New Hampshire Code of Administrative Rules
Env - Department of Environmental Services
Subtitle Env-Hw - Hazardous Waste Programs
Chapter Env-Hw 500 - REQUIREMENTS FOR HAZARDOUS WASTE GENERATORS
Part Env-Hw 514 - SMALL QUANTITY GENERATOR SELF-CERTIFICATION
Section Env-Hw 514.04 - Self-Certification Form: SQG Identification and Description

(a) The facility's business name;

(b) The facility's mailing address;

(c) The facility's street address if different than the facility's mailing address;

(d) The municipality and county in which the facility is located;

(e) The facility's EPA identification number;

(f) The name and title of the individual completing the self-certification form on behalf of the SQG, the individual's daytime telephone number if different from the SQG's and, if available, an email address;

(g) The date or dates on which the self-certification inspection and the file review were conducted;

(h) The name and telephone number of the owner of the property, if other than the SQG;

(i) Whether the facility:

(j) A list of the hazardous wastes generated;

(k) A description of how the SQG's hazardous waste is generated;

(l) The amount of hazardous waste generated monthly for each of the 12 months prior to the declaration being completed;

(m) The amount of hazardous waste currently accumulated at the facility; and

(n) Whether the hazardous waste determination was done by testing, by knowledge of the process and materials used, or by relying on advice from a transporter or consultant.