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a moist anv other hazardous constituent not mentioned above and <br /> concentrations �u dry/ys�.c� <br /> 010 .haste Composition (General components, must total 100%) : <br /> Com onent or ppm Component or PLm <br /> 11 Please enclose a copy of the lao report including test methods used to <br /> analyze f4F g0nstituents in 2pnT1nn 7 . - - - <br /> 12 Please answer the following regarding this waste material : <br /> Yes No Yes No <br /> U SEPA (RCRA) Hazardous Waste? ✓ Forbidden or Class A <br /> State Extremely Hazardous Explosive? <br /> waste' Restricted waste as in <br /> Reactive Waste , (40 CFR / CAC, Title 22 , Section <br /> 261 23) ' ✓ 6690O? <br /> 13 . I certify that the information contained In this and all attached <br /> documents is complete and accurate , and that the contaminants in the <br /> aescribed waste consists of unused petroleum products. poi <br /> lD Ld Y�V 3— <br /> Signature Title Date .--- <br /> SAMPLING DOCUMENTATION <br /> Samnle documentation for all required analytical work must be completed. <br /> Samples collected must be representative of the waste materials. <br /> Recommended procedures for collecting a representative sample are found in <br /> 'Test Methods for Evaluating Solid Waste, Physical/Chemical Methods, U.S . <br /> EPA SW84611 . Equivalent methods may also be used. <br /> Sampler Name Signature <br /> Date and Time of sampling collection: <br /> Description of sample collection point : <br /> Sampling method: ` ` -------� - <br /> Amount of sample Type of container: <br /> Method of Preservation <br /> Chain of Possession- <br /> 3Y Dates to <br /> 3y Dates to- <br /> By - Dates to <br /> Laboratory Receipt By Date- <br />