FORM R REPORTS

Reference Point/Description	Latitude	Longitude	Collection Method	Accuracy Value
N/A	48.162794	-122.143936	N/A	N/A

RCRA ID NUMBER
WAD053823019

NPDES PERMIT NUMBER
NO DATA

UIC ID NUMBER
NO DATA

To correct the FRS latitude, longitude or program ID values click on the "Report an Error" button in the top right corner of this page. Facilities wishing to correct other data elements with the FORM R or FORM A should refer to the related TRI-MEweb tutorial..

For more information, see Collection of Latitude, Longitude and Program ID Data Has Been Discontinued.

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PART I. FACILITY IDENTIFICATION INFORMATION (FORM R)

DOCUMENT CONTROL NUMBER: 1320218917007

Facility Registry System ID:  110000489999

Section 1. Reporting Year

Reporting Year: 2020

Section 2. Trade Secret Information

2.1 Trade Secret: NO

2.2 Sanitized Copy: Unsanitized

Section 3. Certification

CERTIFYING OFFICIAL'S NAME	CERTIFYING OFFICIAL'S TITLE	CERTIFYING OFFICIAL'S SIGNATURE	DATE SIGNED
ANNA COLWELL	PLANT MANAGER	Electronic	23-JUN-21

Section 4. Facility Identification

TRI Facility ID: 98223JHBXT188ST

4.1 Facility Name and Address.

Facility Information

NAME	STREET	CITY	COUNTY	STATE	ZIP CODE
STELLA-JONES CORP	6520 188TH ST NE	ARLINGTON	SNOHOMISH	WA	98223

BIA Tribal Code	Tribe
NO DATA	NO DATA

Mailing Information

NAME	STREET	CITY	STATE	ZIP CODE
STELLA-JONES CORP	6520 188TH ST NE	ARLINGTON	WA	98223

PROVINCE	COUNTRY (NON - US)
NO DATA	NO DATA

4.2 Facility Classification

ENTIRE FACILITY	PARTIAL FACILITY	FEDERAL FACILITY	GOCO FACILITY
YES	NO	NO	NO

4.3 Technical Contact

Not Available to the Public as this information is only for Intranet.

4.4 Public Contact

NAME	PHONE
ANNA COLWELL	2535723033

4.5 NAICS Codes

NAICS CODE	PRIMARY	NAICS CODE DESCRIPTION
321114	YES	Wood Preservation

4.7 Dun Numbers

DUNS NUMBER
NA

5. Parent Company Information

Parent Company Name: STELLA-JONES US HOLDING CORP

Parent Company DUNS Number: 605929814

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PART II. CHEMICAL - SPECIFIC INFORMATION

DOCUMENT CONTROL NUMBER: 1320218917007

Section 1. Toxic Chemical Identity

1.1 CAS Number: N150       PFAS Indicator: NO
1.2 Toxic Chemical or Chemical Category Name: Dioxin and dioxin-like compounds

1.3 Generic Chemical Name: NA

1.4 Distribution of Each Member of the Dioxin and Dioxin like Compounds Category

NA	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17
NO

Section 2. Mixture Component Identity

2.1 Supplier Provided Generic Chemical Name: NA

Section 3. Activities and Uses of the Toxic Chemical

3.1 Manufacture the Toxic Chemical:

Produce: NO	Import: NO	On-Site Use/Processing: NO
Sale/Distribution: NO	Byproduct: NO	Impurity: NO

3.2 Process the Toxic Chemical:

Reactant: NO

Formulation Component: NO

Article Component: NO

Repackaging: NO

Impurity: YES

Recycling: NO

3.3 Otherwise Use the Toxic Chemical:

Chemical Processing Aid: NO

Manufacturing Aid: NO

Ancillary or Other Use: NO

Section 4. Maximum Amount of the Toxic Chemical Onsite During the Calendar Year

Maximum Chemical Amount: 10000 to 99999

Section 5. Quantity of the Toxic Chemical Entering each Environmental Medium Onsite

5.1 Fugitive or Non-Point Air Emissions

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
NO	0	Grams	O - Other Approaches

5.2 Stack or Point Air Emissions

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
NO	0	Grams	O - Other Approaches

5.3 Discharges to Receiving Streams or Water Bodies

NA	STREAM/WATER BODY NAME	REACH Code	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	% FROM STORMWATER
YES	NA

5.4-5.5 Disposal to Land Onsite

5.4.1 Underground Injection Onsite to Class I Wells.

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.4.2 Underground Injection Onsite to Class II-V Wells.

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5 Disposal to Land Onsite

5.5.1A RCRA Subtitle C Landfills

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.1B Other Landfills

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.2 Land Treatment/Application Farming

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.3A RCRA Subtitle C Surface Impoundments

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.3B Other Surface Impoundments

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.4 Other Disposal

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
NO	.0311	Grams	O - Other Approaches

Optional Waste Rock Piles Information

Section 5.5 quantities include "waste rock piles":	NO
Quantity of "waste rock piles" (pounds/year*):

*For Dioxin and Dioxin-like Compounds, report in grams/year

Section 6. Transfers of the Toxic Chemical in Wastes to Off-Site Locations

6.1 Discharges to Publicly Owned Treatment Works (POTWs)

1 - NAME:	ADDRESS:
CITY:	STATE:
COUNTY:	ZIP CODE:

POTW AMOUNT SEQUENCE	TOTAL TRANSFERS (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	WASTE MANAGEMENT TYPE
NO DATA	NO DATA		NO DATA	NO DATA

6.2 Transfers to other Off-Site Locations

1 RCRA Number: UTD981552177	Parent Company Controlled: NO
Name: CLEAN HARBORS ARAGONITE, LLC	Address: 11600 N APTUS ROAD
City: ARAGONITE	State: UT
County: TOOELE	Zip Code: 84029
Country Code (Non - US):	Province:

OFFSITE AMOUNT SEQUENCE	TOTAL TRANSFERS (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	WASTE MANAGEMENT TYPE
1	.0003	Grams	O - Other Approaches	M50 - Incineration/Thermal Treatment

Section 7A. On-Site Waste Treatment Methods and Efficiency

7A.1a. Waste Stream: WASTEWATER

7A.1b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H124 - Phase separation
2	H103 - Absorption
3	H082 - Adsorption
4	H122 - Evaporation

7A.1d. Waste Treatment Efficiency Estimate: Greater than 95% but less than or equal to 99%

7A.2a. Waste Stream: WASTEWATER

7A.2b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H101 - Sludge treatment and/or dewatering
2	H123 - Settling or clarification
3	H103 - Absorption
4	H082 - Adsorption

7A.2d. Waste Treatment Efficiency Estimate: Greater than 99.9999%

7A.3a. Waste Stream: WASTEWATER

7A.3b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H101 - Sludge treatment and/or dewatering
2	H123 - Settling or clarification
3	H103 - Absorption
4	H082 - Adsorption

7A.3d. Waste Treatment Efficiency Estimate: Greater than 99.9999%

Section 7B. On-Site Energy Recovery Processes

ON SITE ENERGY RECOVERY PROCESSES
NA

Section 7C. On-Site Recycling Processes

ON SITE RECYCLING PROCESSES
H39 - Other recovery or reclamation for reuse (including acid regeneration or other chemical reaction proc

Section 8. Source Reduction and Recycling Activities

SECTION	TYPE OF QUANTITY	UNITS	PRIOR YEAR	CURRENT REPORTING YEAR	FOLLOWING YEAR	SECOND FOLLOWING YEAR
8.1a	Total on-site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills		NA	NA	NA	NA
8.1b	Total other on-site disposal or other releases	Grams	0	.0311	.01	.01
8.1c	Total off-site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills		NA	NA	NA	NA
8.1d	Total other off-site disposal or other releases		NA	NA	NA	NA
8.2	Quantity Used for Energy Recovery Onsite		NA	NA	NA	NA
8.3	Quantity Used for Energy Recovery Offsite	Grams	.1012	NA	NA	NA
8.4	Quantity Recycled Onsite	Grams	545.2649	481.0018	480	480
8.5	Quantity Recycled Offsite		NA	NA	NA	NA
8.6	Quantity Treated Onsite		NA	NA	NA	NA
8.7	Quantity Treated Offsite	Grams	.5978	.0003	.0003	.0003

8.8 One-Time Event Release: NA

8.9 Production Ratio   or   Activity Ratio : 1.12

8.10 Source Reduction Activities

SOURCE REDUCTION ACTIVITIES	METHOD 1	METHOD 2	METHOD 3	ESTIMATED ANNUAL REDUCTION
NA

8.11 Additional Data Indicator: NO

No Data Found

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FORM R Schedule 1

PART II. CHEMICAL - SPECIFIC INFORMATION

DOCUMENT CONTROL NUMBER: 1320218917007

SECTION 5. QUANTITY OF DIOXIN AND DIOXIN-LIKE COMPOUNDS ENTERING EACH ENVIRONMENTAL ENVIRONMENTAL_MEDIUM ONSITE

D. Mass (grams) of Each Compound in the Category (1-17)	5.1	NA		5.2	NA		5.3 Discharges to receiving streams or water bodies
	Fugitive or Non- Point Air Emissions			Stack or point air emissions			5.3.1	5.3.2	5.3.3
1	0			0
2	0			0
3	0			0
4	0			0
5	0			0
6	0			0
7	0			0
8	0			0
9	0			0
10	0			0
11	0			0
12	0			0
13	0			0
14	0			0
15	0			0
16	0			0
17	0			0

C. Mass (grams) of Each Compound in the Category (1-17)	5.4 Underground Injection						5.5 Disposal to land onsite
	5.4.1	NA	Yes	5.4.2	NA	Yes	5.5.1A	NA	Yes	5.5.1B	NA	Yes	5.5.2	NA	Yes	5.5.3A	NA	Yes	5.5.3B	NA	Yes	5.5.4	NA
	Underground Injection onsite to Class I Wells			Underground Injection onsite to Class II-V Wells			RCRA Subtitle C landfills			Other landfills			Land treatment/ application farming			RCRA Subtitle C surface impoundments			Other surface impoundments			Other disposal
1																						0
2																						0
3																						0
4																						.0002
5																						0
6																						.004
7																						.0047
8																						0
9																						0
10																						0
11																						0
12																						0
13																						0
14																						0
15																						.0017
16																						0
17																						.0205

SECTION 6. TRANSFERS OF DIOXIN AND DIOXIN-LIKE COMPOUNDS IN WASTES TO OFF-SITE LOCATIONS

6.1 DISCHARGES TO PUBLICLY OWNED TREATMENT WORKS (POTWs)
6.1.A.3 Mass (grams) of Each Compound in the Category (1-17)
1	No Data	2	No Data	3	No Data	4	No Data	5	No Data	6	No Data	7	No Data	8	No Data	9	No Data
10	No Data	11	No Data	12	No Data	13	No Data	14	No Data	15	No Data	16	No Data	17	No Data

6.2 TRANSFERS TO OTHER OFF-SITE LOCATIONS
6.2.1	D.Mass(grams) of Each Compound in the Category (1-17)
1.
	1	0	2	0	3	0	4	0	5	0	6	0	7	.0001	8	0	9	0
	10	0	11	0	12	0	13	0	14	0	15	0	16	0	17	.0002

SECTION 8. SOURCE REDUCTION AND RECYCLING ACTIVITIES FOR DIOXIN AND DIOXIN-LIKE COMPOUNDS

Column F. Mass (grams) of Each Compound in the Category (1-17)	8.1a Total onsite disposal to Class 1 Underground Injection Wells, RCRA Subtitle C landfills , and other landfills	8.1b Total other onsite disposal and other releases	8.1c Total offsite disposal to Class 1 Underground Injection Wells, RCRA Subtitle C landfills, and other landfills	8.1d Total other offsite disposal and other releases	8.2 Quantity used for energy recovery onsite	8.3 Quantity used for energy recovery offsite	8.4 Quantity recycled onsite	8.5 Quantity recycled offsite	8.6 Quantity treated onsite	8.7 Quantity treated offsite	8.8 Quantity released to the environment as a result of remedial actions, catastrophic events, or one-time events not associated with production processes
1		0					0			0
2		0					.0002			0
3		0					.0017			0
4		.0002					.3154			0
5		0					.0583			0
6		.004					13.2362			0
7		.0047					100.4486			.0001
8		0					0			0
9		0					.0002			0
10		0					.0002			0
11		0					.1817			0
12		0					.0209			0
13		0					.2195			0
14		0					.029			0
15		.0017					21.618			0
16		0					1.6148			0
17		.0205					343.2571			.0002

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Dioxin Toxic Equivalents (TEQ) Calculations

Dioxin and Dioxin-like Compounds TEQ Calculations

Form Section	Total (grams)	TEQ (grams)
Section 5.1	0	0
Section 5.2	0	0
Section 5.3.1
Section 5.4.1
Section 5.4.2
Section 5.5.1A
Section 5.5.1B
Section 5.5.2
Section 5.5.3A
Section 5.5.3B
Section 5.5.4	.0311	.0000846
Section 6.1.A.3.1		0
Section 6.2.1	.0003	.0000001
Section 8.1A
Section 8.1B	.0311	.0000846
Section 8.1C
Section 8.1D
Section 8.2
Section 8.3
Section 8.4	481.0018	.5807177
Section 8.5
Section 8.6
Section 8.7	.0003	.0000001
Section 8.8

PART I. FACILITY IDENTIFICATION INFORMATION (FORM R)

DOCUMENT CONTROL NUMBER: 1320218917019

Facility Registry System ID:  110000489999

Section 1. Reporting Year

Reporting Year: 2020

Section 2. Trade Secret Information

2.1 Trade Secret: NO

2.2 Sanitized Copy: Unsanitized

Section 3. Certification

CERTIFYING OFFICIAL'S NAME	CERTIFYING OFFICIAL'S TITLE	CERTIFYING OFFICIAL'S SIGNATURE	DATE SIGNED
ANNA COLWELL	PLANT MANAGER	Electronic	23-JUN-21

Section 4. Facility Identification

TRI Facility ID: 98223JHBXT188ST

4.1 Facility Name and Address.

Facility Information

NAME	STREET	CITY	COUNTY	STATE	ZIP CODE
STELLA-JONES CORP	6520 188TH ST NE	ARLINGTON	SNOHOMISH	WA	98223

BIA Tribal Code	Tribe
NO DATA	NO DATA

Mailing Information

NAME	STREET	CITY	STATE	ZIP CODE
STELLA-JONES CORP	6520 188TH ST NE	ARLINGTON	WA	98223

PROVINCE	COUNTRY (NON - US)
NO DATA	NO DATA

4.2 Facility Classification

ENTIRE FACILITY	PARTIAL FACILITY	FEDERAL FACILITY	GOCO FACILITY
YES	NO	NO	NO

4.3 Technical Contact

Not Available to the Public as this information is only for Intranet.

4.4 Public Contact

NAME	PHONE
ANNA COLWELL	2535723033

4.5 NAICS Codes

NAICS CODE	PRIMARY	NAICS CODE DESCRIPTION
321114	YES	Wood Preservation

4.7 Dun Numbers

DUNS NUMBER
NA

5. Parent Company Information

Parent Company Name: STELLA-JONES US HOLDING CORP

Parent Company DUNS Number: 605929814

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PART II. CHEMICAL - SPECIFIC INFORMATION

DOCUMENT CONTROL NUMBER: 1320218917019

Section 1. Toxic Chemical Identity

1.1 CAS Number: 87-86-5       PFAS Indicator: NO
1.2 Toxic Chemical or Chemical Category Name: Pentachlorophenol

1.3 Generic Chemical Name: NA

1.4 Distribution of Each Member of the Dioxin and Dioxin like Compounds Category

NA	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17
NO

Section 2. Mixture Component Identity

2.1 Supplier Provided Generic Chemical Name: NA

Section 3. Activities and Uses of the Toxic Chemical

3.1 Manufacture the Toxic Chemical:

Produce: NO	Import: NO	On-Site Use/Processing: NO
Sale/Distribution: NO	Byproduct: NO	Impurity: NO

3.2 Process the Toxic Chemical:

Reactant: NO

Formulation Component: NO

Article Component: YES

Repackaging: NO

Impurity: NO

Recycling: NO

3.3 Otherwise Use the Toxic Chemical:

Chemical Processing Aid: NO

Manufacturing Aid: NO

Ancillary or Other Use: NO

Section 4. Maximum Amount of the Toxic Chemical Onsite During the Calendar Year

Maximum Chemical Amount: 10000 to 99999

Section 5. Quantity of the Toxic Chemical Entering each Environmental Medium Onsite

5.1 Fugitive or Non-Point Air Emissions

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
NO	3	Pounds	O - Other Approaches

5.2 Stack or Point Air Emissions

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
NO	1	Pounds	O - Other Approaches

5.3 Discharges to Receiving Streams or Water Bodies

NA	STREAM/WATER BODY NAME	REACH Code	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	% FROM STORMWATER
YES	NA

5.4-5.5 Disposal to Land Onsite

5.4.1 Underground Injection Onsite to Class I Wells.

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.4.2 Underground Injection Onsite to Class II-V Wells.

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5 Disposal to Land Onsite

5.5.1A RCRA Subtitle C Landfills

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.1B Other Landfills

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.2 Land Treatment/Application Farming

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.3A RCRA Subtitle C Surface Impoundments

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.3B Other Surface Impoundments

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.4 Other Disposal

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

Optional Waste Rock Piles Information

Section 5.5 quantities include "waste rock piles":	NO
Quantity of "waste rock piles" (pounds/year*):

*For Dioxin and Dioxin-like Compounds, report in grams/year

Section 6. Transfers of the Toxic Chemical in Wastes to Off-Site Locations

6.1 Discharges to Publicly Owned Treatment Works (POTWs)

1 - NAME:	ADDRESS:
CITY:	STATE:
COUNTY:	ZIP CODE:

POTW AMOUNT SEQUENCE	TOTAL TRANSFERS (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	WASTE MANAGEMENT TYPE
NO DATA	NO DATA		NO DATA	NO DATA

6.2 Transfers to other Off-Site Locations

1 RCRA Number: UTD981552177	Parent Company Controlled: NO
Name: CLEAN HARBORS ARAGONITE, LLC	Address: 11600 N APTUS ROAD
City: ARAGONITE	State: UT
County: TOOELE	Zip Code: 84029
Country Code (Non - US):	Province:

OFFSITE AMOUNT SEQUENCE	TOTAL TRANSFERS (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	WASTE MANAGEMENT TYPE
1	0	Pounds	O - Other Approaches	M50 - Incineration/Thermal Treatment

Section 7A. On-Site Waste Treatment Methods and Efficiency

7A.1a. Waste Stream: WASTEWATER

7A.1b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H124 - Phase separation
2	H103 - Absorption
3	H082 - Adsorption
4	H122 - Evaporation

7A.1d. Waste Treatment Efficiency Estimate: Greater than 95% but less than or equal to 99%

7A.2a. Waste Stream: WASTEWATER

7A.2b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H101 - Sludge treatment and/or dewatering
2	H123 - Settling or clarification
3	H103 - Absorption
4	H082 - Adsorption

7A.2d. Waste Treatment Efficiency Estimate: Greater than 99.9999%

7A.3a. Waste Stream: WASTEWATER

7A.3b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H101 - Sludge treatment and/or dewatering
2	H123 - Settling or clarification
3	H103 - Absorption
4	H082 - Adsorption

7A.3d. Waste Treatment Efficiency Estimate: Greater than 99.9999%

Section 7B. On-Site Energy Recovery Processes

ON SITE ENERGY RECOVERY PROCESSES
NA

Section 7C. On-Site Recycling Processes

ON SITE RECYCLING PROCESSES
H39 - Other recovery or reclamation for reuse (including acid regeneration or other chemical reaction proc

Section 8. Source Reduction and Recycling Activities

SECTION	TYPE OF QUANTITY	UNITS	PRIOR YEAR	CURRENT REPORTING YEAR	FOLLOWING YEAR	SECOND FOLLOWING YEAR
8.1a	Total on-site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills		NA	NA	NA	NA
8.1b	Total other on-site disposal or other releases	Pounds	0	4	4	4
8.1c	Total off-site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills		NA	NA	NA	NA
8.1d	Total other off-site disposal or other releases		NA	NA	NA	NA
8.2	Quantity Used for Energy Recovery Onsite		NA	NA	NA	NA
8.3	Quantity Used for Energy Recovery Offsite	Pounds	1	NA	NA	NA
8.4	Quantity Recycled Onsite	Pounds	3149	2778	2800	2800
8.5	Quantity Recycled Offsite		NA	NA	NA	NA
8.6	Quantity Treated Onsite		NA	NA	NA	NA
8.7	Quantity Treated Offsite	Pounds	3	0	0	0

8.8 One-Time Event Release: NA

8.9 Production Ratio   or   Activity Ratio : 1.12

8.10 Source Reduction Activities

SOURCE REDUCTION ACTIVITIES	METHOD 1	METHOD 2	METHOD 3	ESTIMATED ANNUAL REDUCTION
NA

8.11 Additional Data Indicator: NO

No Data Found

9.1 Miscellaneous, Additional or Optional Information regarding the Form R submission

COMMENT TYPE	DESCRIPTION	COMMENT TEXT
PE119	You have reported 0 lbs transferred off-site.	Error Reviewed / No Comment.

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PART I. FACILITY IDENTIFICATION INFORMATION (FORM R)

DOCUMENT CONTROL NUMBER: 1320218917021

Facility Registry System ID:  110000489999

Section 1. Reporting Year

Reporting Year: 2020

Section 2. Trade Secret Information

2.1 Trade Secret: NO

2.2 Sanitized Copy: Unsanitized

Section 3. Certification

CERTIFYING OFFICIAL'S NAME	CERTIFYING OFFICIAL'S TITLE	CERTIFYING OFFICIAL'S SIGNATURE	DATE SIGNED
ANNA COLWELL	PLANT MANAGER	Electronic	23-JUN-21

Section 4. Facility Identification

TRI Facility ID: 98223JHBXT188ST

4.1 Facility Name and Address.

Facility Information

NAME	STREET	CITY	COUNTY	STATE	ZIP CODE
STELLA-JONES CORP	6520 188TH ST NE	ARLINGTON	SNOHOMISH	WA	98223

BIA Tribal Code	Tribe
NO DATA	NO DATA

Mailing Information

NAME	STREET	CITY	STATE	ZIP CODE
STELLA-JONES CORP	6520 188TH ST NE	ARLINGTON	WA	98223

PROVINCE	COUNTRY (NON - US)
NO DATA	NO DATA

4.2 Facility Classification

ENTIRE FACILITY	PARTIAL FACILITY	FEDERAL FACILITY	GOCO FACILITY
YES	NO	NO	NO

4.3 Technical Contact

Not Available to the Public as this information is only for Intranet.

4.4 Public Contact

NAME	PHONE
ANNA COLWELL	2535723033

4.5 NAICS Codes

NAICS CODE	PRIMARY	NAICS CODE DESCRIPTION
321114	YES	Wood Preservation

4.7 Dun Numbers

DUNS NUMBER
NA

5. Parent Company Information

Parent Company Name: STELLA-JONES US HOLDING CORP

Parent Company DUNS Number: 605929814

---

PART II. CHEMICAL - SPECIFIC INFORMATION

DOCUMENT CONTROL NUMBER: 1320218917021

Section 1. Toxic Chemical Identity

1.1 CAS Number: N590       PFAS Indicator: NO
1.2 Toxic Chemical or Chemical Category Name: Polycyclic aromatic compounds

1.3 Generic Chemical Name: NA

1.4 Distribution of Each Member of the Dioxin and Dioxin like Compounds Category

NA	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17
NO

Section 2. Mixture Component Identity

2.1 Supplier Provided Generic Chemical Name: NA

Section 3. Activities and Uses of the Toxic Chemical

3.1 Manufacture the Toxic Chemical:

Produce: NO	Import: NO	On-Site Use/Processing: NO
Sale/Distribution: NO	Byproduct: NO	Impurity: NO

3.2 Process the Toxic Chemical:

Reactant: NO

Formulation Component: NO

Article Component: YES

Repackaging: NO

Impurity: NO

Recycling: NO

3.3 Otherwise Use the Toxic Chemical:

Chemical Processing Aid: NO

Manufacturing Aid: NO

Ancillary or Other Use: NO

Section 4. Maximum Amount of the Toxic Chemical Onsite During the Calendar Year

Maximum Chemical Amount: 0 to 99

Section 5. Quantity of the Toxic Chemical Entering each Environmental Medium Onsite

5.1 Fugitive or Non-Point Air Emissions

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
NO	.1	Pounds	O - Other Approaches

5.2 Stack or Point Air Emissions

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
NO	0	Pounds	O - Other Approaches

5.3 Discharges to Receiving Streams or Water Bodies

NA	STREAM/WATER BODY NAME	REACH Code	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	% FROM STORMWATER
YES	NA

5.4-5.5 Disposal to Land Onsite

5.4.1 Underground Injection Onsite to Class I Wells.

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.4.2 Underground Injection Onsite to Class II-V Wells.

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5 Disposal to Land Onsite

5.5.1A RCRA Subtitle C Landfills

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.1B Other Landfills

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.2 Land Treatment/Application Farming

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.3A RCRA Subtitle C Surface Impoundments

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.3B Other Surface Impoundments

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

5.5.4 Other Disposal

NA	TOTAL RELEASE (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE
YES

Optional Waste Rock Piles Information

Section 5.5 quantities include "waste rock piles":	NO
Quantity of "waste rock piles" (pounds/year*):

*For Dioxin and Dioxin-like Compounds, report in grams/year

Section 6. Transfers of the Toxic Chemical in Wastes to Off-Site Locations

6.1 Discharges to Publicly Owned Treatment Works (POTWs)

1 - NAME:	ADDRESS:
CITY:	STATE:
COUNTY:	ZIP CODE:

POTW AMOUNT SEQUENCE	TOTAL TRANSFERS (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	WASTE MANAGEMENT TYPE
NO DATA	NO DATA		NO DATA	NO DATA

6.2 Transfers to other Off-Site Locations

1 RCRA Number: UTD981552177	Parent Company Controlled: NO
Name: CLEAN HARBORS ARAGONITE, LLC	Address: 11600 N APTUS ROAD
City: ARAGONITE	State: UT
County: TOOELE	Zip Code: 84029
Country Code (Non - US):	Province:

OFFSITE AMOUNT SEQUENCE	TOTAL TRANSFERS (per year)	UNIT OF MEASURE	BASIS OF ESTIMATE	WASTE MANAGEMENT TYPE
1	0	Pounds	O - Other Approaches	M50 - Incineration/Thermal Treatment

Section 7A. On-Site Waste Treatment Methods and Efficiency

7A.1a. Waste Stream: WASTEWATER

7A.1b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H124 - Phase separation
2	H103 - Absorption
3	H082 - Adsorption
4	H122 - Evaporation

7A.1d. Waste Treatment Efficiency Estimate: Greater than 95% but less than or equal to 99%

7A.2a. Waste Stream: WASTEWATER

7A.2b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H101 - Sludge treatment and/or dewatering
2	H123 - Settling or clarification
3	H103 - Absorption
4	H082 - Adsorption

7A.2d. Waste Treatment Efficiency Estimate: Greater than 99.9999%

7A.3a. Waste Stream: WASTEWATER

7A.3b.	WASTE TREATMENT METHOD(S) SEQUENCE
1	H101 - Sludge treatment and/or dewatering
2	H123 - Settling or clarification
3	H103 - Absorption
4	H082 - Adsorption

7A.3d. Waste Treatment Efficiency Estimate: Greater than 99.9999%

Section 7B. On-Site Energy Recovery Processes

ON SITE ENERGY RECOVERY PROCESSES
NA

Section 7C. On-Site Recycling Processes

ON SITE RECYCLING PROCESSES
H39 - Other recovery or reclamation for reuse (including acid regeneration or other chemical reaction proc

Section 8. Source Reduction and Recycling Activities

SECTION	TYPE OF QUANTITY	UNITS	PRIOR YEAR	CURRENT REPORTING YEAR	FOLLOWING YEAR	SECOND FOLLOWING YEAR
8.1a	Total on-site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills		NA	NA	NA	NA
8.1b	Total other on-site disposal or other releases	Pounds	0	.1	.1	.1
8.1c	Total off-site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills		NA	NA	NA	NA
8.1d	Total other off-site disposal or other releases		NA	NA	NA	NA
8.2	Quantity Used for Energy Recovery Onsite		NA	NA	NA	NA
8.3	Quantity Used for Energy Recovery Offsite	Pounds	0	NA	NA	NA
8.4	Quantity Recycled Onsite	Pounds	2.5	2.2	2.2	2.2
8.5	Quantity Recycled Offsite		NA	NA	NA	NA
8.6	Quantity Treated Onsite		NA	NA	NA	NA
8.7	Quantity Treated Offsite	Pounds	0	0	0	0

8.8 One-Time Event Release: NA

8.9 Production Ratio   or   Activity Ratio : 1.12

8.10 Source Reduction Activities

SOURCE REDUCTION ACTIVITIES	METHOD 1	METHOD 2	METHOD 3	ESTIMATED ANNUAL REDUCTION
NA

8.11 Additional Data Indicator: NO

No Data Found

9.1 Miscellaneous, Additional or Optional Information regarding the Form R submission

COMMENT TYPE	DESCRIPTION	COMMENT TEXT
PE119	You have reported 0 lbs transferred off-site.	Error Reviewed / No Comment.

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