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b COMPOSITION(useoddltlona!/o/rt>,JJaecess6ry) _ r. Values are: ❑ TCLP d Totals Range Total>=100% Constituents Yost Method Units Typical Min Max Sodium fluoride Totals % 97.00 97.00 97,00 SODIUM SILICOFLOURIDE . Totals % - 2.50 2.50 2.50 OTHER COMPONENTS BELOW REPORTABLE Totals % 0.50 0.00 1.00 is V CHARACTERi1`TICS 1, Oxidizer ❑ Yes :Q No 9. Reactive Sulfidesppm ❑ Yes Q No 2,-Explosive ❑ Yes Q No 10.. Reactive Cyanides .';ppm ❑ Yes No 3. Organic peroxide E] Yes Q No 11. Waterr/Air Reactive ❑ .Yes ❑J No 4. Shock Sensitive ❑ Yes Q No 12. Thermally Unstable. _ ❑ Yes No S. Tires_____ _ _ Yes-- No No :.:.13. TSCA:regulated-PCB waste(Contra/sheet----- ❑---Yes- QJ----No-- required With shipment) - 6. Pyrophoric ❑ Yes Q No 14.Medical/lnfectious waste - ❑ Yes ❑J No 7. Compressed Gas ❑ Yes R IN o - 15. Radioactive(If yes,complete profile ❑ Yes [J] No 8. Halogenated Organics ❑ Yes ❑J No Supplementfor Radioactive waste) - 16.Hazardous Secondary Material(HSM)? ❑ Yes ,Q no 17. Possibility of incidental liquids from transportation 3 - ❑ Yes Q No 18. Is waste/material a solid using the paint filter test? ❑J Yes ❑ No 19. pH:(If solid,what Is pH if mixed with.water?) Range; To Typical ❑52 ❑✓_2<12.5 ❑ 212.5 20. Flash Point ;NA OF ❑<140^p 21.Is the waste/material oil bearing from Petroleum Refining,Production or Transportation practices? ❑ N/A El Yes No F:GfVERATOR,S,CERTIEIGATION ;: ,?r ' ''t v , i s: Yes ❑No I certify this Waste/material may be disposed without further treatment. ❑Yes N/A I certify this waste/material meets all requirements of legitimate recycling of Hazardous Secondary Materials under 40 CFR 260.43 and/or I am complying with the conditions for generators using the verified recycler exclusion. 1 authorize US Ecology to correct Inconsistencies on the waste/materlal profile form that impact management decisions with my oral orwritten authorization.US Ecologywlll require re-submittal of the waste/material profile information if substantial changes are determined necessary.I understand waste/material that does not conform to specifications described in this profile maybe rejected by US Ecology unless other contractual arrangements have been agreed to by both parties,I certify,under penalty of law,that I am familiar with this waste/material stream through analysis and/or process knowledge,and that all information provided Is true,accurate,representative and complete,that all known or suspected hazards have been disclosed,and that this form was completed in accordance with the instructions provided. Print Name Signature Title ;ate (� iehtlUr t c� G2 e Plate✓ h Am yl / Revld,,dote• 11/1/19