EOEEA-DEP – Department of Environmental Protection

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Sponsor Information

Name of sponsor(Required)

e.g., municipality or entity hosting the event

Sponsor contact person(Required)

The person to be contacted if MassDEP has questions about this notification form

First Last

Sponsor contact phone(Required)

Sponsor contact email(Required)

Hazardous Waste Transport

Hazardous Waste Generator EPA ID Number to be used for event(Required)

Must be 12 characters. EPA ID numbers are issued by MassDEP and are used to track hazardous waste as it moves on a manifest from the point of generation to its final disposal. The same EPA ID can be used on the manifest unless a different transporter is used.

Name of licensed transporter responsible for on-site management and removal of hazardous waste collected at the event(Required)

Transporter contact person - day of event(Required)

First Last

Title or affiliation(Required)

Transporter contact phone(Required)

Transporter contact email(Required)

Transporter contact address(Required)

Street Address Address Line 2 City State ZIP Code

Emergency coordinator name(Required)

First Last

Emergency coordinator title(Required)

Emergency coordinator phone(Required)

Event Location and Dates

If the Hazardous Waste Transport information above does not apply to all event locations and dates, please fill out another form.

For this section, please indicate the MassDEP Region for the event location. You may find the cities and towns for each region on MassDEP's Regional Offices by Community webpage (save this form or open link in new tab to avoid losing your progress).

Enter Event Information

Name of site where the household hazardous waste event(s) will take place	Event street address	Select MassDEP region	Dates of events at this location (MM/DD/YYYY)	Actions

There are no Events.

Please select all MassDEP Regions where events are taking place.(Required)

I.e. to summarize the MassDEP Region information entered into the previous table.

Central

Northeast

Southeast

Western

Map of location

Per 30.392(5)(b), a map of where an event will take place is required at least 2 days prior to the event.

Drop files here or

Max. file size: 50 MB.

Requirements

The requirements of the event site and for the event operation include:

Designating a coordinator to be available at all times during the event.
Notifying in writing the appropriate MassDEP regional office of the date and location of the event at least one month in advance. NOTE: a completed submittal of this form will be accepted as notification.
Providing a map of the layout of the site to the transporter, and the local emergency response agencies, e.g., police and fire, at least two business days before the event.
Refusing to accept any waste if there is reason to believe that the hazardous waste is not household hazardous waste or not hazardous waste generated by a Very Small Quantity Generator, or waste that is unidentifiable, explosive or reactive, cannot be lawfully disposed of, or is specified as unacceptable in the contract between the sponsor and the transporter.
Providing for traffic control at the site of the event and clear signage.
Assuring that the site has appropriate cleanup and emergency equipment, including a respirator, first aid kit, eyewash fluid, broom, dustpan, shovel, and absorbent.
All collected hazardous and solid wastes shall be removed from the collection location at the end of the event.
Opening and closing the event and verifying that the transporter has completed the packaging and labeling of the accumulated waste.
Implementing of the emergency response plan, should that be necessary.
Ensuring the site has sufficient space for packaging the waste, vehicles entering and exiting and for workers and emergency vehicles.
Ensuring the work area is sufficiently impervious to leaks and spills so that spilled material can be readily collected and removed. Drains must be covered.
Locating the work area at least 50 feet from any ignitable materials not accepted at the event.
Posting “No Smoking” signs.
Obtain and keep on file the quantity of each type of hazardous waste manifested and ultimate disposal facility. Retaining copies of the hazardous waste manifest(s) for the event is sufficient.
NOTE: Your electronic submittal of this form will be accepted as notification to the appropriate MassDEP regional office.

Sponsor Consent

To be completed by an authorized representative of the sponsor.

“I understand that a Household Hazardous Waste Event for hazardous waste from households or VSQG’s must be managed in accordance with all applicable environmental laws and regulations and that MassDEP may inspect this event to verify compliance.”

Name(Required)

First Last

Title or position(Required)

Date(Required)