DTSC Form 1197 "Transportable Treatment Unit Permit by Rule Site-Specific Notification" - California

What Is DTSC Form 1197?

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 August 1, 2015;
  • 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;
  • Fill out the form in our online filing application.

Download a fillable version of DTSC Form 1197 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 DTSC Form 1197 "Transportable Treatment Unit Permit by Rule Site-Specific Notification" - California

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State of California - California Environmental Protection Agency
Department of Toxic Substances Control
TRANSPORTABLE TREATM ENT UNI T PERM I T BY RULE
SI TE-SPECI FI C NOTI FI CATI ON
For Use by Transportable Treatment Unit (TTU)
Treating Hazardous Waste Under Permit By Rule
I nitial
(Pursuant to CCR, title 22,, chapter 45)
Amended
Extension
This form is to be used by all Permit-by-Rule (PBR) Transportable Treatment Units (TTUs) only. This Transportable Treatment
Unit Permit-By-Rule, Site-Specific Notification supersedes DTSC Form 8429A. When submitting an amended notification, put an
asterisk next to the amended information. Please check the extension box only if you are requesting authorization for work
beyond the one year time limit. The wastestreams treated must be limited to those listed in California Code of Regulations (CCR),
title 22, section 67450.11, which are also listed on this form.
I .
GENERAL TTU I NFORM ATI ON
COM PANY EPA I D NUM BER CA __ __ __ __ __ __ __ __ __ __
BOE NUM BER (if available) H __ HQ __ __ __ __ __ __ __ __
TTU SERI AL NUM BER __ __ __ __ __ __ __
COM PANY NAM E (DBA-Doing Business As) _________________________________________________
PHYSI CAL LOCATI ON ___________________________________________________________________
_________________________________________________________________________________________
CI TY
__________________________________________ CA ZI P _________-____________
COUNTY _______________________________
COM PANY M AI LI NG ADDRESS, I F DI FFERENT:
STREET ________________________________________________________________________________
_________________________________________________________________________________________
CI TY
_______________________________________ STATE ____ ZI P ________-____________
OWNER ________________________________________________________________________________
OWNER PHONE NUM BER (_____)______-________
TTU OPERATOR I NFORM ATI ON, ONLY I F DI FFERENT FROM OWNER
OPERATOR NAM E ______________________________________________________________________
STREET ________________________________________________________________________________
_________________________________________________________________________________________
CI TY
____________________________ STATE ____ ZI P __________-________________
OPERATOR PHONE NUM BER (_____)______-________
TTU CONTACT PERSON ___________________ _________________ PHONE NUM BER (_____)_____-__________
first name)
(last name)
DTSC Form 1197 (8/15)
Page 1
(Previously DTSC 8429A)
State of California - California Environmental Protection Agency
Department of Toxic Substances Control
TRANSPORTABLE TREATM ENT UNI T PERM I T BY RULE
SI TE-SPECI FI C NOTI FI CATI ON
For Use by Transportable Treatment Unit (TTU)
Treating Hazardous Waste Under Permit By Rule
I nitial
(Pursuant to CCR, title 22,, chapter 45)
Amended
Extension
This form is to be used by all Permit-by-Rule (PBR) Transportable Treatment Units (TTUs) only. This Transportable Treatment
Unit Permit-By-Rule, Site-Specific Notification supersedes DTSC Form 8429A. When submitting an amended notification, put an
asterisk next to the amended information. Please check the extension box only if you are requesting authorization for work
beyond the one year time limit. The wastestreams treated must be limited to those listed in California Code of Regulations (CCR),
title 22, section 67450.11, which are also listed on this form.
I .
GENERAL TTU I NFORM ATI ON
COM PANY EPA I D NUM BER CA __ __ __ __ __ __ __ __ __ __
BOE NUM BER (if available) H __ HQ __ __ __ __ __ __ __ __
TTU SERI AL NUM BER __ __ __ __ __ __ __
COM PANY NAM E (DBA-Doing Business As) _________________________________________________
PHYSI CAL LOCATI ON ___________________________________________________________________
_________________________________________________________________________________________
CI TY
__________________________________________ CA ZI P _________-____________
COUNTY _______________________________
COM PANY M AI LI NG ADDRESS, I F DI FFERENT:
STREET ________________________________________________________________________________
_________________________________________________________________________________________
CI TY
_______________________________________ STATE ____ ZI P ________-____________
OWNER ________________________________________________________________________________
OWNER PHONE NUM BER (_____)______-________
TTU OPERATOR I NFORM ATI ON, ONLY I F DI FFERENT FROM OWNER
OPERATOR NAM E ______________________________________________________________________
STREET ________________________________________________________________________________
_________________________________________________________________________________________
CI TY
____________________________ STATE ____ ZI P __________-________________
OPERATOR PHONE NUM BER (_____)______-________
TTU CONTACT PERSON ___________________ _________________ PHONE NUM BER (_____)_____-__________
first name)
(last name)
DTSC Form 1197 (8/15)
Page 1
(Previously DTSC 8429A)
EPA ID NUMBER _________________________
TRANSPORTABLE TREATM ENT UNI T PERM I T-BY-RULE
SI TE-SPECI FI C NOTI FI CATI ON
I I .
TREATM ENT SI TE I NFORM ATI ON
TREATM ENT SI TE EPA I D NUM BER CA__ __ __ __ __ __ __ __ __ __
TREATM ENT SI TE NAM E / ADDRESS ______________________________________________________
STREET ________________________________________________________________________________
_________________________________________________________________________________________
CI TY
____________________________ COUNTY _____________ STATE ____ ZI P ________-______
CONTACT PERSON _______________ ________________ TELEPHONE (_____)_______-__________
(first)
(last)
I S TREATM ENT SI TE LOCATED ON I NDI AN LANDS? ___ Yes ___ No
I I I .
TYPE OF COM PANY AT TREATM ENT SI TE - STANDARD I NDUSTRI AL CLASSI FI CATI ON (SI C) CODE
Use either one or two SI C codes (a four digit number) that best describe the treatment site's products, services, or
industrial activity.
Example:2911
Petroleum Refining
3731
Ship Building & Repair
First:
______ ________________________
Second: ______ _________________________
I V.
WORK SCHEDULE
I ndicate the normal working hours and the dates during this calendar year.
Normal Hours of Work - From
____________________ to ____________________
Dates on Site -
From
____________________ to ____________________
Dates on Site -
From
____________________ to ____________________
Dates on Site -
From
____________________ to ____________________
Dates on Site -
From
____________________ to ____________________
Dates on Site -
From
____________________ to ____________________
Dates on Site -
From
____________________ to ____________________
I f you plan on more dates, attach a separate piece of paper showing the additional dates in the same format
and check this box.
DTSC Form 1197 (8/15)
Page 2
(Previously DTSC 8429A)
EPA ID NUMBER _________________________
TRANSPORTABLE TREATM ENT UNI T PERM I T-BY-RULE
SI TE-SPECI FI C NOTI FI CATI ON
V.
WASTESTREAM S AND TREATM ENT PROCESSES
Estimated Total Volume Treated __________ pounds and/or _________ gallons
YES
NO
 
I s the waste treated in this unit radioactive?
 
I s the waste treated in this unit a bio-hazardous/infectious/medical waste?
 
I s remotely generated hazardous waste (Health and Safety Code section 25110.10) treated in this unit?
The following are the eligible wastestreams and treatment processes. Please check all applicable boxes:
1.
Aqueous wastes containing hexavalent chromium may be treated by the following process:
a.
Reduction of hexavalent chromium to trivalent chromium with sodium bisulfite, sodium metabisulfite, sodium
thiosulfate, ferrous sulfate, ferrous sulfide, or sulfur dioxide provided both pH and addition of the reducing
agent are automatically controlled.
2.
Aqueous wastes containing metals listed in CCR, title 22, section 66261.24 (a)(2) and/or fluoride salts may be treated
by the following technologies:
a.
pH adjustment or neutralization.
b.
Precipitation or crystallization.
c.
Phase separation by filtration, centrifugation, or gravity settling.
d.
I on exchange.
e.
Reverse osmosis.
f.
M etallic replacement.
g.
Plating the metal onto an electrode.
h.
Electrodialysis.
i.
Electrowinning or electrolytic recovery.
j.
Chemical stabilization using silicates and/or cementitious types of reactions.
k.
Evaporation.
l.
Adsorption.
DTSC Form 1197 (8/15)
Page 3
(Previously DTSC 8429A)
EPA ID NUMBER _________________________
TRANSPORTABLE TREATM ENT UNI T PERM I T-BY-RULE
SI TE-SPECI FI C NOTI FI CATI ON
3.
Aqueous wastes with total organic carbon less than ten percent (10% ) as measured by EPA M ethod 9060 and less
than one percent (1% ) total volatile organic compounds as measured by EPA M ethod 8240, may be treated by the
following technologies:
a.
Phase separation by filtration, centrifugation, or gravity settling, but excluding supercritical fluid extraction.
b.
Adsorption.
c.
Distillation.
d.
Biological processes conducted in tanks or containers and utilizing naturally occurring microorganisms.
e.
Photodegradation using ultraviolet light, with or without the addition of hydrogen peroxide or ozone,
provided the treatment is conducted in an enclosed system.
f.
Air stripping or steam stripping.
4.
Sludges, dusts, solid metal objects and metal workings, which contain or are contaminated with metals listed in CCR,
title 22, section 66261.24 (a)(2), and/or fluoride salts, may be treated by the following technologies:
a.
Chemical stabilization using silicates and/or cementitious types of reactions.
b.
Physical processes which change only the physical properties of the waste such as grinding, shredding,
crushing, or compacting.
c.
Drying to remove water.
d.
Separation based on differences in physical properties such as size, magnetism, or density.
5.
Alum, gypsum, lime, sulfur, or phosphate sludges may be treated by the following technologies:
a.
Chemical stabilization using silicates and/or cementitious types of reactions.
b.
Drying to remove water.
c.
Phase separation by filtration, centrifugation, or gravity settling.
6.
Wastes identified in CCR, title 22, section 66261.120, that meet the criteria and requirements for special waste
classification in section 66261.122, may be treated by the following technologies:
a.
Chemical stabilization using silicates and/or cementitious types of reactions.
b.
Drying to remove water.
c.
Phase separation by filtration, centrifugation, or gravity settling.
d.
Screening to separate components based on size.
e.
Separation based on differences in physical properties such as size, magnetism, or density.
DTSC Form 1197 (8/15)
Page 4
(Previously DTSC 8429A)
EPA ID NUMBER _________________________
TRANSPORTABLE TREATM ENT UNI T PERM I T-BY-RULE
SI TE-SPECI FI C NOTI FI CATI ON
7.
Wastes, except asbestos, which have been classified by the Department as special wastes pursuant to CCR, title 22,
section 66261.124, may be treated by the following technologies:
a.
Chemical stabilization using silicates and/or cementitious types of reactions.
b.
Drying to remove water
c.
Phase separation by filtration, centrifugation, or gravity settling.
d.
M agnetic separation.
8.
I norganic acid or alkaline wastes may be treated by the following technology:
a.
pH adjustment or neutralization.
9.
Soils contaminated with metals listed in CCR, title 22, section 66261.24 (a)(2), (Persistent and Bioaccumulative Toxic
Substances) may be treated by the following technologies:
a.
Chemical stabilization using silicates and/or cementitious types of reactions.
b.
Screening to separate components based on size.
c.
M agnetic separation.
10.
Used oil, unrefined oil waste, mixed oil, oil mixed with water, and oil/water separation sludges may be treated by the
following technologies:
a.
Phase separation by filtration, centrifugation, or gravity settling, but excluding supercritical fluid extraction.
b.
Distillation.
c.
Neutralization.
d.
Separation based on differences in physical properties such as size, magnetism, or density.
e.
Reverse osmosis.
f.
Biological processes conducted in tanks or containers and utilizing naturally occurring microorganisms.
DTSC Form 1197 (8/15)
Page 5
(Previously DTSC 8429A)