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riz-gaiiadcarClean <br />Oh E TIME WEEKLY MONTHLY QUARTERLY <br />YEARLY MOTHER Other <br />ESTIMATED SHIPMENT FREQUENCY: <br />Harbors Profile No. 3946196 <br />gaYwealm.NrA43OY1pet� <br />RP. <br />CONTAINERIZED <br />F. REGULATORY STATUS <br />BULK LIQUID <br />ZYES <br />NO <br />USEPA HAZARDOUS WASTE? <br />GALLONSISHIPMENT: GAL. <br />001 DOLS <br />STORAGE CAPACITY. <br />OYES <br />NO <br />DO ANY STATE WASTE CODES APPLY? <br />PER SHIPMENT: MIN MAX <br />CONTAINER TYPE: <br />i3 <br />OYES <br />NO <br />IS THIS WASTE PROH An CEP PART gm? <br />VEHICLE TYPE: <br />VEHICLE TYPE: <br />MR CATEGORY: I This is sut*t fP fDR. <br />VAC TRUCK <br />VARIANCE INFO: <br />TOTETANK <br />YES <br />O NO <br />IS THIS UNIVERSAL WASTE? <br />ROLL OFF BOX <br />YES <br />ONO <br />IS THIS A WASTEWATER PER 40 (VR PART 26837 <br />YES <br />ONO <br />IFANY WASTE CODES D00r, D=. (OTHER THAN REACTIVE CYANIDE OR REACTIVE SUI FIDE), D0)4.00011, D012-0017 <br />CHECK COMPATIBLE STORAGE MATERIAL <br />CUSCONACTOR <br />NON -WASTEWATERS. OR DOLS& C 019 APPLY, ARE ANY UNDERLYING HAZARDOUS NHC3) PRESENT ABOVE UNIVERSAL TREATMENT <br />YES <br />ONO <br />OD994KQCUWOF THIS%W7E GENERATEA FOOSORF019 SLUDGE? <br />OTHER <br />YES <br />O NO <br />IS THIS WASTE SUBJECT TO CA-EGMCAL PRETREATMENT DISCHARGE STANDARDS? <br />IF YES, SPECIFY POINT SOURCE CATEGORY USTED IN 40 CFR PART 4 <br />YES <br />NO <br />IS THIS WASTE REGULATED UNC':R THE 9ENZENE NESHAP RULES? <br />FIBER <br />IF YES, IS THE GENERATOR'S TO' AL ANNUAL BENZENE >- 10 Megag.? YES NO <br />YES <br />0 NO <br />ODES THIS WASTE CONTAIN VO -,S IN CONCENTRATIONS »DD PPM7 <br />YESsd <br />NO <br />DOES THE WASTE CONTAIN GREATER THAN 20% OF ORGANIC CONSTTRJENTB WITH AVAPOR PRESSURE>=.SI(PA(.044 PSIA)7 <br />YES <br />ONO <br />DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN RS PURE FORM HAS A VAPOR PRESSURE GREATER THAN <br />YES <br />O NO <br />77 KPa (I1.2PSIA)7 <br />IS THIS CERCLA REGULATED (SIIPERFUND) WASTE? <br />OTHER <br />YES <br />ONO <br />IS THIS WASTE REGULATED UNDER THE OZONE DE PLETING SUBSTANCE ACT FOR ONTARIO' <br />G.D.O.TINFORMATION: Qndudep(opensNPPingne .lwarddassandlDnumbe0. <br />US D.O.T. DESCRIPTION: FWZiTE CaSdiiRel(GA SOLINE, WA TER), 3, UNI203, PG 11 <br />H. TRANSPORTATION REQUIREMENTS <br />Oh E TIME WEEKLY MONTHLY QUARTERLY <br />YEARLY MOTHER Other <br />ESTIMATED SHIPMENT FREQUENCY: <br />IF BULK LIQUID OR BULK SOLID PLEASE INICATE T'1E EXPECTED NUMBER OF LOADS PER SHIPPING FREQUENCY <br />CONTAINERIZED <br />BULK LIQUID <br />BULK SOLID <br />CONTAINERS/SHIPMENT <br />GALLONSISHIPMENT: GAL. <br />SHIPMENT UOM: TON YARD <br />STORAGE CAPACITY. <br />FROM TANKS: TANK SIZE GAL. <br />PER SHIPMENT: MIN MAX <br />CONTAINER TYPE: <br />FROM DRUMS <br />STORAGE CAPACI TONIYD <br />CUBIC YARD BOX <br />VEHICLE TYPE: <br />VEHICLE TYPE: <br />PALLET <br />VAC TRUCK <br />DUMP TRAILER <br />TOTETANK <br />TANK TRUCK <br />ROLL OFF BOX <br />OTHER: <br />RAILROAD TANK GAR <br />INTERMODAL ROLLOFF BOX <br />DRUM SIZE: <br />CHECK COMPATIBLE STORAGE MATERIAL <br />CUSCONACTOR <br />CONTAINER MATERIAL: <br />STEEL <br />STAINLESS STEEL <br />OTHER <br />STEEL <br />RUBBER LINED <br />FIBERGLASS LINED <br />I FIBERGLASS LINE <br />FIBER <br />QEMKANE <br />PLASTIC <br />OTHER <br />OTHER <br />SPECIAL WASTE HANDLING REQUIREMENTS <br />OTHER COMMENTS OR REQUESTS: <br />J. BIENNIAL I ANNUAL REPORTING INFORMATION <br />REPRESENTATIVE SAMPLE HAS SEEN SUPPLIE ONO <br />GENERATORS CERTIFICATION <br />I hereby Reny that all Information submitted In this and atached documents Is correct to the best ofmy&OWedga. sankcertifythatanysamples <br />submitted are representative of the actual waste. If Clear Harbors discovers a discrepancy during the approval process, Generatar9rants <br />AUTHORIZED SIGNATURE <br />Report Printed On:1213j2007 At: 5:39 PM <br />NAME (PRINT) <br />profile\CH_Master_Promptl. r[2 <br />TITLE DA1E <br />Pale 3 of 3 <br />