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EPA ID Number I C I A I L 10 1 0 1 0 12 16 1 9 13 17 15 OMB#: 2050-0024; Expires 01 /31 /2017 <br /> 12. Notification of Hazardous Secondary Material (HSM) Activity <br /> Y ❑ NO Are you notifying under 40 CFR 260.42 that you will begin managing , are managing, or will stop managing hazardous <br /> secondary material under 40 CFR 261 .2(a)(2)(ii), 40 CFR 261 .4(a)(23), (24), or (25)? <br /> If "Yes," you must fill out the Addendum to the Site Identification Form: Notification for Managing Hazardous Secondary <br /> Material. <br /> 13, Comments <br /> No Secondary Material <br /> Site is currently using a State EPA ID number and this application is for a new Federal EPA ID Number, The State EPA ID <br /> number will be inactivated once the new Federal EPA ID number is obtained . <br /> 14. Certification . I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in <br /> accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based <br /> on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the <br /> information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant <br /> penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. For the RCRA <br /> Hazardous Waste Pari A Permit Application, all owner(s) and operator(s) must sign (see 40 CFR 270. 10(b) and 270.11 ) . <br /> Signature of legal owner, operator, or an Name and Official Title (type or print) Date Signed <br /> authorized representative (mm/dd/yyyy) <br /> l Charina Gaspay, REM 06/27/2018 <br /> EPA Form 8700-12, 8700-13 A/B, 8700-23 Page 4 of 4 <br />