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1I✓II , i <br /> U HAZARDOUSi WASTE PREDISPOSA1L EVALUATION NO. <br /> TT OOG IIATION. - 00737 <br /> I. SALES INFORMATION Date 5 III. LABORATORY Date Received <br /> A. Producer Information $ales Rep. ; ick 1. 2. 3. <br /> Name C a ti // n ' Lab. Ref. # <br /> I <br /> Addre _ TE /—^ �� �� A. Chemical <br /> �,�R ameters�[ <br /> EPA ID# <br /> Telephone Zoo/ 2- <br /> Tech. <br /> Tech. Contact L <br /> B. Manufacturing Process i Bali-.- C21ZS <br /> C. Producers Hazardous Waste Information <br /> Description of Waste DOT EPA HAZ VOLUME 1 — <br /> CLASS WASTE # B. Waste Management 1. 2. 3. <br /> 13 Acceptable for Disposal <br /> S' r Handling Method <br /> 2. EPA Code <br /> 3 Chemical Additions <br /> C. Comments <br /> II. PRICING/BID ANALYSIS <br /> A. General 1. 2. 3. <br /> Bid # <br /> Job # 00 <br /> Contract <br /> Customer P.O. # Chemist Lab Director Date <br /> Transporter IV. OPERATIONS <br /> Service Company A. Facility 2.'", 3. <br /> B. Customer Charges Acceptable for Disposal <br /> Disposal 1. 2. 3. Facility _. <br /> Base Price EPA ID# <br /> Additional Expenses B. Waste Management Method <br /> Surcharge Handling Instructions & Comments <br /> DOH Sec. <br /> Total <br /> Additional Expenses <br /> Date General/Site Manager <br /> ' ORIG/LAB-WHITE OPERATIONS-GREEN OUST.SERVICE MANAGER-CANARY <br /> �h I ACCOUNTING-PINK RLE-GOLDENROD <br /> r_ <br />