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' A 1 <br /> G <br /> 10 —For Official Use Only <br /> C ILArCWX. <br /> Description of Hazardous Wiiisies(continued from front) IM <br /> A. Hazardous Wastes from Nonspecific Sources. Enter the four-digitnumber from 40 CFR Part 261 31 for each listed hazardous waste <br /> from nonspecific sources your installation handles. Use additional sheets if necessary. <br /> 1 2 3 4 5 6 <br /> Ji <br /> 7 8 9 10 11 12 <br /> 13. Hazardous Wastes from Specific Sources. Enter the four-digit number Irom 40 CFR Part 261.32 for each listed hazardous waste from <br /> specific sources your installation handles.Use additional sheets if necessary. <br /> 13 14 15 16 17 18 <br /> JTFAIT- UL 7 <br /> 19 20 21 22 23 4 <br /> 1-rfl-F <br /> T. I TE _1 _ 1 L <br /> D I I I IT <br /> 25 26 27 28 29 30 <br /> ri I i T . 11 1 '._ ' I I I '' I I I JT _ 11 -n-_ <br /> C. Commercial Chemical Product Hazardous Wastes. Enter the lour-digit number from 40 CFR Pan 261.33 for each chemical substance <br /> your installation handles which may be a hazardous waste.Use additional sheets if necessary. <br /> 31 32 33 34 35 Sri <br /> 7 T1 ­J I 1 1 -11111 <br /> -FT -- I I L - 1 1 1 1 1 11 =1 _FFF <br /> 39 40 41 42 <br /> 45 46 47 M <br /> _LF ] TI - 111 <br /> D. Listed Infectious Wastes. Enter th e ,:;,:-digit number from 40 CFR Part 261.34 for each hazardous waste from hospitals.veterinary hos- <br /> pitals,or medical and research labo..1;., nes your installation handles.Use additional sheets if necessary. <br /> a9 50 51 52 53 54_f_T_ <br /> L 1 <br /> 111T lid 1H HI <br /> E. Characteristics of Nonlisted Hazardous Wastes. Mark'X'in tha boxes corresponding to the characteristics of nonlisted hazardous wastes <br /> your installation handles.(See 40 CFR Parts 161.21 —261.14/ <br /> ❑ 1. Ignitable ❑ 2. Corrosive ❑ 3. Reactive ❑ 4 Toxic <br /> (00011 (D002) (0003) i D0001 <br /> XI. Certification 1 MON-11M 111 <br /> l certify udder penalty at law that l have personally examined and am familiar with the information submitted In <br /> (lits and all attached documents, and that based on my inquiry of those individuals immediately responsible for <br /> obtaining the information,l believe that the submitted information Is true, accurate, and complete.l am aware that <br /> there are significant Pena/ties for submitting fa/se information,including the possibility of line and imprisonment <br /> Sign at �JNam�e.]nd Official Title IrYAe or print/ Date Signed <br /> Iq <br /> EPA Form 8700-12 (Rev. 11-85) Reverse <br />