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Waste Profile # <br /> V PHYSICAL CHARACTERISTICS OF WASTE <br /> CHARACTERISTIC COMPONENTS % BY WEIGHT(range) <br /> I 1 ClS r (UDol. __# <br /> 2 <br /> 3 <br /> Color Odor(describe) Free Liquids % Solids pH Flash Phenol <br /> kI�av� TYES oNO <br /> Point <br /> n /UV <br /> Gt5�\ Cnj <br /> Content—% OF ----ppm <br /> Attach Laboratory Analytical Report(and or Material Safety Data^Sheet) <br /> Including Required Parameters Provided for this Profile <br /> Does this waste or generating process contain regulated concentrations of the following Pesticides YES r NO <br /> and/or Herbicides Chlordane, Endrin, Heptachlor(and its epoxides), Lindane, Methoxychlor, <br /> Toxaphene, 2, 4-D,2, 4, 5, -TP Silvex as defined in § 40 CFR 261.33? <br /> Does this waste or generating process cause it to exceed OSHA exposure limits from high levels of YES o NO <br /> Hydrogen Sulfide or Hydrogen Cyanide as defined in §40 CFR 261 239 <br /> Does this waste contain regulated concentrations of Polychlorinated Biphenyls(PCBs) as defined in YES o NO <br /> § 40 CFR Part 7619 <br /> Does this waste contain regulated concentrations of listed hazardous wastes defined by § 40 CFR YES NO <br /> 261 31, 261 32, 261 33, including RCRA F-Listed Solvents? <br /> Does this waste contain regulated concentrations of 2, 3,7, 8 -Tetrachlorodibenzodioxin(2, 3,7,8 - YES o NO <br /> TCCD), or any other dioxin as defined in § 40 CRF 26131? - <br /> Is this a regulated Toxic Material as defined by Federal and/or State reguiations7 YES o NO <br /> Is this a regulated Radioactive Waste as defined by Federal and/or State regulations? YES or N <br /> Is this a regulated Medical or Infectious Waste as defined by Federal and/or State regulations? YES or O <br /> Is this waste generated at a Federal Sd&erfund Clean UO-Site Si —- -- — ----- ----� — - - — - S or= <br /> VI GENERATOR CERTIFICATION— ---" - -- - - - - - - - <br /> I hereby certify that to the best of my knowledge and belief, the information contained herein is a true and acurate description of the <br /> waste material being offered for disposal I further certify that by utilizing this profile, neither myself nor any other employee of the <br /> company will deliver for disposal or attempt to deliver for disposal any waste which is classified as toxic waste, hazardous waste, <br /> medical or infectious waste,or any other waste material this facility is prohibited from accepting by law Our company hereby agrees <br /> to fully indemnify this disposal facility against any damages resulting from this certification being inaccurate or untrue <br /> C� zQ 9(`o ecA Gtea �a is r-7e — ?4ar� 1�kc_ <br /> AUTHOR R P E VE NAME AND TITLE(Printed) COMPANY NAME <br /> 11 116/a <br /> AUTHORIZED REPRESENTA IGNATURE DATE <br /> VII. ALLIED WASTE DECISION <br /> Approved Refected Expiration <br /> Conditions <br /> 4 <br /> Name,Title Signature Date <br />