Application to Dispose of Business Generated Hazardous ...



Place your county logo here |Application

to Dispose of Business Generated Hazardous Waste at a Licensed VSQG Consolidation Program | |

Household Hazardous Waste (HHW) Facility Information

|Facility name: |      |Contact name: |      |

|Facility address: |      |

Generator Size – to use this Licensed Very Small Quantity Generator (VSQG) Consolidation Program (Program), your business must qualify as one of the following - check one:

| |Very Small Quantity Generator (VSQG): generate less than 220 pounds (or 22 gallons liquid) of non-acute hazardous waste per calendar month. |

| |Minimal Quantity Generator (MQG): generate less than 100 pounds (or 10 gallons liquid) of hazardous waste per calendar year. |

| |One-time Generator (OTG): generate and dispose of less than 2,200 pounds of hazardous waste as a one-time clean out. Your business no longer |

| |generates hazardous waste in its normal business processes. |

Business Information

|Company name: |      |Telephone: |      |

|Mailing address: |      |

|Location address: |      |

|Contact name: |      |Telephone: |      |

Waste Identification Number

You must obtain a Minnesota Pollution Control Agency (MPCA) issued identification (ID) number to dispose of hazardous waste through this Program. This Program will assist you to do this, or call 651-296-6300 or 1-800-657-3843 for further assistance on how to acquire a Hazardous Waste Generator ID Number.

|My site-specific MPCA Waste ID Number is: |      |

Hazardous Waste Disposal (List amount of hazardous waste generated. Attach an additional sheet, if needed.)

|Waste |Quantity |Waste |Quantity |

|Paint/paint solvents |      |Pesticides |      |

|Cleaners/solvents |      |Fuels |      |

|Laboratory chemicals |      |Other |      |

Certification

I certify that I am authorized to represent this business, the information provided by me on this form is correct and true, and my business meets the definition of a VSQG, MQG, or OTG. I agree to the following:

a) I authorize payment of fees charged by the Program.

b) I am responsible for safely and legally managing and transporting my waste.

c) I have read and agree to follow the guidance and requirements specific to this Licensed VSQG Collection Program.

d) The Program may reject delivery of my waste without cause at my expense.

e) The Program may add fees to properly package or handle wastes that present unexpected problems.

|      | | | |      |

|Generator representative (print name/title) | |Signature | |Date |

About this application

This form can be used by a Household Hazardous Waste (HHW) licensed collection Program as a waste disposal application for a business which has already received a waste identification (ID) number issued by the MPCA.

Use of this form is intended to facilitate proper waste management and disposal for businesses generating hazardous waste (HW). Businesses shall obtain a HW ID number prior to using this Program for HW disposal.

A Licensed VSQG Consolidation Program can use this form to accept business HW from the following generators:

• Very Small Quantity Generators (VSQG) – a business generating less than 220 pounds of non-acute HW per month.

• Minimal Quantity Generator (MQG) – a business generating less than 100 pounds of non-acute HW per year.

• One-Time Generator (OTG) – a business that does not normally generate HW, but that may have a disposal need due to cleaning out a storage area, cleaning up a spill, managing abandoned waste, renovating a building, or other similar circumstances.

Note: In previous years, the Regulated Waste Activity Form was referred to as the U.S. Environmental Protection Agency (EPA) Notification Form; however, the MPCA now issues these ID numbers. For more information, see Changes in getting a hazardous waste identification number at pca.state.mn.us/publications/w-hw0-11.pdf.

For HHW Program information

To obtain information on Minnesota’s HHW Programs, see: pca.state.mn.us/waste/hhw/index.html.

For a complete listing of VSQG collection programs licensed to operate in Minnesota and the specific materials each accepts, see: pca.state.mn.us/publications/w-hw2-51.pdf.

For HW ID Number information

This Program will assist you in attaining a HW ID number or see pca.state.mn.us/publications/w-hw1-02.pdf or Notification of Regulated Waste Activity Form and Instructions, pca.state.mn.us/publications/w-hw7-09.pdf.

Metro area county hazardous waste offices

Anoka County 763-422-7093

Carver County 952-361-1800

Dakota County 952-891-7557

Hennepin County 612-348-3777

Ramsey County 651-266-1199

Scott County 952-496-8177

Washington County 651-430-6655

Minnesota Pollution Control Agency

Brainerd 218-828-2492

Detroit Lakes 218-847-1519

Duluth 218-723-4660

Marshall 507-537-7146

Rochester 507-285-7343

St. Paul 651-296-6300

Willmar 320-214-3786

Need more information?

Visit the MPCA at pca.state.mn.us.

You may also call the MPCA at 651-296-6300 or

1-800-657-3864.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download