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FEB-01-2UU8 FRI 04 : 11 PM t'• UR
<br /> 0111/21/2M II:2Fd 70�7]i4711" UNIVERSAL PAGE 02/03
<br /> uosbq 1 1 Pu PInc. fllPe b use Only
<br /> Number;d Job Number
<br /> WASTE PRODUCT QUESTMNNAIRE
<br /> 6IS26
<br /> L. +A•G,INF(`un�,a9'S0 e,- t LL._c!
<br /> GenergtorNamc_ J ,if�/ I zm
<br /> �.�„•�'_BilllegNse /y
<br /> Address
<br /> ��(_ Y� '�'_' Address^_•r,,,�/,� t _,�F
<br /> City,State Z.tcity,State, ip
<br /> contact Contact �_
<br /> Phone - L., o�--F'ac ...Ed[j. ✓�:G;c'Gl,= Phone _ „_Fax_&"
<br /> BPA un er_—........�,r.,{,�
<br /> II. WASTE PRODIJf)T F)L0.CRIPTI(SM ii f.,'HAFIAC.'i�;t'tl$'rIC3
<br /> A. Waste Product Cgrnrnpn Nso le 4J 42:� - - -
<br /> Process Gel'a"Vnd
<br /> 13. Hazard PU3 Pr[:ped;e:y: —__—._-.__.._.,,_ ... .•..—...,....-- .•— ,�� i — ---�•--^
<br /> 1, U,S. EPA Ha_arduus VVG-.tt7 •acs L7 tdo 2• State Code(s)
<br /> EPA Code(s); ..._.
<br /> c.Is Wel Ptotluot; U Snc:;k Sensitive L7 Reactive 0 Fadloactive i'Pyrophoric Cl El;uleyical G None
<br /> C. Physical PrOpeM103 rl 70'F.
<br /> 1, physical State: 2_ LAyert: 3. Flesh Point(CIO"Cup Only): 4. Viscosity,slmasr to:
<br /> ❑Solid U Sludge ❑Multilayered 0<70'F G 140-200'F +lN9ter
<br /> squid n Empty Container 0 BI-Layered 5 70-i00'F Q No l / ❑Motor Oil
<br /> Any free llgldds at 70°F �ornogenous G7 t01-139°f O Exact ❑Honey
<br /> ❑Yes ❑ No ❑Other
<br /> D, 1, D-ri 2_ M,Salsas 3. Odor: b. Ph.
<br /> 6iyWo%� Ilfs/yallon ❑ey weighl 0Nonee RC2 ❑9.1 -125
<br /> Solid 1[7 Ibsrcubic N. C By Vdumr°_ ❑Strong 02-5 M>12.5
<br /> Any dehns in wAsie: Total _,—_.�.,._ / •',-+.�,dil �:b?I -g O F_xacl , -
<br /> CIYos ❑tau 1 1)tx rl Gra:
<br /> E, Chemical Composition (Acct>unL her 10wni,1!LOIN): Range Metals: Total (PPM) •`li'Strddou. Hufbl0ideD;PPM
<br /> —EF TO xioity (mgyl) Undone .
<br /> _ 8arl urn (gn)
<br /> y Cadmium (Cdl 2 it_
<br /> Canrn*•(e"al _.._..._._.,.,._...._,.,,- ;,-tar:.
<br /> er
<br /> _,._._—.—_....__...............�..,._.. ......._.._ ... .... .____.__._..—. lead (Pb)
<br /> rvlercury(Hg) �_. f
<br /> N. Pteactiaes&Olner
<br /> ckel (Ni) ..,_..--- wastes(PFMJ:
<br /> i
<br /> Selenium (So) OynnMt:s Dioxin
<br /> Silver(Ag) _ Sulfides PC6a
<br /> zinc(Zn) HOC ,_, Phenols
<br /> F. Shipping and Mondung Intormenon:
<br /> 1. . . ar o!le. a enLl es No _ Proper O.U.I. tinipping Name,1
<br /> 3. O.O.T. HFZArd Claes. _ 4. O.O.T.ID NOmbec Q, P
<br /> J �__
<br /> 5. M01hpd or;jhip meal:•_�._- __._[)f lVr1 Ondror Bulk C)IhOr 6. 0.0.1 Shipping Container l._hJC T�•
<br /> 77-
<br /> 7, Protected V'olu mR', .,,_�_—L-._1'Cn::_,,,,,�:....�...___ Gallgns,.�....___.—_CUlaiuyrartls Oi her a. fiQ An+6i,1n;
<br /> par__ .tart-fin+?_—_.,...-.�� r;4:Ck .__ MorI —__�....� UIIf CI' —�—__— y.l
<br /> CUtnmr:nty ._..... ... .. .._.....,.._...,_..... ._......_.... . .......
<br /> CENEP,o.7C`R r.l.':'r f F1.-,ri hION;i' n I F:Dai:'ta i
<br /> I her0b';C^_:'i.l',: -,,; ti;.,r+ pl.l),p�::vp n71n;r,:".:,;: ::r•�1 r:u:Ve,l4•:r!:n n.+.0�� �.•nre all Inlprmalinn suHmittP,d In 1111;and all lhx°lnrnnhed r1nGV rn Cn1,
<br /> Is t111L ::I lite 1'rfl&!: i�q''.I,..'IFi Ir:Eb`"lthn:•r, qCn the ulql fest nothods In 40(11^f: ?.G'! mr it rry.recen;ativ!=oomplc
<br /> as ej 1111f"1 i gqt 29, 10lrtc'i npr nf r-ry krio ,LwJ;le. all k,-,;i,.r, No Ct H 2C•!; .inn ellspected ha2ardeu$CPr^pan2nl$ have bean inclurl,,tf in
<br /> In is dan - 411 molenpl Hat ,:dCk Ug,h will GOmpiy with All t°urreo rS!Idatinn:;,
<br /> Title�O(': `Oxte. '?v
<br /> �{fj(-,Gj F lraM n02 fRe:•.0'1101)
<br />
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