Please Note:  The forms on this web site require the Adobe Acrobat Reader and may require the most recent version.  Adobe Acrobat is free software for viewing and printing Adobe Portable Document Format (pdf) files on all major hardware and operating system platforms.  To download the Adobe Acrobat Reader click on the following link:

http://www.adobe.com/products/acrobat/readstep2.html

Notification of Hazardous Waste or Liquid Industrial Waste activity for this site.

The Michigan Site Identification Form (Revised 12/2007) must be submitted for certain facilities regulated under Part 111, Hazardous Waste Management or Part 121, Liquid Industrial Waste of Michigan's Natural Resources and Environmental Protection Act, 1994 PA 451 (Act 451), as amended, and Subtitle C of the Federal Resource Conservation and Recovery Act, RCRA), and the rules there under, to obtain a Site Identification Number (initial notification).

You must also submit the completed form as a component of a Part A, as a component of the Hazardous Waste Report (biennial report), or you may choose to submit the form as a subsequent notification or as part of the Annual User Fee Charge required for certain types of hazardous waste generators.

You may search our database at http://www.deq.state.mi.us/wdspi/ to determine if the site location already exists (even if under a different facility name). If the physical location does exist in the data system you may request a pre-populated Site Identification Verification form (EQP5150-v) by contacting the closest DEQ district office (click on "Contact_DEQ" near the top of this page) and asking for staff in the hazardous or liquid industrial waste program in WHMD or you can call WHMD in Lansing (517.335.2690) and ask for staff in the Manifest Processing Unit.  If you find that the site you are notifying about does not exist in the data system, you will need to download the blank form.

EQP5150 - Michigan Site Identification Form (directions not included)- Revised 12/2007

EQP5150 - Michigan Site Identification Form Directions (form not included) - Revised 7/2005

This is the replacement form for:

• U.S. Environmental Protection Agency Notification of Regulated Waste Activity Form 8700-12
• U.S. Environmental Protection Agency Hazardous Waste Permit Part A Form 8700-23
• Michigan Notification of Regulated Waste Activity Form
• Identification and Certification Form for EPA Form 8700-13A/B

and it is used in conjunction with the Michigan Hazardous Waste Permit Part A Form EQP5111.

The $50 User Charge Fee

Requests for the issuance of a site identification number for hazardous waste or liquid industrial waste activities are subject to a user charge of $50.00.   The MDEQ will not issue a site identification number until the $50.00 user charge has been paid and the payment has cleared.  The payment can be made by credit card if the application is submitted through MiTAPS (see above).  Or the payment may be made by check if the application is submitted through MiTAPS or a paper copy with the $50.00 check made payable to "State of Michigan " is mailed to:

DEQ OFFICE OF FINANCIAL MANAGEMENT
REVENUE CONTROL UNIT
PO BOX 30657
LANSING,  MI 48909   

To help ensure proper credit, please indicate on the check "Site ID User Charge".

The following are some examples of when the MDEQ considers the facility to be "new" and the $50.00 User Charge must be submitted with the Site Identification form:

• A site identification number has never been assigned to this physical location and the current owner/business is required to obtain a number;
• A site identification number has been previously assigned to this physical location for a previous owner/business and a new legal entity becomes the owner and  is required to obtain a site identification number.  A new legal entity may occur;
• If the site is transferred through, for example, a sale;
• The business is Incorporated (Inc.), a Limited Liability Corporation (LLC), or a Limited Liability Partnership (LLP) and the business entity changes (this could be indicated by a name change);
• The business is not Inc., LLC, or LLP and the principals change.

Emergency Site Identification Numbers

An Emergency Site Identification Number is assigned to any situation where there is an unexpected incident and the cleanup waste can not be accumulated on site because that would further threaten human health and the environment.  Reasons why the waste can not be accumulated on site vary greatly but common reasons are there isn't any room to accumulate the waste (e.g., on the side of the road with minimal shoulder), the waste is too dangerous to be left (e.g., flammable and it is a hot and humid summer day), or there are other hazards in the area that means the waste could not be protected.  When issued, the emergency Site ID number is valid until the immediate threat has been addressed and is provisional upon payment of the requisite $50 user charge.  The numbers are site specific and cannot be transferred between locations.  Any long term clean up requires the generator to file a Site Identification Form (EQP5150-v). 

To obtain an emergency number during normal business hours contact the MDEQ and ask for the Manifest Unit at 517-335-2690.  During evenings, weekends, and holidays contact the Pollution Emergency Alerting System (PEAS) at 1-800-292-4706.  You will receive a copy of EQP5150-v generated from the information received over the telephone regarding your emergency cleanup site.  You are required to fill in all of the additional information that is missing, such as the Federal Identification Number.  After you have completed the form, write a check payable to the "State of Michigan" in the amount of $50.00 to pay for the issuance of the ID number and mail the check and completed form to:
   
DEQ OFFICE OF FINANCIAL MANAGEMENT
REVENUE CONTROL UNIT
PO BOX 30657
LANSING, MI 48909

To help ensure proper credit, please indicate on the check "Site ID User Charge".

Emergency Operating License Form EQP5113

Emergency Operating License Instructions EQP5113I

The following forms must be submitted by facilities that wish to obtain a construction permit or operating license to treat, store, or dispose of hazardous waste.  

Michigan Construction Permit & Operating License Application Form EQP5111, (Revised 12/2/02)

EQP5150 - Michigan Site Identification Form (directions not included) - Revised 12/2007

EQP5150 - Michigan Site Identification Form Directions (form not included) -Revised 7/2005

The completed and signed forms must be mailed to:

DEQ WASTE AND HAZARDOUD MATERIALS DIVISION
HAZARDOUS WASTE SECTION
PO BOX 30241
LANSING , MI 48909-7741

The following Microsoft Word Templates are for the attachments to the Michigan Construction Permit & Operating License Application Form (EQP5111)

Chemical & Physical Analyses

Closure & Post-Closure Care Plans

Closure & Post-Closure Cost Estimates

Use and Management of Containers

Contingency Plan

Corrective Action

Environmental Assessment

Environmental Monitoring Programs

Hydrogeological Report

Personnel Training Application Template

Preparedness and Prevention

Subpart AA Air Emissions

Subpart BB Air Emissions

Subpart CC Air Emissions

Tank Systems

Waste Analysis Plan Application Template

A copy of the federal RCRA Hazardous Waste Part A Permit Application Form is also required as part of your application.  Copies of the Part A and the Notification form are available at the following address on the U.S. Environmental Protection Agency web page:

http://www.epa.gov/epaoswer/hazwaste/data/form8700/forms.htm