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�■�� F�rotile No. 1719030 A Clean Harborii, Company °. REGULATORY STATUS YES 0 NO USEPA HAZARDOUS WASTE? YES NO DO ANY STATE WASTE CODES APPLY? 017L 021L 229 CR02 MA01 NHX1 VTO2 YES 0 NO YES D NO YES I NO YES LVJ NO YES NO YES NO Texas Waste Code DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY? IS THIS WASTE PROHIBITED FROM LAND DISPOSAL WITHOUT FURTHER TREATMENT PER 40 CFR PART 268? LDR CATEGORY: Not Subject t0 LDR VARIANCE INFO: IS THIS A UNIVERSAL WASTE? IS THE GENERATOR OF THE WASTE CLASSIFIED AS VERY SMALL QUANTITY GENERATOR (VSQG) OR A STATE EQUIVALENT DESIGNATION? IS THIS MATERIAL GOING TO BE MANAGED AS A RCRA EXEMPT COMMERCIAL PRODUCT, WHICH IS FUEL (40 CFR 269.2 (C)(2)(11))? DOES TREATMENT OF THIS WASTE GENERATE A F006 OR F019 SLUDGE? YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIBITION FOUND AT 40 CFR 268.3(C)? YES NO DOES THIS WASTE CONTAIN VOC'S IN CONCENTRATIONS >=500 PPM? YES L'C I NO DOES THE WASTE CONTAIN GREATER THAN 20% OF ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE >= .3KPA (.044 PSIA)? YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSURE > 77 KPA (11.2 PS IA)? YES Fy] NO IS THIS CERCLA REGULATED (SUPERFUND) WASTE ? YES L"J NO IS THE WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES? Hazardous Organic NESHAP (HON) rule (subpart G) Pharmaceuticals production (subpart GGG) YES NO IF THIS IS A US EPA HAZARDOUS WASTE, DOES THIS WASTE STREAM CONTAIN BENZENE? YES NO Does the waste stream come from a facility with one of the SIC codes listed under benzene NESHAP or Is this waste regulated under the benzene NESHAP rules because the original source of the waste is from a chemical manufacturing, coke by-product recovery, or petroleum refinery process? YES NO Is the generating source of this waste stream a facility with Total Annual Benzene (TAB) >10 Mg/year? What Is the TAB quantity for your facility? I Megagremlyear (1 Mg = 2,200 lbs) The basis for this determination is: Knowledge of the Waste Or Test Data Knowledge Testing Describe the knowledge: G. DOTITDG INFORMATION DOTITDG PROPER SHIPPING NAME: NON-RCRA HAZARDOUS WASTE, LIQUIDS, (USED OIL WITH WATER) 1. TRANSPORTATION REQUIREMENTS STIMATED SHIPMENT FREQUENCY ONETIME WEEKLY 0 MONTHLY QUARTERLY YEARLY OTHER Other CONTAINERIZED 1-11 CONTAINERS/SHIPMENT STORAGE CAPACITY: 1 CONTAINER TYPE: PORTABLE TOTE TANK BOXIGARTONICASE CUBIC YARD BOX DRUM OTHER: DRUM SIZE: gg 1. SPECIAL REQUEST COMMENTS OR REQUESTS: For Reclamation 40 CFR part 279 BULK LIQUID GALLONS/SHIPMENT: D Min -0 Max GAL. BULK SOLID SHIPMENT UOM: TON YARD TONSIYARDSISHIPMENT: 0 Min - 0 Max GENERATOR'S CERTIFICATION I certify that I am authorized to execute this document as an authorized agent. I hereby certify that all information submitted in this and attached documents is correct to the best of my knowledge.) also certify that any samples submitted are representative of the actual waste. If Clean Harbors discovers a discrepancy during the approval process, Generator grants Clean Harbors the authority to amend the profile, as Clean Harbors deems necessary, to reflect the discrepancy. TURE NAME [ INT) TITLE DATE