HAZARDOUS WASTE TRANSFER FACILITIES NOTIFICATION State Form 52123 (R2 / 10-09) County Indiana Department of Environmental Management Name of facility Location address (number and street) Location city State ZIP State ZIP Owner city State ZIP Owner telephone E-mail Mailing address (number and street) Mailing city Owner’s name Owner address (number and street) Operator’s name Operator address (number and street) Operator city State Operator telephone ZIP E-mail Contact name Contact address (number and street) Contact city State Contact telephone ZIP E-mail TRANSFER FACILITY ACTIVITIES Mix hazardous waste Repackage hazardous waste (except for leaking containers or containers in poor condition) Combine hazardous waste Pump hazardous waste from one vehicle to another Commingle hazardous waste Bulk hazardous waste First name Transfer hazardous waste from one vehicle to another (including containerized hazardous waste) Open hazardous waste containers for purposes other than sampling Last name Signature (This form must be printed, signed and sent to us in the mail.) American LegalNet, Inc. www.FormsWorkFlow.com EXPLANATION OF HAZARDOUS WASTE TRANSFER FACILITIES RULE This information briefly outlines the requirements for hazardous waste facilities that, during transport, mix, combine, commingle, bulk, repackage, (except in response to leaking containers or containers in poor condition), pump hazardous waste from one vehicle to another, transfer hazardous waste (including containerized hazardous waste) from one vehicle to another, or open hazardous waste containers for purposes other than for sampling, to notify IDEM of their existence. Citation 329 IAC 3.1-8-4 Authority: IC 13-14-1; IC 13-14-8; IC 13-22-2-4 Affected: IC 13-22-2-4; 40 CFR 263.12 Affected Persons This rule affects hazardous waste transfer facilities that perform certain activities as listed above. Reason(s) for the Rule There are few standards governing activities at hazardous waste transfer facilities. The purpose of this rule is to locate and identify hazardous waste transfer facilities that conduct hazardous waste activities as detailed above. Notification must include the following: New hazardous waste transfer facilities must submit notification at least thirty (30) days before the hazardous waste management activities begin. The following information must be included. Name Location and mailing address Telephone number Owner’s name Owner’s mailing address Owner’s telephone number Operator’s name Operator’s mailing address Operator’s telephone number Description of the hazardous waste management activities that the owner or operator of the hazardous waste transfer facility conducts Mail notifications to: Nicholas Staller Indiana Department of Environmental Management Office of Land Quality, Data Services Section 100 N. Senate Ave., Rm. 1101 Indianapolis, IN 46204-2251 Economic Impact of the Rule (317) 234-3478 The Indiana Department of Environmental Telephone: Management (IDEM) has determined that this rule E-mail: nstaller@idem.in.gov will have no fiscal impact on state or local governments since the state and local governments do not own hazardous waste transfer facilities. The economic impact on industry owned or operated transfer facilities will be minimal; only the cost of sending a written notification to IDEM. Benefits of the Rule This rule should assist in preventing hazardous waste releases into the environment from these types of activities. American LegalNet, Inc. www.FormsWorkFlow.com