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NUU-1(- iiM1td I t>J From: <br />To:3032666688 Pase:212 <br />MUZ e X*le Atl"effum contaminated gird less 1wrottne <br />w? rxxran?r <br />ell <br />>g. Re ulatory Status please check rtgprrdl?triettra, reespenceo) <br />I- W24toIdentification, <br />tt, noes the ornate meet the definition of a USEPA listed or characteristic hazardous waste as defined by 40 OFF Part 201? 0 Yea; af No <br />1. If yes, please Complete s hu*rdoua waste proMa. <br />b. Doan the waata moot the &f ,ninon of s state ?:azardous waste other than idantifind in D. La? C? Yes Q No <br />1. If yes, please complete a hazardous waste profile. <br />2. Is this waste included in one or more of categories below (Check aI1 that apply)? If yes, attach supporting documentation. ? Yee O(No <br />13 Delisted Hatardoua Waste Q Erclucled Wastes Under 40 U1.4 <br />0 Treated Hazardous Waste Debria Q Wasted ChsrawWriattc Nuardoun Waste <br />$. Is thA wawa Itttm & 1'IRtlONI NO NO, 4 * $) Or tltbtb Mandated GlttittVnt P U yYa, mq'?ttiktttbGtD0it6, 0 Yes 9 NO <br />4. Does the waos represented by this waste pralila ahe*t conta% radioactive matarial? ? Yes (6 No <br />a. If yas, is dirposat regulated by the Nuclear Ragulamry Commiodont 0 Yea ? NO <br />b. If yes, it disposal regulated by a State Agency fbr radioactive wasteMORM? ? 'Yes ONO <br />S. Doan the waste represented by this Wsate profile Sheet cordain Polychlorhwated D(phertyls (PCBs)? © Yes C6 No <br />(If yes, list in Chemical composition - C.1.1) <br />a- It yrt*, om thip PCOs riag4lated by 40 Chit 781? © Yea ? No <br />b. If yes, is it remadiation waste from a project being perfo;med under the Ge!l mpletnentinq option provided in <br />40 CPR 70 I.9 I (a)? 0 Yom © Ate <br />c. If yes, were the PCBs iruported Into the US? 0 Yes ? No <br />6. Does the waste contain untreated, regulated medical or infectious Waste? Q Y4* 0Nv <br />7. Does the waste contain ObaStos? 56 Yob 0 me, <br />a. IfYas, Friable ? Non Friable <br />S. Is this profile for r+emediation waste from a facility that is a major source of Hazardous Air Pollutants (Site Remadiatlan NBf3IW, <br />40 CM 63 subpart GGGGG)? 0 Y4t< ? 140 <br />a. If yes, does the waste contain -000 ppmw VOH"a w tho point of diateztnivartio'n? ? Yes 0 No <br />I X. OiVXW *OP r Gettiieatiion (please Mad sold 1 owsit r by s igeatutre_ae be... I <br />Sy signing this Generator's Waste Profile Sheet. I hereby certify that all: <br />1. Information submitted in this profile and all attached dotzunwnta contain tmc turd Bcallrale descrOTIMS of IM Va&MG Material; <br />E. Relevant information within the possession Qt tTto Generator regarding known or sWeatad MU M$ pertaining to thi v waste has been <br />disalnaad to W'Wtha Contractor, <br />3. Analytical data attached pertaining to the profiled waste was derived [tern testing a repreaentaWe tiooplo in 4acordaAce With <br />40 CPR 26I.20(c) or equlvalont rules: and <br />4. Changes that Occur in the t h araoter of the waste (i.e. changes in the process br new analyticaD will be identified by the Cetter4tor <br />and disclosed to With (and the Contractor if applicable) prior to providing the waste to WM (and the contractot if applicable) . <br />5, Check all that QPply: <br />[] aa- Attached analytical partaftts to the mina. Idatltify laboratM & t3nmpla M tilt: and pararrL atars tested: <br /># Pages: <br />© b. Only the analyVis Identified bn the altachrdtW pertain to the waste (identify by laboratory ,& sample ID Wa and paramatars <br />tmwM. Attachment *: <br />o. Additional Wormation ruacessary to characterize the proitlad waste han been attached (other then analytical, such as MSDS). <br />Indicate the numbar of attached pages: <br />d. I am an agent signing on behalf of the C engrata:t, and the delegatiotl of authority tome from the Generator for this signature <br />4 iwi#ilabft upon requssr. <br />Cortlfication: Title: G4 W,?,J 2J " "`?/?D? <br />Company Name' ? ? -?) low... ? T Name (Print): Y-Gt- ? t7 ? i°(,NA <br />hater Noare V qW FI t ?) / <br />020}O Waste Nlanageatmd, Eat. <br />Page ,2 of 2 <br />May 2010