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Please petit of type wah ELI E typo(12 chars per inch) in the unshaded areas only �!W°1 M'P''ovod. OMB No.20'.L 00.'9 Egva,in n.ci
<br /> GSANo 02 a EPA-0r
<br /> ID - For Official Uae 0
<br /> Vlll. Type of Regulated Waste ActivHy6''d&00d d boxes, hefer to Instiuctlons.)
<br /> A. H ' 'Vlttl x.
<br /> ,f �. c 1;/..oP•v.}`� a.�:� 't`d 4 � B.Used 01 Flle�Ac1IVNIe6`1""ra'T r7.
<br /> 1. Generator(See Instrvctipne} '
<br /> ,$corer Olspo'W at inslaliatlon) _ 1 OB-Spectacation Used Oq Arun -••�'.
<br /> ❑ a. Greater then 1000kg/mo(2, dgk,a) � (• tr 66"A porinit id tar{dlred hi
<br /> ❑ �f4y r1 a" 5*.�.y� "is � : ❑ d Generator MArketiod to Bufrrerr';
<br /> X b. 100 to 1000 kg/mo(220 2,2011 Nrs) "t}4Ptt.� a� q,,,`I � fy'', ❑ b. Other Markerer
<br /> ❑ c. Less than 100 kglrno(2211 { ,i Ort azaNdJe(fi86te reel „. r y
<br /> .. + e pQ� it
<br /> 2.
<br /> , „� �tirketing m t}umer ❑ c. sumer Indlrate davlCaia) ''
<br /> 2. Transporter(Indloate M de In 1-t> cy 1'u Y ^"aa��arKatere Y, 1,:. ype of Combue pevfce, 'P
<br /> ❑ a. For own waste otJy , C7 '~1, t=f '� n `'+Is ,i >•. 4 smt - El1. utility Boller ti fig,
<br /> ❑ b. For comrryetl AI 0115osAs List ❑ ,(IM
<br /> Mode of T p�,, A: 1� �� w
<br /> ❑ 1. Air rl'rS tY �. ' I� 4 { +r'�� - t---4 3 kxlusMel Fumaos 4 {a
<br /> ❑ '
<br /> 'N4ti s
<br /> Se
<br /> 2. Rail t, i,`�,f a ,'r af',i:r•1 rft)us4 ,,,,,F, xs^ ki.,,,r' ' 2. Specificetbn(lead Otl
<br /> ❑ 3. Higtmay i -�"tc rr y«t a7 jj''��rp,"1) .a !n t or On-sae Burner Who Rrot �s
<br /> ❑ 4. Water t 3. �`-4 �e On Meets the�peclllceaoR" Ijj
<br /> IX. Description of Regulated_Y3r)at411,(tlti 'df� #171rahOita finiosii34p=
<br /> A. Characteristics of Nonllated Hater ' 1N��{ u'S ifp`7C Nle
<br /> wastes your Installation tfeltdlea ($qa„ �PEta
<br /> ,�x28124 -' f - ristl°s of honilsted hazarddlb
<br /> F J ) 'C1. Ignitable 2 , ti(DO01) (D602 z fq
<br /> „9 �,,;,}y: D(�r 4�"�r�it ttpebfNo SPA Hazardous Waste numbers)}a the Toxicky F,*
<br /> ❑ - . , ,#� �° .✓ ^' ::' "(i ' Cher�ecteristic contaml�nards 'j� 1 , ..1.,T,t
<br /> B. Listed Hazardous Waetea (Setlp�}q, ij 281�9f = jlnetLctlona N you need to Ilst mora tl,an 12 waste codes.)
<br /> F'
<br /> 10 ,
<br /> sr;
<br /> C. Other Waste■.(State or other wastes;requiring ilOtumbef:'See trtstnrctlone.),;.:
<br /> X. Certification
<br /> I certify under penalty of law that I have personally examined and am familiar with the information submitted In this
<br /> and all attached documents, and that based on my Inquiry of those Individuals Immediately responsible for )
<br /> obtaining the Information, I believe that the submitted Information Is true, accurate, and complete. I am aware ;
<br /> that there are significant penalties for submitting false Information, Including the possibility of lines and '
<br /> Imprisonment.
<br /> S'ti'tat ya me nd Offici (.Title(type or print) Date Signed
<br /> 11tH las asancki
<br /> _( ✓ n y SafetT Spec>a�ist 02/07/92
<br /> XI. Comments
<br /> Packaged Company: iluraLic Acid, Pesticides, Herbicides and others
<br /> NOW Mall completed form to the appropriate EPA Reglonal or Slate Office. (See Section III of the booklet for addresses.)
<br />
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