Instructions for Form CN-0773 "Hazardous Waste Stream Report (Wsr)" - Tennessee

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INSTRUCTIONS FOR FORM CN-0773 - HAZARDOUS WASTE STREAM REPORT (WSR)
90 days
Complete sections 1 and 2 and send to the Division within
of original (start of) generation. Visit our
website at
https://www.tn.gov/content/tn/environment/program-areas/solid-waste/hazardous-waste-
NEW WASTE STREAMS:
management/hazardous-waste-and-used-oil-forms.html
to review all forms required when filing information
about registration or adding new waste streams.
30 days
NOTIFY THE DIVISION:
Within
of significant changes after original notification by filing a new Waste Stream Form.
File this form for each waste stream to report the generation activity for the previous year, referred to as the
FOR ANNUAL REPORTS:
REPORT YEAR in Sections 3, 4, 5, and 6.
Rule 0400-12-01-.03(1)(b) gives the procedure to determine if a waste is regulated as hazardous.
REFER TO:
For annual reports, REPORT YEAR refers to the year the hazardous waste was generated. Your annual report must
REPORT YEAR:
be received by March 1 for waste generation and handling from the previous calendar year.
Start your numbering at 1. This number will follow the Waste Stream on all correspondence and reports. Num-
WASTE STREAM NUMBER
ber all present and future waste streams consecutively.
CHECK all that apply: New Waste Stream, Annual Report, Information Update, Subpart K, Hazardous Secondary
TYPE OF NOTIFICATION
Material, or Consolidated from VSQG.
30 days
Planned episodic generation requires
notice prior to generation. Unplanned events require notification
72 hours
EPISODIC GENERATION
within
after generation. You must provide the date TDEC was notified and the date the waste was
removed from the site, concluding the episodic event.
GUIDANCE
ITEM NAME
ITEM
Name the waste using a specific and unique name if possible. See Rule 0400-12- 01-.02(4) for wastes listed
1
WASTE STREAM NAME
a
by name.
Briefly describe the process by which the hazardous waste is generated. This description may aid in assign-
HOW IS THIS WASTE
1b
ing the specific hazardous waste name and EPA waste code(s) on item 1h. If extra space is needed, use the
GENERATED?
Facility Comments (Item 7) on the back of FORM WSR.
Look up G Source Code on the "Code Listing for Hazardous Waste Form WSR (CN-0773)." This listing can be
found at
https://www.tn.gov/content/tn/environment/program-areas/solid-waste/hazardous-waste-
1b1
SOURCE CODE
management/hazardous-waste-and-used-oil-forms.html
under the heading "Instructions." Click on the item
entitled "Waste Codes."
Choose either kilograms or pounds. Use the same unit on this and all other forms. If you do not know
how to convert from volume units to weight units, enter the volume to weight conversion factor
1c
REPORTING UNITS
(DENSITY). For example, if your unit of measure is originally in gallons, give a conversion factor in pounds
per gallon. Conversion of gallons to pounds: (gallons x pounds per gallon conversion factor) = pounds.
Conversion of pounds to kilograms: (pounds divided by 2.2046) = kilograms.
Check the generation frequency during a year based on whether the waste is generated continuously, at
GENERATION FREQUENCY
1d
various times during the year, or one time.
Check if the generation of the waste stream is active, closed or re-activated. If the waste stream is marked
1e
WASTE STREAM STATUS
"closed," state the "date no longer generated" in 1g or the waste stream will not be closed.
Check one or more characteristics of the waste as appropriate to identify its hazards according to Rule
1f
HAZARD CRITERIA
0400-12-01-.03(1)(b).
GENERATION START DATE - Date the facility began to generate this waste at this site. GENERATION END
DATE - Date generation of waste ceased onsite. DATE CLAIMED AS HAZ SEC MATERIAL - Date material
1g
GENERATION DATES
was declared to be a hazardous secondary material (HSM). Additional notification is required (Form CN-
(mm/dd/yyyy)
1482). DURATION-EPISODIC - provide duration of event in days - a 60 day limit applies to both planned
and unplanned events - see Rule 0400-12-01-.03 (11)(c).
List at least one EPA waste code as determined through the hazardous waste determination process de-
scribed in Rule 0400-12-01-.03(1)(b). In the case of mixtures, list the codes in descending order of concen-
1h
EPA WASTE CODES
tration (P, D, F, U and K).
RADIOACTIVE MIXED
Check "Yes" if the waste is a mixed hazardous and radioactive waste. Check "No" if the waste is simply
1i
hazardous.
WASTE
This is the MAXIMUM amount of waste generated in any one month of the report year. For new waste
MONTHLY MAXIMUM
streams, enter the projected maximum for this item. This information should be reviewed and updated at
1j
GENERATED
a minimum annually.
pH
1k
Indicate the pH for any corrosive waste.
List the flash point (°F) for any ignitable waste.
FLASH POINT
1l
List the British Thermal Units (BTU) of the waste if it is fuel blended or burned for energy recovery. If the
1m
BTU PER POUND
fuel blending exclusion is claimed, the waste must have a > 5,000 BTU/lb.
PAGE 1 OF 3
INSTRUCTIONS FOR FORM CN-0773 - HAZARDOUS WASTE STREAM REPORT (WSR)
90 days
Complete sections 1 and 2 and send to the Division within
of original (start of) generation. Visit our
website at
https://www.tn.gov/content/tn/environment/program-areas/solid-waste/hazardous-waste-
NEW WASTE STREAMS:
management/hazardous-waste-and-used-oil-forms.html
to review all forms required when filing information
about registration or adding new waste streams.
30 days
NOTIFY THE DIVISION:
Within
of significant changes after original notification by filing a new Waste Stream Form.
File this form for each waste stream to report the generation activity for the previous year, referred to as the
FOR ANNUAL REPORTS:
REPORT YEAR in Sections 3, 4, 5, and 6.
Rule 0400-12-01-.03(1)(b) gives the procedure to determine if a waste is regulated as hazardous.
REFER TO:
For annual reports, REPORT YEAR refers to the year the hazardous waste was generated. Your annual report must
REPORT YEAR:
be received by March 1 for waste generation and handling from the previous calendar year.
Start your numbering at 1. This number will follow the Waste Stream on all correspondence and reports. Num-
WASTE STREAM NUMBER
ber all present and future waste streams consecutively.
CHECK all that apply: New Waste Stream, Annual Report, Information Update, Subpart K, Hazardous Secondary
TYPE OF NOTIFICATION
Material, or Consolidated from VSQG.
30 days
Planned episodic generation requires
notice prior to generation. Unplanned events require notification
72 hours
EPISODIC GENERATION
within
after generation. You must provide the date TDEC was notified and the date the waste was
removed from the site, concluding the episodic event.
GUIDANCE
ITEM NAME
ITEM
Name the waste using a specific and unique name if possible. See Rule 0400-12- 01-.02(4) for wastes listed
1
WASTE STREAM NAME
a
by name.
Briefly describe the process by which the hazardous waste is generated. This description may aid in assign-
HOW IS THIS WASTE
1b
ing the specific hazardous waste name and EPA waste code(s) on item 1h. If extra space is needed, use the
GENERATED?
Facility Comments (Item 7) on the back of FORM WSR.
Look up G Source Code on the "Code Listing for Hazardous Waste Form WSR (CN-0773)." This listing can be
found at
https://www.tn.gov/content/tn/environment/program-areas/solid-waste/hazardous-waste-
1b1
SOURCE CODE
management/hazardous-waste-and-used-oil-forms.html
under the heading "Instructions." Click on the item
entitled "Waste Codes."
Choose either kilograms or pounds. Use the same unit on this and all other forms. If you do not know
how to convert from volume units to weight units, enter the volume to weight conversion factor
1c
REPORTING UNITS
(DENSITY). For example, if your unit of measure is originally in gallons, give a conversion factor in pounds
per gallon. Conversion of gallons to pounds: (gallons x pounds per gallon conversion factor) = pounds.
Conversion of pounds to kilograms: (pounds divided by 2.2046) = kilograms.
Check the generation frequency during a year based on whether the waste is generated continuously, at
GENERATION FREQUENCY
1d
various times during the year, or one time.
Check if the generation of the waste stream is active, closed or re-activated. If the waste stream is marked
1e
WASTE STREAM STATUS
"closed," state the "date no longer generated" in 1g or the waste stream will not be closed.
Check one or more characteristics of the waste as appropriate to identify its hazards according to Rule
1f
HAZARD CRITERIA
0400-12-01-.03(1)(b).
GENERATION START DATE - Date the facility began to generate this waste at this site. GENERATION END
DATE - Date generation of waste ceased onsite. DATE CLAIMED AS HAZ SEC MATERIAL - Date material
1g
GENERATION DATES
was declared to be a hazardous secondary material (HSM). Additional notification is required (Form CN-
(mm/dd/yyyy)
1482). DURATION-EPISODIC - provide duration of event in days - a 60 day limit applies to both planned
and unplanned events - see Rule 0400-12-01-.03 (11)(c).
List at least one EPA waste code as determined through the hazardous waste determination process de-
scribed in Rule 0400-12-01-.03(1)(b). In the case of mixtures, list the codes in descending order of concen-
1h
EPA WASTE CODES
tration (P, D, F, U and K).
RADIOACTIVE MIXED
Check "Yes" if the waste is a mixed hazardous and radioactive waste. Check "No" if the waste is simply
1i
hazardous.
WASTE
This is the MAXIMUM amount of waste generated in any one month of the report year. For new waste
MONTHLY MAXIMUM
streams, enter the projected maximum for this item. This information should be reviewed and updated at
1j
GENERATED
a minimum annually.
pH
1k
Indicate the pH for any corrosive waste.
List the flash point (°F) for any ignitable waste.
FLASH POINT
1l
List the British Thermal Units (BTU) of the waste if it is fuel blended or burned for energy recovery. If the
1m
BTU PER POUND
fuel blending exclusion is claimed, the waste must have a > 5,000 BTU/lb.
PAGE 1 OF 3
INSTRUCTIONS FOR FORM CN-0773 - HAZARDOUS WASTE STREAM REPORT (WSR) - continued
ITEM NAME
GUIDANCE
ITEM
Choose the reactive code for wastes that may be reactive from this list:
1
6
- Potentially releases hydrogen cyanide gas
- A Class A or B USDOT explosive
2
7
- Potentially releases hydrogen sulfide
- Reactive by presence of strong oxidants
1n
REACTIVE CODES
3
8
- Reacts violently with water
- Reactive by presence of strong reductants
4
9
- Thermally unstable or shock sensitive
- Reactive by other RCRA criteria or other test/criteria
5
- A USDOT forbidden explosive
Look up W Waste Form Code on the "Code Listing for Hazardous Waste Form WSR (CN-0773)." This listing
can be found at
https://www.tn.gov/content/tn/environment/program-areas/solid-waste/hazardous-waste-
1o
WASTE FORM CODE
management/hazardous-waste-and-used-oil-forms.html
under the heading "Instructions." Click on the item
entitled "Waste Codes."
Enter the North American Industry Classification System (NAICS) code that best represents the end products
or services for which this waste was generated. A complete list of 2017 NAICS Codes is available online at
1p
NAICS CODE
https://www.census.gov/naics/.
USDOT SHIPPING
1q
Give the name required by USDOT to be placed on manifests when the waste is shipped offsite.
NAME
Enter the USDOT hazard class code as defined by the USDOT regulations - (check manifest) - See Chart Fig 1.
1r
USDOT HAZARD CLASS
1s
USDOT ID CODE
Defined by U. S. Department of Transportation (USDOT) Regulations.
List the hazardous constituents in the waste and check the appropriate column for the units (percent by
WASTE STREAM
volume, percent by weight or parts per million (ppm)). For TCLP wastes (D004-D043), use ppm. If the EPA
2
CONSTITUENTS
waste codes are F001-F005, specify the constituents before use concentrations in percentages in the upper
and lower columns. If there is a single, precise concentration, report that information in the "lower" column.
Record amounts of waste generated and handled during the specified report year. To ensure the numbers
ANNUAL GENERATION
3
are correct, use the following formulas: 3a + 3b –3c = 3d and 3d = 4a + 5a + 5b + 5c + 5d.
AND HANDLING
Accurately report the amount in kilograms or pounds of hazardous waste generated for this waste stream
3a
AMOUNT GENERATED
for the Report Year. Enter zero if no hazardous waste was generated during the reported year.
Enter amount in kilograms or pounds of hazardous waste in temporary storage or accumulation area(s) on
3b
AMT ONSITE JAN 1st
January 1 of the Report Year. This should match Item 3c of the previous report year.
Enter amount in kilograms or pounds of hazardous waste in temporary storage and accumulation area(s)
3c
AMT ONSITE DEC 31st
on December 31 of the Report Year.
The amount handled is calculated using the following equations:
3d
AMOUNT HANDLED
3a + 3b - 3c = 3d and 3d = 4a + 5a + 5b + 5c + 5d.
Enter the total amount of waste shipped offsite for the report year, which should match the amount reported
TOTAL AMOUNT
4
a
as shipped offsite on the Offsite Shipping Report (Form OSR).
SHIPPED OFFSITE
Enter at least one of the state TSDR Handling Codes/Waste Management Method Codes that describes the
STATE CODES: STORAGE
technique(s) used to handle the waste through final disposition in the Report Year. Use the state codes
4b
AND FINAL DISPOSAL /
from the "Hazardous Waste Annual Report Code List." If an "other" code is used, provide the treatment/
TREATMENT
disposal method in item 7, facility comments. For example: T18 - high temperature metal recovery.
Enter the management method code that best represents the techniques used to handle the waste through
EPA MANAGEMENT
final disposition. These codes can be found in block 19 on the manifest, typically. If you know the treatment/
4c
METHOD
disposal method, use the EPA codes from the "Hazardous Waste Annual Report Code List." If an "other" code
is used, provide the treatment/disposal method in item 7, facility comments.
TSD PERMITTED
5a - 5d - For onsite handling, use up to four blocks to represent different sets of handling procedures if
STORAGE ONLY OR
necessary. TSDRs who placed hazardous wastes in permitted storage in previous years and who rehandled
5
FACILITY'S ONSITE
that waste onsite this Report Year should enter the rehandling on the TSDR Permitted Activity Report and
HANDLING or TREAT-
not on this form.
MENT
HAZARDOUS WASTE
6
Refer to the instruction sheet titled "Item 6 of Waste Stream Report (Waste Reduction)."
REDUCTION
Use this space to more fully explain information or data in ITEMS 1 through 5.
7
FACILITY COMMENTS
PAGE 2 OF 3
INSTRUCTIONS FOR FORM CN-0773 - HAZARDOUS WASTE STREAM REPORT (WSR) - continued
Fig. 1 HAZARD CLASSES AND LABELING REQUIREMENTS
From
E l e c t r o n i c C o d e o f F e d e r a l R e g u l a t i o n s
h t t p s : / / w w w . g p o . g o v /
https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=65f00e69e811d07fec980475ee652307&ty=HTML&h=L&n=49y2.1.1.3.9&r=PART#se49.2.172_1101
[Amdt. 172-123, 55 FR 52593, Dec. 21, 1990, as amended at 56 FR 66255, Dec. 20, 1991; Amdt. 172-151, 62 FR 1228, Jan. 8, 1997; 64 FR 10776,
Mar. 5, 1999; 64 FR 51918, Sept. 27, 1999; 69 FR 3668, Jan. 26, 2004; 69 FR 64471, Nov. 4, 2004; 78 FR 60753, Oct. 2, 2013; 85 FR 83381, Dec. 21,
2020]
Label Design
Hazard Class or Division
Label Name
or Section
Reference
1.1
EXPLOSIVES 1.1
172.411
1.2
EXPLOSIVES 1.2
172.411
1.3
EXPLOSIVES 1.3
172.411
1.4
EXPLOSIVES 1.4
172.411
1.5
EXPLOSIVES 1.5
172.411
1.6
EXPLOSIVES 1.6
172.411
2.1
FLAMMABLE GAS
172.417
2.2
NON-FLAMMABLE GAS
172.415
2.3
POISON GAS
172.416
3 Flammable Liquid (Combustible liquid) FLAMMABLE LIQUID (none)
172.419
4.1
FLAMMABLE SOLID
172.420
4.2
SPONTANEOUSLY COMBUSTIBLE
172.422
4.3
DANGEROUS WHEN WET
172.423
5.1
OXIDER
172.426
5.2
ORGANIC PEROXIDE
172.427
6.1 (material poisonous by inhalation
POISON INHALATION HAZARD
172.429
(see §171.8 of this subchapter))
6.1 (other than material poisonous by
POISON
172.430
6.1 (inhalation hazard, Zone A or B)
POISON INHALATION HAZARD
172.429
6.1 (other than inhalation hazard, Zone
POISON
172.430
6.2
INFECTIOUS SUBSTANCE
172.432
7 (see §172.403)
RADIOACTIVE WHITE-I
172.436
7
RADIOACTIVE YELLOW-II
172.438
7
RADIOACTIVE YELLOW-III
172.440
7 (fissile radioactive material; see
FISSILE
172.441
7 (empty packages, see §173.428 of this
EMPTY
172.450
subchapter)
8
CORROSIVE
172.442
9
CLASS 9
172.446
PAGE 3 OF 3
Page of 3