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.PA ID Number OMB#: 2050-0024; Expires 11/30/2011 ). Type of Regulated Waste Activity (at your site) Mark "Yes" or "No" for all c rren activities (as of the date submitting the form); complete any additional boxes as instructed. �. Hazardous Waste Activities; Complete all parts 1-7. N ❑ 1. Generator of Hazardous Waste If "Yes", mark only one of the following — a, b, or c. ❑ a. LQG: Generates, in any calendar month, 1,000 kg/mo (2,200 lbs./mo.) or more of hazardous waste; or Generates, in any calendar month, or accumulates at any time, more than 1 kg/mo (2.2 lbs./mo) of acute hazardous waste; or Generates, in any calendar month, or accumulates at any time, more than 100 kg/mo (220 lbs./mo) of acute hazardous spill cleanup material. 0, b. SQG: 100 to 1,000 kg/mo (220 — 2,200 lbs./mo) of non- acute hazardous waste. 13 c. CESQG: Less than 100 kg/mo (220 lbs./mo) of non-acute hazardous waste. If "Yes" above, indicate other generator activities. f ❑ N d. Short -Term Generator (generate from a short-term or one- time event and not from on-going processes). If "Yes", provide an explanation in the Comments section. e ❑ N e. United States Importer of Hazardous Waste e ❑ N f. Mixed Waste (hazardous and radioactive) Generator 8. Universal Waste Activities; Complete all parts 1-2. Y ❑ N 1. Large 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 "Yes", mark all that apply. a. Batteries b. Pesticides c. Mercury containing equipment d. Lamps e. Other (specify) I Other (specify) g. Other (specify) Y ❑ N[ 2. Destination Facility for Universal Waste k Note: A hazardous waste permit may be required for this activity. Y ❑ N 10 2. Transporter of Hazardous Waste If "Yes", mark all that apply. ❑ a. Transporter ❑ b. Transfer Facility (at your site) Y ❑ N 3. Treater, Storer, or Disposer of Hazardous Waste Note: A hazardous waste permit is required for these activities. Y ❑ NX 4. Recycler of Hazardous Waste Y ❑ N 5. Exempt Boller and/or Industrial Furnace If "Yes", mark all that apply. ❑ a. Small Quantity On-site Burner Exemption ❑ b. Smelting, Melting, and Refining Furnace Exemption Y © N K8. Underground Injection Control Y ❑ N P�7. Receives Hazardous Waste from Off-site C. Used Oil Activities; Complete all parts 1-4. Y ❑ Nj�jl'J 1. Used Oil Transporter P( If "Yes", mark all that apply. ❑ a. Transporter ❑ b. Transfer Facility (at your site) Y ❑ N2. Used Oil Processor and/or Re -refiner jJ�` If "Yes", mark all that apply. ❑ a. Processor ❑ b. Re -refiner Y E] N 3. Off -Specification Used Oil Burner 1 Y ❑ N 4. Used Oil Fuel Marketer If "Yes", mark all that apply. ❑ a. Marketer Who Directs Shipment of Off -Specification Used Oil to Off - Specification Used Oil Burner ❑ b. Marketer Who First Claims the Used Oil Meets the Specifications EPA Form 8700-12, 8700-13 A/B, 8700-23 (Revised 11/2009) Page 2 of