Document xYzGraDLJ0Z5Q7yoDzX01Z0g

Chemical Waste Management, Inc. ADDENDUM TO GENERATOR'S WASTE MATERIAL PROFILE SHEET FOR LAND DISPOSAL RESTRICTIONS CWM Location of Original . (shaded area for CWM use only) A. GENERATOR INFORMATION--INSTRUCTIONS FOR COMPLETING THIS FORM ARE FOUND ON THE OPPOSITE SIDE OF THIS PAGE. 1. Generator Name: 2. USEPA ID Number: 3. Waste Profile Sheet Code:\Q\<J 1714^4^2^ B. WASTE STREAM INFORMATION 1. is this a USEPA hazardous waste? .23 Yes G No 2. If yes. is this waste: 25 Characteristic G Listed G Both a. is this waste a nonwastewater or a wastewater? Check ONE: X Nonwastewater G Wastewater o. identify ALL Characteristic and Listed USEPA hazardous waste numbers that apply (as defined by 40 CFR 261). For aach waste number, identify the subcategory (as applicable, check none, or write in the description from 40 CFR 268.41, 268.42. and 268.43). The following waste numbers have subcategories: D001, D002, D003, D006, D008, D009 F001, F002, F003. F004, F005, F025, K006, K046, K061, K069, K071, K106, and U151. USEPA HAZARDOUS WASTE NO. NONE SUBCATEGORY DESCRIPTION To list additional USEPA waste numbers), and subcategories, use the supplemental sheet provided (CWM-6000-B). If an addi tional page (CWM-6000-B) is used, please check here: G 3. If the waste is identified as USEPA Waste No. D008, identify the total concentration of lead: 4. Is this waste a soil and/or debris? u Yes, Soil; Yes, Debris; Yes, Both; No, Neither C. GENERATOR CERTIFICATION--I hereby certify that all information submitted in this and all attached documents con tains true and accurate descriptions of this waste material and all relevant information regarding known or suspected hazards in the posession of the generator has been disclosed. i--------------------------------------------------------------- a. Signature ^ * / / /O 3___ M/} L~Ul fr/h ft- * Title - - _' 4.^_____________ I Name (Type or Print) Date 1- SL 046360 Form CWM-6000-A 1990 Chemical Waste Management, Inc. | <