Notification Form for Polychlorinated Biphenyls (PCBs) Holdings
STANDARD REPORTING FORM FOR PCB HOLDINGS
Background information
The Waste Management (Hazardous Waste) Regulations, 1998, S.I. No. 163 of 1998, require
that all holders of polychlorinated biphenyls (PCBs), used PCBs or PCB-contaminated
equipment containing an aggregate volume of more than 5 litres of PCB-contaminated
materials shall notify the Environmental Protection Agency in writing in relation to those
holdings. The notification must be made by 1 September each year. The notification must
contain the following information:
(a) the name and address of the holder,
(b) the location and quantity of the PCBs or used PCBs,
(c) the location and description of the equipment,
(d) the quantity of PCBs contained in such equipment,
(e) the measures taken or proposed to be taken (including a timescale) for the
decontamination or disposal, as the case may be, of the said PCBs, used PCBs and
equipment, and
(f) the date of giving such notice.
The notification need not specify information listed in items (d) and (e) above as regards any
equipment in respect of which it is reasonable to assume that the fluid content of the
equipment contains between 0.05% and 0.005% by weight of PCBs.
All equipment containing PCB-contaminated materials with concentrations of greater than
500ppm PCBs must be decontaminated or disposed of the equipment in an environmentally
sound manner before 31 December 2010.
Instructions
The standard notification form should be used where possible. Save this file to your computer
with a unique filename, for example “PCB holdings at <insert name of company>”. The form
should preferably be completed electronically, printed out and signed. If this form is not
sufficient to enter your information please use additional pages and include copies with the
notification form. The notification form should be sent to pcbs@epa.ie and to the following
address:
PCB Inventory,
Resource Use Unit
Environmental Protection Agency,
PO Box 3000,
Johnstown Castle Estate,
County Wexford.
Any queries in relation to completing the form should be addressed to the EPA by phone at
053-9160600 or by e-mail at pcbs@epa.ie. Further information on PCBs and PCB-related
legislation is available at www.pcbs.ie.
Please submit this Notification form to the EPA no later than the 1 st of September each
year.
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Environmental Protection Agency
Notification Form for Polychlorinated Biphenyls (PCBs) Holdings
Environmental Protection Agency
PO Box 3000
Johnstown Castle Estate
Co. Wexford
Tel.
Fax.
Web.
E-mail
053 9160600
053 9160699
www.epa.ie
pcbs@epa.ie
PCB Notification Form
Version 4.01 March 2010
PCB NOTIFICATION FORM
To be completed in full in respect of all PCB holdings in accordance with Article 15 of the
Waste Management (Hazardous Waste) Regulations, 1998, S.I. No. 163 of 1998.
Contact Details
Organisation Name:
Address:
Contact Person and their
Role
Telephone:
E-mail:
Site Name for holding:
(If same as above, enter
‘SAME’)
Site Address for holding:
(If same as above, enter
‘SAME’)
Telephone:
E-mail:
PCB Holding Reference:
IPPC or Waste Licence No.:
(If applicable)
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Environmental Protection Agency
Management Plan for Polychlorinated Biphenyls (PCBs)
PCB Holding Details
Type of
Equipment
Location of
Equipment
(See Note 1)
(See Note 2)
Manufacturer
of Equipment
Year of
Manufacture
of
Equipment
Model/
Serial no
Quantity of
PCBcontaminated
material
Contained in
the
Equipment
(litres)
Concentration
of PCBs in the
liquid in ppm
Testing
Laboratory
Name
(See Note 3)
Test Method
used to
determine PCB
concentration
Verification of PCB
Status through
Manufacturer’s
Documentation
(See Note 4)
(See Note 5)
Note 1: Specify the type of equipment held on site (Please consider ALL oil-containing equipment, including Transformers, Power Factor Correction Unit, Circuit Breakers, Capacitors, Regulators, Hydraulic Plant,
Welding Plant, Submersible Pumps and Motor Starters).
Note 2: Provide a Building Name or Reference where the equipment is housed.
Note 3: Identify the Laboratory where PCB testing was conducted (if applicable).
Note 4: Testing must conform to the European Standard IEC61619 for a holding to be confirmed as a Nil Holding. Provide the test method used to determine PCB concentration (e.g. IEC61619, Screen test etc.), if
applicable.
Note 5: Indicate whether the site have received verification of PCB status through manufacturer’s documentation.
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Environmental Protection Agency
Management Plan for Polychlorinated Biphenyls (PCBs)
PCB Holding Details
Type of
Equipment
Location of
Equipment
(See Note 1)
(See Note 2)
Manufacturer
of Equipment
Year of
Manufacture
of Equipment
Model/
Serial no
Quantity of
PCBcontaminated
material
Contained in
the
Equipment
(litres)
Concentration
of PCBs in the
liquid in ppm
Testing
Laboratory
Name
(See Note 3)
Test Method
used to
determine PCB
concentration
Verification of PCB Status
through Manufacturer’s
Documentation
(See Note 5)
(See Note 4)
Please photocopy or extend as necessary to give full PCB inventory.
Note 1: Specify the type of equipment held on site (Please consider ALL oil-containing equipment, including Transformers, Power Factor Correction Unit, Circuit Breakers, Capacitors, Regulators, Hydraulic Plant,
Welding Plant, Submersible Pumps and Motor Starters).
Note 2: Provide a Building Name or Reference where the equipment is housed.
Note 3: Identify the Laboratory where PCB testing was conducted (if applicable).
Note 4: Testing must conform to the European Standard IEC61619 for a holding to be confirmed as a Nil Holding. Provide the test method used to determine PCB concentration (e.g. IEC61619, Screen test etc.), if
applicable.
Note 5: Indicate whether the site has received verification of PCB status through manufacturer’s documentation. Include copies of this documentation with the return.
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Environmental Protection Agency
Management Plan for Polychlorinated Biphenyls (PCBs)
PCB Management
Please provide details on the measures taken or proposed measures to be taken for the decontamination or disposal of
PCBs from the site. In addition, please submit details of the disposal of any PCBs in the past from the site.
Please include the following detail:
a. Identification references for the items of equipment to be decontaminated or disposed of;
b. decontamination procedure including spillage containment to be employed;
c.
labelling;
d. the personnel/contractors undertaking the decontamination or disposal;
e. details of waste contractors to handle the PCB wastes or PCB contaminated equipment, including a
copy of their permit; and
f.
Copies of the C1 and the Transfrontier notification forms for the movement of the PCB waste or PCB
contaminated equipment.
Signature
Signed: _____________________________________________
Print name: __________________________________________
Position within Company: ______________________________
Date: ________________________________________________
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Environmental Protection Agency