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T 13 'time 14 Ur IIH(-LT 6 tJKib�-UL oav--K--Us <br /> Gl' odON SIC & REFINING CO., IN%.4, OCT 13 1992 <br /> CONTAM[r-DATED SOILS PROFILE SHEET rAL HEALTH <br /> Effectivp. March 1, 1992 ENVIRONMEN 0ERMIT/SERV ICES <br /> P <br /> J <br /> !'leasee fitf-!n rmitericti. TI pis is or-, coollcatior.,. r. camcam =rcl/o <br /> -pll amos thin cipply-to your <br /> GENERATOR <br /> FACILITY ADDRESS <br /> MAILING ADDRESS <br /> TELEPHCN� <br /> Tr=C>iNIGAL CONTAC T <br /> BOE# <br /> TRANSPORTER STATE# <br /> CONTAOT TITLE <br /> TELEPHONE EPA <br /> NsW- E 01F WASTE <br /> ACTIVITY PRODUCING WASTE <br /> IS THA WASTE A RCnA TOLP WASTE? YES OR NO <br /> IF YE3. WA3 TE MWYr AF9.51VE AT FACI;.ITY WiTH A HAZAIROOU3 WASTE MANIFF.3T INCLUDIN(i A 00M- P-tiETF-0 <br /> BOX I WITH EPA CODES. <br /> IS THJS A RCRA F-, K-, P.OR U-USTEO WASTE-? EJ SS OR 0 NO <br /> 15 THIS WASTE HAZZAR()CUS BY Ti 7LE 22, 0,0-P. ? U YES OR U NO <br /> IF NO,THE DETERMINATION THAT THE WASTE IS NON-HA7-AA00LJ5 IS BASED UPON CERTIFIED LABORATORY <br /> ANALYSES ANDIOR 05NERATOR KNOWLEDGE OF GENERATION PROCESS AND WASTE CONTAMINANTS. <br /> I CERTIFY 7HA7 THE ABOVE iNF0FlMATiCN TO THE BEST OF MY K1qVNLZ0QE 15 TFILJE AND CORRECT_ <br /> Nly,-ignaluru IndicalwLs pern"sion for HazarOuus Waste Manifests or 5iils of Lading to be, carreoed by G04&on to <br /> confoini with irticrmal=lumisftd on this pro le. <br /> FACILITY DECISION <br /> ACCEPT <br /> BY --1------ ........... DATE <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />