Form DTSC1294 "Transportation Regulatory Exemption Application/Variance" - California

What Is Form DTSC1294?

This is a legal form that was released by the California Department of Toxic Substances Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 3, 2012;
  • The latest edition provided by the California Department of Toxic Substances Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form DTSC1294 by clicking the link below or browse more documents and templates provided by the California Department of Toxic Substances Control.

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Download Form DTSC1294 "Transportation Regulatory Exemption Application/Variance" - California

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State of California - California Environmental Protection Agency
Department of Toxic Substances Control
Transportation Unit
8800 Cal Center Drive
Sacramento, California 95826
Telephone: (916) 255-1772 Fax: (916) 255-6436
V
S
N
ARIANCE
ERIAL
UMBER
(DTSC U
O
)
SE
NLY
T
R
E
A
/V
RANSPORTATION
EGULATORY
XEMPTION
PPLICATION
ARIANCE
The California Code of Regulations (Cal. Code Regs.), title 22, division 4.5, chapter 13, article 4 (article 4) establishes four categories of
transportation variances. Each variance category corresponds to a specific type of hazardous waste transportation operation, which, if
conducted in accordance with the provisi ons of article 4, poses an i nsignificant risk to human health or to the en vironment. When
signed in Part E b y an authorized representative of the D epartment of Toxic Substances Control (DTSC) this document becomes the
issued variance as applied for. Prior to operating pursuant to th is variance, a transporter shall send a copy of this variance to each
hazardous waste generator serviced under its provisions. Complete Part A through D as indicated.
P
A. T
(A
) I
ART
RANSPORTER
PPLICANT
DENTIFICATION
Business Name:
Identification Number (12 Characters):
Transporter Registration Number:
Business Address:
Mailing Address (if different):
Number/Street
Number/Street
P.O. Box
P.O. Box
City, State Zip
City, State Zip
Contact Person:
Telephone Number:
Fax Number:
E-Mail Address:
P
B. S
V
E
(
) R
:
ART
PECIFIC
ARIANCE
XEMPTION
S
EQUESTED
Check the box next to the Transportation Regulatory
Exemption(s) you are requesting. For each variance exemption category requested, list and describe each hazardous waste,
provide the Department of Transportation shipping description or the generic or commonly used industrial name, and the
estimated frequency and quantity transported per month. Use a separate page if necessary. A summary of each variance
exemption category is provided below as guidance only. The actual regulations should be consulted prior to making any
decision that may impact regulatory compliance.
Emergency Response Incident Operations, Cal. Code Regs., title 22, section 66263.43.
Allows a State , local or coun ty governmental emergency response incident unit to transport up to five 85-g allon drums of
hazardous waste from an incident site to a central collection facility using a shipping paper instead of a hazardous waste
manifest. The waste may be accumulated for up to 90 days, and must then be manifested to an authorized facility.
Polychlorinated Biphenyl (PCB) Waste Operations, Cal. Code Regs., title 22, section 66263.44.
Allows a governmental agency or public utility to transport its own PCB waste to a ce ntral collection facility using a shipping
paper instead of a hazardous waste manifest. Handling and storage time for the waste shall meet the provisions of Cal. Code
Regs., title 22, section 66263.18, and must then be manifested to an authorized facility.
DTSC 1294 (04/03/12)
Page 1 of 2
State of California - California Environmental Protection Agency
Department of Toxic Substances Control
Transportation Unit
8800 Cal Center Drive
Sacramento, California 95826
Telephone: (916) 255-1772 Fax: (916) 255-6436
V
S
N
ARIANCE
ERIAL
UMBER
(DTSC U
O
)
SE
NLY
T
R
E
A
/V
RANSPORTATION
EGULATORY
XEMPTION
PPLICATION
ARIANCE
The California Code of Regulations (Cal. Code Regs.), title 22, division 4.5, chapter 13, article 4 (article 4) establishes four categories of
transportation variances. Each variance category corresponds to a specific type of hazardous waste transportation operation, which, if
conducted in accordance with the provisi ons of article 4, poses an i nsignificant risk to human health or to the en vironment. When
signed in Part E b y an authorized representative of the D epartment of Toxic Substances Control (DTSC) this document becomes the
issued variance as applied for. Prior to operating pursuant to th is variance, a transporter shall send a copy of this variance to each
hazardous waste generator serviced under its provisions. Complete Part A through D as indicated.
P
A. T
(A
) I
ART
RANSPORTER
PPLICANT
DENTIFICATION
Business Name:
Identification Number (12 Characters):
Transporter Registration Number:
Business Address:
Mailing Address (if different):
Number/Street
Number/Street
P.O. Box
P.O. Box
City, State Zip
City, State Zip
Contact Person:
Telephone Number:
Fax Number:
E-Mail Address:
P
B. S
V
E
(
) R
:
ART
PECIFIC
ARIANCE
XEMPTION
S
EQUESTED
Check the box next to the Transportation Regulatory
Exemption(s) you are requesting. For each variance exemption category requested, list and describe each hazardous waste,
provide the Department of Transportation shipping description or the generic or commonly used industrial name, and the
estimated frequency and quantity transported per month. Use a separate page if necessary. A summary of each variance
exemption category is provided below as guidance only. The actual regulations should be consulted prior to making any
decision that may impact regulatory compliance.
Emergency Response Incident Operations, Cal. Code Regs., title 22, section 66263.43.
Allows a State , local or coun ty governmental emergency response incident unit to transport up to five 85-g allon drums of
hazardous waste from an incident site to a central collection facility using a shipping paper instead of a hazardous waste
manifest. The waste may be accumulated for up to 90 days, and must then be manifested to an authorized facility.
Polychlorinated Biphenyl (PCB) Waste Operations, Cal. Code Regs., title 22, section 66263.44.
Allows a governmental agency or public utility to transport its own PCB waste to a ce ntral collection facility using a shipping
paper instead of a hazardous waste manifest. Handling and storage time for the waste shall meet the provisions of Cal. Code
Regs., title 22, section 66263.18, and must then be manifested to an authorized facility.
DTSC 1294 (04/03/12)
Page 1 of 2
State of California - California Environmental Protection Agency
Department of Toxic Substances Control
Transportation Unit
8800 Cal Center Drive
Sacramento, California 95826
Telephone: (916) 255-1772 Fax: (916) 255-6436
V
S
N
ARIANCE
ERIAL
UMBER
(DTSC U
O
)
SE
NLY
Consolidation Operations, Cal. Code Regs., title 22, section 66263.45.
Allows a transporter who owns/operates multiple small, RCRA-exempt generation sites to transport u p to 100 ki lograms of
hazardous waste per load from those sites to a temporary hazardous waste storage facility using a shipping paper instead of a
hazardous waste manifest. Handling and storage time f or the waste shall meet the provisions of Cal. Code Regs., title 22,
section 66263.18, and must then be manifested to an authorized facility.
Small Load Operations, Cal. Code Regs., title 22, section 66263.46.
Allows a transporter to transport up to 100 kilograms of RCRA-exempt hazardous waste per load, and no greater than 1000
kilograms per calendar month, directly to an authorized facility using a shipping paper instead of a hazardous waste manifest.
P
C. A
C
C
F
ART
DDRESS OF
ENTRAL
OLLECTION
ACILITY OR TEMPORARY HAZARDOUS WASTE FACILITY
P
D. C
A
ART
ERTIFICATION OF
PPLICANT
I, the undersigned have read, understood and will comply with the provisions of the Cal. Code Regs., title 22, division 4.5, chapter 13,
article 4. I declare under penalty of perjury under the laws of California that th e information and statements provided in this
application are true and correct to the best of m y knowledge. I understand that th ere are significant penalties, including monetary
fines and imprisonment, for k nowingly submitting false information. I understand that I am obligated to imme diately notify DTSC of
any noncompliance with the terms of this varia nce. I und erstand that I am not e xempted from an y requirement of la w except as
specified above, and that the exemption(s) granted by this variance is/are not transferable to another party.
Signature of Authorized Representative:
Date:
Name and Title of Authorized Representative (Print or Type):
P
E. D
C
(DTSC USE ONLY)
ART
ETERMINATION OF
OMPLETENESS
DTSC finds thi s variance application to be complete, and that based on the inf ormation provided above the applicant meets th e
requirements of article 4 for the transportation regulatory exemption(s) requested. DTSC hereby issues to the applicant this variance
for the specifie d exemptions identified in Se ction B. This variance is effe ctive from the issue date through the e xpiration date as
indicated below. This variance is vali d only with a current State of Californi a Hazardous Waste Transporter Registration. This
variance is subject to review at the discretion of DTSC and may be revoked at any time.
Signature of Authorized Representative:
Issue Date:
Name and Title of Authorized Representative (Print or Type):
Variance Expiration Date:
DTSC 1294 (04/03/12)
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