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lel nlniwu-S Clean Harbors Profile Na. 371970-40 <br />13 NO <br />see arM CM=N. <br />tasAwrt <br />saG <br />F. REGULATORY STATUSf <br />0 <br />YES <br />[J)'IFS NO <br />UBEPA HAZARDOUS WASTE? 17019 <br />YES <br />2 N <br />0007 <br />YES <br />©NO <br />DOES THEWASTE CONTAIN GR-ATER THAN 20% OF ORGANIC CONSTITUENTS WTTHAVAPOR PRESSURE> .3KPA(.044 PSIA)? <br />YES <br />MYES NO <br />DO ANY STATE WASTE CODES A'PLY? <br />YES <br />Q NO <br />77 KPa (I1.2PSN)? <br />IS THIS CERCLA REGULATED IS )PERFUNO) WASTE? <br />ES <br />1Z NO <br />3i <br />G. D.Q.T NFORMATION: andmi to proper shipping name, naeerd class and ID numbed. <br />AYES NO <br />IS THIS WASTE PROH rr PAPTnaa? <br />LDRCATEGORY: ThisissWyectl LDR <br />VARIANCE INFO: <br />YES 0 N <br />IS THIS A UNIVERSAL WASTE? <br />YES Q NO <br />IS THISAWASTEWATER PER 40 CFR PART268.21 <br />ES 0 N <br />IF ANYWASTECODES D001.DDR:,D003(OTHER THAN REACTIVE CYANIDE OR REACTNE SUI.FIDE).O D0011, W12-DO17 <br />NON -WASTEWATERS, OR D018- TA43 APPLY. ARE ANY UNDERLYING HAZARDOUS (UHCs) PRIiSENT ABOVE UNIVERSAL TREATMENT <br />ES Q NO <br />ObfMERIZOF THIS WAUTE GENERATEA F006 OR F019 SLUDGE? <br />ES <br />13 NO <br />IS THIS WASTE SUBJECT TO CA rEGORCAL PRETREATMENT DISCHARGE STANDARDS? <br />IF ES, SPECIFY POINT SOURCECATEGORY OSTEO IN 40 CFR PART 4 <br />YES <br />NO <br />IEESOLTHE EZEN�YES NO <br />F ES, IWASTE EGNRATORTAANNUAL B14E10Magag ren <br />YES <br />2 N <br />DOES THIS WASTE CONTAIN VCC'S IN CONCENTRATIONS -500 PPM? <br />YES <br />©NO <br />DOES THEWASTE CONTAIN GR-ATER THAN 20% OF ORGANIC CONSTITUENTS WTTHAVAPOR PRESSURE> .3KPA(.044 PSIA)? <br />YES <br />Q NO <br />DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HASA VAPOR PRESSURE GREATER THAN <br />YES <br />Q NO <br />77 KPa (I1.2PSN)? <br />IS THIS CERCLA REGULATED IS )PERFUNO) WASTE? <br />ES <br />1Z NO <br />IS THISWASTE REGULATED UNDERTHE OZONE DEPLETING SUBSTANCEACT FOR ONTARIO? <br />G. D.Q.T NFORMATION: andmi to proper shipping name, naeerd class and ID numbed. <br />DESCRIPTION:WAST PG It <br />US DOT. Fl.MMabla Liquids, a.os., (GASOLINE), 3, UN1993, <br />H. TRANSPORTATION REQUIREMENTS <br />ESTIMATED SHIPMENT FREQUENCY: ONETIME WEEKLY MONTHLY OWARTERI.Y YEARLY QOTHER Qi6e! <br />IF BULK LIQUID OR BULK SOLID PLEASE IMCATE TAE EXPECTED NUMBER OF LOADS PER SHIPPING FREOUEs CY <br />CONTAINERIZED <br />CONTAINERSISHIPMENT <br />STORAGE CAPACITY: <br />CONTAINER TYPE: <br />CUBIC YARD BOX <br />PALLET <br />TOTE TANK <br />OTHER. <br />DRUM SIZE: <br />CONTAINER MATERIAL: <br />STEEL <br />FIBER <br />PLASTIC <br />OTHER <br />1. SPECIAL REQUEST <br />SPECIFIC DISPOSAL RESTRICTIONS OR REQUESTS'. <br />SPECIAL WASTE HANDLING REQUIREMENTS <br />OTHER COMMENTS OR REQUESTS: <br />BULK LIQUID <br />GALLONS'SHIPMENT: GAL. <br />FROM TANKS: TANK SIZE GAL. <br />FROM DRUMS <br />VEHICLE TYPE: <br />VACTRUCK <br />TANKTRUCK <br />RAILROAD TANK CAR <br />CHECK COMPATIBLE STORAGE MATERIAL <br />STEEL STAINLESS STEEL <br />RUSBERLINEO FIBERGLASS UNED <br />DERAKANE <br />OTHER <br />BULK SOUD <br />SHIPMENT UOM: TON YARD <br />PER SHIPMENT: MIN MAX <br />STORAGE CAPACI TONIYD <br />VEHICLE TYPE: <br />DUMP TRAILER <br />ROLL OFF BOX <br />INTERMCDAL ROLLOFF BOX <br />CUSCONACTOR <br />OTHER <br />J. BIENNIAL !ANNUAL REPORTING INFORMATION <br />SIC CODE 1000 SOURCE COOS FORM CODE <br />K.SAMPLESTATUS YES SAMPLED BY DAT E SAMPLED WHERE SENT <br />GENERATORS CERTIFICATION <br />I hereby certify that all Information submitted m this and a Rached documents is correct to Ne best of my knowledge. I aal T certify that any samples <br />submitted are representative of the actual waste. If Clean Harbors dismvera a discrepancy during the approval Process, 3eneratorgrants <br />Clean Harbors the authority to amand the profits, as Clean Herno s deems necessary, to revact the discrepancy. <br />AUTHORIZED SIGNATURE NAME (PRINT) TITLE DA'E <br />Report Printed On: 12/3/2007 At: 5:40 PM profi1e\CH_Master_Pr0mpt1,rllt Paple 3 of 3 <br />