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r 140574 <br />usPCi <br />A SrrhuLary d <br />Union Paafic Carporafi°n <br />Waste Profile Sheet <br />for PCB Waste Shiaments <br />Exhibit A to <br />I. Generator Information <br />Generator Company Name <br />Co 7L tv~ ~ h1 n u.l + G eo(~ <br />Genera[pr Faciliry Atltlress <br />!~fl'otf L"5 Nr+:s T /Ir rni%z- <br />u yG.+w.wj r s s <br />cy /n ILES .r~Ernr oi- S~tersef <br />Y~t°'~ bt~nnrs.:n Co~n+y CLC.o. <br />Generator Mailing Atltlress Gtr GA G//os/ij~ <br />!~[/. /L1rNCR.'KS crrtn Qwi~~j <br />/ 3 i 3 S/~.~'e» ~vY.. 2,5 <br />DenatT co 8oza3 <br />Invoice Ouecnons <br />cJhL-sF( ~N~Ia~i~~cN~t_ <br />I4"5 G Corti' Ave. 5re E <br />6 ru-n~ Tc. ~ co 3 ,5° I <br />waste type (cnecfc onel <br />a. Mineral Oil Dielectric Fluid < 10,712 ppm PCB <br />~~ b. Kerosene Flushing Fluid < 4000 ppm PCB <br />~~ c. Commercially Graded #6 Oil < 4000 ppm PCB <br />7 d. Other Oils < 500 ppm PCB <br />e. Flushed PCB Transformers per 40 CFR 761.60(b)(1)(i) <br />f, Drained PCB Transformers (circle one) a. <500 ppm b. >500 ppm <br />~~ g. Contaminated Soil, Debris and/or Rags <br />h. Non-PCB or Small PCB Capacitors (<100inn) <br />i, Drained PCB Hydraulic Machines <br />j. Drained/empty PCB Articles or Containers <br />~ k. Liquids < 500 ppm <br />I, Dredged Materials and/or Sewage Sludge <br />m.LargeCapacitors <br />~_ n. Mineral Oil Dielectric Fluid > 10,712 ppm PCB <br />3Co.Other nI~ pr ~ < Z,7D PPrri <br />US EPA 10 <br />c, r- ~ o ~t- 2 ~ ~ <br />Facihry Comaq (requiretl) <br />f2.yGr4 ClQJS b <br />Pnon~ ~ 3~~ - 2 56 ~} <br />J Fax <br />Tecnnical Comae <br />c'd r3a.l+z~r <br />Phone Fax <br />~7a 241 r-16j6 970 ~Yy-43(Z <br />Broker C°mazt <br />Phone Fax <br />If sp rfic veaiment is esved, ple a specity: . <br />J~Y1C.t.~Z2.vc: re.....~~~..1.....f)!ma,~1-'~~'~.c~.C ......................................... <br />III. Chemical Composition <br />Constituent Concentration <br />z ~ o - °Ic,~: goo <br />/~ s 3~- ~~ <br />.e_~ 5 <br /> <br /> <br /> <br /> <br /> <br /> <br />TOTAL (must add up to 100%) 100% <br />IV. State of Waste <br />a. are Free Ligwtls Prasenty b. Is waste comb~neo w,tn RCRA waste? c. Concentration of PCBs in waste -Available laboratory tleta must fx submidetl <br />(Yes ^ No ^ Yes ~ No 3S5 - 6~ I PPrn <br />,2+zmo/uG.p~..e~v,Pntgrli`-....and o.r/ .~!'orn....a.bano4~n.KO'.....GrXCI. ..Mi~.e~..Ca!r.S.OL.i..JRra~... . <br />- ~ci ur.....c[r~rYx <br />f n $., .............. \.... . <br />s. If waste is rrom cleanup, oesrnhe waste type, source ana state it invotvee in tee: <br />f}FyavE~.....L/re.n..~.~~. ...~. NR..F.rGE ..... .... .. .. ... .. .... ........... ...... .. ....... <br />V. The following MUST ACCOMPANY EACH LOAD <br />a. a listing of the dimensions b, date removed from service c. weight of PCBs in kilograms <br />d. total weight of equipment e. nameplate capacity f, unique identification number <br />