Form C-138 "Request for Approval to Accept Solid Waste" - New Mexico

What Is Form C-138?

This is a legal form that was released by the New Mexico Energy, Minerals and Natural Resources Department - a government authority operating within New Mexico. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2011;
  • The latest edition provided by the New Mexico Energy, Minerals and Natural Resources Department;
  • 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 printable version of Form C-138 by clicking the link below or browse more documents and templates provided by the New Mexico Energy, Minerals and Natural Resources Department.

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Download Form C-138 "Request for Approval to Accept Solid Waste" - New Mexico

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District I
State of New Mexico
Form C-138
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
Revised August 1, 2011
811 S. First St., Artesia, NM 88210
*Surface Waste Management Facility Operator
District III
Oil Conservation Division
and Generator shall maintain and make this
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
documentation available for Division inspection.
District IV
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
REQUEST FOR APPROVAL TO ACCEPT SOLID WASTE
1. Generator Name and Address:
2.
Originating Site:
3.
Location of Material (Street Address, City, State or ULSTR):
4.
Source and Description of Waste:
3
3
Estimated Volume ___________yd
/ bbls Known Volume (to be entered by the operator at the end of the haul) __________ yd
/ bbls
5.
GENERATOR CERTIFICATION STATEMENT OF WASTE STATUS
I, ___________________________, representative or authorized agent for ________________________________________ do hereby
certify that according to the Resource Conservation and Recovery Act (RCRA) and the US Environmental Protection Agency’s July 1988
regulatory determination, the above described waste is: (Check the appropriate classification)
RCRA Exempt: Oil field wastes generated from oil and gas exploration and production operations and are not mixed with non-
exempt waste.
Operator Use Only: Waste Acceptance Frequency
Monthly
Weekly
Per Load
RCRA Non-Exempt: Oil field waste which is non-hazardous that does not exceed the minimum standards for waste hazardous by
characteristics established in RCRA regulations, 40 CFR 261.21-261.24, or listed hazardous waste as defined in 40 CFR, part 261,
subpart D, as amended. The following documentation is attached to demonstrate the above-described waste is non-hazardous. (Check
the appropriate items)
MSDS Information
RCRA Hazardous Waste Analysis
Process Knowledge
Other (Provide description in Box 4)
GENERATOR 19.15.36.15 WASTE TESTING CERTIFICATION STATEMENT FOR LANDFARMS
I, ___________________________, representative for ________________________________________ do hereby certify that
representative samples of the oil field waste have been subjected to the paint filter test and tested for chloride content and that the samples
have been found to conform to the specific requirements applicable to landfarms pursuant to Section 15 of 19.15.36 NMAC. The results
of the representative samples are attached to demonstrate the above-described waste conform to the requirements of Section 15 of
19.15.36 NMAC.
5.
Transporter:
OCD Permitted Surface Waste Management Facility
Name and Facility Permit #:
Address of Facility:
Method of Treatment and/or Disposal:
Evaporation
Injection
Treating Plant
Landfarm
Landfill
Other
Waste Acceptance Status:
APPROVED
DENIED (Must Be Maintained As Permanent Record)
PRINT NAME: ___________________________________
TITLE: ____________________________
DATE: ____________
SIGNATURE: _________________________________________
TELEPHONE NO.: __________________________
Surface Waste Management Facility Authorized Agent
District I
State of New Mexico
Form C-138
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
Revised August 1, 2011
811 S. First St., Artesia, NM 88210
*Surface Waste Management Facility Operator
District III
Oil Conservation Division
and Generator shall maintain and make this
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
documentation available for Division inspection.
District IV
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
REQUEST FOR APPROVAL TO ACCEPT SOLID WASTE
1. Generator Name and Address:
2.
Originating Site:
3.
Location of Material (Street Address, City, State or ULSTR):
4.
Source and Description of Waste:
3
3
Estimated Volume ___________yd
/ bbls Known Volume (to be entered by the operator at the end of the haul) __________ yd
/ bbls
5.
GENERATOR CERTIFICATION STATEMENT OF WASTE STATUS
I, ___________________________, representative or authorized agent for ________________________________________ do hereby
certify that according to the Resource Conservation and Recovery Act (RCRA) and the US Environmental Protection Agency’s July 1988
regulatory determination, the above described waste is: (Check the appropriate classification)
RCRA Exempt: Oil field wastes generated from oil and gas exploration and production operations and are not mixed with non-
exempt waste.
Operator Use Only: Waste Acceptance Frequency
Monthly
Weekly
Per Load
RCRA Non-Exempt: Oil field waste which is non-hazardous that does not exceed the minimum standards for waste hazardous by
characteristics established in RCRA regulations, 40 CFR 261.21-261.24, or listed hazardous waste as defined in 40 CFR, part 261,
subpart D, as amended. The following documentation is attached to demonstrate the above-described waste is non-hazardous. (Check
the appropriate items)
MSDS Information
RCRA Hazardous Waste Analysis
Process Knowledge
Other (Provide description in Box 4)
GENERATOR 19.15.36.15 WASTE TESTING CERTIFICATION STATEMENT FOR LANDFARMS
I, ___________________________, representative for ________________________________________ do hereby certify that
representative samples of the oil field waste have been subjected to the paint filter test and tested for chloride content and that the samples
have been found to conform to the specific requirements applicable to landfarms pursuant to Section 15 of 19.15.36 NMAC. The results
of the representative samples are attached to demonstrate the above-described waste conform to the requirements of Section 15 of
19.15.36 NMAC.
5.
Transporter:
OCD Permitted Surface Waste Management Facility
Name and Facility Permit #:
Address of Facility:
Method of Treatment and/or Disposal:
Evaporation
Injection
Treating Plant
Landfarm
Landfill
Other
Waste Acceptance Status:
APPROVED
DENIED (Must Be Maintained As Permanent Record)
PRINT NAME: ___________________________________
TITLE: ____________________________
DATE: ____________
SIGNATURE: _________________________________________
TELEPHONE NO.: __________________________
Surface Waste Management Facility Authorized Agent