NEW JERSEY DEPARTMENT OF ENVIRONMENTAL PROTECTION
Division of Solid & Hazardous Waste - Bureau of Resource Recovery &
Technical Programs
P.O. Box 414, Trenton, NJ 08625-0414
INTERMEDIATE HANDLER AND DESTINATION FACILITY ANNUAL REPORT
(as required by N.J.A.C. 7:26-3A.44)
REPORTING PERIOD: JAN. 1, 1998 TO DEC. 31, 1998
SECTION 1: GENERAL INFORMATION - ALL FACILITIES MUST COMPLETE THIS
SECTION
| 1. FACILITY NAME |
| NJDEP FACILITY ID NO |
2. LOCATION
(STREET ADDRESS) |
| CITY |
COUNTY |
STATE |
ZIP CODE |
| CONTACT PERSON |
TITLE |
TELEPHONE NO.( ) |
| 3. MAILING ADDRESS |
| CITY |
STATE |
ZIP CODE |
| 4. FACILITY STATUS (
U
one only)
" Intermediate Handler (Facility that either treats
or destroys, but does not do both) |
| " Destination Facility
(Facility that treats and destroys) |
| " Both Intermediate
Handler & Destination Facility (File separate reports if you check this
box) |
| " Neither Intermediate
Handler nor Destination Facility (Please proceed to Section 4, Page 5) |
NOTE: If your facility has stopped treating and destroying on-site, you
must still complete the report for any waste that was processed by that unit
during this reporting period.
5. INTERMEDIATE HANDLER - Complete this question if your
facility is an intermediate handler.
An intermediate handler is a facility that either treats regulated
medical waste (RMW) or destroys RMW, but does not do both.
If you are not an intermediate handler, skip this question and proceed to
Question 6.
To identify the quantities of RMW processed, refer to the medical waste tracking
forms for RMW received for processing or generator logs kept at your facility
as required.
Method of On-site Treatment or Destruction |
Quantity of Treated 1 RMW
Processed (lbs/yr) |
Quantity of Untreated 2 RMW Processed (lbs/yr) |
Quantity of Solid Waste Processed (lbs/yr) |
| Chemical Disinfection |
|
|
|
| Grinding |
|
|
|
| Steam Sterilization |
|
|
|
| Microwave |
|
|
|
| Other |
|
|
|
5a. Manufacturer/Trade Name__________________________________________
5b. Age of Unit______________________________________________________
5c. Design Operating Capacity (lbs/hr)__________________________________
5d. Permitted Capacity (lbs/hr)_________________________________________
5e. Actual Operating Capacity (lbs/hr)____________________________________
5f. Average Daily Usage (hr/day)_______________________________________
1 Include waste accepted from other sources that was treated prior to shipment
to your facility.
2 Include waste accepted from other sources.
NOTE: IF YOU HAVE MORE THAN ONE UNIT AT THIS FACILITY, COPY THIS PAGE
AS NEEDED AND PROVIDE THE INFORMATION FOR EACH UNIT
6. DESTINATION FACILITY Complete this question if your facility
is a destination facility.
A destination facility is a facility that both treats regulated medical waste
(RMW) to reduce or eliminate its infectious nature and destroys RMW by rendering
it unrecognizable. If you are not a destination facility, skip this question
and proceed to Section 2.
To identify the quantities of RMW processed, refer to the medical waste tracking
forms for RMW received for processing or generator logs kept at your facility
as required.
Method of RMW On-Site Treatment and Destruction |
Quantity of Treated 1 RMW Processed
(lbs/year) |
Quantity of Untreated 2 RMW Processed
(lbs/year) |
Quantity of Solid Waste (not RMW) or Overclassified Waste Processed
(lbs/year) |
| Steam Sterilization/Shredding Machine |
|
|
|
| Incineration |
|
|
|
| Disinfection/Grinding-Shredding Machine |
|
|
|
| Microwaving/Shredding Machine |
|
|
|
| Other/Describe |
|
|
|
1 RMW that has been treated prior to processing by this method. Include treated
RMW accepted from other sources.
2 Include untreated RMW accepted from other sources.
NOTE: IF YOU HAVE MORE THAN ONE UNIT AT THIS FACILITY, COPY THIS PAGE
AS NEEDED AND PROVIDE THE INFORMATION FOR EACH UNIT.
SECTION 2 WASTE ACCEPTED (INCLUDE GENERATORS WHO SELF TRANSPORT
TO YOUR FACILITY)
NOTE: IF YOU ACCEPTED WASTE FROM MORE THAN THREE SOURCES, COPY
THIS PAGE AS NEEDED.
| 7a. |
| A. Name |
| Street Address |
City
 State
Zip
RMW Reg. No. |
B. Type of Waste You Accepted:
Treated Waste 1
lbs |
Untreated Waste
lbs |
C. Source of Waste:
Waste generated in New Jersey
lbs |
Waste generated out-of-state
lbs |
7b.
A. Name |
| Street Address |
| City
State
Zip
RMW Reg. No. |
B. Type of Waste You Accepted:
Treated Waste 1
lbs |
Untreated Waste
lbs |
C. Source of Waste:
Waste generated in New Jersey
lbs |
Waste generated out-of-state
lbs |
7c.
A. Name |
| Street Address |
| City
State
Zip
RMW Reg. No. |
B. Type of Waste You Accepted:
Treated Waste 1
lbs |
Untreated Waste lbs |
C. Source of Waste:
Waste generated in New Jersey
lbs |
Waste generated out-of-state lbs |
1 Waste that was treated before being given to your facility
SECTION 3: ASH AND RESIDUE INFORMATION
8. ASH - Complete if your facility uses an incinerator.
A. Pounds of ash transported off-site during reporting period: Wet/dry(circle
one)___________lbs per year.
B. Transporter Name
________________________________________________________________________________
Address ________________________NJDEP Solid Waste Transporter Reg. No.
__________________
C. Disposal Facility Name:
__________________________________________________________________________________
Address_________________________NJDEP Solid Waste Facility Reg.
No._____________________
9. RESIDUE - Complete if your facility uses a system
other than incineration.
A. Pounds of processed residue from treatment and destruction
unit:__________________lbs per year.
B. Transporter Name
__________________________________________________________________________________
Address ________________________NJDEP Solid Waste Transporter Reg. No.
__________________
C. Disposal Facility Name:
___________________________________________________________________________________
Address ___________________________Permit No.___________________________________
SECTION 4: STATUS OF TREATMENT AND/OR DESTRUCTION UNIT
Only complete this Section if your on-site treatment and destruction system
(i.e. incinerator, disinfection/grinding, microwaving/shredding) has been
shut down temporarily or permanently. Skip to Section 5 if your on-site treatment
and/or destruction system is still operating.
10. Has your treatment and/or destruction unit ceased operation?
Date of shutdown:_________________Temporary______Permanent______
If Temporary - Explain
_________________________________________________________________________________
_________________________________________________________________________________
10b. Will your facility seek to renew permits or continue to operate
this unit in the future? Yes____No___
10c. Will your facility use another on-site treatment and destruction system
in lieu of the one that has ceased operation at your facility? Yes ___
Type___________________Trade Name__________________No___
10d. Will your facility instead send RMW off-site for disposal? Yes_____
No_____
If yes, by which transporter?
Name______________________________________________________
Address___________________________________ NJDEP Reg
No.__________________________
Disposal Facility
Name______________________________________________________________
Address____________________________________________________________________________
SECTION 5 CERTIFICATION
I certify 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.
___________________________________________________________________________________
Name (please print)
Signature
Title
____________________________________________
Date
This report must be submitted by February 15,
1999 to the following address:
New Jersey Department of Environmental Protection
Division of Solid & Hazardous Waste
Bureau of Resource Recovery & Technical Programs
P.O. Box 414
401 East State Street
Trenton, NJ 08625-0414
ID98-REP.doc 1/11/99