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JUI-06-04 08:46 FROM-Evergreen 0,1 5107862558 T-702 P 003/003 F-348 <br /> ruyaacar <br /> O.z% O CI [JMultilayered ❑Suspended lL,) °/, EfNone ❑said <br /> El 2-5% [1F ® Ell-Layered LD Settleable v % ❑Mild ❑Semisolid <br /> E)5-10% ❑Br ❑Single Phase ❑Dissolved Q y> ❑strong gLiquid <br /> ❑10-30% ❑ I Describe, ❑ Gas <br /> ❑ n30% Exact ColorColor ❑Flowable Powder <br /> ❑Pumpeble Semisolld <br /> PH Specific Gray. Flash Point BTU/LI3 rVyiscosity <br /> Ela2% p<.8 ❑<80 D Yai High(Syrup) <br /> I ❑2-5% ❑-8-1.0 ❑80-100 %ASH ❑Medium(Oil) <br /> Q-5-e NIA ❑ 1.0 ❑ 101-140 0 ❑Low Water <br /> 09-125 ❑T1.0-12 ❑ 141-200 Wafer Solubility Hazardous <br /> ❑ e12 5 >1 2 ❑>200 Characteristics <br /> ❑Exact C&No Flash ❑ Reactive Specify <br /> ❑Exact ❑Radioactive <br /> Explosive <br /> Annual Report Information Type I Size <br /> SIC Code Present Container <br /> Source Shipping Container <br /> Form <br /> OriginPer Month <br /> System Per Year <br /> Type One Time Only <br /> Yes No <br /> Is this waste subject to subpart CC regulations(i.e. contains>500 ppm volatile organic compounds)? Cl 14 <br /> Area there underlying hazardous constituents, other than mercury listed in 40CFR26848? ❑ X1 <br /> Does the waste contain>500 ppm of any 40CFR Part 261 Appendix VIII Constituents? ❑ <br /> If any of the above Items were answered yes, explaln below- <br /> Comments: <br /> Certification <br /> (bereby certify that 1 have personally examined and am familiar with the information submitted in this and all attached <br /> locurnents. Based on my inquiry of those individuals immediately responsible for obtaining the information, i believe <br /> hat the submitted information is true, accurate, and complete to the hest or my knowledge and ability and that all <br /> suspected hazards have been disclosed. <br /> 7 -c4- <br /> Date <br /> �cfia <br /> Tint NameJTItIe I V l <br /> 1 <br /> ur.voMWnil+m R.oyiwywsac r,ou. 1 <br /> i <br /> f <br />