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FEB -01-200B FRI 04;32 PM <br />P. NU <br />WA6K ftdetL'rAI)l< 33[YL <br />Dif Dellen no / Kerdoon' 'op <br />1EMENNO / KERDOON'S LABORATORY IS CERTIFIED BY THE CALIFORNIA DEPARTMENT OF HEALTH <br />SERVICES ENVIRONMENTAL LABORATORY ACCREDITATION PROGRAM (ELAP) CERT.#2037 i <br />GENERATOR'S WASTE PROFILE WORKSHEET = <br />GENERATOR'S INFORMATION <br />A. GENERATOR'S NAME AY`LS&r S�i�i✓ <br />EPA ID#[f 4Td011f�l �Sf�/ <br />C. GENERATOR'SADDRESS Az//A L///1q <br />D. <br />PHONE <br />E. CITY, STATE, ZIP 7/z��-1����!� <br />F GENERATOR CONTACT MAI FN fIM 14 5 <br />G, <br />TITLE TjQRVK 1) JA- Ii AC P <br />H. CUSTOMER NAME Ponder Environmental SrVS- I. <br />I <br />PHONE(70)7 748-7775 <br />J_ TRANSPORTERNAME Ponder Environmental Srvs.K_ <br />PHONE (7QI7 74B-7775 <br />L. TRANSPORTER EPA ID# CAR000180737 <br />M. <br />CONTACT Jim Ponder <br />A- NAME OF WASTE RQ Waste Flammable LicTuid <br />B_ CALIFORNIA HAZARDOUS WASTE CODE NO. 213 <br />C. EPA HAZARDOUS WASTE CODE NO. D001, D018 <br />D. DESCRIBE PROCESS GENERATING WASTE Tank Cleaning <br />E. DOES THIS WASTE CONTAIN PCS'S7 <br />F DOES THIS WASTE CONTAIN DIOXIN? (FO20-FO28) <br />G. DOES THIS WASTE CONTAIN SULFIDES OR CYANIDES? <br />H. DOES THIS WASTE CONTAIN PESTICIDES OR HERBICIDES? <br />(IF YES, IDENTIFY IN ITEMS A OR D ABOVE.) <br />1. DOES THIS WASTE CONTAIN SOLVENTS? <br />(IF YES, IDENTIFY IN ITEMS A OR D ABOVE) <br />J, DOES THIS WASTE CONTAIN PLATING WASTE? <br />K. HAS THIS WASTE BEEN MIXED WITH RCRA LISTED WASTE? <br />(F, K, U OR P EPA WASTE CODES) <br />L IF YOU HAVE MSDS FOR COMPONENTS IN THIS WASTE, <br />PLEASE ATTACH .................................................. <br />M. IF YOU HAVE CURRENT ANALYSIS OF THIS <br />yes X no <br />yes X no <br />yes X no <br />yes X no <br />yes X no <br />yes X no <br />yes X no <br />................ ........ MSDS ATTACHED x - <br />WASTE, PLEASE ATTACH.................................................................CHEMICAL ANALYSIS ATTACHED ❑ <br />GENERATOR'S <br />I HEREBY CERTIFYTHATTHE INFORMATION PROVIDED ON THIS DOCUMENT, IS TRUE AND ACCURATE, AND NO INTENTIONAL MIS- <br />REPRESENTATION HAS BEEN COMMnTED 6 NE. I FURTHER CERTIFY T AT ANY SAMPLE(S) PROVIDED WITH THIS WASTE <br />PROFILE WERE TAKEN AND PRE SERV ACCOR NOE WffH 40 CFR 28 PPENDIX 1 AND ARE ACCURATE AND REPRESEN- <br />TATIVE OF MY ACTUAL WASTES M. I HEREB AGREE TO NOTI EMENNOJ KERDOON SHQULD THIS WASTE STREAM <br />CHANGE IN ANY WAY. <br />--2-- BATE <br />PRINT NAME AND TITLE <br />FORM N0.10DI REV.1.2.01 <br />