DSHW-2025-001479

urAH OpanrMENT oF ENVTnoITENTAL euAury
DIVISION OF SOLID AND HAZARDOUS WASTE
Dennls R. Downs. Director
SQG Program
P. O Box 144880
salt Lake Gity, uT 84114-4880
(801)-538'6170
HAZARDOUS WASTE GENERATOR EVALUATION FORM
Facility Name:,.42fuztZ,za (*.2/--EPA ID Number A, TAaeA ./Z/?a/
Street Address:5za ZioCode= 9#rI
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Gounty:,fZ Contact person = .//"A / /4/ttl,tra// phone Number:
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Generator Status =1Fl4G Number of Employees Date of Visit:6-/0-?A
lnspectors: ,4e.zza, '1 - .2,';7a= -
Other Personnel:
WASTE STREAM / GENERATION PROCESS GENERATION RATE
PER MONTH
HAZARDOUS
WASTE CODE
PROPERLY
MANAGED ?
lhe/u .4pt '22/a*;/l zza/b/.ru figg-.ftarf
-f/o/, " {za,-z )fuzr/a2.?//
l-I
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Total Quantity of Hazardous
Waste Generated per Month:<,Zzo@
RESPONSE NEGESSARY, @ No RESPONSE DUE BY: 7-/O -7F
COMMENTS: E A,G '-6zgo
,?J '*5 'oO Z- (o -1
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-El!ilfElS
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:
Naffie, Printed:
Signature:
Title:
INSPECTOR:
Name, Printed
Signature:
Title:
/
Date= f- *F{Date:
Page 2 of 6
(Example)
Date: April 9, lggT
Time: 10:00 amto 11:00 am
Discussion lead by: John Doe, Health and Safety Coordiflator
Topics discussed
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 "Hazaxdous Waste."
Use and Management of Containers
a. Maintain a log weekly on the hazardous waste containers, are the containers closed,
ed, dated and in good condition. If not, please contact the emergency coordinator in order to
lem.
opics as discussed.
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Employee Name (Please Print)
1.
2.
3.
Emptoyee Signature
ISTHIS IS ONLY AN EXAMPLE AND MUST BE ADAPTED SPECIHCALLY TO
YOUR FACILITY AND TRAINING FORMAT.
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OIAH DrvrsroN oF solrD a Page 3 of 6
AND HAZARDOUS WASTE
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. hems marked "OK" meet the minimum requirements ol the
regulations. ltems marked "NA" do not apply to your facility.
R315.5.2 DETERMINATION OF WHETHER A WASTE IS HAZARDOUS
ACTION NEEDED:
-02 2.t b.
R315.3 NOTIFICATION AND EPA HAZARDOUS WASTE IDENTIFICATION NUMBERS:
lf you generate between 100 and 1000 Kgs (220-2200 pounds) of hazardous waste per month or up to 1 Kg ol acutely
hazardous waste, you are classified as a Small Quantity Generator (SOG), and you must notify the Executive Secretary of
the Utah Solid and Hazardous Waste Control Board and obtain an EPA lD number. This is accomplished by notifying 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 for management to
a transporter or to a treatment, storage and disposal facility (TSDF) that has an EPA lD Number.
ACTION NEEDED:
R315.5.4 MANIFESTS
Only use approved manifest lorm 87OO-22 and 87OO-22A when otfering hazardous wastes for transport to a TSDF or use the
manifest of the state that the TSDF is located in, if required by that state.
Designate another lacility or instruct a transporter to return wastes if they are undeliverable.
Fillout all applicable sections of the manifest.
Use a contractual disposal agreement only if a generation rate is less than 1000 Kg/month (SQG or less).
Keep copies of contractual agreements for three years after service ends.
ACTION NEEDED:
R315.5.5 RECORD KEEPING
Keep copies of manifestsforllEJ@
Keep all records, including determination of generation rates, waste characterization documentation, disposition, etc., lorthree
years.
ACTION NEEDED:
R315.5.7 EXCEPTION REPORTING
ll TSDF does not return generators' copy of manilest within 60 days, a generator must submit a letter stating so
and a copy of the manifest to the Executive Secretary of the Utah Solid and Hazardous Waste Control Board.
ACTION NEEDED:
R315.5.9 PACKAGING, LABELING, MARKING AND PLACARDING
Package, Label and mark waste in accordance with DOT 49 CFR prior to shipment.
ACTION NEEDED:
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R315.5.10 ACCUMULATION TIME
Do not store hazardous wastes for longer than 180 days, or 27O days if applicable, without a permit.
Do not exceed 6000 Kg ol hazardous wastes stored at your facility at any time.
Mark thejlelglhe accumulation period began on each container of hazardous wastes. Satellite accumulation containers are
the exception.
Label each tank and container with the words "HAZARDOUS WASTET while it is being used to accumulate hazardous wastes.
Designate and authorize an emergency coordinator(s) who is(are) readily available by some means at all times.
Post the following inlormation nelt to each telephone at the facility: Name and telephone number of the emergency
coordinator(s) location(s) of lire extinguishers, spill control equipment and lire alarms, telephone number of the local fire
department (or equivalent emergency response lor facility).
Ensure that all employees are familiar with hazardous waste handling and emergency procedures.
The emergency coordinator must respond appropriately to emergencies that have the potential of invoMng hazardous waste(s).
ACTION NEEDED:
Page 4 of 6
These are only examples that will help you comply with the regulations, you
for and make it specific to YOUR facility.
t
st ADAPT the following information
SEE #10e
Today's date
Letters to: Your Hospital
Your local Police Department
Your local File Department
Dear sir or Madaffie,
In accordance with 40 CFR 265 Subpart C, we are required to notiff you that we generate hazardous 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, listed wastes, etc.
We make ovory 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
UNIVERSAL WASTE
MERCURY.CONTAINING
LAMPS
date
o
mu
l*7 e and 7f
!S IN CASE OF EMERGENCY DIAL 91 1ra EMERGENCY COORDINATOR IS CARL CAREFUL.
EXT. 2536!s FIRE EXTINGUISHERS' LOCATION MARKED ON
WALLIg SPILL CONTROL EQUIPMENT LOCATED AT TIME
CLOCK
?o, DrvrsroN oFsoLrD Page 5 of 6
AND HAZARDOUS WASTE
SMALL QUANTITY GENERATOR
COMPLIANCE EVALUATION FORM
-d ,. sprLL RESpoNsE (THEsE RULES ARE FouND rN R31s-s)rU a. Take appropdate action to minimize threats to human health and the environment by notifying the Utah State Department of
Environmental Quality at [phone] or 1{00-572-6400 (24 hour number) if more than 1 Kg of acutely hazardous waste
or 100 Kg of hazardous wast6 or material which when spilled becomes hazardous waste, is spilled as specified in 40 CFR
261 .33(e). Notify the National Response Center when applicable and provide the appropriate information, listed in R315-9(c), in
the spillreport.
ACTION NEEDED:
L USE AND MANAGEMENT OF CONTATNERS (THESE RULES ARE FOUND tN 40 CFR 265 SUBPART l)a. Hold Hazardous Wastes in containers that are in good condition.b. Store hazardous wastes in containers that are compatible with the waste.4+f""p n-"rO"rr*"q Do not open, tranclle or store containers of hazardo0s waste in a manner which may cause a release.
@i hsoec.t qontqiners nf hazafdous :rvaste at least weekly to look.fgr signs of leakage or deterioration. A loq should be kept..-T. Do not store incompatible hazardous wastes r-rn the same container.g. Do not store hazardous wastes in containers that previously held an incompatible material without cleaning it first.h. Separate incompatible hazardous wastes by means of a dike, berm or other method.
ACTION NEEDED"
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PREPAREDNESS AND PREVENTION (THESE RULES ARE FOUND lN 40 CFR 265 SUBPART C)
You must operate your facility in such a manner that MINIMIZES the possibility of fire, explosion or any unplanned release.
You must have the following preparedness and prevention equipment unless the wastes' you stores do not pose the hazards
that the equipment is designed to respond to: lnternal communications or alarm capable ol instruction, such as an intercom; A
device capable of summoning outside emergency assistance (such as a direct alarm to the fire department or a telephone);
portable fire eXinguishers; water at adequate pressure and volume to supply fire fighting needs; Alarms and communication
devices accessible to personnel where they are handling hazardous wastes.
You must maintain and test where necessary all communication systems; fire, spill response, decontamination and protective
equipment.
You must maintain aisle space to allow unobstructed movement of personnel and emergency equipment
Make arrangements with local fire, police and hospitals to respond to emergency situations at your facility. Maintain
documentation of notilication letters, responses or lack of responses from these agencies.
Document refusals by authorities to emergency arrangements.
ACTION NEEDED:
LAND DISPOSAL RESTRICTIONS (LDR) (THESE RULES ARE FOUND lN 40 CFR 268.7(aX4))
ll you treat your hazardous wastes to render them non-Land Disposal Restricted, you must develop and lollow a written waste
analysis plan. This waste analysis plan must be based on a laboratory analysis of the waste, and must contain all necessary
elements, including frequency. The waste analysis plan must be submitted to the Executive Secretary of the Utah Solid and
Hazardous Waste Control Board at least 30 days prior to treatment.
Maintain an assessment o, LDR status on file for each hazardous waste generated at the facility.
A notice and certification that each waste is, either not land disposal restricted, or if it is restricted, that it is land disposable after
treatment, must accompany each manifested shipment of hazardous waste.
Maintain all LDR Documentation lor five years after the waste is shipped otf site.
ACTION NEEDED:
R315.16 UNIVERSAL WASTES, FLUORESCENT LIGHT TUBES
Fluorescent light tubes must be recycled or disposed ol hazardous waste. Any broken tubes must be managed as a hazardous
waste, but can still be recycled. Do not dispose of tubes in the regular trash or in the dumpster.
Label either the waste tubes or container holding the tubes as "UNIVERSAL WASTE- MERCURY CONTAININGLAMPS".
ACTION NEEDED:
R315.5.13 EXPORTS OF HAZARDOUS WASTE
R315.5.14 IMPORTS OF HAZARDOUS WASTE
usE AND MANAGEMENT OF TANK SYSTEMS (THESE RULES ARE FOUND lN 40 CFR 26s.2O1SUBPART J)
OTHER ACTIONS NEEDED:
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Page 6 of 6
CONTAINER MANAGEMENT LOG
Date Inspectors
Name
Are containers
labeled with the
words
"HAZARDOUS
WASTE"?
Is accumulation
date marked on all
hazwdous waste
containers and is
that date less than
180 old ?
Are hazardous
waste containers
closed and are all
brurgs and bung
rings secure?
Are all
Hazardous
waste
containers in
good
condition?
If any columns are marked
No,what was done to bring the
container into compliance?
Yes No Yes No Yes No Yes No