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State Waste Information <br />State Waste Codes <br />Benzene Information <br />Are you a TSDF? <br />To be completed when From an industry regulated under Benzene NESHAP? is Yes <br /> <br />To be completed when Are you a TSDF? is Yes <br />Please complete the Benzene NESHAP questionnaire <br />Does this material contain <br />benzene? <br />To be completed when Are you a TSDF? is No <br /> <br />Flow Weighted Average <br />Concentration in PPM1N <br />To be completed when Does this material contain benzene? is Yes <br /> <br />What is your current facility's total <br />annual benzene quantity in <br />megagrams? <br />Is this waste soil from a <br />remediation? <br />To be completed when Are you a TSDF? is No <br />0 Less than (<) 1 Mg <br />0 1 - 9.99 Mg <br />0 More than (>)10Mg <br />To be completed when Are you a TSDF? is No <br />Benzene Concentration in PPMW To be completed when Is this waste soil from a remediation? is Yes <br /> <br />Does the waste contain more than <br />(>)10% water/moisture? <br />To be completed when Are you a TSDF? is No <br />Has material been treated to <br />remove 99% of the benzene or to <br />achieve less than lOppmw? <br />Is material exempt from controls in <br />accordance with 40 CFR 61.342? <br />To be completed when Are you a TSDF? is No <br />To be completed when Are you a TSDF? is No <br />Specify Exemption To be completed when Is material exempt from controls in accordance with 40 CFR 61.342? is Yes <br />Is this waste stream subject to <br />treatment and control <br />requirements of 40 CFR Part 61, <br />Subpart Fl? <br />To be completed when Are you a TSDF? is No <br /> <br />Facility Remediation & Clean Up <br />Facility remediation subject to 40 No <br />CFR 63 GGGGG? <br />Does the material contain less than <br /> To be completed when Facility remed iatio n subject to 40 CFR 63 GGGGG? is Yes <br />M500 ppmwV0HAPS at the point <br />of determination? <br />CERCLA or State-Mandated clean- No <br />up? <br />To be completed when CERCL4 or State-Mandated clean-up? is Yes <br />Please submit the Record of Decision or other documentation to assist others in the evaluation for proper disposal. <br />Radioactive Waste <br />Identify Isotopes and pCi/g <br />To be completed when Regulated, Licensed or NORM Radioactive Waste? is Yes <br /> <br />Page 4 of 6 <br />Generated on: 12/2/2021 ID: 0a5856b5-1dcb-4d3c-8907-7ecfebl4baee%