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OMB4: 2050-0024 Expires 1 113 0 2 01 1 SEND COMPLETED United States Environmental Protection Agency A . 4 FORM 70' The appropriate State RCRA SUBTITLE C SITE IDENTIFICATION FORM or Regional Office. 1. Reason for Submittal Reason for Submittal: ❑ To provide Initial Notification (first time submitting site Identification information / to obtain an EPA ID Number for this location). MARK ALL ❑ To provide subsequent Notification (to update site Identification Information for this location). SOX(ES) THAT ❑ As a component of a First RCRA Hazardous Waste Part A Permit Application. APPLY ❑ As a component of a Revised RCRA Hazardous Waste Pen A Permit Application (Amendment a ) ❑x As a component of Hazardous Waste Report (IF marked, see sub-bulat below) ❑ Site was a TSD facility and/of generator of > 1,000 kg of hazardous waste, > 1kg of acute hazardous waste, or > 100 kg of acute hazardous waste split cleanup In one or more months of the report year (or state Equivalent LOG regulations) Site EPA ID Number EPA ID Number: CA2890090002 3. SltaName Site Name: LAWRENCE LIVERMORE LAB SITE 300 4. She Location Street Address: Corral Hollow Road Information City, Town or Village: Tracy County: SAN JOAQUIN State: CA Country: United States zip Code: 95376 5. Site Land Type Site Land Type: ❑ Private ❑ County ❑ DlshkN ❑x Federal ❑ Tribal ❑ Municipal ❑ State ❑ Other 6. NAIC Code(s) for the A 541710 B. Site (at !seat 5 -digit codes) C. D. 7. Site Mailing Address Street or P.O. Box: P.O. Box 808 City, Town or Village: Livermore State: CA Country: UNITED STATES Zip Code: 94551 8. Site Contact Person Flat Namo: Joseph MI: G Last Name: Byrne Title: Nuclear Facilities Operations Supervisor Streator P.O.Box: P.O. Box 808 City, Town or Village: Livermore State: CA Country: UNITED STATES Zlp Code: 94551 Email: Phone Number: 9254222681 Extanalon: Fax: 9254238118 -. Legal Owner Name of Site's US Department of Energy Date Became 09/01/1952 and Operator Legal Owner: Owner. of the Site Owner Type: []Private ❑ County ❑ District ❑x Federal ❑Tribal ❑ Municipal ❑ State ❑ Other Streetor P.O.Box: 1000 Independence Ave. SW City, Town or Village: Washington Phone: state: DC Country. ITN ITED STATES Zlp Code: 20585 Name of Site's Date Became Operator: Lawrence Livermore National Operator 10/01/2007 Operator Type: ❑x Private ❑ County ❑ District ❑ Fedeal ❑ Tribal ❑ Municipal ❑ state ❑ Ot w EPA Farts 8700-12, 8700.13 AB, 8700-23 (Revised 112009) Pull 1 of 67 EPA ID No.CA2890090002 OMBH: 2050-0024 Expires 11/30/2011 10. Type of Regulnlad Weals Activity (al your site) Mark 'es' or 'No' for all current activities (as of the data submitting the form); complete any additional boxes se Instructed. A. Hazardous Waste Activities; Complete all parts 1.7. Y N❑ 1. Generator of Hazardous Waste 11 'Yes', choose only one of the following -a, to or e. ❑x a. LOG: Generales, In any calendar month, 1,000 kg/mo (2,200 IbsJmo.) or more of hazardous waste; OR Generates, In any calendar month, or accumulates at any time, more than 1 kghno (2.2 lbsJmo.) of acute hazardous waste; OR Generates, In any calendar month OR a0cumdates at any time, more than 100 kglmo (220 lbslmo.) of acute hazardous spill cleanup material. ❑ b. SQG: 100 to 1000 kg/mo(220 - 2,200 lbslmo.) of non-acute hazardous waste. ❑ c. CESOG: Less Ihan 100 kg/mo (220 lbslmo.) of non-acute hazardous waste. If 'Yes' above, Indicate other generator activities. Y❑ NQ d. Shan -term Generator (generate from a short-term or one-time event and not from ort -going processes). II 'Yes', provide an explanation In the Comments section. Y ❑ NO Q. United Slates Importer of Hazardous Waste Y Rx N ❑ I. Mixed Waste (hazardous and radioactive) Generalcr B. Universal Waste Activities; Complete all parts 1-2. Y❑ NQ 1. Largo Quantity Handler of Universal Waste (YOU accumulate 5,000 kg or more) [refer to your State regulations to determine what Is regulated]. Indicate types of universal waste managed at your site If'Yee', mark all that apply. a. Batteries ❑ b. Pesticides ❑ c. Mercury containing equipment ❑ d. Lamps ❑ e. Other (specify) ❑ I. Other (specify) ❑ g. Other (spedty) ❑ Y❑ NQ 2 Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this activity. EPA Form 8700-12. 0700.13 AB, 8700-23 (Revised 1112009) Y❑ NQ 2 Transporter of Hazardous Waste If *Yes", mark all that apply. ❑ e. Transporter ❑ b. Transfer Facility (at your site) Y Q N ❑ 3. Treater, Storer or Disposer of Hazardous Waste Note: A hazardous waste permit is required for these activities. Y❑ NO 4. Recycler of Hazardous Waste Y❑ No S. Exempt Boller and/or Industrial Furnace If 'Yea", mark all that apply. ❑ a. Small Quantity On -Site Burner Exemption ❑ b. Smelting. Melting, and Refining Furnace Exemption Y ❑ NQ 6. Underground Injectlon Control Y ❑ N 0 7. Receives Hazardous Waste from OM -site. C. Used Oil Activities; Complete all parts 1-4. Y ❑ NO 1. Used Oil Transporter If "Yes% mark all that apply. ❑ a. Transporter ❑ It. Transfer Facility (at your she) Y❑ NO 2. Used 011 Processarand/or Ro-ranner If 'Yes", mark all that apply. ❑ a. Processor ❑ b. Re-rel:ner Y❑ IN 3. Off-SPeclllcatlon Used Oil Bumcr Y ❑ NQ 4. Used Oil Fuel Marketer If'Yes', mark all that apply. ❑ a. Marketer Who Directs Shipment of Oh -Specification Used Oit to Oti-Specificatlon Used Ori Sumer ❑ b. Marketer Who First Claims the Used Ol Meaw the Specifications Page 2 of 67