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04/14:'00 16:14 F2U 2098166181 Inland-Traciy - Z004 <br /> t ]T�11�T. r�T I�fnal Use Only <br /> �, BY. Y �l l V1�119 ill . Job NumEier: . <br /> WASTE PRODUCT - . - <br /> 29027 <br /> L GENERAL INFOP-MIr4'I10N r <br /> Generator Name 10 1 Q r1j 'o-►t q n 4�r _Blllmg Name r W L S4 ar v r r v�wt..t <br /> Address_ 00 i r A Additm <br /> C IY,Stair,Zip Tea t+r C4 City,Static,Zip <br /> Cantaa T c miwt - <br /> Phone 2 a 6 $- 037 Fax <br /> T Phone Fax <br /> EPA N»mbcr L rF O <br /> II- WASTE PRODUCT DESCR[PT10N&CHARACTERISTICS` <br /> k Waste Product Common Name 0 i 1 So r N <br /> 1. Pratms Cwwwating Wagte t t f Z{(•��a C�h r r <br /> B_ Hazardous Properties: <br /> 1- U-S_EPA Hazardous Waste? Q Yes I Vo 2. State Code(s). -� -- — <br /> EPA Code(s): bW_P_ <br /> c-Is Waste Product ❑Shock Sensitive ❑Reaftive ❑RadioaotNe ❑pyeophoric ❑Ecological ISI None <br /> C- Physical Properties et 70'F <br /> 11. Physical Stade: 2- Layers 3. F[asfi Mrit(Closed Cm 0*)' 4- lfiseodly,slrrlllarto: <br /> 9SoGd ❑$lodge p Multllayered ❑�70'F ❑141)-2000 F ❑Weder <br /> ❑Liquid ❑Empty Gontainer ❑Bi-Layered ❑7(l-1()O'F 'IVO Flash ❑Motor Oil <br /> Any fnae liquids at 74°F ,(cfrlorriagei,ous ❑11)1-139°F I3 Exact D Honey <br /> E3 Yes El No <br /> pother <br /> D. 1_ Density: 2 %SaSds 3. Odor. d. W <br /> Lpuld❑ _ Ibsl IlQn ❑By Weight ZMone D<2 L19.1-11S <br /> *aid ❑—_ lWcubia It ❑By Volum ❑Slmng ❑2-5 0>12.5 <br /> Any debris In waste: Tata) ❑MJild ❑Exact <br /> (0 Yes ❑No Describe: <br /> Explain <br /> E Chemical Composition(Acmunt for 1t)U%et brei): Range Metals —Total(PPM) Pestaides,Hertaia4eb PPM <br /> F Sal Calci ` G LIDO rr�3t7 K - - ole -- <br /> �y FF Toxicity(mg/l) Lindane- - - - - - <br /> W-0 96 <br /> Arsenio(As) Malhoxychlor <br /> Barium(Ba) <br /> % Toxaphene <br /> _ Cadmium(Cd) <br /> 9L Z4_0. <br /> % Chromium(Cr) 2.4,5-TP <br /> Copper(IU) Other <br /> Lead(Pb) r <br /> 9b . <br /> Mercury[H9) Aeaedves&C)Mer <br /> Nickel(Ni) <br /> Wastes(PPM)_ <br /> SeieniUn7(Se1. Cyanides Dioxin <br /> Surer(Ag] — — Sut6des PGSs <br /> Mne(Zn) _ — HOC <br /> F_ skipping and Handing IrdamraElor> -- <br /> f No 2- Proper D.0-T-Shipping Name. +u ecn�f �h'1 z X04 10 <br /> -- -— <br /> 1. D-o-T_Hazardous Material? Yes - <br /> 3- 0-4-T. Hazard Class: -- 4- d"O.T.Ic Number; <br /> 5- Method of shipmer'rt orBulk:—Other 6_ D.O=T ShiPPirg Container <br /> 7- Prol�d Volume: —Tans Gallons Cubic Yards._------- Qther e- RQ amount <br /> Per One Ti rte WA_Month r Year <br /> Comments -- <br /> _ <br /> ill rCFTIERATOR CERTIFICATION STNrWENTr f <br /> hembyaertity mat as an errthex`med revreWnlatire of the gen9ratOr named e1iav2, all Intormauon suummftj in mis Etna et,y 11,e anacho.i,u 7' <br /> Is true andlaeeurate-Analysis of the waste was conducted in accordance with the approved test mettrods 9n 40 GFR 261 have been : <br /> as-defined in 40 CFR 2x3720-To the t"of my knowledgP4 all know <br /> n(40 CFR 261)and suspected hazardous ca pon <br /> th;$documantatian. Gari ing will comply tv"all tx nwit regulatlons. <br /> rr` <br /> Tide <br /> Signature " <br />