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f <br /> i <br /> EPA ID Number G A L 0 0 02 9 9 4 1 4 OMB# 2060-0024 ; Expires 05/3112020 ) <br /> ) <br /> E <br /> D. Pharmaceutical Activities <br /> ®Y . . ®✓ 1 . .Operat€ ng under 40 ,CFR 266 :Subpa.rt P f6r. the . management of. hazar lous waste pharmaceuticals —if <br /> "Yes'; :markoplynne ;Note See the €tem by item instructions for definitions of healthcare.facifityand <br /> 4 <br /> reverre ,distributor , . . : .. ;. : : . . . : . : . _ i <br /> i <br /> a . Healthcare Facility i <br /> b . Reverse Distributor 4 <br /> ® 2I..': Withdrawing from operating under. 40 :CFRW 4 .26I I 6 .Subpart P for the , management of hazardous waste <br /> pharmaceuticals Note: : You may only w€thdraw. if you area healthcare facility that is no longer an LQG or. : <br /> SQG. . ++ ; i <br /> ) <br /> i <br /> 12. Eligible Academic Entities with Laboratories— Notification for opting into or withdrawing from managing laboratory hazardous <br /> wastes pursuant to 40 CFR 262 Subpart K. E <br /> 5 <br /> E]Y N . A .' Opting into or currentiy operating under 40 CFR 262 Subpart K for the management of hazardous <br /> wastes in laboratories-- If "Yes", mark all that apply. Note: See the item-by-€tem. instructions for defini- <br /> tions of types of.eligible academic entities . <br /> 1 . College or University <br /> 2 . Teaching Hospital that is owned by or has a formal written affiliation with a college or university R <br /> 3 . Non-profit Institute that is owned by or has a formal written affiliation with a college or university <br /> E <br /> Elyr N B . }Withdrawing from .40. CF&R ,262_ Subpart ;K. for:the .management of hazardous wastes in laboratories. <br /> 0 . . <br /> t <br /> i <br /> i <br /> 13. Episodic Generation <br /> E] N : Areyouan $QG .ar.VSgG4 . .generatI .?ng ,hazardous .waste from a :pianned, or unplanned episod € c event, lasting l <br /> 4 . <br /> . . <br /> no, more than .60. days, that moves you to a higher generator category if "Yes", you must. fill out the Ad- ) <br /> dendum for . pisodic Generator? <br /> i <br /> 14. LQG Consolidation of VSQG Hazardous Waste <br /> 1 <br /> N . : Are :you, an L.QG, notifying of consolidating VSQG Hazardous Waste Under the Control of the Same. Person <br /> pursuant to 40. CFR 262.E 7(f)? _If "Yes", ybu must fill out the Addendum for LQG Consolidation of VSQGs . <br /> hazardous waste <br /> i <br /> s <br /> 15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional ) OR Entire Facility ( required ) q <br /> . . . <br /> ®Y � N LQG. Site Closure of. a Central Accumulation Area. (CAA) or Entire Facility. . <br /> I <br /> e <br /> A, QCentral Accumulation Area ( CAA) ockritire Facility <br /> s <br /> B . Expected closure date : mm/dd/yyyy <br /> C. Requesting new closure date: mm/dd/yyyy <br /> D. Date closed : mm/dd/yyyy <br /> F] 1 . In compliance with the closure performance standards 40 CFR 262 . 17( a)( 8) ) <br /> a <br /> 2 . Not in compliance with the closure performance standards 40 CFR 262. 17(a) (8) <br /> a <br /> i <br /> 9 <br /> i <br /> � k <br /> C <br /> EPA Form 8700-12, 8700-13 A/B, 8700-23 Page of 6 <br /> j� a <br /> 1 k <br /> I <br /> i <br /> I <br />