Document 1qBGm3kEpb6RVLZ9m9zzMN8Z

GENERATOR'S WASTr MATERIAL PROFILE SHEET MISCELLANEOUS SPECIAL WASTE INSTRUCTIONS FOR COMPLETING THIS FORM ARE FOUND ON THE OPPOSITE SIDE, RETURN THIS FORM AND ATTACHMENTS TO: 0. \aJMT_________________________________ _______________________________________________________________ i 2. Box /95'T Sulpha* ^ LA 70LLS AUc*il?>Al.% waste profile sheet CODE lc-H I T.65,42 5, -< (CaaIjiss- wk general information GENERATOR NAME: --Xboi. FACILITY'A^ DDRESS: I__ 9.0. So*. /anp. J~aKg (IhfitLzs-, Uu 7Qboz. dblMTRANSPORTER: l_ -------------------------- 1 TRANSPORTER PHONE: 1(7/s)torZ?Z---------------------------------- GENERATOR USEPA ID. 1 L-iA D iO,Q,&)tfoibtSiOii> ^dolUf^bio, Souj-ke.'CrJ- $oaA - lALA-LaIc*, LA. \GENERATOR STATE 1.0. (_ TECHNICAL CONTACT L. iPefiAyI TITLE: \-EMt Cctiltol \tij~ I PHONE: I (jft)4*?/-376 NAME OF WASTE: L. As/thALi PROCESS GENERATING WASTE: I iL___ /^tv/ /Vyj/V/rU/^/WTP- B cCLuAwSSrIiFVICAATiiIuOnM wOF vWAmSiTkE MMAfUTBERniInAL i(rFmROimM mINSaTiRTUWCTHIOuNnS^): If oH\tn&AiAL flfoduc4e ttit VheMtcAls f afP *prxjlc/*ki*ir (xtbLt}-*d-f Ciw^Si r. ^ H- 1- ^ % ---------------------------------------------------------------------------------------------- H-jurr~-- DESCRIPTION OF MATERIAL (FOLLOW SUPPLEMENTAL INSTRUCTIONS): I J JUL700 1986 < Che.VA.ori firemix. ClAl ~ IZoyJ I ^5 Ul. ** oai'es Of/jc Uss oP dishIIAtUs;^0 o^feSi-Ltort , P&4Aole.or\ hphAlk d'`0/0 P^oUum DtsimAj.& /0-`h/0 ^MiVe. (Lo/^pojfijJs &-/% ;//e,vs /-S-% '*Ws`(assfi ^ *""* ATTACHMENTS (INDICATE BELOW WHAT ATTACHMENTS -- ANALYSIS. STUOIES. PRODUCT SPEC SHEETS. ETC. -- ARE MADE): CWMI Msss ^EOEJN/EJ C SHIPPING INFORMATION METHOD OF SHIPMENT BULK LIQUID D BULK SOLID gr DRUM (TYPE(SIZE) L /Z-V ^ gDClVi K' ake Charles nFac*1il*ity ANTICIPATED VOLUME t_ PER ^5^*ONE TIME ^ WEEK _ MONTH _l GALS .1_ ^QUARTER I~ YEAR I J CUBIC YDS .l_ ______ s\,___JO other J/jlAL. 0Aa/ IENERATOR CERTIFICATION. BY SIGNING THIS PROFILE SHEET, GENERATOR CERTIFIES THAT r. UNLESS CLEARLY STATED ABOVE OH IN THE ATTACHMENTS. THIS WASTE MATERIAL IS NOT A HAZARDOUS WASTE ' AS DEFINED BY EITHER USEPA MO CFR PART 2611 OR THE STATE in WHICH THE WASTE IS NOW LOCATED, * V --_ _ THE WASTE DOES NOT CONTAIN POLYCHLORINATED BIPHENYLS OR 2. 3, 7, 8 - TCDD. UNLESS CLEARLY NOTED THIS SHEET AND ITS ATTACHMENTS CONTAIN TRUE AND ACCURATE DESCRIPTIONS OF THE WASTE MATERIAL. AND ALL RELEVANT INFORMATION IN THE POSSESSION OF GENERATOR HAS BDECEGNn DL/I'WSCWLLOWSOECDU. A t (?. K_a___L__O_________^______'_-__/__e__a___A NAME: ay*___________________________________ ____________________________________ . -g\-a Kn(LL>^L TPfJiJujJ SIGNATURE: TITLE: I <Mrrt0rJM*Ae/A l ('jblMkJ.- /yiJ DATE:! SL 046272