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Fingerprint Verification Analysis Checklist <br />Date submitted 11/7/16 <br />WDR # W356453 <br />Item # 1 <br />C <br />COC # (if applicable) 20601C <br />IGD # (if applicable) 02149.R1.0 <br />Generator D. DEARING <br />IGD annual verification ❑Yes ® No <br />Bldg./Room 834 <br />Field Technician D. DEARING FEB <br />Complete applicable tests, as indicated <br />P F N/A (P = Pass, F = Fail, N/A = Not Aoolicable) <br />nKiviRONMENTAL HEALTH <br />® <br />❑ <br />I Waste container label matches WDR and container contents ®Yes ❑No DEPA <br />® <br />❑ <br />Container contents match WDR: <br />Identity ®Yes ❑No Quantity/Weight/Volume ®Yes ❑No Container Size ®Yes ❑No <br />® <br />❑ <br />❑ <br />Waste Form ®Solid ❑Liquid (❑AQ ❑NAL) ❑Sludge ❑Sediment (<_ 5% solids) <br />Additional info. (e.g., powder, granular, particle size?): BLACK AND GRANULAR <br />®❑ <br />❑ <br />Odor: ®No ❑Yes, Explain: <br />❑ <br />❑ <br />® <br />If liquid, from top to bottom including non -liquid layers: <br />Laver <br />Percentage <br />Color <br />Turbidity <br />Viscosity <br />S=Solid L=Li uid <br />% volume <br />light, medium, dark <br />clear, cloudy, opaque <br />ve It, It, med, heavy <br />1 <br />❑S ❑L <br />2 <br />❑S ❑L <br />3 <br />0 ❑L <br />❑ <br />❑ <br />® <br />Packing or absorbant material present ❑Yes ❑No (If yes, what type quantity ) <br />❑ <br />❑ <br />® <br />pH ❑ Meter pH ❑ Paper (Possible interference: ) <br />❑ <br />❑ <br />® <br />Alcohol Hydrometer test % Alcohol <br />❑ <br />❑ <br />® <br />I Peroxide test ppm Stabilized with Hydroquinone ❑Yes ❑No Final Peroxide ppm <br />❑ <br />❑ <br />® <br />Oxidizer test ❑Positive ❑Negative <br />❑ <br />❑ <br />® <br />1 Solubility test ❑Soluble ❑Insoluble <br />Comments: <br />Verification Failure Description: <br />Verification Failure Resolution: <br />Field verification performed b p. M 004657 Date: 11/7/16 <br />Field verification ®Pass ❑ Fail (If failed ensure section above is completed) <br />WCG 0006 <br />See WIC 103 <br />Effective Date: 9/13/16 <br />Expiration Date: 9/13/19 <br />