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FEB -01-1996 15:50 <br />619 Pacific Gas and ElecMc Compaoy <br />PCB Variance Shipping Omper <br />Instructions: <br />7 <br />U -M, Ian 1W) <br />Uft&jC*M' M, Sedan <br />1. Use this form when shipping PCB -contaminated debris or electrical equipment (5 ppm or greater) from field locations <br />to the nearest approved, manned PG&E facility. <br />2. Do not use this form for shipping "in-service equipment" within the PG&E system. <br />3. A guide for estimating weight, volumes, and RQs of PCB material is shown on the reverse side of the form. If the <br />volume meets or exceeds the RO, use shipping name A. otherwise use shipping name B. <br />4. The facility hazardous waste coordinator should keep these forms on file at the facility for three years, then send them <br />to a long-term storage facility. <br />5. If concentration is unknown, you must assume the equipment and/or debris is 50 to 499 ppm and fill out this form. <br />AMr@n erSpill: <br />OrY�%% ' ��� t7 ✓ ' /'/�/� <br />Destination of ahtpmam (i.e. G&E Ser Center, Malan Facility), <br />Proper Shipping Name: <br />Emar en <br />g cY Response Guide No. 37 <br />❑ A. Polychlorinated Biphenyls, 9, UN2315, PG III, RQ <br />X'8. Non-RCRA Hazardous Waste (Solids or Liquids) 4/0 <br />Emergency Response Telephone No. <br />1 (NO)321-1MO <br />Number of <br />Containers <br />Type of Container <br />Estimated Totals <br />Weight (Kg) <br />D;eLfSi <br />X Electrical Equipment r��ASfSf ~3 <br />Date7Zy� <br />❑ Ecopod (Spill Debris/Soil) <br />❑ 55 -Gallon Drum with Removable Head (Solids) <br />❑ 55 -Gallon Drum with Bung (Liquids) <br />❑ Other. <br />ncentration of PCBs PCB Concentration From Information on Equipmentnown: <br />r <br />❑ Unknown PCB Concentration -Assume to Contain PCBs (50 to 499 ppm) <br />"This is to certify that the above-named materials are properly classified, described, packaged, marked, and labeled and <br />are in proper condition for transportation according to the applicable regulations of the Department of Transportation." <br />Name, Tice, and company Telephone Number of Person Preparing Shipping <br />Name, ritle, and Company Telephone Number d Parson Accepting Shipment <br />Paper (at Spill):/%1 7 XeA-A� <br />(a[ Fanlity): <br />aOf-% —151/ <br />1-?PK1 N tea z -o 9 6OW/6 <br />Signature <br />D;eLfSi <br />tu <br />Date7Zy� <br />I Rofemnca Guide or estimating weighfa of PCB wastos m shown on reverse side or form. <br />Distribution Instructions: <br />1. While—DNi&lon PCB Coordinator <br />2. Yellow—Crew Headquarters/Factllly Hazardous Waste Coordinator <br />3. Pink—Corporate Environmental Comultent/H.U. Environmental Coordinator <br />Facility Hazardous Waste Coordinator fills In this section: <br />Laboratory Test Results: Dlsposklon/Destination of Equipment <br />(Example: ISO ppm) <br />vr*(¢ A/`1°a? <br />x7_ u ­'os <br />Shipper's Number: <br />24553 <br />r�CAP— <br />TOTAL P.01 <br />