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On WAST&C0131i <br /> 3, TEAS wA$79 CONTAINS <br /> Note if the waste conisins any of the following: <br /> Dn nut check those kkntlifed with(rk)if otherwise"41fted In$lateen 2. <br /> t1 <br /> Free t.lqufd5 bloxlRs M Etiological Agents d Rldlosctiva malariais <br /> U Frer.Cyanide Ci Organic Solvents M rathoons C7 PC6s not regulated by <br /> M Fray►iuifide ❑Used or Waste Qlts'a 0 ORKA iubfitincrs TSCA 40 CFR 741 <br /> F.1 Froo Ammonia CI Virgin o ig* p Biological Matertala M None of the afore <br /> If any of the above aro checked, specify typo Ilf applicable)and toncenlral)on In the waste; <br /> 4. SUPPLCMCMTAL INFORMATION <br /> C3 Nan. M MSCI sheets CXTC:LP Data Z Additional Anslyticlrl Dili {�Ytemollttter <br /> © Queer—dwCrilu No.Of hit's �1 <br /> S. GiNSRATOR'S CIEIITI#ICATION <br /> I hereby certify that the above and attached clescriptfon is eeknpiete and accurate to the twat of my Isnowledge erttl obility,to detarmine, that no <br /> deliberate or willful omissions of Cornpesktion ar properties exists,that all known or suspected hoards have been disclosed.and that the waste <br /> is not dalgnstad s S-Iarardeus Waste by the USEPA or contsirss PCBs regulated by TSCA 46 CfR 761. <br /> GANOXATOR'S AUTHORIZEDSIIINATORYi f W <br /> t# h�i1 a�Ka G�iir� N <br /> MS PAINT MWE e:1CN �Lku TITLE INiTiAtS <br /> �•.� REPRESENTAT#VE SAMPLE 'CERTIFICATE <br /> This Sactlert Is ie be fornpleted by the por$*A obtaining the(ample of the above described wute,preferably i reprosentat)vis of the generllor. <br /> DO NOT COLLECT 09 SUBMIT SAMPLES THAT ARE RADIOACTIVE, SMOCK SENSITIVE.EXPLOSIVE,Olt;PYI(OP•TORIC. <br /> I certify that the sample kdentifitd balaw that Is being forwarded to BFi for evaluation Is rapresentative of tete walm descrftoed Above. <br /> Calkeetar's Norrie: �.... _, ... lR i t7ff Cabsq_ <br /> l' <br /> Signatures C�eneratet✓a Nnnee� <br /> 'Company. Weist@Dgscdpdon. — -- <br /> 34210300 <br /> Title: Date C0119cw. WCD ttkx S, <br /> w--- <br /> Tsisphone Number; t f Gatti at BPI La#: _t3hl LAA N <br /> unwed <br /> Revksidt Y!1 <br />