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-ieaMaroor5 k-Audfil 171d[L.11.11`6 r-1011le 14U. 1. n I010'+V1 R REGULATORY STATUS YES NO USEPAHAZARDOUS WASTE? V YES NO D ANY STATE WASTE CODES APPLY? P-1 ......._-------........... ........... i35-2 Texas Waste Code YES NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY? YES V l NO IS THIS WASTE PROHIBITED FROM LAND DISPOSAL WITHOUT FURTHER TREATMENT PER 40 CFR PART 268? LDR CATEGORY: Not il to LOR VARIANCE INFO: YES NO 13 THIS A UNIVERSAL WASTE? YES NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS VERY SMALL QUANTITY GENERATOR(VSOG)OR A STATE EQUIVALENT DESIGNATION? YES NO IS THIS MATERIAL GOING TO BE MANAGED AS A RCRA EXEMPT COMMERCIAL PRODUCT,WHICH IS FUEL(40 CFR 261.2(C)(2)(11))? YES I_!�11 NO DOES TREATMENT OF THIS WASTE GENERATE A F006 08 F019 SLUDGE7 YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIBITION FOUND AT 40 CFR 268,3(C)? YES L%"' NO DOES THIS WASTE CONTAIN VOC'S IN CONCENTRATIONS>=500 PPM? YES NO DOES THE WASTE CONTAIN GREATER THAN 20%OF ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE>=.3KPA(.044 PSIA)? YES 5�! NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSURE>77 KPA 01.2 PSIAP YES EVI NO IS THIS CERCLA REGULATED(SUPERFUND)WASTE? YES NO IS THE WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES? Hazardous Organic NESHAP(HON)rule(subpart G) Pharmaceuticals production(subpart GGG) YES NO IF THIS IS A US EPA HAZARDOUS WASTE,DOES THIS WASTE STREAM CONTAIN BENZENE? YES NO Does the waste stream come from a facility with one of the SIC codes listed under benzene NESHAP or is this waste regulated under the benzene NESHAP roles because the original source of the waste Is from a chemical manufacturing,coke by-product recovery,or petroleum refinery process? YES NO Is the generating source of this waste stream a fadlity with Total Annual Benzene(TAB)>10 Mgtyear? What is the TAB quantity for your facility? I--- T Mgagram/year(I Mg=2,200 lbs) The basis for this determination is:Knowledge of the Waste Or Test Data Knowledge Testing Describe the knowledge: G.DOT/TVG INFORMATION D0T/TDG PROPER SHIPPING NAME: NON-RCRA HAZAADOLIS WASTE,SOLIDS,(DEBRIS CONT W/HYDRAULIC OIL) H. TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY OTHER CONTAINERIZED BULK LIQUID BULK SOLID P-1 CONTAINER&SHIPMENT STORAGE CAPACITY: GALLONS/SHIPMENT: 0 Min-0 Max GAL. SHIPMENT UOM: TON YARD CONTAINER TYPE: TONSNAROSISHIPMENT: "1(1-D Max PORTABLE TOTE TANK D0XjCAn70N;GA5E CUBIT.YAW)HOX DRUtA OTHER 01TUMSUE: I.SPECIAL REQUEST COMMENTS OR REQUESTS, GENERATOR'S CERTIFICATION I corilly that I am aillhorutod to execute this document as an authorized agent.I hereby Certify that all inl0imation submitted in this and allach9d dOCurrionIS is WneCt to the best 01 my knowlodge.1 also certify that any isamp!qa submitted am(00fegenlative of the actual wazto.11 Lean Harbors d4cmorz a discrepancy during the approval process,Gonefalor grants Clean Harbors the Puthonty to amend the piofito.as Clown Hoibors deems 6ecessary,to reflect the discrepancy. AUTHORIZED SIGNATURE NAME(PRINT) TITLE DATE r1opezOpatriotenvironmemal,corn This waste ptotile has been submitted uejN Clean Harbcrs'olaclronlc aignahito system.