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Mar. 5. 2015 9:56AM RGE W LOWRY, INC • No. 7452 P. 1 <br /> 08-01-'13 13:29.Ff3O Nes'Environmental 661-322-8883 T-052 P00k/9915 F'-066 <br /> Qe lenno /' Kerdvo=nRECEIVE® <br /> DEMENNQ/KERDOON'S l�kRATORY.IS.CERTIFIED BY.THE CALIFORNIA DEPARTMENT OF HEALTH APR 08 ZOIS <br /> SERVICES EVVIRONMEWALIABORATORY.ACCREDITATION`PROGRAM•(.EEAP): CERT 8A <br /> # 37 <br /> ..0i ERAT:OR,! . WASTE P.ROF'ILE :'W' <br /> M:(. <br /> . . AFNT <br /> .GENERATOR'S'INFORMATIOJ • r <br /> A. GENERATOR'S' NAME AuLc 4A," 'fir, iL S. EPA ID66030r77__ <br /> C. GENERATOR'S ADDRESS `'1371 S:.6&4e D. PHONE (24 46cL^FJM <br /> E: CITY'STATE,ZIP' /� <br /> =• F,. GENERATOR CONTACT G. TITLE <br /> COLES ENVIRONMENTAL <br /> J. TRANSPORTER-NAME Coles Environmental K, PHONE( ) 6611322-8256 <br /> L. TRANSPORTER EPA ID# CAL 000 266 462 M. CONTACT Mary Miller <br /> A. NAME OF WASTE PAIWO Lm-le Aff 4& JL1 � r !ifiti <br /> R- CALIFORNIA-HAZARDOUS WASTE CODE NO._ 3 <br /> C. EPA HAZARDOUS WASTE CODE N0. <br /> D. DESCRIBE PROCESS GENERATING WASTE a <br /> IS THIS WASTE REGULATED UNDER THE BEtgZENE N HAP RULES9 yes no • <br /> E. DOES THIS`WASTE CONTAIN;P.CB'S? yes Fv(l .no <br /> F. DOES THIS WASTE CONTAIN DIOXIN?(F020-F028) yes no <br /> G. DOES THIS WASTE CONTAINSULFIDES OR CYANIDES? yes �_00 <br /> H: DOES THIB'WA.STE CONTAIN PESTICIDES OR HERBiCI[)ES? yes �_no <br /> (IFYES;IDENTIFY.IN ITEMS AOR P'ABOVE.) <br /> I. DOES THIS WASTE:CONTAIN:SOLVENTS? ] yes no <br /> (IF'YS% IDENTIFY:IN ITEMS.A OR D ABOVE:) ; <br /> J, DOES THIS WASTE CONTAIN PLATING WASTE? yes no <br /> K. HAS THIS:WASTE BEEN MIXED WITH'RCRA.LISTED WASTE? I--� <br /> IF, K, U OR P EPA WASTE•CODES) -!!- yes _no <br /> L.. IF YOU HAVE MSDS FOR COMPONENTS IN THIS WASTE, <br /> -- - -- -PLEASE-'ATTACH-:--.Y.-:r.:...-...... <br /> .........................:...............::—:-.-.—:MSDS'AITACHE.D'I�:--- ----- <br /> M. IF YOU HAVE..CURRENT ANALYSIS OFTHIS' <br /> WASTE, PLEASE.ATTACH '. ...........................................may . , , . CHEMICAL ANALYSIS ATTACHED ❑ <br /> N. PACKAGING/VOLUME �BULK LIQUID DRUMS,In OTHER, Cl AMOUNT�� <br /> GALLONS [:] LBS. E] CUBIC YARDS PER: E]DAY 0 MONTH []QUARTER m YEAR <br /> GENERATOR'S CERTIFICATION <br /> 1 HEREBY CERTIFY THAT THE INPORMATION PROVIDEO ON THIS DOCUMENT 16 TRUE AND ACCURATE,AND NO INTENTIONAL MIS• <br /> REPR6SEWATION HAS BEEN COMMITTED BY ANYONE.I FURYHEI9 CERTIFY THAT ANY SAMPLE(S)PROVIDED WITH THIS WASTE <br /> PROFILE WERE TAKEN AND PRESERVED IN ACCORDANCE WITH 40-CFR'251,APPENDIX 1 AND ARE.A000RATE AND REPRESEN- <br /> TATIVE OF MV ACTUAL WASTE STREAM. I HEREBY AGREE'TO NOTIFY DEMENNO I KERDOON.SHOULD THIS WASTE STREAM <br /> / CHANGE IN ANY WAY. <br /> \ AUTHORIZED SIGNATURE —DATE <br /> PRINT NAME AND TITLE COLIN KELLY. .(Agent for Customer) _ <br /> 9 Is benzene waste from a chemical man curing, e by-product recovery,or <br /> FORM NO. 1001 REV.4.15.08,5.25.10 __.._i�..... -_n__-- --._— .__ 171 M <br />