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EPA ID Number C A D 0 019 1 814 5 0 8 OMB#2050-0024; Expires 05/31/2020 <br /> 10. Type of Regulated Waste Activity(at your site) <br /> Mark"Yes"or"No"for all current activities(as of the date submitting the form);complete any additional boxes as instructed. <br /> A.Hazardous Waste Activities <br /> R]Y []N 1. Generator of Hazardous Waste—If"Yes", mark only one of the following—a, b,c <br /> ❑ a. LQG -Generates, in any calendar month(includes quantities imported by importer site) <br /> 1,000 kg/mo(2,200 Ib/mo)or more of non-acute hazardous waste;or <br /> -Generates,in any calendar month,or accumulates at any time, more than 1 kg/mo <br /> (2.2 Ib/mo)of acute hazardous waste;or <br /> -Generates, in any calendar month or accumulates at any time,more than 100 kg/mo <br /> (220 Ib/mo)of acute hazardous spill cleanup material. <br /> ❑ b.SQG 100 to 1,000 kg/mo(220-2,200 Ib/mo)of non-acute hazardous waste and no more than <br /> 1 kg(2.2 lb)of acute hazardous waste and no more than 100 kg(220 Ib) of any acute <br /> hazardous spill cleanup material. <br /> c.VSQG Less than or equal to 100 kg/mo(220 Ib/mo)of non-acute hazardous waste. <br /> If"Yes"above, indicate other generator activities in 2 and 3,as applicable. <br /> ❑Y Z 2. Short-Term Generator(generates from a short-term or one-time event and not from on-going <br /> processes). If"Yes",provide an explanation in the Comments section. <br /> [:]Y Z N 3. Mixed Waste(hazardous and radioactive)Generator <br /> F]Y ZN 4. Treater,Storer or Disposer of Hazardous Waste—Note:A hazardous waste Part B permit is required for <br /> these activities. <br /> E]Y ZN 5. Receives Hazardous Waste from Off-site <br /> Y v/ N 6. Recycler of Hazardous Waste <br /> a. Recycler who stores prior to recycling <br /> b. Recycler who does not store prior to recycling <br /> F]Y Z 7. Exempt Boiler and/or Industrial Furnace—If"Yes",mark all that apply. <br /> a.Small Quantity On-site Burner Exemption <br /> b.Smelting, Melting,and Refining Furnace Exemption <br /> B.Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes <br /> handled at your site. List them in the order they are presented in the regulations(e.g. D001, D003, F007, U112).Use an <br /> additional page if more spaces are needed. <br /> U066 U067 <br /> C.Waste Codes for State Regulated(non-Federal)Hazardous Wastes. Please list the waste codes of the State hazardous <br /> wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if more <br /> spaces are needed. <br /> 352 <br /> EPA Form 8700-12,8700-13 A/B,8700-23 Page 3 of 7 <br />