PCB INSPECTION CHECKLIST (REVISED FEBRUARY, 1999)

Name of Facility: _________________________________________________________

Address of Facility: ______________________________________________________

______________________________________________________

I. PCB USE/REUSE (Regulatory threshold = 50 ppm PCB)

TRANSFORMERS (containing >3 lb of fluid)

1. Does the facility use or have in storage for reuse any PCB transformers
or PCB contaminated transformers? _____Yes _____No

If yes, complete table 1 and indicate below the total numbers.

a. Total number of PCB transformers in service: __________

b. Total number of PCB contaminated transformers in service: __________

c. Total number of PCB transformers in storage for reuse: __________

d. Total number of PCB contaminated transformers in storage

for reuse: __________

2. Describe the basis of the facility’s classification of its transformers

(i.e., testing, name plate/label, service records, assumptions)

_________________________________________________________________________

_________________________________________________________________________

If assumptions were made, were they in accordance with §761.2(a)(i.e.,

pre 7/79 or unknown date, mineral oil - PCB contaminated; pre 7/79 or
unknown date, non-mineral oil - PCB)? _____Yes _____No

761.30(a)(1)(i)
3. Are there any PCB transformers in use or in storage for reuse that pose
an exposure risk to food or feed? _____Yes _____No

If yes, describe:_________________________________________________

1
 __________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

761.30(a)(1)(vi)(A)
4. Have all PCB transformers in use or in storage for reuse been registered
with the EPA by December 28, 1998? _____Yes _____No

5. Have transformers which were identified as PCB transformers after

December 28, 1998 been registered with EPA no later than 30 days after
such identification was made? _____Yes _____No _____N/A

(If yes to either of the above, obtain a copy of the registration form and
the return receipt signed by EPA. The facility must retain a copy of this
material as required by §761.30(a)(1)(vi))(C))

6. Does the facility have any PCB transformers in or near commercial

buildings? _____Yes _____No

(If no, skip to question 16)

7. Based on the facility’s information, including electrical schematic

diagrams, which of the following describes the type of transformers that
are located in or near a commercial building?

a. Network/Higher Secondary Voltage ( 480 volts) _____

b. Network/Lower Secondary Voltage (<480 volts) _____
c. Radial/Higher Secondary Voltage ( 480 volts) _____
d. Radial/Lower Secondary Voltage (<480 volts) _____

(Note that a is prohibited (761.30(a)(1)(ii); b must be protected for high

current faults; c must be protected for both high and low current faults; and
d must be protected for high current faults(761.30(a)(1)(iv) & (v))

8. Describe below the type of enhanced electrical protection (i.e., current

limiting fuses, circuit breakers, relays, etc.) that the facility has
provided for its PCB transformers in or near commercial buildings.

____________________________________________________________________________

2
____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

761.30(a)(1)(vii)
9. Were PCB transformers located in or near a commercial building
registered with the building(s) owner(s)? _____Yes _____No

(Note: PCB transformers located within a commercial building must be

registered with the building owner of record while PCB transformers located
near commercial buildings must be registered with all building owners located
within 30 meters of the transformers)

10. Did registration occur by December 1, 1985? _____Yes _____No

If no, explain why:_____________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.30(a)(1)(xv)
11. For any transformer(s)located in or near commercial buildings assumed to
contain less than 500 ppm of PCBs that were tested and found to contain
500 ppm or greater of PCBs, did the facility initiate the following:

a. register the transformer(s) with the building owner within thirty

(30) days of discovery? _____Yes _____No _____N/A

If yes, is a copy of the registration letter available?

_____Yes _____No

(if yes, obtain a copy, if no, explain why)

________________________________________________________________________

________________________________________________________________________

b. install necessary protective equipment on radial or lower secondary

voltage network transformers within 18 months of discovery or by Oct.
1, 1990, whichever is later? _____Yes _____No _____N/A

3
 c. retrofill and reclassify or remove the above transformers within 18
months of discovery if enhanced electrical protection was not
provided?
_____Yes _____No _____N/A

12. List each building (name and address) and building owner with whom
registration occurred:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

13. Are copies of the registration letters available? ___Yes _____No

If yes, obtain copies

If no, explain why:

________________________________________________________________________

________________________________________________________________________
761.30(a)(l)(vii)
14. Did registration with the building owner(s) include provision of the
following:

a. Specific location of PCB transformers? _____Yes _____No

b. Principal constituent of dielectric fluid? ____Yes _____No

c. Type of transformer installation? _____Yes _____No

761.30(a)(l)(iii)
15. Has the facility installed any PCB transformers which were placed in
storage for reuse or which were moved from another location in or near
commercial buildings since October 1, 1985? _____Yes _____No

If yes, list locations and dates of installations and volume of each PCB
transformer installed:

4
 _________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

________________________________________________________________________

761.30(a)(1)(viii)
16. Are any combustible materials stored within:

a. PCB transformer enclosure? _____Yes _____No

b. 5 (five) meters of a PCB transformer enclosure? _____Yes _____No

c. 5 (five) meters of an unenclosed PCB transformer? _____Yes _____No

If any are answered yes, take photographs and list the locations, type of
situation, type of combustibles and any relevant comments:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

761.30(a)(l)(ix)
17. Are visual inspections of each in use or stored for reuse PCB
transformer for leaks performed at least once every three months since
August 1981? _____Yes _____No

If no, indicate missing inspections:

_________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

761.30(a)(1)(xii)

5
18. Are inspection logs available? _____Yes _____No
If yes, obtain copies.

If no, explain why:_______________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

761.30(a)(l)(x)
19. Have arrangements been made to repair or replace leaking (i.e. PCB oil
running off or about to run off the external surface) PCB transformers?
_____N/A _____Yes _____No

If yes, describe arrangements:____________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

If no, explain why:_______________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

761.30(a)(1)(x)
20. Was clean-up of released PCBs resulting from a leaking PCB transformer
initiated within 48 hours of its discovery? _____N/A _____Yes _____No

If no, explain why:_______________________________________________

_

__________________________________________________________________

__________________________________________________________________

761.30(a)(1)(x)

6
21. Was an active leak of PCBs from a PCB transformer adequately contained
after its discovery? _____N/A _____Yes _____No

761.30(a)(1)(x)
22. Are daily inspections performed of actively leaking PCB transformers to
verify proper containment? _____N/A _____Yes _____No

761.30(a)(1)(xi)
23. Were any fire-related incidents involving a PCB transformer reported to
the National Response Center? _____N/A _____Yes _____No

761.30(a)(l)(xii)
24. Are inspection logs maintained for these daily inspections?
_____N/A _____Yes _____No

If yes, obtain copies.

761.30(a)(1)(xii)
25. Are inspection and maintenance records maintained at least 3 years after
disposal of the PCB transformer? _____N/A _____Yes _____No

761.30(a)(1)(xii)
26. Do inspection/maintenance records include:

a. Location of transformer? _____Yes _____No

b. Date of Inspection? _____Yes _____No

c. Date leak discovered? _____Yes _____No

d. Inspector's Name? _____Yes _____No

e. Location of Leaks? _____Yes _____No

f. Amount of dielectric fluid released? _____Yes _____No

g. Date(s) of cleanup, containment provision

and leak repair? _____Yes _____No

761.30(a)(l)(xiii)
27. If annual inspections are performed of in use or stored for reuse PCB
transformers:

a. Does adequate (i.e. 100%) secondary containment exist for these

transformers? _____Yes _____No

7
 Obtain dimensions.

b. Does evidence exist to demonstrate that testing of these transformers

was performed and that they contained less than 60,000 ppm PCB after
3 months of in-service use? _____Yes _____No

If yes, obtain copies of test results.

761.30(a)(l)(xiv)
28. Were weekly inspections performed and records maintained at least 3
years where a PCB transformer in use or stored for reuse posed an
exposure risk to food or feed prior to October 1, 1985?
_____N/A _____Yes _____No

761.30(a)(2)(i) and (ii)

29. Were any PCB transformers serviced as follows:

a. Dielectric fluid containing more than 500 ppm PCB was used?
_____N/A _____Yes _____No

b. Transformer coil was removed? _____N/A _____Yes _____No

c. Mixture of dielectric fluids, some of which contained more than

500 ppm PCB, was used? _____N/A _____Yes _____No

If any are answered yes, obtain copies of appropriate records that are
available.

761.30(a)(2)(v)
30. If there was testing of a transformer(s) for reclassification
purposes, did such testing occur after a minimum of 3 months of in-
service use subsequent to last servicing and did temperature of
dielectric fluid reach 50o C or more?
_____N/A _____Yes _____No

761.40(a)
31. Are all PCB transformers in use or in storage for reuse properly
marked with a ML label? _____Yes _____No

If no, describe circumstances:

8
 ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

761.40(j)
32. Are all vault/room doors, fences, hallways or other accessways to PCB
transformers properly marked with a ML label? _____Yes _____No

If no, describe cases where ML mark is missing and take photographs:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.30(a)(l)(xv)
33. Does the facility have any mineral oil transformers assumed to contain
less than 500 ppm of PCBs that were tested and found to contain 500 ppm
or greater of PCBs? _____Yes _____No

If yes, has the facility initiated the following:

a. Marked the transformer(s)with a PCB ML label within seven (7)days

after discovery? _____Yes _____No

b. Marked the vault door, machinery room door, fence, hallway or other
means of access to PCB transformers with a PCB ML label within seven
(7) days after discovery? _____Yes _____No

CAPACITORS (containing > 3 lb of fluid)

34. Does the facility use or have in storage for reuse any large PCB
capacitors? _____Yes _____No

If yes, complete Table 2 and indicate below the total numbers:

a. Total number of PCB large high voltage capacitors in service: _______

9
 b. Total number of PCB large low voltage capacitors in service: _______

c. Total number of PCB large high voltage capacitors in storage for

reuse:_______

d. Total number of PCB large low voltage capacitors in storage for

reuse:_______

35. Describe the basis of the facility’s classification of its large

capacitors (i.e., name plate/label, service records, assumptions)

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

761.2(a)(4)
36. Has the facility assumed that any capacitor manufactured prior to July 2,
1979 or any capacitor whose date of manufacture is unknown and whose PCB
concentration is not established contains 500 ppm PCB?
_____Yes _____No _____N/A

761.30(l)(1)(i)
37. After October 1, 1988, did the facility have any PCB Large High or Low
Voltage Capacitors in use or in storage for reuse that pose an exposure
risk to food or feed? _____Yes _____No

761.30(l)(1)(ii)
38. After October 1, 1988, did the facility have any PCB Large High or Low
Voltage Capacitors in use in an area other than a restricted-access
electrical substation or a contained and restricted-access indoor
installation? _____Yes _____No

761.40(c)(2)(ii)
39. Are all PCB large high voltage capacitors individually marked with
an ML label unless they are installed in a protected location such
as on a power pole, a structure, or behind a fence, in which case
the pole, structure or fence must be properly labelled?
_____Yes _____No

10
 If no, describe circumstances:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.40(k)(1)
40. Are all PCB large low voltage capacitors individually marked with an ML
mark unless they are installed in a protected location such as on a
power pole, structure, or behind a fence, in which case the pole
structure or fence is labelled by April 26, 1999?
_____N/A _____Yes _____No

761.40(k)(2)
41. Is all equipment containing a PCB large high or low voltage capacitor
labelled with an ML mark by April 26, 1999?
_____N/A _____Yes _____No

VOLTAGE REGULATORS (containing >3 lb of fluid - regulations effective Aug.

28, 1998)

42. Does the facility use or have in storage for reuse any PCB voltage
regulators that contain three (3) lbs or more of dielectric fluid?
_____Yes _____No

If yes, answer the following questions:

761.40(l)(1)
43. Are all PCB voltage regulators individually marked with an ML label?
_____Yes _____No

761.40(l)(2)
44. Are locations of PCB voltage regulators such as vault doors, machinery
room doors, fences, hallways or other means of access marked with an ML
label? _____Yes _____No _____N/A

761.30(h)(1)(ii)(B)

11
45. Are fire related incidents involving voltage regulators reported to the National Response
Center? _____Yes _____No _____N/A

761.30(h)(1)(ii)(C)
46. Are inspections of PCB voltage regulators performed in a fashion similar
to those required for PCB transformers (i.e., same frequency, scope, provisions when leaks occur,
documentation, etc.)? _____Yes _____No

761.30(h)(1)(ii)(D)
47. Does facility owning PCB voltage regulators comply with the recordkeeping and reporting
requirements applicable to PCB transformers (§761.180)?
_____Yes _____No

HEAT TRANSFER OR HYDRAULIC SYSTEMS

48. Does the facility have any heat transfer or hydraulic systems?
_____Yes _____No

If yes, answer the next question:

761.30(d) & (e)

49. Does heat transfer or hydraulic system(s)contain PCBs above 50 ppm?
_____Yes _____No

If yes, how many systems and what was the basis of determination:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

12
PCB CONTAMINATED POROUS SURFACES

50. Does the facility have a continued use of any PCB contaminated porous
surface (porous surface includes concrete, wood, and coated metal surfaces; contaminated
2
means >10 ug/100cm )? _____Yes _____No

If yes, answer the following questions:

761.30(p)(1)(i)
51. Was the source of PCB contamination removed or contained to prevent further release to
the porous surface(s) in use? _____Yes _____No

761.30(p)(1)(ii)
52. Was the surface(s) properly cleaned if accessible?
_____Yes _____No _____N/A

761.30(p)(1)(iii)
53. Was the surface(s) properly coated and marked with an ML label?
_____Yes _____No

Note: there are other authorized uses of PCB but they are not covered by this checklist

54. Does the facility store for reuse, in an area not meeting the
requirements of §761.65 (Storage for Disposal), any PCB Article?
_____Yes _____No

If yes, answer the following questions:

761.35(a) & (b)

55. Has the facility stored for reuse any PCB Article for greater than 5 years after the
date the Article was originally removed from service or 5 years after August 28, 1998, whichever
is later, without written approval from EPA? _____Yes _____No

13
 761.35(a)(1)
56. Has the facility complied with all use and marking requirements
applicable to the PCB Articles in storage for reuse (see questions above
pertaining to §761.30 and §761.40)? _____Yes _____No

761.35(a)(2)
57. Has the facility maintained records on its PCB Articles in storage for
reuse which indicate when they were removed from use, the projected
location and future use of the Articles and repair or servicing dates, if
applicable? _____Yes _____No

Pertinent Comments:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Transformer Observations

Table 1

14
_______________________________________________________________________________
_______________________

Transformer Make, In Stor. Dielectric PCB/PCB ML

No Minor* Mod* Major*
Ser#,Instal. Type Location In Use for Reuse Fluid Name Contam. Affixed?
Leak Leak Leak Leak
_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

* Minor Leak - oil on outer surface but not about to run off
Moderate Leak - oil about to run off of outer surface

15
 Major Leak - oil running off article onto surface below
Take photographs of leak and collect sample if PCB concentration is unknown

Capacitor Observations

Table 2

_______________________________________________________________________________
_______________________

PCB Capacitor In In Storage Dielectric Fluid

ML Label
Description/Voltage Location Use for Reuse Name/Volume/Wt.
Affixed? Leaking

(Y) (N) (Y)* (N)

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

16
_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

_______________________________________________________________________________
_______________________

* Take photographs of leak

II STORAGE FOR DISPOSAL (Regulatory threshold = 50 ppm)

(If PCB items are in storage for disposal, complete Table 3)

761.65(a)(1)
1. Were any PCB Articles, PCB Containers or other PCB items in storage for
disposal for more than one (1) year from the date in which the item was
removed from service for disposal? _____Yes _____No

761.65(a)(2)
If yes, did the facility obtain a one (1) year extension from EPA?
_____Yes _____No

761.65(b)(l)(i)
2. Does the storage facility have an adequate roof and walls to prevent rain
water from reaching the stored PCBs or PCB Items? _____Yes _____No

761.65(b)(l)(ii)
3. Does the storage facility have an adequate floor with continuous curbing
at least six inches high? _____Yes _____No

4. What are the dimensions of the curbed storage area?

_____Length _____Width _____Depth

5. List below the internal volume of the largest PCB Article or Container in
the storage area (1) and the figure representing 25 percent of the total
internal volume of all the PCB Articles or Containers in the storage area
(2):

(1)____________________________

(2)____________________________

17
 761.65(b)(1)(ii)
6. Does the floor and curbing provide a containment volume equal to at least
two times the internal volume of the largest PCB Article or Container
stored therein or 25 percent of the total internal volume of all the PCB
Articles or Containers stored therein, whichever is greater?
_____Yes _____No

761.65(b)(l)(iii)
7. Are there any drain valves, floor drains, sewer lines, or other openings
that would allow liquids to flow from the curbed storage area?
_____Yes _____No

If yes, describe which type of potential outlet is present.

__________________________________________________________________________

__________________________________________________________________________

_______________________________________________________________________

761.65(b)(l)(iv)
8. Are the storage area floor and curbing constructed of continuous smooth
and impervious materials, such as Portland cement, concrete or steel, to
prevent or minimize penetration of PCBs? _____Yes _____No

What material was used for construction of storage area?

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.65(b)(l)(v)
9. Is the storage area located at a site that is below the 100-year
flood water elevation? _____Yes _____No _____Unknown

If no, provide documentation that the storage area is above the 100-year
flood water elevation. If unknown, obtain as much information as possible
so that determination can be made in the Region.

761.65(c)(5)

18
10. Are PCB Articles and PCB Containers in storage for disposal checked
for leaks at least once every 30 days? _____Yes _____No

761.65(c)(5)
11. Are records available which document when inspections of the
storage facility are performed, by whom and the results of such
inspections? _____Yes _____No

If yes, obtain copies

12. Are there any leaking PCB Articles or PCB containers in storage
for disposal? _____Yes _____No

761.65(c)(5)
13. Have the contents of leaking PCB Articles or PCB Containers in
storage for disposal been transferred to properly marked
non-leaking containers? _____N/A _____Yes _____No

If no, explain why:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.65(c)(5)
14. Have spilled or leaked materials from PCB Articles or PCB
Containers in storage for disposal been immediately cleaned up
using absorbents or other adequate means?
_____N/A _____Yes _____No

If no, explain why:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.65(c)(6)

19
15. Are all containers used for the storage of liquid or non-liquid PCB
waste in accordance with DOT regulations (49 CFR §171-180)?
_____N/A _____Yes _____No

761.65(c)(7)(ii)
16. Has an SPCC plan been prepared and implemented in cases where PCB
liquids are stored in containers (incl. tanks) that are larger than
those specified in the DOT regulations (i.e. 55 gal drums)?
_____N/A _____Yes _____No

761.65(c)(8)
17. Are PCB Articles and PCB Containers dated as to when they were
placed in storage? _____Yes _____No

761.65(c)(8)
18. Is storage managed so that the PCB Articles and PCB Containers can
be located by the date they entered storage? _____Yes _____No

761.65(c)(8)
19. Are records available which indicate the date and quantity of each
batch of PCBs either added to or removed from large (> 55 gallon)
containers in storage? _____N/A _____Yes _____No

20. Does the facility store any bulk PCB remediation waste or PCB bulk
product waste at the clean-up site or site of generation?
_____Yes _____No

If yes, answer the following questions:

761.65(c)(9)
a. Has the waste been stored for 180 days or less?
_____Yes _____No

b. Is the waste placed in a pile designed and operated to control

wind dispersion? _____Yes _____No

c. Does the waste generate leachate? _____Yes _____No

d. Is the storage site provided with a liner, a cover and a run-on

control system? _____Yes _____No

761.40(a)(10)

20
21. Is each storage area and the PCB Items stored therein for disposal
properly marked with a ML label? _____Yes _____No

If no, describe items not properly marked:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

22. Does the facility utilize a temporary storage area for PCB Items?
_____Yes _____No

If yes, list types of PCB Items in temporary storage and answer the
following questions:
_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.65(c)(l)
23. Have any PCB Items been in temporary storage in excess of 30 days?
_____Yes _____No

If yes, how much in excess of 30 days?

______________________________________________________________________

761.65(c)(1)
24. Is there a notation on PCB Items in temporary storage indicating
when the item was removed from service? _____Yes _____No

761.65(c)(l)(ii)
25. Are there any leaking PCB Articles or PCB Equipment in temporary
storage which have not been placed in a non-leaking container that
contains a sufficient amount of sorbent material?
_____Yes _____No

21
 761.65(c)(l)(iv)
26. Has an SPCC plan been prepared for a temporary storage area where
PCB Containers containing liquid PCBs at a concentration 50ppm are
being stored? _____N/A _____Yes _____No

761.65(c)(1)(iv)
27. Are PCB containers containing liquid PCBs at a concentration
50 ppm in temporary storage authorized by DOT regulations (49 CFR
§171-180)? _____N/A _____Yes _____No

761.65(c)(3)
28. Is the temporary storage area properly marked with an ML label?
_____Yes _____No

29. Does the facility store any PCB items on pallets next to a
designated storage area? _____Yes _____No

If yes, list PCB Items stored at that location:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

761.65(c)(2)
30. Does the storage facility have immediately available unfilled
storage equal to 10 percent of the volume of PCB large, high voltage
capacitors and PCB contaminated electrical equipment stored outside the
facility? _____Yes _____No

761.65(c)(2)
31. Are the capacitors or other electrical equipment stored outside the
facility checked for leaks at least weekly? _____Yes _____No

32. Is the facility a commercial storage facility (i.e., accepts PCB wastes
from other facilities)? _____Yes _____No

22
 If yes, answer the following:

761.65(d)(1) & (2)

a. Has the facility received final approval from EPA to operate as a commercial storage
facility? _____Yes _____No

If yes, obtain evidence, including proof that it has met financial responsibility requirements and
has an acceptable closure plan.

Pertinent Comments:________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

23
 PCB ITEMS IN STORAGE FOR DISPOSAL ( 50 ppm)

Table 3

ITEM ITEM RECORD PCB ML ITEM REMARKS

DESCRIPTION DATED? DATE LABEL? LEAKING?
(Y) (N) (Y) (N) (Y) (N)

24
 ITEM ITEM RECORD PCB ML ITEM REMARKS
DESCRIPTION DATED? DATE LABEL? LEAKING?
(Y) (N) (Y) (N) (Y) (N)

III. PCB WASTE PROCESSING (EXCLUDING STORAGE), CLEAN-UP AND DISPOSAL

(Regulatory threshold = 50 ppm)

1. Is the facility a commercial facility (i.e., accepts PCB wastes from other facilities)?
_____Yes _____No

If yes, is it permitted by EPA? _____Yes _____No

761.60(b)(1)(i)(B) & (b)(4)

2. Has the facility removed all free-flowing liquid from its PCB and PCB contaminated transformers
through the use of a solvent for at least 18 continuous hours? _____Yes _____No
_____N/A

761.60(b)(6)(i) & (ii)

3. Has the facility removed all free-flowing liquid from its other PCB and PCB contaminated articles?
_____Yes _____No _____N/A

761.1(a)(5)

25
4. Does it appear as though the facility is diluting any of its PCB waste prior to disposal?
_____Yes _____No _____N/A

5. Check which of the following types of PCB waste the facility handles
(state whether waste is cleaned up/decontaminated, processed, or
disposed of):

a. PCB liquids _______________________________________________

b. PCB transformers __________________________________________

C. PCB capacitors ____________________________________________

d. Other PCB Articles ________________________________________

e. PCB Contaminated Equipment ________________________________

f. PCB Containers ____________________________________________

g. PCB Remediation Waste* (describe types & concentrations)

___________________________________________________________

___________________________________________________________

h. PCB Bulk Product Waste** ___________________________________

___________________________________________________________

i. R & D Related PCB Waste ___________________________________

j. PCB/Radioactive Waste _____________________________________

26
 k. Other (describe) __________________________________________

*
- means waste containing PCB as a result of a spill, release, or
other unauthorized disposal. It includes bulk PCB remediation waste (i.e.,
soil, sediment, sludge), non-porous surfaces, porous surfaces, and
liquids

**
- means waste derived from manufactured products containing PCBs in a non-
liquid state. It includes demolition debris, material from shredding operations
(i.e., fluff), coatings, insulation and fluorescent light ballasts containing PCB
contaminated potting material

6. Is the facility involved with clean-up/decontamination of any PCB remediation waste?

_____Yes _____No

If yes, for each specific type of PCB remediation waste, describe its PCB concentration, the
clean-up procedure employed and the level of clean-up achieved (state if it’s self-
implementing).

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

27
7. Does the facility perform decontamination activities on any PCB waste materials, other
than PCB remediation waste, including water, organic liquids, non-porous surfaces (either
coated or uncoated) or concrete? _____Yes _____No

If yes, describe the PCB concentration of the waste, decontamination procedure employed and the
level of decontamination achieved (state if it’s self implementing).

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

8. For each PCB waste identified in question 5 as being disposed of at the facility,
indicate below its PCB concentration and the method and location of its disposal.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

28
______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

9. For any mixed media or multi-phase waste, does the facility use the media having the highest PCB
concentration to determine the appropriate method of disposal? _____Yes _____No
_____N/A

761.50(a)
10. Indicate below if any of the following disposal prohibitions were observed at the
facility?

a. open burning of PCBs _______________

b. discharging of PCB contaminated water ( 3 ug/l) to treatment works or navigable streams

__________________

c. processing liquid PCBs into non-liquid forms _________________

d. spills or other uncontrolled discharges ___________________

761.60
11. Describe below any other disposal of PCB items that was not in accordance with the following
disposal matrix.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

29
______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

PCB DISPOSAL METHODS

Incin- High Indus- Chemical Approved Permitted Approved RA Approved

erator Effic- trial Waste Hazard. Solid Disposal Self-Imple-
Type of iency Furnace Landfill Waste Waste Facility menting
Waste Boiler Landfill Facility Procedure
PCB Liquids X
(>500 ppm)
PCB Liquids (50-500 X X
ppm)
Drained PCB X X
Containers/Articles
Drained PCB X X X
Contaminated
Articles/Containers

30
Large Undrained PCB X X (under
Capacitors certain
condi-
tions
PCB Remediation X X X
Waste - Liquid (<500
(not decontaminated) ppm)
PCB Remediation X X X
Waste - Non-Liquid
(not decontaminated)
Non-Liquid PCB- X X X X X
Bulk Product Waste
Non-Liquid PCB- X X
Soil, Rags, Debris
Non-Liquid PCB- X X X
Sludges, Sediment

Other Pertinent Comments

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

31
______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

32
IV. RECORDKEEPING AND REPORTS RELATED TO USE, STORAGE AND DISPOSAL
OF PCB

Note: If the facility is a disposer or commercial storer of PCB waste skip to question 12

761.180(a)
1. Does the facility have in use, or in storage for future use or disposal, the
following:

a. 99.4 lbs. (45 kg.) or more of PCBs in PCB Container(s)?

______Yes ______No

b. One or more PCB Transformers? ______Yes ______No

c. 50 or more large high or low voltage PCB capacitors?

______Yes ______No

761.180(a)
2. Has the facility developed and maintained all annual records and the annual document
log as of July 1, 1991, and each year thereafter? ______Yes ______No

a. Are the annual records and the annual document log prepared on a calendar year
basis? ______Yes ______No

33
 b. Has the facility retained the annual records and the annual document logs
for at least three (3) years after it no longer used or stored PCBs or PCB Items?
______Yes ______No

3. Where are the records maintained?_____________________________________

______________________________________________________________________

a. How are the records compiled and by whom?________________________

_________________________________________________________________

_________________________________________________________________

761.180(a)(l)(i),(ii) & (iii)

4. Do the facility's annual records contain the following:

a. All signed manifests generated by the facility during

the calendar year? ______Yes ______No

b. All Certificates of Disposal that have been received by the facility

during the calendar year? ______Yes ______No

c. Records of inspections and clean-ups? _____Yes _____No

761.180(a)(2)(i) & (ii)

5. Does the written annual document log contain the following:

34
 a. The name, address, and EPA identification number of the facility?
______Yes ______No

b. The calendar year covered by the annual document log?

______Yes ______No

c. The unique manifest number of every manifest generated by the

facility during the calendar year? ______Yes ______No

6. Does the written annual document log contain the following

information from each manifest and for unmanifested waste that may be stored at
the facility:

761.180(a)(2)(ii)(A)

Bulk PCB waste (e.g. in a tanker or truck) _____N/A

a. Its weight in kilograms? ______Yes ______No

b. The first date it was removed from service for disposal? ______Yes
______No

c. The date it was placed into transport for off-site storage or

disposal? ______Yes ______No

d. The date of disposal, if known? ______Yes ______No

761.180(a)(2)(ii)(B)

PCB Articles (e.g. transformer or capacitor) _____N/A

a. The serial number (if available) or other means of identifying each PCB
Article? ______Yes ______No

35
 b. The weight in kilograms of the PCB waste in each PCB Article? ______Yes
______No

c. The date it was removed from service for disposal?

______Yes ______No

d. The date it was placed in transport for off-site storage or disposal?

______Yes ______No

e. The date of disposal, if known? ______Yes ______No

761.180(a)(2)(ii)(C)

PCB Containers _____N/A

a. A unique number identifying each PCB Container?

______Yes ______No

b. A description of the contents of each PCB Container?

______Yes ______No

c. The total weight in kilograms of the material in each PCB Container?

______Yes ______No

d. The first date material was placed in each PCB Container? ______Yes
______No

e. The date each container was placed in transport for off-site storage or
disposal? ______Yes ______No

f. The date of disposal, if known? ______Yes ______No

761.180(a)(2)(ii)(D)

36
 PCB Article Containers _____N/A

a. A unique number identifying each PCB Article Container?

______Yes ______No

b. A description of the contents of each PCB Article Container? ______Yes

______No

c. The total weight in kilograms of the contents of each PCB Article Container?
______Yes ______No

d. The first date a PCB Article was placed into each container? ______Yes
______No

e. The date the container was placed in transport for off-site storage or
disposal? ______Yes ______No

f. The date of disposal, if known? ______Yes ______No

761.180(a)(2)(iii)
7. Does the facility's annual document log contain the total numbers and total weights
(kg.) for the following items:

a. Total number of PCB Articles (by specific type)?

______Yes ______No _____N/A

b. Total weight of PCBs in PCB Articles?

______Yes ______No _____N/A

c. Total number of PCB Article Containers?

______Yes ______No _____N/A

d. Total weight of contents of PCB Article Containers?

37
 ______Yes ______No _____N/A

e. Total number of PCB Containers? ______Yes ______No _____N/A

f. Total weight of contents of PCB Containers?

______Yes ______No _____N/A

g. Total weight of bulk PCB waste that was placed into storage for disposal or
disposed during the calendar year? ______Yes ______No
_____N/A

761.180(a)(2)(iv), (v) & (vi)

8. For PCBs and PCB Items remaining in service at the end of the calendar year, do records
indicate the following:

a. Total number of PCB Transformers?

______Yes ______No _____N/A

b. Total weight (kg) of PCBs in transformers?

______Yes ______No _____N/A

c. Total number of large high or low voltage PCB Capacitors? ______Yes

______No _____N/A

d. Total weight (kg) of PCBs and PCB Items in PCB Containers? ______Yes
______No _____N/A

e. Identification of contents of PCB containers (liquids, capacitors,

etc.)? ______Yes ______No _____N/A

761.180(a)(2)(vii)

38
9. For any PCBs or PCB Items received from or shipped to another facility owned or operated
by the same generator, does the annual document log contain the same information as asked in
Question No. 6?
______Yes ______No _____N/A

761.180(a)(2)(viii)
10. Does the facility's annual document log contain a record of each telephone call (or
other means of verification) made to each commercial storer or disposer to confirm
receipt of PCB waste transported by an independent transporter?
______Yes ______No _____N/A

761.180(a)(2)(ix)
11. Does the facility’s annual document log contain the name, address and telephone number
of the person to whom a PCB item containing >50ppm PCB, excluding small capacitors, has
been distributed in commerce for reuse along with date of transfer and the serial or internal
identification number of the item? _____Yes _____No _____N/A

Skip to next section of checklist

Questions for Disposer ( )/Commercial Storer ( ) Facilities (check appropriate type)

12. Has the facility developed and maintained all annual records and the annual document
log as of July 1, 1991, and each year thereafter? ______Yes ______No

a. Are the annual records and the annual document log prepared on a
calendar year basis? ______Yes ______No

b. Has the facility retained the annual records and the annual document logs
for at least three (3) years after it no longer used or stored PCBs or PCB Items?
______Yes ______No

39
 c. Has the facility prepared and submitted to the EPA Regional
Administrator annual reports by July 15th for each preceding calendar year?
______Yes ______No

13. Where are the records maintained?___________________________

____________________________________________________________

a. How are the records compiled and by whom?______________

_______________________________________________________

_______________________________________________________

761.180(b)(l)(i) & (ii)

14. Do the facility's annual records contain the following:

a. All signed manifests generated or received by the facility

during the calendar year? ______Yes ______No

b. All Certificates of Disposal that have been generated or received by

the facility during the calendar year?
______Yes ______No

c. Records of inspections and clean-ups? _____Yes _____No

761.180(b)(2)(i) & (ii)

15. Does the written annual document log contain the following:

a. The name, address, and EPA identification number of the facility?

______Yes ______No

b. The calendar year covered by the annual document log?

40
 ______Yes ______No

c. The unique manifest number of every manifest generated or received

by the facility during the calendar year and the name and address of the generator?
______Yes ______No

761.180(b)(2)(ii)(A)
16. Does the written annual document log contain the following
information from each manifest and for unmanifested waste that may be stored or disposed of
at the facility:

Bulk PCB waste (e.g. in a tanker or truck) _____N/A

a. Its weight in kilograms? ______Yes ______No

b. The first date it was removed from service for disposal?

______Yes ______No

c. The date it was received at the facility? ______Yes ______No

d. The date it was placed into transport for off-site storage or

disposal? ______Yes ______No

e. The date of disposal, if known? ______Yes ______No

761.180(b)(2)(ii)(B)

PCB Articles (e.g. transformer or capacitor) _____N/A

a. The serial number (if available) or other means of identifying each PCB Article
(not in a PCB Container or PCB Article Container)?
______Yes ______No

41
 b. The weight in kilograms of the PCB waste in each PCB Article? ______Yes
______No

c. The date it was removed from service for disposal?

______Yes ______No

d. The date it was received at the facility? ______Yes ______No

e. The date it was placed in transport for off-site storage or disposal?

______Yes ______No

f. The date of disposal, if known? ______Yes ______No

761.180(b)(2)(ii)(C)

PCB Containers _____N/A

a. A unique number identifying each PCB Container?

______Yes ______No

b. A description of the contents of each PCB Container?

______Yes ______No

c. The total weight in kilograms of the material in each PCB Container?

______Yes ______No

d. The first date material (PCB Waste) placed in each PCB Container was removed
from service for disposal? ______Yes ______No

e. The date it was received at the facility? ______Yes ______No

f. The date each container was placed in transport for off-site

storage or disposal? ______Yes ______No

42
 g. The date of disposal, if known? ______Yes ______No

761.180(b)(2)(ii)(D)

PCB Article Containers _____N/A

a. A unique number identifying each PCB Article Container?

______Yes ______No

b. A description of the contents of each PCB Article Container? ______Yes

______No

c. The total weight in kilograms of the contents (PCB Waste)of each PCB Article
Container? ______Yes ______No

d. The first date a PCB Article placed into each container was removed from
service for disposal? ______Yes ______No

e. The date it was received at the facility? ______Yes ______No

f. The date the container was placed in transport for off-site storage or disposal?
______Yes ______No

g. The date of disposal, if known? ______Yes ______No

17. Does the facility use EPA's "PCB VOLUNTARY FORM FOR THE ANNUAL REPORT" to document the
annual report? ______Yes ______No

43
761.180(b)(3)(i) & (ii)
18. Does the facility's annual report contain the following information:

a. The name, address, and EPA identification number of the facility? ______Yes
______No

b. A list of the numbers of all signed manifests of PCB waste initiated or

received by the facility during the calendar year? ______Yes ______No

761.180(b) (3) (iii), (iv), (v), & (vi)

19. Does the facility's annual report include the total weights and total numbers, by PCB
waste type (bulk, transformers, capacitors, article containers, and containers) in each of
the following categories:

a. In storage at the facility at the beginning of the calendar year? ______Yes

______No

b. Received or generated at the facility during the calendar year? ______Yes

______No

c. Transferred to another facility during the calendar year?

______Yes ______No

d. Disposed of at the facility during the calendar year?

______Yes ______No

e. Remaining in storage for disposal at the facility at the end of the calendar
year? ______Yes ______No

(Refer to EPA's "PCB Voluntary Form For The Annual Report" as a guide to answering this question)

44
Pertinent Comments

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

45
SUBPART K - PCB WASTE DISPOSAL RECORDS AND REPORTS
(40 CFR Part 761.202-761.218)

761.205(c)(2)
20. Is the facility exempt from the EPA notification requirements because it is only a generator
of PCB waste through its use, owning, servicing or processing of PCBs or PCB items but does
not own or operate a designated storage for disposal area subject to the requirements of
§761.65(b) or §761.65(c)(7)? _____Yes _____No

If yes, skip to question 25c

761.202(c)
21. Has the facility engaged in PCB waste handling activities on or prior to February 5, 1990?
_____Yes _____No

761.202
22. Has the facility applied for an EPA identification number?
_____Yes _____No

46
If yes, what was the date of the application and has the ID number been officially issued?
____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

If no, does the facility already have a RCRA identification number?

_____Yes _____No

761.205(b)
If the facility has a RCRA ID number, did it notify EPA of its PCB waste activities by April 4, 1990?
_____Yes _____No

761.205(c)(2)(iii)
23. Has the generator submitted separate notifications to EPA for each PCB storage area it
owns or operates on different sites or properties? _____Yes _____No _____N/A

761.205(f)
24. Has the facility resubmitted a notification form within 30 days from the time that its waste
handling activities changed?
_____Yes _____No _____N/A

25. If the facility did not engage in PCB waste activities until after February 5, 1990
and has not yet received an EPA identification number or if the facility engaged in PCB waste
activities on or before February 5, 1990 but has not applied for an EPA identification number
have any of the following occurred:

761.202(b)(c)&(d)

47
 a. The facility is a generator of PCB waste and processed, stored, transported or
offered for transport or disposed of such PCB waste after June 4, 1990? _____Yes
_____No

761.202(b)(c)&(d)
b. The facility is not a generator of PCB waste but has engaged in transporting,
commercial storage or disposal of such PCB waste after June 4, 1990? _____Yes _____No

761.202(b)(c)&)d)
c. The facility is a generator that offered PCB waste to transporters, commercial
storers, or disposers who have not received an EPA identification number? _____Yes
_____No

761.202(b)(c)&(d)
d. The facility is not a generator of PCB waste but has delivered such waste to a
transporter, commercial storer or a disposer that have not received an EPA identification
number? _____Yes _____No

761.207(a)
26. Has the generator prepared a manifest whenever it ships PCB waste, including drained
PCB contaminated transformers off-site?
_____Yes _____No _____N/A

If No or N/A skip to question 33

761.207(a)
27. Was the manifest prepared on EPA Form 8700-22 with a continuation sheet if necessary?
_____Yes _____No

If no, describe what manifest was used.

____________________________________________________________________________

____________________________________________________________________________

48
____________________________________________________________________________

28. Was the following information specified on the manifest

761.207(a)(1)
a. For each bulk load of PCBs, its identification, the earliest date of removal from
service for disposal and its weight in kilograms?
_____Yes _____No _____N/A

761.207(a)(2)
b. For each PCB container or article container, an identification number, type of PCB
waste, earliest date of removal from service for disposal and its weight in kilograms?
_____Yes _____No _____N/A

761.207(a)(3)
c. For each PCB article, its serial number or other identification, date of removal from
service for disposal and weight in kilograms of its PCB waste? _____Yes _____No
_____N/A

761.207(g)
d. An approved off-site commercial storage or disposal facility for PCB waste? _____Yes
_____No

761.209(a)
29. Did the generator of PCB waste, transporter or the storage or disposal facility retain on
file copies of the appropriate manifests?
_____Yes _____No

761.209(a)
30. Were the manifests properly signed? _____yes _____no

761.208(a)(4)

49
31. Did the generator receive the hand signed manifest within 35 days after the PCB waste was
accepted by the transporter?
_____Yes _____No _____N/A

761.208(a)(4)
If yes, did the generator confirm by telephone or other means (if shipped by an independent
transporter) within a day after receiving the hand-signed manifest that the commercial storer or
disposer actually received the manifested waste? _____Yes _____No _____N/A

761.208(a)(4)
If no, did the generator telephone or communicate by other means first with the commercial storer or
disposer and then, if necessary, with the transporter to determine the status of the PCB waste?
_____Yes _____No _____N/A

761.208(a)(4)
32. If the generator has not received a hand-signed manifest from an EPA approved facility
within 10 days from the date of the telephone call to the transporter, did it submit an
exception report to the EPA Regional Administrator? _____Yes _____No _____N/A

761.211(a)
33. Is there evidence to indicate that either a transporter or a commercial storer or disposer
accepted a shipment of PCB waste after April 4, 1990 without a properly signed manifest?
_____Yes _____No _____N/A

761.211(c)
If yes, describe and state whether an "Unmanifested Waste Report"
was submitted to the EPA Regional Administrator within 15 days after the unmanifested PCB waste was
received.

____________________________________________________________________________

____________________________________________________________________________

50
____________________________________________________________________________

____________________________________________________________________________

761.210(a)
34. Is there evidence to indicate that a significant discrepancy regarding the amount of PCB
waste stated on the manifest occurred?
_____Yes _____No _____N/A

761.210(b)
If yes, describe the discrepancy and attempts to reconcile it, and state whether a letter was
submitted to the EPA Regional Administrator if it is was not resolved within 15 days after the PCB
waste was received

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________
Answer questions 35 and 36 if
the facility is a disposer of PCB waste

761.215(c)(1)&(2)
35. Does the disposer submit to the EPA Regional Administer, no later than 45 days from the
end of the one (1) year storage for disposal date a One-year Exception Report if it receives
PCB or PCB items more than 9 months after they were removed from service for disposal and, it

51
could not dispose of the affected PCBs or PCB items within 1 year of the date of
removal from service for disposal? _____Yes _____No

761.218(a)&(b)
36. Does the disposer prepare a Certificate of Disposal for each shipment of PCB waste that it
accepts and does it send a copy to the generator identified on the manifest within 30 days
of the date that disposal of the PCB waste was completed? _____Yes _____No

Answer question 37 if the facility is a generator or commercial storer of PCB waste

761.215(d)(1)&(2)
37. Does the generator or commercial storer submit to the EPA Regional Administrator, no
later than 45 days, a One-year Exception Report if it transferred PCB or PCB items to the
disposer within 9 months after they were removed from service for disposal and it either has
not received, within 13 months after removal from service for disposal, a Certificate
of Disposal confirming the disposal of the affected PCBs or PCB items or it receives a
Certificate of Disposal confirming disposal more than 1 year after the date of removal from
service? _____Yes _____No

Pertinent Comments

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

52
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

53
 Addendum to PCB Checklist

The following items are not addressed in the checklists but, if the situation warrants, they should be
addressed in the inspection report.

761.20(a)
1. Were any PCBs being used in other than a totally enclosed manner?

761.20(b)
2. Were PCBs being manufactured without an exception?

761.20(c)
3. Were PCBs being processed or distributed in commerce without an exception?

4. Does the facility have any waste oil? If so, collect a sample of it for PCB analysis. Also,
determine whether any waste oil containing detectable concentrations of PCBs are being used as a
sealant, coating or dust control agent.

54
5. If the facility used PCBs in a hydraulic or heat transfer system, collect samples of sludges from
drainage systems near the hydraulic or heat transfer system.

6. If there were any spills or uncontrolled discharges of PCBs in excess of 50 ppm at the facility
were they cleaned up in accordance with spill cleanup policy contained in 40 CFR 761.125?

55