Document NGdQMKdm782g5dzYk07rreaOy

CERTIFICATION OF REPRESENTATIVE SAMPLE SALES CODE mH 2S6>03 WASTE PROFILE SHEET CODE GENERAL DIRECTIONS: IN ORDER TO DETERMINE WHETHER WE CAN ACCEPT THE SPECIAL WASTE DESCRIBED IN THE ABOVE NUMBERED PROFILE SHEET, WE MUST OBTAIN A REPRESENTATIVE SAMPLE OF THE WASTE. WE WILL ANALYZE THE SAMPLE TO VERIFY THE INFORMATION YOU HAVE PROVIDED US, SO IT IS PARTICULARLY IMPORTANT THAT THE SAMPLE BE TRULY REPRESENTATIVE. IN MOST CIRCUMSTANCES YOU WILL BE OBTAINING THE SAMPLE. HOWEVER, IN THOSE CASES IN WHICH WE OBTAIN THE SAMPLE, WE MUST ASK THAT ONE OF YOUR EMPLOYEES BE PRESENT TO DIRECT THE PARTICULAR SOURCE TO BE SAMPLED AND TO WITNESS THE SAMPLING. IN SUCH CASE, YOUR EMPLOYEE MUST SIGN THIS CERTIFICATION AS A WITNESS. THIS CERTIFICATION MUST BE RETURNED, WITH THE REPRESENTATIVE WASTE SAMPLE, TO: CHEMICAL WASTE MANAGEMENT. INC. ROUTE 2 BOX 1935 SULPHUR. LA 70663 ATTN: SALES OFFICE * THE UNDERSIGNED CERTIFIES THAT HE/SHE OBTAINED A REPRESENTATIVE SAMPLE OF THE WASTE MATERIAL DESCRIBED IN THE "GENERATOR'S WASTE MATERIAL PROFILE SHEET" ABOVE REFERENCED, AND THAT THE FOLLOWING REPRESENTATIONS ARE TRUE AND CORRECT: 1. HOUR AND DATE OF SAMPLING: 60 D7/j7/^ 2. SOURCE FROM WHICH SAMPLE TAKEN: 1WAW.. ' -34*4*^ :*j dae/Mj jAsd ClMttJaf*____ ..... --_____________________________________________________________ 3. EQUIPMENT AND SAMPLING METHOD USED- y iZ/Ui/g, iLW ?jic Li-fJI*.___ y ______________________________________________________________________ __ 4. AMOUNT OF SAMPLE OBTAINED: ________ / _______________________ 5. TYPE OF CONTAINER INTO WHICH SAMPLE WAS PLACED: s+//e- 6. THE SAMPLING EQUIPMENT USED, AND THE CONTAINER INTO WHICH THE SAMPLE WAS PLACED, WERE THEMSELVES UNCONTAMINATED BEFORE USE. 7. AT THE TIME OF SAMPLING I AFFIXED A LABEL TO THE CONTAINER IN THE FOLLOWING FORM WITH THE FOLLOWING INFORMATION (FILL IN THIS PORTION, INCLUDING YOUR SIGNATURE, JUST AS IT APPEARS ON THE LABEL YOU PREPARED): GENERATOR: TWi/Slk/tfS , WASTE NAME: J'bu}Jhe.-rn SAMPLE HOUR/DATE: Qzfio C7jx7/X3 PROFILE SHEET CODE:**'*' ^zf^s SAMPLER SIGNATURE- 4 WITNESS VERIFICATION: I WAS PERSONALLY PRES ENT DURING THE SAMPLING DESCRIBED; I DIRECTED THE WASTE SOURCE TO BE SAMPLED; AND I VERIFY THE INFORMATION ABOVE NOTED. -E* WITNESS:. --flgjeAei Ln T SAMPLER NAME: SIGNATURE: TITLE: SIGNATURE: EMPLOYER: TITLE: v5>. Uii3 /^Aj^/yy) DATE:------ ' L 'fbA\/ " EMPLOYER:__ J-fi/elusle/mS , J^ja, DATE:___if*! 3Jib LABORATORY REVIEW OF SAMPLING PROTOCOL. BASED UPON MY REVIEW OF THE ABOVE PROFILE SHEET. I CONCLUDE THAT THE ABOVE METHODOLOGY IS: -ADEQUATE FOR YIELDING A REPRESENTATIVE SAMPLE. INADEQUATE FOR THE REASONS NOTED HEREON Q a6q9 ? DATE:........................................ . SL , Waste Mi agerosnt, !nc. RECERTIFICATION OF GENERATOR'S WASTE MATERIAL PROFILE SHEET *r -ECP" P*ED i'*.-? t ru-r <52-^ UIH-.&ZSJU 03. ICATION f :*v ^ INSTRUCTIONS: A COPT OF Th COMPLETE GENERATORS WASTE MATERIAL PROFILE SHEET WHICH IS BEING =ECEPT|F 0 M.JST SE ATTACHED TO THIS RECERTIFICATION ORDINARILY ThE last COMPLETE PROFILE SHEET WILL BE attached to your contract if *cu have ant d?a C_l*t locating ThE last CO VFLETE profile sheet. CGntaC" ; PERSON SHOWN EELOW IN ADDITION WE ASK. YOU TO COMPLETE ThE REMAINDER OF th'S fo=M and y; a; .'E ' 5 ONES ST an a ^'-OR.ZEO EVRlOTEE ANSWERS MUST BE vac ; " . ^ELL OUEST.ONS AND MUST BE COMPLETED IN INK. INFORMATION SUPPLIED WILL BE MA-NTAINE; !n ST=ICT CON- 1ENCS CONSISTENT ;VTh CAL REQUIREMENTS *ET,JRN "HIS c^tM ANO ATTACHM*!1,S2 T3C* * 6_ -ChtMuCAl. W/>5^c.-- t "*ic. -ZJeh/J /3A * +J -a i jd-- --/yp^x).-------------------------------------- Ai.,.. LA A GENERAL INFORMATION . PPO,^GCNERATOR NAME: JZiA,i<.U fiax JOQQFACILITY ADORESS l tffl, 1 TRANSPORTER PHONE: | Pi)t/*AiitaL. SbtAh^m 1_ Ukp. CkAA)^r fa____ 7a 1*07. Q&aALp L.TECHNICAL CONTACT, I ____ fid-'Ci'f NAME OF WASTE. L-- I TRANSPORTER L gjJM - . 7x . i^A GGEENNEERRAATTOORRUUSSEEPPAAID10 >ULA >,0,0,2,/),8 It&.Dle, _1 GENERATOR state t.D L />//. {Ljffir / ^RK,rt ks'L ' PHONE l (V?) Vf/> 1^70 j title i PROCESS GENERATING WASTE. L B CHANGES OR ADDITIONS SINCE LAST PROFILE SHEET PREPARATION OR RECERTIFICATION 1 HAVE YOU OBTAINED ANY LAdORATORY ANALYSIS OF THIS WASTE' C YES ^NO (IF YES, PLEASE ATTACH COPIES) 2, HAVE you CHANGED the RAW MATERIALS USED IN THE WASTE GENERATING PROCESS' G YES 2"n0 3. HAVE YOU CHANGED the WASTE-GENERATING PROCESS ITSELF' G YES 2"nO A ARE YOU AWARE OF ANY FACTS OR CIRCUMSTANCES WHICH HAVE, OR REASONABLY COULD HAVE. ALTERED THE PHYSICAL OR HA2ARD0US CHARACTERISTICS. OR CHEMICAL COMPOSITION OF THE WASTE' G YES G'nO --** l 5 ARE YOU AWARE OF ANY HUMAN HEALTH EFFECTS OF EXPOSURE TO THE WASTE NOT PREVIOUSLY OESCRIBED' _ YES --NO 6. IF YOU ANSWERED 'YES' TO QUESTIONS 2. 3, 4 OR 5. PLEASE PROVIDE DETAILS BELOW: h SPCClFtC CONSTITUENTS DOES THIS WASTE CONTAIN POLYCHLOflINATEO BIPHENYLS' O YES 1, t DOES this WASTE CONTAIN 2. 3. TCOO? YES "NO GJ'nO I D SHIPPING INFORMATION J^ETHOO OF SHIPMENT: JS. BULK LIOUID BULK SOLID DRUM (TYPE/SIZE) L < < 3/3011-BBlTICIPATED VOLUME: l CpER D ONE TIME G WEEK D MONTH I GALS I C QUARTER ^.YEAR Q I____ _1 CUBIC YDS. L_ J OTHER t_ ' ARPEICERTIFICATION. 1 AM AN EMPLOYEE OF THE GENERATOR AUTHORIZED TO SIGN THIS CERTIFICATION THE INFORMATION PROVIDED IN TTHH^fytRECERTIFIED WASTE PROFILE SHEET :TATTACHED HERETO. AND THE INFORMATION SUPPLIED ABOVE. ARE COMPLETE. TRUE ANO CORRECT. ~//7 F-^4/t /le^AtrLU) NAME: _l SIGNAATTUURREE-1, J TITLE: jSV.zfW. /vm J DATE::< - SL 046096 J V te K nagement, Inc. nECEH.lFICATION OF GENERATOR'S WASTE MATERIAL PROFILE SHEET RECERTIFIED ^ASTE PROFILE SHEET CODE \ieM \2.6,LQ3 rAUCTIONS: A COAv OT The complete GENERATORS WASTE MATERIAL PROFILE SHEET which IS being RECERTIFIED MUST be attached TO this RECERTiFiCATiOn form INAHILT ThE LAST COMPLETE PROFILE SHEET WILL 8E ATTACHED TO TOUR CONTRACT 'F YOU HAVE ANT DIFFICULTY LOCATING THE LAST COMPLETE PROFILE SHEET CONTACT Tm> son shown below in addition we ask you to complete the remainder of this form anotomave it signed by an authorized employee answers must be made tc QUESTIONS AND MUST BE COMPLETED IN INK INFORMATION SUPPLIED WILL BE MAINTAINED IN STRICT CONFIDENCE CONSISTENT WITH LEGAL REQUIREMENTS i (th L lJA^e. /V)AMfX>trFORM and attachments TO I g/Vyic/E ------- ; XaJ(L i 3cHm--@tAnutc*L--/had ___ - d/iAljtSS -7- bcwhiAejA____ ^Mcal 2ecejiUrJt Jheajc- GENERAL INFORMATION IA?CRATORNAME ^ XfJC. Cjnl^L--,/^/^tAW . i y TRANSPORTED u LiTyADCdESS L-9,0' &>% /AQO PfilVAntilO- Sotrf-LAU @haA \ft)es-llak*L ; La LaUg Pjt L .a _____ 7^0 2- --(iG/tAld Li_____ PeAAJ -: - T. E Etshl. 7 3...J TANSPORTER RHONE ( / J L172- LAP OQ Q/LLS M.=Generator*jsepa -8 o GcNcflATOP state i 0 L ^> P<?- 1 SHONE (3-#37a J)ouj{JieAM\ __ fr/rjsiz iht>rfUcMam flp [jjtjAky Jaoi)S Cqi/s1i`<l~ VS uticom if;u /,a' hNGES OP A0C1T1C NS ^ NCE lASt $.^TT PREPARATION OR RECERT:FIXATION = 3 2T*,o = -es i-- , {* , ;. e " if-- " H -A'.p r- -EA"ONAaw 1" 'A C - , ^_ A^E PRC . DS OETA'_S 8EwC.\ < ' A e-*S`CAL CP ^a^OL'E >i = iC*:; ; t-EV T~_ ICIF1C CONSTITUENTS -IIS WASTE CONTAIN =Ol'Ci-lORiNATED BIPHENYLS' ~YES HIS WASTE CONTAIN 2 3 7 8- TCDD^ YES 'JZ NO ?VO PPING INFORMATION D Of^AtlPMENT Jf^BULK LIQUID __ BULK SOLID ^ DRUM ,TYPE SIZEi L. =AT^P.UME \tfCGQ- ________ | GALS. I _ ONE TIME -- WEEK ~ MONTH _ QUARTER jjf YEAR 3 I________ _l CUBIC YDS SL 046097 OTHER l_ 'IFICATION I AM an EMPLOYEE OF THE GENERATOR AUTHORIZED TO SIGN THIS CERTIFICATION ThE INFORMATION PROVIDED IN THE RECERTIFIED waste profile SHEET IED HERETO. AND The INFORMATION SUPPLIED ABOVE ARE COMPLETE. TRUE AND CORRECT L1 '____................................................. ......... ___________ |_____ I SIGNATURE: K^S A^.jl l .....^ T^jlAAxi ZMfi&hlMEtJfaL_____\ /yeti fills* --I DATE L. 773; g& ' TE mATERIAL PROF(LE|SHECT^?:' 1 E25603 GENERAL INFORMATION GENERATOR NAME: I PPG IndUStHeS. IflC. j transporter: i CUM - Orafuie. TX P.FACILITY ADDRESS: L 0. Box 1000 . Columbia Southern Road - Westlake. LA i Lake ..Charles, LA_____70602___________ (318) 625-9U03 _J TRANSPORTER PHONE: L 8 8 16J GENERATOR USEPA I.O. L A D O 0 0 i5 it M,_J GENERATOR STATE LD. L TECHNICAL CONTACT: i AnHy Plaiirfio1 name of Dowtherm System Rinse _l title: i Pit- Fnv____ Fnrpman phone:i(^1R) aQ1-4ftM process generating waste: i Production of Anahydrous Caustic B PHYSICAL CHARACTERISTICS OF WASTE COLOR Red/Brown to Clear____ PH: 0** 0 7.1-10 0~ 0 IO.T-I2J 0 XDODOR NONE MILO G STRONG nr*rjnat. 0< *0 NIA SPECIFIC GRAVITY PHYSICAL STATE p 70*F 0 SOLID 0 SEMT-SOUO DQ 0UOUIO POWDER LAYERS 0 MULTILAYERED 0 SI-LAYERED 0 SINGLE PHASED FREE UOUIOS 0 YES 0 NO VOLUME l__ _____ iLi 0 1J-1.4 0 T.S-T.Y FLASH 0< 70 *F POINT 70 *F - I0O-F 0> Z0O*F ,, XJ NO PLASH 0 CLOSED CUP 0 OPEN CUP 04.T-B.9 T > 1 Q EXACT |_ 01-..U 0 EXACT (_ D> Vaa [9 Q 101'F 13B*F 0 140*F-a00-F Q EXACT, C CHEMICAL COMPOSITION 1TOTALS MUST ADO TO 100%) 1 KMnfl .NaOH* , Dowthemi ,Water rO METALS Q TOTAL |PPM) 0 EPA EXTRACTION PROCEDURE |m/L, . J ,41 1* ARSENIC (A*) 1 - None SELENIUM (S*)l___ --i ,4l .4 1 59-100 i 1% BARIUM IBM 1 1CADMIUM (Cd) CHROMIUM (Cr) 1 1% MERCURY IHql 1 1* 1 FAO (Ph) 1 None. None None None None 1 , . 1Sll t/ER (Ag) . COPPER (Cu) *- -- NICKEL INI) l__ ZINC (Zn| I___ TMAIIIIJU(TI) |___ None None None None None ____ 1 1 J* .CHROMIUM.HEX (Cr + 6) |_ None__ 1 --------- --> il.ip-W- J* ft OTHER COMPONENTS TOTAL |PPM) J l_ CYANIDES -None, PCB'S Hone. J l_ -JKASULFIOES -Mooa- PHENOLICS l_ F SHIPPING INFORMATION D.O.T. HAZARDOUS MATERIAL? .0 YES 0 NO proper shipping naufi Dnuithpnn ^yct.pm Rinse i 1hazaro class None 1 1i.d. no. None METHOD OF SHIIP^NT: 0 BULK UOUID 0 DRUM (TYPEVSIZE) l_ i r.q. None t 0 BULK SOLID ANTICIPATED VOLUME:<3000-6000 I GALS. _l CUBIC YAROS per- Gone time f J OTHER U week^ 0 QUARTER^ ''''0VEAR 0 MONTH 0._________ a HAZARDOUS CHARACTERISTICS 0REACTIVITY: NONE 0 PYROPHORIC 0 EXPLOSIVE 0 WATER REACTIVE 0 SHOCK SENSITIVE 0 OTHER I_________ OTHER HAZARDOUS CHARACTERISTICS: 0 NONE 0 RADIOACTIVE 0 ETIOLOGICAL 0 0PESTICIDE MANUFACTURING WASTE . OTHER |_ USEPA HAZARDOUS WASTE? 0 YES G NO USEPA HAZARDOUS CODEIS) l_ IL STATE HAZARDOUS WASTE? ..0 YES STATE COOF/SII . HA 0 NO H SPECIAL HANDLING INFORMATION . . 0 ADDITIONAL PAGEISl ATT/ I HEREBY CERTIFY THAT ALL INFORMATION SUBMITTED IN THIS AND ALL ATTACHED DOCUMENTS IS COMPLETE AND ACCURATE. AND THAT ALL KNOWN OR SUSFCCTEO HAZARD* HAYI BEEN OtBCLOBCD. AUTHORIZED SIGNATURE . y - TJTLE _ _ DATI SL 046098 Pit. nv. Liaison Foreman /?/!. ./ FORM WMI-EOOO-BISJ *> IBM WASTE MANAGEMENT, INC.