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APP. S. 1999 9:35AM CAL/EPA DTSC — HWMP Ho. 919 P.3,-3 <br />SUPPORTING INFORMATION <br />APPLICATION FOR HOUSEHOLD HAZARDOUS WASTE ACTIVITY VARIANCE <br />Along with the Application for Hazardous Waste (HW) Activity Variance, we will need the following <br />information to determine whether or not a variance will be issued. PIease give your answers on a separate piece of <br />paper and attach it to the signed Application for Hazardous Waste Activity Variance. <br />1. What HSC or Title 22, California Code of Regulation sections are you requesting a variance from? <br />_ a. HSC, section 25201 (facility permit require rs) <br />b. HSC, section 25160 (manifest requirements) <br />c. HSC, section 25163 (a) (HW transporter/hauler registration requirements) <br />T d. Other HSC, section(s) <br />_ e. Title 22, Cal. Code Regs., section(s) <br />2. Describe the physical characteristics and chemical composition of the HW or the specification of the HW <br />management activity to which the variance applies (e.g., CESQG, HHW), <br />3. Whose waste will be collected? From where will the HW be transported? <br />4. What quantities of HW are involved? How frequently will HW be transported under this variance? <br />5. How will the HW be packaged, marked or labeled for transportation? <br />6. Give the'proper DOT shipping description for the 14W, if applicable, (List standard DOT classes, if known) <br />7. Give the name of registered transporter or hauler? <br />S. Where will the HW be taken? Is this an authorized or permitted facility? If stored for consolidation purposes, <br />give the temporary storage facility address and indicate how long it will be stored at this location. <br />9. Do you have the proper insurance coverage for transporting hazardous waste? If not and you wish a variance <br />from the insurance requirements, give your reasons why you believe the insurance coverage is not necessary. <br />Tell us what types and amounts of insurance coverage you and/or your contractor do carry. <br />10. Will the waste be shipped using a Uniform Hazardous Waste Manifest? If a manifest variance is also <br />requested. give reasons showing why you need this variance. If a manifest variance is granted, a shipping <br />paper will be required to accompany the shipment — it so, attach an example of shipping papers you plan <br />to use. <br />11. If bullring any wastes (e.g.. oil, latex paint, solvents, flammables, etc.) provide the contact name, phone <br />member, and mailing address of your local fire department and the local Air Quality Management District. <br />04vised 5/98) 2 <br />