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TREATMENT/DISPOSAL LOCATION FORM NO. MD 14931 - <br /> DRIVER H &S GOCLES OR HARD PROTECTIVE RESPIRATORY <br /> SITE J ' •� ❑ ANN REQUIREMENTS ®FACE SHIELD ❑HAT —RUBBER❑BOOTS —PROTECTIVE <br /> —RESPIRATORY <br /> _POND PROTECTION <br /> STATU'LOI0,'DING- / , ❑ LANDFILL GEAR ®GLOVES ❑OTHER <br /> f <br /> DESIGNATED BY {l�Li REQUIRED FOR WASHOUT: El FACE SHIELD ❑GEAR ❑RUBBER GLOVES <br /> '` � L <br /> GENERATOR ( 'Igo,.�'.l,f'. ; ;,U �, � RATE S <br /> .i O 0 20 40 60 80 100 <br /> TRUCK COMPANY / �h fi �',N L <br /> DENSITY /q GIL ( <br /> y DRIVER 7CL L) V f S <br /> MAr IAL-0ESGgIPnon NORMALITY (Nm) n <br /> /��yw_.j e CONTENTS <br /> METALS <br /> DATE AND TIME SAMPLE RECEIVED CONCENTRATION RATE CONCENTRATION RATE <br /> SAMPLE NO. ' PHENOLS(Pn) II nn PPM NICKEL(Ni) <br /> TIME DISPATCHED 10 LOCATION SULFIDES(SI) /✓:/ PPM LEAD(Pb) <br /> DATE / <�- t�f <br /> CYANIDE(Co) Al I) PPM MERCURY(Hg) <br /> IT JOB NO2 PHASE OIL(04 rR/ '% CADMIUM Cd) <br /> J <br /> PROFIT CENTER ':1[ SOLIDS ISO) •�/ % SELENIUM(Sel <br /> 1 <br /> WASTE STREAM NO. SOLIDS ON �•� <br /> { ' 7 NEUTRALIZATION(S.) % CHROMIUM(Cr) <br /> WASTE MANIFEST NO.rY le (. r /� 0 POLAR(PI) _��D % ARSENIC(AS) <br /> DISPOSAL TYPE T _ L _ <br /> 1/ NONPOLAR(NP) °A THALLIUM(TI) <br /> HAZARDOUS CLASSIFICATION.� N HALOGENATED(Ha) ;ci <br /> PRODUCT CODE <br /> T OTHER CONTENTS OTHER METALS <br /> cl L%C,j o <br /> MB m <br /> DRY TONS OTY. <br /> BASE RATE <br /> COMMENTS: OTHER CHARGES — <br /> y� CC"�"•rJ' ^I PROD.CODE DESCRIPTION U 0 M. OTY. RATE <br /> WASHOUT <br /> l.' <br /> SPEJ WIN <br /> HOLIDAY CALLOUT <br /> CONSISTENCY ODOR ANALYST <br />