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Home My WebLink AboutDSHW-2025-001475,n' OMB#: 205G0024 Expires 12€1€8 BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION I.ABEL OR ENTER: SITE NAME A AND E GENERATOR INC. 264 WEST 8OO SOUTH EPA|DNO. lU,r, Dl q3r5r 3t4t7r3r1gI U.S. ENVIRONMENTAL PROTECTION AGENCY 1987 Hazardous Waste Generation and Shipment Report IDENTIFICATION AND CERTIFICATION FORM slc WHO MUST COMPLETE THIS FORM? Form lC must be comploted by wery slte that rocolved thls packago. INSTRUCTIONS: Please read the detailed instructions beginning on page 8 of the 1987 Fhzardous Waste Generationand Shipment Report lnstructions booklei before completing this form. Completg Soqions I through lV and Sections Vl through lX immsdlately, Complete Saction V, certilication, after you have finished the tull roport package. SEC. l. Site name and physical location which may differ trom the mailing address. Complete items Athrough G. Mark [} lor items A, B, C, D, F, and G il same as label; il different, enter correclions. ll label is absent, enter information. A. Site/company nams same as rabet >trf A AND E GENERATOR , INC . Of -.+-raber n ru rTr D0 r3 r 5r 34 r7 r 3r1 r9 I C. Addrsse number and strect namo of physlcd locatlon Same as label n,-r 264 WEST 900 ot.< lf not lmown, cntcr lndustrlal perlq bulldlng namc or othcr phyalcal locatlon descrlption SOUTH SALT LAKE CITY, UTAH 84101 D. City, town, vlllagc, ctc. samc as labcl n sarrr LAKE OI -+ E. County SALT LAKE F. Statc Samc as labcl X or -...-.r I Ur Tl G. Zip Code Samc as labcl tr or-.-.-.-..-{, l8r4r1 r0r1l-r I I I I SEC. ll. Mailing address of site. Mark [| tor A, B, C, and D if same as label; if different, ontor corrections. A. Number and strce! IamG of mailing addrcss Samc as label tr or B. City, town, village-9t_c. Same as label - ffI OI --.+ C. Statc Samc as labcl E er---... I r I D. Zip Code Same as label t$ or--....< I t I I t t-t I I r I EPA Form 8700 - 13A ($80) (Rev. 1l€s) Revised (12-g7l SEC. III Name, title, and tolephone number of lho person who should b€ contacted if questlons arise regarding this report. A. Pleasc print: Last namc Flrct namc BILANZICH JERRY M.t. D B. Tltlc G.M. C. Tclcphonc l8r 0r1 I l3r2r8r-lBr 68r91 Extcnslonlfffl SEC. tv. Enter th€ Standard lndustrial Classilication (SlC) Code that describes the principal producis, group of products, produced or distributed, or the seMccs rendered at the site's physical location. Entsr more than one SIC Code only il no one industry description includes the comblned activities ol the sit€. SIC codes are listed beginning on page I of tho 1987 Hazardous Waste Generation, Shipment and Management Bepon Codebook. 17,5r3r9 I A. lrrrl B.c. lrrrl lrrrl D. Itrrl E. lrrrJ F. SEC V. I cortify undor ponalty ol law lhat I have personally examined and am familiar with the information submitiad ln this and all attached documents, and that basod on my inquiry of those lndividuals lmmediately responsible lor obtainlng the information, I believe that the submitted informaiion is tru€, accurate, and complote. I am aware that thare are rlgnlficant penaliles ior submltting false information, lncluding the possibility ol lineand imprisonmont. A. Please prlnt Last narnc Flrd namc JERRY D. BILANZTCH M.t.Tltlc GENERAL I\4ANAGER B. Signaturc fup Datc of signalurclr9t l'7t l8r8lMo. Dav Yr. Page 1 olry FORttlE SEC.vl.icY E NO - SKTPTOSECTTONVI. E YES - Didthisslto generateanyhazardouswasteduring 1987? EYEs-[Hgl^ffi$i,ffi H{i,hl#*e*m[ffi usn,ffi RI=ff NEff i3\fl ['-'#[ff3i]'1ii^3Tl El Category 1: More than 1000 kg (2,200 lb) in one or more months XI Category 2: More than 100 kg (220|b) but no more than 1(x)0 kg (2,200|b) in any single month ! Category 3: No more than 1(X) kg (220 lb) in any slngle month I Ma* X]it ttris slte changed lrom Category 1 to Category 2 or 3 due to waste minimization activity conducted during 1986 or 1987. El No - coNTtNUE BELovl/, MARK[XNpfi ToALLTHATAeeLv. I Generated, excluded or dellsted wastes fr Generatea hazardous waste prlor to 1987 but do not expect to generate in the luture - MARKmFOR REASON lN ONE BOX BELOW I Waste was lrom one:0me event(s) (e.g. spills, remedial actions, etc.] tr Waste minimization actlvlty undertaken during 1986 or 1987 I Out of business I Generated hazardous waste prlor to 1987 and oxpsc't to gonorato ln the future tr Never generated before but exp€ct to generate in tho future tr Never generated and do not expec.t to gonerato in tho futuro - MARK m FOR REASON lN ONE BOX BELOW E Protoctive notifier only tr Misunderstood the rsquirements tr tloufied lo socure tensportation servlces fl Oher Det-AlN REASON FOR GENEMTOR NOTIFIGATION lN COMMENTS SEC Does thls slte have RCRA lnterim Status or a BCRA permit to treat, store, or dispose hazardous waste? NO - SKTPTOSECTTONVII YES - Did the she lreat, store, or dlspose (t/S/D) hazardous waste ln RCM-regulated units during 1987? E YES - SKIP TO SECTTON Vil n No - coNTtNUE BELOW MARKmNEXTTOALLTHATapPLY tr T/S/D excluded waste during 1987 tr T/S/D hazardous wast€ in exempt units during 1987 tr T/Si/D hazardous wasre prlor to 1987 but did not T/s/D wasro durlng 1987. MARK m N ONE BOX BELOW I T/S/D will resumo in the future I Have notilied of planned closure El Site is in closure or post closure tr Never T/S/D hazardous waste prior to 1987 but MARKffi N ONE BOX BELOW El Expect to T/S/D hazardous waste in the future tr Do not exp€ct to T/VD hazardous waste in lhe luture . B(PIAIN REASON FOR INTER|M STATUS OR PERMIT lN COMMENTS tl xxltr- \ Do you wish to wlthdraw this slte's generator notification or EPA Part A permit application? Wthdraw generator notification Wthdraw Part A permit application No No sec. lDoes this site have an area not requiring a RCRA Part A or Part B permit that is used exclusively for the short term-lx laccumulation of hazardous waste? fINO fl YES --..-. DOES THE AREA HAVE: Containers tl No Tanks ffiYes ENTER THE NUMBER OF TANKS AND THEIR TOTAL CAPACIW IN GALLONS. ffiNo". SYes-l r r lNumber L r r I t r r t I lo"rron omments:1,987 from,Jan. to May, SOLVENT WAS DTSPOSED OF tsy EKO-TEK. SrNCE MAY, SOLVENT fS LEASED FROM SAFETY KLEEN, PTCKED UP AND RECYCLED ORDISTILLED. ALL SOLID WAST DEPOSED OF BY SAFETY KLEEN. Page 2 of