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Mar. 5. 2015 9:56AM GEORGE W LOWRY, INC No. 1452 P. 1 <br /> 08-01-'13 13:.29.•FAO.o1es'Environmental 661-322-8880• 8-052 P0004/0015.F-066 <br /> AvR 08 2011 <br /> DEMENNQ/KERDOON'S.LABORATORY.'IS.CERTIFIEDBYTHE CALIFORNIA DEPARTMENT OFHEAITH ' <br /> SERVICES ENVIRONMENTAL LABORATORYACCREDITATION'PROGRAM (,ELAP):'CEtiT# 037 EA11/IpOAIUCNTAL <br /> .GE:NERATOR'S.' YYASTE P.ROF:ILE `-WGR.KS-H.EE7 . I4!=a,�,,)colo-,ocr,IT <br /> GEN6RATOVS INFORMATION <br /> A. GENERATOR'SNAME PQd-�c _"4ek-xm4 R. EPA 10 6603r8r77 <br /> C. GENERATOR'SADDRE//SS X1372 S.,Jr.• iBne D. PHONEM 460-0j5M <br /> E: CITY`STATE;ZIP'Ao7C. CA- %'9_.< <br /> F. GENERATOR CONTACT G. TITLE <br /> A.:-.._CUSTOME.RNAME COLESENVIRONMENTAL - —1 , PHONE•(_„.) 66'1/32&8258 <br /> J. TRANSPORTER,NAME Coles Erivironmental.' K; PHONE( ) 6617322-8256 <br /> L. TRANSPORTER-EPA ID# CAL 000 258 462 M. CONTACT Mary Miller <br /> A. NAMEOFWASTE uN '4el •le [v+. I yr. ' !u- (ifilc <br /> B. CALIFORNIA.HAZARDOUS WASTE CODE NO._ 'a(3 <br /> C. EPA HAZARDOUS WASTE CODE NO. <br /> D. DESCRIBE PROCESS GENERATING WASTE - a <br /> IS THIS WASTE REGULATED'UNDER 111E BENZENE,NE P'RULES? Yes :✓ no • <br /> l E_ DOES THIS'WASTE CONTAIN P.CB'S? yes �.no <br /> F DOES THIS WASTE CONTAIN DIOXIN? (F020-F028) yes _;]—no <br /> G. DOES THIS WASTE CONTAIN'SULFIDES OR CYANIDES? yes 7 no <br /> H, DOES THI9:WASTE CONTAIN PESTICIDES'OR HERB9CI[5ES? yes r✓. no <br /> (16 YES, fDENTIFY.IN ITEMS AOA D'ABOVE.) <br /> I. DOES THIS•WASTE:CONTAIN SOLVENTS? 64_yes no <br /> (1F'YES; IDENTIFY:IN ITEMS:A-OR D ABOVE:). ; <br /> •J, DOES THISWASTE CONTAIN PLATING WASTE? �_yes no <br /> K. HAS THIS:WASTE BEEN MIXED WITWRCRA.LISTED WASTE? <br /> (F K,.6 bR P EPA-WASTE•CODES) no <br /> L.. IF YOU HAVE MSDS FOR OdMPONENTS IN THIS WASTE, <br /> —=------PL'-EASE-A7TACH-.—.. ?.:................................ ..............-:--.---MSDS-A7TAEHED-Ej:---- -M. IF YOU HAVE.CURRENT ANALYSIS OF THIS' <br /> WASTE, PLEASE.ATTACH'.(........................I..../...........,,..�y. . . , . CHEMICALANALYSISATTACHED 0 <br /> N. PACKAGING/VOLUME U BULK LIQUID tp DRUMS.L J OTHER' ' ❑ AMOUNT: / <br /> GALLONS L] LBS. E] CUBIC YARDS PER: 0 DAY L]MONTH E]OUARTER m YEAR <br /> GENERATOR'S CERTIFICATION <br /> I HEREBY CERTIFY THAT THE INFORMATION PROVIDED ON THIS DOCUMENT,16 TRUE AND ACCURATE,AND NO INTENTIONAL MIS• <br /> REPRESENTATION HAS BEEN COMMITTED BYANYONE.I PURYHER CERTIFY THATANY-SAMPLE(S)PROVIDED WITH THIS WASTE <br /> PROFILE WERE TAKEN AND PRESERVED IN ACCORDANCE WITH aO.CFR`251,APPENDIX 1 AND ARE.ACCURATE AND REPRESEN• <br /> TATIVE OF MY ACTUAL WASTE STREAM. I HEREBY AGREE'TO NOTIFY DEMENNO I KERDOON.SHOULD THIS WASTE STREAM <br /> CHANGE IN ANYWAY. <br /> AUTHORIZED SIGNATURE ��~ � —DATE ! 7F, /6— <br /> PRINT <br /> 6— <br /> PRINT NAME AND TITLE COLIN KELLY .(Agent for Customer) T <br /> FORM NO. 1001 REV,4.15.08,5.25•10 <br /> • Is benzene waste from a chemical ma-. n�Luring,Ma by-product recovery,or <br /> __,-_,_„� <br /> ---- ------ ..-- I�t <br />