Sample
Form:
For
the
Purpose
of
Notice
and
Comment
Only
[
Sample]
Notification
Form
for
Materials
that
are
Excluded
from
the
Definition
of
Solid
Waste
Under
40
CFR
261.2(
g)

The
purpose
of
this
notification
is
to
provide
general
information
regarding
the
facility
claiming
an
exclusion
from
regulation
for
a
solid
waste
under
the
Resource
Conservation
and
Recovery
Act
(
RCRA)
for
materials
generated
and
reclaimed
in
a
continuous
process
within
the
same
industry
per
40
CFR
261.2(
g).
The
information
herein
will
be
used
by
the
State
or
Regional
Agency
to
document
and
verify
the
exclusion.

Name
of
Facility:

Address
of
Facility
Street:

City:
State:
Zip:

EPA
ID
Number:
(
if
applicable)

Contact
name:

Contact
phone
#:

Industry:

Brief
identification
of
the
excluded
material(
s)
and
handling
(
e.
g.,
electric
arc
furnace
dust):
