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Hazardous Waste Managerrm ilt I-INddi" Waste Generator Services Fingerprint Verification Analysis Checklist General Information Date submitted: b- 14 - OS WDR #: Z 31 Item #: COC # (if applicable): 00 106 PIW# (if a licable): Generator: ,-,, n+ tr U HWM Field Technician: Et, t t,�JMn Bldg./Room: RMMA ❑ Yes No WEF # (if a licabl ): fjIN WEF annual verification: ❑ Yes No PKE # (if applicable): Conditional Profile ❑ WA ❑ Total solids I Field Operations I Complete applicable tests, as indicated P F N/A (P = Pass, F = Fail, N/A = Not Applicable) ❑ Waste Form: ❑ Solid Liquid (® AQ ❑ NAL) ❑ Sludge (estimated free liquid content range ) ✓✓'' El Gas El Sediment (:5 5% solids) Additional info. (e.., powder, granular, particle size?): ❑ ❑ I Odor: S1 No ❑ Yes, Explain: ❑ ❑ I If liquid, from top to bottom including non-li uid layers: ❑ I Oil & Grease Layer Percentage S=Solid L --Liquid % volume Color light, medium, dark Turbidity Viscosity clear, cloudy, opaque ve It, It, med, heavy ❑ I Oxidizer screen I ❑ SN L L' ` -v v..--� A r ❑ Total solids 2 ❑ L S (J i LL h(il YV W+— ❑ Water compatibility ❑ Other: 3 JE1S❑L El Copper Lead Molybdenum-- - ❑ KI ❑ ❑ Container contents match WDR: Identity -M Yes ❑ No Quantit /Wei ht[Volum Yes ❑ No Container Si Yes ❑ No ❑ ❑ Waste container label matches WDR and container contents Yes ❑ No [3 EIN I Packing orsorbant material present E]Yes E]No (If yes, what type quantity ElH ❑ Meter pH ❑ Paper (Possible interference: ) EIJEM I Alcohol Hydrometer test % Alcohol 1:111:119 1 Peroxide test m Stabilized with H dr uinone ❑ Yes ❑ No Final Peroxide ppm ❑ EJU I Oxidizer test ❑ Positive ❑ Negative ❑ JE1 N I Cyanide test ❑ Positive ❑ Negative ❑ JEJ IV I Sulfide test ❑ Positi ❑ Negative Field verification performed by: Emp. #: 13 00� Date: Field verification Pass ❑ Fail -� if failure, complete back of form (Comments/Resolutions) _ __- Fingerprint Verification Laboratory Check all applicable tests and document results on WGS Verification Results Report - ❑ Rad. screening ❑ I Cyanide test ❑ I Solubility ❑ pH ❑ I Oil & Grease ❑ I Specific Gravity- ❑ Normality ❑ I Oxidizer screen _ ❑ Sulfide test ❑ Flash point ❑ Paint filter ❑ Total solids ❑ Solvent screen: ❑ PCBs ❑ I Peroxide test ❑ Water compatibility ❑ Other: Metals: ❑ Arsenic ❑ Barium ❑ Nickel ❑ Selenium E] Cadmium ❑ Chromium ❑Cobalt ❑ Silver ❑ Zinc El Copper Lead Molybdenum-- - ❑ Other Elements, Anions; ❑ Bromine ❑ Chloride 0 Chlor' e ❑ Cyanide ❑ Fluoride ❑ Nitrate Lj Sulfate - Lab verification performed by: Emp. #: C"O L Date: Conditional Profile selected: WEF# Lab verification Wass ❑ Fail —> if failure, complete back of form (Comments[ResQlt�-Uo4s) WGSjorm 0006 (2/00) Page t