CAFB HW Report 2021.pdf

EPA Form 8700 12, 8700 13 A/B, 8700 23 Page __ of __

United States Environmental Protec on Agency

RCRA SUBTITLE C SITE IDENTIFICATION FORM

City, Town, or Village County

State Country Zip Code

La tude Longitude

2. Site EPA ID Number

� Obtaining or upda ng an EPA ID number for on going regulated ac vi es (Items 10 17 below) that will con nue for a period of me.

� Submi ng as a component of the Hazardous Waste Report for __________ (Repor ng Year)

� No fying that regulated ac vity is no longer occurring at this Site

� Obtaining or upda ng an EPA ID number for conduc ng Electronic Manifest Broker ac vi es

� Submi ng a new or revised Part A (permit) Form

� Site was a TSD facility, a reverse distributor, and/or generator of 1,000 kg of non acute hazardous waste, > 1 kg of acute hazardous waste, or > 100 kg of acute hazardous waste spill cleanup in one or more months of the repor ng year (or State equivalent LQG regula ons)

1. Reason for Submi al (Select only one.)

7. North American Industry Classi ca on System (NAICS) Code(s) for the Site (at least 5 digit codes)

3. Site Name

4. Site Loca on Address

6. Site Land Type

� Private � County � District � Federal � Tribal �Municipal � State � Other

A. (Primary) C.

B. D.

5. Site Mailing Address

Street Address

State Country Zip Code

City, Town, or Village

� Same as Loca on Street Address

Street Address

� Use Lat/Long as Primary Address

OMB# 2050-0024; Expires 04/30/2024

✔ 2021

N M 7 5 7 2 1 2 4 4 5 4

27 SOW AFSOC USAF CANNON AFB NM

100 AIR COMMANDO WAY

CANNON AFB Curry

NM US 88103

34.39831 -103.32175

100 AIR COMMANDO WAY STE 100

CANNON AFB

NM CURRY 88103

92811

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First Name MI Last Name

Title

Street Address

State Country Zip Code

Email

Phone Ext Fax

City, Town, or Village

8. Site Contact Informa on

Owner Type

� Private � County � District � Federal � Tribal �Municipal � State � Other

Street Address

City, Town, or Village

State Country Zip Code

Email

Phone Ext Fax

Comments

9. Legal Owner and Operator of the Site

A. Name of Site’s Legal Owner

B. Name of Site’s Legal Operator

EPA ID Number

Full Name Date Became Operator (mm/dd/yyyy)

Operator Type

� Private � County � District � Federal � Tribal �Municipal � State � Other

Street Address

City, Town, or Village

State Country Zip Code

Email

Phone Ext Fax

Comments

� Same as Loca on Address

� Same as Loca on Address

� Same as Loca on Address

Full Name Date Became Owner (mm/dd/yyyy)

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

BRITTNEY T LYTLE

HAZARDOUS WASTE PROGRAM MANGER

402 S CHINDIT BLVD. BLDG 102

CANNON AFB

NM CURRY 88103

brittney.lytle.1@us.af.mil

575-904-6734

UNITED STATES AIR FORCE

100 AIR COMMANDO WAY

CANNON AFB

NM US 88103

UNITED STATES AIR FORCE

100 AIR COMMANDO WAY

CANNON AFB

NM US 88103

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10. Type of Regulated Waste Ac vity (at your site) Mark “Yes” or “No” for all current ac vi es (as of the date submi ng the form); complete any addi onal boxes as instructed.

A. Hazardous Waste Ac vi es

� Y � N 1. Generator of Hazardous Waste—If “Yes”, mark only one of the following—a, b, c

� a. LQG Generates, in any calendar month, 1,000 kg/mo (2,200 lb/mo) or more of non acute hazardous waste (includes quan es imported by importer site); or Generates, in any calendar month, or accumulates at any me, more than 1 kg/mo

(2.2 lb/mo) of acute hazardous waste; or Generates, in any calendar month or accumulates at any me, more than 100 kg/mo

(220 lb/mo) of acute hazardous spill cleanup material.

� b. SQG 100 to 1,000 kg/mo (220 2,200 lb/mo) of non acute hazardous waste and no more than 1 kg (2.2 lb) of acute hazardous waste and no more than 100 kg (220 lb) of any acute hazardous spill cleanup material.

� c. VSQG Less than or equal to 100 kg/mo (220 lb/mo) of non acute hazardous waste.

� Y � N 2. Short Term Generator (generates from a short term or one me event and not from on going processes). If “Yes”, provide an explana on in the Comments sec on. Note: If “Yes”, you MUST indicate that you are a Generator of Hazardous Waste in Item 10.A.1 above.

� Y � N 3. Treater, Storer or Disposer of Hazardous Waste—Note: Part B of a hazardous waste permit is required for these ac vi es.

� Y � N 5 Recycler of Hazardous Waste

� a. Recycler who stores prior to recycling

� b. Recycler who does not store prior to recycling

� Y � N 6. Exempt Boiler and/or Industrial Furnace—If “Yes”, mark all that apply.

� a. Small Quan ty On site Burner Exemp on

� b. Smel ng, Mel ng, and Re ning Furnace Exemp on

� Y � N 4. Receives Hazardous Waste from O site

EPA ID Number

B. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes handled at your site. List them in the order they are presented in the regula ons (e.g. D001, D003, F007, U112). Use an addi onal page if more spaces are needed.

C. Waste Codes for State Regulated (non Federal) Hazardous Wastes. Please list the waste codes of the State hazardous wastes handled at your site. List them in the order they are presented in the regula ons. Use an addi onal page if more spaces are needed.

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D001

D002

D003

D005

D006

D007

D008

D009

D010

D011

D018

D023

D035

D040

F001

F002

F003

F005

F006

P001

P075

3 6

� Y � N 2. Underground Injec on Control

� Y � N 4. Recognized Trader—If “Yes”, mark all that apply.

� a. Importer

� b. Exporter

� Y � N 5. Importer/Exporter of Spent Lead Acid Ba eries (SLABs) under 40 CFR 266 Subpart G—If “Yes”, mark all that apply.

� a. Importer

� b. Exporter

EPA ID Number

11. Addi onal Regulated Waste Ac vi es (NOTE: Refer to your State regula ons to determine if a separate permit is required.)

B. Universal Waste Ac vi es

� Y � N 1. Large Quan ty Handler of Universal Waste (you accumulate 5,000 kg or more) If “Yes” mark all that apply. Note: Refer to your State regula ons to determine what is regulated.

� a. Ba eries

� b. Pes cides

� c. Mercury containing equipment

� d. Lamps

� f. Other (specify) ______________________________________________

� e. Aerosol Cans

� g. Other (specify) ______________________________________________

� Y � N 2. Des na on Facility for Universal Waste Note: A hazardous waste permit may be required for this ac vity.

C. Used Oil Ac vi es

� Y � N 1. Used Oil Transporter—If “Yes”, mark all that apply.

� a. Transporter

� b. Transfer Facility (at your site)

� Y � N 2. Used Oil Processor and/or Re re ner—If “Yes”, mark all that apply.

� a. Processor

� b. Re re ner

� Y � N 3. O Speci ca on Used Oil Burner

� Y � N 4. Used Oil Fuel Marketer—If “Yes”, mark all that apply.

� a. Marketer Who Directs Shipment of O Speci ca on Used Oil to O Speci ca on Used Oil Burner

� b. Marketer Who First Claims the Used Oil Meets the Speci ca ons

A. Other Waste Ac vi es

� Y � N 3. United States Importer of Hazardous Waste

� Y � N 1. Transporter of Hazardous Waste—If “Yes”, mark all that apply.

� a. Transporter

� b. Transfer Facility (at your site)

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12. Eligible Academic En es with Laboratories—No ca on for op ng into or withdrawing from managing laboratory hazardous wastes pursuant to 40 CFR Part 262, Subpart K.

� Y � N A. Op ng into or currently opera ng under 40 CFR Part 262, Subpart K for the management of hazardous wastes in laboratories— If “Yes”, mark all that apply. Note: See the item by item instruc ons for de ni ons of types of eligible academic en es.

� 1. College or University

� 2. Teaching Hospital that is owned by or has a formal wri en a lia on with a college or university

� 3. Non pro t Ins tute that is owned by or has a formal wri en a lia on with a college or university

EPA ID Number

� Y � N Are you an LQG no fying of consolida ng VSQG Hazardous Waste Under the Control of the Same Person pursuant to 40 CFR 262.17(f)? If “Yes”, you must ll out the Addendum for LQG Consolida on of VSQG hazardous waste.

� Y � N LQG Site Closure of a Central Accumula on Area (CAA) or En re Facility.

A. � Central Accumula on Area (CAA) or � En re Facility

B. Expected closure date: ____________ mm/dd/yyyy

C. Reques ng new closure date: ____________ mm/dd/yyyy

D. Date closed : ____________ mm/dd/yyyy � 1. In compliance with the closure performance standards 40 CFR 262.17(a)(8) � 2. Not in compliance with the closure performance standards 40 CFR 262.17(a)(8)

14. LQG Consolida on of VSQG Hazardous Waste

15. No ca on of LQG Site Closure for a Central Accumula on Area (CAA) (op onal) OR En re Facility (required)

� Y � N Are you an SQG or VSQG genera ng hazardous waste from a planned or unplanned episodic event, las ng no more than 60 days, that moves you to a higher generator category. If “Yes”, you must ll out the Addendum for Episodic Generator.

13. Episodic Genera on

D. Pharmaceu cal Ac vi es

� Y � N 1. Opera ng under 40 CFR Part 266, Subpart P for the management of hazardous waste pharmaceu cals—if “Yes”, mark only one. Note: See the item by item instruc ons for de ni ons of healthcare facility and reverse distributor.

� a. Healthcare Facility

� b. Reverse Distributor

� Y � N 2. Withdrawing from opera ng under 40 CFR Part 266, Subpart P for the management of hazardous waste pharmaceu cals. Note: You may only withdraw if you are a healthcare facility that is a VSQG for all of your hazardous waste, including hazardous waste pharmaceu cals.

� Y � N B. Withdrawing from 40 CFR Part 262, Subpart K for the management of hazardous wastes in laboratories.

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EPA ID Number

18. Comments (include item number for each comment)

19. Cer ca on I cer fy under penalty of law that this document and all a achments were prepared under my direc on or su pervision in accordance with a system designed to assure that quali ed personnel properly gather and evaluate the informa on submi ed. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gath ering the informa on, the informa on submi ed is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are signi cant penal es for submi ng false informa on, including the possibility of nes and imprisonment for knowing viola ons. Note: For the RCRA Hazardous Waste Part A permit Applica on, all owners and operators must sign (see 40 CFR 270.10(b) and 270.11).

Signature of legal owner, operator or authorized representa ve Date (mm/dd/yyyy)

Printed Name (First, Middle Ini al Last) Title

Email

Signature of legal owner, operator or authorized representa ve Date (mm/dd/yyyy)

Printed Name (First, Middle Ini al Last) Title

Email

17. Electronic Manifest Broker

� Y � N Are you no fying as a person, as de ned in 40 CFR 260.10, elec ng to use the EPA electronic manifest sys tem to obtain, complete, and transmit an electronic manifest under a contractual rela onship with a haz ardous waste generator?

16. No ca on of Hazardous Secondary Material (HSM) Ac vity

� Y � N Are you no fying under 40 CFR 260.42 that you will begin managing, are managing, or will stop managing hazardous secondary material under 40 CFR 260.30, 40 CFR 261.4(a)(23), (24), (25), or (27)? If “Yes”, you must ll out the Addendum to the Site Iden ca on Form for Managing Hazardous Secondary Material.

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TODD E. RANDOLPH, Col, USAF Commander, 27 SOMSG todd.randolph@us.af.mil

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

ACUTE PHARMACEUTICAL WASTES

P001

G11

W005 ✔

3 1

AZD081705402 H141 1

OHD980613541 H040 2

1 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CLARUS PARTS WASHER WASTE (W/ CADMIUM)

D006

G09

W203 ✔

0 1

IND093219012 H141 161

SOURCE/FORM COMMENT:

Parts washer fluid filter. Fluid contains a non-hazardous chemical that was contaminated with cadmium from other sources such as trailer maintenance parts. From: Cleaning various trailer maintenance parts such as wheel bearings and nuts and bolts.

2 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CONSOLIDATED PRODUCT CONTAMINATED MATERIALS (CPCM)

D005

D006

D007

D008

D011

D018

D023

D035

D040

F001

F002

F005

G15

W002 ✔

9471 1

AZD081705402 H141 1538

IND093219012 H141 6391

3 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CONSOLIDATED PRODUCT CONTAMINATED MATERIALS (CPCM)

D005

D006

D007

D008

D011

D023

D035

F005

G15

W002 ✔

277 1

IND093219012 H141 277

4 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CONSOLIDATED PRODUCT CONTAMINATED MATERIALS (CPCM)

D005

D006

D007

D008

D035

F001

F002

F005

G15

W002 ✔

216 1

IND093219012 H141 216

5 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CONSOLIDATED PRODUCT CONTAMINATED MATERIALS (CPCM)

D005

D006

D007

D008

F001

F002

F005

G15

W002 ✔

266 1

IND093219012 H141 266

6 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CONSOLIDATED PRODUCT CONTAMINATED MATERIALS (CPCM)

D005

D006

D007

D035

F001

F002

F005

G15

W002 ✔

195 1

IND093219012 H141 195

7 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CORROSIVE & TOXIC

D010

G11

W105 ✔

3 1

OHD980613541 H040 3

8 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

CORROSIVES,

D002

G11

W105 ✔

65 1

AZD081705402 H141 65

9 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

DUST/DEBRIS/FILTERS FROM CATM RANGE CLEANING

D008

G09

W304 ✔

1192 1

ARD981057870 H061 1192

SOURCE COMMENT:

This process involves a military firing range ventilation system that runs while live firing is in effect.

System has an internal vacuum system to collect lead dust and the IAP collection point is a result of this process.

10 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

FLAMMABLE/IGNITABLE,

D001

D035

G11

W219 ✔

1657 1

ARD981057870 H061 997

AZD081705402 H061 705

FORM COMMENT:

General expired shelf life products that have a flash point of <60 degrees Celsius and/or <140 degrees Fahrenheit

11 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

FUEL NOZZLE CLEANING

D002

G02

W107 ✔

551 1

IND093219012 H070 681

12 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

MAGNETIC/MAGNAFLUX INSPECTION BATH FLUID

D006

G08

W219 ✔

1504 1

AZD081705402 H141 1504

IND093219012 H070 126

FORM CODE COMMENT:

Water based solution contaminated with Cadmium

13 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

PAINT RELATED,

D001

D005

D007

D035

G11

W209 ✔

1221 1

ARD981057870 H061 592

AZD081705402 H061 593

14 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

PAINT RELATED,

D001

D007

D035

G11

W209 ✔

650 1

ARD981057870 H061 650

15 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

PAINT-RELATED LIQUID WASTE

D001

D005

D007

D035

F003

F005

G06

W209 ✔

2042 1

ARD981057870 H061 1779

AZD081705402 H061 456

16 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

PRODUCT CONTAMINATED MATERIAL

D001

D018

G13

W002 ✔

60 1

ARD981057870 H061 60

17 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

PRODUCT-CONTAMINATED MATERIALS

D005

D006

D007

D035

F005

G06

W002 ✔

0 1

IND093219012 H141 1163

18 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

REACTIVE EXPIRED ITEMS

D003

G11

W001 ✔

7 1

OHD980613541 H040 7

19 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

RECOVERED FUEL- GASOLINE

D001

D018

G15

W206 ✔

3592 1

AZD081705402 H061 1050

IND093219012 H061 3145

20 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

RECOVERED FUEL- GASOLINE

D001

D018

G11

W204 ✔

935 1

AZD081705402 H061 169

IND093219012 H061 583

21 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

SPENT METHANOL

D001

G01

W203 ✔

9 1

ARD981057870 H061 9

22 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

USED AIRCRAFT WASH PADS

D006

G13

W002 ✔

1374 1

ARD981057870 H061 770

AZD081705402 H141 192

IND093219012 H141 333

23 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

USED BEAD-BLASTING MEDIA & ASSOCIATED CONTAMINATED MATERIALS

D005

D006

D007

G09

W002 ✔

708 1

IND093219012 H141 261

SOURCE COMMENT:

Bead Blasting process removing paint from aircraft parts and support equipment parts

24 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

WASTE DENTAL AMALGAM TRAPS/CAPSULES

D009

D011

G09

W002 ✔

19 1

IND093219012 H141 14

SOURCE COMMENT:

The dental clinic performs several dental procedures on patients involving the removal of old dental work resulting in the collection of dental amalgam that is RCRA Hazardous Waste

25 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT ______ (repor ng cycle)

WASTE GENERATION AND MANAGEMENT (GM) FORM

1. Waste Characteris cs

A. Waste Descrip on

2. On site Genera on and Management of Hazardous Waste

� Y � N Was any of this waste that was generated at this facility treated, disposed, and/or recycled on site? If yes, con nue to On site Process System 1.

3. O site Shipment of Hazardous Waste

� Y � N A. Was any of this waste that was generated at this facility shipped o site for treatment, disposal, or recy cling? If yes, con nue to Site 1.

4. Comments

C. State Hazardous Waste Code(s)

B. EPA Hazardous Waste Code(s)

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 1

Process System 1 Management Method Code Quan ty

Process System 2 Management Method Code Quan ty

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 2

B. EPA ID of facility to which waste was shipped C. Management Method Code D. Total Quan ty Shipped

Site 3

H. Quan ty UOM � lbs/gal � sgDensity

D. Source Code Management Method (G25) Country Code (G62)

E. Form Code F. Waste Minimiza on Code G. Radioac ve Mixed � Y � N

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

WASTE FUEL

D001

F003

G05

W505 ✔

28 1

ARD981057870 H061 28

26 26

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT

OFF SITE IDENTIFICATION (OI) FORM

1. Site 1

A. EPA ID Number of O site Installa on or Transporter

B. Name of O site Installa on or Transporter

C. Handler Type (mark all that apply) � Generator � Transporter � Receiving Facility

4. Comments

D. Address of O site Installa on

City, Town, or Village

State Zip Code

Street Address

Country

2. Site 2

A. EPA ID Number of O site Installa on or Transporter

B. Name of O site Installa on or Transporter

C. Handler Type (mark all that apply) � Generator � Transporter � Receiving Facility

3. Site 3

A. EPA ID Number of O site Installa on or Transporter

B. Name of O site Installa on or Transporter

C. Handler Type (mark all that apply) � Generator � Transporter � Receiving Facility

D. Address of O site Installa on

City, Town, or Village

State Zip Code

Street Address

Country

D. Address of O site Installa on

City, Town, or Village

State Zip Code

Street Address

Country

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

IND058484114

HERITAGE TRANSPORT

5400 WEST 86TH ST.

INDIANAPOLIS

IN 46231 US

TXR000033175

CHEMICAL TRANSPORTATION, INC.

400 INGLEWOOD DR

EL PASO

TX 79927 US

ARD981057870

RINECO CHEMICAL INDUSTRIES, LLC

1007 VULCAN ROAD

BENTON

AR 72015 US

1 3

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT

OFF SITE IDENTIFICATION (OI) FORM

1. Site 1

A. EPA ID Number of O site Installa on or Transporter

B. Name of O site Installa on or Transporter

C. Handler Type (mark all that apply) � Generator � Transporter � Receiving Facility

4. Comments

D. Address of O site Installa on

City, Town, or Village

State Zip Code

Street Address

Country

2. Site 2

A. EPA ID Number of O site Installa on or Transporter

B. Name of O site Installa on or Transporter

C. Handler Type (mark all that apply) � Generator � Transporter � Receiving Facility

3. Site 3

A. EPA ID Number of O site Installa on or Transporter

B. Name of O site Installa on or Transporter

C. Handler Type (mark all that apply) � Generator � Transporter � Receiving Facility

D. Address of O site Installa on

City, Town, or Village

State Zip Code

Street Address

Country

D. Address of O site Installa on

City, Town, or Village

State Zip Code

Street Address

Country

N M 7 5 7 2 1 2 4 4 5 4 OMB# 2050-0024; Expires 04/30/2024

AZD081705402

HERITAGE ENVIRONMENTAL SERVICES LLC

284 EAST STOREY RD

COOLIDGE

AZ 85128 US

IND093219012

HERITAGE ENVIRONMENTAL SERVICES LLC

7901 W MORRIS ST

INDIANAPOLIS

IN 46231 US

OHD980613541

HERITAGE THERMAL SERVICES INC

1250 SAINT GEORGE ST

EAST LIVERPOOL

OH 43920 US

2 3

United States Environmental Protec on Agency

HAZARDOUS WASTE REPORT

OFF SITE…