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c. GENERATOR CLASSIFICATION <br /> 1; IS THIS A USEPA HAZARDOUS WASTE? ( )YES ( ) NO <br /> ' $ THE FACILITY REQUIRES RESULTS FROM THE ACTUAL SPENT CARBON. THE SAMPLE ANALYZED MUST BE REPRESENTATIVE AND MUS'• <br /> SUPPORT THE CLASSIFICATION. FOR BENZENE NESHAP GENERATORS,TOTAL BENZENE ANALYSIS IS ALSO REQUIRED. <br /> 1 a. IF THIS 15 USEPA HAZARDOUS WASTE,LIST ALL APPLICABLE WASTE CODES (D,F,K,P d U)IN THE SPACE PROVIDED BELOW. <br /> WASTE CODE 1 WASTE CODE 2 WASTE CODE 3 <br /> WASTE CODE 4 WASTE CODE 5 WASTE CODE 6 <br /> WASTE CODE 7 WASTE CODE 6 WASTE CODE 9 <br /> 77 1 <br /> -;4. IS THIS IS A GENERATOR STATE HAZARDOUS WASTE? ( )YES ( ) NO <br /> ICJ IDENTIFY ALL GENERATOR STATE WASTE CODES. <br /> :ass: IS THIS WASTE SUBJECT TO THE LAND DISPOSAL RESTRICTION NOTIFICATION? ( )YES ( I NO <br /> ' E. LIST REQUIREMENTS FOR PPE TO HANDLE THE ABOVE WASTES: <br /> I.f o S Pes&.,A �- Le PiL a -4 Qu <br /> 2�.o <br /> 1 GENERATOR CERTIFICATION <br /> I HEREBY CERTIFY THAT ALL INFORMATION ON THIS AND ALL ATTACHED DOCUMENTS IS TRUE AND THAT THIS INFORMATION <br /> ACCURATELY DESCRIBES THE SUBJECT SPENT CARBON. I FURTHER CERTIFY THAT ALL SAMPLES AND ANALYSES SUBMITTE <br /> ARE REPRESENTATIVE OF THE SUBJECT SPENT CARBON IN ACCORDANCE WITH THE PROCEDURES ESTABLISHED IN 40 CFR <br /> 261 APPENDIX I OR BY USING AN EQUIVALENT METHOD. ALL RELEVANT INFORMATION REGARDING KNOWN OR SUSPECTED <br /> HAZARDS IN THE POSSESSION OF THE GENERATOR HAS BEEN DISCLOSED. I AUTHORIZE WCAI TO OBTAIN A SAMPLE FROM <br /> ANY WASTE SHIPMENT FOR PURPOSES OF CONFIRMATION OR FURTHER INVESTIGATION. IF I AM A CONSULTANT SIGNING <br /> ON BEHALF OF THE GENERATOR, 1 HAVE THEIR PROPER APPROVAL. <br /> FESSin <br /> PRINTED NAME: 1NR�CC�•J S �{�•-X% SPE . �rF�oe WA)'ppN�<<c^ <br /> c� 0' Nm <br /> No.28602 x <br /> SIGNATURE: Exp.3/31/98 <br /> q l I a�P <br /> "EVItL6�S..a�(L ATITLE: Ce�JJI"Ft�S aS.aEi� A•a�0 '�2 <br /> F �J . scr(A4-0-Sz� <br /> DATE: <br /> PAGE 2/2 <br /> WCAI PROFILE FORM -REV.1 <br /> 1 <br />