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BENZENE <br /> Please complete this section if you answered Yes to From an industry regulated under Benzene NESHAP? <br /> Are you a TSDF? 0 Yes 0 No <br /> If Yes,Please complete the Benzene NESHAP questionnaire. <br /> If No, <br /> Does this material contain benzene? 0 Yes 0 No <br /> If Yes,Flow Weighted Average Concentration in PPMW <br /> What is your current facility's total annual benzene quantity in megagrams? <br /> 0 Less than(<)1 Mg <br /> 0 1-9.99 Mg <br /> 0 More than(>)10 Mg <br /> Is this waste soil from a remediation? 0 Yes 0 No <br /> If Yes,Benzene Concentration in PPMW <br /> Does the waste contain more than(>)10%water/moisture? 0 Yes 0 No <br /> Has material been treated to remove 99%of the benzene or to achieve less than 10ppmw? 0 Yes 0 No <br /> Is material exempt from controls in accordance with 40 CFR 61342? 0 Yes 0 No <br /> If Yes,Specify Exemption <br /> Is this waste stream subject to treatment and control requirements of 40 CFR Part 61,Subpart FF? 0 Yes 0 No <br /> FACILITY REMEDIATION&CLEAN UP <br /> Facility remediation subject to 40 CFR 63 GGGGG? 0 Yes (�) No <br /> If Yes,Does the material contain less than(<)500 ppmw VOHAPS at the point of determination? 0 Yes 0 No <br /> CERCLA or State-Mandated clean-up? 0 Yes 0 No <br /> If Yes,Please submit the Record of Decision or other documentation to assist others in the evaluation for proper disposal. <br /> RADIOACTIVE WASTE <br /> If you answered Yes to Regulated,Licensed or NORM Radioactive Waste?,please complete this section. <br /> Identify Isotopes and pCI/g <br /> Isotope PCI/G <br /> PCBS <br /> Please complete this section if you answered Yes to Contains PCBs? <br /> Regulated by 40 CFR 761? 0 Yes 0 No <br /> Remediation under 40 CFR 761.61(a)? 0 Yes 0 No <br /> PCB imported into the US? 0 Yes 0 No <br /> ASBESTOS <br /> Please complete this section if you answered Yes to Contains Asbestos? <br /> Is the Asbestos Friable or Non-Friable? 0 Friable 0 Non-Friable 0 Non-Friable regulated <br /> SHIPPING INFORMATION <br /> Event Frequency * One Time 0 On-Going <br /> Anticipated Number of Loads 4 <br /> Estimated Annual Qty <br /> Unit of Measure 0 Tons 0 Yards 0 Drums 0 Gallons 0 Other <br /> Shipping Frequency 0 Once 0 Daily 0 Weekly 0 Monthly * Other <br /> Qty Per Shipment 20 Yard bins <br /> Container Type CM <br /> Container Size 20 Yards <br />