Kansas Small Business Environmental Assistance Program - KDHE

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Kansas Small Business Environmental Assistance Program - KDHE
Facility name
                                  KDHE registration number
                                  Hazardous waste generator category
                                  EPA ID (if any)

                                  Kansas Small Business
                                  Environmental Assistance Program
                                  Confidential technical assistance
                                  Phone: 800-578-8898
                                  Email: sbeap@ksu.edu
                                  Web site: www.sbeap.org

Paid for in part by the Kansas Department of Health and Environment
Kansas Small Business Environmental Assistance Program - KDHE
Kansas Department of Health and Environment (KDHE)
                                           Contact Information

Bureau of Environmental Remediation                                            Bureau of Waste Management
Benjamin Haring, I.E., I.G                                                     Ken Powell
Unit Manager: Kansas Dry-Cleaning Program                                      Section Chief: Compliance, Enforcement, Waste Reduction &
Kansas Department of Health and Environment                                       Assistance Section
1000 SW Jackson, Suite 410                                                     Kansas Department of Health and Environment
Topeka, KS 66612-1367                                                          1000 SW Jackson, Suite 320
Phone: 785-296-5531                                                            Topeka, KS 66612-1366
E-mail: Ben.Haring@ks.gov                                                      Phone: 785-296-1121
Web site: www.kdheks.gov/dryclean/                                             E-mail: Ken.Powell@ks.gov
                                                                               Web site: www.kdheks.gov/waste/
Dry cleaners must register annually with this bureau, which administers
the Kansas Drycleaner Environmental Response Act (DERA). It is a               This bureau regulates storage and disposal of solid and hazardous
regulatory program focused on preventing spills from being released off        waste in accordance with KDHE (state) and EPA (federal) regulations.
site. It offers financial assistance for assessment and remediation
activities at dry-cleaning facilities where spills (releases) have occurred.

Bureau of Air                                                                  Small Business/Pollution Prevention
Connie Ellis                                                                   Jayson Massey
Section Chief: Air Compliance and Enforcement Section                          Public Service Executive
Kansas Department of Health and Environment                                    Division of Environment
1000 SW Jackson, Suite 310                                                     Kansas Department of Health and Environment
Topeka, KS 66612-1366                                                          1000 SW Jackson, Suite 430
Phone: 785-296-1556                                                            Topeka, KS 66612-1367
E-mail: Connie.Ellis@ks.gov                                                    Phone: 785-296-1526
Web site: www.kdheks.gov/air-permit/indexCE.html                               E-mail: jayson.massey@ks.gov
                                                                               Web site: www.kdheks.gov/sbcs/
This KDHE bureau regulates air emissions. It ensures dry cleaners              This KDHE division provides support services to the public, communities,
minimize air leaks and contaminants in order to meet KDHE (state) and          and small Kansas businesses through grants and technical assistance.
EPA (federal) regulatory requirements.                                         Contact this group with general questions about your permit, whom to
                                                                               best answer your questions or pollution prevention technologies.
Kansas Small Business Environmental Assistance Program - KDHE
PLACE HOLDER ONLY—Replace with separate PDF version for better resolution
Kansas Small Business Environmental Assistance Program - KDHE
Instructions for Use
GENERAL
Kansas dry cleaners are regulated under three different environmental compliance programs — the Kansas Drycleaner Environmental Response Act (DERA),
hazardous air pollutants (NESHAP) and hazardous waste. This calendar is designed to help you keep records required by all three of these programs.
NESHAP and DERA records must be kept at your facility for a minimum of five years, and the hazardous waste records for three years, so we recommend
keeping all records for five years. Use a separate calendar for each perchloroethylene (perc) machine. Request additional copies if needed. A different
compliance calendar exists for petroleum and other non-perc users.

DERA AND HAZARDOUS WASTE INSPECTIONS
All dry cleaners must register annually in January with the KDHE Bureau of Environmental Remediation. Secondary containment structures must be made of
steel, epoxy or polyethylene and be large enough to accommodate a worst-case spill. Conduct weekly inspections of the secondary containment, and each
storage container and storage area. Sign the inspection logs provided for each month in the calendar. Make a note on the corrective action forms of any
problems that were found, what was done to correct each problem, the date each problem was corrected and who corrected it. Use the envelope at the back of
the calendar to store your hazardous waste and perc purchase receipts. Follow the pollution prevention guidelines listed at the back of the calendar. You can
review the perchloroethylene dry-cleaners users’ guide at http://www.kdheks.gov/dryclean/download/Prechloroethylene_Facility_Guide.pdf for more
information.

SEPARATOR WATER AND EVAPORATION SYSTEMS
Separator water (and/or dry-cleaning wastewater) cannot be drained in the sanitary sewer. In Kansas, you are allowed to evaporate separator water in a
heated evaporation unit, or a non-thermal unit that utilizes air atomization or misting at your facility, provided the separator water contains no free-phase
(dissolved or suspended) dry-cleaning solvent. Do not store separator water (and/or dry-cleaning wastewater) at your facility for more than 60 days.

MONITORING AIR POLLUTION CONTROL DEVICES
Refrigerated condenser
Check high- and low-pressure gauges of the refrigerated condenser every week. Take either pressure or temperature readings. If you measure temperature,
take readings of the exhaust off the condenser. Record the pressure or temperature and date in the space provided. Maintain pressures within the
manufacturer’s specified range. (see machine’s maintenance manual). In the block marked “Is temp less than or equal to 45º Fahrenheit (7.2º Celsius)?”, check
“Y” or “N” for “yes” or “no.” If you checked “N,” the machine must be adjusted or repaired, and a corrective action form, located at the back of the calendar,
should be filled out.

Carbon adsorber
If the machine was installed before Sept. 22, 1993, you are allowed to use a carbon adsorber as a substitute for a refrigerated condenser. Measure weekly the
carbon adsorber exhaust using a colorimetric detector tube or perc gas analyzer able to detect perc concentrations of 100 parts per million (ppm) or less. The
weekly measurement should be taken at the end of the last dry-cleaning cycle while the perc is released to the carbon adsorber prior to steaming out (or
cleaning) the adsorber. Record the perc concentration (ppm) in the column provided. If you happen to have both a refrigerated condenser and carbon adsorber,
you do not have to take and record readings for each unit, just one or the other will do. Circle which unit is monitored: “refrigerated condenser” or “carbon
adsorber.”

NESHAP INSPECTION LOG
If your machine was installed before Dec. 9, 1991, and you buy less than 140 gallons of perc per year, you must inspect for perceptible (sight, smell or feel)
leaks at least every other week. Otherwise, inspect weekly. All perc machines should be inspected for vapor leaks monthly using a halogenated hydrocarbon
detector or a perc gas analyzer. Record results of the inspections on the calendar. If leaks are found, they must be repaired within 24 hours. Record these
repairs on a corrective action form, located at the back of the calendar. If parts are needed, they must be ordered within two days and installed within five
working days of receipt. See page 3 of this calendar for tips on how to use a perc leak detector.
                                                                                                                                                       Page 1
Kansas Small Business Environmental Assistance Program - KDHE
HAZARDOUS WASTE
   Perc dry cleaners must document their hazardous waste determination for each waste stream — use the Kansas waste determination form found at the
     back of this calendar or the new Kansas Waste Determination mobile app, which is now available at respective app stores for both Android and Apple
     products.
   Label hazardous waste containers with the words “Hazardous waste “ and date appropriately if hazardous waste is accumulated for more than 72 hours at
     your facility.
   If separator water contains free-phase (dissolved or suspended) perc, it must be managed as a hazardous waste. If it does not, then it can be evaporated
     in a heated evaporation unit or air-atomized mister.
   Have your hazardous waste hauled by a licensed hazardous waste transporter and maintain copies of the manifests in the envelope at the back of this
     calendar.

CORRECTIVE ACTION FORMS
 Fill out corrective action forms at the back of this calendar if you did any repair on your machine. If more forms are needed, make copies of the blank form,
   print it from the online calendar, or contact SBEAP. These forms can be maintained in the envelop at the back of the calendar.

EMERGENCY CONTACT FORM
   Post emergency numbers by the telephone (see envelope in the back of calendar for this form) as required for hazardous waste generators.

                                                           FOR MORE INFORMATION

                            Contact SBEAP at 800-578-8898 or check its website at www.sbeap.org for dry-cleaner
                            information. Several publications and useful tools are available on the dry-cleaner industry
                            resource page at www.sbeap.org/resources/industries/dry-cleaners.

                            The KDHE Dry-Cleaning Program website is http://www.kdheks.gov/dryclean/index.html.
                            Here you can do the required annual registration of your dry cleaner online. You can also
                            find Kansas registered dry cleaners.

                            Both SBEAP and the KDHE Dry Cleaning Program websites have electronic copies of
                            compliance calendars and The Kansas Drycleaners Manual, a manual that assists with
                            understanding environmental requirements for Kansas dry cleaners.

                            The KDHE Hazardous Waste Generator Handbook, as well as other helpful hazardous
                            waste forms and technical guidance documents, are available on KDHE’s website at
                            www.kdheks.gov/waste/p_inspections.html.

                                                                                                                                                     Page 2
10 Tips for Using Your Perc Detector
                                  (Halogenated hydrocarbon detector or perchloroethylene gas analyzer)
1. Don’t forget to inspect for leaks with the perc detector once a month. If a vapor leak is detected, you are required to document the leak and
   repair it within 24 hours, unless parts must be ordered. If parts must be ordered, you must repair vapor leaks within five days of receiving the part(s).

2. Figure out how it should be calibrated. Work with your supplier to be certain of this! Most require fresh air prior to testing for leaks. It is rec-
   ommended you calibrate the leak detector outside of your shop. If you turn it on near a leak, it may calibrate incorrectly. For example, if there is a leak of
   100 parts per million (ppm) and you turn the detector on near that leak, it will reset its “zero-point” to 100 ppm and will not detect leaks any smaller than
   that.

                         Example perc leak detectors

3. Operate your detector according to the manufacturer's instructions. Don’t hesitate to call your vendor if you have questions.

4. Check for leaks when they are most likely to occur. Check for leaks during the drying cycle since the dry-cleaning machine is operating under
   pressure. Check for leaks around the distillation unit while it is running. You probably won’t find leaks during the wash cycle, since perc liquid is being
   agitated in the drum and the condenser isn’t running.

5. Place the tip of the detector at the surface (within one to two inches) of the area being checked. Move it slowly back and forth before moving
   to the next area.

6. Inspect all of the following components:

        a.   Hose and pipe connections, fittings, couplings and valves           f.   Water separators
        b.   Door gaskets and seating                                            g.   Muck cookers
        c.   Filter gaskets and seating                                          h.   Stills
        d.   Pumps                                                               i.   Exhaust dampers
        e.   Solvent tanks and containers                                        j.   Diverter valves

7. If the detector beeps rapidly, you may have a leak. Go back to the area where you first detected the beeps. You want to find the exact spot
   where the detector reliably beeps, so you know the precise part or location to repair.

8. If the instrument detects a perc vapor leak or is set off, make sure to air it out before continuing the inspection. Otherwise, you may have
   mixed or incorrect results.

9. The detector must be able to detect vapor concentrations of 25 ppm by volume. It must also either emit an audible or visual signal that varies
   as the concentration level changes.

10. Keep the perc detector away from refrigeration systems. Otherwise, a refrigerant leak may cause your detector to be set off.

                                                                                                                                                            Page 3
What is a 12-month running total?
Calculating your 12-month running total                                                                             It is the total amount of perc you
                                                                                                                    purchased in the previous 12 months.

 Step 1: Fill out last year’s information.
 Record this information from last year’s calendar (2018). Refer to this page instead of looking at your old calendar each month.

 12-month total from December 2018: __________ gal

 Jan. 2018 perc purchases: __________ gal              May 2018 perc purchases: __________ gal                Sept. 2018 perc purchases:__________ gal

 Feb. 2018 perc purchases: __________ gal              June 2018 perc purchases: __________ gal               Oct. 2018 perc purchases: __________ gal

 Mar. 2018 perc purchases:__________ gal               July 2018 perc purchases: __________ gal               Nov. 2018 perc purchases: __________ gal

 April 2018 perc purchases: __________ gal             Aug. 2018 perc purchases: __________ gal               Dec. 2018 perc purchases: __________ gal

  Step 2: Take a look at this example for May 2019.
  EXAMPLE: May 2019 12-month running total                 This is the amount you purchased from May
                                                           2018 through April 2019. This is 12 months of
                                                           purchases (the running total). Let’s assume you
  12-month total from last month (Apr. 2019) =    80       bought 80 gallons in those 12 months.
                                                                                                                    Step 3: Fill out your calendar.
       Subtract perc purchased in May 2018 =      20       Assume you bought 20 gallons in May 2018. You                 Determine each month’s 12-
                                     Subtotal =   60       need to subtract May 2018 so you can add in the               month running total as the
                                                           new May 2019 data.                                            year continues. Make sure to
     This month’s (May 2019) perc purchases
                                                                                                                         keep all receipts on site for
     Date                  Gallons                         This is only 11 months worth of purchases! You                five years. Continue to
                                                           need to add in the newest month’s (May’s) totals              refer back to this page for
    5/14                    20                             to get back up to 12 months of purchases.                     last year’s perc purchases.
                                                                                                                         For further assistance, call
    5/27                    10                             Assume you bought 20 gallons of perc on May 14                SBEAP at 800-578-8898.
                                                           and another 10 gallons on May 27, 2019. That is
                       May 2019 perc total =      30       30 gallons total.
               Current 12-month running total
               (Subtotal + May 2019 total) =      90       Now you add together the subtotal and May 2019
                                                           perc purchases. This is the new 12-month running
                                                           total (June 2018 through May 2019).

                                                                                                                                               Page 4
January 2019                                                                                                            Perchloroethylene cleaners

                                                                                                                        Weekly Inspection
                Perc Purchase Running Total                                    Date                                                    1/2   1/9       1/16        1/23        1/30
                              12-month total                                   Time
               from last month (Dec. 2018 =
                                                                               Hazardous Waste
                    Subtract perc purchased
                                                                               Are containers in good condition?                   Y     N   Y     N   Y    N     Y        N   Y   N
                             January 2018 =
                                  (see pg 3)                                   Are waste containers made of
                                                                                                                                   Y     N   Y     N   Y    N     Y        N   Y   N
                                                                               appropriate material?
                                      Subtotal =                               Are containers tightly closed?                      Y     N   Y     N   Y    N     Y        N   Y   N
               This month’s perc purchases*                                    Are individual containers clearly
                                                                               labeled as “Hazardous Waste” with
             Date                  Gallons                                                                                         Y     N   Y     N   Y    N     Y        N   Y   N
                                                                               the date waste was first put into the
                                                                               container?
                                                                               Containment Area
                                                                               Is wastewater stored no longer than
                                                                                                                                   Y     N   Y     N   Y    N     Y        N   Y   N
                    January 2019 perc total =                                  60 days?
                                                                               Is secondary containment around
              Current 12-month running total                                                                                       Y     N   Y     N   Y    N     Y        N   Y   N
                                                                               each machine in good condition?
           (Subtotal + January 2019 total) =
                                                                               Is hazardous waste secondary
                                                                                                                                   Y     N   Y     N   Y    N     Y        N   Y   N
             *Keep receipts in envelope at back of calendar.                   containment in good condition?
                                                                               Are the following items leak-free?
                                                                               Circle method of inspection (S or D) **             S     D   S     D   S    D     S        D   S   D
          Carbon Adsorber/Condenser Monitoring Log                             Hose and pipe connections, fittings,
                                                                                                                                   Y     N   Y     N   Y    N     Y        N   Y   N
                                                                               couplings and valves
                       See “Instructions for Use” page 1                       Door gasket and seal                                Y     N   Y     N   Y    N     Y        N   Y   N
                                                                               Pump                                                Y     N   Y     N   Y    N     Y        N   Y   N
                          During drying                                        Solvent tank and containers                         Y     N   Y     N   Y    N     Y        N   Y   N
                             phase                                   Is temp
                                            Is pressure    Outlet              Water separator                                     Y     N   Y     N   Y    N     Y        N   Y   N
              Perc                                                     less
                                               within       temp
            concen-       High-      Low-                            than or   Muck cooker                                         Y     N   Y     N   Y    N     Y        N   Y   N
   Date                                      manufac-      during
             tration    pressure   pressure                         equal to
                                               turing        cool              Still                                               Y     N   Y     N   Y    N     Y        N   Y   N
             (ppm)      reading    reading                             45°F
                                              range?       down                Exhaust damper                                      Y     N   Y     N   Y    N     Y        N   Y   N
                         (psi or    (psi or                         (7.2°C)?
                          bar)       bar)                                      Diverter valve                                      Y     N   Y     N   Y    N     Y        N   Y   N
    1/2                                       Y     N               Y     N    Filter gasket and seal                              Y     N   Y     N   Y    N     Y        N   Y   N
                                                                               Cartridge filter housing                            Y     N   Y     N   Y    N     Y        N   Y   N
    1/9                                       Y     N               Y     N
                                                                               ** S = sight, smell or feel           ** D = detector (required at least once each month)
    1/16                                      Y     N               Y     N
                                                                                                    Week     1   Inspected   by   _______________________________________
    1/23                                      Y     N               Y     N
                                                                                                    Week     2   Inspected   by   _______________________________________
    1/30                                      Y     N               Y     N                         Week     3   Inspected   by   _______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).                       Week     4   Inspected   by   _______________________________________
                                                                                                    Week     5   Inspected   by   _______________________________________
TIP OF THE MONTH!
Transfer information from last year’s calendar to this year’s calendar on page 3.
Look in the machine’s maintenance manual and record the manufacturer’s spec-
ified range for pressure. Record here _______________________. The information
                                                                                                  January 2019
will be needed to determine whether you are in compliance each month.

     SUNDAY             MONDAY                   TUESDAY          WEDNESDAY                 THURSDAY        FRIDAY       SATURDAY
                                            1                     2                     3              4             5
                                                                                                       
                                                                  Weekly inspection    

                                                                  Carbon adsorber/
                                                 New Year’s Day   condenser log    

6                  7                        8                     9                     10             11            12

                   Update running total                         Weekly inspection 
                   (see page 3)
                                                                  Carbon adsorber/
                                                                  condenser log    

13                14                        15                    16                    17             18            19

                                                                  Weekly inspection 
                                                                  Carbon adsorber/
                                                                  condenser log    

20                 21                       22                    23                    24             25            26

                                                                  Weekly inspection 
                                                                  Carbon adsorber/
                   Martin Luther King Jr.                         condenser log    
                         Day (US)

27                 28                       29                    30                    31
                                                                  Weekly inspection 
                                                                  Carbon adsorber/
                                                                  condenser log    
                                                                  
                                                                  Registration due
                                                                       to KDHE

Go to www.kdheks.gov/dryclean
and register your business!                              Kansas Small Business Environmental Assistance Program
                                                                                                   1-800-578-8898
                                                                                                 www.sbeap.org
February 2019                                                                                                   Perchloroethylene cleaners

              Perc Purchase Running Total                                                                          Weekly Inspection
                             12-month total                                   Date                                                  2/6       2/13        2/20           2/27
              from last month (Jan. 2019) =                                   Time
                   Subtract perc purchased                                    Hazardous Waste
                          February 2018 =
                                 (see pg 3)                                   Are containers in good condition?                Y          N   Y   N      Y     N         Y   N
                                                                              Are waste containers made of
                                      Subtotal =                                                                               Y          N   Y   N      Y     N         Y   N
                                                                              appropriate material?
              This month’s perc purchases*                                    Are containers tightly closed?                   Y          N   Y   N      Y     N         Y   N
                                                                              Are individual containers clearly
           Date                   Gallons                                     labeled as “Hazardous Waste” with
                                                                                                                               Y          N   Y   N      Y     N         Y   N
                                                                              the date waste was first put into the
                                                                              container?
                                                                              Containment Area
                  February 2019 perc total =                                  Is wastewater stored no longer than
                                                                                                                               Y          N   Y   N      Y     N         Y   N
                                                                              60 days?
             Current 12-month running total
         (Subtotal + February 2019 total) =                                   Is secondary containment around
                                                                                                                               Y          N   Y   N      Y     N         Y   N
                                                                              each machine in good condition?
              *Keep receipts in envelope at back of calendar.                 Is hazardous waste secondary
                                                                                                                               Y          N   Y   N      Y     N         Y   N
                                                                              containment in good condition?
                                                                              Are the following items leak-free?
        Carbon Adsorber/Condenser Monitoring Log                              Circle method of inspection (S or D) **          S          D   S   D      S     D         S   D
                                                                              Hose and pipe connections, fittings,
                                                                                                                               Y          N   Y   N      Y     N         Y   N
                                                                              couplings and valves
                      See “Instructions for Use” page 1
                                                                              Door gasket and seal                             Y          N   Y   N      Y     N         Y   N
                         During drying                                        Pump                                             Y          N   Y   N      Y     N         Y   N
                            phase                                   Is temp   Solvent tank and containers                      Y          N   Y   N      Y     N         Y   N
                                           Is pressure    Outlet
             Perc                                                     less
                                              within       temp               Water separator                                  Y          N   Y   N      Y     N         Y   N
           concen-       High-     Low -                            than or
 Date                                       manufac-      during
            tration    pressure   pressure                         equal to   Muck cooker                                      Y          N   Y   N      Y     N         Y   N
                                              turing        cool
            (ppm)      reading    reading                             45°F    Still                                            Y          N   Y   N      Y     N         Y   N
                                             range?       down
                        (psi or    (psi or                         (7.2°C)?
                         bar)       bar)                                      Exhaust damper                                   Y          N   Y   N      Y     N         Y   N
                                                                              Diverter valve                                   Y          N   Y   N      Y     N         Y   N
  2/6                                        Y     N               Y     N    Filter gasket and seal                           Y          N   Y   N      Y     N         Y   N
 2/13                                        Y     N               Y     N    Cartridge filter housing                         Y          N   Y   N      Y     N         Y   N
 2/20                                        Y     N               Y     N    ** S = sight, smell or feel          ** D = detector (required at least once each month)
 2/27                                        Y     N               Y     N
                                                                                                        Week   1   Inspected   by   _______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).                           Week   2   Inspected   by   _______________________________________
                                                                                                        Week   3   Inspected   by   _______________________________________
                                                                                                        Week   4   Inspected   by   _______________________________________
TIP OF THE MONTH!
An envelope attached to the end of the calendar is handy for keeping receipts of
solvent purchases and repair costs.
                                                                                              February 2019

     SUNDAY            MONDAY                 TUESDAY      WEDNESDAY                THURSDAY                   FRIDAY       SATURDAY
                                                                                                          1             2

                                                          

                                                                                                                             Groundhog Day

3                 4                      5                6                     7                         8             9

                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    

10                11                     12               13                    14                        15            16

                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log           St. Valentine’s Day

17                18                     19               20                    21                        22            23

                                                          Weekly inspection 
                                                          Carbon adsorber/
                       Presidents’ Day                    condenser log    

24                25                     26               27                    28

                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    
                                                          

                                                  Kansas Small Business Environmental Assistance Program
                                                                                            1-800-578-8898
                                                                                          www.sbeap.org
March 2019                                                                                                           Perchloroethylene cleaners
                                                                                                                  Weekly Inspection
              Perc Purchase Running Total                                        Date                                                3/6   3/13       3/20        3/27
                            12-month total                                       Time
             from last month (Feb. 2019) =                                       Hazardous Waste
                  Subtract perc purchased                                        Are containers in good condition?               Y     N   Y   N     Y     N     Y        N
                             March 2018 =                                        Are waste containers made of
                                (see pg 3)                                                                                       Y     N   Y   N     Y     N     Y        N
                                                                                 appropriate material?
                                   Subtotal =                                    Are containers tightly closed?                  Y     N   Y   N     Y     N     Y        N
                                                                                 Are individual containers clearly
             This month’s perc purchases*                                        labeled as “Hazardous Waste” and
                                                                                                                                 Y     N   Y   N     Y     N     Y        N
                                                                                 with date waste was first put into the
           Date               Gallons
                                                                                 container?
                                                                                 Containment Area
                                                                                 Is wastewater stored no longer than
                                                                                                                                 Y     N   Y   N     Y     N     Y        N
                                                                                 60 days?
                  March 2019 perc total =
                                                                                 Is secondary containment around
                                                                                                                                 Y     N   Y   N     Y     N     Y        N
            Current 12-month running total                                       each machine in good condition?
          (subtotal + March 2019 total) =                                        Is hazardous waste secondary
                                                                                                                                 Y     N   Y   N     Y     N     Y        N
                                                                                 containment in good condition?
           *Keep receipts in envelope at back of calendar.
                                                                                 Are the following items leak-free?
                                                                                 Circle method of inspection (S or D) **         S     D   S   D     S     D     S        D
         Carbon Adsorber/Condenser Monitoring Log                                Hose and pipe connections, fittings,
                                                                                                                                 Y     N   Y   N     Y     N     Y        N
                                                                                 couplings and valves
                                                                                 Door gasket and seal                            Y     N   Y   N     Y     N     Y        N
                      See “Instructions for Use” page 1
                                                                                 Pump                                            Y     N   Y   N     Y     N     Y        N
                         During drying                                           Solvent tank and containers                     Y     N   Y   N     Y     N     Y        N
                            phase                                      Is temp
             Perc
                                           Is pressure       Outlet
                                                                         less
                                                                                 Water separator                                 Y     N   Y   N     Y     N     Y        N
                                              within          temp               Muck cooker                                     Y     N   Y   N     Y     N     Y        N
           concen-       High-      Low-                               than or
  Date                                      manufac-         during
            tration    pressure   pressure    turing           cool
                                                                      equal to   Still                                           Y     N   Y   N     Y     N     Y        N
            (ppm)      reading    reading                                45°F    Exhaust damper                                  Y     N   Y   N     Y     N     Y        N
                                             range?          down
                        (psi or    (psi or                            (7.2°C)?
                         bar)       bar)                                         Diverter valve                                  Y     N   Y   N     Y     N     Y        N
                                                                                 Filter gasket and seal                          Y     N   Y   N     Y     N     Y        N
   3/6                                       Y     N                  Y     N
                                                                                 Cartridge filter housing                        Y     N   Y   N     Y     N     Y        N
  3/13                                       Y     N                  Y     N
                                                                                 ** S = sight, smell or feel        ** D = detector (required at least once each month)
  3/20                                       Y     N                  Y     N
  3/27                                       Y     N                  Y     N                    Week   1   Inspected   by   _______________________________________
                                                                                                 Week   2   Inspected   by   _______________________________________
                                                                                                 Week   3   Inspected   by   _______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).                    Week   4   Inspected   by   _______________________________________
TIP OF THE MONTH!
The Kansas Dry-Cleaner Manual has environmental regulatory information presented in        March 2019
an easy-to-read format. Call 800-578-8898 if you need a new copy. Find it on the web at
http://sbeap.org/files/sbeap/publications/DryCleanerManual.pdf

     SUNDAY                  MONDAY        TUESDAY         WEDNESDAY                THURSDAY        FRIDAY       SATURDAY
                                                                                               1             2

                                                          

3                       4             5                   6                     7              8             9
                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    

10                      11            12                  13                    14             15            16
                                                          Weekly inspection 
                                                          Carbon adsorber/
Daylight Saving Time                                      condenser log    
      begins

17                      18            19                  20                    21             22            23
                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    
    St. Patrick’s Day                                          Spring begins

24                      25            26                  27                    28             29            30
                                                          Weekly inspection 
                                                          Carbon adsorber/
                   31                                     condenser log    
                                                          

                                                 Kansas Small Business Environmental Assistance Program
                                                                                           1-800-578-8898
                                                                                         www.sbeap.org
April 2019                                                                                                         Perchloroethylene cleaners

                                                                                                                    Weekly Inspection
              Perc Purchase Running Total                                           Date                                                4/3   4/10       4/17        4/24
                            12-month total                                          Time
           from last month (March 2019) =
                                                                                    Hazardous Waste
                  Subtract perc purchased
                                                                                    Are containers in good condition?               Y     N   Y   N     Y     N     Y     N
                              April 2018 =
                                (see pg 3)                                          Are waste containers made of
                                                                                                                                    Y     N   Y   N     Y     N     Y     N
                                                                                    appropriate material?
                                  Subtotal =                                        Are containers tightly closed?                  Y     N   Y   N     Y     N     Y     N
             This month’s perc purchases*                                           Are individual containers clearly
                                                                                    labeled as “Hazardous Waste” and the
           Date               Gallons                                                                                               Y     N   Y   N     Y     N     Y     N
                                                                                    date waste was first put into the
                                                                                    container?
                                                                                    Containment Area
                                                                                    Is wastewater stored no longer than
                                                                                                                                    Y     N   Y   N     Y     N     Y     N
                    April 2019 perc total =                                         60 days?

            Current 12-month running total                                          Is secondary containment around
                                                                                                                                    Y     N   Y   N     Y     N     Y     N
            (Subtotal + April 2019 total) =                                         each machine in good condition?
                                                                                    Is hazardous waste secondary
                                                                                                                                    Y     N   Y   N     Y     N     Y     N
             *Keep receipts in envelope at back of calendar.                        containment in good condition?
                                                                                    Are the following items leak-free?
                                                                                    Circle method of inspection (S or D) **         S     D   S   D     S     D     S     D
          Carbon Adsorber/Condenser Monitoring Log                                  Hose and pipe connections, fittings,
                                                                                                                                    Y     N   Y   N     Y     N     Y     N
                                                                                    couplings and valves
                       See “Instructions for Use” page 1
                                                                                    Door gasket and seal                            Y     N   Y   N     Y     N     Y     N
                          During drying                                             Pump                                            Y     N   Y   N     Y     N     Y     N
                             phase                                        Is temp
                                                               Outlet               Solvent tank and containers                     Y     N   Y   N     Y     N     Y     N
              Perc                           Is pressure                less than
                                                                temp
   Date
            concen-      High-     Low -     within man-
                                                               during
                                                                         or equal   Water separator                                 Y     N   Y   N     Y     N     Y     N
             tration   pressure   pressure    ufacturing                      to    Muck cooker                                     Y     N   Y   N     Y     N     Y     N
                       reading    reading                        cool
             (ppm)                             range?                       45°F
                        (psi or    (psi or                     down
                                                                         (7.2°C)?   Still                                           Y     N   Y   N     Y     N     Y     N
                         bar)       bar)                                            Exhaust damper                                  Y     N   Y   N     Y     N     Y     N
   4/3                                         Y     N                  Y     N     Diverter valve                                  Y     N   Y   N     Y     N     Y     N
                                                                                    Filter gasket and seal                          Y     N   Y   N     Y     N     Y     N
   4/10                                        Y     N                  Y     N
                                                                                    Cartridge filter housing                        Y     N   Y   N     Y     N     Y     N
   4/17                                        Y     N                  Y     N
                                                                                     ** S = sight, smell or feel         ** D = detector (required at least once each month)
   4/24                                        Y     N                  Y     N
                                                                                                      Week   1   Inspected   by   _______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).
                                                                                                      Week   2   Inspected   by   _______________________________________
                                                                                                      Week   3   Inspected   by   _______________________________________
                                                                                                      Week   4   Inspected   by   _______________________________________
TIP OF THE MONTH!
No matter how little hazardous waste is generated, it cannot go to the landfill or                April 2019
down the drain. Toxic liquids can enter the ground water if leaked from sewer-
drain joints or landfill liners.

     SUNDAY            MONDAY               TUESDAY          WEDNESDAY                 THURSDAY        FRIDAY            SATURDAY
                  1                    2                    3                      4              5                  6
                                       
                                                            Weekly inspection 

                                                            Carbon adsorber/
                                                             condenser log    

7                 8                    9                    10                     11             12                 13
                                                             Weekly inspection 
                                                             Carbon adsorber/
                                                             condenser log    

14                15                   16                   17                     18             19                 20
                                                             Weekly inspection 
                                                             Carbon adsorber/
                                                             condenser log    
                         Tax day                                                                       Good Friday

21                22                   23                   24                     25             26                 27

                                                             Weekly inspection 
                                                             Carbon adsorber/
                                                             condenser log    
      Easter            Earth Day

28                29                   30
                                                             

                                                   Kansas Small Business Environmental Assistance Program
                                                                                             1-800-578-8898
                                                                                           www.sbeap.org
May 2019                                                                                                          Perchloroethylene cleaners
                                                                                                                      Weekly Inspection
                                                                               Date                                                5/1     5/8      5/15         5/22     5/29
             Perc Purchase Running Total                                       Time
                          12-month total                                       Hazardous Waste
           from last month (April 2019) =
                                                                               Are containers in good condition?              Y      N   Y    N    Y     N      Y     N   Y   N
                Subtract perc purchased
                                                                               Are waste containers made of
                             May 2018 =                                                                                       Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               appropriate material?
                              (see pg 3)
                                                                               Are containers tightly closed?                 Y      N   Y    N    Y     N      Y     N   Y   N
                                  Subtotal =
                                                                               Are individual containers clearly
           This month’s perc purchases*                                        labeled as “Hazardous Waste” and the
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               date waste was first put into the
         Date                  Gallons                                         container?
                                                                               Containment Area
                                                                               Is wastewater stored no longer than
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               60 days?
                    May 2019 perc total =                                      Is secondary containment around
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               each machine in good condition?
          Current 12-month running total
          (Subtotal + May 2019 total) =                                        Is hazardous waste secondary
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               containment in good condition?
           *Keep receipts in envelope at back of calendar.                     Are the following items leak-free?
                                                                               Circle method of inspection (S or D) **        S      D   S    D    S     D      S     D   S   D
                                                                               Hose and pipe connections, fittings,
      Carbon Adsorber/Condenser Monitoring Log                                 couplings and valves
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                   See “Instructions for Use” page 1                           Door gasket and seal                           Y      N   Y    N    Y     N      Y     N   Y   N
                      During drying
                                                                               Pump                                           Y      N   Y    N    Y     N      Y     N   Y   N
                         phase                                   Is temp       Solvent tank and containers                    Y      N   Y    N    Y     N      Y     N   Y   N
                                        Is pressure    Outlet
          Perc                                                     less        Water separator                                Y      N   Y    N    Y     N      Y     N   Y   N
                                           within       temp
        concen-       High-      Low-                            than or
Date
         tration    pressure   pressure
                                         manufac-      during
                                                                equal to
                                                                               Muck cooker                                    Y      N   Y    N    Y     N      Y     N   Y   N
                    reading    reading     turing        cool                  Still                                          Y      N   Y    N    Y     N      Y     N   Y   N
         (ppm)                                                     45°F
                     (psi or    (psi or   range?       down
                                                                (7.2°C)?       Exhaust damper                                 Y      N   Y    N    Y     N      Y     N   Y   N
                      bar)       bar)
                                                                               Diverter valve                                 Y      N   Y    N    Y     N      Y     N   Y   N
5/1                                       Y    N                Y     N        Filter gasket and seal                         Y      N   Y    N    Y     N      Y     N   Y   N
5/8                                       Y    N                Y     N        Cartridge filter housing                       Y      N   Y    N    Y     N      Y     N   Y   N
5/15                                      Y    N                Y     N
                                                                               ** S = sight, smell or feel          ** D = detector (required at least once each month)
5/22                                      Y    N                Y     N
5/29                                      Y    N                Y     N    If “N” is an-               Week   1   Inspected   by   _______________________________________
                                                                                                       Week   2   Inspected   by   _______________________________________
                                                                                                       Week   3   Inspected   by   _______________________________________
                                                                                                       Week   4   Inspected   by   _______________________________________
                                                                                                       Week   5   Inspected   by   _______________________________________
TIP OF THE MONTH!
A dike or other secondary containment structure around waste storage areas and dry-cleaning          May 2019
machines will help protect water quality should a leak or spill occur. The envelope at the end of
the calendar contains an Emergency Response page. Fill in the information and post where em-
ployees or customers can see whom to call in case of a spill.

     SUNDAY              MONDAY                TUESDAY           WEDNESDAY                THURSDAY        FRIDAY       SATURDAY
                                                                1                     2              3             4

                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    

5                   6                     7                     8                     9              10            11
                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    

12                  13                    14                    15                    16             17            18
                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    
     Mother’s Day                                                                                                      Armed Forces Day

19                  20                    21                    22                    23             24            25
                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    

26                  27                    28                    29                    30             31

                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    
                         Memorial Day

                                                      Kansas Small Business Environmental Assistance Program
                                                                                                1-800-578-8898
                                                                                              www.sbeap.org
June 2019                                                                                                      Perchloroethylene cleaners
                                                                                                                Weekly Inspection
            Perc Purchase Running Total                                          Date                                            6/5       6/12       6/19        6/26
                           12-month total                                        Time
            from last month (May 2019) =                                         Hazardous Waste
                 Subtract perc purchased                                         Are containers in good condition?              Y    N    Y    N     Y     N     Y     N
                             June 2018 =                                         Are waste containers made of
                                                                                                                                Y    N    Y    N     Y     N     Y     N
                               (see pg 3)                                        appropriate material?
                                 Subtotal =                                      Are containers tightly closed?                 Y    N    Y    N     Y     N     Y     N
                                                                                 Are individual containers clearly
           This month’s perc purchases*                                          labeled as “Hazardous Waste” and
                                                                                                                                Y    N    Y    N     Y     N     Y     N
                                                                                 the date waste was first put into the
         Date                Gallons                                             container?
                                                                                 Containment Area
                                                                                 Is wastewater stored no longer than
                                                                                                                                Y    N    Y    N     Y     N     Y     N
                                                                                 60 days?
                   June 2019 perc total =                                        Is secondary containment around
                                                                                                                                Y    N    Y    N     Y     N     Y     N
                                                                                 each machine in good condition?
           Current 12-month running total
           (Subtotal + June 2019 total) =                                        Is hazardous waste secondary
                                                                                                                                Y    N    Y    N     Y     N     Y     N
                                                                                 containment in good condition?
                                                                                 Are the following items leak-free?
           *Keep receipts in envelope at back of calendar.
                                                                                 Circle method of inspection (S or D)
                                                                                                                                S    D    S    D     S     D     S     D
                                                                                 **
         Carbon Adsorber/Condenser Monitoring Log                                Hose and pipe connections, fittings,
                                                                                                                                Y    N    Y    N     Y     N     Y     N
                      See “Instructions for Use” page 1
                                                                                 couplings and valves
                                                                                 Door gasket and seal                           Y    N    Y    N     Y     N     Y     N
                         During drying                                           Pump                                           Y    N    Y    N     Y     N     Y     N
                            phase                                      Is temp
                                          Is pressure        Outlet              Solvent tank and containers                    Y    N    Y    N     Y     N     Y     N
             Perc                                                        less
                                             within           temp
 Date
           concen-      High-     Low -    manufac-          during
                                                                       than or   Water separator                                Y    N    Y    N     Y     N     Y     N
            tration   pressure   pressure                             equal to   Muck cooker                                    Y    N    Y    N     Y     N     Y     N
                      reading    reading     turing            cool
            (ppm)                                                        45°F
                       (psi or    (psi or   range?           down                Still                                          Y    N    Y    N     Y     N     Y     N
                                                                      (7.2°C)?
                        bar)       bar)                                          Exhaust damper                                 Y    N    Y    N     Y     N     Y     N
  6/5                                        Y      N                 Y     N    Diverter valve                                 Y    N    Y    N     Y     N     Y     N
                                                                                 Filter gasket and seal                         Y    N    Y    N     Y     N     Y     N
  6/12                                       Y      N                 Y     N
                                                                                 Cartridge filter housing                       Y    N    Y    N     Y     N     Y     N
  6/19                                       Y      N                 Y     N
                                                                                 ** S = sight, smell or feel           ** D = detector (required at least once each month)
  6/26                                       Y      N                 Y     N

                                                                                                Week   1   Inspected   by   ______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).
                                                                                                Week   2   Inspected   by   ______________________________________
                                                                                                Week   3   Inspected   by   ______________________________________
                                                                                                Week   4   Inspected   by   ______________________________________
TIP OF THE MONTH!
You are halfway through the year! Have you been keeping up with inspections?
Solvent leaks or spills will be caught sooner with regular inspections. Use this
                                                                                                June 2019
calendar to record results of inspections.

     SUNDAY               MONDAY           TUESDAY          WEDNESDAY                THURSDAY         FRIDAY             SATURDAY
                                                                                                                     1
                                                          

2                    3                4                    5                     6              7                    8
                                                           Weekly inspection 
                                                           Carbon adsorber/
                                                           condenser log    

9                    10               11                   12                    13             14                   15
                                                           Weekly inspection 
                                                           Carbon adsorber/
                                                           condenser log    

                                                                                                       Flag Day

16                   17               18                   19                    20             21                   22
                                                           Weekly inspection 
                                                           Carbon adsorber/
                                                           condenser log    
     Father’s Day                                                                                    Summer begins

23                   24               25                   26                    27             28                   29

                                                           Weekly inspection 
                                                           Carbon adsorber/
                30                                         condenser log    

                                                 Kansas Small Business Environmental Assistance Program
                                                                                           1-800-578-8898
                                                                                         www.sbeap.org
July 2019                                                                                                         Perchloroethylene cleaners
                                                                                                                      Weekly Inspection
                                                                               Date                                                7/3    7/10      7/17         7/24     7/31
             Perc Purchase Running Total                                       Time
                           12-month total                                      Hazardous Waste
           from last month (June 2019) =
                                                                               Are containers in good condition?              Y      N   Y    N    Y     N      Y     N   Y   N
                 Subtract perc purchased
                                                                               Are waste containers made of
                              July 2018 =                                                                                     Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               appropriate material?
                               (see pg 3)
                                                                               Are containers tightly closed?                 Y      N   Y    N    Y     N      Y     N   Y   N
                                  Subtotal =
                                                                               Are individual containers clearly
           This month’s perc purchases*                                        labeled as “Hazardous Waste” and the
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               date waste was first put into the
         Date                  Gallons                                         container?
                                                                               Containment Area
                                                                               Is wastewater stored no longer than
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               60 days?
                     July 2019 perc total =                                    Is secondary containment around
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               each machine in good condition?
          Current 12-month running total
          (Subtotal + July 2019 total) =                                       Is hazardous waste secondary
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                                                                               containment in good condition?
           *Keep receipts in envelope at back of calendar.                     Are the following items leak-free?
                                                                               Circle method of inspection (S or D) **        S      D   S    D    S     D      S     D   S   D
                                                                               Hose and pipe connections, fittings,
      Carbon Adsorber/Condenser Monitoring Log                                 couplings and valves
                                                                                                                              Y      N   Y    N    Y     N      Y     N   Y   N
                   See “Instructions for Use” page 1                           Door gasket and seal                           Y      N   Y    N    Y     N      Y     N   Y   N
                      During drying
                                                                               Pump                                           Y      N   Y    N    Y     N      Y     N   Y   N
                         phase                                   Is temp       Solvent tank and containers                    Y      N   Y    N    Y     N      Y     N   Y   N
                                        Is pressure    Outlet
          Perc                                                     less        Water separator                                Y      N   Y    N    Y     N      Y     N   Y   N
                                           within       temp
        concen-       High-      Low-                            than or
Date
         tration    pressure   pressure
                                         manufac-      during
                                                                equal to
                                                                               Muck cooker                                    Y      N   Y    N    Y     N      Y     N   Y   N
                    reading    reading     turing        cool                  Still                                          Y      N   Y    N    Y     N      Y     N   Y   N
         (ppm)                                                     45°F
                     (psi or    (psi or   range?       down
                                                                (7.2°C)?       Exhaust damper                                 Y      N   Y    N    Y     N      Y     N   Y   N
                      bar)       bar)
                                                                               Diverter valve                                 Y      N   Y    N    Y     N      Y     N   Y   N
5/1                                       Y    N                Y     N        Filter gasket and seal                         Y      N   Y    N    Y     N      Y     N   Y   N
5/8                                       Y    N                Y     N        Cartridge filter housing                       Y      N   Y    N    Y     N      Y     N   Y   N
5/15                                      Y    N                Y     N
                                                                               ** S = sight, smell or feel          ** D = detector (required at least once each month)
5/22                                      Y    N                Y     N
5/29                                      Y    N                Y     N    If “N” is an-               Week   1   Inspected   by   _______________________________________
                                                                                                       Week   2   Inspected   by   _______________________________________
                                                                                                       Week   3   Inspected   by   _______________________________________
                                                                                                       Week   4   Inspected   by   _______________________________________
                                                                                                       Week   5   Inspected   by   _______________________________________
TIP OF THE MONTH!
Have an emergency plan for dealing with solvent spills? Prevent leaks and spills
from leaving the property by keeping a spill clean-up kit nearby. In the enve-
                                                                                                       July 2019
lope at the back of the calendar is an Emergency Response page. Fill in the in-
formation and post where employees or customers can see whom to call.

     SUNDAY              MONDAY            TUESDAY         WEDNESDAY                THURSDAY                FRIDAY       SATURDAY
                    1                 2                   3                     4                      5             6

                                                          Weekly inspection 

                                                          Carbon adsorber/
                                                          condenser log           Independence Day

7                   8                 9                   10                    11                     12            13
                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    

14                  15                16                  17                    18                     19            20
                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    

21                  22                23                  24                    25                     26            27
                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    

28                  29                30                  31
                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    
     Parents’ Day
                                                          
                                                 Kansas Small Business Environmental Assistance Program
                                                                                           1-800-578-8898
                                                                                         www.sbeap.org
August 2019                                                                                                       Perchloroethylene cleaners

                                                                                                                        Weekly Inspection
              Perc Purchase Running Total                                           Date                                                     8/7   8/14       8/21       8/28
                            12-month total                                          Time
              from last month (July 2019) =                                         Hazardous Waste
                  Subtract perc purchased                                           Are containers in good condition?                    Y     N   Y   N     Y     N     Y      N
                            August 2018 =                                           Are waste containers made of
                                 (see pg 3)                                                                                              Y     N   Y   N     Y     N     Y      N
                                                                                    appropriate material?
                                      Subtotal =                                    Are containers tightly closed?                       Y     N   Y   N     Y     N     Y      N
              This month’s perc purchases*                                          Are individual containers clearly labeled
                                                                                    as “Hazardous Waste” and the date                    Y     N   Y   N     Y     N     Y      N
           Date                 Gallons                                             waste was first put into the container?
                                                                                    Containment Area
                                                                                    Is wastewater stored no longer than 60
                                                                                                                                         Y     N   Y   N     Y     N     Y      N
                                                                                    days?
                   August 2019 perc total =
                                                                                    Is secondary containment around each
                                                                                                                                         Y     N   Y   N     Y     N     Y      N
             Current 12-month running total                                         machine in good condition?
           (Subtotal + August 2019 total) =                                         Is hazardous waste secondary
                                                                                                                                         Y     N   Y   N     Y     N     Y      N
                                                                                    containment in good condition?
              *Keep receipts in envelope at back of calendar.                       Are the following items leak-free?
                                                                                    Circle method of inspection (S or D) **              S     D   S   D     S     D     S      D
                                                                                    Hose and pipe connections, fittings,
           Carbon Adsorber/Condenser Monitoring Log                                                                                      Y     N   Y   N     Y     N     Y      N
                                                                                    couplings and valves
                          See “Instructions for Use” page 1                         Door gasket and seal                                 Y     N   Y   N     Y     N     Y      N
                                                                                    Pump                                                 Y     N   Y   N     Y     N     Y      N
                             During drying
                                phase                                     Is temp   Solvent tank and containers                          Y     N   Y   N     Y     N     Y      N
                                               Is pressure      Outlet
                 Perc
                                                  within         temp
                                                                            less    Water separator                                      Y     N   Y   N     Y     N     Y      N
               concen-       High-      Low-                              than or   Muck cooker                                          Y     N   Y   N     Y     N     Y      N
     Date                                       manufac-        during
                tration    pressure   pressure                           equal to
                           reading    reading     turing          cool              Still                                                Y     N   Y   N     Y     N     Y      N
                (ppm)                                                       45°F
                            (psi or    (psi or   range?         down
                                                                         (7.2°C)?   Exhaust damper                                       Y     N   Y   N     Y     N     Y      N
                             bar)       bar)
                                                                                    Diverter valve                                       Y     N   Y   N     Y     N     Y      N
     8/7                                           Y   N                 Y     N    Filter gasket and seal                               Y     N   Y   N     Y     N     Y      N
     8/14                                          Y   N                 Y     N    Cartridge filter housing                             Y     N   Y   N     Y     N     Y      N
     8/21                                          Y   N                 Y     N    ** S = sight, smell or feel           ** D = detector (required at least once each month)
     8/28                                          Y   N                 Y     N
                                                                                                         Week     1   Inspected   by   _______________________________________
                                                                                                         Week     2   Inspected   by   _______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).                            Week     3   Inspected   by   _______________________________________
                                                                                                         Week     4   Inspected   by   _______________________________________
TIP OF THE MONTH!
Label hazardous waste containers with “Hazardous Waste” and mark labels with
the accumulation start date (the date you first put waste into the container).
                                                                                         August 2019

     SUNDAY           MONDAY              TUESDAY         WEDNESDAY                THURSDAY        FRIDAY       SATURDAY
                                                                               1              2             3

                                                         

4                5                   6                   7                     8              9             10
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    

11               12                  13                  14                    15             16            17
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    

18               19                  20                  21                    22             23            24
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    

25               26                  27                  28                    29             30            31
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    

                                                Kansas Small Business Environmental Assistance Program
                                                                                          1-800-578-8898
                                                                                        www.sbeap.org
September 2019                                                                                                       Perchloroethylene cleaners

                                                                                                                      Weekly Inspection
                Perc Purchase Running Total
                                                                                   Date                                                 9/4     9/11      9/18       9/25
                              12-month total
               from last month (Aug. 2019) =                                       Time
                                                                                   Hazardous Waste
                    Subtract perc purchased
                          September 2018 =                                         Are containers in good condition?                   Y   N    Y   N     Y    N     Y    N
                                  (see pg 3)                                       Are waste containers made of
                                                                                                                                       Y   N    Y   N     Y    N     Y    N
                                                                                   appropriate material?
                                       Subtotal =
                                                                                   Are containers tightly closed?                      Y   N    Y   N     Y    N     Y    N
               This month’s perc purchases*                                        Are individual containers clearly
                                                                                   labeled as “Hazardous Waste” and the
            Date                    Gallons                                                                                            Y   N    Y   N     Y    N     Y    N
                                                                                   date waste was first put into the
                                                                                   container?
                                                                                   Containment Area
                                                                                   Is wastewater stored no longer than
                                                                                                                                       Y   N    Y   N     Y    N     Y    N
               September 2019 perc total =                                         60 days?
                                                                                   Is secondary containment around
            Current 12-month running total                                                                                             Y   N    Y   N     Y    N     Y    N
                                                                                   each machine in good condition?
      (Subtotal + September 2019 total) =
                                                                                   Is hazardous waste secondary
                                                                                                                                       Y   N    Y   N     Y    N     Y    N
                                                                                   containment in good condition?
             *Keep receipts in envelope at back of calendar.
                                                                                   Are the following items leak-free?
                                                                                   Circle method of inspection (S or D) **             S   D    S   D     S    D     S    D
                                                                                   Hose and pipe connections, fittings,
           Carbon Adsorber/Condenser Monitoring Log                                couplings and valves
                                                                                                                                       Y   N    Y   N     Y    N     Y    N
                        See “Instructions for Use” page 1                          Door gasket and seal                                Y   N    Y   N     Y    N     Y    N
                                                                                   Pump                                                Y   N    Y   N     Y    N     Y    N
                           During drying
                              phase           Is pressure      Outlet
                                                                         Is temp   Solvent tank and containers                         Y   N    Y   N     Y    N     Y    N
               Perc                                                        less    Water separator                                     Y   N    Y   N     Y    N     Y    N
                                                 within         temp
             concen-       High-      Low -                              than or
    Date
              tration    pressure    pressure
                                               manufac-        during
                                                                        equal to   Muck cooker                                         Y   N    Y   N     Y    N     Y    N
                         reading     reading     turing          cool              Still                                               Y   N    Y   N     Y    N     Y    N
              (ppm)                                                        45°F
                          (psi or     (psi or   range?         down
                                                                        (7.2°C)?   Exhaust damper                                      Y   N    Y   N     Y    N     Y    N
                           bar)        bar)
                                                                                   Diverter valve                                      Y   N    Y   N     Y    N     Y    N
     9/4                                        Y     N                 Y     N    Filter gasket and seal                              Y   N    Y   N     Y    N     Y    N
    9/11                                        Y     N                 Y     N    Cartridge filter housing                            Y   N    Y   N     Y    N     Y    N
    9/18                                        Y     N                 Y     N
                                                                                   ** S = sight, smell or feel           ** D = detector (required at least once each month)
    9/25                                        Y     N                 Y     N

If “N” is answered above, fill out corrective action form (back of calendar).                           Week     1   Inspected   by   _______________________________________
                                                                                                        Week     2   Inspected   by   _______________________________________
                                                                                                        Week     3   Inspected   by   _______________________________________
                                                                                                        Week     4   Inspected   by   _______________________________________
TIP OF THE MONTH!
Floor drains are not allowed in secondary containment structures. This require-       September 2019
ment will help protect ground water quality.

     SUNDAY              MONDAY               TUESDAY      WEDNESDAY                 THURSDAY        FRIDAY       SATURDAY
1                   2                    3                4                      5              6             7
                                                          Weekly inspection 
                                                          Carbon adsorber/
                           Labor Day                      condenser log    

8                   9                    10               11                     12             13            14
                                                          Weekly inspection 
                                                          Carbon adsorber/
Grandparents’ Day                                         condenser log    

15                  16                   17               18                    19             20            21
                                                          Weekly inspection 
                                                          Carbon adsorber/
                                                          condenser log    
                                                          
22                  23                   24               25                     26             27            28

                                                          Weekly inspection 
                                                          Carbon adsorber/
                         Autumn begins                    condenser log    
                                                          
29                  30                                    

                                                  Kansas Small Business Environmental Assistance Program
                                                                                            1-800-578-8898
                                                                                          www.sbeap.org
October 2019                                                                                                           Perchloroethylene cleaners

                Perc Purchase Running Total                                                                              Weekly Inspection
                              12-month total                                    Date                                               10/2       10/9     10/16      10/23       10/30
              from last month (Sept. 2019) =                                    Time
                    Subtract perc purchased                                     Hazardous Waste
                             October 2018 =                                     Are containers in good condition?                  Y     N   Y    N    Y    N     Y     N     Y   N
                                  (see pg 3)                                    Are waste containers made of
                                                                                                                                   Y     N   Y    N    Y    N     Y     N     Y   N
                                      Subtotal =                                appropriate material?
                                                                                Are containers tightly closed?                     Y     N   Y    N    Y    N     Y     N     Y   N
               This month’s perc purchases*                                     Are individual containers clearly
            Date                   Gallons                                      labeled as “Hazardous Waste” and the
                                                                                                                                   Y     N   Y    N    Y    N     Y     N     Y   N
                                                                                date waste was first put into the
                                                                                container?
                                                                                Containment Area
                                                                                Is wastewater stored no longer than
                   October 2019 perc total =                                                                                       Y     N   Y    N    Y    N     Y     N     Y   N
                                                                                60 days?
              Current 12-month running total                                    Is secondary containment around
                                                                                                                                   Y     N   Y    N    Y    N     Y     N     Y   N
           (Subtotal + October 2019 total) =                                    each machine in good condition?
                                                                                Is hazardous waste secondary
                                                                                                                                   Y     N   Y    N    Y    N     Y     N     Y   N
                                                                                containment in good condition?
              *Keep receipts in envelope at back of calendar.
                                                                                Are the following items leak-free?
                                                                                Circle method of inspection (S or D) **            S     D   S    D    S    D     S     D     S   D
          Carbon Adsorber/Condenser Monitoring Log                              Hose and pipe connections, fittings,
                                                                                                                                   Y     N   Y    N    Y    N     Y     N     Y   N
                                                                                couplings and valves
                       See “Instructions for Use” page 1                        Door gasket and seal                               Y     N   Y    N    Y    N     Y     N     Y   N
                          During drying                                         Pump                                               Y     N   Y    N    Y    N     Y     N     Y   N
                             phase                                    Is temp   Solvent tank and containers                        Y     N   Y    N    Y    N     Y     N     Y   N
                                            Is pressure     Outlet
              Perc                                                      less
                                               within        temp               Water separator                                    Y     N   Y    N    Y    N     Y     N     Y   N
            concen-       High-     Low -                             than or
   Date                                      manufac-       during              Muck cooker                                        Y     N   Y    N    Y    N     Y     N     Y   N
             tration    pressure   pressure                          equal to
                        reading    reading     turing         cool
             (ppm)                                                      45°F    Still                                              Y     N   Y    N    Y    N     Y     N     Y   N
                         (psi or    (psi or   range?        down
                                                                     (7.2°C)?
                          bar)       bar)                                       Exhaust damper                                     Y     N   Y    N    Y    N     Y     N     Y   N
                                                                                Diverter valve                                     Y     N   Y    N    Y    N     Y     N     Y   N
   10/2                                        Y     N               Y     N
                                                                                Filter gasket and seal                             Y     N   Y    N    Y    N     Y     N     Y   N
   10/9                                        Y     N               Y     N    Cartridge filter housing                           Y     N   Y    N    Y    N     Y     N     Y   N
  10/16                                        Y     N               Y     N
                                                                                     ** S = sight, smell or feel            ** D = detector (required at least once each month)
  10/23                                        Y     N               Y     N
                                                                                                          Week     1   Inspected   by   _______________________________________
  10/30                                        Y     N               Y     N                              Week     2   Inspected   by   _______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).                             Week     3   Inspected   by   _______________________________________
                                                                                                          Week     4   Inspected   by   _______________________________________
                                                                                                          Week     5   Inspected   by   _______________________________________
TIP OF THE MONTH!
For a facility closing or not operating for 45 continuous days, remove dry-                    October 2019
cleaning solvents and wastes. Notify KDHE. For more details, see pages 7 and 26
of the Kansas Dry-Cleaner Manual.

     SUNDAY           MONDAY              TUESDAY         WEDNESDAY                    THURSDAY           FRIDAY       SATURDAY
                                     1                   2                         3                 4             5
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    

6                7                   8                   9                         10                11            12
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    

13               14                  15                  16                        17                18            19
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    
                      Columbus Day                           National Boss’s Day

20               21                  22                  23                        24                25            26
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    

27               28                  29                  30                        31
                                                         Weekly inspection 
                                                         Carbon adsorber/
                                                         condenser log    
                                                                                        Halloween
                                                                      

                                                Kansas Small Business Environmental Assistance Program
                                                                                          1-800-578-8898
                                                                                        www.sbeap.org
November 2019                                                                                            Perchloroethylene cleaners

                                                                                                             Weekly Inspection
            Perc Purchase Running Total                                      Date                                             11/6      11/13       11/20      11/27
                           12-month total                                    Time
            from last month (Oct. 2019) =                                    Hazardous Waste
                 Subtract perc purchased                                     Are containers in good condition?               Y     N     Y    N     Y    N     Y     N
                       November 2018 =                                       Are waste containers made of
                                                                                                                             Y     N     Y    N     Y    N     Y     N
                               (see pg 3)                                    appropriate material?
                                    Subtotal =                               Are containers tightly closed?                  Y     N     Y    N     Y    N     Y     N
                                                                             Are individual containers clearly
           This month’s perc purchases*                                      labeled as “Hazardous Waste” and the
                                                                                                                             Y     N     Y    N     Y    N     Y     N
                                                                             date waste was first put into the
         Date                    Gallons                                     container?
                                                                             Containment Area
                                                                             Is wastewater stored no longer than
                                                                                                                             Y     N     Y    N     Y    N     Y     N
                                                                             60 days?
            November 2019 perc total =                                       Is secondary containment around
                                                                                                                             Y     N     Y    N     Y    N     Y     N
                                                                             each machine in good condition?
         Current 12-month running total
   (Subtotal + November 2019 total) =                                        Is hazardous waste secondary
                                                                                                                             Y     N     Y    N     Y    N     Y     N
                                                                             containment in good condition?
          *Keep receipts in envelope at back of calendar.                    Are the following items leak-free?
                                                                             Circle method of inspection (S or D) **         S     D     S    D     S    D     S     D
                                                                             Hose and pipe connections, fittings,
     Carbon Adsorber/Condenser Monitoring Log                                                                                Y     N     Y    N     Y    N     Y     N
                                                                             couplings and valves
                     See “Instructions for Use” page 1                       Door gasket and seal                            Y     N     Y    N     Y    N     Y     N
                                                                             Pump                                            Y     N     Y    N     Y    N     Y     N
                        During drying
                           phase                                   Is temp   Solvent tank and containers                     Y     N     Y    N     Y    N     Y     N
                                            Is pres-     Outlet
            Perc                                                     less    Water separator                                 Y     N     Y    N     Y    N     Y     N
                                           sure within    temp
          concen-       High-       Low-                           than or   Muck cooker                                     Y     N     Y    N     Y    N     Y     N
 Date                                       manufac-     during
           tration    pressure    pressure                        equal to
                      reading     reading     turing       cool              Still                                           Y     N     Y    N     Y    N     Y     N
           (ppm)                                                     45°F
                       (psi or     (psi or   range?      down
                                                                  (7.2°C)?   Exhaust damper                                  Y     N     Y    N     Y    N     Y     N
                        bar)        bar)
                                                                             Diverter valve                                  Y     N     Y    N     Y    N     Y     N
 11/6                                        Y    N               Y     N    Filter gasket and seal                          Y     N     Y    N     Y    N     Y     N
 11/13                                       Y    N               Y     N    Cartridge filter housing                        Y     N     Y    N     Y    N     Y     N
 11/20                                       Y    N               Y     N    ** S = sight, smell or feel           ** D = detector (required at least once each month)
 11/27                                       Y    N               Y     N                   Week   1   Inspected   by   _______________________________________
                                                                                            Week   2   Inspected   by   _______________________________________
If “N” is answered above, fill out corrective action form (back of calendar).
                                                                                            Week   3   Inspected   by   _______________________________________
                                                                                            Week   4   Inspected   by   _______________________________________
TIP OF THE MONTH!
Do not discharge any dry-cleaning solvents or other waste into sanitary sewers,
storm sewers, septic tanks, underground storage tanks, water bodies or soil!
                                                                                             November 2019

     SUNDAY                 MONDAY               TUESDAY         WEDNESDAY                THURSDAY             FRIDAY       SATURDAY
                                                                                                         1             2

3                      4                    5                   6                     7                   8             9
                                                                Weekly inspection 
                                                                Carbon adsorber/
Daylight Saving Time                                            condenser log    
        ends                                     Election day
                                                                
10                     11                   12                  13                    14                  15            16
                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    
                            Veterans’ Day

17                     18                   19                  20                    21                  22            23
                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    

24                     25                   26                  27                    28                  29            30
                                                                Weekly inspection 
                                                                Carbon adsorber/
                                                                condenser log    
                                                                                           Thanksgiving

                                                        Kansas Small Business Environmental Assistance Program
                                                                                                  1-800-578-8898
                                                                                                www.sbeap.org
December 2019                                                                                                   Perchloroethylene cleaners

             Perc Purchase Running Total                                                                            Weekly Inspection
                            12-month total                                         Date                                              12/4    12/11     12/18       12/25
            from last month (Nov. 2019) =                                          Time
                   Subtract perc purchaed                                          Hazardous Waste
                        December 2018 =                                            Are containers in good condition?                Y   N    Y    N     Y    N     Y     N
                                (see pg 3)                                         Are waste containers made of
                                                                                                                                    Y   N    Y    N     Y    N     Y     N
                                  Subtotal =                                       appropriate material?
                                                                                   Are containers tightly closed?                   Y   N    Y    N     Y    N     Y     N
             This month’s perc purchases*                                          Are individual containers clearly
          Date                Gallons                                              labeled as “Hazardous Waste” and the
                                                                                                                                    Y   N    Y    N     Y    N     Y     N
                                                                                   date waste was first put into the
                                                                                   container?
                                                                                   Containment Area
                                                                                   Is wastewater stored no longer than
             December 2019 perc total =                                                                                             Y   N    Y    N     Y    N     Y     N
                                                                                   60 days?
           Current 12-month running total                                          Is secondary containment around
                                                                                                                                    Y   N    Y    N     Y    N     Y     N
     (Subtotal + December 2019 total) =                                            each machine in good condition?
                                                                                   Is hazardous waste secondary
                                                                                                                                    Y   N    Y    N     Y    N     Y     N
            *Keep receipts in envelope at back of calendar.                        containment in good condition?
                                                                                   Are the following items leak-free?
                                                                                   Circle method of inspection (S or D) **          S   D    S    D     S    D     S     D
          Carbon Adsorber/Condenser Monitoring Log
                                                                                   Hose and pipe connections, fittings,
                                                                                                                                    Y   N    Y    N     Y    N     Y     N
                       See “Instructions for Use” page 1                           couplings and valves
                          During drying
                                                                                   Door gasket and seal                             Y   N    Y    N     Y    N     Y     N
                             phase                            Outlet
                                                                         Is temp   Pump                                             Y   N    Y    N     Y    N     Y     N
              Perc                           Is pressure               less than   Solvent tank and containers                      Y   N    Y    N     Y    N     Y     N
                                                               temp
            concen-      High-      Low-     within man-                or equal
   Date                                                       during               Water separator                                  Y   N    Y    N     Y    N     Y     N
             tration   pressure   pressure    ufacturing                     to
                       reading    reading                       cool               Muck cooker                                      Y   N    Y    N     Y    N     Y     N
             (ppm)                             range?                      45°F
                        (psi or    (psi or                    down
                                                                        (7.2°C)?   Still                                            Y   N    Y    N     Y    N     Y     N
                         bar)       bar)
                                                                                   Exhaust damper                                   Y   N    Y    N     Y    N     Y     N
   12/4                                       Y      N                 Y     N     Diverter valve                                   Y   N    Y    N     Y    N     Y     N
  12/11                                       Y      N                 Y     N     Filter gasket and seal                           Y   N    Y    N     Y    N     Y     N
  12/18                                       Y      N                 Y     N
                                                                                   Cartridge filter housing                         Y   N    Y    N     Y    N     Y     N

  12/25                                       Y      N                 Y     N     ** S = sight, smell or feel         ** D = detector (required at least once each month)

If “N” is answered above, fill out corrective action form (back of calendar).                        Week   1   Inspected   by   _______________________________________
                                                                                                     Week   2   Inspected   by   _______________________________________
                                                                                                     Week   3   Inspected   by   _______________________________________
                                                                                                     Week   4   Inspected   by   _______________________________________
TIP OF THE MONTH!
Annual registrations (due January 31) can be completed online. See pages 5 or          December 2019
24 of the Kansas Dry-Cleaner Manual for details.

     SUNDAY           MONDAY              TUESDAY          WEDNESDAY                 THURSDAY        FRIDAY       SATURDAY
1                2                   3                     4                     5              6             7

                                                           Weekly inspection 
                                                           Carbon adsorber/
                                                           condenser log    

8                9                   10                    11                    12             13            14
                                                           Weekly inspection 
                                                           Carbon adsorber/
                                                           condenser log    

15               16                  17                    18                    19             20            21

                                                           Weekly inspection 
                                                           Carbon adsorber/
                                                           condenser log    
                                                                                                                   Winter begins
22               23                  24                    25                    26             27            28

                                     Weekly inspection 
                                     Carbon adsorber/
                                     condenser log    
                                                                Christmas Day                                           
                                                                      
29               30                  31                                                                                

                                                Kansas Small Business Environmental Assistance Program
                                                                                          1-800-578-8898
                                                                                        www.sbeap.org
Corrective action forms—keep these records for five years.

After determining your equipment has an air leak, you must do the        After determining your equipment has an air leak, you must do the
following:                                                               following:
    Repair the leak within 24 hours, if no parts are needed.                Repair the leak within 24 hours, if no parts are needed.
    If parts are needed, order within two days.                             If parts are needed, order within two days.
    Install parts within five days of receipt.                              Install parts within five days of receipt.
    Record details of repair work below.                                    Record details of repair work below.

Any other repairs (e.g., hazardous waste storage containers, secondary   Any other repairs (e.g., hazardous waste storage containers, secondary
containment structures) must be made within five days.                   containment structures) must be made within five days.

Machine no. or area of leak: ________________________________            Machine no. or area of leak: ________________________________

Date of initial inspection: ___________________________________          Date of initial inspection: ___________________________________

Inspector: ________________________________________________              Inspector: ________________________________________________

Date problem was corrected: ________________________________             Date problem was corrected: ________________________________

Describe problem and solution: ______________________________            Describe problem and solution: ______________________________

_________________________________________________________                _________________________________________________________

_________________________________________________________                _________________________________________________________

Are parts needed?       Yes ________             No ________             Are parts needed?       Yes ________             No ________

Date ordered: _________________ Date received: _______________           Date ordered: _________________ Date received: _______________

Date installed: _________________                                        Date installed: _________________

Describe: _________________________________________________              Describe: _________________________________________________

__________________________________________________________               __________________________________________________________

Use this form when corrective actions are necessary.                     Use this form when corrective actions are necessary.
Pollution Prevention Guidelines
                                                          (Perc cleaners)

   Close machine doors immediately after transferring articles to or from the machines.

   Keep machine doors closed between transfers.

   Follow the manufacturer’s instructions for operating and maintaining machines and equipment.

   Drain cartridge filters in a closed container for at least 24 hours before disposing.

   Store all perc and wastes in sealed containers that do not leak.

   Inspect all dry-cleaning equipment at least weekly for any leaks that are obvious by sight, smell or touch.
         Leaks include instances where drops of perc are visible on the outside of a machine or where air can be felt coming
           from a machine. (Existing, small-area sources need to be inspected every other week.)
         Dry-cleaning equipment includes hoses, pipes, fittings, couplings, valves, gaskets, seals, pumps, solvent tanks and
           containers, water separators, muck cookers, stills, diverter valves and cartridge filter housings.

   At least one weekly inspection each month must be done using a halogenated hydrocarbon detector or a perc gas analyzer.

   Repair any leaks within 24 hours or, if repair parts must be ordered, within five days of receiving the parts. Parts must be
     ordered within two working days of finding the leak.

   Keep copies of design specifications and operating manuals for each dry-cleaning machine.
Waste Determination Documentation Form
Facility name: _______________________________________

Waste name: ________________________________________

Description process: __________________________________

Pounds of waste generated monthly: ______________________

Does this waste meet the definition of solid waste?                             Yes    No

Is this waste exempt from the definition of solid waste or hazardous waste?     Yes    No

Was laboratory analysis used to make this determination?                        Yes    No

If yes, record the name and KDHE certificate number for the laboratory: _______________________________________
If yes, attach a copy of the analytical results to this sheet.

Was knowledge of the process used to make this decision?                        Yes    No

If yes, list the name and date of each document (MSDS, process flow diagrams, etc.) reviewed
and/or attach them to this sheet:
_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Is this waste nonhazardous?                           Yes    No           List the name and title of the person making this
                                                                          determination: __________________________
Is this waste a listed hazardous waste?               Yes    No
If yes, list waste codes: _____________________                           Date of this determination: _________________

Is this waste a characteristic hazardous waste?       Yes    No
If yes, list waste codes: _____________________
337-002
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