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r) <br /> v <br /> Page 2 of 2 <br /> • <br /> . y . <br /> ALLIED WASTE <br /> GENERATOR WASTE PROFILE SHEET (continued) <br /> Waste Profile# <br /> V. Physical Characteristics of Waste <br /> Characteristic Components %by Weight(range) <br /> 1- <br /> 2- 25e7P --1 O—io <br /> 3. <br /> Color. Odor(describe): Free Liquids: %Solids: pH: Flash Point: Phenol <br /> /� Q YES or gli0 7z` .F <br /> e/ � l'OGr/ /'Zvs',l Content % /l0'0 Z— ppm <br /> Attach Laboratory Analytical Report(and/or Material Safety Data Sheet) <br /> Including Required Parameters Provided for this Profile <br /> Does this waste or generating process contain regulated concentrations of the following Pesticides and/or Herbicides: <br /> Chlordane,Endrin,Heptachlor(and it epoxides),Lindane,Methoxychlor,Toxaphene,2,4-D, or 2,4,5-TP Silvex as ❑YES or gi NO <br /> defined in 40 CFR 261.33? <br /> Does this waste or generating process cause it to exceed OSHA exposure limits from high levels of Hydrogen Sulfide or YES or 0 NO <br /> Hydrogen Cyanide as defined in 40 CFR 261.237 <br /> — <br /> Does this waste contain regulated concentrations of Polychlorinated Biphenyls(PCBs)as defined in 40 CFR Part 7611 ❑YES or®NO <br /> Does this waste contain regulated concentrations of listed hazardous wastes defined in 40 CFR26131,261.32,261.33, YES or M NO <br /> including RCRA F-Listed Solvents? _ <br /> Does this waste contain regulated concentrations of 2,3,7,8-Tetrachlorodibenzodioxin(2,3,7,8-TCCD),or any other YES or tRi NO <br /> dioxin as defined in 40 CFR 261.31? <br /> Is this a regulated Toxic Material as defined by Federal and/or State regulations? ❑YES or NO <br /> Is this a regulated Radioactive Waste as defined by Federal and/or State regulations? 0 YES orFfit NO <br /> Is this a regulated Medical or Infectious Waste as defined by Federal and/or State regulations? ❑YES orNO <br /> Is this waste generated at a Federal Superfund Clean Up Site? ❑YES or NO <br /> VI. Generator Certification <br /> I hereby certify that to the best of my knowledge and belief,the information contained herein is a true and accurate description of the waste <br /> material being offered for disposaL I further certify that by utilizing this profile,neither myself nor any other employee of the company will <br /> deliver for disposal or attempt to deliver for disposal any waste which is classified as toxic waste,hazardous waste or infectious waste,or any <br /> other waste material this facility is prohibited from accepting by law. Our company hereby agrees to fully indemnify this disposal facility against <br /> any damages resulting from this certification being inaccurate or untrue.I further certify that the company has not altered the form or content of <br /> this profile sheet as provided by Allied Waste industries,Inc. <br /> AUTHORIZED REPRESENTATIVE NAME AND TITLE(Printed) COMPANY NAME <br /> AUTHORIZED REPRESENTATIVE SIGNATURE DATE <br /> VII.Allied Waste Decision <br /> [1Approved nRejected Expiration: <br /> Conditions: <br /> Name,Title Signature Date <br /> ©Allied Waste,August 2000 <br />