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BFI WASTE CODE <br /> 3. THIS WASTE CONTAINS <br /> 7Free <br /> te contains any of the following: <br /> hose identified with(*)if otherwise specified in Section 2. <br /> ❑Etiological Agents El Radioactive Materials <br /> s O Dioxins p PCBs not regulated by <br /> ❑Or anic Solvents ❑Pathogensye g p OSHA Substances TSCA 40 CFR 761 <br /> Fl Free Sulfide ❑Used or Waste Oils* None of the above <br /> ❑Free Ammonia ❑Virgin Oils* ❑Biological Materials <br /> If an of the above are checked, specify type (if applicable) and concentration in the waste: <br /> ��"*y <br /> x <br /> 4. SUPPLEMENTAL INFORMATION "' 'r"` <br /> TCLP D to ❑Additional Analytical Data ❑Memo/Letter <br /> rdeliberate <br /> ❑MSD Sheets ❑ No. of Pages S. F <br /> ibe <br /> e and accurate to the best o <br /> -TPN ��ez,Z'- e <br /> 5. GENERATOR'S CERTIFICATION <br /> that r <br /> lful omissions of ove dcompstoattached n or pption is roperties exists,that all known or suspectedfhazardmy s have been diwledge and sclosed, and hat the way <br /> a Hazardous Waste by the US <br /> or contains PCBs regulated by TSCA 40 CFR 761. <br /> GENERATOR'S AUTHORIZED SIGNATORY: <br /> Q ���� MGR, , <br /> / j)- Z �h/�r� SIGNATURE TITLE INITIALS <br /> DATE PRINT NAME <br /> REPRESENTATIVE SAMPLE CERTIFICATE ,h.:t,. a. . <br /> This ST Sby the AMPLESeTHAT ARE RADIOACTIVE,SHOCK SENSITIVE,of the above EXPLOSIVE,OR PYROPHORICescribed waste, rerably a entative of the generat <br /> DO NOTOT COLLECT OR SUBMI <br /> I certify that the sample identified below that is being forwarded to BFI for evaluation is representative of the waste described above. <br /> D (r,T Z— (Peel Off label) _ <br /> Collector's N1- <br /> Signature: <br /> aSignature: -- Generator's Name: <br /> �,•( $ <br /> Company: , �AS'Ss Waste Description: <br /> Date Collected: WCD No.SS <br /> Title: , <br /> Telephone Number. (�9 ) ' <br /> Date at BFI Lab:---------BFI Lab No. <br /> ustwcd <br /> Revised:3/91 <br />