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INST11AT, INC NONHAZARDOUS MATERIAL N-H WH Doc d <br /> A liquid>i' Ve dispascrl a:ompaery PROFILE SHEET Date O S'j lib <br /> GENERATOR INFORMATION BILLING 1NFORMA'1 ON <br /> Gent aimeir <br /> Contact <br /> (Ela) phone 1.5.1-$dao Fax.C.$7X544-���, ``�f��tS, lf.�Phoue <br /> Moiling Address lf�Se+ a'+rMailing Address C <br /> Site Addrexs J" <br /> .ra S-�.e��►r �_,,,_`�aja4 Dona Custoater Have Aooatnt With lisoxat,lno,_ <br /> MATERIAL DESCRIPTION SOURCE OF MATERIAL <br /> Gei�eral Mal¢nal and Pieces Description - Anter rfi�te s <br /> p .r t i'1..1a.� Aborta Owund BMW Tw k <br /> Type of Co nard(s) UndsrVound alWW Tank Nam <br /> Crude Oil L_API Gravity) SOUMA ease(not UST related) <br /> Gasoline Diesel Other(liar each) =Z_ n toting well dawwlering or pump teal <br /> Sur&=Impoundments <br /> Originating Sale of Material Olhi r(Ust Spedfiaialy) <br /> _ M i.A i uA—V%- l adL% „t-6-:6A-& .. <br /> Specific Current Site of Material(if datferent) EWmated QuaneUy ^' <br /> Ertimaled%sedimard S w/o <br /> ANALYTICAL DATA MATERIAL PROPIUMES <br /> Pie=check tests which have been corAucted and for which ✓ Liquid <br /> data is attached Solids Satad/Grit Fines <br /> Bioassay Text CAM Mdals Color <br /> lgkutability Volaule cgpAka Odor <br /> VTPH PCB's 011ier <br /> =2 Ober_lam= tu�rui G <br /> HAZARDOUS WASTI CHARACTERISTICS Yea Na <br /> 1 h the Flashpoint las than 14W F 7 ). 132 Is the pH las khan or equal to 2 or greater than or equal.to 12.5 7 ❑ <br /> 3 Is MoVidd suspected boaohio eyatudesor sulfides <br /> 4 Is!hare soy reason to suspect the wastaer watar world prone bode in a(tt6 ❑ Sr <br /> baro-assay test 7 ❑ <br /> HYDROCARBON CHARACTZRIMCS <br /> 1 Was the wastewater tested for h7+droe esimis? ❑ <br /> then:2 is a detectable hydrocarbon odor 7 <br /> 3 Is there an oillwater phase m the wastewater? ❑ <br /> 4 Is there evidence of an anhilawa? ❑ <br /> 5 Was the wastewater toted for chlorinated hydroearbeoa? 13 <br /> 6 Is there reason to stuped the Moen-of dtlaruwted hydroaxabm ❑ lot <br /> such as mchoiocthylene 7 til <br /> HEAVY lbSTALS <br /> I Wan the wastewater less for heavy metals 7 ❑ <br /> 2 Is these reason to suaped the prrsmce of heavy araals Sufi as led or silver? ❑ <br /> GE1411MAT011AGREEMENT AND CERTIFICATION <br /> Gesaesdw beieby artilies to Instsat.Inc.that this profile aided sod its titAdW of igoidw am rept ewAsdive of acid coolain has sod sonde desmrpt)mu <br /> tithe @*)ad msttertal,and that Generator has tinned b be dWk"d an menet uAcinstim rdding to known or sulpaded harards la sock arMaisl. <br />� Gessastor aodastmda thea may be rm tidditmnal fee Car remsral dmweai�debris k strbjeee material Generator agrees b early�if!bare is a <br /> cbwpa in the material aI . mformatma submitted. Generator certifies that the material to be delivered to ISI in aoakmcdo in aooaedstwe with the <br /> Cdaessia Code of Rs W,,jsans gjda2.Chapin l 1 N the Godo ofF*IuW Regalahmis(m hicluig RCRA said CERCLA),and any arppiitabls load Iowa or <br /> a V I aadyud by a Califomw AW CaUW L*otakq.Oaoastar asRitia!lien all atamples was oallsoMttlaiolrlala�ll� <br /> If M discerns after ba"taken delivery that the—t real is od caoaMait wilt the mkrmmbwn provided in the Prafik Sboat.Gerierdar shall be doomed <br /> in I p , of its agreement hereunder lit such event.ISI may a)dW ddtvary,stellar sarmieats its apsaraad to WOO additiwtrl MONK b)araspe Por*A <br /> ranee of the inch W to the ale as.ad forth above,err to a loadm as may be designated in wining by Generator.ander o)eras I I any riglih wail"N"M <br /> aniTabk b W m acmml of Oener2 or's baeach. Generator gtea b pqi IEi lbr all eels aodlar espwrtR marred is d:wsdaoaap,binding and dispmiag <br /> ofdi ameonfmmmg mmaul properly usdudatig,without hmt4stim the owls of atimpimg,matynk treatment.dupn4 lraowxwim mom hol. <br /> cow dtmp fora,files and penallia. Generator agrees to rndemotly rad hold bamlaw 19 and its otSoars,duadan,anployees,aid apeMs qpd"ant'=at!,. <br /> lnsbihtia„damages,penalties,fine,aastorDws fees uicwsed by 151 to the a mat such liabilities am caused by Generator's negligence,williid mimandaad at <br /> vraishm of applsaible laws or ceguktxw <br /> If Iles Profile Shed is signed on bafiaif of oeneratm by another pony,sadi party oerltliaa that it has lWl pvaw and sudwrity to bud Gewsator to the tams <br /> . pond oaoahtseris act forth herrn Such party further agrees to bra jm d y and aerarally lubk with Gaiorsti r for all repaarMatiom,md(koliotn,ad <br /> sg eannar W of generator vAth are ad forth harem <br /> ` a <br /> Prink ROW-17-GA7 s:srtsaum <br /> ommrwReprtaemtau �•Ahalnorrrnl Paint 4 0.��O O O <br /> Titles Date <br />