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Hazardous Waste Notification Form NOTIFICATION PURSUANT TO 40 CFR 403.12(p) HAZARDOUS WASTES DISCHARGED TO METROPOLITAN ST. LOUIS SEWER DISTRICT FACILITY NAME: __________________________________________________________________________________ FACILITY ADDRESS _______________________________________________________________________________ CONTACT PERSON: _________________________________________ PHONE:____________________________ TITLE OF CONTACT PERSON: ______________________________________________________________________ If your facility will discharge to the sewer during the next 12 months any quantity of hazardous waste, complete the following: HAZARDOUS WASTE NAME HAZ. WASTE NUMBER TYPE OF DISCHARGE (Cont./Batch/Other) MASS TO BE DISCH. NEXT 12 MO. (lbs) For each hazardous waste listed above, provide the following information to the extent it is known and readily available to you: HAZARDOUS CONSTITUENTS EST. MASS DISCH./MO. (lbs) EST. CONC. IN DISCH. (PPM) EST. MASS TO BE DISCHARGED DURING NEXT 12 MO. (lbs) CERTIFICATION: I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. I further certify that the facility named above has a program in place to reduce the volume and toxicity of hazardous wastes generated to the degree the company has determined to be economically practical. PRINTED NAME: __________________________________ SIGNATURE: _______________________________ TITLE: ___________________________________________ DATE: _____________________________________ Submit copies of this form to: Metropolitan St. Louis Sewer District (MSD) Missouri Department of Natural Resources (MDNR) United States Environmental Protection Agency (USEPA) PUBLIC NOTICE METROPOLITAN ST. LOUIS SEWER DISTRICT POTENTIALLY APPLICABLE RCRA REQUIREMENTS FOR INDUSTRIAL USERS The Metropolitan St. Louis Sewer District, in accordance with section 403.8(f)(2)(iii) of the General Pretreatment Regulations (40 CFR 403), hereby provides industrial users with notice of potentially applicable requirements under Subtitles C and D of the Resource Conservation and Recovery Act. Subtitles C and D of RCRA regulate solid and hazardous waste management. The State of Missouri also has promulgated solid and hazardous waste management rules. If you generate or transport hazardous wastes, you may be subject to the regulations. To ensure that your operations comply with federal and state hazardous waste management regulations, contact the State and Federal agencies at the bottom of this notice. NOTIFICATION REQUIREMENTS FOR INDUSTRIAL USERS DISCHARGING MATERIALS TO THE SEWER SYSTEM THAT WOULD BE HAZARDOUS IF OTHERWISE DISPOSED In accordance with section 403.12(p) of the General Pretreatment Regulations (40 CFR 403): (1) The Industrial User shall notify the POTW [Publicly Owned Treatment Works, or Sewer District], the EPA Regional Waste Management Division Director, and State hazardous waste authorities in writing of any discharge into the POTW of a substance, which, if otherwise disposed of, would be a hazardous waste under 40 CFR part 261. Such notification must include the name of the hazardous waste as set forth in 40 CFR part 261, the EPA hazardous waste number, and the type of discharge (continuous, batch, or other). If the Industrial User discharges more than 100 kilograms of such waste per calendar month to the POTW, the notification shall also contain the following information to the extent such information is known and readily available to the Industrial User: An identification of the hazardous constituents contained in the wastes, an estimation of the mass and concentration of such constituents in the wastestream discharged during that calendar month, and an estimation of the mass of constituents in the wastestream expected to be discharged during the following twelve months. All notifications must take place within 180 days of the effective date of this rule. Industrial users who commence discharging after the effective date of this rule shall provide the notification no later than 180 days after the discharge of the listed or characteristic hazardous waste. Any notification under this paragraph need be submitted only once for each hazardous waste discharged. However, notifications of changed discharges must be submitted under 40 CFR 403.12 (j). The notification requirement in this section does not apply to pollutants already reported under the self- monitoring requirements of 40 CFR 403.12 (b), (d), and (e). (2) Dischargers are exempt from the requirements of paragraph (p)(1) of this section during a calendar month in which they discharge no more than fifteen kilograms of hazardous wastes, unless the wastes are acute hazardous wastes as specified in 40 CFR 261.30(d) and 261.33(e). Discharge of more than fifteen kilograms of non-acute hazardous wastes in a calendar month, or of any quantity of acute hazardous wastes as specified in 40 CFR 261.30(d) and 261.33(e), requires a one-time notification. Subsequent months during which the Industrial User discharges more than such quantities of any hazardous waste do not require additional notification. (3) In the case of any new regulations under section 3001 of RCRA identifying additional characteristics of hazardous waste or listing any additional substance as a hazardous waste, the Industrial User must notify the POTW, the EPA Regional Waste Management Waste Division Director, and State hazardous waste authorities of the discharge of such substance within 90 days of the effective date of such regulations. (4) In the case of any notification made under paragraph (p) of this section, the Industrial User shall certify that it has a program in place to reduce the volume and toxicity of hazardous wastes generated to the degree it has determined to be economically practical. If an industrial user needs to make notification under 40 CFR 403.12(p), it should contact the local, State and Federal agencies at the bottom of this notice. POTW [Sewer District] State DNR Office EPA Regional Office Metropolitan St. Louis Sewer District Missouri Dep't of Natural Resources US Environmental Protection Agency Division of Environmental Compliance St. Louis Regional Office Region 7 10 E. Grand Ave. 7545 S. Lindbergh Blvd., Suite 210 901 N. 5th Street St. Louis, MO 63147 St. Louis, MO 63125 Kansas City, KS 66101 314-436-8710 314-416-2960 1-800-223-0425 (over)