COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

VVVA Generator's Non-hazardous Waste Profile Sheet 110907CA MA MANApE EW D. Regulatory Status (Please check appropriate responses) 1. Waste Identification: a. Does the waste meet the definition of a USEPA listed or characteristic hazardous waste as defined by 40 CFR Part 261? ❑ Yes'd No 1. If yes, please complete a hazardous waste profile. b. Does the waste meet the definition of a state hazardous waste other than identified in D.l.a? ❑ Yes ❑ No 1. If yes, please complete a hazardous waste profile. 2. Is this waste included in one or more of categories below (Check all that apply)? If yes, attach supporting documentation. ❑ Yes No ❑ Delisted Hazardous Waste ❑ Excluded Wastes Under 40CFR 261.4 ❑ Treated Hazardous Waste Debris ❑ Treated Characteristic Hazardous Waste 3. Is the waste from a Federal (40 CFR 300, Appendix B) or state mandated clean-up? If yes, see instructions. ❑ Yes (A No 4. Does the waste represented by this waste profile sheet contain radioactive material? ❑ Yes No a. If yes, is disposal regulated by the Nuclear Regulatory Commission? ❑ Yes ❑ No b. If yes, is disposal regulated by a State Agency for radioactive waste/NORM? ❑ Yes ❑ No 5. Does the waste represented by this waste profile sheet contain Polychlorinated Biphenyls (PCBs)? Ll Yes u No (If yes, list in Chemical Composition - C.11) a. If yes, are the PCBs regulated by 40 CFR 761? ❑ Yes ❑ No b. If yes, is it remediation waste from a project being performed under the Self -Implementing option provided in 40 CFR 761.61(a)? ❑ Yes ❑ No c. If yes, were the PCBs imported into the US? ❑ Yes ❑ No S. Does the waste contain untreated, regulated medical or infectious waste? ❑ Yes No ❑ Yes No 7. Does the waste contain asbestos? ❑ Friable ❑ Non Friable a. If Yes, 8. Is this profile for remediation waste from a facility that is a major source of Hazardous Air Pollutants (Site Remediation NFSHAP, 40 CFR 63 subpart GGGGG)? ❑ Yes A No a. If yes, does the waste contain <500 ppmw VOHAPs at the point of determination? ❑ Yes ❑ No E. Generator Ceatucation (Please read and certify by signature below) By signing this Generator's Waste Profile Sheet, I hereby certify that all: 1. Information submitted in this profile and all attached documents contain true and accurate descriptions of the waste material; 2. Relevant information within the possession of the Generator regarding known or suspected hazards pertaining to this waste has been disclosed to WM/the Contractor; 3. Analytical data attached pertaining to the profiled waste was derived from testing a representative sample in accordance with 40 CFR 261.20(c) or equivalent rules; and 4. Changes that occur in the character of the waste (i.e. changes in the process or new analytical) will be identified by the Generator and disclosed to WM (and the Contractor if applicable) prior to providing the waste to WM (and the contractor if applicable). 5. Check all that apply: (� a. Attached analytical pertains to the waste. Identify laboratory & sample ID #'s and parameters tested: Docl76.pdf # Pages: ❑ b. Only the analysis identified on the attachment pertain to the waste (identify by laboratory & sample ID #'a and parameters oasbed).Attachment #: ❑ c. Additional information necessary to characterize the profiled waste has been attached (other then analytical, such as MSDS). Indicate the number of attached pages: ❑ d. I am an agent signing on behalZthe rator, and the delegation of authority to me from the Generator for this signature is available upon request. Certification Signature: _ Title: Safety & Facilities Manager Company Name: HOLT of CA Name (Print): Nathan Ladd Date: 17, <Z0'/0 ©2010 Waste Management, Inc. Page 2 of 2 May 2010