2510-FM-BWM0053
Instructions
6/2005
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
INSTRUCTIONS FOR NOTIFICATION OF
HAZARDOUS WASTE PERMIT-BY-RULE ACTIVITY FORM
This form must be used to satisfy the hazardous waste permit-by-rule notification requirement of 25 Pa. Code
§270a.60(a)(1). Any Federal regulations cited in this document have been incorporated into Pennsylvania's hazardous
waste regulations. For more information on Pennsylvania's hazardous waste permit-by-rule provisions, contact the
Department at 717-787-6239.
This completed Notification Form should be sent to the appropriate Regional Office of the Pennsylvania Department of
Environmental Protection, Bureau of Waste Management (see enclosed list of Regional Offices and areas served).
Item I - Installation's EPA ID Number
All permit-by-rule facilities are required to have an EPA Identification (ID) Number. Enter the EPA ID Number for your
facility. If you do not have an EPA ID Number, please contact the Department at 717-787-6239.
Item II - Name
Enter the legal name of the installation.
Item III - Location of installation
Enter the municipality and county information for the physical facility location. A municipality is the city, borough, or
township within which the installation is physically located.
Item IV - NAICS Codes
List, in descending order of significance, the six-digit North American Industry Classification System (NAICS) Code(s)
which best describe your activity in terms of the principal products or services you produce or provide. Also specify each
classification in words (NAICS Short Title). These classifications may differ from the NAICS Codes describing the
operation generating the hazardous wastes.
NAICS Code numbers are descriptions which may be found in the North American Industry Classification System which is
available from the NAICS Association, 801-545-9453, www.naics.com. A copy may be available at your local library.
Item V - Type of Hazardous Waste Permit-by-Rule Activity
Mark an "X" in the appropriate box to indicate the type of permit-by-rule you are claiming. Refer to the Department's
regulations at 25 Pa Code § 270a.60 for information on the types of permit-by-rule available and the applicable
requirements. Attach a detailed description of your activity and other information available to support your claim. Contact
the Department at 7l7-787-6239 if you have any questions.
Item VI - Existing Environmental Permits
Enter the permit number for each Federal or State permit for your location. If you have filed an application but have not yet
received a permit enter the number of the application, if any. If you have more than one permit under a particular permit
program, list the additional permit numbers on a separate sheet of paper.
2510-FM-BWM0053
Form
6/2005
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
NOTIFICATION OF HAZARDOUS WASTE PERMIT-BY-RULE ACTIVITY
I.
Installation’s EPA I.D. Number
II.
Name of Installation
Ill.
Location of Installation
Municipality (Township, Borough, City)
IV.
V.
County
North American Industry Classification System (NAICS) Codes for the installation (six-digit number in order of
priority)
1.
Specify:
2.
Specify:
3.
Specify:
4.
Specify:
Type of Hazardous Waste Permit-by-Rule Activity (attach supporting narrative description)
1. Elementary neutralization unit - see definition of this term at 40 CFR §260.10 and applicable permit-by-rule
requirements at 25 Pa. Code §270a.60(b)(1).
2. Wastewater treatment unit - see definition of this term at 40 CFR §260.10 and applicable permit-by-rule
requirements at 25 Pa. Code §270a.60(b)(1)
3. Generator treatment in accumulation containers, tanks or containment buildings - see permit-by-rule
requirements at 25 Pa. Code §270a.60(b)(2). NOTE: An individual permit will be required for a treatment
activity that is regulated by standards in addition to those applicable to generator accumulation units (e.g.,
thermal treatment).
4. Treatment of spent, lead-acid batteries at a battery manufacturing facility prior to their reclamation - see
permit-by-rule requirements at 25 Pa. Code §270a.60(b)(3).
5. Treatment of hazardous waste onsite, at the site where it is generated, prior to reclamation of the hazardous
waste at that site - see permit-by-rule requirements at 25 Pa. Code §270a.60(b)(4).
6. Treatment of recyclable materials (hazardous wastes that are recycled) to make the materials suitable for
onsite or offsite reclamation of economically significant amounts of any precious metal identified in 40 CFR
Part 266, Subpart F - see permit-by-rule requirements at 25 Pa. Code §270a.60(b)(5).
VI.
Existing Environmental Permits
A. NPDES (Discharges to Surface Water)
D. PSD (Air Emissions from Proposed Sources)
B. UIC (Underground Injection of Fluids)
E. Municipal Waste (As defined in Act 97)
C. RCRA (Hazardous Waste)
F. Residual Waste
G. Other Permits
(Specify)
2510-FM-BWM0053
Region List
6/2005
Regional Offices and Counties Served
I. Southeast Region
2 E. Main Street
Norristown, PA 19401-4915
Telephone: 484-250-5960
Bucks, Chester, Delaware, Montgomery, and
Philadelphia
II. Northeast Region
2 Public Square
Wilkes-Barre, PA 18711-0790
Telephone: 570-826-5425
Carbon, Lackawanna, Lehigh, Luzerne,
Monroe, Northampton, Pike, Schuylkill,
Susquehanna, Wayne and Wyoming
III. Southcentral Region
909 Elmerton Avenue
Harrisburg, PA 17110
Telephone: 717-705-4938
Adams, Bedford, Berks, Blair, Cumberland,
Dauphin, Franklin, Fulton, Huntingdon, Juniata,
Lancaster, Lebanon, Mifflin, Perry and York
IV. Northcentral Region
208 W. Third Street, Suite 101
Williamsport, PA 17701
Telephone: 570-327-3740
Bradford, Cameron, Clearfield, Centre, Clinton,
Columbia, Lycoming, Montour,
Northumberland, Potter, Snyder, Sullivan,
Tioga and Union
V. Southwest Region
400 Waterfront Drive
Pittsburgh, PA 15222
Telephone: 412-442-4120
Allegheny, Armstrong, Beaver, Cambria,
Fayette, Greene, Indiana, Somerset,
Washington and Westmoreland
VI. Northwest Region
230 Chestnut Street
Meadville, PA 16335
Telephone: 814-332-6848
Butler, Clarion, Crawford, Elk, Erie, Forest,
Jefferson, Lawrence, McKean, Mercer,
Venango and Warren