Document X8O7MNp6p4med6k6m0bDRZM8x
I /SavX
waste management, me. --r-<r _ / /<S\
VW-T-'
RECEP^'FICATION OF
IV* GENERATOR'S WAS'. MATERIAL PROFILE SHEET
WASTE *AOFJL 5m=TCOO
L&U A,8 ft LftO.b,
INSTRUCTIONS: A COPY OF THE COMPLETE GENERATOR'S WASTE MATERIAL PROFILE SHEET WHICH IS EElHG RECERTIFIED MUST SE ATTACHED TO THIS RECERTiFICATiOh FORM ORDINARILY the last complete profile sheet will BE attached to your contract, if you have any difficulty locating the last complete profile SHEET, contact Thi person SHOWN BELOW. IN ADOITlOH WE AS* YOU TO COMPLETE The REMAINDER OF THIS FORM AND TO HAVE IT SIGNED BY an AUTHORIZED EMPLOYEE. ANSWERS MUST BE,made Tc ALL QUESTIONS ANO MUST SE COMPLETED IN IN*. Information SUPPLIED WILL BE uAinTAIMEO IN STRICT CONFIDENCE CONSISTENT WITH LEGAL REQUIREMENTS.
RETURN THIS FORM AND ATTACHMENTS TO: |_____________ vJasM
f. Xvc,
XalM___ /^ava/oat dA(\
a twro*iMt>ow
Cax lysLah,Sj'Aa/a
4/-fin .*_____A
Jnr--
(CMHUTORMAMI; L_.
T'tjc/t>sAf/es
*J transports*; . ,, CulM /3a/ Ep'Twy 7--:------
__ . r^WrtAOWIM: 1____JA(YA
L (itPoaA ' vJ&sJlAk*f La
_| TRANSPORTER PHONE: L (7/3) 4ZT7- 1,772- ___ _
J GENERATOR USEPa IO. i^A
I
v.lAke. PMfiLer. L ytka-La _________________________________
TECHNICAL CONTACT; i. dtiXaLf) /_____Perry__________
*L J TITLE:
_| GENERATOR STATE 10. l_ PHONE: L (M)
NAME OF WASTE: ^Daiiri'hc.r m___ tuid.___ uZ/iisA l- tj/ka<Luj-J.tr/ oP /'Ik/LiA*}* J
PROCESS GENERATING WASTE:
Ar/eJ /)*>AsAaooS OauJir.
ab changes or additions since last profile sheet preparation or recertification
1. HAVE TOO OBTAINED ANT LABORATORY analysis OF THIS WASTE? Q YES GTnO (IF YES. PLEASE ATTACH COPIES!
I have YOU changed The Raw materials USED IN THE WASTE-GENERATING PROCESS? YES (5"40 3 HAVE YOU CHANGED The WASTE-GENERATING PROCESS ITSELF? G YES S' NO
, ARE YOU AWARE OF AMY FACTS OR CIRCUMSTANCES WHICH HAVE. OR REASONABLY COULD HAVE, ALTEREO THE PHYSICAL OR HAZARDOUS CHARACTERISTICS OR ChEmica COMPOSITION OF THE WASTE? G TES O'NO
S. ARE YOU AWARE of ANY HUMAN HEALTH EFFECTS OF EXPOSURE TO The waste NOT PREVIOUSLY DESCRIBED? G TES E'nQ
t. IF YOU ANSWEREO -YES' TO QUESTIONS Z14 OR S. PLEASE PROVIDE OCTAILS BELOW:
cwux Eaieis
/ft DEC 18 1986
1i uc.T f'vi: Urati )P ` V-
Lake Charles Facility
C SPECIFIC CONSTITUENTS DOES THIS WASTE contain POLYCHLORINATED Biphenyls? G yes
DOES THIS waste CONTAIN Z. Z. T. I TC007 G TES S'nO
G^no
D SHIFFINO INFORMATION
G 25-METHOO of SHIPMENT: Z SUL* LIQUID
BULK SOLID
DRUM .TYPE-SIZE'11 .iffC Jtjltfi
ahUCIPATCDVOLUML- |_
_! gals. I_
PER: Done Time C VYEE* C WCsTn Cl O-jARTsr j^YIAR Cl
^ C.BICTOS. L.
vZZfi^-
RECERTIFICATION. I AM AN EMPLOYEE OF THE GENERATOR AUTHORIZED TO SICs Th.s CERTIFICATDIOONN.. TTHHEE IINNFFOORRMMAATTIIOONN PPRROOVVIIDOEED0 IINN TThE RECERTIFIED WASTE PR5.-t t-ii
- y/? Thji 4a'TaCmIO HERETO. ANO THE INFORMATION SUPPLIED ABOVE. ARC COMPLETE. TRUE AMO CORRECT. --
`^
y
M NAME;
JjA/AtC CaAlet-LJ'.
TITLE: SA. P~ u i/ivi-M.j/. ) Laa.
_l SIGNATnUiRnEe:.,
I Cjt l, I, 1--
_l DATE:I___ fi-JirS/t
tUfa-
FORM WUI-SO-B (R*. IZ/B4I A IBB* WASTE MANAGEMENT INC.
SL 046087
/Sab
Wast Management, Inc.
GENERATOR'S W>, .E MATERIAL PROFILE SHEET
A-89606
A GENERAL INFORMATION
PPGGENEMTON NAME: L. Industries, Inc.
CWM - Orange, TX
J TRANSPORTER: I__
FACILITY AOOAESS: L. P. 0. Box 1000
, (318) 625-9003
TRANSPORTER PHONE;
L Columbia Southern Road
_i generator usepa i.d. ,L A i D, 0,018, 0, 8, 6, 5t 0,
f Lake Charles, LA itechnical contact: Andy P. Plauche
70602
J GENERATOR STATE I.O.
*____________ L
Pit. Env. Foreman
(3181 491-1814
J TITLE: L
J PHONE: L.
,name OP WAITE Dowtherm and Mater
Production of Chlorinated Solvents and Anahydrous Caustic
PROCESS GENERATING WASTE: L
' PHYSICAL CHARACTERISTICS OF WASTE
COLON
Black to Brown
0ODOR
NONE
E STRONG
0 MILD
DESCRIBE *
`
pH: < * **
04.1-S.S
El T
0T.1-1O
N/A
>0.1-12.5
>
ii
SPECIFIC < GRAVITY
H-b-i-0
0 EXACT
LAYERS
PHYSICAL STATE O 70*F
0 MULTILAYERED
Usouo LJ SEMI'SOUO
BU BILAYEREdV?
B liquid
0 POWDER
/J
T
|JiJ SINGLE PHASED
FREE LIQUIDS
0 YES
0 NO
VOLUME C90-10Qil
1J-1.4 IS-1.7
FLASH < 70-F
POINT ,, 07O*F1OO*F
> TOO-F NO FLASH
0 CLOSED CUP 0 OPEN CUP
>
01OI*F-1WF
0IAO'F-200'F
Q EXACT,____
' C CHEMICAL COMPOSITION (TOTALS MUST ADD TO ,00%)
, Biphenyl________________________ . Phenyl Ether
Water
1. Solid
j i_:
V
20-801|.%
, ,,2Q-AV.
- ,_l l_ 0 10)|%
--I L.
|%
_l U
0 METALS g) TOTAL (PPM)
Q PA EXTRACTION PROCEDURE lipp/L)
ARSENIC (A,) L_
None
selenium (S*n
None
BARIUM (Ba)
L_
None
SILVER (Afl| i,
None
CADMIUM (Cd| L*
None
COPPER (Cu) l
None
CHROMIUM (Cr)
None
NICKEL (Ni) L -N.QD-
MERCURY (Ho) L_
None
ZINC On)
L
None
LEAD iPhl
1__ None
Hone,THALUUM (TO L
_l* icr+<i , chromium-hex
None _l
L
!*/ *E OTHER COMPONENTS - TOTAL |PPMI
J l_
i% rVANItlFft 1
None
J !_
KU1FIDF* 1
None
PCB-S
L None
PHENOUCS L Section C
F SHIPPING INFORMATION O.O.T. HAZARDOUS MATERIAL?
C YES
0 NO
proper shipping mam.i Dnwtbprm and Water
J
hazard class i None
, i.o. no. i None_ ,-J FLO. None
BMETHOO OF SHIPMENT:
BULK UOUIO
SULK SOLID
[gp^mrYPt/RiZF) 55 gallon drum
,
Q HAZARDOUS CHARACTERISTICS
ISREACTIVITY:
NONE
0 PYROPHORIC
O EXPLOSIVE
0 WATER REACTIVE
l_J SHOCK SENSITIVE
0 OTHER
OTHER HAZARDOUS CHARACTERISTICS:
El NONE
RADIOACTIVE
ETIOLOGICAL
O PESTICIDE MANUFACTURING WASTE
0 OTHER |_
ANTICIPATED VOLUME: L. t5
, QALI I_________________ I CUBIC YARDS USEPA HAZARDOUS WASTE?
YES
El NO
, 0TMW , Tons|
USEPA HAZARDOUS CODE(S) I--------------------------------------------1 I---------------- 1 L
--I l_
0PER:
ONE TiME
0 WEEK
0 MONTH
STATE HAZAROOUS WASTE?
O YES
S' NO
Lj QUARTER
LX YEAR
G.iR STATE COOEISIL
H SPECIAL HANDLING INFORMATION .
Clean up all spills - Non-Hazardous Industrial Solid Waste
V. Q.7b OPtL
C
s - s:V'
^ xttxc
I HEREBY CERTIFY THAT ALL INFORMATION SUBMITTED ir. Tn.S AND ALL ATTACHED DOCUMENTS IS COMPLETE ANO ACCURATE as; TrtT A.. *n:.V. --
SUSPECTED HAZARDS HAVE BEEN OiSCLOSEO.
AUTHORIZED SIGNATURE
*
TITLE
--
_ DATE
-HOI* ("lit FR/WT
MUCTt IEIIFBA^MCuT ir
^lant Env. Liaison Foreman , ,S^/Zr~
-I L
rSL 04608f
Waste Management Inc.
RECERl 1CATI0N OF GENERATOR'S WASTE MATERIAL PROFILE SHEET
LJU>>
RECERTIFIED
X5JWASTE PROFILE SHEET CODE
I. J--
1A1S ft JetQ,(p,
MSTRUCTtOHS: A COPT OF THE COMPLETE GENERATOR'S WASTE MATERIAL PROFILE SHEET WHICH IS 8EING RECERTIFIED MUST SE ATTACHED TO THIS RECERTIFICATION FORM ORDINARILY The LAST COMPLETE PROFILE SHEET WILL BE ATTACHEDTO TOUR CONTRACT. IF TOUHAVE ANT DIFFICULTY LOCATING THE LAST COMPLETE PROFILE SHEET. CONTACT THE PERSON SHOWN BELOW IN ADDITION WE ASK YOU TO COMPLETE THE REMAINDER OF THIS FORM AND TO HAVE IT SIGNED ST AN AUTHORIZED EMPLOYEE ANSWERS MUST SE MAOC TC all Questions ano must se completed in ink. information supplied will SE maintained in strict confidence consistent with legal requirements.
THS FORM AND ATTACHMENTS TO: I------------------ (LtfMlCAL Vl/OS/g /l/UyAO
w~
/3</LmvpaI dA[>
aA/ f Tt/C*
OAety^ LaijiSi'AjJa
------- Am Auefds-)-<?',ju
* hA. GCEMNERA* INFORMATION
SENERATOR NAME: |_ FACIUrTAOORESS: l_ &O.60X /Ap*
I (Lain** .a SnitMiArki -Paa A
vies-lUkts., La
_| TRANSPORTER: L_ i TRANSPORTER PHONE: I
_J GENERATOR USEPA I D. ,-i4
^2.7- io772nt&ht5\OiC*`
MueX. La 7ok>e>2.______
_| GENERATOR STATE I.O. L
TECHNICAL CONTACT: . &AaLF>__ ____ Perry
:: I a/V J TITLE
I SotPcjA jrsf PHONE: t (l,f)44/.4i 7.
atdrLNAME OF WASTE: I__ ,fintdthcx.AA--
--u/aA
PROCESS GENERATING WASTE: l At>4<fch'liJ
Sa/eed-ls
>: CHANGES OR AOOITIONS SINCE LAST PROFILE SHEET PREPARATION OR RECERTIFICATION
A/jJ
B'1. have you obtained any laboratory analysis of this waste? yes
no iif yes. please attach copies)
G 32. have you changed the raw materials used in the waste-generating process?
yes ''no
G3 HAVE YOU Changed the WASTEGENERATING PROCESS ITSELF?
YES (B'no
Afj<>uS CAuij-!*.
<
4. ARE YOU AWARE OF ANY FACTS OR CIRCUMSTANCES WHICH HAVE. OR REASONABLY COULD HAVE. ALTERED THE PHYSICAL OR HAZARDOUS CHARACTERISTICS. OR CHEMICAL COMPOSITION OF THE WASTE? Q YES S'NO
C5. ARE YOU AWARE OF ANY human HEALTH EFFECTS OF EXPOSURE TO ThE WASTE NOT PREVIOUSLY DESCRIBED?
YES B'no
S IF YOU ANSWERED "YES" TO QUESTIONS 2. 3. 4 OR S. PLEASE PROVIDE DETAILS BELOW:
C SPECIFIC CONSTITUENTS does this waste contain polychlorinateo biphenyls? G yes B'no OOES THIS WASTE contain 2. 3. 7. 8 TCOO? G yes B'no
0 SHIPPING INFORMATION
METHOD OF SHIPMENT; 0 BULK UOUIO BULK SOUQ B- ORUM (TYPE/SIZE) I
^MTTIICIPATEDVOLUME: L.
J gals. i_
W- Q ONETIME WEEK Q MONTH QUARTER 5.YEAH I
^/UaI _| CUBIC YDS. t_
_] OTHER l
-<
-<
REiCriERTIFICATION. I AM AN EMPLOYEE OF THE GENERATOR AUTHORIZED TO SIGN THIS CERtTiIfFiIcCaAtTiIOoNn. TtHhEe IiNnFfOorRMmAaTtIioOnN PpRrOoVvIiOoeEoO IiNn Ttlhe rReE<CERTIFIED WASTE PROFILE SHEET
co",eCT-attached HERETO, ANO THE INFORMATION SUPPLIED ABOVE. ARE COMPLETE. TRUE ANO
^7}
// /
I Fi Anns. CqaJL
CL.LC
J SIGNATURE.
tto-
TITLE: > SA` -f a/La A. At.lAlyS.4-
i OATErl___
SL 046089
-ORM WMI-SO-B(Rv 1Z/8A) 198* WASTE MANAGEMENT INC.
*
~
SALES
CODE
CERTIFICATION OF REPRESENTATIVE SAMPLE
LCH
AllLo^
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 IMPORTANTTHATTHE SAMPLE BE TRULY REPRESENTATIVE. IN MOST CIRCUMSTANCES YOU WILLBEOBTAINMG THE SAMPLE. HOWEVER, IN THOSE CASES IN WHICH WE OBTAIN THE SAMPLE, WE MUST ASK THAT ONEOF 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:
PC> //-6-%(o
-2. SOUR^ FRO^WHICH SAMPLE TAKEN: --. DculH txrt -l
A~
...
^S. EQUIPMENT AND SAMPLING METHOD USED: Yal*. qar*jeA -P/acJ<Lc/ >vA
______--StitH*
/
jyyafe-----------------------------------------------------------------------------------------
4. AMOUNT OF SAMPLE OBTAINED: /
__________________________________
5. TYPE OF CONTAINER INTO WHICH SAMPL F WAR PI ACFn- fhAnf+te.
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: WASTE NAME:
W uW*r
SAMPLE HOUR/DATE: /2*> //-&-(, PROFILE SHEET CODE LCM -A UU SAMPLER SIGNATURE:
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.
/Ty&wg &
WITNESS:.
SIGNATURE
SAMPLER NAME: jg .dtAidlil
SIGNATURE:.
TITLE: EMPLOYER:
,Wv
TITLE:.
DATE:
EMPLOYER:. DATE:
LABORATORY REVIEW OF SAMPLING PROTOCOL
BASED UPON MY REVIEW OF THE ABOVE PROFILE SHEE I CONCLUDE THAT THE ABOVE METHODOLOGY IS:
ADEOUATE FOR YIELDING A REPRESENTATIVE SAUPEJS INADEQUATE FOR THE REASONS NOTED HEREON5^
DATE:___________________________
SL 04609C
THIS FORM HAS BEEN DEVELOPED BY D FOR THE USE OF CHEMICAL WASTE MANAGEMENT, INu. AND OTHER WASTE MANAGEMENT, INC. COMPANIES.
SALES
CODE -jL <?--
LCH WASTE PROFILE SHEET CODE
GENERATOR'S WASTE MATERIAL PROFILE SHEET
GENERAL DIRECTIONS: In order for us to determine whether we can lawfully, safely and environmentally transport, store, treat or dispose of your waste stream, we must ask certain information about your waste. All of the information we seek is necessary, for our purposes and yours. Be complete in your answers: if your response is "none," so indicate. Answers must be in ink or typewritten. Information you provide will be maintained in strictest confidence. Please make a copy of this form for your records, returning the original to the location indicated below.
THIS FORM AND ANY SUPPLEMENTAL INFORMATION SHOULD BE RETURNED TO:
___________________________ CWM____________________________________ ___________________________ Rt. 2, Box 1955__________________________
Carlyss, LA 70663
Attn: Chief Chemist 1 GENERATOR NAME: PPG Industries, Inc.
2. GENERATING FACILITY NAME/ADDRESS/USEPA FACILITY I.D. NUMBER (IF ANY): PPG Industries. Inc. P. O. Box 1000, Columbia Southern Road, Lake Charles, LA 70602
EPA ID # LAD008086506
COMPANY CONTACTS:
gfnfrai Andy P* Plauche'
TITLE
J. Mike DiGiglia
TITLE
technical Arlen L. Greathouse
TITI F
Mark W. Wood
TITLE
wartf WAMF Water contaminated with Dowtherm
Pit. Env. Foreman Env.Contr.Asst. Sr. Env. Engineer Supv.Env.Lab
PHONE PHONE PHONE PHONE
(318) 491-4814 (318) 491-4307 (318) 491-4422 (318) 491-4450
procfsr generating wartf- Production of Chlorinated Solvents and Anhydrous Caustic
6. WASTE CHARACTERISTICS:
A. PHASES/LAYERS: BILAYERED (X
MULTILAYERED O
NONE
B. PHYSICAL STATE AT 70F:
SOLID
SEMI-SOLID
LIQUID 21
C. SOLIDS:
POWDER
OTHER:
TOTAL (%): ^ 1______ TOTAL DISSOLVED (ppm or %):
__________
D. SPECIFIC WEIGHT (AS # PER UNIT): _ 8.3 Ib/gal_____________________________
E. pH: 6-8 (Show the following as range of %)
AS: H-SO. HC1 HF HNO,
N/A _ N/A
N/A _ N/A _
%
% % %
OTHFR-
%
h.po. N/A _ NaOH N/A _
NH.OH N/A _ CaiOHi, N/A _
__ % % % %
%
F FI ARH POINT:
^ 200
F
G. VAPOR PRESSURE (in mm of Hg at 25C): Variable
H. BTU PER #: VariableASH CONTENT Variable %
I. CHARACTERISTIC COLOR Black _____________ ... J. HALOGENATED?N/A^ % SULFONATED?
% (CLOSED CUP TEST ONLY)
DISTINCTIVE ODOR Strong, pungent N/A %
K. ALPHA RADIATION AS pCi/l: N/A
FORM WMI-50-A (Rev 11-5-00) <1980 WASTE MANAGEMENT, INC
SL 046091
7. WASTE COMPOSITION:
A. ORGANIC COMPONENTS (WITH RANGES -- INDICATE WHETHER % OR ppm)
Dowtherm A:
Biphenyl Phenyl Ether
___ 50% of Dowtherm phase _ 50% of Dowtherm phase
(ATTACH ADDITIONAL PAGES IF NECESSARY)
DOES THIS WASTE CONTAIN ENDRIN, LINDANE, METHOXYCHLOR, TOXAPHENE, 2,4-D, 2,4,5-TP SILVEX, OR ANY
OTHER ORGANIC COMPOUNDS LISTED BY USEPA AT 40 CFR 261.24? Nn
IF SO, PLEASE NOTE ABOVE.
B. HEAVY METALS (WITH ppm RANGES):
TOTAL
TOTAL LEACHABLE
TOTAL
TOTAL LEACHABLE
Ag N/A As N/A
Ba N/A Cd N/A
Cr N/A Cu N/A
Hg N/A Ni N/A Pb N/A Se N/A Zn N/A
Other (ATTACH ADDITIONAL PAGES)
(IF YOU HAVE DETERMINED TOTAL LEACHABLES USING USEPA'S "EP TOXICITY TEST PROCEDURE" -- AT 40 CFR, PART 261, APPENDIX II -- SO INDICATE BY MARKING "EP" AFTER THE RESULT SHOWN ABOVE.)
C. INORGANIC COMPONENTS (WITH % RANGES):
OTHER
TOTAL CYANIDE FREE CYANIDE SULFIDE AS:
N/A N/A _
N/A -
% % %
--%
_%
_%
BISULFITE AS:
N/A _
%
%
SULFITE AS:
N/A -
%
%
(ATTACH ADDITIONAL PAGES IF NECESSARY)
D, DOES THIS WASTE STREAM CONTAIN BIOLOGIC MATERIALS, PATHOGENS, OR ETIOLOGICAL AGENTS? _bi?
IF SO, ATTACH ADDITIONAL PAGES DESCRIBING SUCH MATERIALS.
E. IS THE WASTE A PESTICIDE OR PRODUCED BY A PESTICIDE MANUFACTURING PROCESS? No
IF SO, INDICATE WHETHER IT CONTAINS:
ORGANOPHOSPHATES -- CONTAINING SULFUR CARBAMATES CHLORINATED HYDROCARBONS
YES
NO
8. HAZARDOUS COMPONENTS AND CHARACTERISTICS A. HAZARDOUS PROPERTIES (INSERT NUMBER CODES PER INSTRUCTIONS ON LAST PAGE) (1) TOXICITY RATING: INHALATION__I___ DERMAL ___ ORAL _!
Flammability
(2) HAZARD IDENTIFICATION SYSTEM:
Health
Reactivity
Special Instructions
B. LIST ANY OTHER ACUTE OR CHRONIC HAZARDS ASSOCIATED WITH OR ALLEGED TO BE ASSOCIATED WITH
HUMAN CONTACT-WITH OR EXPOSURE TO THE WASTE:
-
SL 046092----
9. REGULATORY CLASSIFICATION OF WASTE
A. IS THIS WASTE A "HAZARDOUS MATERIAL" AS DEFINED BY REGULATIONS OF THE U.S. DEPARTMENT OF
TRANSPORTATION PURSUANT TO THE HAZARDOUS MATERIALS TRANSPORTATION ACT?
__________
(SEE 49 CFR 172.101 AND 173 FOR "HAZARDOUS MATERIALS" LIST AND CHARACTERISTICS.) IF SO. PLEASE
ADVISE OF THE FOLLOWING: (1) CORRECT SHIPPING DESCRIPTION: (2) HAZARD CLASS(ES):______________
Waste Dowtherm and water Non- Hazardous
(3) MATERIAL I.D. NO.(S)
B. DOES THIS WASTE CONTAIN ANY "HAZARDOUS SUBSTANCE" AS DEFINED BY REGULATIONS OF THE U.S. ENVIRONMENTAL PROTECTION AGENCY PURSUANT TO SECTION 311 OF THE CLEAN WATER ACT? N
(SEE 40 CFR 117 FOR "HAZARDOUS SUBSTANCES" AND CATEGORIES.) IF SO, PLEASE ADVISE OF THE FOLLOWING:
(1) THE NAMES OF EACH HAZARDOUS SUBSTANCE PRESENT IN THE WASTE. THE HAZARD CATEGORY (X, A, B, COR D) AND THE APPROXIMATE CONCENTRATION OF THE SUBSTANCE BY WEIGHT IN THE WASTE
(ATTACH ADDITIONAL PAGES IF NECESSARY)
C. IS THIS WASTE A "HAZARDOUS WASTE" AS DEFINED BY REGULATIONS OF THE U.S. ENVIRONMENTAL
PROTECTION AGENCY PURSUANT TO SECTION 3001 OF THE RESOURCE CONSERVATION AND RECOVERY
ACT? No___ (SEE 40 CFR. PART 261 FOR WHAT IS A "HAZARDOUS WASTE.") IF SO, STATE
(1) THE USEPA HAZARDOUS WASTE NUMBER(S): ----- --------------------------------------------------------------------------------(2) DO YOU CLAIM TO BE A SMALL QUANTITY GENERATOR? No (SEE 40 CFR 261.5.)
D. IS THIS WASTE A "HAZARDOUS WASTE" AS DEFINED BY THE ENVIRONMENTAL REGULATORY AGENCY IN
YOUR STATE?__ _________ IF SO, STATE WHY IT IS SO DEFINED AND ANY STATE HAZARDOUS WASTE CODE
NUMBERS ASSIGNED: TT--.___________
*
11
10. IS THE INFORMATION PROVIDED IN SECTIONS 6-9 BASED UPON LABORATORY ANALYSIS OF THE WASTE
MATERIAL? No IF SO, PLEASE ADVISE OF THE DATE OF THE MOST RECENT ANALYSIS:
___________
11. HAVE YOU OBTAINED TOXICITY STUDIES OF THIS WASTE STREAM? No THE RESULTS.
jF SO) PLEASE ATTACH A COPY OF
12. QUANTITY/SHIPPING REQUIREMENTS:
ANTICIPATED VOLUME IS:500
GALLONS
TONS
CUBIC YARDS
DRUMS
OTHER
PER: DAY
WEEK
MONTH O
YEAR ft
ONE TIME
transportation EQUIPMENT REQUIRED: Vacuum Trvck or Drums.
SERVICE/SCHEDULING REQUIREMENTS:
As required.
CONFIDENTIALITY AGREEMENT:
as consideration for the Generator's release of the above information, and any other supplemental data provided, agrees to treat
such information as confidential property and will not disclose such information to others except as is required by law, and in
such circumstances only after first giving notice to the Generator.
_
By: ------------------------------------------------------------------------------1' Name
SL 046093
Title
\
SALES
COPE
CERTIFICATION OF REPRESENTATIVE SAMPLE
LCH A-89606
' WASTE PROFILE SHEET CODE
GENERAL DIRECTIONS; IN ORDER TO DETERMINE WHETHER WE CAN ACCEPTTHE SPECIAL WASTEDESCRIBED 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 THATTHE SAMPLE BETRULY REPRESENTATIVE. IN MOST CIRCUMSTANCES YOU WILL BEOBTAINING 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 ^J^j^NED. WITH THE REPRESENTATIVE WASTE SAMPLE. TO:
Rt. 2, Box 1955 _____________ Carlvss. LA 70663___________________________
Attn:.......................... Chief Chemist
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: A.M. 5/10/83
2. SOURCE FROM WHICH SAMPLE TAKEN:
Drum of waste
3. EQUIPMENT AND SAMPLING METHOD USED: Glass Coliwaso; Grab Sample
4. AMOUNT OF SAMPLE OBTAINED:__ 1 9uar<>_____________________________
5. TYPE OF CONTAINER INTO WHICH SAMPLE WAS PLACED:
Glass Jar
6. THE SAMPLING EQUIPMENT USED, AND THE CONTAINER INTO WHICH THE SAMPLE WAS PLACED. WERE THEMSELVES UNCONTAMINATED BEFORE USE.
I 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: SAMPLE HOUR/DATE: PROFILE SHEET CODE SAMPLER SIGNATURE
PPG Industries, Inc.
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.
WITNESS: Andy P. Plauche*
SIGNATURE:
SAMPLER NAME
/AAike Dtgigiia
SIGNATURE
TITLE_____ EMPLOYER: DATE: _____
mi /c
Environmental Control Assistant PPG Industries, Inc.
5/31/83
TITLE
Plant Environmental Foreman
fmpi nvpn* PPG Industries, Inc.
DATE
' 5731/83
FORM WMf-51 (RW. ! 1-5-SO)
LABORATORY REVIEW OF SAMPLING PROTOCOL. v 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,..
DATESL 046094