Document ree5kgRXzEa1yqvnpnyZdVO0V
cnemicai waste Manag m nt, Inc.
RECERTIFICATION F GENERATOR'S WASTE MATERIAL PROFILE SHEET
PUEAMI PftWCT IN INK OR TTPE (EM*, 13-pMQii)-
V
IH_
D97849
Waste Profile Sheet Code
CWM Location of Original:
(SHADED AREAS FOR CWM USE ONLY)
CWM Sales Rep. fh
INSTRUCTIONS FOR COMPLETING THIS FORM ARE FOUND ON THE OPPOSITE SIOE. ANSWERS MUST BE MADE TO ALL
QUESTIONS. A copy of the previously completed Generator's Waste Material Profile Sheet which is being recertified must be attached
to this recertification form. Return this form and attachments tn'
_ Gheinical Waste Management . Inc. Route 2 Box 1955
Sulphur. LA ATTN: DOROTHY ORTEGO
7\n r.nfia- 70663
A. GENERAL INFORMATION i feanerdfiiatiatiiK.
PPG Industries,
1 Facility Adrimw P 0 Box 1000
Columbia Southern Road
Lake Charles. LA
fi Tpf'hnioai Contact- Gerald L. Perry
Inc. 7 Title- Env.
? GMM*afLjt*e0tt.}D:
TlwTMno^
LAD008086506
4 Generator State irV GD~019"0495
a. 7ipr.nd<*- 70602 Control SDec. a Phone-( 318)491 4370
r i naup nr u/astf
Solids contaminated with Dowtherm
? PROCESS GENERATING WASTE Production of chlorinated solvents and anydrous caustic
C. CHANGES OR ADDITIONS SINCE LAST PROFILE SHEET PREPARATION OR RECERTIFICATION
1. Have you obtained any laboratory analysis of this waste? O Yes t^l No. If yes, please attach copies.
2. Have you changed the raw materials used in the waste-generating process?
3. Have you changed the waste-generating process itself? G Yes
No
Yes Q No
4. Are you aware of any facts or circumstances which have, or reasonably could have, altered the physical characteristics or
chemical composition of the waste?
G Yes G No
5. Are you aware of any human health effects of exposure to the waste not previously conveyed to Chemical Waste
Management, Inc.?
Q Yes Q No
6. If you answered "Yes" to questions 2,3,4 or 5, please provide details by attaching additional pages.
D. SPECIFIC CONSTITUENTS 1. Is this waste a listed Dioxin waste as defined by 40 CFR 261,31 (e.g,, F020, F021, F022, F023, F026, F027, or F028)? 2. Is this waste a listed solvent waste as defined by 40 CFR 261.31 (F001, F002, F003, F004, or F005)? 3. Does this waste contain greater than 1000 ppm total halogenated organic compounds?
G Yes 51 No
Yes
No
Yes 'S No
E. REPRESENTATIVE SAMPLE 1. SB 1 have obtained and will send a representative sample of this waste to Chemical Waste Management, Inc. as outlined on the attached Certification of Representative Sample. 2. i hereby authorize Chemical Waste Management, Inc. to obtain a representative sample of this waste from any shipment arriving after the receipt of this recertification form. DO NOT COMPLETE the attached Certification of Representative Sample form.
F. TRANSPORTATION INFORMATION Has the transportation information for this waste changed from that on the attached
Generator's Waste Material Profile Sheet? ^ No
G Yes
If Yes, complete the remainder of this Part F.
1 i? this a dqt Hazardous Material^ G Yes O No
? Anticipated Annual Volume/Units:
^
3 Prnper Shipping Name:
4 Hamrd Class-
fi in #
fi Additional Description: (
)
7 Method of Shipment: G Bulk Liquid l-! Bulk Solid Cl Drum (Type/Size): . ... /
Other-
fl CERCI A Reportable Ouantity (RO):
3 RO l Inits (lh/kg)-
10 1ISFPA Hazardous Waste? G Yes f~l No 11 IJRFPA Hazardous Waste Numbers):
12. State Hazardous Waste? G Yes G No
13. State Hazardous Waste Number(s):
G. RECERTIFICATION The information provided in this document, the attached Chemical Wast Management, Inc. Generator's Waste Material Profile Sheet, and all other attached documents contain true and accurate descriptions of this waste material. All new information regarding known or suspected hazards in the possession of the generator has been disclosed.
r\oH0A
Env. Control Specialist
1. Signature fieralH _L Pprry
/" / # /"` ,.-- *._<va i l3. Name (Type or Print) en
2. Title 4. Date
nft/Tfi/qL
SL 046118
cn mical Waste Manag ment, Inc.
4
% GENERATOR'S CERTIFICATION OF REPRESENTATIVE SAMPLE
PLEASE PRINT IN INK OR TYPE (ESI*, 12-pttCh).
V
CWM Location of Original:
LCtt
D97849
Waste Profits Sheet Code
(SHADED AREAS FOR CWM USE ONLY)
CWM Sales Rep. #T __
This completed form must be returned, with the representative sample, to: Chemical Waste Management. Inc.___________________________
Route 2 Box 1955_______ ___________________ __________________
Sulphur. LA
70663___________________________
ATTN! DOROTHY ORTEGO__________
INSTRUCTIONS FOR COMPLETING THIS FORM ARE FOUND ON THE OPPOSITE SIDE. In order to determine whether Chemical Waste Management, Inc. can accept the special waste described in the Generator's Waste Material Profile Sheet referenced above, you must obtain and supply us with a representative sample of the waste. We may analyze the sample to verify the information that you have provided to us. A representative sample is defined as a sample obtained using any of the applicable sampling methods specified in 40 CFR 261-Appendix I or an equivalent method. Collect a representative sample of your waste and complete the form below. Apply the peel off label and ship your sample along with this form to the address noted above. If you have any questions regarding obtaining a representative sample of your waste, please refer to the instructions for this form, or contact your Chemical Waste Management, Inc. sales representative.
A. SAMPLING METHOD (Indicate which method was employed) If sampling requirement has been waived by Chemical Waste Management, Inc., do not complete this Generator's Certification of Representative Sample form. 1 C I have obtained a representative sample of the waste material described in the Generator's Waste Material Profile Sheet referenced above according to the sampling methods specified in 40 CFR 261-Appendix I. 2. E I have obtained a representative sample of the waste material described in the Generator's Waste Material Profile Sheet referenced above using a method equivalent to the sampling methods described in 40 CFR 261-Appendix I.
B. SAMPLE SOURCE (e.g., drum, lagoon, pit, pond, tank, vat)
Drum
C. SAMPLE LABEL - COMPLETE LABEL BEFORE REMOVING
1. Waste Profile Sheet Code: 2. Generator's Name: 3. Name of Waste: 4. Sample Hour/Date:
5. Sampler's Signature:
v.ll-J-catarrnatoc_v/Jiov/tharr
.'.q/C 7/hr
..
L'iqnatur.:
I
6. Print Sampler's Name:_____________ W. H, Cooper_______________________ 7 Sampler's Title: ___________________ Environmental Control Specialist
8. Sampler's Employer (if CWM, see D. below):
PPG Industries, Tnc.* I * * 4
D. WITNESS VERIFICATION (if required) In most circumstances you will be obtaining the sample. However, in those cases in which Chemical Waste Management, Inc. obtains the sample, one of your employees must be present to direct the particular source to be sampled, to witness the sampling, and to complete this Part D. I was personally present during the sampling described. I directed the waste source to be samplecfrand I verify the information noted above. 1. Witness'Signature: .______046119______________
2. Witness' Name: 3. Witness' Title:! 4 Witness' Employer: 5. Date: --
JENERATOR USEPA I.D. lL lA I i 0 18101816151016
TECHNICAL CONTACT; I GSFdld L. Perry
1 TITLE;
name of wastei Solids contaminated with Dowtherm
PROCESS GENERATING WASTE: l Production of chlorinated solvents
318) 491-4370
B PHYSICAL CHARACTERISTICS OF WASTE
COLOR
Black to Brown
GODOR
NONE
0 STRONG
nWJMRC 1
G MILD
I
PHYSICAL STATE 70f
US SOUO
G UOUID
La SEMI-SOLID
G POWDER
op- 3-T-Tf
LAYERS
G MULTILAYERED REEI
G BI-LAYERED
GD SINGLE PHASED
Byes
El no
VOLUME L Q-SO*>
PH; <*
LS 7.1.10
10.1 12.5
N/A
SPECIFIC <
GRAVITY
10
[X] 1.3-14 1.5-1.7
FLASH < 70-F
POINT ,, 70*F-100*F
> 200"F |X] NO FLASH
Jxfclosed CUP ^ OPEN CUP
H A1-6.S
> '
Si1-1-1-2
> '.7
'01-F- 139*F
Q EXACT,___
mi
EXACT
exact l.
14O*F-20O*F
C CHEMICAL COMPOSITION (TOTALS MUST ADD TO 100%)
Biphenyl_______________________ . Phenvl Ether
Solids (dirt, absorbent, shell.
and sand)
-J L 1-5
-I L.
J*
.cwm___________________ _____ i\ipf wni-iif"PV
VF--AUG 43" iyiJ3 j
i ......... TEcort
D METALS p?TOTAL (PPM) k/'O EPA EXTRACTION PROCEDURE (mglU
arsenic lAM t___ None____ i
selenium ism___ None.
BARIUM JBal 1 CADMIUM <Cd) l
None None
SILVER (Ag) t COPPER jCVI i
None None
CHROMIUM iCrt L . MERCURY (HQ) |--'
None None
__i
NICKFL (Ml) l ZINC (Zn) |___
None None
LEAD IPbl
1_____ None
THALLIUM ITT! L
None
chromium.hex ict+si
None
J ..............
1-----
E OTHER COMPONENTS TOTAL (PPM)
CYANIDES 1.... None... ....,
sulfides i
None
i
pcb^s
*__ None
phenoucs Section C
HAZARDOUS CHARACTERISTICS
D O T HAZAROOUS MATERIAL? YES
IS NO
SolidsPROPER SHIPPING NAME 1 contain,_with Dowtherm__
hazard class i None
t i.q. no. i None i R Q i None
METHOD OF SHIPMENT; BULK UOUID
ED BULK SOLID
REACTIVITY: IZ] NONE D EXPLOSIVE
PYROPHORIC
SHOCK SENSITIVE
O WATER REACTIVE Q OTHER i
OTHER HAZARDOUS CHARACTERISTICS:
(x) NONE
CD RADIOACTIVE
G ETIOLOGICAL
(Z1 drum(typeisize). 55 gallon drum____ i
ANTICIPATED VOLUME l_
40
PER; ONE TIME
GALS. L.
_i OTHER I__ WEEK
J CUBIC YARDS
Drums
MONTH
O PESTICIDE MANUFACTURING WASTE
usepa hazardous waste7
G yes
O OTHER i.......... m NO
USEPA HAZARDOUS CODEIS) 1
1
STATE HAZARDOUS WASTE?
G YES
< -----
E] NO
<I
QUARTER
51 YEAR
H SPECIAL HANDLING INFORMATION 5E
l______
STATE CODEIRII
Clean up all spills - non-hazardous Industrial Solid Waste
.G ADDITIONAL PAGEIS) ATTACH
I HEREBY CERTIFY THAT ALL INFORMATION SUBMITTED IN THIS AND ALL ATTACHED DOCUMENTS IS COMPLETE AND ACCURATE. AND THAT ALL KNOWN OR
SUSPECTED HAZARDS HAVE BEEN DISCLOSED.
v
AUTHORIZED SIGNATURE
TITLE "
DATE
SL 046120
QAaDiLi
,Env. Control Specialist
Wll^lllIVliftB
IAW4W IflUllugwtifeVMkj kin -
4 GENERATOR " CERTIFICATION OF REPRESENTATIVE SAMPLE
PLCASC PRINT IN INK OR TYPE (EM*. 12-pMch).
CWM Location of Original:
mm Diwi Wasta Profile Sheet Code
(SHADED AREAS FOR CWM USE ONLY)
CWM Sales Rep. #:
This completed form must be returned, with the representative sample, to:
INSTRUCTIONS FOR COMPLETING THIS FORM ARE FOUND ON THE OPPOSITE SIDE. In order to determine whether Chemical Waste Management, Inc. can accept the special waste described in the Generator's Waste Material Profile Sheet referenced above, you must obtain and supply us with a representative sample of the waste. We may analyze the sample to verify the information that you have provided to us. A representative sample is defined as a sample obtained using any of the applicable sampling methods specified in 40 CFR 261-Appendix i or an equivalent method. Collect a representative sample of your waste and complete the form below. Apply the peel off label and ship your sample along with this form to the address noted above. If you have any questions regarding obtaining a representative sample of your waste, please refer to the instructions for this form, or contact your Chemical Waste Management. Inc. sales representative.
A. SAMPLING METHOD (Indicate which method was employed) If sampling requirement has been waived by Chemical Waste Management, Inc., do not complete this Generator's Certification of Representative Sample form. 1. w I have obtained a representative sample of the waste material described in the Generator's Waste Material Profile Sheet referenced above according to the sampling methods specified in 40 CFR 261-Appendix I. 2. I have obtained a representative sample of the waste material described in the Generator's Waste Material Profile Sheet referenced above using a method equivalent to the sampling methods described in 40 CFR 261-Appendix I.
AB. SAMPLE SOURCE (e.g., drum, lagoon, pit, pond, tank, vat)
C. SAMPLE LABEL -- COMPLETE LABEL BEFORE REMOVING
r
i
1. Waste Profile Sheet Code: 2. Generator's Name: 3. MB^M Name of Waste: 4. BHH Sample Hour/Date:
5. H Sampler's Signature:
Jar
_
. . JMajxlZZ.
1. Waste Profile Sheet Code: 2. Generator's Name: 3. Name of Waste:
. 4. Sample Hour/Date:
5. Sampler's Signature:
D. WITNESS VERIFICATION (if required) In most circumstances you will be obtaining the sample. However, in those cases in whict
Chemical Waste Management. Inc. obtains the sample, one of your employees must be present to direct the particular source to b* sampled, to witness the sampling, and to complete this Part D.
I was personally present during the sampling described. I directed the waste source to be sampl d, and I verify the informatioi
noted above.
w~
1. Witness'Signature: ------------------------------------------------------------------------------------------------------------------_------- SL 046121------2. Witness' Name: ___________ ___________________________ _____ 3. Witness' Title:
4. Witness' Employer: I_______________________________________ 5. Date:
13:07
713 S74 *989
CWMCl'ST SVC
@009'010
7. -.---
......... -
/V V-^W
WASTE PROFILE SHEET COPE
ina. _
IDT
GENEIUTORtS^ASTCMiEBIAL PROFILE-SHEET
^`vr'
TSOH D-97849
* GENERAL W RMATION
generator name. , PPG Industries, Inc.
_l
,,yjQMtranbPQR'
-
Baytown,
TX.
FACILITY ADDRESS U
0. Box 1000
27-6772
Columbia Southern Road - Westlake, La,
GENERATOR USER* ID j-
'frtl'Q 1
^ < 5> 0 i t |
Lake Charies LA technica; contact.i Gerald L. Perry
70602 __________
i title
1EN
Ts^JZT
n1l3ia) 491-4370
name of waste Solids contaminated with Dowtherm__________
PROCESS GENERATING WASTE
Production of chlorinated solvents ypfitovftfrfotqftflffw*
'b physical characteristics of waste
COLOR
Black to Brown
CODOR
NONE
0 STRONG
_ MILD
nPAORlRE 1
1
pH. SPECIFIC _J < 8 GRAVITY __
.8 1 0
PHYSICAL STATE W*F
US SOUD
G SEMI-SOLID
O LIQUID
I_l POWDER
LAYERS
G MULTILAYERED
Q BI-LAVERED
S3 SINGLE PHASED
FREE UQMOS
G YE5
VOLUME '
flash i_J< 70`f POINT _
70*FIOO*F
[_!> J0B*F 53 N0 FLASH
S NO
`*1 ^CLOSED CUP
Q OPEN CUP
'01 *F '3'F SXACT ,___
^ '0*F-MO*F
' C CHEMICAL COMPOSITION (TOTALS MUST ADD TO '00*A!
Biphenyl_________________________
| 1-p
,J Nonev .rO METALS niTOTAL (PPM) <*1G EPA EXTRACTION PROCSCl
ARSENIC (At)
SELENIUM (Sa*_
Phenyl Ether
J1-5 J, l barium (Bat
J ,95-99
CADMIUM (COI
None None
SILVER fAg> u. CORPBft (Cut Up
and sand).
CWMI JCliil
. None| IN.1 CHROMIUM (Cr)
NICKEL (NO L_
NoneJ | MERCURY (HE)
ZinC (Zm
i_
/`I l LEAD IPfct
None
THALLIUM (Til L.
_________ i*l Lchrauiuu.mgv if. .ah
None --I
L-
None None None
None None None
AU6 t9 1QS5
OTHER COMPONENTS TOTAL (PPMi
L
ICTANlOiS L None
PCS'*
None
JLPIOES l None
j phenoucs iSection C
DOT HAZARDOUS MATERIAL? G YE5
Sj NO
HAZARDOUS CHARACTERISTICS
REACTIVITY: Xl NONE
G PYROPHORIC
G SHOCK SENSITIVE
proper shipping name'Solids contarn. with Dowthenti Jl LJ EXPLOSIVE
lJ water reactive __ OTHER i__________
ihazard class None
i 10 NC l. None
, a , None J OTHER hazardous Characteristics
METHOD OF Shipment, _: SULK LlOUlD
G 8ULIL SOUD
. NNOONNEE
G RADIOACTIVE
G ETIOLOGICAL
A: DRUM (TYPC/SIZEl L 55 gallon drum
O PESTICIDE MANUFACTURING WASTE
- , OTHER l.
ANTICIPATED VOLUME. L--
40
GALS L_ OTHER L
j Cubic yards
Drums
| USEPA HAZARDOUS WASTE' USEPA HAZARDOUS CODEIS)
_j YES ' L.
?.0
PER __ 3n TIME
I WEEK
| STATE MAZAROOUS WASTE?
YES 2 NO
__ QUARTER
51 YEAR
STATE COPEi&n
H SPECIAL HANDLING INFORMATION .
Clean up all spills non-hazardous Industrial Solid. Waste_______________
J ADDITIONAL PAGStSl ATT AC !
^^SBEBYCE^iFYlHAT ALL !NORMAIION SuEM!7TED_IN THIS AND A^L ATT AChEDJJOCUMENT^^OMrLE'S AND ACCURATE AND That ALL KNOWN OR
SUSPECTED HAZARDS HAVE SEEN OISCIOSED
-
AUTHORIZED SIGNATURE
TITLE
DATE SL ,,04, 6, 12o2o
1 - (18*'91
5-3: US 713 874 8989
C^M CUST SVC
Chemical Waste Managem nt, inc.
RECERTIFICATION OF GENERATOR'S WASTE MATERIAL PROFILE SHEET
DliiU MINT IN INK ON TYM (EHta. 12-pttS*)-
010.-010
i LCH
D 97849
Waste Prattle Sheet Code
CWM Location of Original:
(SMADID ANtAS SON CWM USE ONLY)
CWM
:
INSTRUCTIONS FOR COMPLETING THIS FORM ARE FOUND ON THE OPPOSITE SIDE. ANSWERS MUST BE MAOE T ALL
QUESTIONS. A copy of the previously completed Generator's Waste Material Profile Sheet which is being recertified must be attached
to this recertification form.
Return this form ana attachments to: --_________ - -______________________ --________
-
Zip Code:,
A. GENERAL INFORMATION
i. Generator Name: PPG Industries. Inc.2. Generator USEPA IP _LAD008086506_________________________
3. Facility Address: P O Box 10004. Generator State ID; GD-019-0495 Columbia Southern Road _______ _
Lake Charles. LA5. z\oCode:
70602
6. Technical Contact: william H. Cooper
7, Title: Assoc. Rcs.Chem. g, Phone: ( 318) 491 4250
B. 5 NAME OF WASTE
Solids Contaminated with Dowtherm______ _
2. PROCESS GENERATING WASTE Production of chlorinated solvents and anhydrous caustic
C. CHANGES OR ADDITIONS SINCE LAST PROFILE SHEET PREPARATION OR RECERTIFICATION
1 G SI. Have you obtained any laboratory analysis of this waste? Yes
No. If yes. please attach copies.
2. Have you changed the raw materials used in the waste-generating process?
Yes 0 N
3. Have you changed the waste-generating process itself? Q Yes 1x3 No
4 Are you aware of any facts or circumstances which have, or reasonably could have, altered the physical characteristics 0
chemical composition of the waste?
D Yes SI No
5. Are you aware of any human health effects of exposure to the waste not previously conveyed to Chemical Wast;
Management, Inc.?
Yes E No
5. if you answered "Yes" to questions 2, 3. 4 or 5, please provide details by attaching additional pages.
D. SPECIFIC CONSTITUENTS
*
' is tms waste a listed Dioxin waste as defined by 40 CFR 261.31 (e.g.. F020, F021. F022. =023 '025. "227, or F028)? 2. Is this waste a listed solvent waste as defined by 40 CFR 261.31 (F001. F002, FQ03, F004. or F005)? 3. Does this waste contain greater than 1000 ppm total halogenated organic compounds''
Dyes Yes Yes
G No E Mi 2! No
E. representative sample 1. G I have obtained and will send a representative sample of this waste to Chemical Waste Management. Inc. as outlined or, *.r attached Certification of Representative Sample. 2. 0 1 hereDy authorize Chemical Waste Management. Inc. to obtain a representative sample of tnis waste from any shipment arnvir after tne receipt of this recertification form. DO NOT COMPLETE the attached Certification of Representative Sample form
F. TRANSPORTATION INFORMATION Has the transportation information for this waste changed from that on the attaene
Generator's waste Material Profile Sheet? 13 No
Q Yes
It Yes, complete the remainder of this Part F.
' is this a DOT Hazardous Material? G Yes No
2. Anticipated Annuat Volume/Units:
2. Proper Shioping Name; Solids Contaminated with Dowtherm
40 / drums
__________
4. Hazard Class: _______ _________________________________________
S. I.D. #:
NoMA................................... .... .
S Additional Description: 1 _
7. Methoo of Shipment: D Bulk Liquid G Bulk Solid E Drum (Type/Size):___ iZl--' 33_Ral Other:
8. CERCLA ReoortaDi# Quantity (RQ): _
None
9. RQ Units (Ib/kg):
None
10. USEPA Hazardous Waste? Q Yes 3 No
:2. State Hazardous Waste? "" G Yes 0 No
11 USEPA Hazardous Waste Number(s):. 13. StateHazardoiXS Waste Number(s):__
SL
046123
RECERTIFICATION The information provided in this document, the attached Chemical Waste Management, Ine. Generate Waste Material Profile Shew t*, and Pal*l *other attached documents contain true and accurate descriptions of this waste material, new information regardinig knnoowwnnao;i suspected hazards in tne possession of the generator nas been disclosed.
Associate Research Chpminr