Laserfiche WebLink
i <br /> wa I <br /> r i <br /> INSTRUCTIONS <br /> Please complete one form for each type of waste stream. Do not mix waste either in the field or during shipment to the <br /> landfill. <br /> Section A: Name theenerator of the <br /> g waste; usually, the owner of the site or client. " <br /> Section B: Describe geographical location of where the waste was removed/excavated from. Attach a map if necessary. <br /> Section C: State type of industry and chemicals associated with the Contaminated Soil. <br /> Cite the source of the chemical 'information reported. (For personnel communication, or report, <br /> include name/tide and date). <br /> I <br /> Section D: List reports that contain the investigation and chemical characterization of contaminated soil. Attach report <br /> if available. j <br /> Section E. Check appropriate column for each type of analysis. If yes,write the number of samples in the"Yes'column. <br /> Section F: Use number of samples and soil volume to estimate representative soil volume per sample (e.g., 20 cu i <br /> yd/samples) insert "20" in the column 'Soil Vol/Sample". <br /> Indicate if soil samples were collected in-situ or after stockpiling. <br /> Indicate whether "Hot Spots" of the contaminated soils were sampled. <br /> Indicate whether soil samples were composite samples or not, and the number of samples for each <br /> composite (e.g., 4 into 1). n <br /> Section G: List elevated concentrations of primary contaminants found in 'Hot Spots'. Include priority organics or metal's <br /> detected in 'Hot Spot" samples. <br /> i <br /> • Average concentration is the statistical average of only.the-samples collected frd] the waste <br /> stream that will be received at the landfill, i <br /> • Highest concentration is the concentration of primary contaminants in "Hot Spot" samples. <br /> • Modal concentration is the most occurring concentration range detected. <br /> Vol. of waste is an estimated volume of affected soil for the chemical listed. <br /> % vol. of waste is soil volume of affected soil for specific chemicals compared to total. Volume of ; <br /> affected soil (e.g., 10 cu yd of toluene soil out of total soil volume of 50 cu yd containing BTXE is <br /> 20%). <br /> Section H: Certification. Signature, seal, date and registration number of Engineer or Geologist is required. <br /> 90-102A 09/04/90 <br /> I <br /> t <br />