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RECERTIFICATION OF
' <s^S}' I ~T71 ~ ^ ,
GENERATOR'S WASTE ATERIAL PROFILE SHEET
.1
INSTRUCTIONS: A CORY OR TNI COMPLETE GENERATORS WASTE MATERIAL PROFILE SHEET WHICH IS SE1MO RECERTIFIED MUST BE ATTACHE0 TO THIS RECERtlFCATiON PC
ORDINARILY the last COMPLETE PROFILE SHEET WILL be ATTACHED TO YOUR CONTRACT. IF YOU HAVE ANY DIFFICULTY LOCATING THE LAST COMPLETE PR FILE SHEET CONTACT
PERSON SHOWN BELOW IN ADOITION WE ASA YOU T COMPLETE THE REMAINDER OF THIS FORM ANO TO HAVE IT SIGNEO BY AN AUTHORISED EMPLOYEE. ANSWERS MUST IE MAO
all QUESTIONS ANO MUST St COMPLETED IN INK. INFORMATION SUPPLIED WILL BE MAINTAINED IN STRICT CONFIDENCE CONSISTENT WITH LEGAL REQUIREMENTS
TURN THIS FORM ANO ATTACHMENTS TO: |_ CHEMICAL WASTE MANAGEMENT. INC.
___________ _ '
l
u ROUTE 2 BOX 1935
SULPHUR. LA 70663
A GENERAL INFORMATION
PPG INDUSTRIES, INC.
OENERATORNAMS; L.
J TRANSPORTER: CWMI-BAYTOWM. TX
-FACILITY ADDRESS:
-P . Q _ RQY )fVin
COLUMBIA SOUTHERN ROAD - WESTLAKE. LA
TRANSPORTER PHONE: 713/427-6772 ,L ,A ,D,0,0 ,8 .QJUUi ,0
LAKE CHARLES, LA 70602
J GENERATOR STATE LO. L.
TECHNICAL CONTACT: L--PATRICE M . MCFARLAIN
: ,(Wpivv(
I T[TLt .Pit-
NAME OP WASTE: 12
i^(\Wvmn-VA
Fnv II. Fnrpmai.--. ,.f318) 491-4420
CNoAaJA.
PROCESS GENERATING WASTE.
X
S CHANOE5 OR ADDITIONS SINCE LAST PROFILE SHEET PREPARATION OR RECERTIFICATION
1. HAVE YOU OBTAINED ANY LABORATORY ANALYSIS OF THIS WASTE? YES &HQ (IF YES. PLEASE ATTACH COPIES)
Z. HAVE YOU CHANGED THE RAW MATERIALS USED IN THE WASTE-GENERATING PROCESS7 P YES QTrO
X HAVE YOU CHANGED THE WASTE-OENERATING PROCESS ITSELFT YES B"NO
X ARE YOU AWARE OF ANY FACTS OR CIRCUMSTANCES WHICH HAVE, OR REASONABLY COULD HAVE. ALTERED THE PHYSICAL OR HAZAAOOUS CHARACTERISTICS. OR CHEN COMPOSITION OF THE WASTE? YES El WO
1 ARE YOU AWARE OF ANY HUMAN HEALTH EFFECTS OF EXPOSURE TO THE WASTE NOT PREVIOUSLY DESCRIBED? YES B^O
X IF YOU ANSWERED "YES" TO QUESTIONS X X 4 OR X PLEASE PROVIDE DETAILS BELOW:
n SJSMgl VEffj
AUG 2 8 1985
I-ak* Churix*
x+ ,, .
C SPECIFIC CONSTITUENTS DOES THIS WASTE CONTAIN FOLYCHLORINATE0 S1FHENYLST O YES
DOES THIS WASTE CONTAIN X X 7. TCDD? O YES e<o
0*NO
>
DMETSHHOIPDPOINFGSIHNIFPOMREMNATT: IOQN BULK UOUID
jsCm SOUS
DRUM (TYPCJSIZE) L
AHTICIPAYIO VOLUME: PER: ONI TIME D WEEK
>rlfv u um i imm mw nKKA
D MONTH pvnm
_J gals. l. QUARTER B'yEAR Q I m ---
_l CUBIC YDS. L. 1 --
JLfc.
___ _
J OTHER l_
TObSS
, ___ ______
RECERTIFICATION. I AM AH EMPLOYEE OF THE OENERATOR AUTHORIZED TO SIGN THIS CERTIFICATION. THE INFORMATION PROVIOED IN THE RECERTIFIED WASTE PROFILE :
N4AYMTAEC: H ED HERETO. AND THE INFORMAHON5UPPUED ABO-V--E--.--A--R--E----C--O---M--P--L--E--T--E--.--T--R---u--e AND COSRKRZEHCATT. URfcl
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.
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TITLE.L-kihQ.
JrgfrftttNVN-
------------ --------------- :------------- 1dat*l_p-------------------- 1
sr
SL 046188 --
generatorname: i
//-<5W PPG Industries Inc. i transporter:i CWM. OranQe. TX
fAC4UTVadoress: ( P. 0. Box 1000 Lake Charles. LA 70602 if 318)j' TRANSPORTER PHONE: 625-9003____ i , Columbia Southern Road. Westlake. LA __ i generator usepa lo. d A D i Qi Oifli Qifli 61S1 0161
TECHNICAL CONTACT: I------- Mike
""
; ''
GENERATOR STATE LO. I
I
. l titip. I EflV . Control Asst. I wm.ll f 318) 491-4370 ~i
NAME OF WASTE: l_ Ceramic Saddles .from Tnrineratnr Ahsnrhpr^__j
PROCESS GENERATING WASTE: L Production of Chlorinated Organic Solvents
J
rt PHYSICAL CHARACTERISTICS OP WASTE
COLOR
White to Gray
ODOR OnONE Q STRONG
53 MILO -
ntftCftlAFl/ IIM
I
Qn/a
SPECIFIC 5)< J
GRAVITY
EJ-SrlO
.PHYSICAL STATE TO'P
LAYERS Q MULTILAYERED
FREE UOUIOS
IXJ SOLID
LJ SEMI-GOUD G BMJLYERED
O YES
O UOUIO -
D POWDER
{El SINGLE PHASED VOLUME
FLASH < 70'f
POINT _ [J70'P-1WF
> Wf g] NO FLASH
53 NO Hi
Qcloseocup Q OPEN CUP
Q 1-1-1.1
Q 101 *F U8*F
Q EXACT,______
exact
Q 140"F*W0*F
C CHEMICAL COMPOSITION (TOTALS MUST AOO TO 100%)
L-CLIIY iciic lhliiilh me
, 1,1,2-Trichloroethane
. Perchloroethylene . 1.1.1.2-Tetrachloroethane
/ . * .1
. Ceramic Saddles . Carbon
*
-Jj i__________
> <30 ppm
l;
li 1
1%
r METALS Q TOTAL (PPM)
ARSENIC (AM
None
BARIUM (Bl)
None
NoneCAOMIUM (CO) L_
CHROMIUM (Cl) L
None
Q EPA EXTRACTION PROCEDURE (mgm
SELENIUM (S*)(_
None
SILVER (Ag)
Jonfi-
COPPER (Cut I__ NICKEL (Nl L.
None None -
, . 95-99,%
MERCURY (Hg) I
LEAD (Pty
L.
' NOOg '
None
ZINC (Zn)
L.
THALUUM(TI) u
Hone
Hone
i 1-5
i% CHROMIUM-HEX (Cr + 61L
None.
1 ffi^L W
Ai mi n . A Tot
OTNER COMPONENTS TOTAL (PPM
s . None . , None
PCB-S PHENOUCS t_
None None
HAZARDOUS CHARACTERISTICS
REACTIVITY; 0 NONE
0 PYROPHORIC
SHOCK SENSITIVE
stfe Solid, NOS
EXPLOSIVE
DO WATER REACTIVE
OTHER i
upment:
no. iNA 9189 i R.o,i None j
Q bulk uouio
ml* ouo
OTHER HAZARDOUS CHARACTERISTICS:
' ;BlInONE
: O RADIOACTIVE
D ETIOLOGICAL
DRUM (TYPE/SIZE)
ANTICIPATED VOLUME: L,
10
PER: OMf TiMff % * * to is> QUARTER'
_l OALS. I
J OTHER l_ Q WEEK
Byear
O PESTICIDE MANUFACTURING WASTE
G OTHER
J CUBIC YARDS
Tons
USEFA HAZARDOUS WASTE?
51 YES
O HO
USEPA HAZARDOUS COOE|S) L-EQ24-I I. II L
STATE HAZARDOUS WASTFT
[] YES
. Fo24
STATE 0001(5) I
___________ ;
NO
H SPECIAL HANDLING INFORMATION .
Avoid contact with skin or eves. material Immediately.
Flush with water if contact occurs.
Clean up spilled.
. ADDITIONAL PAGElSl ATTACH
I HERESY CERTIFY THAT all INFORMATION SUBMITTED in THIS ANO ALL ATTACHED DOCUMENTS IS COMPLETE ANO ACCURATE. AND THAT ALL KNOWN OR
SUSPECTED HAZARDS HAVE BEEN DISCLOSEDAUTHORUfP SIGNATURE
_ TJTLS --
... . OAT1 ..
tori
UENT. inc.
Environmental Control Assistant
SL 046189
waste profile sheet code
Wv \/?
PPG industries. Inc, i transporter-> CWM. Orange, T1
P.FACILITY ADDRESS: L Q. Box 1000
Lake Charles, I A__ 7Qfifl?____i transporter phone:i(313)
i Columbia Southern Road, Westlake
AGENERATOR USEPA I D 1----- 0 if) ifl ift Ip fLife
MikeTECHNICAL CONTACT: L NAME OF WASTE: L Ceraaic
Dlfiiylla
Saddler.froa
incinerator
J GENERATOR STATE I.D. L
WW1 '
TITLE. iEnv. Control Asst. J PHONE (318) ,4wmt-
Absorber
PROCESS GENERATING WASTE: L Prodnrtlon Of Chlorinated flrgantr Solvents
B PHYSICAL CHARACTERISTICS OF WASTE-
COLOR
ODOR CD NONE
B MILD
White to Gray
CD STRONG
DFSORlRF 1
1
[J N/A
SPECIFIC C<-8
GRAVITY 1-8-10
PHYSICAL STATE 70"F
JtD SOLID
CD SEMI-SOLID
CD LIQUID
CD POWDER
LAYERS
CD MULTILAYERED
CD BI-LAYEREO
&D SINGLE PHASED
CD<FLASH
70-F
POINT
Q 70'F-100`F
fcj " 1 6 a
Q 101-F - 139*F [j H0-F-2CWF
FREE LIQUIDS
D YES
SD NO
vnniup i
%i
. rrxft )A . V. SiULJ. K*
`MriM*
V*
'
CLOSED^ J*
OPEN ' *r j'&y-
C CHEMICAL COMPOSITION (TOTALS MUST ADD TO 100%)
tEthylene dichloride 1.1 .^-Trichloroethane
Percnioroethylene LJ. JJ-Tetrachloroethane
fo metals l%| , ARSENIC (As)
jj
TOTAL(PPM) L Hone
<30
I--I 1 BARIUM (Ba)
pma 1 CADMIUM (Cd)
L L
Hone None
CHROMIUM (Cr) L
None
D EPA EXTRACTION PROCEDURE (moiL)* Nonaj SELENIUM <K*)|
1
SIL.VFR (A/)) |
Nne
_l
COPPFR iC.ift 1
Moacw1 '
1 NICK FI INiI |_.. iifiSff
1 1 t 1
Ceramic SafliJes carbon
il-S
i o\ ! MERCURY (Hg) L
Norw
J
I%1 LEAD (Pb)
L_____ Hone________ t
l%l lchromium hfx icr + Rii
Nnnp
ZINC (7n>
l,
THAI \ lUMfU) l 11
.. U-tK'..
1 ___ 1
rE OTHER COMPONENTS - TOTAL (PPM)
| CYANIDES '+[_________ MPnC__________ _l L _|0/mSULFlDES
PCB*S
F SHIPPING INFORMATION
DOT HAZARDOUS MATERIAL7
[xl Y&S
[Hi NO
HazardousPROPER SHIPPING NAMEL Waste Solid. NOS
V HAZARDOUS CHARACTERISTICS
REACTIVITY jP NONE
PYROPHORIC
CJ SHOCK SENSITIVE
EXPLOSIVE
CD LjWATER REACTIVE
OTHER I__________________
HAZARD CLASS L-URM-L.
I I D NO. HA
METHOD OF SHIPMENT i J BULK LIQUID
DRUM (TYPE/SIZE) L
ANTICIPATED VOLUME
10
! J ONE TIME QUARTER
J GALS L.
_J OTHER I__
CD WEEK
G YEAR
--i r.q. iNone e BULK SOLID
_l CUBIC YARDS
Tons CD MONTH
,_____
OTHER HAZARDOUS CHARACTERISTICS
D none
radioactive
CD etiologIcal*11
PESTICIDE MANUFACTURING WASTE
USEPA HAZARDOUS WASTE1?
jj YES
,,
-V
U OTHER I
.
HU
,4*1 > -
USEPA HAZARDOUS COOE(S) L-EG2A-I i
STATE HAZARDOUS WASTE9
jj YES
CD NO
STATE CODE(S) I FQ24_____________
r s*l.,
* ad v^t'i
'***-'* AufJr^nV -
H SPECIAL HANDLING INFORMATION .
Avoid contact with .Skin or eyes*__ Flush with water if contact occurs. Clean up spilled
material iamedlately.
. CD ADDITIONAL PAGE(S1 ATTACHED
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.
AUTHORIZED SIGNATURE
''
--
TITLE
DATE
Cr ^ 046190
/ Z'1'f
Envlrtwental Control A1stm
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 namf- PPG Industries, Inc.2
2. GENERATING FACILITY NAMEMDDRESS/USEPA FACILITY I.D. NUMBER (IF ANY): PPG Industries, Inc. P. O. Box 1000, Columbia Southern Rood, Lake Charles, LA 70602
EPA ID #LAD 008086506
COMPANY CONTACTS:
gfnfrai
Andy P. PJauehe'
TITLE PI t.Env. Foreman
J. Mike DiGiglia
. TITI E Env.Contr.Asst.
tfchnicai
Arlen L. Greathouse _ _ Mark W. Wood
TITLE Sr.Env.Engr. TITLE Supv. Env. Lab
wastf namf- Ceramic saddles from incinerator absorber
PHONE PHONE PHONE PHONE
(318) 491-4814 (318) 491-4370 (318) 491-4422 (318) 491-4450
PROCESS GENERATING WASTE: Mfg. of chlorinated oraanic solvents
6. WASTE CHARACTERISTICS:
A. PHASES/LAYERS: BILAYERED MULTILAYERED NONE iX
B. PHYSICAL STATE AT 70 F:
SOLID M
SEMI-SOLID
LIQUID
POWDER
OTHER:
C. SOLIDS. TOTAL (%): 100% TOTAL DISSOLVED (ppm or %):
D. SPECIFIC WEIGHT (AS # PER UNIT): _1500 Ib/yd^______ '_____________
E. pH: 3-5 (Show the following as range of %)
AS: H,SO,, HC1 HF HNO,
OTHER:
N/A _ N/A
N/A _ N/A _
_
% h.po. N/A _ % NaOH N/A _ % NH.OH N/A _ % CafOHL N/A _
%
_% %
_% Vo
_%
F. FI ASH POINT __N/A
G. VAPOR PRESSURE (in mm of Hg at 25SC):
H. BTU PER #:
N/A
1. CHARACTERISTIC COLOR
Grey
J. HALOGENATFD? ~
Variable
K. ALPHA RADIATION AS pCi/l: . N/A
% f
N/A
. -%
% mi nspn nup tfst dnii vi
ASH CONTENT N/A DISTINCTIVE ODOR Slight SULFONATED? . N/A
FORM WMI-50-A (Rev 11-5-801 ' 1980 WASTE MANAGEMENT. INC.
SI 46l9i
7. WASTE COMPOSITION:
A. ORGANIC COMPONENTS (WITH RANGES -- INDICATE WHETHER-% OR ppm)
30 ppm total any of th fo I lowing compounds:
Ethylene Dichloride
1,1,1,2 Tetrachloroethane
1,1,2 Trichloroethane
Perchloroethylene
(ATTACH ADDITIONAL PAGES IF NECESSARY)
DOES THIS WASTE CONTAIN ENDRIN, LINDANE, METHOXYCHLOR. TOXAPHENE, 2,4-D, 2,4,5-TPSILVEX, OR ANY
OTHER ORGANIC COMPOUNDS LISTED BY USEPA AT 40 CFR 261,24? No
IF SO, PLEASE NOTE ABOVE.
B. HEAVY METALS (WITH ppm RANGES):
TOTAL
TOTAL LEACHABLE
TOTAL
TOTAL LEACHABLE
Ag_NA
Hg N/A
____________________________
a, N/A
Ni JVA
Rg N/A cri N/A__________
Ph N/A Se_N^
Cr_NZA
Zn_N/A
CuJ^
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 MARRING "EP" AFTER THE RESULT SHOWN ABOVE.)
C. INORGANIC COMPONENTS (WITH % RANGES):
OTHER
TOTAL CYANIDE
N/A -
%
--%
FREE CYANIDE SULFIDE AS:
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? No. IF SO, ATTACH ADDITIONAL PAGES DESCRIBING SUCH MATERIALS.
E. IS THE WASTE A PESTICIDE OR PRODUCED BY A PESTICIDE MANUFACTURING PROCESS? IF SO, INDICATE WHETHER IT CONTAINS:
No
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 __Q___ DERMAL J2___ ORAL _J___
Flammability
(2) HAZARD IDENTIFICATION SYSTEM:
Health
X?>\ _\ 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:
Avoid contact with eyes.
Si. OA6192
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? Yes (SEE 49 CFR 172.101 AND 173 FOR "HAZARDOUS MATERIALS" LIST AND CHARACTERISTICS.) IF SO, PLEASE ADVISE OF THE FOLLOWING:
(1) r.nRRFCT shipping DESCRIPTION- Waste Hazardous Substance, Solid, Nos
(2) hazard class(ES): QRM-E NA 9188 (3) material i.d. no.(S) KOI 8, KOI 9, K020, K021
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? Yes (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, C OR D) AND THE APPROXIMATE CONCENTRATION OF THE SUBSTANCE BY WEIGHT IN THE WASTE:
1,2 DicnToroe thane, Q, > 30 ppm_______
(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? Tes (SEE 40 CFR, PART*261 FOR WHAT IS A "HAZARDOUS WASTE.") IF SO, STATE:
(1) THE USEPA HAZARDOUS WASTE NUMBER(S): K018/ KOI 9, K020, K021
(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? Yes
|F S0, STATE WHY IT IS SO DEFINED AND ANY STATE HAZARDOUS WASTE CODE
NUMBERS ASSIGNED. Contains listed compounds: LA ff508-14
10. IS THE INFORMATION PROVIDED IN SECTIONS 6-9 BASED UPON LABORATORY ANALYSIS OF THE WASTE
MATERIAL? Yes__ if SO, PLEASE ADVISE OF THE DATE OF THE MOST RECENT ANALYSIS: Unavailable
11. HAVE YOU OBTAINED TOXICITY STUDIES OF THIS WASTE STREAM? No THE RESULTS.
|F SO, PLEASE ATTACH A COPY OF
12. QUANTITY/SHIPPING REQUIREMENTS:
ANTICIPATED VOLUME IS:___________ __________________
GALLONS
TONS &4
CUBIC YARDS
DRUMS
OTHER
PER: DAY O
WEEK
MONTH
YEAR H
ONE TIME
TRANSPORTATION EQUIPMENT REQUIRED: Roll-off truck and closed top roll-off
SERVICE/SCHEDULING REQUIREMENTS:
As required
GENERATOR'S AUTHORIZED SIGNATORY:
Environmental
Tin p Contr*
n
S73//P2
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 requir d by law, and in
such circumstances only after first giving notice to the Generator.
By: ---------. _ Name
SL 046193
Title
SALES
CODE
> LCH A-89611
WASTE PROFILE SHEET CODE
CERTIFICATION OF REPRESENTATIVE SAMPLE
GENERAL DIRECTIONS: IN ORDER TO DETERMINE WHETHER WE CAN ACCEPTTHE 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(Af^|' BE RETURNED. WITH THE REPRESENTATIVE WASTE SAMPLE, TO:
Rt. 2, Box 1955 ____ Corlvss. 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. 5/14/83
2. SOURCE FROM WHICH SAMPLE TAKEN:
________________ _
3. EQUIPMENT AND SAMPLING METHOD USED: Scoop/ Grab Sample
4. AMOUNT OF SAMPLE OBTAINED: 1 9uqrt
5. TYPE OF CONTAINER INTO WHICH SAMPLE WAS PLACED: Gloss jar
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: SAMPLE HOUR/DATE: PROFILE SHEET CODE: SAMPLER SIGNATURE:
PPG Industries, Inc. A.M. 5/14/83
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.
SAMPLER NAME
Mike DiGiqltg.
SIGNATURE;
ShsA*
l
WITNESS: Andy P. Plauche1
SIGNATURE:
Plant Environmental Foreman
EMPLOYER: PPG Industries. Inc.________
DATE:
5/24/83
_______________
rOftMWMt*S
11440)
WA*TF MANAflFMCWT iMC
TITLE: Plant Environmental Control Assistant
EMPLOYER: PPG Industries, Inc.
DATE:
5/24/83
LABORATORY REVIEW OF SAMPLING PROTOCOL.
BASED UPpN MV REVIEW OF THE ABOVE PROFILE SHEET. v . I CONCLUDE THAT THE ABOVE METHODOLOGY IS:
ADEQUATE FOR YIELDING A REPRESENTATIVE SAMPLE.
: a INADEQUATE FOR THE REASONS NOTED HEREON.
DATE:------------------------------------------
sl 046194