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JUN-01-2001 FRl 08; 41 AM P. 001 <br /> Ub/yYJ�(I/�GQ[CJYJr t]tl:.]L !q (17L( UNSVERbAL l'fllik )w 174 <br /> �.r `0►�7b 4v t ve01, Inc. interttal Use only <br /> J Job Number; <br /> WASTE PRODUCT QUESTIONNAIRE <br /> 1, aRM <br /> LUkL <br /> CAC"cAtPY NaiQMP,.OR1 S <br /> �y,,.....�. <br /> ( ! <br /> AddrefiBilling Name, VjFMRAZETB0VMTAL <br /> atap,Zi 4Nve101 IIS <br /> CvtccJty,&tatq Zip <br /> RCIA CA 945i6 <br /> Phone Contact <br /> EPA Number �—. ` � Phone47 66gg `rax <br /> _ _`Z4L-747-197.7 <br /> 11. WASTE PRODUCT DESCRIPTION A CHARACTEA)STICS ;;11 <br /> A. Waste Product Common Nana YfL ' <br /> 1- Pr0I Generating Waste ,[YJ/fy(rj <br /> B. H9Fardous Properties; <br /> 1. U.S, EPA HazaMgUe Wants? ❑Yea q 2, State Code(&I �y <br /> e,Is Waste Product: 0 Shock Soneitive ❑Reactive El Redloacf)ve EPA Code(a); <br /> C. PhY910e1 Plopenlaa at 71pY op rj Et(vlcgloal n None <br /> 1. Physical Ming 2. Leye.a: 3. Flesh Paint Gazed Cu ON <br /> L7$gild 0 Sludge ( P y). 4, VMcdettY similar Id; <br /> 1 g ❑M-Layeerad L7�70"F p140.200'p 0Water <br /> quid ❑Empty Gvntrinar. Q B4Layered y�^��7+ 1011°P ❑No Far <br /> in Ilea liquids at o F omogenous "C]101-139°F d Monet CII <br /> G1 Yea ❑No j ❑Exact -- t�Honey <br /> D, 1, Banally: 2. 9hsollaa <br /> 13Othor <br /> Liquid❑ 3. Odor: q, 11 ib.Mallon <br /> Q By weight Q None Ck2 <br /> Solid Cl� ibo/cublc ft. ❑By Volume09.1-12.5 <br /> Any debris In waste: la strong f�2-6 E>4 2.5 <br /> Total -9❑Mild ❑5.1 <br /> ❑vee d Na ❑Exact <br /> Explain Describe: <br /> E C e IcaI Comp05111 h 4ftcount(or 10D%of total); ,1I <br /> % Total (PPM) Pestciides,Herbicides:PPM <br /> % _EP Toxicity(mg/1) Endrin . . . . . . <br /> Arssn)c(As) Lindane . . . . . . <br /> barium(8a)y0 Methoxychlor <br /> Cadmium(Cd) Toxaphene <br /> er(Cu) other Gapp <br /> other <br /> % Lead(Py) - <br /> % Merwry(Hg) <br /> Nickel(NI) R28QUWS BI Omer <br /> qh Wastes(PPM); <br /> % Salanlym(Se) Cyanides <br /> -- Dioxin <br /> �....,.�% Silver(Ag) Sulfides �—PCBs <br /> F. Shipping and Handling IMarmnlldc; Zinc(ZnJ HOC Phanvlg <br /> 1. ID 0-T- Hazardous Material? Yea �_ d 2. Prpppr D.D.T Shi <br /> ppinp Name: hr <br /> D.O.T. ID Number. __ Pp• <br /> S. Method al Shipment: Drum snI aulk�.. Olhef 8. D.O.T. Sh- <br /> Ipping Container <br /> 7, fhoJsClan volume: TOIIe_..... Gallon. Cub'c Yards-_. <br /> Per._.,T One rma Olher 8, R4 Amount <br /> Walk Month <br /> III. GENERATOR CERTIFICATION STATEMENT <br /> I hera4Y cerrltY Ihal:r.an agihilrQa{I re WVppr111111Ven11hu Oengn for nalr@vl Mrnron, all Informavan submitted in trill and all <br /> is twe andlaccurale.Aaelyaia of 1hn I VI was oouducteN In ACEI uqunl:�f witll the apprDved feet methods in 4❑ F the attadhad dgCUmanti <br /> as d"nod In dp CF 261.20'. To the ball of my hnOwlvdya,all knuwo 14(i Cf R 2dp and srrapected hazardousC R 261 on a represantaklve namplo <br /> this dgcum ntallo an marartai and packaging W11141pm ly with all eurrenI revulativns. cvmpanepts have been included n <br />— - - - �.j'' <br /> Signature _ (r - <br /> -- - Tita <br /> nano mo raa.,m+nq <br />