Document kaL88JODjVyrDRKmXLxON5b6b

CERTIFICATION OF REPRESENTATIVE SAMPLE SALES CODE L\\ 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: CWMI______________________________________________________. P.0. BOX 55, HWY, 17. MILEMARKER 163. EMELLE, ALABAMA 35459 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: HOUR AND DATE OF SAMPLING:___ 0_ SOURCE FROM WHICH SAMPLE TAKEN: _ /IPX: \a< EQUIPMENT AND SAMPLING METHOD USED: AMOUNT OF SAMPLE OBTAINED:^ <2- Q7X__________________ TYPE OF CONTAINER INTO WHICHSAMPLEWASPLACED~^S^^6 7 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: "FFOr ZEl's/IXLSTBXE.S,, -ElS/O. WASTE NAME: PTFX AT PHASi! Sample hour/date: tgroSc - d- tC PROFILE SHEET CODE: LCjH- R-^TS/A/ Sampler signature^. WITNESS VERIFICATION: I WAS PERSONALLY PR ENT DURING THE SAMPLING DESCRIBED; I DIRECTED THE WASTE SOURCE TO BE SAMPLED; AND I VERIFY THE INFORMATION ABOVE NOTED. VSJVMPLER NAME'Pacc/ A. Signature: V'flTLE: FMPinvFR- PPG- JA/TiATP3as;JltfG. V0ATE: __________________ ~ FORM WMI-51 (Rev 8/83) VfTTLE: ________ EMPLOYER:~PT^ jrAJpQLs-rtaig^. Xa/c. DATE: If - (1 "Zb 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. DATE:. LAB MGR:__________________ _ SL 046177 Wa?*e Management, Inc. DECERTIFIED WAi,*E rrof-ll $hEEt CODE F> JER1 ICATION OF GENERATOR'S WASTE MATERIAL PROFILE SHEET UiiUAq n s; ^ < f INSTRUCTIONS a r-av '"A COMP-.F" CENEPA'OP S WAS'E ViTfSIli. OOOFILt SHEET which ,s BEING RECERTtC<EC MUS' BE A"AChED TC This RECERTIFICATION sorv I ORDINARII'1TF: .AS" rOMPtE7? PROc Lt SHEET WILt BE ATTACHED TO TOUR CONTRACT 'F YOU HAVE ANY DIFFICULTY LOCA'NGThE LAST COMPLETE PROFILE SHEET CONTACT th IpERSON SHCLVN BE-OW 'N ADDit ON WE ASA YOU th COMPLETE the REMAINDER OF this FORM AND TO HAVE IT SIGNED By an AUTHORISED EMPLOYEE ANSWERS MUST BE MADE T J^l QUESTIONS AND MUS~ BE COMPLETED N NA iNFQRJtAJlQN SUPPLIED WILL BE MATTAINED IW STRICT CONFIDENCE CONSISTENT WITh lEGAl REQUIREMENTS ^^TyPN THIS FORM AND ATTAChMSN'5 TO X^LjO I OX- ~ CVtTTYN, A JLL jfCzHfTL0 \ ^ lYLC pbsc-l. ^5- <T A GENERAL information ~FPGgenerator N~ME t XNDULS.-re.xgs.jJTA/Cu. ~RC,SQy.facility aDDPFSS : /OOP_____________ < tfianspopteo <Lu>m -"brvtw/v, rx________ TRANSPORTER o^ONE ! tLTTfgRV VJgsri-A^fcj LA G-tNEnt'OCMccti 1 D L ft P-OC ? *5 Oife LAKg. LC^msJAA/ft 7C&CJL, GENcPatoR S"aTe ! D !__________ t iG-g&ftk.D k-_.IFfeRR>, Y TLE ,EM/JR.. CAiNlrRfsi. JEMi-phone C3jyVl/*J-ttB70 technical contact NAME OF WASTE ATX____ X A/TH&M & DlftTE T/^AS^: PROCESS NG. waste ...TRyQdouCaTeq N____of CrtLAgjdftTEP //^rearr,arsons CHANGES OR ADDITIONS SINCE LAST PROFILE SHEET PREPARATION OR RECERTIFICATION "AVc ' 00 C = ""A ne: any lAoO^^'CRY analysis OF this waste* _ TS *iF vES r.sase attao copies 2 y^AVE *CU C-ANGEO '-E RAW VATERIALS USED in the WASTE GENERATING PROCESS' Z 5^N0 3 HAVE YOU C-anGEO TmE WASTE-GENERATING PROCESS ITSELF'1 _ YES ?N0 4 ARE YOU AWARE D~ -Sv FaC"S 0= CIRCUMSTANCES WHICH HAVE OR SEASONABLY CQUlD -AVE ALTERED THE PH^s Cal OR HAZARDOUS CHARACTERISTICS, OR CHEV'CA. COMPOSITION OF The WASTE' ^ YES S'nO - 5 ARE YOU AWARE 0C Anv HUMAN HEALTH EFFECTS OF EXPOSURE TO THE WASTE NOT PREVIOUSLY DESCRIBED7 Z YES S'hJO 6 IF YOU ANSWERED ' YES TO QUESTIONS 2 3 4 OR 5 PLEASE PROVIDE DETAILS BELOW >r SPECIFIC CONSTITUENTS DOES THIS WASTE CONTAIN POLYCHLORINATED BIPHENYLS9 DOES THIS WASTE CONTAIN 2 3 7 6- TCDD? _ YES C^NO YES NO -< f D SHIPPING INFORMATION ^^EThOD OF SHIPMENT Z SULK LIQUID Z BULK SOLID ^^BticipatedVOLUME i ^PER Z ONE TIME ___ - 1 GALS L WEEK _ MONTH^ p QUARTER DRUM (TYPE'SlZEl i--^ Z YEAR Z _J CUBIC YDS U other .^O TbfiJS, 'oRtE(CERTIFICATION. ' AM AN EMPLOYEE OF tH GENERATOR AUTHORIZED TC SIGN THIS CERTIFICATION, THE INFORMATION "ROVIDED IN THE RECERTIFIED WASTE PROFILE SHEET ATTACHED HERETO AND THE INFORMATION SUPPLIED ABOVE ARE COMPLETE, TRUE and CORRECT "NAME- iG-S&ftKLfr L..~P&Rft,y StEMATURE- 9/uciMj zLj.^PikAU TITLE- CftiUmOk. S^r.rfli.r.sr date Ci____ <aj ? (a i SL 046178 FORM WMI^n-RfR^v H ?/R4i ' 1 QA4 WASTF MANAGFMFNT INC