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T/ <br /> W 1 <br /> Description of Hazardous Will (continued Iram cont <br /> A.Hazardous Wastes from Nonspecific Sources. Enter the four-digit number from 40 CFR Pan 261.31 for each listed hazardous wool* <br /> from nonspecific sources Your installation handles. Use additional sheets if necessary. <br /> 1 2 ] 4 6 e <br /> e e 10 n 12 <br /> B. Hazardous Wastes from Specific Sources. Enter the four-digit number from 40 CFR Pan 261.32 for each lined hazardous wool@ from <br /> specific Wurcee your installation handles. Use additional sheets it necessary. <br /> 13 14 16 16 17 t9 <br /> 19 20 21 22 23 24 <br /> 26 20 27 28 29 30 <br /> C.Commercial Ch mltal Product Hazardous Waves. Enter the fourrdigo number from CF'R Port 261.33 for each chemical substance <br /> your installation handtss which may be a hazardous waste. Use additional sheets if necessary. <br /> 31 32 33 34 36 36 <br /> 37 38 39 40 41 42 <br /> TTT <br /> 43 44 46 46 47 48 <br /> D. , Infectious Wastes. Enter the four-digit number from 40 CFR Pon 261.34 for each hazardous wart*from hospitals,veterinary hos- <br /> pnale,or medical and research laborstories your installationhandles. Use additional sheets if r.ocessary. <br /> I' ll 49 60 61 r <br /> 2 h-6J-d <br /> hTd <br /> E. Chencterietips of Nonlieted Hazardous Wastes. Mark 'X In the boxes corresponding to the charecteri tics of nonlia]W hazardous wastes <br /> your inatallali n handles.(sae 40 CFR Paris 261.21 —261.24) <br /> 1.Ivnitable ❑ 2. Corrosive ❑ 3. Reactive ❑ 4.Toxic <br /> fLtGOt) ([X702) (D003) (D000) <br /> XI. Certification <br /> l certify under penshy of low that l have personally examined end am familiar with the information submitted in <br /> this and ell attached documents, and that based on my inquiry of those individuals immediste/y responsible for <br /> obtaining the information, /believe that the submitted information is true, accurate, andcomp/ete. lam aware that <br /> there are significant penalties for submitting false information, including the possibility of fine andimprisonment. <br /> Sipnaturs Name and Official Title ttyp@ or print) Date Blpned <br /> EPA faro 070412(Rev. 11-86)Aev*res <br /> DESCRIPTION' ThIIS ZS 4 ONF %tI1L'o 2E6ivE5 <br /> r 4:0 <br /> 1L t�:OSS F SA,L- O IF <br /> Q T "SEA_TC r_-R&m MZEMeu A-L- o f o N E Ot>p &4jL. GW_Lal lhIc <br /> S'i,f4A,(oG TA"K • E sTltNv -rC 'two 5 5 aLLo1.� C ter - S <br /> t�"C h o"$L t1v v o>� wAS'tc T� F3E (Z�Moa>i5a . <br />