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\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs16\insrsid4070582 Ver. #7 Rev. 07/06 jco \par }}{\footerf \pard\plain \s15\ql \li0\ri0\widctlpar\tqc\tx4320\tqr\tx8640\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs16\insrsid4070582 Ver. #7 Rev. 07/06 jco \par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}} {\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8 \pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw60\brsp20 \brdrl\brdrs\brdrw60\brsp20 \brdrb\brdrs\brdrw60\brsp20 \brdrr\brdrs\brdrw60\brsp20 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs46\insrsid4070582 INMETCO}{\b\fs46\super\insrsid4070582 {\field{\*\fldinst SYMBOL 226 \\f "Symbol" \\s 23}{\fldrslt\f3\fs46}}}{\b\fs46\sub\insrsid4070582 \tab }{\b\fs46\insrsid4070582 \tab }{\b\fs35\insrsid4070582 PROFILE SHEET \tab \tab \tab }{\b\fs19\insrsid4070582 page 1 of 2 \par }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs23\insrsid4070582 \par In order to determine if a material can lawfully and safely be processed by INMETCO, it is required that the Generator fill out, sign and send this original two-page profile with a representative sample}{\fs23\cf6\insrsid4070582 *}{\fs23\insrsid4070582 (approximately 1 pound for solids or 16 ounces for liquids) to: \tab \par }\pard \ql \fi720\li720\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\fs23\insrsid4070582 INMETCO\tab \tab \tab \par Attn: Lab, Maintenance Warehouse \par One Inmetco Drive \par Ellwood City, PA 16117 \par }\pard \ql \li0\ri-180\widctlpar\aspalpha\aspnum\faauto\adjustright\rin-180\lin0\itap0 {\fs23\insrsid4070582 If you have questions, please call: 724.758.2800, or Fax 724.758.2845, or by email at }{\field\flddirty{\*\fldinst {\fs23\insrsid4070582 HYPERLINK "mailto:sales@inmetco.com" }{\fs23\insrsid4070582 {\*\datafield 00d0c9ea79f9bace118c8200aa004ba90b020000001700000012000000730061006c0065007300400069006e006d006500740063006f002e0063006f006d000000e0c9ea79f9bace118c8200aa004ba90b320000006d00610069006c0074006f003a00730061006c0065007300400069006e006d006500740063006f002e00 63006f006d000000}}}{\fldrslt {\cs19\fs23\ul\cf2\insrsid4070582 sales@inmetco.com}}}{\fs23\insrsid4070582 \par }\pard \ql \li360\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 {\fs20\cf6\insrsid4070582 * Samples must be sent in accordance with DOT approved shipping container, packaging & labeling requirements. \par }\pard \qc \li0\ri0\widctlpar\brdrt\brdrs\brdrw30\brsp20 \brdrl\brdrs\brdrw30\brsp20 \brdrb\brdrs\brdrw30\brsp20 \brdrr\brdrs\brdrw30\brsp20 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 {\fs23\insrsid4070582 Prescreen analysis fee is $100 by check or $150 by Purchase Order \par (Payment must accompany the sample). \par }\pard \qc \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 {\b\f1\cf2\insrsid4070582 This form must be filled out in its entirety before submitting to Inmetco. \par }\pard \ql \li0\ri0\widctlpar\brdrb\brdrs\brdrw30\brsp20 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs23\insrsid4070582 \tab PO# _____________________________\tab CHECK No.# __________________________ \par }\pard \ql \li0\ri0\sl120\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\fs16\ul\insrsid4070582 \par }\pard \ql 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\li720\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 {\fs23\insrsid4070582 Brief description o f material and process which generates it: ________________________________ _________________________________________________________________________________ \par }\pard \ql \fi720\li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs23\insrsid4070582 Amount Generated (tons or gallons): __________________________Net tons or gallons /Year}{\fs23\ul\insrsid4070582 \par }\pard \ql \fi720\li0\ri-900\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin-900\lin0\itap0 {\fs23\insrsid4070582 Net tons or gallons Avail. Now: ___________ Container Type (drums/totes/boxes/sacks or bulk): ______ \par }\pard \ql \fi720\li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs23\insrsid4070582 Is this a hazardous waste (per US EPA 40 CFR, section 261.20)? ___ yes ___ no \par If yes, EPA Waste Code(s): __________________________________________________________ \par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs23\ul\insrsid4070582 Physical Characteristics at 70}{\fs23\ul\super\insrsid4070582 o}{\fs23\ul\insrsid4070582 F}{\fs23\insrsid4070582 : \tab ___ solid with _____ % free liquid or: \par }\pard \ql \fi720\li2880\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin2880\itap0 {\fs23\insrsid4070582 ___ liquid with _____ % solids, number of phases: _______________ \par }\pard \ql \li0\ri0\sl480\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\fs23\insrsid4070582 Bulk solids must be }{\b\fs23\ul\insrsid4070582 >}{\b\fs23\insrsid4070582 20% solids with no free liquids, liquids must not have strong odor. \par }{\b\fs16\insrsid4070582 \par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\ul\insrsid4070582 \par Chemical Characteristics}{\fs20\insrsid4070582 :\tab pH range ____ to ____ (based on analysis or knowledge) \par }\pard \ql \fi720\li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 Is the material: \tab \tab Ignitable, D001 (FP <140}{\fs20\super\insrsid4070582 o}{\fs20\insrsid4070582 F)\tab \tab ___ yes ___ no \par \tab \tab \tab Corrosive, D002 (pH }{\fs20\ul\insrsid4070582 <}{\fs20\insrsid4070582 2.0 or }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 12.5) \tab ___ yes ___ no \par }\pard \ql \fi720\li2160\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin2160\itap0 {\fs20\insrsid4070582 Reactive, D003\tab \tab \tab \tab ___ yes ___ no \par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 Levels (ppm) of the following (0 or NP for \'93not present\'94): \par }\pard \qc \fi720\li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 Antimony _____ Tin _____ Thallium _____ Beryllium _____Dioxins _____ \par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 Other Hazardous Constituents _______________________________________________________ \par Does material contain the following:\tab \tab \tab \tab }{\fs20\ul\insrsid4070582 Yes/Level}{\fs20\insrsid4070582 \tab }{\fs20\ul\insrsid4070582 No}{\fs20\insrsid4070582 \par }\pard \ql \fi720\li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 Total Cyanide }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 250 ppm\tab \tab \tab \tab \tab ___/__________\tab ___ \par Sulfide }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 500 ppm\tab \tab \tab \tab \tab ___/__________\tab ___ \par Radioactive }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 2 pci/g (ionizing type if Yes)\tab \tab \tab ___/__________\tab ___ \par BTU }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 5000 BTU/pound\tab \tab \tab \tab \tab ___/__________\tab ___ \par PCB }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 49 ppm\tab \tab \tab \tab \tab \tab ___/__________\tab ___ \par Total Organic Carbon (TOC) }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 500 ppm\tab \tab \tab ___/__________\tab ___ \par Volatile Organic Compounds (VOC) }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 500 ppm\tab \tab ___/__________\tab ___ \par }\pard \ql \fi720\li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 TOC + VOC }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 500 ppm\tab \tab \tab \tab \tab ___/__________\tab ___ \par }\pard\plain \s18\ql \li1440\ri-1080\widctlpar\aspalpha\aspnum\faauto\adjustright\rin-1080\lin1440\itap0 \fs23\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid4070582 If yes, is the concentration of organic \tab \par compounds listed in 40 CFR, Part 261 \par }\pard\plain \ql \fi720\li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid4070582 \tab Appendix VIII }{\fs20\ul\insrsid4070582 >}{\fs20\insrsid4070582 500 ppm? \tab \tab \tab }{\fs20\insrsid4070582 ___/__________\tab ___ \par }\pard\plain \s18\ql \li1440\ri-1080\widctlpar\aspalpha\aspnum\faauto\adjustright\rin-1080\lin1440\itap0 \fs23\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid4070582 \par }\pard\plain \ql \fi720\li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid4070582 Total Organic Halogens (TOX) }{\fs20\ul\insrsid4070582 >}{ \fs20\insrsid4070582 500 ppm\tab \tab \tab ___/__________\tab ___ \par }\pard\plain \s18\ql \li720\ri-1080\widctlpar\aspalpha\aspnum\faauto\adjustright\rin-1080\lin720\itap0 \fs23\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid4070582 \par }\pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\ul\insrsid4070582 TCLP Information}{\fs20\insrsid4070582 : Circle }{\b\fs20\ul\insrsid4070582 Y}{ \fs20\insrsid4070582 or }{\b\fs20\ul\insrsid4070582 N}{\fs20\insrsid4070582 based on analysis or generator knowledge, mark level if known, attach analysis if available: \par }\pard \ql \li0\ri0\sl-80\slmult0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 \par }\pard \ql \fi720\li0\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs20\insrsid4070582 Arsenic>5 ppm (Y/N) _______ \tab Barium> 100 ppm (Y/N) _______ \tab \tab Cadmium>1 ppm (Y/N) _______ \par Chromium>5ppm (Y/N) _______ \tab Lead>5ppm (Y/N) _______ \tab \tab Mercury>0.2ppm (Y/N) _______ \par Selenium>1ppm (Y/N) _______ \tab Silver>5ppm (Y/N) _______ \par }\pard \ql \li0\ri0\widctlpar\brdrb\brdrs\brdrw30\brsp20 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\fs23\insrsid4070582 Wastes may not carry EPA codes F001 thru F005, F039 or be radioactive, a herbicide or a pesticide. \par }{\b\fs16\insrsid4070582 \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw15\brsp20 \brdrl\brdrs\brdrw15\brsp20 \brdrb\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp20 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 {\b\fs16\insrsid4070582 \par }\pard \qc \li0\ri0\widctlpar\brdrt\brdrs\brdrw15\brsp20 \brdrl\brdrs\brdrw15\brsp20 \brdrb\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp20 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 {\fs23\ul\insrsid4070582 Generator Certification}{ \fs23\insrsid4070582 \par }\pard \ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw15\brsp20 \brdrl\brdrs\brdrw15\brsp20 \brdrb\brdrs\brdrw15\brsp20 \brdrr\brdrs\brdrw15\brsp20 \aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 {\fs16\insrsid4070582 \par }{\fs23\insrsid4070582 I hereby certify that all of the information given on this profile is true and accurate and has been fully disclosed to describe this waste material in regard to known or suspected hazards to humans and the environm ent. I understand that INMETCO is not responsible for determination of waste type classification. If any changes occur in the character of the waste, the Generator shall notify INMETCO prior to sending the material to INMETCO. \par \par ______________________________________\tab ________________________________________ \par Signature\tab \tab \tab \tab \tab \tab Title\tab \tab \tab \tab \tab \par \par __________________________________________________ ______________________________ \par Printed /Typed Name \tab \tab \tab \tab \tab \tab \tab \tab \tab Date \par }}