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V11A It)
<br /> 0 S4 F tc. vt e 0 '3
<br /> flhl lin Prone
<br /> mc-&Alf r-t—' H0A4-F-
<br /> !'he tvaac
<br /> 269 -riie tio no, meel (Ile tmmrilt�')t
<br /> t)iec, ((I tile J�riti disposal restI,clicli,is (,f'40 CFR
<br /> ikleniified oil this f0rill 3"t st' tet tile ipp,licable pr011ibiti0l) le'e's sPec'')et' it) 268 32 llursualll to 40 C'F'R
<br /> ill Part 268: SUbpart D or do not n)
<br /> 26'� -(it), the required "'IfOrrilati011 11PP"c"'Ille to eacil identified belo\v(check al! bo\CS that RM)NI
<br /> Tre;ma�ility 61'0111� M wastewater X Notiwasle\�-ttlrr
<br /> (woveivoters contoin less than 1�Iofilfecable solids alld less than 7oiol Orgonic C(11'110))
<br /> ged in florl-CW,,k/non-CWA-equivatent/nor Clatg I
<br /> F)001 Ignitable(ej.cept for High TOC) MP.na 'Melll-s
<br /> [)001 Ignitable(except i01. 11iIZll TOC) managed in CNh'A/CWA-equivalent!ClirSs I SEM/A systems
<br /> EJ I)00I .jig,,"I,0C Ignitable treater than )0%total organic carbon)
<br /> [E D002 Corrosive managed ill CIO or,cIass
<br /> ❑ D002 Corrosive managed in CWA/CWA-equivalerit/Clflss I SDWA systems
<br /> ❑ D003 Reactive Sulfides based on 261.23(a)(5)
<br /> ❑ DOM Reactive Cyanides based on 201.23(a)(5) -cwAlflorl-C%Y A-eq u iv ate n thl(IM 0W. I
<br /> E3 D003 Water Reactives based all 261.23(a)M,(3) and(4)mana.u-ed 41 non
<br /> sygems
<br /> F— 0003 Water ed on 261 23(ay"),Q)and(4)managed in CWA/CWA-eqLIiValeIltlClaSS I SIDWA syste"Is
<br /> J -I i ves ba,
<br /> ❑
<br /> I)t)03 (Mer lzeaciives based on 261,23(a)(1)
<br /> prl.)004-4; boxes ore checAed, complete and ottoch Form UC to oddresv undei-lvwp ho:ordomv conslitil,MY 61/71(.1,"11)"t,"'Llves(.tre to bc,
<br /> Ysfem
<br /> SD 14�11 s s
<br /> mona DO 05 l3aritin, [�� D006 Cndilliurn E] D006 Cadi
<br /> iunl-t imtaininG Gatto ries
<br /> E] J)(.)Q4 ❑Arsenic EJ DO08 Lead acid batteries
<br /> 0 DOO-1 chrtlrriillrrt 0 D008 Lead residue and rusidues f'roill RMERC
<br /> El D009 1-401 y inorganic(>260 mg/kg total), including incinerator
<br /> lot including incinerator residue
<br /> EJ D009 Iligli-l"elcul". 11>')60 mg!k cop El D009 All D009 wastewaters
<br /> F� D009 I,Ov,,-mercury-(<260 mg/ke lcttol)
<br /> El D010 Selenium ❑ DOI I Silver
<br /> E] D012 Endrin 0 D023 0-Cresol ❑ D033
<br /> ❑ D013 Lindane M D024 m-CIT-01 ❑ D034 HexachlorOetill"Ine
<br /> 0 D025 p-Cresol D035 Methyl 0011YI kefoCie
<br /> ❑ D014 MetI'OxYcl'IOt D036 Nitrobenzene
<br /> DO I5 Toxaphene ❑ D026 Cresols(Tatat) El D037 PentachloroPhe"Of
<br /> 0016 2,4-D D D027 p-Dichlorobenzene ❑
<br /> D038 Pyridine
<br /> DOI? 21,4,5-TP(Silver) 0 D028 1,2-Dichloroethane
<br /> ❑CJ D018 Benzene 0 ID029 1,l-Dichloroeflijtene ❑ D039 Tetra chloroethy leate
<br /> F-I D019 Carbon tetrachloride D D030 2,4-Dinitrotoluene E] D040 Trichloroefl-TYIcne
<br /> ❑ D020 Cillordline 11D031 Heptachlor
<br /> El D041 2,4,5-TrieMorophenot
<br /> D021 Chlorobenzene EJ D032 Hexachloroberizene n D042 2,41,6-TrichlorophenOl
<br /> ❑ D022 Chloroform 0 D043 Vinyl chloride
<br /> Note: Ifany bolded entries are checked,form LJC Illtist becompleled to address underlying llazardOLIS C0115JIM11S, unless the material Is
<br /> trettled In a Clean Water Act(CWA)treatment PrOce',,`
<br /> In-addition,(lie l'0110V,'ir1R wastes are included in this S 1
<br /> secticy,or,the bock oJ'thisjbrm Cliech the hozordousoste tw
<br /> [f this box is check-ad, complete the F001 4:'005
<br /> M l�-'001-1:005SPelllsOlve-"'S, (' likely to be present i17 the)VOSle
<br /> that applies, and idenf?fil(lie constituents
<br /> 11'(his shipmentmrics additional waste elides 11111"Ie not addressed above, identify then here!
<br /> EPA 5uSu bcalegoLy(if appliC')b)e)r
<br /> t)c.-�,.,tenoa(Jf applicable) EPA \Vaste ode
<br /> Waste
<br /> rot-ili EZ Revised(l7/3INS ;I tii osided fort"
<br />
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