have any questions please contact Oelene Thomas at
538-6r 70.
Sincerely,
IM
Dennis R. Downs
Exec ut i ve Sec reta ry
Utah Solid and Hazardous Wastes
Commi ttee
Steve Burkett, U,S. EnvironmentaJ Protection AgeflcV,
Region VIII
F
V
'a cEnTERAToR sTANDARDS
s-755
161:1921
Appendix-Form-Notilication of Hazardoue Vl'aste Actisity
EF.\ Fo:m 8700-12 iaevised 11/SJ)
) ?rq.ncr.rs tr,. hrrlt tA rt..r,^.rix4r.t .rL.rs ci,ry Form Afiu oy''tl oua uo zo5o ,o?e -';I1\irlitS,irir.,lrr 6rrrr .i?.tlF4 n':F tt-IIE l\.,,e, lt ) 7hlrilC?efS lr,,f htfl?1rtl ll.r. rrnlhit4r.rf afe.fs Cf'ly
rerE PA Notification of I'iazarctous Waste Activity
Un,tc:d Stirtr.g Lnvr: onmerrtol Prot-ec!rcn AEencyWarhrrrgron, DC 2O4tJ0
Plldse tetil to tne lnstruct:ons lor
F : I t ng Nol ; I tc it, on bef or I corr19161l69thrs lorm. Tne rnformatron reauestedFere rS rgCuried by iaw (SeUton30lO ol tlie Rescurce Consetyottonand Rer.avery Acti.
For Oificiai Use Onl
Ctlmments
liiitriliilriir
lnsrl.lat,on'S EeA lD Number;ffiffi
l. Name c.tf lnstallation
Dsie. Recerved
hr. mLl. daVl
!j. tnsgllation Mailing.Addresg i
StreetorPO Bort: t---l-3 J 4 5i9 si t i
Sta te ZIP Ccwie
ZIP Coce
I I , l. l, I
State
ly.l11slal I :r tio n C crr$g!
Trrffiil ;i;Fi .
li-cme and T,tre .'Iasl. lnrl. enC i Phorrg Nurntler (erea code and nunber)
're[l;T.,Tl;ffiV. Ownershi
ciI
FIB iGl la;i-T ,ffiFl ;Emi;A Narne ol lnstatla?ron's Leoal Owner
Vlr Tvpg-gf Beg boxe. s. Aeler to instuctiong
B. Uscd Oil Fucl Activiticr
El r a. Generalor
E a. Transpo*er -E e. Off-Soeoficar,on Uscd Orl Fuel
| (rnter 'X' and rnarh ,pgropt,atc botes betowl
I tr i. Generator Marhetrng to Eurrrer
l' Eu othertutarketer
E c. Eurnern 7. Sp".iftcation Used Oil tlel HarkeEerH
-
(Or On-Sit,e Br.rrrer) tlho First Clatms
tFE OiI lubeBs tjt SGctfication.
_ A.. Harerdo.qil{gt-g-A.ctivity -
El r b Less rhan t.OOO kg.,'mo
E g. Tr€ater,'srorer/Drsgose,
E o Underground lnlectron -' - .
E S. Marker or Burn Hazardous Waste Fuei(cnter'X' ancl mar.t apprcgrtatc boxes below)
E u. Other Markere r - :..-.
Vll. Wasts Fuel Eurning: Type of Combustion Device /carcr x'in al! rpgtogri.t. boxcstotdtc.rc trpc olcombusuon dcvic4slin
whrch harardous waste lucl or oll-spealicahoo used otl lucl is bwned. Scc instructtons lor clcl,nit,ons ol combustrcn davrccs.l
0 l.uritiry Bortcr . ' E B tndust,i.t gortcr E C. tndusrrat Furnaca
Vlll. Modc of Trang2oitallgnlqantplterc cnly - entet'X .boxles
E a. e,, D e Rart E c Hrghway E o. warsr E e. orher lsgccttyl
@ggwgnt NolrIseligl!
Ma,k 'X' r^ the appropiar? hor to rndrcatc whathe, thr3 ls your rnsttllaiton 3 iast nolrtrcatron ol harardou3 waslo aclrvrty o, ! 3ub3aquani
nolrtrcalron. ll th's rr not your lrrgl notrl;calron. rnler you, mslallatron's EPA lO Number rn th? sgaco grovdcd batow.
E A Frrst Noirf rc;ttron F g. Subsequent Norrftcat on (complewlem Cl
C. lnstatlatron's EPA lO Number
il
EPA Form 87OO-12 (Rev
12-2d-85
1 f -851 Prevrous edrlton rS Obsolete.
Publisheti by THE BUREAU OF NATIONAL AFFAIRS. lNC.. Washington, D.C.20037
Continw on filvcrr
[Editor's notel 121
/t
{
FEDERAL R EGUI-.ATIONS-161 :1922 {,
)"
lD - For Oflichl Ulc Only
escnptron ot Harardous Wsstes (conttnued lrom lronll
A, tlat.rdout Wutlr lrom l{onlDacitic Soulcar. EntG. tha tour.dieit numbc, Irom aO CFR ?tn 261.31 lor aach trsr.d h.r.r(bu3 w.rr!lrom lronspccrlrc soutcli your rn3rallat,on handlc3. Ulo addtronal shccfa i, naca$ary.
F I ol olt
8. Hr:rrdour Wria. ttom Sgccilit: Sourro. Crrrcr thc lour.dtgit oumbar ,tom .lO CfB Pan 261.32 lor mcn hrrcd h!:a.dou3 w.$3 trorn
t9acitrc rosrca3 you? in$tllat,or'r hrndlat. Usa addi$onal th'calt f naca3tary.
C. Commafci.l Ch.macal Producl Har.rdo6 W.ata.. Enta, rha rou?drett n:Jrnb.r lrom S CFR ?ln 261.33 loe r.ch chcmlcal 3ub3lracGyour rn3bllation htndlas whrch m.y ba r harar(bui warto. Utc rddrtronal ahaaf! i, naca3sary.
O. Lisl.d lntaciioua waata.. Entar tha tour.drglt nurnoar trom 10 CFR ha 261.34 to? aach hutrdoui ra3ta l?onr trosprlaii, vrlGfinrry lt6-
Irtal3. o, madrcal anal laiaarch laborltortas your matallatron htndla3. Uaa a(rdrtDnal 3haara tl nactr3ary.
E. Ch.nct rirticr o, llonlaatad llarardos! wa.t3a. La?l 'X' an tha bor.t corr.tpotiding to ihc charactarrnrcs ol aonh3tcd lr.ratdout h3Ll -your rn3urr.tron lr.ndl.r. lS.. Q CFR P.nt 26r.2, - 26t.21t lr. *!HRb.[frO
E[ t. rynnsbtc E 2. co.r*,r. El 3. R."o,'. EJ i. r"if, r""l0oo" lwJ2, lDoo3t @NOt
X. Cenrfication
I ceaily under penalty ol lew thet I htvc pcrsonally cramincd and am lamiliar with the inlormation submiaed in
this and atl attached documcnts. and thot bascd on my inquiry ol those iMividuels immcdiately responsibtc lor
obtaining the information, I believc that thc submitted inlormation is true, ,ccuzate, anc! cwnplete. I am awerc that
therc ere signilicaqt pena\i*tor submining lalsc inlormation, including the possibilitl ol linc and imgrisonincnt.
l{rmo rnd Ot{icid Tith {typo ot p?in0
t t-861 RrYurr
[Editor'r notel
Envrronment Reporter 122