The U.S. Environmental Protection Agency (EPA), Region 6 and National Enforcement Investigations Center (NEIC) conducted an inspection at Columbia Medical City of Lewisville, Lewisville, TX, on December 10 and 11, 2018. Medical City of Lewisville (MCL) is a general medical hospital providing a variety of medical services, including an emergency room, cancer treatment, labor and delivery, surgery, and rehabilitation services. During the inspection EPA observed waste management operations and reviewed facility records. The investigation identified four violations: Section 3010 of RCRA (Notification); 40 CFR Part 26234(a); 40 CFR Part 265.174, and 40 CFR 273.14. On February 24, 2020, EPA Region 6 issued a Consent Agreement and Final Order (CAFO) under its authority pursuant to the Resource Conservation and Recovery Act (RCRA) to Columbia Medical City of Lewisville. The CAFO requires MCL to pay a civil penalty of $77,459 and certify to their return to compliance.