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er 1HAta.11m. <br />QNO <br />Ilan Clean Harbors Profile No. 392126 <br />YES <br />O NO <br />(UHCs) ABOVE UNIVERSAL TREATMENT <br />bD 114€AN!OF THIS WAE TE GENERATE A F006 OR FO 19 SLUDGE? <br />F. REGULATORY STATUS <br />ONO <br />OYES NO USEPA HAZARDOUS WASTE? <br />i DOiB <br />IF YES, SPECIFY POINT SOURCE CATEGORY LISTED IN 40 CFR PART 4 <br />OYES NO DO ANY STATE WASTE CODES APPLY? <br />NO <br />43 <br />YES <br />YES <br />OYES NO IS THIS WASTE PROHIBITED 3. I Ann njqArvqAlTgpATmpNypFp an rvP oear>ea> <br />LDR CATEGORY' This Is saf LDR. <br />rNO <br />DOES THIS WASTE CONTAIN VO —,S IN CONCENTRATIONS s=500 PPM? <br />ELL <br />VARIANCE INFO: <br />YES Q NO IS THIS UNIVERSAL WASTE? <br />YES <br />YES ONO IS THIS A WASTEWATER PER 40 (:FR PART 268.2? <br />DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSURE GREATER THAN <br />YES <br />QNO <br />IFANYWASTE CODES D001.DW:.0003(OTHERTHAN REACTIVE CYANIDE OR REACTIVE SUt FIDE), D004-DO011, 0012.0017 <br />NON -WASTEWATERS, OR D018- C043 APPLY, ARE ANY UNDERLYING HAZARDOUS PRESENT <br />YES <br />O NO <br />(UHCs) ABOVE UNIVERSAL TREATMENT <br />bD 114€AN!OF THIS WAE TE GENERATE A F006 OR FO 19 SLUDGE? <br />YES <br />ONO <br />IS THIS WASTE SUBUSCT TO CA-EGORICAL PRETREATMENT DISCHARGE STANDARDS? <br />IF YES, SPECIFY POINT SOURCE CATEGORY LISTED IN 40 CFR PART 4 <br />YES <br />NO <br />EESHAPRULES? YES.13 HGETQFhSO Al- ANNUALBNZEN1 <br />IFEENERATTHE ANNUAL ems? YES <br />YES <br />YES <br />ONO <br />ONO <br />rNO <br />DOES THIS WASTE CONTAIN VO —,S IN CONCENTRATIONS s=500 PPM? <br />DOES THE WASTE CONTAIN GREATER THAN 20% OF ORGANIC CONSTITUENTS WTH A VA'OR PRESSURE a=.SKPA (.044 PSIA)? <br />YES <br />O NO <br />DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSURE GREATER THAN <br />YES <br />ONOS <br />77 Pal (I1.2PSIA)? <br />THIS CERCLA REGULATED (SUPERFUND) WASTE? <br />YES <br />ONO <br />I S THIS WASTE REGULATED UNDER THE OZONE DEPLETING SUBSTANCE ACT FOR ONTARIO` <br />G. U.O.T INFORMATION: (Ingpde Proper shipping hams, I erred elan and ID number). <br />US <br />H. TRANSPORTATIONREQUIREMENTS <br />ESTIMATED SHIPMENT FREQUENCY: ONETIME WEEKLY MONTHLY QUARTERLY YEARLY QOTHER Ocher <br />IF BULK UQUID OR BULK SOLID PLEASE INICATE TI IE EXPECTED NUMBER OF LOADS PER SHIPPING FREQUENCY <br />CONTAINEi12ED BULK LIQUID BULK SOLID <br />CONTAINERS/SHIPMENT GALLONSISHIPMENT: GAL. SHIPMENT UDM: TON YARD <br />STORAGE CAPACITY: FROM TANKS: TANK SIZE GAL PER SHIPMENT: MIN MAX <br />CON7AINER TYPE: FROM DRUMS <br />CUBIC YARD BOX STORAGE CAPACI TOWYD <br />PALLET VEHICLE TYPE: VEHICLE TYPE: <br />70TETANK VAC TRUCK DUMP TRAILER <br />OTHER: TANKTRUCK ROLL OFF BOX <br />DRUM SIZE: RAILROAD TANK CAR INTERMODAL ROLLOFF BOX <br />CONTAINER MATERIAL: CHECK COMPATIBLE STORAGE MATERIAL CUSCONACTOR <br />STEEL STEEL STAINFIBERGLASS <br />SS EEI.UNE OTHER <br />FIBER RUBBER LINED FIBERGLASS LINED <br />PLASTIC DERAKANE <br />OTHER OTHER <br />L SPECIAL REQUEST <br />SPECIFIC DISPOSAL RESTRICTIONS OR REQUESTS: <br />SPECIAL WASTE HANDUNG REQUIREMENTS <br />OTHER COMMENTS OR REQUESTS: <br />J. BIENNIALIANNUAL REPORTING INFORMATION <br />SIC CODE 1000 SOURCE CODE FORM CODE <br />K. SAMPLE STATUS YES SAMPLED BY DATESAMPLED WHERE SENT <br />REPRESENTATIVE SAMPLE HAS BEEN SUPPLIE MONO <br />I hereby CeNfy that all Information sulrn hoxi In this and at ached dommems is ween to the best of my knowledge. I aeb --Mfy that any samples <br />_ submitted are representetrvedere aclLed waaleJl.Cleanfivisors dilscoversadisrapangdurAq Ne appmvel Wosess, Ceheator g2lrts <br />Clean Namara the authority to amend Me profile, as Clear Harbors deems necessary, m reQacl the disvepaney. <br />AUTHORIZED SIGNATURE NAME (PRINT) TITLE D.' -T <br />^z-rr-rmarts <br />Report Printed On:12/3/2007 At: 5:35 PM profile\CH_Master_Promptl.rp: Pag° 3 of 3 <br />