Fill in a Valid Mo 780 1164 Form Open Document Now

Fill in a Valid Mo 780 1164 Form

The MO 780 1164 form is a crucial document issued by the Missouri Department of Natural Resources Hazardous Waste Program, outlining the process for notifying authorities about regulated waste activities. This comprehensive form ensures the proper registration and tracking of hazardous waste, setting specific provisions for new and reactivating registrations, including a mandatory initial fee unless it's an update to an existing, active registration. Providing detailed guidance for completion and submission, it serves as an essential tool for environmentally responsible waste management. To simplify the legal obligations surrounding hazardous waste in Missouri, complete the necessary details on the MO 780 1164 form by clicking the button below.

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When it comes to managing hazardous and regulated waste, understanding the necessary procedures and paperwork is crucial for compliance with environmental regulations. The MO 780-1164 form, provided by the Missouri Department of Natural Resources Hazardous Waste Program, stands as a key document in this process. Primarily, this form serves to notify authorities about regulated waste activities, whether it's a new notification or a subsequent one. With an initial fee for new and reactivating registrations, the form emphasizes the need for complete and accurate information to avoid processing delays. Instructions attached to the form ensure that applicants can correctly fill out and submit their notifications, detailing everything from the facility's waste activities to ownership details. Critical sections of the form include identifying the type of waste activity—be it hazardous waste generation, universal waste management, or used oil activities—and providing the necessary information about the facility's contact details, ownership, and the precise nature of the regulated waste activity. Failure to meticulously follow these guidelines could not only result in the form being returned but also have broader implications for a facility's compliance status with environmental regulations.

Example - Mo 780 1164 Form

MISSOURI DEPARTMENT OF NATURAL RESOURCES

HAZARDOUS WASTE PROGRAM

NOTIFICATION OF REGULATED WASTE ACTIVITY

All new and reactivating registrations require a $100 initial fee. Registrations without this fee will not be processed. The fee is not required if only updating information to an existing and active registration. Form must be completed in its entirety, or it will be returned. Instructions are at the end of this form. Completed form should be sent to:

Hazardous Waste Program

or

Hazardous Waste Program

P.O. Box 176

 

1730 East Elm Street

Jefferson City, MO 65102 - 0176

 

Jefferson City, MO 65101-4130

573-751-3176

 

 

I. TYPE OF NOTIFICATION

 

 

A. NEW NOTIFICATION

B. SUBSEQUENT NOTIFICATION

EPA ID NUMBER

MISSOURI ID NUMBER

II. NAME OF INSTALLATION (BUSINESS NAME, SITE NAME OR D.B.A)

III. LOCATION OF INSTALLATION (PHYSICAL ADDRESS)

STREET

CITY

STATE

ZIP CODE + 4

COUNTY NAME

IV. INSTALLATION MAILING ADDRESS

STREET

CITY

STATE

ZIP CODE + 4

A. Billing Address (Fill this section out for a separate billing address. If left blank, fee invoices will be sent to mailing address)

STREET

CITY

STATE

ZIP CODE + 4

V. INSTALLATION CONTACT

FIRST NAME

E-MAIL ADDRESS

LAST NAME

 

TITLE

 

 

 

 

 

 

TELEPHONE NUMBER WITH AREA CODE

EXTENSION

 

 

 

 

VI. OWNERSHIP

Note: Make copies of this section for multiple ownerships.

A. NAME OF INSTALLATION’S LEGAL OWNER

STREET, P.O. BOX OR ROUTE NUMBER

CITY

 

STATE

 

ZIP CODE + 4

 

 

 

 

TELEPHONE NUMBER WITH AREA CODE

EXTENSION

E. CHANGE OF INSTALLATION OWNER INDICATOR

 

 

YES

NO DATE OF CHANGE:

 

 

 

 

 

C. INSTALLATION OWNER TYPE - MARK ONE

PRIVATE COUNTY

DISTRICT

FEDERAL

TRIBAL

MUNICIPAL

STATE

HOSPITAL

OTHER

D. NAME OF PROPERTY’S LEGAL OWNER

STREET, P.O. BOX OR ROUTE NUMBER

CITY

 

 

 

STATE

 

ZIP CODE + 4

 

 

 

 

 

TELEPHONE NUMBER WITH AREA CODE

EXTENSION

E. CHANGE OF PROPERTY OWNER

 

 

YES

NO

DATE OF CHANGE:

 

 

 

 

 

 

 

F. PROPERTY OWNER TYPE (MARK ONE)

PRIVATE

COUNTY

DISTRICT

FEDERAL

TRIBAL

MUNICIPAL

STATE

HOSPITAL

OTHER

MO 780-1164 (11-12)

Page 1 of 8

VII. TYPE OF REGULATED WASTE ACTIVITY (ONLY MARK THE FOLLOWING SECTIONS THAT APPLY)

A. Hazardous Waste Activities

B. Universal Waste Activities

1. Generator of hazardous waste (Choose only one of the following

1. Large quantity handler of universal waste (accumulate 5,000kg

four categories.)

 

or more). [Refer to Missouri regulations to determine what is

a. LQG: Greater than 1,000kg (2,220 lbs.) of non-acute

 

regulated.] Indicate types of universal waste managed or

hazardous waste or 1kg (2.2 lbs.) of acute hazardous waste

 

accumulated at your site. Check all boxes that apply.

in a calendar month.

 

 

MANAGE

b. SQG: Generate 100 to 1,000kg (220-2,220 lbs.) of non-

 

a.

Batteries

acute hazardous waste at any one time.

 

b.

Lamps

c. CESQG: Generate less than 100kg (220 lbs.) of hazardous

 

c.

Pesticides

waste in a calendar month and never accumulate 100kg

 

d.

Thermostats

(220 lbs.) or more of hazardous waste at any one time.

 

 

2. Destination facility for universal waste. Note: A hazardous

d. Not a generator. Generate no hazardous waste at any time.

 

waste permit may be required for this activity.

 

 

 

In addition, indicate other generator activities.

C. Used Oil Activities (Check all boxes that apply)

e. United States importer of hazardous waste.

1.

Used oil transporter – Indicate types of activities.

 

 

 

f. Mixed waste (hazardous and radioactive) generator.

 

 

a. Transporter

 

 

 

 

 

 

b. Transfer facility

For items 2 through 8, check all boxes that apply.

 

 

 

2. Transporter of hazardous waste.

2. Used oil processor or re-refiner – Indicate types of activities.

a. Transporter.

 

 

a. Processor

b. Transfer Facility (at your site).

 

 

b. Re-refiner

3. Treater, storer or disposer of hazardous waste (at your

 

 

 

site).

3.

Off-specification used oil burner

Note: A hazardous waste permit is required for this activity.

 

 

 

4. Recycler of hazardous waste (at your site).

4. Used oil fuel marketer – Indicate types of activities.

Note: A hazardous waste permit may be required for this

 

 

a. Marketer who directs shipment of off-specification used oil

activity.

 

 

to off-specification used oil burner.

5. Exempt boiler or industrial furnace.

 

 

b. Marketer who first claims the used oil meets the

a. Small quantity on-site burner exemption.

 

 

specifications.

b. Smelting, melting and refining furnace exemption.

 

 

 

6. Underground injection control.

D. E-Scrap Recycling Activities

7. Receives hazardous waste from off-site.

1.

E-Scrap Recycling

 

8. Precious metals reclamation.

 

 

 

VIII. DESCRIPTION OF REGULATED WASTE ACTIVITY (USE ADDITIONAL SHEETS IF NECESSARY)

A. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes handled at your site. List them in the order they are presented in the regulations (e.g., D001, D003, F007, U112). For waste codes see 40 CFR 261.20 - 261.24 or 40 CFR 261.31 - 261.33. Use additional page if more spaces are needed for waste codes.

B. Waste Code for State-Regulated (e.g., non-Federal) Hazardous Waste. List the waste codes of the State-regulated hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use additional page if more spaces are needed for waste codes.

IX. NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM (NAICS CODE(S)

Visit www.census.gov/eos/www/naics for NAICS code list.

A.

B.

C.

D.

DESCRIBE PRINCIPAL BUSINESS ACTIVITY

X. COMMENTS

XI. CERTIFICATION

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment.

SIGNATURE (ORIGINAL INK REQUIRED)

NAME AND OFFICIAL TITLE (TYPE OR PRINT)

DATE SIGNED

MO 780-1164 (11-12)

Page 2 of 8

NAME OF INSTALLATION

EPA ID

XII. DESCRIPTION OF REGULATED WASTE CONTINUED (ADDITIONAL SHEET)

B. Listed Hazardous Waste. (See 40 CFR 261.31 - 33. Use this page only if you need to list more waste codes.)

SIGNATURE (ORIGINAL INK REQUIRED)

NAME AND OFFICIAL TITLE (TYPE OR PRINT)

DATE SIGNED

MO 780-1164 (11-12)

Page 3 of 8

Notification of Regulated Waste Activity Instructions

Note: All new registrations and reactivations require a $100 initial fee as stated in 260.380.1 (1), Revised Statutes of Missouri, or RSMO. Registrations without this fee will not be processed. The fee is not required if you are only updating information to an existing, active registration.

ITEM I. - TYPE OF NOTIFICATION

A. New Notification: Check this box if this is the first notification for the installation named in Section II of the form.

B. Subsequent Notification: If you are filing a subsequent notification enter your EPA ID number and MO ID number in the space provided.

Note: When the owner of a facility changes, the new owner must notify the department of the change, even if the previous owner already received an EPA ID number. Because the EPA ID number is 'site-specific,' the new owner will keep the existing ID number. If the facility moves to another location, the owner/operator must notify the department of this change. In this instance a new EPA ID number will be assigned, since the facility has changed locations. The same is true of a Missouri Generator ID number as for an EPA ID number.

ITEMS II. AND III. - NAME AND LOCATION OF INSTALLATION

Complete Items II and III. Note: The address you give for Item III, "Location of the Installation," must be a physical address, or

directional description (example: number of miles from a known junction, not a post office box or route number.)

County Name: Enter the county name for the site. If the county name is unknown, contact the local post office.

ITEM IV. - INSTALLATION MAILING ADDRESS

Enter the installation mailing address. This is the address all correspondence will be sent to. If the mailing address and the location of the installation (Item III) are the same, you can print "SAME" in the box for Item IV.

A. Billing Address: This section is only for those facilities that would like bills sent to a different address. If this section is left blank, all fee invoices will be sent to the Installation Mailing Address.

ITEM V. - INSTALLATION CONTACT

Enter the name, title, email address and business telephone number with area code of the person who should be contacted regarding information submitted on this form.

ITEM VI. – OWNERSHIP

A. Name of Installation's Legal Owner (Business Owner):

Enter the name of the legal owner(s) of the installation. Also enter the address and phone number where this individual can be reached. Make copies of this section for multiple ownerships.

B. Change of Installation Owner Indicator: If the owner of the installation (business) has changed since the facility's original notification, check the box marked "Yes" and enter the date that the owner changed.

C. Installation Owner Type: Check the box that best describes the legal status of the current business owner of the facility.

Note: The Ownership code for Hospitals may only be used if a facility is licensed under Chapter 197 of the RSMO.

D. Name of the Property's Legal Owner: Enter the name of the legal owner(s) of the property. Also enter the address and phone number where this individual can be reached. Make copies of this section for multiple ownerships. If the property owner and the installation's legal owner (Item VI.A.) are the same, you can print "SAME" in the box for item VI.D.

E. Change of Property Owner Indicator: If the owner of the property has changed since the facility's original notification, check the box marked "Yes" and enter the date that the owner changed.

F. Property Owner Type: Check the box that best describes the legal status of the current owner of the property.

ITEM VII. - TYPE OF REGULATED WASTE ACTIVITY

A. Hazardous Waste Activities: Check the boxes to show the hazardous waste activities at this installation.

1.a.-c. Generator: If you generate a hazardous waste that is identified by characteristic or listed in 40 CFR Part 261check the appropriate box for the quantity of nonacutely hazardous waste that would indicate the highest generation per month or accumulation at any one time. If you generate acutely hazardous waste, please refer to 40 CFR Part 262 and 10 CSR 25-5 for further information.

d. Not a Generator: Mark only if a.-c. do not apply but you are completing the form for another reason.

In addition to the above, check the following appropriate boxes to indicate other generator activities occurring at this site. (Mark all boxes that apply.)

MO 780-1164 (11-12)

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Notification of Regulated Waste Activity Instructions continued

d. United States Importer of Hazardous Waste: Check this box if you import hazardous waste from a foreign country into the United States. Refer to 40 CFR 262.260 for additional information.

e. Mixed Waste Generator: Check this box if you are a generator of mixed waste (waste that is both hazardous and radioactive). RCRA defines 'mixed waste' as waste that contains both hazardous waste and source, special nuclear, or by- product material subject to the Atomic Energy Act, or AEA, RCRA section 1004(41), 42 U.S.C 6903 (63 FR 17414; April 9, 1998).

2.Transporter of Hazardous Waste: Check this box if you transport hazardous waste within the United States and mark all that apply.

a.Transport: Mark if you transport hazardous waste within the United States. The federal regulations for hazardous waste transporters are found in 40 CFR Part 263.

b.Transfer facility: Mark if you hold manifested hazardous waste(s) at your site for a period of 10 days or less while the waste is in transit. The federal regulations for hazardous waste transfer facilities are found in 40 CFR Part 263.12.

3.Treater/Storer/Disposer: If you treat, store or dispose of regulated hazardous waste, check this box. You are reminded to contact your state to request Part A of the RCRA permit application. The federal regulations for hazardous waste facility owners/operators are found in 40 CFR Part 264 and 265; the State regulations are found in 10 CSR 25-7.

4.Recycler of Hazardous Waste: If you recycle regulated waste (recyclable materials), check this box. The federal regulations for owners or operators of sites that recycle hazardous waste are found in 40 CFR 261.6. A hazardous waste permit may be required for this activity. You may also be subject to other federal and state regulations.

5.Exempt Boiler or Industrial Furnace:

a.If you burn small quantities of hazardous waste in an on-site boiler or industrial furnace in accordance with the conditions in 40 CFR 266.108, check the box to indicate that you qualify for the small quantity on-site burner exception.

b.If you process hazardous wastes in a smelting, melting or refining furnace solely for metals recovery, as described in 40 CFR 266.100(d), or to recover economically significant amounts of precious metals, as described in 40 CFR 266.100(g), or if you process hazardous wastes in a lead recovery furnace to recover lead, as described in 40 CFR 266.100(h), check the box to indicate that you qualify for the smelting, melting and refining furnace exception.

6.Underground Injection Control: If you generate, treat, store, or dispose of hazardous waste and there is an underground injection well located at your site, check the box. The federal regulations for owners or operators of underground injections wells are found in 40 CFR Part 148.

7.Receives Hazardous Waste From Off-site: Check this box if you received hazardous waste from another site, whether this waste was received as a commercial transaction or waste received from a restricted group of off-site generators.

8.Precious Metals Reclamation: Check this box if you will be performing precious metals reclamation at your site.

B.Universal Waste Activities: Refer to 10 CSR 25-16.273 requirements and definitions for universal waste. Also refer to 40 CFR 261.9 and 40 CFR Part 273 for the Federal Regulations covering universal waste.

1.Large Quantity Handler of Universal Waste, or LQHUW: You are a large quantity handler if you accumulate a total of 5,000 kg or more of any universal wastes (calculated collectively) at any time. Check the appropriate boxes to indicate the types of universal wastes you generate and/or accumulate at your site. If your state has additional universal wastes, indicate what they are and check the corresponding boxes.

2.Destination Facility: Check this box if you treat, dispose of, or recycle universal wastes on site. A hazardous waste permit is required if you treat or dispose of universal wastes; a permit may be required if you recycle universal waste.

MO 780-1164 (11-12)

Page 5 of 8

Notification of Regulated Waste Activity Instructions continued

C. Used Oil Management Activities: Check the appropriate boxes to indicate which used oil fuel activities are taking place at this installation. The Federal regulations for used oil management are found in 40 CFR Part 279; the State regulations are found in 10 CSR 25-11.

1.Used Oil Transporter/Transfer Facility: If you transport used oil, or if the site you are registering is a used oil transfer facility, check the appropriate boxes to indicate your activity.

2.Used Oil Processor/Re-refiner: If you are processing or re-refining used oil at the facility which you are registering for, check the appropriate boxes to indicate your activity.

3.Off-Specification Used Oil Burner: If you burn used oil fuel, check the appropriate box.

4.Used Oil Marketer: If you market used oil fuel, check the appropriate boxes.

Note: Used oil generators are required to notify only if they are marketing directly to a burner.

D. E-Scrap Recycling Activities: Check this box if you are handling E-scrap at your site.

ITEM VIII. - DESCRIPTION OF REGULATED WASTE ACTIVITY

Only persons involved in hazardous waste activity (Item VII.A.1 & Item VII.A.8) need to complete this item.

Transporters requesting an EPA Identification number do not need to complete this item, but must mark A.2 and sign the 'Certification' in Item XI. You will need to refer to 40 CFR Part 261 and 10 CSR 25-4 in order to complete this section. Part 261 identifies those wastes EPA defines as hazardous. If you need help in completing this section, please contact the Hazardous Waste Program.

A.Federally Regulated Hazardous Wastes: If you handle hazardous wastes described in 40 CFR Part 261, enter the appropriate 4-digit code(s) in the boxes provided.

B.State-Regulated Hazardous Wastes: If you manage hazardous wastes that have a Missouri waste code, enter the appropriate codes in the boxes provided.

ITEM IX. - NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM, or NAICS, CODE(S)

Box A. Provide the North American Industry Classification System code that best describes your site's primary business production process for your products or services. Use the six digit code (most specific description) if available for your business; if not, use the five digit code; do not enter any codes with four or fewer digits.

Box B.-D. List other North American Industry Classification System codes that describe the primary business production process for your site. Use the most specific five or six digit codes available.

You can obtain North American Industry Classification System codes from the following sources:

North American Industry Classification System Online at www.census.gov/eos/www/naics and at some libraries.

Principal Business Activity - Enter a description of the activity that best typifies your business, (e.g., manufacture steel chairs and related products.)

ITEM X. – COMMENTS

Use this section as needed to provide additional information. You may attach additional sheets if needed.

ITEM XI. – CERTIFICATION

This certification must be signed by the owner, operator, or an authorized representative of your installation. An

'authorized representative' is a person responsible for the overall operation of the facility (e.g., a plant manager or superintendent or a person of equal responsibility). All notifications must include the certification to be complete.

Mail completed forms and $100 fee, if applicable, to:

Missouri Department of Natural Resources

or

Missouri Department of Natural Resources

Hazardous Waste Program

 

Hazardous Waste Program

1730 E. Elm

 

P.O. Box 176

Jefferson City, MO 65101-4130

 

Jefferson City, MO 65101

MO 780-1164 (11-12)

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Notification of Regulated Waste Activity Instructions continued

DEFINITIONS

The following definitions are included to help you to understand and complete the Notification Form:

ACT or RCRA means the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act of 1976, as amended by the Hazardous and Solid Waste Amendments of 1984, 42 U.S.C. Section 6901 et seq.

Authorized Representative means the person responsible for the overall operation of an installation or an operational unit (i.e., part of a facility). An authorized representative could be a superintendent or plant manager, or person of equivalent responsibility.

Boiler means an enclosed device using controlled flame combustion and having the following characteristics:

1.The unit has physical provisions for recovering and exporting energy in the form of steam, heated fluids or heated gases.

2.The unit's combustion chamber and primary energy recovery section(s) are of integral design (e.g., they are physically formed into one manufactured or assembled unit).

3.The unit continuously maintains an energy recovery efficiency of at least 60 percent, calculated in terms of the recovered energy compared with the thermal value of the fuel.

4.The unit exports and utilizes at least 75 percent of the recovered energy, calculated on an annual basis (excluding recovered heat used internally in the same unit, for example, to preheat fuel or combustion air or drive fans or feedwater pumps).

5.The unit is one which the Regional Administrator has determined on a case-by-case basis, to be a boiler after considering the standards in 40 CFR 260.32.

Burner means the owner or operator of any boiler or industrial furnace that burns hazardous waste fuel for energy recovery and that is not regulated as a RCRA hazardous waste incinerator.

Disposal means the discharge, deposit, injection, dumping, spilling, leaking or placing of any solid waste or hazardous waste into or on any land or water so that such solid waste or hazardous waste or any constituent thereof may enter the environment or be emitted into the air or discharged into any waters, including ground waters.

EPA Identification (ID) Number means the number assigned by EPA to each hazardous waste generator, hazardous waste transporter, and treatment, storage or disposal installation; large quantity handler of universal wastes; used oil transporter, used oil processor/re-refiner, off-specification used oil fuel burner and used oil fuel marketer.

E-Scrap Recycler means a person or group that engages in recycling of end-of-life electronic equipment; including but not limited to, computer equipment such as central processing units, laptop computers, computer monitors, and other cathode ray tubes.

Generator means any person, by site, whose act or process produces hazardous waste identified or listed in 40 CFR Part 261.

Hazardous Waste means a hazardous waste as defined in 40 CFR 261.3.

Industrial Furnace means any of the following enclosed devices that are integral components of manufacturing processes and that use controlled flame combustion to accomplish recovery of materials or energy: cement kilns, lime kilns, aggregate kilns (including asphalt kilns), phosphate kilns, coke ovens, blast furnaces, smelting, melting

and refining furnaces, titanium dioxide chloride process oxidation reactors, methane reforming furnaces, pulping liquor recovery furnaces, combustion devices used in the recovery of sulfur values from spent sulfuric acid and other devices as the Administrator may add to this list.

Installation means all contiguous land, structures, other appurtenances and improvements on the land, used for treating, storing or disposing of hazardous waste. An installation may consist of several treatment, storage or disposal operational units. (For entities that only transport regulated wastes, the term installation refers to the headquarters of that entity's operations.)

Large Quantity Universal Waste Handler means a universal waste handler who accumulates 5,000 kilograms or more of universal waste (batteries, pesticides, or thermostats, calculated collectively) at any time.

Municipality means a city, village, town, borough, county, parish, district, association, Indian tribe or authorized Indian tribal organization, designated and approved management agency under Section 208 of the Clean Water Act, or any other public body created by or under state law and having jurisdiction over disposal of sewage, industrial wastes or other wastes.

Off-Specification Used Oil Fuel means used oil fuel that does not meet the specification provided under 40 CFR 279.11.

On-Specification Used Oil Fuel means used oil fuel that meets the specification provided under 40 CFR 279.11.

Operator means the person responsible for the overall operation of an installation.

MO 780-1164 (11-12)

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Notification of Regulated Waste Activity Instructions continued

Owner means a person who owns an installation or part of an installation, including the property owner.

Precious Metals Reclamation means recycling and recovery of precious metals (i.e., gold, silver, platinum, palladium, iridium, osmium, rhodium, and ruthenium) from hazardous waste.

Storage means the holding of hazardous waste for a temporary period, at the end of which the hazardous waste is treated, disposed of, or stored elsewhere.

Transportation means the movement of hazardous waste by air, rail, highway or water.

Transporter means a person engaged in the off-site transportation of hazardous waste by air, rail, highway or water.

Treatment means any method, technique or process, including neutralization, designed to change the physical, chemical or biological character or composition of any hazardous waste to neutralize such waste, or to recover energy or material resources from the waste, or to render such waste nonhazardous or less hazardous so it is safer to transport, store or dispose of, or amenable for recovery, amenable for storage or reduced in volume. This includes any activity or processing designed to change the physical form or composition of hazardous waste so as to render it nonhazardous.

Universal Waste means batteries as described in 40 CFR 273.2, pesticides as described in 40 CFR 273.3 as modified by paragraph (2)(A)3. 10 CSR 25-16, mercury switches as described in subparagraph (2)(A)4.A. 10 CSR 25-16, thermostats as described in 40 CFR 273.4, as incorporated in 10 CSR 25-16, mercury containing thermometers and manometers as described in subparagraph (2)(A)4.B. 10 CSR 25-16 and mercury containing lamps as described in subparagraph (2)(A)4.C. 10 CSR 25-16.

Used Oil means any oil that has been refined from crude oil, or any synthetic oil, that has been used and as a result of such use, is contaminated by physical or chemical impurities.

Used Oil Fuel means any used oil burned (or destined to be burned) for energy recovery including any fuel produced from used oil by processing, blending or other treatment and that does not contain hazardous waste (other than that generated by a conditionally exempt small quantity generator and exempt from regulation as hazardous waste under provisions of 40 CFR 261.5). Used oil fuel may itself exhibit a characteristic of hazardous waste and remain subject to regulation as used oil fuel provided it is not mixed with hazardous waste.

Used Oil Processing means chemical or physical operations designed to produce from used oil, or to make used oil more amenable for production of, fuel oils, lubricants or other used oil derived products. Processing includes, but is not limited to: blending used oil with virgin petroleum products, blending used oils to meet the fuel specification, filtration, simple distillation, chemical or physical separation, and re-refining.

Used Oil Processor means an installation that processes on- or off-specification used oil.

Used Oil Re-refiner means an installation that produces lubricating oils and greases, industrial fuel, asphalt extender, gasoline and other products from on- or off-specification used oil.

Utility Boiler means a boiler that is used to produce electricity, steam or heated or cooled air or other gases or fluids for sale.

Waste Fuel means hazardous waste fuel or off-specification used oil fuel.

MO 780-1164 (11-12)

Page 8 of 8

File Attributes

Fact Name Fact Detail
Form Purpose The form is intended for notification of regulated waste activity to the Missouri Department of Natural Resources Hazardous Waste Program.
Initial Fee Requirement All new and reactivating registrations require a $100 initial fee. Updates to existing and active registrations are exempt from this fee.
Form Completion Every section of the form must be completed in full, or it will be returned to the sender.
Submission Details The completed form should be sent either to the Hazardous Waste Program at P.O. Box 176, Jefferson City, MO 65102 - 0176 or 1730 East Elm Street, Jefferson City, MO 65101-4130.
Governing Law The form and its processes are governed by Section 260.380.1(1) of the Revised Statutes of Missouri (RSMO) and relevant Missouri regulations.
Types of Registrations The form caters to both new and subsequent notifications of regulated waste activity, delineating between first-time registrations and updates or changes to existing ones.

How to Write Mo 780 1164

Filling out the Missouri Department of Natural Resources MO 780 1164 form is essential for notifying the Hazardous Waste Program of regulated waste activity. This procedure is mandatory for all new and reactivating registrations, requiring careful attention to detail to ensure complete and accurate completion. The steps outlined below are designed to guide you through this process efficiently, ensuring compliance with state regulations.

  1. Decide the type of notification by marking either “A. NEW NOTIFICATION” if this is the first notification for the installation or “B. SUBSEQUENT NOTIFICATION” if updating or reactivating a registration. For subsequent notifications, enter the existing EPA ID NUMBER and MISSOURI ID NUMBER.
  2. Provide the NAME OF INSTALLation in Section II.
  3. Fill in the LOCATION OF INSTALLATION with the physical address, including STREET, CITY, STATE, ZIP CODE + 4, and COUNTY NAME.
  4. Complete the INSTALLATION MAILING ADDRESS. If it's the same as the location, write “SAME”. For a separate billing address, fill in the corresponding fields under "A. Billing Address".
  5. In SECTION V, enter the name, title, email, and phone number of the INSTALLATION CONTACT.
  6. Address OWNERSHIP details:
    • Enter the installation’s legal owner’s name, address, and phone number.
    • Mark “YES” under E. CHANGE OF INSTALLATION OWNER INDICATOR and provide the date of change if applicable.
    • Check the INSTALLATION OWNER TYPE that best describes the legal status of the current business owner.
    • For the property's legal owner details, if different, fill out similar details as A. or mark as “SAME” if identical.
    • Indicate if there has been a change in property ownership and the type of property owner in section F.
  7. Select the TYPE OF REGULATED WASTE ACTIVITY that applies to your installation in SECTION VII, marking all applicable boxes for Hazardous Waste, Universal Waste, and Used Oil Activities.
    • For hazardous waste generators, select the correct category based on the amount of waste generated.
    • Mark any additional activities that apply, such as waste transporter or recycler.
  8. For SECTION VIII, describe the regulated waste activity in detail, including waste codes for federally and state-regulated hazardous wastes.
  9. Enter the appropriate NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM (NAICS) CODE(S) in SECTION IX.
  10. Add any relevant COMMENTS in SECTION X if necessary.
  11. The CERTIFICATION section must be signed and dated by an authorized individual, certifying the accuracy and completeness of the form.
  12. Finally, mail the completed form along with the required $100 initial fee (if applicable) to the provided address of the Hazardous Waste Program. Make sure to use original ink for signatures.

After submitting the MO 780 1164 form, your notification will be processed by the Missouri Department of Natural Resources. This step is crucial for maintaining compliance with state regulations on hazardous waste management. Ensure all information is accurate and complete to avoid delays or penalties. Keep a copy of the form and any correspondence for your records.

What You Should Know About This Form

What is the purpose of the MO 780-1164 form?

The MO 780-1164 form serves as a notification document for the Missouri Department of Natural Resources. It is used by businesses and installations to declare regulated waste activities to the state. These activities can range from hazardous waste generation to recycling, and the form helps ensure compliance with state environmental regulations. Completing and submitting this form is a necessary step for facilities that handle regulated wastes, to both inform the state of their activities and to fulfill legal requirements for safe waste management and disposal.

Who needs to fill out the MO 780-1164 form?

This form must be filled out by any facility that engages in activities regulated under the hazardous waste program in Missouri. This includes, but is not limited to, facilities that:

  • Generate hazardous waste, including generators of all sizes (large, small, and conditionally exempt small quantity generators).
  • Transport, treat, store, or dispose of hazardous waste.
  • Recycle regulated hazardous waste.
  • Engage in universal waste activities, such as large quantity handlers or destination facilities for universal waste.
  • Are involved in used oil activities, including transporters, processors, re-refiners, and marketers.
Facilities updating information for an existing and active registration may also need to use this form.

Is there a fee to submit the MO 780-1164 form?

Yes, there is a $100 initial fee required when either registering as a new facility or reactivating a registration with the Missouri Department of Natural Resources' Hazardous Waste Program. It is important to note that this fee must accompany the submission of the form; otherwise, the registration will not be processed. However, if a facility is merely updating information on an existing and active registration, then this fee is not required.

How do you submit the MO 780-1164 form?

To submit the MO 780-1164 form, a facility must complete the document in its entirety and mail it with the appropriate fee (if required) to one of the following addresses based on their needs:

  • If sending via standard postal service: Hazardous Waste Program, P.O. Box 176, Jefferson City, MO 65102 - 0176
  • If sending via courier or overnight delivery: Hazardous Waste Program, 1730 East Elm Street, Jefferson City, MO 65101-4130
Incomplete forms or forms without the required fee will be returned.

What happens if you do not correctly complete or submit the MO 780-1164 form?

If the MO 780-1164 form is not correctly completed or if it is submitted without the required fee (for new and reactivating registrations), the Missouri Department of Natural Resources will return the form. This can delay the processing of your registration, potentially hindering your facility's operations. Additionally, operating without properly registering regulated waste activities might lead to noncompliance issues, which can result in fines or other penalties. It's crucial to ensure the form is accurately completed and all necessary documentation and fees are provided to avoid any disruptions to your business operations.

Common mistakes

    When filling out the MO 780-1164 form, mistakes can occur that may lead to delays or rejections. It's vital to approach this form with diligence to ensure that your notification of regulated waste activity is accepted without issue. Here are seven common errors:

  1. Not including the initial fee: New and reactivating registrations require a $100 fee. Failure to include this fee results in the application not being processed. It's crucial to remember that this fee is not needed for updates to an existing, active registration.
  2. Incomplete information: The form must be completed in its entirety. Leaving sections blank or not providing sufficient detail can lead to the form being returned.
  3. Misidentifying the type of notification: Accurately distinguishing between a new notification and a subsequent notification is essential. Incorrectly marking the type of notification can complicate the registration process.
  4. Incorrectly identifying the installation's location: The location of the installation must be a physical address or a clear directional description. Using P.O. boxes or incomplete addresses can lead to misunderstandings or the misrouting of documents.
  5. Not designating a separate billing address when necessary: If invoices should be sent to a different address, this must be specified. Otherwise, all fee invoices will be sent to the mailing address provided, which could lead to payment delays.
  6. Omitting the North American Industry Classification System (NAICS) code: Providing the correct NAICS code(s) is crucial as it helps in identifying the principal business activity. Neglecting to include this information can affect the processing time.
  7. Failing to sign the form in original ink or providing incomplete certification details: The certification section requires an original signature and complete name and official title to be valid. Electronic signatures or photocopies are not accepted, and incomplete details can invalidate the submission.

Adhering to these guidelines and thoroughly reviewing the form before submission can significantly increase the likelihood of a successful notification process.

Documents used along the form

When dealing with the MO 780-1164 form for notifying of regulated waste activity, entities often need additional documents and forms to ensure compliance and thoroughness in their hazardous waste management practices. These additional documents help in providing detailed information, meeting regulatory compliance, and ensuring safe and legal waste management.

  • EPA Form 8700-12: Known as the RCRA Subtitle C Site Identification Form, this form is crucial for obtaining an EPA ID number. It collects basic information about the facility generating hazardous waste, the types of waste handled, and the site's waste management practices.
  • Uniform Hazardous Waste Manifest: This standardized form is a tracking document required for the transportation of hazardous waste. It ensures the safe and trackable movement of hazardous waste from its point of generation to the disposal facility.
  • Hazardous Waste Annual Report: Facilities required to submit this report provide detailed information about the quantities and management of hazardous waste generated over the year. It's a critical tool for regulatory oversight.
  • Notification of Hazardous Waste Activity: While similar to the MO 780-1164 form, this notification may be required in different jurisdictions or under specific circumstances. It informs the appropriate agency about a facility’s hazardous waste activities.
  • Biennial Report Form (EPA Form 8700-13A/B): Large quantity generators and treatment, storage, and disposal facilities must submit this report every two years. It covers the generation, management, and final disposition of hazardous wastes.

Complementing the MO 780-1164 form with these documents ensures a comprehensive approach to hazardous waste management. By maintaining detailed and accurate records, facilities not only adhere to regulatory requirements but also contribute to environmental protection and public health safety.

Similar forms

The Mo 780 1164 form is similar to other regulatory forms that organizations must complete for environmental compliance, specifically related to hazardous waste management. One such document it closely resembles is the EPA Form 8700-12, also known as the Notification of Regulated Waste Activity.

The EPA Form 8700-12 serves a pivotal role in the United States for facilities to obtain an EPA ID number, signifying their status as hazardous waste generators, transporters, or treatment/storage/disposal facilities. Both forms focus on providing detailed information about the type of hazardous waste activities at a site, the nature and quantity of waste handled, and the facility's operational specifics. Key similarities include sections for identifying the facility and contact information, describing the types of hazardous waste managed, and highlighting the facility's waste generation category (e.g., Large Quantity Generator, Small Quantity Generator, etc.). However, the Mo 780 1164 form is tailored to the specific regulations and requirements of the Missouri Department of Natural Resources, emphasizing state-specific regulatory interests alongside federal compliance needs.

Another document akin to the Mo 780 1164 form is the RCRA Subtitle C Site Identification Form. This form serves as a foundational component of environmental regulatory compliance on a national scale, facilitating the tracking of hazardous waste from its point of creation to its final disposal. It shares the objective of promoting safe and responsible hazardous waste management practices. Both documents require detailed information regarding the facility's hazardous waste activities, such as the generation, transportation, treatment, storage, or disposal of hazardous wastes. Additionally, these forms collect data on the facility's operators, waste codes applicable to the waste handled, and any relevant environmental protection practices the facility employs. The critical difference lies in the specific instructions and regulatory nuances tailored to either federal or, in the case of the Mo 780 1164 form, Missouri state regulatory frameworks.

Dos and Don'ts

When you're preparing to fill out the Missouri Department of Natural Resources Hazardous Waste Program MO 780 1164 form, you're taking a crucial step toward compliance with regulatory requirements. This form, intricate in its expectations, serves as a notification for various regulated waste activities. To navigate this process smoothly, here are 6 do's and don'ts that will ensure your application is both compliant and complete.

  • Do ensure that the form is filled out in its entirety. Leaving sections incomplete can lead to the form being returned, delaying your compliance process.
  • Do include the $100 initial fee if you are registering a new or reactivating registration. This fee is vital for the processing of your application.
  • Do use the provided instructions at the end of the form as a guide. These are tailored to help you accurately complete the form and avoid common mistakes.
  • Do send the completed form to the correct address, as stated on the form itself. Choosing the right address ensures your form reaches the right department without unnecessary delays.
  • Don't forget to sign the form with original ink. Electronic signatures or copies are not accepted, and this oversight can invalidate your entire submission.
  • Don't overlook the need to update information if your business has already registered. While the initial fee isn't required for updates, ensuring your information is current is critical for compliance.

Navigating through the MO 780 1164 form with these do's and don'ts in mind will streamline the process, ensuring your waste activities are correctly registered and compliant with Missouri's regulations. Always remember to review your entries for accuracy and completeness before submission. A well-prepared form not only reflects positively on your business's commitment to environmental responsibility but also facilitates a smoother regulatory process.

Misconceptions

  • One common misconception is that the $100 initial fee is required for all submissions of the MO 780 1164 form. However, this fee is only required for new registrations and reactivations. If you're merely updating information on an existing and active registration, no fee is necessary.

  • Another misconception is that if you change the mailing or billing address, a new EPA ID number is required. The truth is, an EPA ID number is site-specific and remains the same unless the physical location of the facility changes.

  • Many believe that only hazardous waste generators need to complete the MO 780 1164 form. In reality, the form is also necessary for those engaged in universal waste activities, used oil activities, and recyclers of electronic scrap, among others.

  • Some think that completing the form once covers all future activities. This isn't accurate, as subsequent notifications are required for changes such as new regulated waste activities or changes in ownership.

  • There's a misconception that only large businesses generating vast amounts of hazardous waste need to worry about this form. However, even small quantity generators and those handling minor quantities of universal waste have regulatory reporting requirements.

  • Another is that the form is overly complicated and cannot be completed without professional help. While detailed, instructions are provided to guide filers through each section, making it possible for individuals to complete it accurately with diligence.

  • Many mistakenly believe that once submitted, the MO 780 1164 form doesn't require any further action. Yet, regular updates are crucial, especially when there's a change in the type of waste activity or the contact information of the installation.

  • A final common misconception is that the information provided on the form is only used for billing purposes. The data collected is crucial for the Missouri Department of Natural Resources to maintain accurate records on waste generation and management practices, essential for environmental protection efforts.

Key takeaways

Understanding the correct process for completing and submitting the Missouri Department of Natural Resources Notification of Regulated Waste Activity form, MO 780-1164, is crucial for entities managing hazardous waste within the state. Here are key takeaways to guide you through this process:

  • All new and reactivating registrations must include a $100 initial fee; without this fee, the registration will not be processed. However, this fee is not needed for updates to an existing, active registration.
  • The form demands complete information for processing. Partially filled forms risk being returned, delaying compliance and potentially incurring financial and legal repercussions.
  • When identifying the type of notification—whether new or subsequent—accurately providing the EPA ID number and MO ID number, if available, is essential for tracking and recording purposes.
  • Providing detailed contact information and the physical address of the installation is required for official communications and site-specification.
  • For facilities with a separate billing address, the form allows specifying this information to ensure that invoices are sent to the correct location, preventing financial delinquencies.
  • The form includes a section for detailing the type of regulated waste activity, including hazardous waste generation, universal waste activities, and used oil activities. Accurate classification aids in compliance with Missouri's waste management regulations.
  • There's a provision for indicating a change in installation or property ownership. It's important to notify the Department of any changes to maintain accurate records and avoid potential legal issues.
  • The form requires a detailed description of the regulated waste activity and, where necessary, the inclusion of waste codes as classified by federal or state regulations for hazardous wastes.
  • A certification section at the end of the form requires a signature, affirming that the information provided is accurate to the best of the signer’s knowledge. Submitting false information can result in severe penalties, including fines and imprisonment.

Compliance with these guidelines ensures that entities managing hazardous or regulated wastes in Missouri adhere to state requirements, promoting environmental safety and avoiding regulatory penalties.

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