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Aug -09-01 01:59pm From- T-394 P.02/02 F-391 <br />AM 0 <br />[w uem%Fnn 01, MW On <br />DEMENNO / KERDOON'S LASCRATORY IS CERTIFIED BY THE CAUFORNIA DEPARTMENT OF HEALTH <br />SERVICES ENVIRONMENTAL LABORATORY ACCREDITATION PROGRAM (ELAP) CERT. # 2037 <br />G�NERATORPS WASTE PROFILE <br />GENERATOR'S INFORN:ATION <br />A. GENERATOR'S NAME a- d• 7 S. EPA <br />C. GENERATOR'S ADDRESS - jJQ )&-IJ -T, n e% D. PHONE Wo4.32 �Z -"G 4/ <br />L ci P <br />E. CITY, STATE. ZIP ®��' M <br />F. GENERATOR CONTACT Zia! '� r+M �i�I`JN/IM G. TITLE <br />H. CUSTOMER NAME nv,Mv vy\e.7 4 I. PHONE A?) 7p % 7 97 i <br />J. TRANSPORTER NAME h' I I a4 K. PHONE OW) -7-2 7 -2-17 <br />I <br />L. TRANSPORTER LPA ID#(X-A ft32k -i�t73 (� M. CONTACT <br />A. <br />B. <br />C. <br />D. <br />NAME OF WASTE rm -K�'.,P,A_ w r�(�.�, j r�4k� <br />CALIFORNIA HAZ 1kRDOUS WASTE CODE NO. <br />EPA HAZARDOUS WASTE CODE NO. A)?) A) <br />DESCRIBE PROC: _SS GENERATING WASTE�a�+� c:;a..wn:s <br />LST /�U-- <br />-®.a,1 +..:t�•�L- d��^ <br />E. <br />DOES THIS WASTE CONTAIN PCB'S? <br />yes <br />no <br />F. <br />DOES THIS WASTE CONTAIN DIOXIN? (FO20-FO28) <br />yes <br />Y no <br />G. <br />DOES THIS WASTE CONTAIN SULFIDES OR CYANIDES? <br />yes <br />)c__. no <br />H. <br />DOES THIS WASTE CONTAIN PESTICIDES OR HERBICIDES? <br />yes <br />_E no <br />(IF YES, IDENTIFr' IN ITEMS A OR D ABOVE.) <br />I. <br />DOES THIS WASTE CONTAIN SOLVENTS? <br />yes <br />;_ no <br />i <br />(IF YES, IDENTIF'1' IN ITEMS A OR D ABOVE.) <br />J. <br />DOES THIS WASTE CONTAIN PLATING WASTE? <br />yes <br />y no <br />I K. <br />HAS, THIS WASTE BEEN MIXED WITH RCRA LISTED WASTE? <br />(F. K U OR P EPA WASTE CODES) <br />yes <br />_�_ no <br />L. <br />IF YOU HAVE M:=.DS FOR COMPONENTS IN THIS WASTE, <br />PLEASE ATTACI........................................................................................MSDS ATTACHED ❑ <br />M. <br />IF YOU HAVE CUfIRENT ANALYSIS OF THIS <br />WASTE, PLEASE ATTACH.........:.......................................................CHEMICAL <br />ANALYSIS ATTACHED O <br />l7CrvCnfilvn a %.Qn I Ir-Ik.Al IVIm <br />I HEREBY CERTIFY THAT THE INFORMATION PROVIDED ON THIS DOCUMENT, IS TRUE AMC) ACCURATE, AND NO INTENTIONAL MIS- <br />REPRESENTATION HAS SEEN COMMITTED BY ANYONE. I FURTHER CERTIFY THAT ANY SAMPLE(S) PROVIDED WITH THIS WASTE <br />PROFILE WERE TAKEN AMC, PRESERVED IN ACCORDANCE WITH 40 CFR 261, APPENDIX t AND ARE ACCURATE AND REPRESEN- <br />TATIVE OF MY ACTUAL WA!'Tf- STREAM. I HEREBY AGREE TO NOTIFY DEMENNO / KERDOON SHOULD THIS WASTE STREAM <br />CHANGE IN ANY WAY /,/(3 -r1j1n p j,AS 7'19KC� <br />AUTHORIZED SIGNATL RE A DATE / 9 <br />PRINT NAME AND TITLE _ _ �1.�1,/ la U NYl C G•'� m 74 /"% <br />FORM NO. 1001 REV. 1-2-01 <br />