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Wa-ste Management of North AneK-ica GENERATOR'S SPECIAL WASTE PROFILE SHEET \/��1�J TYPE A Waste PLEASE POINT III INK OR TYPE WMA 054695 INSTRUCTIONS FOR COMPLETING THIS FORM ARE ATTACHED Waste Profile Sheet Code (Shaded Areas For WMNA Use Only) Renewal Data of Service Agreement: WMNA Sales Rep#: A. WHERE IS THE WASTE GENERATED? 1. Generator Name: 2. Facility Address(site of waste gene etion): 1'7,2 n Z) S •��r_In n cl _ 3. Generator City, Stale/Province: 0 N 4. Zip/Postal Code: !2 fl-330 S. Generator USEPA/Federal ID: Cf)LO nn 3 -X7/ 6. Generator State/Province ID: 7. Technical Contact: 8. Phone: (ao/)k:5S - 0. WHERE ARE WASTE MANAGEMENT, INC. INVOICES SENT? 1. BErGenerating Facility(A, above), or 2. Company Name: _- 3. Phone: ( ' )_- 4. Address: 5. Generator City, Stale/Province: 6. Zip/Postal Code: C. PHYSICAL CHARACTERISTICS OF WASTE(Sade Instructions) 1. Name of Waste: �•�S_12n 61 e- r� r 5 2. Process Generating Waste: 1ocA4z Y. 3. Special Handling Instructions: f/wn< 4. Color 5. Does the waste have a 6. Physical State CO 70°F21`C: 7. Layers 8. Specific Gravity: 9. Free Liquids: strong incidental odor? IA Solid ❑ Semi-Solid ❑ Multi-layered ❑Yes 19 No ® No ❑ Yes if so, ❑ Liquid ❑ Powder ❑ Bi-layered Range Volume: describe: Other 1�1 Single Phased -�•N 10.pH:❑_2 ❑ >2-4 ❑ 4-7 1.1 7 FA 7-10 ❑ 10- < 12.5 ❑ >_ 12.5 ❑ Range ❑ NA 11.Flash Point: Cff None ❑ <140°F/60°C ❑ 140°-199+160^-830C ❑ a 200°F/930C ❑ Closed Cup ❑ Open Cup D. TRANSPORTATION INFORMATION 1. Method of Shipment: ❑ Bulk Liquid ❑ Bulk Sludge ❑ Bulk Solid ❑ Drum/Box N Other 2. Annual Amount/Units: 3. Supplemental Inlonnalion: 4. Is this a DOl hazardous material? ® No ❑ Yes (II so,complete 5, 6&7) 5. Hazard Class/ID#: 6. Repairable Quantity/Units(lb/kg): _ 7. Shippin0 Name: a JAChack this box if additional information is attached. "Pum I'age and(•eelptele Side 2 a