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HomeMy WebLinkAboutHAZARDOUS WASTE State, of Californ~ - Californm Envwonment~l P~-tion Agen..? l)epnrtlllent of Toxic Substances Control ....... ~ Page I of 6 ONSITE HAZ OUS WASTE TREA/IVIENT NOTIFICATION FORM FACILITY SPECIFIC NOTIFICATION ~ Imtial For Use by H~?~rdous Waste Generators Perforrmng Treatment ~__ Amended fx,-~ Under Conditional Exempuon and Conditional Authorization. :J?;~ '~ ~!~:' ' and by Perrmt By Rule Facilities Please r~er to the attached Instructions before completing this form. You may. not(f'y for more than one permming t~er by using this notification form. DTSC 1772. You must attach a separate unit specific notificanon form for each untt at this location. There are different unit specific notification forms for five of the categories and an additional notification form for transportable treatment units (TTU'sL You only have to submit forms for the tier(s)/category. (ies) tl~t cover your unit(s). Discard or recycle the other imuse, d forms. Number each page of your completed notification package and indicate the total number of pages at the top of each page at the 'Page ~ of ~' Put your EPA ID NumOer on each page. Please provide all of the information requested: all fielda must be completed except those that stale 'if different' or 'if available'. Please type the information provided on this form and any attachments. " The notification fees are assessed on the basis of the highest tier the notifier will operate under and will be collected by the State Board of EqUalization. DO NOT SEND YOUR FEE PAYMENT WII~-I THIS NOTIFICATION FORM. I. NOTIFICATION CATEGORIES Indicate the number of units you operate in each tier. l'hls will also be the number of unit specific notification forms you must attach. Conditionally Exempt Small Quantity Treatment operators may not openxte units under any other tier. Number of units and attached unit specific notifications for each tier reported. A. .. , Conditionally Exempt-Small Quantity Ttw. atment (CESQT) D. Permit by Rule (PBR) B. ,, X Conditionally Exempt-Specified Wastestrw..am (CESg0 E. CE--Commercial Laundry (CE-CL) C. Conditionally Authorized (CA) F. Conditionally Exempt-Limited (CEL) II. GENERATOR IDENTIFICATION EPA ID NUMBER CA L 0 0 0 1 7 6 6 1 6 BOE NUMBER (if available) H~HQ~ FACILITY NAME I.ONGS DRUG STORES ~# i7 iDBA-Domg Business AS~ PHYSICAL LOCATION ##00 COFFEE ROAD CITY BAKERSFIELD CA ZIP 93308 COUNTY KERN CONTACT PERSON BRUCE HUNTER PHONE NUMBER( 805 ~ 588 - 0290 ~Firs~ Name) ~Last Name) STORE MANAGER MAILING ADDRESS, IF DIFFERENT: COM-PANY NAME LONGS DRUG STORES CALIFORNIA, INC. STREET 1~1 NORTH CIVIC DRIVE CITY WALNUT CREEK STATE CA ZIP 9#596. COUNTRY (only comolete tf not USA) CONTACT PERSON KEITH LANDES PHONE NUMBER( 510 '3_210 - 6999 (First Name) CLast Name~ ENVIRONMENTAL MANAGER DTSC '"'~ Page t I,,. (I/96) EPA ID NUMBER CAL0( '6616 Page 2 of 6__ RADIOACTIVE MATERIALS OR WASTE YES NO ~ Does the facility use. store or treat radioactive materials or radioactive waste? IV. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSI~"ICATION (SIC) CODE: Use either one or two SIC codes ia four digit numberl that best describe your company's products, services, or industrial a~vity. Example: 7384 Photofinishing lab 7'218 Industrial launderers Fire: 5912 RETAIL CHAIN DRUG Seexmd: STORE V. PRIOR PERMFI' STATUS: Check yes or no to em:It question: YES NO ~] 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462'1 in 1992 for this location? ~] ~'~ 2. Do you now have or have you ever held a stale or federal b=-urdoua waste facility full perm/t or interinl status for any of these treazm~t umu? [._J {X{ 3. Do you now have or have you ever held a stale or federal full permit or interim stares for any other h~?:~rdons waste activities at this location7 ~] {X{ 4. Have you ever held a variance issued by the Department of Toxic Substances Control for thc tr~nn~t you are now notifying for at bis location? [-~ [] 5. Has ti,As location ever been inspected by be state or any local agency as a h,?~rdous wasm g~n~rator? VI. PRIOR ENFORCEMENT HISTORY: Not required from conditionally exempt generators or commercial laundries. YES NO ~ "~ Within the last three years, has this facility, been the subject of any convictions, judgments, settlement, or final orders resulting from an action by any local, state, or federal environmental, haTardous waste, or public health · enforcement agency? (For the purposes of this form. a notice of violation does not constitute an order and need not be reported unless it was not corrected and became a final on:ret.) [] If you answered Yes, .check this box and attach a listing of convictions, judgments, settlements, or o~ers and a copy of the cover sheet from each document. (See the Imatructions for more information'} VII:- ATTACHMENTS: Attachments are not required from commercial laundries. ~ t. A plot plan/map detailing the locatioms) of the covered unit{s) in relation to the facility boundaries. ~w _.~ A unit specific notification form for each unit to be covered at this location. DTSC 1772 (1/96'1 Page 2 EPA ID NUMBER CAL000'. 16 Page 3 of VIII. CERTlY'ICATIONS: This form rnu~t be signed by an authorized co~. orate officer or any. other person in the company who has operational control and performs decision-making functions that govern operation of the facili~ (per Title 22. California Code of Regulations {CCR) Section 66270.11). All three copies mu,ct have original signatures. Waste Minimization I certtf3.' that I have a program in place to reduce the volume, quantity., and toxicity of waste generated to the ciegree I have deterrmned to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which vmnirmzes the present and future t~ to human health and the environmem. Tiered Permittinl Certification I certify that the unit or units described m these documents meet the eligibility and opermmg r~quirements of state statutes and regulations for the indicated permitting tier, including generator and secondary cov)-inment requirements. I understand that if any of the umts operate under permat by Rule or Conditional Authorization, I will also provide the required financial assurance for closure of the treatment unit by October 1. 1996. 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 directly r~ponaible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility, of fines and imprisonment for knowing violations. TERRY BURNSIDE VICE PRESIDENT - MERCHANDISING Name (Pnnt or Ty~ ,-, Title Si Date Signed IX. REQUESTING A SHORTENED REVIEW PERIOD: Generators operating under CA and/or CE are legally authorized to operate 60 days after submitting a complete notification. DTSC may. shorten the time period between notification and ~uthorizatton when the owner or operator establishes good cause. If you need to be authorized sooner than the standard 60-day period, please check the box below and state the reason. Your authorization will be automatically effective on the date your completed notification form is received by, DTSC. (Use ,~,t, fftional sheets, if necessary.) YES [] Reason: OPERATENG REQUIREMENTS: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tierts). ~;'hese operating requirements are set forth in the statutes and regulations, some of which are referenced in the Tier-Specific Fact Sheets available from DTSC's regional and headquarters offices. SUBMISSION PROCEDURES: All three forms must have original signatures, not photocopies. You must submit two copi~ of this completed notification by certified mall. return receipt requested, to: Department of Toxic Substances Controt Program Data Management Section, HQ-10 Attn: TP Notifications - Form 1772 400 P Street..*th Floor. Room 4453 (walk in only) P.O. Box 806 Sacramento. CA 95812-0806 You must also submit one copy of the notification and attachments to the local regulatory, agency in your jurisdiction aa listed in Appendix 2 of the mstruction materials. You must also retain a copy as part of your operating record. PLEASE, DO NOT SEND YOUR FEE PAY1VfE,NT WITH THIS FORM. DTSC 1772 (1/96) Page 3 EPA ID NUMBER Paget~ of 6 CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuam to Health and Safety Code Section 25201.5(c)) · The Tier-Specific Fact Sheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting thi_~ notification package. UNIT NAME LONGS DRUG STORt~S CALIFORNIA, INC. UNIT ID NUMBER ##17 .NUMBER OF TREATMENT DEVICES: ~ Tank, s) 7 Coma~ner(s)/Container Treatment Areais) *One Electrolytic Unit, one metered pump station & two silver recovery columns.'* Each unit must be clearly identified and labeled on the plot plan attached to Form 1/'72. Assign your own unique number to each unit. The number can be sequential (I. 2. $) or using any system you choose. Enter the estimated monthly total volume of haz. ardou$ waste treated bv this unit. This should be the maximum or'highest amount treated in any month. Indicate in the narrative (Section lI) if your operatior.~ have seasonal variations. I. WAb~YES~REAMS AND TREATMENT PROCESSF~: Estimated Monthly Total Volume Treated: pounds and/or 15t3_-3~_t) gallons 'ES NO ~ ~] is the waste treated in this unit radioactive? ~'] [] la the waste treated in this unit a bio-hn?ardous/infectious/medical waste? [~ ~'~ Is remotely generated ha,ardous waste (HSC 25110.10) treated in this unit? The following are the eligible waste, streams and treattnent processes. Please check all applicable boxes: C~ 1. Treating resins mixed or cured in accordance with the manufacturer's instructions (including one-part and pre-impregnated materials). [] 2. Treating containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. '~ 3. D~ing special wastes, as classified by the department pursuant to Title 22, CCR, Section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. ~ 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to Title 22, CCR, Section 66261.124. NOTE 5. NO AUTHORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media ttsed to demineralize water. (To be eligible for this exemption, this waste cannot contain more than 10 percent acid or base by weight.) (Effective January. 1. 1995). - 6. NO ALrI'HORIZATION IS NEEDED to neutralize acidic or alkaline (base) wastes from the food processing industry.. (Effective January. 1, 1996). ~ 7. Recovery. of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. NOTE Silver recovery, from photofinishing is completely exempt from authorization requirements if the quantity treated is 10 gallons or less in any calendar month. Do not complete this form if you qualify for this exemption. (Retain documentation verifying your eligibility for this exemption, such as developer invoices.) DTSC 1772B (1/96) Page 10 i~ EPA ID NUMBER C.A'L000~.~16 Page 5__ of 6 CONDITIONALLY EXEMIrF - SPECIFIED W~STESTREAMS UNIT SPECIFIC NOTIFICATION (punuant to Health and Safety. Code Section 2~201.5(c)) 8. Gravity separation of the following, including the use of flocculan~s and demulsifiers if: [] a. The settling of solids from the waste where the resulting aqueousfliquid stream is not h~7~rdous. .~, b. The separation of oil/water mLxmres and separation sludges, if the average oil recovered per month is than 25 barrels (42 gallons per barrel). (NOTE: AB 485 (Ch 625. 1995) allows certmn used oii/wmer separation under new the CEL category.. See Form 1772L and CIEL Faa Sheet.) ~] 9. Neutralizing acidic or alkaline (basic) material by a state certified laboratory, a laboratory operated by educatiomd institution, or a laboratory which treat~ ie~ than one gallon of onsite generated hamrdoas in any single batch. (To be eligible for conditional exemption, this w~ste ~nnot contain mor~ ~ 10 percmt acid or base by weight.) [~] 10. H,~m~lous waste tr~tment is carried out in quality control or quality a~surance laboratory at a facility that is not an offsite h~zm'dous w~te facility. [~] 11. A wastestream and tr,'~tment technology combination certified by the Depm'tment pursum~ to Se~ian 25200.1.5 of the Health and Safety. Code as appropriate for authorization under CESW. Please enter certification number:. (Se~ Appendix 5) [-~ 12. The treatment of formaldehyde or glutaraldehyde by a health care facility using a teclmology combination certified by the Depm-tment pursuant to section 25200.1.5 of the Henlth and Safety Code. Please enter certification number:. Il. NARRATIVE DF_~CRII~FIONS: Provide a brief description of the specific waste treated and the tremment proce~ used. 1. SPECIFIC WASTE TYPES TREATED: SPENT PHOTOGRAPHIC FIXER SOLUTIONS. _ SEASONAL VOLUMES INCREASE DURING HOLIDAY PERIODS. 2. TREATMENT PROCESSfES~ USED: ~H VF~ I~F_C©VERY UNITS BY METALLIC REPLACEMENT. ITl. RESIDUAL MANAGEMENT: Check Yes or No to each question ax it applies to ail residuals from this treatment unit. YES NO ~-~ ~'~ I. Do you discharge non-b~rdous aqueous waste m a publicly owned treatment works (POTW)/sewer? [] ~ 2. Do you discharge non-hazardous aqueous waste under an NPDES permit? ~ ~ 3. Do you have your residual h~7~ous waste hauled offsite by a registered hazardous waste hauler? If you do, where is ~hc waste scm? Check all that apply. ~] a. Offsite recycling SAFETY-KLEEN, 3~6! S. MAPLE ST., FRESNO, CA 9~725 ~. b. Thermal rreatmem ILDgg#905202 ~ c. Disposal m land ~ d. Furtaer treatment ~ f~- 4. Do you dispose of n°n-ha-~rdous solid waste res/dues at an offsit¢ location'? ~ ~ 5. O~er method of disposal. Spec/fy: DTSC 1772B (I/96} Page 11 EPA ID NUMBER CAL00012~6 Page 6__ of 6_. CONDITIONALLY EXF~IPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC .NOTIFICATION (pursuant to Health and SMew. Code Section 25201.5(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to dernanstrate eligibili~, for one of the onsite treatment tiers, facilities are required to provide the basis.for determining that a ha:.ardous waste permit is not required under the federal Resource Conservation and Recovery. Act (RCRA) and the federal regulations adopted under RCRA (Title 40; Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of )'our onsite treatment units: [] 1. The ba:'ardous waste being treatexl is not a ha?ardous waste under federal law although it is regulated as a hazardous waste under California state [aw. E~ 2. The waste is treated in wastewater treatment units (tan~), as defined in 40 CFR Part 260. i0, and discharged to a publicly owned treatment works (PO'FW)/sewermg agency, or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. [-'] 3. The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewermg agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. [~ 4. Thc waste is treated in a totally enclosed treatment facility as defined in 40 CFR Pan 260.10; 40 CFR 264. l(g)(5). [--] 5. The company generates no more than 1130 kg (approximately 27 gallons) of ha~'~rdous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260. i0 and ,10 CFR 261.5. r'"2, 6. The waste is treated in an accumulation tank or container within 90 days for over 1000 kg/month generators and 180 or 270 days for generators of I00 to 1000 kg/month. 40 CFR 262.34.40 CFR 270. l(c)(2)(i), and the Preamble to the March 24. 1986 Federal Register. ~ 7. Recyciable materials are recla'mexi to recover econormcally significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(ivL 40 CFR 264. l(g)(2), and ,10 CFR 266.70. ~ 8. Empty container nnsing and/or treatment. 40 CFR 261.7. ~-~ 9. Other: Specify: V. _ TRANSPORTABLE TREATMENT U~'NIT: Check )'es or No. Please refer to the Instructions for more information. YES NO ? ~ ~] Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. 3TSC 1772B (1/96) Page 12 F~OM : LONGS DRUG ~417 PHONE NO. : ~. Dec. 02 lg97 10:11AM P8 ..... --.- ~ I " " ROM : LONGS DRUG ~417 PHONE NO. : Dec. 02 1997 10;10~M P6 ~ NOTIFICATION OF ~'SILVER-ONLY" HAZARDOUS WASTE TREATMENT FORM Company Name ['~W~)(% ~_~('fl. (C~:' q~ Company EPA ID Number CA I_ O O (D _k~__ (.o _~_]_ __~ Company Address (Mailing) C(ecr , CA zip code qqVq Unit Name ~ Unit ID Number C I I-7 Is your company eligible Ior me exemptions noted on page 1.9 YES X NO If no, then disregard this noficel If yes, then please check the applicable wastestream box: The recovery of silver from photofmishing/photoimaging solutions and photoimaging solution wastewaters (provided [hat the solutions and wastewaters are "silveroonly" hazardous wastes, and are not hazardous for any other reason or constituent). 1. Wastestream # 2 under CESQT (DTSC 1772B) - if applicable. [] 2. Wastes~ream # 7 under CESW (DTSC 1772B). 3. Wastestream # 10 umler CA (DTSC I?TZB). ............ un.er PBR (DTSC "~"""~ -- if applicable. Are you authorized for any other treatmem activity? YES NO/~ If yes, under which tier are you authorized? .CESW...~ CESQT CA PBR STD, PERMIT . FULL PERMIT Of your estimated monthly total volume of wastes treated, what portion is "silver-only" hazardous photofinishing wastes treated to recover silver? [ O0~/e, (If this "silver-only" hazardous photofinishing portion is a significant portion of your total wastes treated, you may be eligible for regulation under a lower permit tier. Please contact your local CUPA to determine or confn'm your.regulatory tier status.) I certify under penalty of law that this document was pre~l under my direction or supervision and the information is, to the best of my knowledge and belief, true./accu~tt)ff, and complete. l~ame (Print or lype) Signitur~ / 'liue Date Please submit the completed notification form to your local CUPA and also send a copy to: Department of Toxic Substances Control Unified Program Section P.O. Box 806 Sacramento, CA 95812-0806 Page ~ o~ ~ ONS WAS NOT CA ON FACILI~ SPECIFIC NOTIFICATION ~ Imtifl For Use bv Hazardous W~te Generators Peffo~ng Treatment ~ Amend~ Under Condition~ Exempuon =d Condition~ Au~on~tion. ~d by Pe~t By Rule F~ilities Ple~e r~er to 'the attached l~t~ct~o~ b~ore completing this fo~. You ~ noti~ for more than one pe~itting tier by ~ing this notificatton fo~. DTSC 1~. You ~t ~tach a $epar~e unit specific not~fic~on fo~ for ea~ umt ~ th~ loc~Wn. ~re are different unit speci~c notific~on fo~ for.five of the c~egones a~ an ~difio~l ~tification fo~ for tr~ponable tre~ units ~'s~. You only have to s~t fo~ for the tiertx)/c~ego~(i~) t~ cover your umt(s). Discard or re.cie the ot~er ~ fo~. Nu~er each page of your completed notificmton pac~ge a~ i~icme the total nu~er of pages at the top of ea~ page at the 'Page ~ of ~' ~t your EPA ID Nu~er on ea~ page. Ple~e provide aH of the info--ion requited: Ml fie~ ~t be co~leted ~cept those t~ stye 'if different' or 'if avai~le'. Ple~e ~e the info--ion promded on this fo~ ~ ~ ~tachmems. ~e notificatWn fe~ are ~s~$ed on the b~s of the ~gh~t tier the ~tifier will operate u~er ~ will be collea~ ~ t~ Stye Board of Eq~liz~ion. DO NOT SEND YOUR ~E PAYMENT WITH THIS NOTIFICATION FORM. I. NO~CA~ON CA~GO~S l~icate the nu~er of units you oper~e in each aer. ~is will a~o be the ~er of unit spe~fic notific~ion fo~ you ~t ~tach. Co~n~y ~e~t S~l ~ Tm~nt ope~om ~ not ope~e un~s u~er ~y other ~er. Nmber of uni~ and attached uffit sp~ific notifimtiom for tach tier re~. A. Conditionflly ~empt-S~l Q~tiW T~ment (CESQ~ D. Pe~t by Rule (PBR) B. X Condit~nflly Exempt-S~ifi~ W~testm (CES~ E. CE--Co~emifl ~und~ {CE-CL) C. Conditionflly Au~on~ (CA) F. Condition~ly ~empt-Li~ted (CEL) II. GE~RATOR ~E~CA~ON EPA ID NUMBER CA L 0 0 0 1 7 6 6 1 6 BOE NUMBER(if available)H~HQ FACILITY NAME I ONGS DRUG STORES #~ 1'7 , DBA-Doing Business PHYSICAL LOCATION ~00 COFFEE ROAD CITY BAKERSFIELD CA ZIP 93308 COUNTY KERN CONTACT PERSON BRUCE HUNTER PHONE NUMBER( 805 ) 588 . 0290 ~First Namc~ ~st Name~ STORE MANAGER MAIL~G ADD.SS. IF DI~RE~: COMPANY NAME LONGS DRUG STORES CALIFORNIA, INC. STREET lql NORTH CIVIC DRIVE CITY WALNUT CREEK STATE CA ZIP 9~596_ COUNTRY CONTACT PERSON PHONE NUMBER/ 510 '~ 210 - 6999 l~i~ Name~ /~st Nam~ ENVIRONMENTAL MANAGER DTSC 1772 (1/96) Page i EPA ID NUMBER Page 2 of 6__ III. RADIOACTIVE MATERIALS OR WASTE YES NO ~ ~ Does the facility use. store or treat ra~tioactive materials or radioactive waste? W. TYPE OF COMPANY: STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE: Use either one or two SIC codes (a four digit nurnberj that best describe your company. 's products, services, or mdusmal activity. Example: 7384 Photofinishing lab 721___~8 Industrial launderers First: 5912 RETAIL CHAIN DRUG Second: STORE V. PRIOR PERMIT STATUS: Check yes or no to each question: YES NO ['-] [] 1. Did you file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? ~2 ~ 2. Do you now have or have you ever held a staxe or federal h~Tardous waste facility full permit or interim status for any Of these treatment units? D ['~ 3. Do you now have or have you ever held a stale or federal full permit or interim smms for any other baTardous waste activities at this location? ~] ~'] 4. Have you ever held a variance issued by the Department of Toxic Substancea Control for thc treatment you are now notifying for at this location? ['"] ~'] 5. Has this location ever been impected by the state or any local agency as a h~ardous wasl~ getmrator? VI. PRIOR ENFORCEMENT HISTORY: Not required from conditionally exempt generators or contrner~ial laundries. YES NO ~ ~~ Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final orders resulting from an action bv any local, state, or federal environmental, hazardous waste, or public health enforcement agency.? (For the purposes of this form. a notice of violation does not constitute an order and need not be reported unless it was not corrected and became a final or, er.) If you answered Yes, .check this box and attach a li~ting of convictions, judgments, settlements, or orders and a copy of the cover sheet from each document. (See the L~tructions for more informatiom VII.- A'I'rACH~fTS: Attachments are not required from commercial laundries. ~ i. A plot plan/map detailing the locatioms) of the covered unms) in relation to the facility boundaries. ~ _.~ A umt specific notification form' for each unit to be covered at this location. DTSC 1""~ Page 2 , ~~ (1/96) EPA ID NUMBER CAL00017(~_~ Page 3 of_ VIII, CERTIFICATIONS: This form must be signed by an authorized co~. orate officer or any other person in the company who has operational control and performs decision-making functions that govern operation of the facili~. (per Title 22, California Code of Regulations tCCRI Section 66270. II). All three copies must have original signatures. Waste Minimization I certifY,' that I have a program in place to reduce the volume, quantit3,., and toxicity, of waste generated to the degree I have detertmned to be econotmcally practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which rmnirmzes the present and future threax to human health and the environment. Tiered Permitting Certification I certify that the unit or units described in these documents meet the eligibility and operating r~qutrements of state statutes and regulations for the indicated permitting tier, including generator aad secondary containment requirements. I understand that if any of the units operate under penmt by Rule or Conditional AuthoriZation, I will also provide the required finaacial assurance for closure of the treatment unit by October 1. 1996. I certi~ under penalw of law that this document and all attachments wer~ p~-paxexi under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Ba.~d on my inquiny of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penaltiea for submitting false information, including the possibility, of fines and imprisonment for knowing violations. TERRY BURNSIDE VICE PRESIDENT - MERCHANDISING Name (Pnnt or Title Signature Date Signe IX. REQUESTING A SHORTENED REVIEW PERIOD: Generators operating under CA and/or CE are legally authorized to operate 60 days after submitting a complete notification. DTSC may. shorten the time period between notification and ~uthori:ation when the owner or operator establishes good cause, lf you need to be authorized sooner than the standard 60-day period, please check the box below and state the reason. Your authorization will be autornatically effective on the date your completed notification form is received by. DTSE. (Use ,~tdirional sheets, if necessary.) YES [--~ Reason: OPERATING REQUIREMENTS: Please note that ~enerators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier~s~. ~7~ese operntin~ requirements are set forth in the statutes and regulations, some of which are r~erenced in the Tier-Specific Fact Sheets available from DTSC's regional and headquarters offices. SUBMISSION PROCEDURES: All three forms mu~t have original signatures, not photocopies. You must submit two copies of this completed notification by cer~ff'~ed ma~l, re~urn receipt requested, to: _ Depa~ment or- Toxic Substances Control Program Data Management Section, HQ-tO Arm: TP Notifications - Form 177~ 400 P Street. 4th Floor, Room 4453 (walk in only) P.O. Box 806 You must aJso submi~ one cops' of the noiificat~on and attachments to the local regulator~, agency in your jurisdiction as listed in .Appendix 2 of d~e instruction materials. You must also retain a copy as pa~ of your operating record. PLEASE. DO NOT SEND YOUR FEE PAYMENT WITH THIS FORM. DT$C 177~ (1/96~ Page ~ EPA ID NUMBER Page ~__ of ~6 CONDITIONALLY EXEMPT- SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.$(c)) · The Tier-Specific Fact Sheets cmltnin a summary of the operating requirements for this catego~. P~ease review those requirements carefully before completing or submi~tlng thi_q notiti~tlon package. UNIT NAME LONGS DRUG STORES CALIFORNIA, INC. UNIT I:D NUMBER 111417 .NUMBER OF TREATMENT DEVICES: ..... Tank(s) 7 . Contamer(s)/Contatner Treatment Area(s) *One Electrolytic Unit, one metered pump station & two silver recovery columns.'* Each unit mu~t be clearly identified and labeled on the plot plan attached to Form l /"72. 3_isign your own unique number to each unit. The number can be sequential (1, 2. 3) or u~ing any ~ystem you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. This should be the maximum or'highest amount treated in any month. Indicate in the narrative (Section II) if your operations have seasonal variations. I. WASTF_~'REAMS AND TRF~TMENT PROC~: Estimated Monthly Total Volume Treated: pounds and/or ! 50-300 gallons 'ES NO ~ IX] Is the waste treated in this unit radioactive? ['"] [] Is the waste treated in this unit a bio-hazardous/infectious/medical waste? [] [~] la remotely generated baTardous waste (HSC 25110.10) treated in this unit? The following are the eligible wastestrearra and treattnent processes. Please check all applicable boxes: [] 1. Treating resins mixed or cured in accordance with the manufacturer's instructions (including one-part and pre-impregnated materials). [] 2. Treating containers of 110 gallons or less capacity that contained hazardous~ waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. ~ 3. Drying special wastes, as classified by the department pursuant to Title 22, CCR, Section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. [] 4. Magnetic separation or screening to remove components from special waste, as classified by the department pursuant to Title 22, CCR, Section 66261.124. NOTE 5. NO AUTHORIZATION. IS NEEDED to neutralize acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water, tTo be eligible for this exemption, this waste cannot contain more than 10 percent acid or base by weight.) (Effective January. l, 1995). - 6. NO ALrrHOR1ZATION IS .NEEDED to neutralize acidic or alkaline (base) wastes fr6m the food processing industry.. (Effective January. 1, 1996). ~ 7. Recovery. of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at the same location) in any calendar month. NOTE Silver recovery, from photofinishing is completely exempt from authorization requirements if the quantity treated is 10 gallons or less in any calendar month. Do not complete this form if you qualify for this exemption. (Retain documentation verifying your eligibility for this exemption, such as developer invoices.) DTSC 1772B (I/96) Page 10 EPA ID NUMBER CAL000 6 __ Page 5__ ol 6 CONDmONALLY EXEMIrr. SPECWIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety. Code Section 2.5201.5(c)) 8. Gravity separation of the following, including the use of flocculants and demulaifiers if: [~ a. The settling of solids from the waste where the resulting aqueo~/liquid stream is not baT~rdous. ~,1 b. The separation of oil/water rmxmres and separation sludges, if the average oil recovered per month is leas than 25 barrels (42 gallons per barrel). (NOTE: AB 483 (Ch 625. 1995) allows ce,mn ~ed oil~water separation under new the eEL category.. See Form 1772L and CEL Fact Sheet. ~ I~ 9. Neutralizing acidic or alkaline (basic) material by a state certified laboratory, a laboratory operated by an educational institution, or a laboratory which treats less thnn one gallon of onsite generated hazardous waste in any single batch. (To be eligible for conditional exemption, this waste cannot contain more tllm110 pe~,cent acid or base by weight.) ~] 10. l~a,~lous waste tr~tment is carried out in quality control or qtmlity assurance laboratory at a facility that is not an offsite hazardous waste facility. ~'] 11. A wastestrenm and tr~tment technology combination certified by the Department pursuant to Section 25200.1.5 of the Flealth and Safety Code as appropriate for authorization under CESW. Please enter certification umber:. (Sec Appendix 5) ['~ 12. The treatment of formaldehyde or glutnraldehyde by a health care facility using a tecimoio~y combination certified by the Department pursuant to section 2S200.1.$ of the Health and Safety Code. Please enter certification number:. ri. NARRATIVE DESCRIPTIONS: Provide a bri~ d~cript~on of the xpec~fic waste treated ~ the trearrntnt l~rocex~ ~. 1. SPECIFIC WASTE TYPES TREATED: SPENT pHOTOGRAPHIC FIXER SOLUTIONS.. SEASONAL VOLUMES INCREASE DURING HOLIDAY PERIODS. 2. TREATMENT PROCESS(ES/USED: qll VFI~ I~F~(~VE]~¥ UNITS BY METALLIC REPLACEMENT. flI. RESIDUAL MANAGEMENT: Check t/ex or No to each qu~tion a.~ it applie~ to all r~idua~ porn thi__~ treatment ~t. YES NO [~ ~'~ I. Do you discharge non-haTardous aqueous waste to a publicly owned treatment works (POTW)/scwer? [-~ [~ 2. Do you discharge non-ha?ardons aqueous waste under an NPDES permit? ~ 3. Do you have ),our residual haTar~ious waste hauled offsitc by a registered haTardons waste hauler?. If you do. where is thc waste sent? Check all that apply. _ ['~ a. Offsite recycling SAFETY-KLEEN, 3561 S. MAPLE.ST., FRES[qO, CA 93725 ~ b. Thermal treatment ILD98#908202 [~ c. Disposal to land t [~ ct. Furtilcr treatnlcnt ~ 5. Other mcthocl of disposal. Specie: DTSC 1772B (1/96) Page 11 EPA!D NUMBER CAL000176O Page 6 of 6 CONDITIONALLY EXEMFT - SPECIFIED WASTES'rREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Sa. fei3,. Code Section 25201.5(c)) BASIS FOR NOT NEEDllVG A FEDERAL PERMIT: In order to demonstrate eligibili~, for one of the onstte treatment tiers, facilities are required to provide the basis.for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recove~ Act IRCRA)'and the federal regulations adopted under RCRA (Title 40; Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsue treatment units: ~-~ 1. The hazardous waste being treated is not a h~,~rdous waste under federal law although it is regulated as a b~-~rdous waste under California state law. {-~ 2. The waste is treated in wastewater treatment umts (tanks), as defined in 40 CFR Pan 260. i0, and discharged to a publicly owned treatment works (POTW)/sewermg agency, or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. [] 3. Thc waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewering agency or under an NPDES permit. 40 CFR 264. l(g)(6) and 40 CFR 270.2. [~ 4. The waste is treated in a totally enclosed treatment facility as defined in 40 CFR Pan 260.10:40 CFR 264. l(g)(5). [-'] 5. The company generates no more than 100 kg (approximately 27 gallons) of hazardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261,5. ~-~, · 6. The waste is treated in an accumulation tank or container within 90 days for over 1000 k~,/month_ .~enerators and 180 or 270 days for generators of 100 to 1000 kglmonth. 40 CFR 262.34.40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. i_~ 7. Recyclable materials are reclaimed to recover econormcallv significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. [~ 8. Empty container rinsing and/or treatment. 40 CFR 251.7. [] 9. Other: Specify: V. _ TRANSPORTABLE TREATMENT U~'NIT: Check }'es or No. Please refer to the Instructions for more information. YES NO ~ [~] Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. DTSC I772B (I/96) Page 12 ROM : LONGS DRUG ~417 PHONE NO. :. Dec. 02 1997 10: llAM P8 ROM : LONGS DRUG ~417 PHONE NO. : Dec. 02 1997 10:lOAM P6 F ~.~--J.~v'i~ ~ ..... ~1'~'1 ............ ' ._~..~ , - _ _~