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HomeMy WebLinkAbout0750 ATTUCKS LANE - Health 1750 444Q(,S C".A- Barns�t� 6 Aqs -Gig`' - sof r Commonwealth of Massachusetts Executive Office of Environmental Affairs apart ent of Environmental Protection' MIM W' d Southeast Regional Office William F. Weld Governor Daniel S.Greenbaum Commissioner 'eNPY September 30, 1993 On-Cape Lithographers, Inc RE: SMAPCD--BARNSTABLE 22 Attucks Lane, Independence Park 310 CMR 7 . 02 (2) (a) , Hyannis, Massachusetts 02601 Action Code F-L1, Source No. 8014 NON-SE-93-7064 ATTENTION: Mr. Norm Barnes NOTICE OF NONCOMPLIANCE THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION .IN RESPONSE TO THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES. Department personnel have learned from information submitted on August 30, 1993 and September 24 , . 1993 , that activity occurred at On-Cape Lithographers, Inc. , 22 Attucks Lane,. Independence Park, Hyannis, Massachusetts, in noncompliance with one or more laws, regulations, orders, licenses, permits, or approvals enforced by the Department. The Department is charged with the enforcement of Massachusetts General Laws, Chapter 111, Sections 142A-E and 142J, and Chapter 21C, Sections 4 and 6, of the General Laws and regulations promulgated thereunder: 310 CMR 6. 00 and 310 CMR 7 . 00. Attached hereto is a written description of: 1. each activity referred to above, 2 . the requirements violated, 3 . the action the Department now wants you to take, and 4 . the deadline for taking such action. If you fail to take any action the Department now wants you to take by the prescribed deadline, or if you otherwise fail to remain in compliance in the future with "requirements applicable to you, you could be subject to legal action, including, but not limited to, criminal prosecution, court- imposed civil penalties, or civil administrative penalties assessed by the Department. A civil administrative penalty may be -assessed for every day from now on that you are in noncompliance with the requirements referred to above. The Department also takes this opportunity to advise you of its efforts under the Toxics Use Reduction Act (TURA) , to reduce the use of toxic or hazardous substances in the Commonwealth. By evaluating where and how your facility uses toxics, you may discover that methods such as substitution, process modification, etc. , may reduce your facility' s use of 20 Riverside Drive a Lakeville,Massachusetts 02347 s FAX(508)947-6557 s Telephone (508) 946-2700 I A` -2- ;, toxHcs and/or the generation of hazardous waste at your facility. As you continue to reduce or eliminate the use of toxics or the generation of toxic waste, you may cut environmentally driven costs, and/or reduce the regulatory requirements applied to your facility. The Office of Technical Assistance (OTA) , within the Executive Office of Environmental Affairs (EOEA) , provides technical assistance to industries on toxic use reduction. Their consultation is free, confidential, and assistance-oriented. For further information, contact: * The Office of Technical Assistance (617) 727-3260, for free, confidential, technical assistance including on-site assessments, financial evaluations, and other resources. i * DEP's Toxic Use Reduction Implementation Team (617) 292-5870, for guidance material on TUR (toxic use reduction) planning. * The Toxics Use Reduction Institute (508) 934-3262, for courses for certification of Toxics Use Reduction Planners. Very truly yours, ;9'Zh-*n K. Winkler, Chief Air Quality Control Section W/SR/cb ATTACHMENTS - Notice of Noncompliance Plan Application Package CERTIFIED MAIL # P 808 785 625 RETURN RECEIPT REQUESTED cc: DEP-SERO ATTN: C. Natho D. Nagle B. Hill Board of Health Town Hall Hyannis, 14A 02601. DEP/DAQC ATTN: Karen Regas Office of Technical Assistance 100 Cambridge St. Suite 1904 Boston, MA 02202 ATTN: Richard Bizzozero r' NOTICE OF NONCOMPLIANCE cf, NONCOMPLIANCE SUMMARY NAME OF ENTITY IN NONCOMPLIANCE: On-Cape Lithographers, Inc. LOCATION WHERE NONCOMPLIANCE OCCURRED OR WAS OBSERVED: 22 Attucks Lane, Independence Park, Hyannis, Massachusetts DATE WHEN NONCOMPLIANCE OCCURRED OR WAS OBSERVED: April 16, 1993 DESCRIPTION OF NONCOMPLIANCE, REQUIREMENTS NOT COMPLIED WITH, ACTIONS TO BE TAKEN AND THE DEADLINE FOR TAKING SUCH ACTION: . Upon review of your Air Quality source registration which was submitted in response to the June 21, 1992 NON, the Department has determined that On-Cape Lithographers, Inc. is subject to the permitting requirements of 310 CMR 7 . 00. 310 CMR 7 . 02 (2) (a) states, in part, that "No person shall construct, substantially reconstruct or alter any facility .subject to the requirements of 310 CMR 7. 02 (2) (a) unless . the plans, specifications, Standard Operating Procedure and Standard Maintenance Procedure have been submitted to the Department for approval, and written plan approval has been granted by the Department. No person shall operate any facility required to submit a comprehensive plan application under 310 CMR 7 . 02 (2) (a) unless said plan application has been submitted to the Department for review and written approval has been granted by the Department. . . " Under 310 CMR 7. 02 (4) (b) 1, On-Cape Lithographers, Inc. is subject to the requirements of 310 7. 02 (2) (a) because the facility has potential VOC emissions equal to or greater than five (5) tons per year. Therefore, on or before October 25, 1993 , On-Cape Lithographers, Inc. must submit a Comprehensive Plan Application, in accordance with 310 CMR 7 . 02, which demonstrates compliance with 310 CMR 7 : 00 "Air Pollution Control Regulations" (hereafter referred to as "the regulations") for the Komori six color printing press and the Heilleburg four color printing press. A Plan Application Package has been enclosed' for your convenience. The Department requires that the application fee for a comprehensive plan application be doubled per 310 CMR 4. 04 (3) (b) which states, in part, "that the Department may require. that persons applying for permits as a result of enforcement action by the Department, shall pay double the otherwise . applicable fee. " On-Cape Lithographers, Inc. is invited to attend a "scoping meeting" at the Southeast Regional Office of the DEP to discuss the scope of the submittal of the enclosed, Plan Application Package to the Department. -2- d It is requested that both a representative of On-Cape Lithographers, Inc. , and the consultant who will be preparing the Plan Application, attend this meeting. Contact John Winkler at (508) 946-2779, to schedule this meeting. The Department requires a written response within fifteen (15) days of receipt of this Notice, addressing each of the items above and indicating the actions taken in order to achieve and maintain compliance with the Regulations. Should you have any questions relative to air quality control, please contact Steve- Risi at (508) 946-2774 . DATE: %U/¢-�I-� BY: L � `1-�- < hn K. Winkler, Chief Air Quality Control Section f 9 n Commonwealth of Massachusetts Executive Office of Environmental Affairs ®apartment of RfcE�vEO Environmental Protection JuN ' Southeast Regional Office 4 1993 ftVF William F. Weld Governor Daniel S.Greenbaum Commissioner s P Y June 21, 19 � o : ®. On-Cape Lithographers Inc. RE: BARNSTABLE--BWP 22 Attucks Lane, Independence Park On-Cape Lithographers Inc. _ Hyannis, Massachusetts 02601 22 A_ttucks�Lene, Inde_ pende—ce Park 310`'CMR-3-0:'0-0 0 Hazardous_ Waste Status: Small Quantity .Generator EPA ID# MAD NON-SE-93-9032 ATTENTION: Mr. Norm Barnes NOTICE OF NONCOMPLIANCE THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION IN RESPONSE TO THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES.. Department personnel on April 16, 1993 , conducted a Multi-Media compliance inspection at On-Cape Lithographers Inc. , located at 22 Attucks Lane, Independence Park, Hyannis, Massachusetts, and observed activity in noncompliance with one or more laws, regulations, orders, licenses, permits or approvals enforced by the Department. The purpose of this inspection was to determine the status of On-Cape Lithographers Inc. relative to compliance with the Massachusetts Hazardous Waste Regulations as contained in . 310 CMR 30. 000 and adopted under the provisions of Sections 4, 6 and 9 of Chapter 21C of the Massachusetts General Laws as applicable.. Attached hereto is a written description of: 1. each activity referred to above, 2. the requirements violated, 3. the action the Department now wants you to take, and 4. the deadline for taking such action. If you fail to take any action the Department now wants you to take by the prescribed deadline, or if you otherwise fail to remain in compliance in the future with requirements applicable to you, you could be subject to legal action, including but not limited to, criminal prosecution, court imposed civil penalties or civil administrative penalties assessed for every day from now on that you are in noncompliance with the requirements referred to above. 20 Riverside Drive a Lakeville,Massachusetts 02347 0 FAX(508)947-6557 0 Telephone (508) 946-2700 r I � -2- The Department also takes this opportunity to advise On-Cape Lithographers Inc. of its efforts under the Toxics Use Reduction Act (TURA) , to reduce the use of toxic or hazardous substances in the Commonwealth. By evaluating where and how your facility uses toxics, you may discover that methods such as substitution, process modification, etc. , may reduce your facility' s use of toxics and/or the generation of hazardous waste at your facility. As you continue to reduce or eliminate the use of toxics or the generation of toxic.. waste, you may cut environmentally driven costs and/or reduce the regulatory requirements applied to your facility. The Office for Technical Assistance (OTA) within, the Executive Office of Environmental Affairs (EOEA) , provides technical assistance to industries on toxic use reduction. Their consultation is free, confidential, and assistance-oriented. For further information, you may contact: The office of Technical Assistance (617) 727-3260, for free, confidential, technical assistance including on-site assessments, financial evaluations, and other resources. DEP's Toxic Use Reduction Implementation Team (617) 292-5870, for uidance: material on TUR toxic use reduction planning. g ( ) P g•. r The Toxics Use Reduction Institute (508) 934-3262 , for courses for certification of Toxics Use Reduction Planners. Very, truly yours, Gerald A. Monte, Chief RCRA Section M/AAM/re ! i CERTIFIED MAIL NO. P808 785 574 . RETURN RECEIPT REQUESTED Attachments: NON cc: DEP - SERO ATTN: C. Natho D. Nagle DEP - BWP ATTN: Compliance Board of Health Town Hall 367 Main Street Hyannis, MA 02601 -3- cc: Office of Technical Assistance 100 Cambridge Street Suite 1904 Boston, MA 02202 ATTN: Richard Bizzozero i j NOTICE OF NONCOMPLIANCE NONCOMPLIANCE -SUM ARY NAME OF ENTITY IN NONCOMPLIANCE: On-Cape Lithographers Inc. LOCATION WHERE NONCOMPLIANCE OCCURRED OR WAS OBSERVED: 22 Attucks Lane, Independence Park Hyannis, Massachusetts 02601 E DATE WHEN NONCOMPLIANCE OCCURRED OR WAS OBSERVED: April 16, 1993 DESCRIPTION OF NONCOMPLIANCE, REQUIREMENTS NOT COMPLIED WITH. ACTION TO BE TAKEN AND THE DEADLINE FOR TAKING SUCH ACTION: Department personnel from the Bureau of Waste Prevention conducted an inspection of On-Cape Lithographers 'Inc. on the above date. During the inspection, the. following violations were observed relative to Hazardous Waste: 1. On-Cape Lithographers Inc. had three (3) 55 gallon satellite containers of waste ink related material, one (1) 5 gallon satellite container of waste fixer, and one (1) 5 gallon satellite container of waste developer, all which were improperly labeled, in violation of 310 CMR 30. 351 (8) (a) which references 30. 340 (1) (b) . Therefore, within five 5. days of receipt of this Notice, On-Cape Lithographers Inc. shall ensure that. the waste paint related material, fixer and developer satellite accumulation container's are labeled with the following: a. The words "Hazardous Waste" ; b. The hazardous waste identified in words; and c. The hazard(s) associated with the waste(s) indicated in words. Hereafter, On-Cape Lithographers Inc. shall maintain compliance with the it regulations governing the labeling of satellite containers. i 2 . On-Cape Lithographers Inc. had three (3) 55 gallon satellite containers of waste ink related material referenced in item one located by the multi color press, in violation of 310 CMR 30.351(4) (c) . ' Therefore, within one (1) day of receipt of this Notice, On-Cape Lithographers Inc. shall' ensure that the two (2).. full 55 gallon drums are moved to an established accumulation area. - Hereafter,. On-Cape Lithographers Inc shall ensure that only one satellite accumulation container is used at each specific point of I , -2- generation. 3 . One of the satellite accumulation containers referenced in item 1 & 2 above was uncovered, in violation of 310 CMR 30. 351(4) (e) which .references 30. 685. Therefore,., within one (1) day upon receipt of this Notice, On-Cape Lithographers . Inc. shall close all open hazardous waste satellite accumulation containers. Hereafter, On-Cape Lithographers Inc. shall ensure that all hazardous waste satellite accumulation containers remain closed at all times, except when waste is being added or removed. 4 . On-Cape Lithographers Inc. had one (1) 55 gallon container of waste oil that was improperly labeled, in violation of 310 CMR 30.253 (5) (b) including 30. 351(8) (a) which references 30. 340 (1) (b) . Therefore, within five (5) days of receipt of this Notice, On-Cape Lithographers Inc.- shall ensure that the waste oil accumulation drums are labeled with the following: a. The words "Waste Oil" ; b. The type of hazard(s) associated with the waste(s) indicated in the words; and C. The date upon which accumulation began. Hereafter, On-Cape Lithographers Inc. shall maintain compliance with the regulations governing the labeling of waste oil accumulation containers. 5. On-Cape Lithographers Inc. had various hazardous waste drums in the accumulation area which were improperly labeled, in violation of 310 CMR I 30. 351(8) (a) which references 30. 340 (1) (b) . Therefore, within five (5) days of receipt of- this Notice, On-Cape Lithographers Inc. shall ensure that the hazardous waste accumulation containers are labeled with the following: j a. The words "Hazardous Waste" ; b. The hazardous waste identified in words; C. The hazard(s) associated with the wastes) indicated in words; d. The date accumulation began. Hereafter, On-Cape Lithographers Inc. shall maintain compliance with the regulations governing the labeling of hazardous waste accumulation -3- containers. 6. The hazardous waste drums referenced above in item 5 were missing bung covers, in violation of 310 CMR 30.351(8) (b) which references 30.340 1 a which in turn references 30. 685. f i Therefore,._ within one (1) day of receipt of this Notice On-Cape Lithographers - Inca shall ensure all hazardous waste accumulation containers remain closed with their bungs in place. Hereafter, On-Cape Lithographers Inc. shall ensure that all hazardous waste accumulation containers remain closed at all times except when wastes are being added or removed. In order to determine compliance with Air Quality regulations the Department may, for the purpose of conducting a continuing inventory of air pollution source emissions, require any person owning, operating or controlling an air contamination facility shall register on a form obtained from the Department such information as the Department may specify include: a. the nature and amounts of emissions from the facility b. information which may be needed to determine the nature and amounts of emissions from the facility, and C. any other information pertaining to the facility which the Department requires. A source registration has been enclosed for your convenience. Any questions should be directed to either Cindy Martin or Steven Risi . at extension 2773 or 2774. In addition, Department personnel, under authority of the. United States Environmental Protection Agency (EPA) , conducted a Land Disposal Restrictions Inspection of On-Cape Lithographers Inc. in order to determine compliance with 40 CFR, Part 268. You are advised that the information obtained by the Department during this portion of the inspection will be submitted to the Regional EPA Office in Boston. The EPA will., in turn, determine and implement any enforcement or other action which it deems necessary. . The Department requires a written response within . fifteen (15) days of receipt of this Notice; addressing each of the items above and indicating the actions taken in order to • achieve and maintain compliance with the Regulations. y -4- Should you have any questions relative to hazardous waste management at your company, please contact Angela Antonelli-Miller of this office at (508) 946-2827 . DATE: BY: Gerald A. Monte, Chief RCRA Section lean Venture, Inc. N0 45303 201 South First Street Invoice Date Elizabeth, NJ 07206 (908)355-5800 December 31 . 1997 FAX(908)355-3495 SOLD TO: JOB LOCATION/DESCRIPTION TOWN OF BARNSTABLE: ATTUCKS LANE PUBLIC HEALTH HYANNIS . MA 367 MAIN STREET EMERGENCY REPONSE OIL HYANNIS„ MA 02601 SPILL 12/05, 12/06, 12/10/97 14 Page 1. YOUR ORDER NO. OUR ORDER NO. CUSTOMER NO. TERMS PAYMENT DUE DATE MA2773 5844 NET 30 DAYS 1/30J98 TO CHARGE FOR WORK PERFORMED AS FOLLOWS: LABOR: SUPERVISOR 6. 00 HRS 90.00 540.00 FOREMAN 6.00 HRS 67.50 405.00 EQUIPMENT OPERATOR 6.00 HRS 60.00 360.00 EQUIPMENT: PICK-UP TRUCK 1 .00 EACH 125. 00 125.00 RACK. TRUCK DAILY 1 . 00 DAY 200. 00 200. 00 VACUUM TRUCK 1 .00 EACH 540.00 540.00 MISC. HAND TOOLS 1 .00 EACH 50.00 50.00 PADS 1 .00 BALE 72. 00 72. 00 SPEEDI-DRI 3.00 BAG 10. 00 30. 00 55 GALLON DRUMS 2.00 DRUM 35. 00 70.00 DISPOSAL: OILY. SOLIDS 2.00 EACH 125. 00 250.00 TRANSPORTATION 200.00 QA/QC FEE 1 .00 EACH 40.00 40.00 L/M/E #12987 ----------------- MANIFEST ##NJA2759899 Total 2 .882,. 00 JOB COMPLETE 07--01 _-_._____...___..__-. Amount Due 2,882. 00 PLEASE NOTE: INTEREST CHARGES OF 1.5%PER MONTH(18%PER YEAR)WILL ACCRUE ON ALL PAST DUE AMOUNTS.ON UNPAID AMOUNTS,INTEREST AND ALL EXPENSES OF COLLECTIONS INCLUDING A REASONABLE ATTORNEY FEE IN AN AMOUNT OF 20%WILL BE CHARGED. ORIGINAL INV I TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory -�•Printers BOARD OF HEALTH 3.Auto Body Shops - unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS laSS: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATEF Sqye ,. , IV / an IN OUT IN OUT IN OUT #&gallons Age Test 0 AI s:I'Vi WSW Heavy Oils: waste ,s. Synthetic Organics: degreasers v� Miscellaneous: 00,440pi1g, DISPOSAL/REC:LAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply z'-�_2 Town Sewer Public O On-site ` OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well' j���L O On-site system ��,d� cr- 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC ✓ 4s ` A(Catch basin/Dry well , On-site systeml�'�' - 5.Waste Transporter Narne of Hauler Destination W od 2. Person( Interviewed VInspector Date r � �� �� TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops ` unsatisfactory- 4.Manufacturers C0MPANY0 ;QZ G� ';�ky,� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Z Z LL lZa Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Ta,nks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Leavy Oils: 1-s X waste motor oil (C) PPeSs I�LJ 0"I Z-ss- x new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers 5'/P-t'u Miscellaneous: 6-f aL" � .�-�aI*•�z 1�� �-S 5 �. 5 DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage a 2.Water Supply �I f V— � � %6&— � ��� �N- 12- pp y Town Sewer *ublic /1 fj / C7 Z ^o 04,10 /ton-site OPrivate is' �vifJ�-, luo- .f CCJu' Grve��+n a f/dY9 3. Indoor Floor Drains YES NO 0 Holding tank:MDC x 5 �'c�f' 0 Catch basin/Dry well �r tr i- &,,,,, p'., O On-site system bv► ® z/v• �/® Gcw, S der, 4. Outdoor Surface drains:YES—,P�_NO ORDERS: 0 Holding tank:MDC AN tc to O Catch basin/Dry well �" IV-On-site system v Caz,l � o� �- /�r�diin �hS, •r�c v�r.,— �� 5. Waste Transporter l�ac,G,° aGe.v� e�1 � rd e��l !o� �• Name of Hauler Destination WAste Product �:Liceris ZZ er on(s) Interviewed Inspecto Dat _ o_N0V,09J,93.09:49AM ATLANTIC`DESIGN�508�898 5859 T I_ I't.t 2,1 ' ?, 10 : 35 No ,►04 F' ,r,? _ r � 054N MINOR, INC. RNOINIIRO&WVIRONMINTAL SCIfiN= October asp 1993 Xr. :pha Winkler Massachusetts PRO - scut hear st+ Regional Office go 2llwarside Drive Lekaviile , MA 03341 no, Katias of Mor-40"P1161ftee ulntione" RegUIgtion 310 CM1 7 .00 "Aix Pollution Control Reg pooping mansion rosultr. Derr Xr. Winklesr a to uugordance with the Natiaa Of Nondo>aplia ►frii"i our officen of dated patober 4th, 1e�3, this 2+ttraz' is int:andad Uthogrsphoro, intontion of compliance with 310 CS+tR b0. on octa"r 20th, 1993 On 04po 1�ithographelrs attended the 116COO A9 Session" during which the foll0wi,nq aonctosions were agreed upon! the apgis,oarion foe for the 0ompxoh4n01V4 pl*n app� tcatiori will riot e deadline for lubmittaI of the be doubled par 310 IM 4 .0412) (b) iT. X ril 20th, nd�durit pcolayrohahsive plan a p0catson will bo e'�ol, ded aon�liderkti.olna: 1903. Thoos ooncoe�sivns were, based on the 1 10winq co the► �'soop!►na +fin Cap* Lithographers showed go'd faith by hers hA• sposion" with their consulting engineers, or caps•Li.rier&pat, their taken t»hd initiative by co>ntinoQuely radvvt+� VO hat Within the text Nix laaili.ty over the pasta rerst On Caps felt %*Atha it would be Possible to rsduos #mission* •von further and it: would provide ahem time to bett+sr evdlg&to gslrt Available Control To►Ohnnlogy o tr�,Iailsllr There options include testing n.w, Loa VoC aleanin� solutiona, fountain soltttioAllll and isopropyl aSpaho} substitutes, hll parties involved Colt tWhrltiti Would be in their best i,ntiOrsat: tro provias on caps Lithographers the time to fully study the new technologies. it: would provide on C&Pa US tiros to rnduae their amxrlsipna even further and ii °UdrdattOP 6 nnuar �w il neprintingidty and ovNluats the now tschncloa * AvAibl� o Please cell it you have anY qud0tiansn aancstni>ng this matter. � nasrely Ror»Nalr~ borne$ d4naral Manager p.C. Mark O'DOnvghus %f you conour with the contents of this letter plaoss sign here, kwr,aa st n< 2211. Mofn 51, • WN 203 pd I" +db' >fe revnos C�rr»r • R��Ite 444 Mlilord, MA 04787 gandwlcn, MA 42663 N. Dam*.iA 02747 (6M)A71.2206 ' FAX A7r .0321 N. p65.02e2 • PAX 040•oa64 ceaat"7 FAX I State of New Jersey I IIII II III II III II III II III IIIII IIIII IIIII I IIII Department of Environmental Protection 2 7 5 9 8 9 9. Hazardous Waste Regulation Program Manifest Section CN 421,Trenton,NJ 08625-0421 Please type or print in block letters.(Form designed for use on elite(12-pitch)typewriter.) Form Approved. OMB No.,2050-0039. Expires 9-30-97 1. Generator's US EPA ID No. Page 1 UNIFORM HAZARDOUS Manifest 2.Do u t o. Information in the shaded areas WASTE MANIFEST ' , of is not required by Federal law. a 3. Generator's Name and Mailing Address A. StatManifest cument•Num r. 275989 N ! B. r£(p- en.Site Address) 4. Generator's Phone01 ( > 4 d# 5. Transporter 1 Company Name 6. US EPA ID Number G. State Trans.ID-N ll?EP (acm ♦M�- V two, 7 110 0 . 01217111413 Decal No.- 7. Transporter 2 Company Name 8. US EPA ID Number D. Transporter's Phone( - } w v E. State Trans.ID-NJDEP: c 9. Designated Facility Name and Site Address 10. US EPA 1D Number Debal fslo of F. Transporters Phone'( } .o G. State Facility's ID rZA. s ° 1 k1 010121 0 0101416 H: Facirty's Phone( ) a c 12.Containers 13.' 14'. a) 11. US DOT Description(Including Proper Shipping Name, Hazard Class or Diyision, I. E ID Number and Packing,Group) Total Unit Waste No. o HM #., f No. Type y Quantity Wt/Vol C G b. E Z tJ m E t R C A C, - A C T - - - _ m R d. c J. )Wgpnal Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above a, C= V90110 Of w a. C. a: c. v b. d b. d. w 15. Handling Special Instructions and Additional Information t P 9Z vtumf, 20 d 0 E 16. GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are E classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government yregulations. c If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated'to the degree I.have determined T to be economically practicable and that I have selected the practicable method of treatment,storage;or disposal currently available to me'which-minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator;I have made a good faith;effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford: . EPrinted/Typed Name Signature ,.car 7 Month Day. Year c m c T 17. Transporter 1 Acknowledgement of Receipt of Materials R y A Printed/Typed.Name ✓a ,. "' Signature'' '; x s x Months Day Year VN 2. ` -i a •-.".°""M'_ i '�„8r, s.+l.H,,,Kh... P 1 F # # * R c P 0 18. Transporter 2 Acknowledgement of Receipt of Materials cm T Printed/Typed Name Signature _ Month Day Year E R 19. Discrepancy Indication Space t N F A CTI C `^ L W T20. Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Co y Printed/Typed Name Signature - Month Day Year EPA Form 8700-22(Rev.9/88)Previous editions are obsolete. SIGNATURE AND INFORMATION MUST BE LEGIBLE ON ALL COPIES 6—GENERATOR MAIL TO- TSD'S STATE oil I � I 'ri )'FI i61h L INFORMATIONItem 13: TOTAL QUANTITY-Enter the total quantity of waste described on each line. ! DO NOT USE FRACTIONS ou%Wastt11ed to track waste from the point of generation to final Item 14: UNIT(Wt./Vol.)-Enter The appropriate abbreviation from Table R.(bebw)for the . 1 fc ,.;ti ' unit of measure used in determining the total quantity of waste'described ons fcr��lerto'g &a i o-ccomplishthis goal,it is essential that on the ac line- manifeshbe cjmpleted correct�g.Incomplete,incorrect or illegtble'manife;gt are vid'dfbhs�of■^ ,a er 'i`t4tc:h'_r f ■- " the law,and could make you subject to civil or criminal liabilities;ascspeoified in;the flew Jersey`j f �!y}Sy TABLE II Hazardous Waste Regulations. �ij3s't(#i„,+ UNITS OF MEASURE INSTRUCTIONS-IMPORTANT:i_tat ••Gtia t 1 l 31r1c , ;•G-Gallons(liquids only) r' READ ALL INSTRUCTIONS BEFORE COMPLETING i*« ; •,t, -••� P-Pougds. tr.'` r:t. a t r •aw ' < Y-Tons(lards, .)' _- ' Y,-C lbiC yardsr State&Federal regulations require Generators,,TrAhsporters,and Treatment,Storage&Disposal" nD a r Facilities(T$DFs1,to use this form apd H necessar the.cbntinuatioh sheet for both inter-and K-Liters(liquidsm only) Y K-Kilograms = +y intrastate shipments.Continuation sheets may be purchas@d'comme'rcially and photocopied to i M-Metric Tons,(1000 kg) •'s" ' i- -�prowde copies as�e&cribedbelow. ! �� ;K:Cubic Meters '- file J4w Jersey.manifest contains 8 copies. ALL COPIES MUST BE LEGIBLE.This form Item•15: SPECIAL HANDLING INSTRUCTIONS AND ADDITIONAL INFORMATON- i t {a redesigned for fide on a 12 pitch(e6)typewriter;9 firm ballpoint pen may also be used Use this space,to Indicate special transportation,treatment,storage,disposal,: 1 n { - only You press dowO,HARD.The 8 copies:muot'be filed with the approprate party as they ,. or Billtbf tadirig information,if any.If an alternate facility is designated,note { Y i. it here.For INTERPATIONAL SHIPMENTS,generators must enter the point of are c6hipteted.tOPY DISTRIBUTION is as-follows: departure (city &+.state) in this space. This space may also be used for i ORIGINAL: DESTINATION STATE-TSDF:must mail original to the state regulatory agency emergency r6spopse,telephone numbers, and,any other information the -- , where the facility is located. - - _ _.__ _ _"__ _. .-_.generatpr_is required to include about the shipment in adcordande with 49 CFR { + -COPY 2. GENERATOR STATE-The'1t&mail this copy back'to the state'regulatory Part 172,Subpart G as applicable for, RCRA hazardous waste and USDOT ` hazardous materials. t agencywtiere the waste was generated: I Item 16: GENERATOR'S CERTIFICATION-The Generator must read,sign(by hand)and COPY,3: '� GENERATOR:CO2Y-The TSDF mails lls copy back.lolbe geuerator.of.the _ '�_;a State the-certificatipn.This mgssbe done the_day the transporter picks up the + waste. ° :r �,,,t U'rta waste shipment(date of receipt by iransgprter).If a mode,oiher than hgtiway, { L is used,the word"highway"should be lined out and the appropriate mode(rail+ ? COPY 4i TSDF COPY-TSDF keeps-this copyfor his records. ° water,air)inserted in the space.If another mode in addition to the highway t , h6 th COPY RT 5:. TRANSPOER COPY ttAnsporier.kepo s,;Copy fcLrShks records �}__,- ',•--,mode,is used either the appropriate additional mode (e.g."and rail")_in th9's _ t NOTE.If a:cogtinuing'transporter is'used the generator is•resporislble.for 1, space. supplying him with a legible photocopy,which must contain required signatures. Item A: STATE MANIFEST DOCUMENT NUMBERFNufnbeY preprinted by New Jersey + ' except on the continuation sheets.Enter this,,number on each.Continuation COPY 6: DESTINATION STATE�The be mails this copy to the state regulatory sheet attached to a manifest:- a agency whe( he d`esigi'atard fsclllty'(TSDF)is located. Item B: STATE GEN ID-The State.Generator ID is the street ad'dress'of,the waste COPY 7;. ,. GENERATOR STATE.7he,generator.mails this copy to the state regulatory generation site.If the mailing address and•the sitr{address are'the Same,enter i t agency where the,waste was generated. t3.• t 'same". kern C: STATE TRAN#1 ID-Enter the New Jersey state permit number.This must `COPY 8'•"—GENERATOR COPY-The`generator keees ihis`popy for his records. L-� - include botK'the trarsp6rteWs•permit-number-and the-decal number'of the ALL`8 CI, MUST BE LEGIBLE ( hazardous,waste•transpprt unfit or,hazaidous waste,vehicle which contains the ,T. :>y .• waste..For,.raii,s(1ip[Peni(s),a�'er the a)pha numenc I.D.numberassigned to n i the railcar 1ti lieu of the'deeal Number. ' i x M} tF6T FORM'.COUISITION _- __ _-,_._ - Item D:- —TRANSPORTER PHONE-Enter a telephone number with area code where an 1' If'I:he deshnatwri•(consignrrient) state supplies a manifest &.requires its use,then'the authorized agent of the traWporter can be reached. ; t generator is obligated to obtain the manifest from that state. Item E: STATE TRAN 02 ID-If applicable,enter the,New Jersey;late(permit number, N t does,not supply the:manifest,but the(generator state does,then of the waste carrying NE-if of the second vehicle. 2. If the destination state t r Item F:. TRANSPORTER PHONE-If applicable, enter a telephone number with area r Cth@ generator is obi gated to obtain the manifest form from the yenerator state. code where an authorized agent of the second transporter may be reached' - 3. if neither,the-generator, state-or the consgnment-state supplies-the-manifest;-4hem-the---ltem-G:r ---STATE FACILITYS ID-No entry is required-by New Jersey. - generator may obtain the manifest from an source. ItemH:s FACILITY PHONE-Enter a.telephone number with area code of the'TSDR ° �« I Y t designated to receive the waste listed on The manifest. 1 t Item I: WASTE NO.-Enter the 4-digit hazardous waste number as it appears in N.J.A.G GENERATIOR SECTION 7:26G-5.1 et�sec.(For example X047'•is the waste number.designated for r- i I pink/red water from TNT operations.)The proper waste number that accurately Item 1: GENERATOR'S+EPAyID N0.- NIFEST DOCUMENT NO.-Enter the generator's 'j E - - - - describes.theshprnent,shall.be determined.according-to the hierarchy at 1a- I EPA identification number.The manifest document numbei ns a unique 5-digit` ' N.J.A.C.7c26G-6.2. I er numb(*the generator assigns to each manifest,for his recordkeeping purposes. Item J: ADDITIONAL DESCRIPTIONS FOR MATERIALS LISTED ABOVE-Enter a Use of,serially increasing numbers(e. .,00001,00002,etc.)is recommended. description of analysis for any waste which does not have a complete USDOT .}I " Item 2: PAGE 1 Of Enter the tot'l numbet of pages used to complete this manifest; shipping description or has an n.o.s.designation.Enter a general description + l i.e,lhetfirstpage plus the nu ber of continivatidn sets,if any. of the waste stream(i.e.groundwater contaminated with creosote and copper ! .,_sulfate).Additionally,Jar any n.o.s.entry iribm.tLwhich does ngt conform Item 3: GERIFOATOR'S NAME-&M L-ING-ADDRESS-Enter the-name lag'tined to`^ to the requirements at 49 CFR 172.203(k)enter the two components,and t 1 EPA)&mailing address of nie gene4tor,The address should be the location their percentages,which most predominantly contribute to the hazards of the + r that will manage the returned'manifest forms. mixture or solution.Enter the physical state(S=Solid,L=Liquid,G-Gas, } „ ° Item 4: GENERATOR'S PHONE NUMBER-Enter a telephone number with area code St.=Sludge)EPA hazard codes(I=Ignitable,C=Corrosive,R=Reactive, K where an authorized agent of thR.generator,can bg reached in an emergency. E=TCLP,H=Acute Hazardous,T-Toxic).Enter additional'infor mation as w _ I _ _ required by,the waste code hierarchy at N.J.A.C..7:26-G-6.2. _ I Item 5: -TRANSPORTER1 COMPANY NAME-Enter.tie eompany-namertas notified to. — t EPA)of the'fiirst transporter whb will transport the waste. -TRANSPORTER SECTION `• t 4 r Item 6: US EPA ID NUMBER-Enter the EPA identification number of the first i r transporter identified,in item 5. It is a violation by the transporter-if he accepts hazardous waste from•a generator who fails Item 7: TRANSPORTER 2 COMPANY NAME If applicable,enter the company.name to properly complete the manifest,transports waste to an unauthorized facility,and/or fails _ _ to obtain the date and handwritten signature of the next hauler or owner/operator of the TSD (as notified-to EPA)'of.the second transporter who.,will.transport.the.waste, - facility on the manifest.if more than two(2)transporters will be used,use a continuation sheet and Item 17: TRANSPORTER 1 ACKNOWLEDGEMENT-Print or Type the name of the �# list the transporters in the order they will be transporting the waste. person accepting the waste on behalf of the first transporter.That person must , Item 8: US EPA ID NUMBER-If a second transporter is used, enter the EPA acknowledge acceptance of the waste described on the manifest by signing • - , •--ar d-enterin the date•of receipt. " _.- _ A -'identificatan Zu 6e�of the second tr'Anspote-r identified in itemf7:' -' gg Item 9> DESICaNAT D FACILITY NAME&SITE:AD&ESS-Enter the company name Item Is TRANSPORTER 2 AGKNOWLEDGEMENT-.rif applicable;follow instructions for ° item 17 for the second transporter. and site address(as notified to the EPA)of the treatment,storage,or disposal ut ♦ designated to receive the waste listed on this manifest. The NOTE: ALL HAZARDOUS WASTE.TRANSPORTERS OPERATING IN NEW JERSEY facility (TSDF)des. 9 MUST HAVE A VALID NEW JERSEY HAZARDOUS WASTE TRANSPORTERS t address must be the site address,which may,differ from the mailing address. PERMIT. Item 10: EPA ID NUMBER-Enter the EPA identification number of the designated TSDP, a . (or waste reuse facility)listed in item 9. DESIGNATED FACILITY(TSDF)SECTION I r -" -1t`em 11 -USDOT DESCRIPTION=EIJte7-ttie'Rorrect"USDOT SI1lkping ham(,'haz rtl stags ITEM 19 --•DIS0 PAidGY.INpICATIONr SPACE, The authorized-reprgse(rtetive•of--tire `r divisign,thg identjfica')iothum r aria the,paciii4group(49 CFR 172.2tY1) "' design lea facility trust'note in this space'any significant'discrepancy'between 4 ps na f-r- ..,. $( r > Ie;• .. Ahe,wastd',described;on the.manifest.and the,waste aptually received at the f The wdrtl"Zva3/fe must appsa�as part olihe USDOT shipping name if the 4a'ste facility.Any rejected materials should be listed here,along.wlth an gxplanatlorl i is a federal RCRA hazardous waste(49 CFR 172.101).For a waste with a of the disposition of the rejected wastes.Owners and operatdrs"of facilities ; gMigaatfon enter Jhe.00rma#gnmas-requiredkfy 49 CFR 172.203.Enter, yy.+� r„r:nlocated�authorized;States(i.e.;those States•thaYhave received authorization , f additional shipping,escription i5fprma)'!�as required by 49 C,R 172 Subpart _ r. ,6f 1 from.tli@ U.S�EPA to administer the hazardous waste Program)should contact C,It,.rr9ore than tf was t s.ar0:b2me shipped,a,secondmanifpsrpr coritinuafion, 'their State agency for Information on State Discrepancy Rebort-requirements. •- s`h'eets should be usew r iniordiat16 on USDOT waste de'scnpiiorrs,callyour'. Item 20 IFACILIYN`tlWNEfI/bPERATOR CERTIFICATION-Print or type the name of the z i , i fi'peisonrAaeivingitne waste on behalf of the.owner/operator of the designated USDOT regional office. TSDF:-That-person must acknowledge-receiving the waste•described on.the I t «:,4 Item 12:1 nte, 'CONTAINERS(NO.&TYPE)-Er the number of contain8rs for each waste. manifest by signing and entering the data of receipt:'L" d' •* and the appropriate abbreviations from Table 1(below)for the type of container' item K: HANDLING CODES-TSDF SHOULD COMPLETE-Enter the ultimate handling; 7 e1 used: w+ -, --_ - T �- method utilized at the designated facility for each waste.Only the following ° n -process-codes-may be used:.Storage=SG1 (container);-S02-(Tank); SO4.- g' (Surface:rImpouhdMdtIJ);:S05.(Other-specify);;Treatmenta}01,^(Tank) T02.• ! - _ TABLE 1_ _ _ _ _ _:___. •...(Surface Impoundment);-TOa{Incinerator);T04-(Other specity);.bisposal_D7.9 CONTAINER TYPES (Injection Weil),080(Landfill);D81 (Land Application);D82 40bean Disposal);- D83(Surface Impoundment);D84(Other-specify): +. DM-Metal drums,barrels,kegs 'NOTE For interstate'shipments you may be required to comply with the manifesting,. i `L.DW-WogdeRdfunlS.bartelS Kegs y-��.�. _ _ _ "�_ ._..- _..requirements-of both the-consignment.and-generator,states regarding._tha DF-Fiberboard or plastic drums,barrels,kegs .�_ completion of spetzific,ipforootionincluded in lettereditems A-(C.Please check + -TP-Tanks portable -•- ---- - - -- ------- -with both generator and-consignment states for specific requirements..New �� r,•.;;i• T Jersey requires that all information be filled in except for Item"G". - _ TT-Cargo Tanks(Tank trucks) Yr4 „ TC-Tank cars Public reporting burden for this collection of information is estimated to average:37 minutes PDT-Dump truck for generators,15 minutes for transporters,and 10 minutes for treatment,storage and disposal CY-C finders -- �-' ' feet ties:-This-Ancludee-time for-reviewing-mstructions,•gather!nhgg data,and completing and f 4 Y reviewing the form.Send comments regarding the burden,estimaes.including,;suggestions for CM-Metal boxes,cartons,cases(including roll-offs) reducing this burden,to:Chief,Information Policy Branch,PM-223.U.S.Environmen al Protection l CW-Wooden boxes,cartons,cases Agency, 401 M Street, SW Washington;DC 20460: and to the Office of Information and CF-Fiber or plastic boxes,cartons,cases Regulatory Affairs,Office of Management and Budget,Washington,DC 20503, A T BA-Burlap,cloth,paper/plastic bags t `G?L4 vyi` :f - _� .1. la St' �_, °-.+.. _ .-..�..�, .. .yr.._.�.�.�a .s...r+++�..�.-.-w.. w..�... ,p,a.,.11l .o..na+...-a+e. ,ow....r�-.w....m.....r,.p.,..a.•_w -.. � �.,. _. _. __, - TAP E ti�.� .. ie7�`.,aM�}'?� ,-',L,i:Y.V.tJrtL�.i1,(1',+`t,i�fy •�-tl.��.�ur-. ^r .,r }� + k - I Ilil ii ili II lil it 111 i II III II I ii�1i i iiii State of New Jersey I III 11 " Department of Environmental Protection 2 7 5 9 8 9 9 Hazardous Waste Regulation Program Manifest Section CN 421,Trenton,NJ 08625-0421 Please type or print in block letters.(Form designed for use on elite(12-pitch)typewriter.) Form Approved. OMB No; 2050-0039. Expires 9-30-97 1. Generator's US EPA ID No. I Manifest 2.Page 1 UNIFORM HAZARDOUS rr� �o Informatiorn in the shaded areas WASTE MANIFEST 6 '$ It ° T t / of I is not required by Federal law. a 3. Generator's Name and Mailing Address A. State Manifest Document Number NJA • ' 5 � # � B. MrTltn.Site Address) N f -o� 4. Generator's Phone( ) 5. Transporter 1 Company Name 6. US EPA ID Number C. State Trans.ID-NJDEP 14 "��w Zip �s0100101217111.413 Decal No.- 7. Transporter 2 Company Name 8., US EPA ID Number D. Transportcr's Phone(,, ) Lu - - E. State Traop.'ID-NJDEP m 9. Designated Facility Name and Site Address 10. US EPA ID Number Decal No r o r10 su �M�Rstt� ( F. Transporters Ph one,( -1 . o Etivbt V sM G. State Facility's ID o ` t7l JI.A 010121 21 0 01 H. Facility s Phone c 1 r R In i 12.Containers 13. 14. m 11. US DT Description(Including Proper Shipping Name;Hazard'Class o�Division,. ,; , ,, I. E ID Number and Packing Group) Total Unit Waste No. o HM No. Type Quantity Wt/Vol a.`o ! #t 0 a G G b. E N L E y R c A C. T. o R d. a - o J. AtiyliInal Descriptions for Materials listed Above K. Handling Codes for Wastes Lrsted`Above [tt�iF PrO90 gr $ d a.co w b. d. b. d_ i w 15. Special Handling Instructions and Additional Information M ( ) Vuftft! CIO vtatmaf'. All 4 21 `° �` v m E 16_ GENERATO94 CERTIFICATJON4 kherebyrdeclare'that the Oontents of this consignment are fully and3aocuratelyrdeseribed above by propdr shipping name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government yregulations. o` If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity.of waste generated to the degree I have.determined T to be economically practicable and that I have selected the practicable'method of treatment,storage,or disposal currently available to me which minimizes'the present and future threat to-human health and the environment; OR, if I am a small"quantity generator, I have made a good faith:effort,'to minimize my waste generation and select the best waste management method that is available to me and that I can afford: i `m Printed/Typed Name Signature r Month Day Year cf'"'"w F 7r ✓4 #' � i{ � .sue iy';. ft, tr es'�, _..-*•, r x. i ya ` T a ~. o 17. Transporter 1 Acknowledgement of Receipt of Materials R ` a A Printed/Typed Name ► Signature a Month Day Yeai 4 t y} P Z0 18. Transporter 2 Acknowledgement of Receipt of Materials L T Printed/Typed Name Signature Month Day Year E �. R ` 19. Discrepancy Indication Space F I A y CTI C 20. Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19.. RAJ TCo y Printed/Typed Name ignature Month Day Year Q0 S EPA Form 8700-22(Rev.9/88)Previous editions are obsolete.: SIGNATURE AND INFORMATION MUST BE LEGIBLE ON ALL COPIES GENERATOR MAIL TO GENERATOR STATE_ E !t;r i 191 !�i .Z�it `AL INFORMATION Item 13: TOTAL QUANTITY-Enter The total quantity of waste described on each line. DO NOT USE FRACTIONS f I R�a a1n gifas( Hds!gTed to track waste from the point of generation To final+ Item 14: UNIT(Wt./Vol.)-Enter the appropriate abbreviation from Table ll(belovd,tor the tyi j�dlg �Ss�Rfrria e 'gr$4 fin of if �complish this goal,it is essential that all items olr a '-'A)dat unit of measure used in determining the total quantity of wa"ate d&scrftd on each line_ } . , manifest$e completed correctlj Incomplete,incorrect or illegrb(e man Tests'aretvrolatiorxr;ot ,O l; Mt. ! the law, Hell cduld make you subject to civil or criminal liabilities as specifte{hir)The tfew�J�er�ey 3Gt.V a '• r.t I,' TABLE II ! Hazardous Waste Regulations. ` woti ,t Etr1£<' UNITS OF MEASURE INSTRUCTIONS-IMPORTANT: a r`' a,'.-.Z �('LN . 01-0-1 i 4%� �s(liquids only) READ'ALLINSTRUGrTIQNS BEFORE COMPLETING 1t.s f•,1(4- , cr)+T:`Tons120001bs.) 'r ta•t..r. r0: ,1 .0yl > -re . .r -. . _ _.Y�Cubit rds _ r i State&Federftl regulations require Generators,Transporters,arrd Treatment,Storage&Disposal ;x ) , r. ul't L-Liters(I quids+only) i�(3�; Facilities(TSDFs)to use this form and if necessary tle continuation sheet for both inter-and K-Kilograms,- r�- . , r o Intrastate shipments.Conttnuation sheets may be purcrased commercially aid photocopied to t ( MIT-Metric Tons(1000 kg) t "a) •4 AAIl�f �+ { provide copies 6s desOYbed bdl6W. , «.. _ J-`. ;_ _ -.: _ .t N-Catitc MBters p r New Jertey manifest conttins$copies.ALL COPIES MUST BE LEGIBLE.This form Item 15: SPE IAL HANDLNG INSTRUCTIONS AND ADDITIONAL INFORMATON- ,a esigned for use bn a 12 pilc(d(eNt ^lypewrlter,a firm ball point pen may also be used Use his space to indicate special transportation,treatment,storage,disposal, or Bill of Lading information,if any.If an alternate facility is designated note. . only if you press down (ARD.The 8 cop!es must be filed with the appropriate party as they ithere.For INTERNATIONAL SHIPMENTS,generators must enter the point of r are comple4ed.C6P1'DISTRIBUl10N'is ife follows: departure (city &'state) in this space. This space may also be used for ORIGINAL: DESTINATION STATE-TSDF must mail original to the state regulatory agency emergency response telephone numbers, and any other information the. _ where the facility is located_ . t_. .__ _ _-.. _ _ _generator is required to include about the shi ment in accorQence'with 49 CFR COPY 2: GENERATOR STATE•-Thb TSDF mails this copy back to the staWi'egul0tory Part 172,`Subpart G as applcable for f1GI�A:;haiar,qus waste and-USDOT ti agency wMre the waste was generated. s hazardous materials. r Item 16: GENERATOR'S CERTIFICATION-The Generator must-read,sign(by hand)and ClOPY3:1 GENERATQR COPY-ThtTSDF•mails.t his copy back to the gegerator of the _� � date the certification.This must be done the day the transporter picks up the + waste ship`menC(date of receipt b'trags`porffer).If'-4-thode other than.highway 3 waste. ]f +3' of A t (.0 is used,the word"highway"should be lined oUt'and'the appropriate mode(rail,; ' -COPY 4 - TSDF-COPY-TSDF keeps this copy for his records. water,air)inserted in the space.0 another mode in addition to the highway r - 4 r COPY 5' TRANSPORTER COSY=7he franspo5 rer keepsiTis;copil for records. mode is used,either the appropriate additional mode(e.g."and rail")in this' `N6TE'dt,d Continuing'transporter isluse-c'fhe generatq gesponsYlle for - `` -.spade. _. _.... _ . r�4 Item A: STATE MANIFEST DOCUMENT NUMBE)t-Number preprinted "New Jersey, t supplying_hi t`with.a legible photocopy;which mustco0tain required signatures. y, , except d continuation sheets, Enter this number on each..continuatio t- _ COPY 6: DESTINATION STATE--The geni3ratorimails this copy to the state regulatory sheet attached the rn ched to a manifest. � - ageilcywhere the designated facility(TSDF)is located. Item B: STATE GEN ID-The State Generator ID`is the street address of,the Waste; COPY 7: GENERATOR`STATE-ftie generator mails this copy to the state regulatory generation site.If the mailing address and the site address are the same,enter' agency where the waste was generated. same". Item G. STATE,RAN#1 ID-Enter the New Jersey state permit number.This must r COPY 8: _ GENERATOR COPY-The generator k4eps1his oopyfo"isrecorijs: •- -- - - t- -include-both the-lransporter's permit number and the decal number,of the• ALL'8'COPIES MUST•BE LEGIBLE + hazardous waste transport,unit-or-bazardoy4s,waste vehicle which contains that waste.For Mt7�idment(s)enter tt>b ag5ha numeric T.D.number assigned to ` the railcar inl u'of IINe'decal number: MA�UFEST FOkM:ACOUISITION - ---item D:- TRANSPORTER PHONE-Enter a telephone number with area-cede where an. - 1, If the destination(consignment) state supplies 4 manifest &IrequireS its use, then the authorized agent of the transporter pan be reached. generator is obligated to obtain the manifest from that state. Item E: STATE TRAN#2 ID-If applicable,enter the New Jersey State permit number' S • 2: If the destination state does not supply the manifest,but the generator state does,then of the waste carrying portion of the second vehicle. C• Item F: TRANSPORTER PHONE-If applicable, enter 8 telephone number with area. I the generator fs otlligated to obtain the manifest form from the generator state. code where an authorized agent of the second transporter may be reached. 3 1 41 r tflef.kKle gener3ler s1 1 :d4 tlta eoftsignmeht state-suppfies-the manifOst,-than 4he__Item.G; _-STATE FACILITY.'S ID-No entry is required by New Jersey, r p, gener�to ;inlay gbPai he t amfest from any source. ItemH: FACILITY PHONE-Enter a telephone number with area code of the TSDF, designated to receive the waste listed on the manifest. } 1'• t._ i" ICEN RATOR SECTION , Item I: WASTE NO,-Enter_the 4-digit hazardous waste number as it appbars in N.J.A.C' 7:26G-5.1 at. (For example"K047"is the waste.number Idesignafed for + , + " lia. 1P !GENERAT(jR'S LPA ID N'O.-MANIFEST DOCUMEN"(NO.-Enter the generator's pink/red water from TNT operations.)The proper waste number that accurately, r "EPA ioisntifidation number:The"9Tianifepl-d6cum�int'nufibe.r ig a'unidue'5-digit '- describes the-shipment,.-shall.be determined according to the hierarchy at; N.J.A.C.7:26G-6.2. r number the generator assigns to each I��anifest,for His recordkeeping purposes. Item J: ADDITIONAL DESCRIPTIONS FOR MATERIALS LISTED ABOVE-Eaten Use of serially increasing numbers(e.g.00001,00002,etc)is recommended. description of analysis for any waste which does not have a complete USDOT. r ' Item 2: PAGE 1 Of Enter the total numberrof pages 6seil to complete this manifest; shipping description or has an n.o.s.designation.Enter a general description 1I i.e,the first page plus the number of c tntinuation sheets,if any. of the waste stream(i.e.groundwater contaminated with creosote and copper �. - _sultate)Additionally,for,any n.o:s.entry,in Item 11 which does not conform ' Item 3: GENERATOR'SNAMEn&MAILING RESB-Enter the name(as notified to to'the requirements at 49 CFR 172.203(kj enter the two components,and + EPA)&'mailing address of the generator.The address should be the location their percentages,which most predominantly contribute to the hazards of the, that will manage the returned manifest forms. ` + mixture or solution.Enter the physical state IS-Solid,L=Liquid,G Gasj Item 4: GENERATOR'S PHONE NUMBER-Eriter a telephone number with area code SL=Sludge)EPA hazard codes(I s Ignitable,C-Corrosive„R-Reactive! = where an authorized,agent of the,generatr c E a n be reached in an emergency. b TCLP,H-Acute Hazardous,T x i - item 5:.• • TRANSPORTER 1 COMPANY.NAtv1Er•,Enter t requir Toxic).Enter additional information as ed the waste code hierarchy at N.J.A.C.7:26-G-6.2. .cowrpany.name,(as notified to. _ _._ _� ._.- _ ;., _ 'A EPAyof the first transporter who will transport the waste. TRANSPORTER SECTION T' Item 6: US EPA ID NUMBER-Enter the EPA identification number of the 'first transp rter identified tQ item 5. It is a violation by the transporter if he accepts hazardous waste from a generator who fails Item7: TRANSPORTER 2 COMPANY NAME If applicable to properly complete the manifest,transports waste to an unauthorized facility,and/or fails ,enter the company name to obtain the date and handwritten signature of the next hauler or owner/operator of the TSD (as notified to EPA),of:the 6dGQOd'transporler Who wiK.r"risport thg waste, _-facility on the,manifest, -r ' more,than two(2)transporters willi be-used,use a continuation sheet and Item 17: TRANSPORTER 1 ACKNOWLEDGEMENT-Print or type the name of the } ifLt the transporters in the Order they will be Transporting the waste: person,accepting the waste on behalf of the first transporter.That person must Item 8. US EPA ID NUMSER-If a, secoriq transporter is Used; enter the EPA acknowledge acceptance of the waste described on the manifest by signing " tlehtlflcatlOn numtterof Yhe'seddrrd HeC klenttftetl irl item%. -and dhtering the date of receipt_ Item 9 DESIGNATED FACILITY NAME& SITE ADDRESS=Enter the.company name Item 98:_ TRANSPORTER 2'ACKNOWLEDGWENT-�If:applicab[C follow instructions for item 17 for the second transporter. and site address(as.notified to the EPA)Of the treatment,storage,or disposal NOTE: ALL HAZARDOUS WASTE TRANSPORTERS OPERATING IN NEW-JERSEY' facility(TSDF)designated to receive the waste listed on this manifest. The MUST HAVE A VALID NEW JERSEY HAZARDOUS WASTE TRANSPORTER'Sj +, address must be the site address,which may differ from the mailing address. PERMIT. Item 10: EPA ID NUMBER-Enter the EPA identification number of the designated TSDF (or waste reuse facility)listed in item 9. DESIGNATED FACILITY(TSDF)SECTION -Item 11. USDOT-DESCRIPTIQN-Enter the correct USDOT-shipping•neme hazard class--ITEM 19: DISCREPANCY-INDIGATION SPACE-The•authorized representative of that or division,the Identification numbbr and the packing group(49 CFR 172.202). t T+`-designated fadiHty must.note in this space any significant dlsb?epancy between ' The'wordwaste'musf�appear as pa"rf of the'USDf3T shfttphg ndrdeiif the waste - ?" ,v"`,. the waste.described'on the manifest and the waste actually received at the c' is a federal RCRA hazardous waste(49 CFR 172.101).For a waste with a facility.Any rejected materials should be listed here,along with an explanation 1 ' of the disposition of the rejected wastes.Owners and operators Of facilities + n.p.s,designation enter th?irformation as leglu1md,.Z 4T9 QER 17,2.203.Eriter located in authorized States(i.e.,-those States,that have received authorization " additional_shipping.(iescnptrojiinformatidn as reguii,tdd y d CF I'T72 Subpart �y t yN n from the U.S.EPA to adrhjniste the hazBRious waste program)should FOntact 3 C,if more than 4 wastes are barn shi�ped,a second man fast or continuafior� '`)heir State agency for infbrmatiomon 5fate Discrepancy Report requirements:, sheets should be used.Porinformation on USDt 4a`ste descriptions call ybur11 r 6m 20i 1 t' FACILITY'OWNER/OPERATOR�CERTIMCATION-PridEortype the name of the USDOT regional office. 3 il, 1` rperson receiving the waste on behalf of tho,owner/oWrator of the designated i TSDF.-That person..must_acknowledge receiving the-waste described on the Item 12:" CONTAINERS(NO.&TYIYE)=En(er'tli> number of confainers for each wa t�,' manifest b signingand entering the date of receipt..., ' and the appropriate abbreviations from Table t(below)for the type of container p y g p ( Item K: HANDLING CODES-TSDF SHOULD COMPLETE-Enter the ultimate handling' )used: method utilized at the designated facility for each waste.Only the following , --process-codes may be.used:.Storage SOI-(container);_S02.(Tank); SO4,__ TABLE 1 (Surfacg:,Impoundment); S05 (Other§pacify);-Treatment-T01 (Tank); �02 y i�y _ -G`-ON�IN15R TYPES" -,. �" (nueceon Wce ell);DBOnLandf3)�iD81e(Land'Application);DSQf(Ocean Disposal); + DM-Metal drums,barrels,kegs 1 D83(Surface Impoundment);684(Other-specify). p t' f_ )DW-Wooden drums,barrels,kegs 'NOTE For interstate shipments you may be required To comply with the manifesting _ _ _L ..requirements-of_both the..consignment.and generator states regarding..the DF-Fiberboar od r aspc drums,barrelsMc gs` completion of=¢pecific,information included in lettered,items A-K.Plegse check TJ?-Tanks.porfable_ . - _ _ _ _ - _with both generator and consignment states for specific-requirements.New TT-Cargo tanks(Tank trucks) 3l. f Jersey requires that all information be filled in except for Item'G", r i TC-Tank cars Public reporting burden for this collection of information is estimated to average:37 minutes DT-Dump truck for generators,15 minutes for transporters,and 10 minutes for treatment,storage and disposal _ _ _ _ __ _._._____-Jacifides..This.includes.Time.for-reviewing instructions_gatheringg data, and completing and V CY-CylindeYs"' "`" reviewing the form.Send comments regarding the burden estimatea including suggestions for CM-Metal boxes,cartons,cases(including roll-offs) reducing this burden,to:Chief,Information Policy Branch;PM-223:U.S.Environmental Protection CW-Wooden boxes,cartons,cases Agency, 401 M Street, SW, Washington, DC 20460' and to the Office of Information and; t CF-Fiber or plastic boxes,cartons,cases Regulatory Affairs,Office of Management and Budget,Washington,DC 20503. I ' BA-Burlap,cloth,paper/plastic bags } ' - T THE FOLLOWING IS/ARE THE BEST � IMAGES FROM POOR QUALITY ORIGINAL (S) MA G�� C DATA •'e ,•,L.n.. ..nk il,: i.> ..., t ;i,_ „ . ;I State of New Jersey i Department of Environmental Protection i„•;r Hazardous Waste Regulation Program anifest Section CN 421,ITrenton,NJ 08625-0421 Form Approved. OMB No. 2050-0039. Expires 9-30-97 F Please type or print in block letters.(Form designed for use on elite(12-pitch)typewriter.) Manifest 2.Page 1 Information in the shaded areas UNIFORM HAZARDOUS 1. Generators EPA ID No. oc�tmgrt�o.g � 7 of 1 is not required by Federal law. WASTE MANIFEST i A. States�current Number 3. Generator's Name and Mailing Address TM II, B. r' I n.Site Address) ewe ,� 4. Generator's Phone( :iVv ) f 5. Transporter 1 Company Name 6. US EPA ID Number G State Trans.ID NJDEP ; 1 Decal No.- :' ` 8. US EPA ID Number D. Transporter's Phone 7.' Transporter 2 Company Name ( ) E: State Trans..ID-NJDEP ' 10. US EPA ID Number - Decal No 9. Designated Facility Name and Site Addressst , ;- ,,t F Juansporter's Phone( cu rs ) s Y1,4.1 G.'State Facility's ID. VW a H. Facility's Phone( ) 12.Containers 13. t 3... Total:t Unit Waste No..' i. I` US Descnptic, ncitrcbrhg Roper Ship�tng Na H�rard Class oaDtf�ir/on,-;a r`9: No. Type Quantity Wt/VOI HM ID'Number and Packing Group) i v, or€9 4a. t n.a T mat i a"MA, 4 0 b. a i s ,iJ 300i,, A C' L• 4.rkai.a .M... t CT ., ,- u , f R 4 '` K, Handling Codes for Wastes Listed Above i n J. �ditpnal Descriptions for Materials"Listed Above y rtnit+i v€ f x s xH, ,,n a C. r F • .,, ,�. � �s�ic,bt ;.,. • 1 « In. d. d 1 1 �f�l�llS�! IDS• $ Special Handling Instructions and Additional Information r Ip t. +, t �- r '.n., 1 1 }�' l t1 t�kr ' ,,r. t�t' ;�s .. ...t•, �•.. +u•t 6..,.... .� ... ii t ,:,�' tt•d.:.✓, �i,L). . Fi a r , f, �,Et 1t -t'. .. J 1 ' P:J(l(`i Ff) TO ERTIFICAT1pNat�tereby•{feclare ghat the:' ` tents of this¢ons' .ment{are'-fully and ecarirately des4ibed above try proper shipping name and are t6 'GENE(iA classified,pad 6d,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulab4ns: a, ;...: , H I am a'large quantity generator;l certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determine to be economically practicable and that I have selected'the practicable method of treatment,storage,or disposal currently available to me which minimizes the present :and future threat to human health and the environment; OR, if I am a small`cluantity generator, I have made a good faith effort to minimize my waste generation {i s, :.and select the best waste management method that is available to me and that I can afford. & Printed/Typed Name *,c e rot b + , �« +:,,r, , Signs r . Month e M Day Year nature ��{( r H ,r c 10 T 17.::Transporter 1 Acknowledgement of Receipt of Materials. `o R ) Month Day Year �- �^ Signature' y I A ..Printed/Typ`�eld j]Jame s si ,r g c P 0 18. Transporter 2 Acknowledgement of Receipt of Materials Month Day+• Printed/Typed Name• - Signature T 19. Discrepancy Indication Space �l A c Cot+ I ,^ L W t 1 20. Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Month Day Year T Signature y Printed/Typed Name i ,,., i SIGNATURE AND INFORMATInN MI.)ST BE LEGIBI_F ON ALL COPIES �._rr-nlr_r?ATr)n r 0PY IV. RESTRICTED WASTE NOTIFICATION I4INE RCRA WW NWW APPLICABLE ITEM CODE. SUBCATEGORY ABCD_ [ ] ( ] ABCD- ABCD- ABCD [ ] [ 1 ABCD_ [ ] [ 1 I ABCD_ [ ] [ I ABCD_ [ ) { ) ABCD_ [ 1 [ l ABCD_ [ ] [ ] ABCD_ [ ] [ 1 i V. F001 - F005 SPENT SOLVENT WASTES CONSTITUENT_ (S) ABCD F001 ABCD F002 ABCD F003 ABCD F004 ABCD F005 ABCD_ acetone ABCD_ ethyl ether ABCD benzene ABCD_ methanol ABCD_ n-butyl alcohol ABCD methylene chloride ABCD_ iso-butyl alcohol ABCD methyl ethyl ketone ABCD carbon disulfide ABCD methyl isobutyl ketone ABCD_ carbon tetrachloride ABCD nitrobenzene , ABCD chlorobenzene ABCD_ pyridine ABCD_ m-cresol ABCD_ tetrachloroethylene ABCD o-cresol ABCD_ toluene ABCD_ p-cresol ABCD_ 1,1,1-trichloroethane ABCD cresylic acid ABCD_ 1,1,2-trichloroethane ABCD_ cyclohexanone ABCD_ trichloroethylene ABCD o-dichlorobenzene ABCD trichloromonofluoromethane ABCD_ ethyl acetate ABCD_ 1,1,2-trichiloro-1,2,2-trifluoroethane ABCD_ ethyl benzene ABCD xylenes VI. CALIFORNIA LIST WASTES ABCD_ NICKEL > 134 mg/1 ABCD LIQUIDS WITH PCB's > 50 PPM F, ABCD THALLIUM > 130 mg/1 ABCD_ HALOGENATED ORGANIC CARBON (HOC's) > 1000 mg/1 VII. NON HAZARDOUS WASTE CERTIFICATION I certify that the following manifest line items are not subject to any land disposal restrictions as specified in 40 �PFR Subpart D and all applicable prohibitions set forth in Part 268 or RCRA Section 3004 (d). ABCD_ NON HAZ CODE 0 1 X�' i) ABCD NON HAZ CODE ABCD NON HAZ CODE ABCD NON HAZ CODE VIII. CERTIFICATION "I notify that I personally examined and am familiar with the waste through analysis and testing or through knowledge of the waste to support this notification that the waste described on this page does not comply with the treatment standards specified in 40 CPR 268, Subpart D or RCRA Section 3004(d), and all applicable prohibitions set forth in appropriate regulatory treatment standards prior to land disposal." L"17 p / � // �S Signature: Date. Print Name: ��� t f 9 r Ye t,- Title: C 414, I'll Revised 12/94 INSTRUCTIONS LAND DISPOSAL RESTRICTIONS n Tlfl NO CATION AND CERTIFICATION PORA9 PHASE II The USEPA recently promulgated Phase II of the Land Disposal Restriction (LDR) program, These regula- tions are effective.as of 12/19/94. The new regulations intend to simplify and provide consistency in the LDR program. Cycle Chem, Inc. has revised the Land Disposal Notification and Certification form in order to assist you in complying with the new requirements. Although its our hope that you will find this format easy to use, if you have an questions feel free to contact our staff at (908) 355-5800 and we will be ad to assist f Y any � you. This form can be used for four manifest items or an additional continuation form. The instructions are as follows: Section I Note the Line Items and corresponding USEPA Hazardous Waste Codes as noted on the accompanying manifest. Note,whether the waste meets the criteria for wastewater or nonwastewater. Also note your CCI generator product code. Section II For all wastes that exhibit a characteristic and are managed in non-Clean Water Act, non-CWA equivalent and non-Class I SDWA Systems (except for the 40 CFR Part 261.21 (a) (1) High TOC Subcategory): Simply circle the line item for each applicable EPA Waste Code. If your waste has any "underlying hazardous constituents" as defined in 40 CFR Part 268.38 you must list the corresponding manifest line items. In addition you must identify the constituent which is present in the waste at a level above the Universal Treatment Standard. Section III For Lab Packs which contain only wastes which are not excluded under Appendix IV to 40 CFR Part 261 you may choose the alternate treatment certification. You must note the corresponding manifest line items. Section IV If any other subcategories apply to your waste,you must circle the appropriate line item, and note each RCRA waste code with the corresponding applicable subcategory. You must also note whether the waste is a wastewater or nonwastewater. i Section V Simply circle the line item for each applicable EPA Waste Code. You must note the corresponding manifest line items next to the applicable constituent(s) for all F001-F005 spent solvent wastes. Section VI If the waste is subject to any California List Restrictions you must circle the line item next to the corresponding restriction. Certifications Section VII Non Hazardous Waste Certification Simply denote (x) next to this certification for all wastes not subject to any land disposal restriction, circle the appropriate line items and list the appropriate waste code(s). Sign and date. Section VIII Hazardous Waste Certification Simply denote (x) next to this certification if you are managing a restricted waste as noted in any categories listed on this LDR. Sign and date. E. METALS/®RGANICS'(mgAg or ppm) ❑ EP TOX ❑"TCLP ❑TOTAL~ "F.LIQUID WASTE CHARACTERISTICS EP TOX LESS EP TOX LESS; Fuels and WWT Candidates METAL EPA CODE THAN ACTUAL METAL, EPA CODE THAN ACTUAL- II ' Arsenic D064 �L) <5.0 Hexachlorobenzene D032. <0 13 OR NIC PHASE y Barium D005 [ <100 Hexachloro-1,3-butadiene D033 <05 + AO OUS PHASE: % = 100% Benzene D018 <0.5 Hexachloroethane D034 <3.0 Cadmium D006 <1.0 Lead D008 <5.0 RANGE Carbon tetrachloride D019 11 <0.5 Lindane D013 D<0.4 'HEAT VALUE BTU/Ib j Chlordane D020 ® <0.03. Mercury D009 <0.2 Chlorobenzene D021 i� <100.0 Methoxychlor D014 [I <10.0 TOTAL HALOGE " _% mg/1 Chloroform D022 [ <6.0 Methyl ethyl ketone D035 (� <200.0 ASH CONTENT % Chromium D007 <5.0 Nitrobenzene D036 <2.0 %SULFUR ❑ <0.5% % o Cresol D023 <200.0 Pentachlorophenol D037 <100.0 m-Cresol D024 <200.0 Pyridine D038 . <5.0 BS&W % ' p-Cresol D025 Lp <200.0 Selenium D010 <1.0 WATER CONTENT \:� O Cresol D026 <200.0 Silver D011 q <5.0 2,4-D D016 <10.0 Tetrachloroethylene D039 <0,7VISCOSITY(cps): i 1,4-Dichlorobenzene D027 <7.5 Toxaphene D015 <0.5 TOC -mg/I 1,2-Dichloroethane 0028 <0.5 Trichloroethylene D040 <0:5 COD_ mg/I 1,1-Dichloroethylene D029 ��� <0.7 2,4,5-Tricnlorophenol D041 <400.0." BOD mg/l 2,4-Dinitrotoluene D030 <0.13 2,4,6-Trichlorophenol D042 <2.0 OIL&GREASE __.mg/I Endrin D012 <0.02 2,4,5-TP(Silvex) D017 <1:0 Heptachlor Vinyl chloride D043 <0.2 TOX._ mg�/I (and its hydroxide) D031 <0.008. Copper, NA <100.0 Zinc NA 11<500.0 HOC mg/1 G. SHIPPING/MANIFEST INFORMATION SHIPMENT METHOD REGULATORY INFORMATION ❑ BULK LIQUID ❑ OTHER(SPECIFY) USEPA HAZARDOUS WASTE? ❑ YES ENO ❑.BULK SOLID - USEPA HAZARDOUS CODE(S)." ❑ DT ❑ RO J DRUM(SIZE)_ _ APPLICABLE SUBCATEGORIES ANTICIPATED VOLUME ❑ GALS. ❑ DRUMS STATE HAZARDOUS WASTES ,<YES. ❑ NO ❑ TONS ❑ CUBIC YDS. STATE CODE(S) S t/►A 1 t (QUPERI ONE TIME ❑ ART R A O ���^ O QU E ❑ YE R D.O.T.HAZARDOUS WASTE? ❑ YES QNO TRANSPORTER: PROPER SHIPPING NAME TRANSPORTER PHONE/CONTACT: 61pa "t AAie15bo I TRANSPORTER USEPA I.D.I I I I I I I I I I I I L CLASS J I.D.N : P.G. R Q _ H. WASTE CERTIFICATION 1. Does this waste material contain polychlorinated biphenyls?YES NO 2. Does this waste material contain herbicides or pesticides as described in,the 40 CFR Part 261.24 Table#1,Waste Nos, DO12'DO17? YES_ NO- 3. Does this waste material contain or ever contain the listed"spent"solvents which would classify the waste as any or all EPA Waste Nos.F001,F002,F003, F004, F005 as per 40 CFR Part 261.31? YES NO ° 4. Does this waste material contain leachable levels of any of the metals covered by EPA Waste Nos. D004 thru D011 as per 40 CFR Part 261.24? YES_ NO 5. Does this waste contain any dioxins as specified by 40 CFR Part 261:31'Waste Nos. F020, F021, F022, F023, F026,F027, F028? YES NO PCB 50 Ni >134 6. Is this waste material a"California List"waste,as per 40-CFR Part 268.32? YES NO HOC >_1000 -Th >. 130 7. Does this waste material contain D018-D043 as per 40 CFR Part 261.2.4? YES. NO 8. Does this waste material contain"U",""K"or"P"wastes as defined per 40 CFR Part 261.32 and•261.33? YES NO"� 9. Is this waste considered non-hazardous by.USEPA standard? YES". h< NO 10. Is this waste characteristic for D001,D002 and D018-DO43 and will be managed in non-CWA,non-CWA equivalent and non-Class I SDWA systems(except for the 40 CFR Part 261.21 (a)(1)High TOC subcategory)? Yes No Does this waste contain any underlying hazardous constituents as defined'in 40 CFR Part 268.2(i)? Yes No � If yes,please list constituents in section D GENERATOR CERTIFICATION 1 hereby certify that all information submitted:in this and all attached documents is complete,contains true and accurate descriptions and�s representative of the waste material,and that all relevant information regarding known or suspected hazards in the possession of the generator has been disclosed" If CYCLE CHEM.discovers,after having taken delivery of the waste,that any waste does not conform to the identification and desorption on this MPS. "then CYCLE CHEM shall provide notice of such condition to the Generator and coordinate the return of the nonconforming waste to the point of origin as set h'forth on the manifest or-to such other locations designated in writing by the Generator. Generator agrees to reimburse CYCLE CHEM for all handling. packaging,cleanup and transportation costs or'charges,damage to equipment,and costs associated with lost time incurred by CYCLE CHEM during the receipt,handling,temporary storage and return of such nonconforming waste to point of origin or to such other location designated by,Generator. Authorized Signature Title Name(Print or Type) Date PAGE 2 44494 E. MExT,ALS.l�RGANICS (mg/kg or ppm) El EP TOX ❑ TCLP ❑TOTAL. . F.LIQUID WASTE CHARACTERISTICS EP TOX LESS EP TOX LESS _, Fuels and WWT Candidates METAL EPA CODE THAN ACTUAL METAL EPA CODE THAN ACTUAL i) 'I Arsenic D004 <5.0 Hexachlorobenzene D032 <0.13 OR6 NIC PHASE Barium D005 L�] <100 Hexachloro-1,3-butadiene D033 <0.5 + AQQ� OUS PHASE % = 100% Benzene 0018 <0.5 Hexechloroethane D034 <3.0 ! Cadmium D006 <1.0 Lead D008 <5.0 RANGE Carbon tetrachloride D019 I <0.5 Lindane D013 <0.4 Chlordane D020 1 <0.03 Mercury 0009 <0.2 HEAT VALUE BTU/lb Chlorobenzene D021 r <100.0 Methoxychlor D014 <10.0 TOTAL HALOGEf�T _% mg/I Chloroform D022 © <6.0 Methyl ethyl ketone D035 <200.0 ASH CONTENT Chromium D007 <5.0 Nitrobenzene D036 <2.0 %SULFUR ❑ <0.5%. o-Cresol D023 <200.0 Pentachlorophenol D037 <100.0 f m-Cresol D024 <200.0 Pyridine D038 <5.0 BS&W % . p-Cresol D025 <200.0 Selenium D010 <1.0 WATER CONTENT Cresol D026 <200.0 Silver D011 <5.0 2,4-D D016 <10.0 Tetrachloroethylene D039 <0.7 VISCOSITY(cps): Q "` OF 1,4-Dichlorobenzene D027 <7.5 Toxaphene DO15 <0.5 TOC mg/I 1,2-Dichloroethane D028 <0.5 Trichloroethylene D040 <0.5 COD_ mg/I 1,1-Dichloroethylene D029 <0.7 2,4,5-Trichlorophenol D041 <400.0 BOD mg/I 2,4-Dinitrotoluene D030 <0.13 2,4,6-Trichlorophenol D042 <2.0 OIL&GREASE__-mg/I Endrin D012 <0.02 2,4,5-TP(Silvex) D017 <1.0 Heptachlor Vinyl chloride D043 <0.2 TOX- mg/I (and its hydroxide) D031 <0.008 Copper NA <100.0 Zinc NA <500.0 HOC mg/I r . G. SHIPPING/MANIFEST INFORMATION SHIPMENT MEt`THOD ;,REGULATORY INFORMATION v_ O'BULK LIQUID El OTHER(SPECIFY) USEPA HAZARDOUS WASTE? ❑YES C1N0 ❑ BULK SOLID _ ❑ DT ❑ RO USEPA HAZARDOUS CODE(S) f DRUM(SIZE) _ APPLICABLE SUBCATEGORIES ANTICIPATED VOLUME El GALS. ❑ DRUMS STATE HAZARDOUS WASTE? .5<YES ❑'NO ❑ TONS ❑ CUBIC YDS. (QUA TITY) STATE CODE(S) t .�_ tAAnt(3 PER & ONE TIME ❑ QUARTER El YEAR D.O.T.HAZARDOUS WASTE? ❑.YES WN0 TRANSPORTER: _ I TRANSPORTER PHONE/CONTACT: PROPER SHIPPING NAME J P���I,t 1 A4A� f) 1 L? TRANSPORTER USEPA I.D.I I I I I I I I I I I ,I I CLASS I.D.N . P.G. R Q.. €: 'L 3 i H. WASTE CERTIFICATION 1. Does this waste material contain polychlorinated biphenyls?YES NO 2. Does this waste material contain herbicides or pesticides as described in the 40 CFR Part 261.24 Table#1,Waste Nos. D012-DO17? YES NO. IC 3. Does this waste material contain or ever contain the listed"spent"solvents which would classify the waste as any or all EPA Waste Nos.F001,F002,F003, F004,F005 as per 40 CFR Part 261.31? YES NO 4. Does this waste material contain leachable levels of any of the metals covered by EPA Waste Nos. D004 thru D011,as per 40 CFR Part 261.24? YES_ NO y t 5. Does this waste contain any dioxins as specified by 40 CFR Part 261.31 Waste Nos. F020, F021, F022, F023, F026, F027, F028? YES NO PCB 50 Ni >134 6. Is this waste material a"California List"waste,as per 40 CFR Part 268.32? YES NO HOC >1000 Th >130 .- T., Do§sahis waste m0terial contain D01t&0043,as per 40 CFI Part 261.a4? YES ' NQ 8. Does this waste material contain"U","K"or"P"wastes as defined per 40 CFR Part 261.32 and 261.33? YES NO 9. Is this waste considered non-hazardous by USEPA standard? YES- k� NO 10. Is this waste characteristic for D001,D002 and D018-DO43 and will be managed in non-CWA,non-CWA equivalent and non-Class I SDWA systems(except for the 40 CFR Part 261.21 (a)(1)High TOC subcategory)? Yes No Does this waste contain any underlying hazardous constituents as defined in 40 CFR Part 268.2(i)? Yes No If yes,please list constituents in section D GENERATOR CERTIFICATION " I hereby certify that all information submitted in this and all attached documents is complete,contains true and accurate descriptions and is representative of the waste material,and that all relevant information regarding known or suspected hazards in the possession of the generator has been disclosed If CYCLE CHEM discovers,after having taken delivery of the waste, that any waste does not conform to the identification and description on this MPS. then CYCLE CHEM shall provide notice of such condition to the Generator and coordinate the return of the nonconforming waste to the point of origin as set forth on the manifest or to such other locations designated in writing by the Generator. Generator agrees to reimburse CYCLE CHEM for all handling. packaging,clean up and transportation costs-or charges,damage to equipment,and costs associated with lost time incurred by CYCLE CHEM during the . r receipt,handling,temporary storage and,return of such nonconforming waste to point of origin or to such other location designated by Generator. Authorized Signature Title ` _ Name(Print or Type) b Date 44494 f PAGE 2 MATERIAL PROFILE SHEET INSTRUCTIONS(Continued) SECTION D—Chemical Composition List all organic and/or inorganic components of the waste using specific chemical names.If trade names are used,attach Material Safety Data Sheets or other documents which adequately describe the composition of the waste.For each component,estimate the range(in percents)in which the component is present. In case of extreme pH (2 or less or 12.5 or greater)indicate specific acid or caustic species present.This list must include any hazardous components listed in Parts F,G and/or H which exceed 10,000 ppm(1%).The total of the maximum values of the components must be greater than or equal to 100%,including water,earth,etc. Proper chemical names or at least specific generic names are required under chemical composition.If specific chemical names are not known,specific generic names such as"naphtha,mineral spirits,kerosene,solidified phenolic resin,latex paint,alkyd paint,nonionic detergent,crankcase oil,cutting oil,hydraulic fluid,etc."that correspond to specific well known chemical mixtures with specific properties should be used. Vague descriptions such as"solvents","oil and water"are not acceptable.Terms such as"inerts"or"non-hazardous ingredients' are not acceptable without identification of the nature of the inerts (e.g., soil, construction debris, water) or an authoritative source for the description such as "non- hazardous per manufacturer's MSDS." , If this waste contains PCBs,cyanides,phenolics or sulfides,indicate the concentration(s).If this waste does not contain these constituents,indicate by checking the"NONE"box(es)which apply.If the concentration of these constituents is unknown,please indicate"UNK"under"ACTUAL".Indicate the MSDS or supplemental analyses are attached. SECTION E—Metals Indicate whether metals content was determined by EP Tox (extraction procedure toxicity)lTCLP (Toxicity Characteristics Leaching Procedure) from 40CFR 261-Appendix 11 or represents the total metals. For each metal,check only one box indicating that the metal content will not exceed the stated amount or enter the actual metal content indicated by your test results in the"ACTUAL"column in parts per million.If you know a metal is NOT present, indicate by writing "NP" under "ACTUAL". An actual concentration of zero is not appropriate. If metal concentrations are unknown, please indicate "UNK"under"ACTUAL". SECTION F—Liquid Waste Characteristics If the waste material is a liquid,fuel or wastewater treatment candidate,complete this section. SECTION G—Shipping/Manifest Information Indicate if this waste is a USDOT Hazardous Material(49CFR172.101). Anticipated Annual Volume/Units—Enter the amount of this waste which will be generated and transported annually.Use appropriate units to describe this volume(e.g.,cubic yards,gallons,kilograms,pounds). Proper Shipping Name—Enter the proper USDOT shipping name for this waste(49CFR172.101). Hazard Class—Enter the proper USDOT hazard class(49CFR172.101). I.D.#—Enter the proper USDOT Identification Number(49CFR172.101). Additional Description—Enter any additional shipping information required(40CFR172.203)(e.g.,"RQ",the names of Hazardous Substance Constitu- ents as they would appear on the Uniform Hazardous Waste Manifest and the packaging). Method of Shipment—Indicate the anticipated method(s)of shipment by checking the appropriate box(es).If drums are to be used,*see 49CFR173 for DOT drum specifications. CERCLA Reportable Quantity(RQ)-Enter the Reportable Quantity for this waste from 49CFR172.101 or 40CFR302. RQ Units(lb/kg)—Indicate the appropriate units for the RQ listed. USEPA Hazardous Waste—Indicate if this waste is a USEPA Hazardous Waste(40CFR261). USEPA Hazardous Waste Number(s)—If the answer above was"YES",then enter the appropriate USEPA Hazardous Waste Number(s)(e.g., D002, F002, K028, P006,U220)(40CFR261). Subcategories—If the answer above was"YES",enter the appropriate subcategories as per 40CFR268.42. State Hazardous Waste—Indicate if this waste is a hazardous waste as defined by the state in which it is now located. State Hazardous Waste Number(s)—If the answer to the question was"YES",then enter the appropriate State Hazardous Waste Number(s). Hazard Codes—List all applicable hazard codes for manifesting purposes,i.e.,"T"for toxic,"C"for corrosive. SECTION H—Waste Certification Indicate either"YES"or"NO"relative to waste materials subject to the Land Disposal Restrictions under 40CFR Part 268 and/or having PCB,herbicide, pestir!c,e or dioxin origins.Generator must initial this section upon completion. SECTION I—MPS Change Verification Generator should initial this section to allow a CYCLE CHEM representative to amend or correct any information on the MPS. GENERATOR CERTIFICATION After completing and reviewing the form,an authorized representative of the generator must sign and date the MPS in the space provided.In the section that reads Title, print the signatory's Name and Title. Forward the completed form with all appropriate attachments to the respective facility. Your approved copy will be returned to you. If you have any questions,please don't hesitate to contact CYCLE CHEM Customer Service. 217 SOUTH FIRST STREET CHMM ELIZABETH,NJ 07206 77 RECYCLING TREATMENT&DISPOSAL OF HAZARDOUS WASTE (908)355-5800 INSTRUCTIONS FOR MATERIAL PROFILE SHEET In order for Cycle Chem to evaluate a waste stream for disposal, standard information regarding the specific characteristics of the waste:must be reviewed.This information will allow CYCLE CHEM to properly identify the most efficient treatment/disposal method. 1 U A 1A 41 The Material Profile Sheet (MPS) has been designed to provide this information in a clear and concise form. Please keep in mind that the more information that can be supplied now,the less likely,additional information will be requested later.,Requests for additional information(i.e.,Analytical Data,M.S.D.S.,samples,etc.)can delay the approval process. Here are a few guidelines to assist you in completing the Material Profile Sheet: SECTION A—General Information Generator Name—Enter the name of the facility actually generating the waste;not the parent corporation or financier of the project. Generator U.S.E.P.A.ID No.—This number has a three letter prefix consisting of a two letter state abbreviation and D(NYD, NJD;PAD),followed by nine digits.If your facility does not have an E.P.A.ID Number,call us and we will direct you to the proper regulatory agency. Generator State ID No.—Enter the facility state identification number,if applicable. Pick-Up Address—Enter the address of the facility where the waste is generated and transported from,including street,city,state and zip code.Unless we are instructed otherwise,all manifest copies will be sent to that address. Billing Address—Enter the address to which the invoice should be Sent.Write"SAME"if it is the same as the facility address. Technical Contact—Enter the name,title,and phone number of the person who can provide the most technical information regarding the waste. Name of Waste—Enter a specific descriptive name for the waste.Brand names of commercial products and generating site specific names should be provided to supplement the specific descriptive name but cannot replace it. Examples of suitable waste names would include: "Spent drycleaning solvent(ABC Chemical,Cleansolv 101)","Tank bottoms from Muriatic Acid Storage(Tank 409)","Aqueous laboratory waste from Polymer QC Lab".If the waste material is a discarded,off-spec or spent commercial product,please attach a copy of the manufacturer's material safety data sheet(MSDS)to the MPS. Process Generating the Waste— Provide a description of the process generating the waste, for example: "Nickel electroless plating operation", "Electronic parts manufacture degreasing operation"or"auto body spray paint operation." SECTIONS B,C,D,E AND F—General Instructions Please answer all questions in Section B,C,D,E and F. Do not leave blanks and do not use"Not Applicable"or"N/A". if the waste material does not exhibit the property or contain the substance in question,enter"None". Your answers to questions in these sections can be based on the following sources of information. 1. Your knowledge of the process generating the waste,including feedstocks,products and by-products,and contaminants that may be in the waste material. 2. If the waste material is discarded, off-spec or spent commercial product, you may use information from the product's MSDS supplemented to include contaminants that may have entered the waste material and changes in its composition and/or properties resulting from its use. For. example, oil and grease would be likely contaminants, in a degreasing solvent. Please attach a copy of the manufacturer's MSDS for the original product if the waste is a discarded,off-spec or spent commercial product. 3. Physical/chemical analysis of waste material.If you are relying upon direct analyses of the waste material to ascertain its properties or composition, please attach a copy of the analytical results to the MPS. In addition,please indicate what type of waste sample was analyzed(grab,composite, time weighted composite), how representative the sample is expected to be, considering the normal variability of the waste stream, and the sampling equipment used to collect the sample(thief,dipper,trowel,auger,weighted bottle,coliwasa,dredge,etc.)Standard EPA Test Methods for Evaluating Solid Waste(SW-846)must be used for any parameters for which they are available.ASTM,or other standard methods,will be used for additional parameters. SECTION B—Physical Characteristics of Waste COLOR—Describe the color of the waste(e.g.,blue,clear,varies). a WASTEWATER;NONWASTEWATER—A wastewater must meet the criteria of <1%total organic carbon and <1 Rio total suspended solids. ODOR—DO NOT SMELL THE WASTE!if the waste has a known incidental odor,then describe it(e.g.,acrid,pungent,solvent,sweet). PHYSICAL STATE—Check applicable boxes. LAYERS—Check applicable boxes. SPECIFIC GRAVITY— Indicate the specific gravity. The specific gravity of water is 1.0. Most organics are less than 1.0. Chlorinated solvents, most inorganics and paint sludge are greater than 1.0. FREE LIQUIDS—Check"YES"if liquid is usually present when packaging for shipment and estimate the percent of liquid volume.Check"NO"if there are no free liquids as defined by the Paint Filter Test(SW 846 Method 9095). Check "YES" if liquid and is able to be pumped through a 2" double diaphragm pump(Wilden Co).Check"YES"if liquid and able to pour out of a drum by gravity if turned upside down. PH—Indicate for liquid or liquid portions of the waste.Check the appropriate boxes which cover the pH of the waste.For solid or organic liquid wastes, indicate the pH of a 10%aqueous solution of the waste,if applicable.Check"NA"for non-water soluble materials(e.g.bricks,dismantled tanks,empty drums,gases,rocks). FLASH POINT—Indicate the liquid flash point obtained using the appropriate testing method(40CFR261.21).The liquid flash point is important from a transportation standpoint(49CFR173.115). Solids with flammable potential should also be identified in PART C.3(e.g., Pyrophoric, RCRA Reactive, Other).Indicate test method. SECTION C—Other Hazardous Characteristics and Special Handling Considerations Enter information regarding other hazardous characteristics of the waste.Enter any information that would assist in the safe and effective handling of this waste.Attach manufacturer's MSDS for the waste as a whole or for constituents of the waste and any analytical data available.The more information provided,the faster the approval process. 6 217 SOUTH FIRST STREET MATERIAL PRgFIM SHEETS CHEMELIZABETH,NJ 07206 PRooucT cone r., 908 355-5800 PROCESS CODE 1 RECYCLING TREATMENT&DISPOSAL OF HAZARDOUS WASTE ( ) f A. GENERATOR INFORMATION GENERATOR US EPA I.D. I M i t' I S I D I 1 7 1 9 I D I (o I A I (I I 44494 GENERATOR STATE I.D. GENERATOR NAME �0.t>nS�A1�p AAii BILLING ADDRESS IF DIFFERENT MAILING ADDRESS MAt� O f -1 CONTACT t G C_• TECHNICAL CONTACT o jr irvi "tj Y41140TITLE PHONE g0 SITE ADDRESS A_,SAt_KS LA✓ e NAME OF WASTE 6+ lr�,I AIn� Orl PROCESS GENERATING WASTE SD I C leet h c4 B. PHYSICAL CHARACTERISTICS OF WASTE COLORNISUAL DESCRIPTION STRONG INCIDENTAL ❑ YES PHYSICAL STATE 70°F �^DUMPABLE? ODOR PRESENT? NO SOLID SINGLE PHASE ,KJ ES ❑ NO f� +e ! a ► FPuen able.., r �.-,. 13 AG f t t "'Cl❑ LIQUID BI-LAYERED p �. ❑ WASTEWATER ElPOWDER ❑ MULTI-LAYERED El YES KNOB^ DESCRIBE Pourable?"NONWASTEWATER El SEMI-SOLIDEl SLUDGE ❑ YES l�J��^WO CORROSIVITY(pH) SPECIFIC GRAVITY FLASH POINT LIQUID/SOLID ❑ s2.0 ❑ 9.01-12.49 ❑ <.8,- ❑ 1.2-1.4 ❑ <70°F ❑ >200°F %Total Solids r ) El 2.01-5 El >_12.50 El .8-1�Ow , /A ❑ 1.4-1.7 ❑ 70°F-100°F ❑ NO FLASH %SuspendedSolids 5.01-9 ❑ EXACT pH ❑ 1.0-1.2 //i t ❑ >1.7 ❑ 101°F-141°F ❑ EXACT %Dissolved ❑ EXACT ❑ 142°F-200°F Solids IGNITABLE(if solid) ❑ICLOSED CUP %Free ❑ YES NO ❑ OPEN CUP Liquids i C. OTHER HAZARDOUS CHARACTERISTICS SPECIAL HANDLING CONSIDERATIONS INDICATE IF THIS WASTE IS: ❑ SUBJECT TO NESHAP SUBPART FF ❑ RCRA REACTIVE BENZENE REGULATIONS ❑ WATER REACTIVE ❑ ETIOLOGICAL ❑ RADIOACTIVE ❑ PESTICIDE MANUFACTURING WASTE ❑ OXIDIZING MATERIAL ❑ EXPLOSIVE/SHOCK SENSITIVE ❑ PYROPHORIC NONE OF THE ABOVE .i D. CHEMICAL COMPOSITION RANGE t. MIN.-MAX. 2. INDICATE IF THIS WASTE CONTAINS ANY OF THE VIA 1.1p FOLLOWING: NONE or LESS THAN or ACTUAL PCB's ❑ <50 ppm ppm S - % Cyanides ❑ <250 ppm ppm Phenolics ❑ <50 ppm ppm Sulfides ❑ <500 ppm ppm ❑ MSDS ATTACHED ❑ SUPPLEMENTAL ANALYSIS ATTACHED % DESCRIBE: TOTAL(MUST BE>_100%) ALL CHEMICALS LISTED ON MSDS MUST BE INCLUDED IN THIS SECTION. ALSO LIST ALL SUBSTANCES REGULATED UNDER NO.OF PAGES ATTACHED: OSHA 1910.1000,SUBPART Z. PAGE 1 217 SOUTH FIRST STREET MATERIAL:PRCIILE:51,E]ET� CYC�I ELIZABETH,NJ 07206 PRODUCT CODE .LE CHUM RECYCLING TREATMENT&DISPOSAL OF HAZARDOUS WASTE (908)355-5800 PROCESS CODE A: GENERATOR INFORMATION GENERATOR.US EPA I.D. I M I �I 5, 101 1 I -7 19 I 61 to A I to I 44494 GENERATOR STATE I.D. I I I GENERATOR NAME B :fn_ A_)51,P- RQ&Aa&1Pn BILLING ADDRESS IF DIFFERENT MAILING ADDRESS 11 M 1111 S,tv p (S: m 1 CONTACT +4 1 Gr..- TECHNICAL CONTACT -/rr U �1 nIY1G1 TITLE PHONE ��0 1�+d -A SITE ADDRESS A�h.r_k�P RyAlymI M� NAME OF WASTE Q> f --ni� � /� '►�� PROCESS GENERATING WASTE B. PHYSICAL CHARACTERISTICS OF WASTE . COLORNISUAL DESCRIPTION PHYSICAL STATE @ 70°F DUMPABLE? t I. STRONG INCIDENTAL ❑ YES �^ �[ ODOR PRESENT? [� NO SOLID T� SINGLE PHASE ,CJ YES ❑ NO wn AC- { lJ 61-LAY ERED Pumpable? ❑ LIQUID ❑�WASTEWATER DESCRIBE ❑ POWDER ❑ MULTI-LAYERED ❑ YES KNO ❑ SLUDGE Pourable? ' LNONWASTEWATER ❑ SEMI-SOLID ❑ YES LLI T10 1t CORROSIVITY(pH) SPECIFIC GRAVITY FLASH POINT LIQUID/SOLID El <_2.0 ❑ 9.01-12.49 El <.8,- ❑ 1.2-1.4 El- <70°F 0-->200°F %Total Solids ❑ 2.01-5 El > ❑_12.50 .8-1�0�. ,� � �A ❑ 1.4-1.7 ❑ 70° Suspended F-100°F ❑ NO FLASH � 5.01-9 ❑ EXACT pH ❑ 1.0-1.2 ❑ >1.7 El101°F-141°F ❑ EXACT Solids %Dissolved ❑ EXACT ❑ 142°F-200°F �> Solids _ IGNITABLE(if solid) ❑_t.-LOS.ED CUP. %Free ❑ YES, NO ❑ OPEN CUP_ Liquids C. OTHER HAZARDOUS CHARACTERISTICS SPECIAL HANDLING CONSIDERATIONS INDICATE IF THIS WASTE IS: ❑ SUBJECT TO NESHAP SUBPART FF RCRA REACTIVE BENZENE REGULATIONS ❑ WATER REACTIVE ❑ ETIOLOGICAL ❑ RADIOACTIVE ❑ PESTICIDE MANUFACTURING WASTE - ❑ OXIDIZING MATERIAL ❑ EXPLOSIVE/SHOCK SENSITIVE ❑ PYROPHORIC NONE OF THE ABOVE a D. .CHEMICAL COMPOSITION RANGE 1. MIN.-MAX. 2. INDICATE IF THIS WASTE CONTAINS ANY OF THE { 1 FOLLOWING: r101 Y I 40 1✓1� NONE or LESS THAN or ACTUAL IN t- IP z ©S % PCB's ❑ <50ppm ppm T _ - % Cyanides ❑ <250 ppm ppm Phenolics ❑.<50 ppm ppm Sulfides ❑ <500 ppm ppm % ❑ MSDS ATTACHED 0 ❑ SUPPLEMENTAL ANALYSIS ATTACHED. - % DESCRIBE: TOTAL(MUST BE>_100%) ALL.CHEMICALS LISTED ON MSDS MUST BE INCLUDED IN THIS SECTION. . ALSO LIST ALL SUBSTANCES REGULATED.UNDER NO.OF PAGES ATTACHED: OSHA 1910.1000,SUBPART Z. PAGE 1 . '. 4 . UNIVERSAL TREATMENT STANDARDS Roqulated coniftent common name CAS# WW NWW Acenophthylene 208-96-8 0,059 3.4 trans-1,3-Dichlotopropylene 10061.02.6 0,036 18 Pentachlorophenol 87-86-5 0.089 7.4 Acenaphthene 83-32-9 0.059 3.4 Dieldrin 6057-1 0,017 0.13 Phenoceflne 62-44.2 0.081 16 Acetone 67-64.1 0.28 160 Diethyl phthalate - • 84.66-2 0.20 28 Phenonthrene - 85-01.8 0.059 &6 Acetontidie` 75-05.8 5.6 1.8 2.4 Dimethyi phenol 105-67.9 0,036 14. Phenol_ 108.95.2 0,039 6.2 Acetophenone 96.86-2 0.010 9.7 Dimethyl phthalate 131-11=3 '0,047 28 Ph6rate 298-02.2 0.021 4.6 2-Acetylonynofluorene 53.96.3 11059 140 DI-n-butyl phthalate 84.74-2 0.057 28 Phthalic acid 100-21.0 0.055 28 Acrolein 107-02-8 0.29 NA Ilk Dlnitrobenzene 100.25.4 0.32 2.3 Phthollo anhydride 85.44.9 0.055 28 Acrylamlde 79-06.1 19 23 4,6-Dlnitro-ocresol 53452.1 0.28 160 Prenamlde 239"-S 0.093 1.5 Acryonl1fl a 107.13-i 0.24 84 24-Dlnitrophenol 51.28-5 0.12 160 Pyrene 129.00-0 0.067 8.2 Alddn 309-00.2 0.021 0.066 24-Dlnitrotoluene 121-14.2 0.32 140 Pyrldlne 110.86.1 0.014 16 4.Aminobiphenyt 92-67-1 0.13 NA 26-Dlnitrotoluene 606.20.2 0.55 28 Safrole 9459.7 0.081 22 Aniline 6253.3 0.81 14 DI-n-octyt phthalate 117.84-0 0.017 28 Slivex(24,5-TP) 93.72-1 0.72 7.9 Anthrocene 120.12-7 0.059 3.4 p-Dtmetylaminoozobenzene 60-11-7 0.13 NA 2,4,5,-T (20- 93.765 0.72 7.9 Aramite 14057-8 0.36 NA DI-n-propyinitrosomine 621-64-7 0.40 14 Tdchkxoph=xyocekockd) alpha-BHC 319-84-6 0.00014 0.066 1,4-Dloxane 123.91.1 NA 170 1,2,4,5 Tetrachbrobenzene 95.945 0.055 14 beta-BHC 319-85.7 0.00014 0.066 Diphenyiamine 122-39-4 13 TCDDs(AN NA 0.000063 0.001 delta-BHC 319-86-8 0.023 0,066 (difficult to distinguish from, Tetrachkxodbenzo-p-dloxtrs) gamma-BHC 58.89-9 0.0017 0.066 diphenylnitrosamine) 0.92 TCDFs NA 0.000063 0.001 Benzene 71-13-2 0.14 10 Diphenyinitrosomine 86-30.6 13 (AN Tetrochlaodbenzoturats) Benz(a)anthrocenes 56-55-3 0.059 3.4 (difficult to distinguish from 1,1,1.2-Tetrachlo(oethane 630.20-6 0.057 6.0 Benzal chloride 98-87.3 0.055 6.0 diphenylomine) 0.92 1,122-Tetrachloroethane 79-34.6 0.057 6.0 Benzo(b)floufanthene 205-99.2 0.11 6.8 1,2-Diphenylhydrazine 122-66.7 0.087 NA Tetracholoroethylene 127-18-4 0.056 6.0 (dxflcult to distinguish from _ Diwlfoton 298.04.4 0.017 6.2 23,4,6-Tetrachbrophenol 58-90.2 0.030 7.4 bamo(k)frduudxsthena) Endosulfon 1 939.98-8 0.023 0.066 - Toluene 108-88-3 0.080 10 Benzo(k)flouranthene 207-08-9 0.11 6.8 EndosuMan 11 33213-6.5 0.029 0.13 Toxophene 8001-36-2 0.0095 2.6 (difficult to dirtingulsh from Endosulfon sulfate 1.37.07-8 0.029 0.13 Bromoform 75-25.2 0.63 15 bemo(b)floumn*mw) Endrin 72.20-8 0.0028 0.13 (Tribromomethane) Benzo(g,h,l)peTylene 191-24-2 0.0055 1.8 Endrin aldehyde 7421-93.4 0.025 0.13 1,2,4-Tdchlorobenzene 120.82-1 0.055 19 Benzo(a)pyrene 50-32.8 0.061 3.4 Ethyl acetate 141-78.6 0.34 33 1,1,1-Trlchioroethone 7155.6 0.054 AO Bromoddchloromethone 75-27-4 0.35 15 Ethyl cyanide(Proponenitdie) 107-12-0 0.24 360 1,1,2-Tdchioroethane 79.00-5 0.054 6.0 Methyl bromide 74.83-9 0.11 15 Ethyl benzene 10041-4 0.057 10 Tdchloroethylene 79-01.6 0.054 &0 (Bromomethane) Ethyl ether 60-29.7 0.12 160 TdcNOtartoratkbranettwne 75.69.4 0.020 30 4-Bromophenyiphenylether 101-55.3 0.055 15 bis(2-Ethyihexyl)phthalate 117.81-7 0.28 28 24,5-Trichlorophenoi 95.954 ale 7.4 n-Butyl alcohol 71.36-3 &6 2.6 Ethyl methacrylate 97.63.2 0.14 160 2,4,6-Tdchlorophenol 88.06.2 0.035 7.4 Butyl benzyl phthalate 85.68-7 0,017 28 Ethylene oxide 75-21.8 0.12 NA 1,2,3-Trlchbropropane 96.184 0.85 30 2-sec-Butyl-4,6• 88.85-7 0.066 2.5 Famphur 52.85-7 0.017 15 1,1,2•Tdchloro-),22- 76-13-1 0.057 30 dintrophenoi(Dinoseb) Fluoranthene 206-44-0 0,068 3.4 trifluoroethane Carbon disulfide 75.15-0 3.8 7.8 myt rev Fluorene 86-73-7 0.059 3.04 tris-(2,3 Dlbromopropyl) 126-72-7 0.11 1110 Carbon tetrachloride 56-23-5 0.057 6.0 Heptachlor 76.44-8 0.0012 0.066 phosphate Chlordane(alpha& 57-74-9 0.0033 0.26 Heptachlor epoxlde 1024.57-3 0.016 0.066 Vinyl chloride 75-014 0.27 6.0 gamma Isomers) Hexachiorobenzene 118.74.1 0.055 10 Xylenes-mixed Isomers 1330.20.7 0.32 30 p-Chioranlline 106.47.8 0.46 16 Hexochlorobutodlene 87.68.3 0.055 5.6 (sum of o-,m-,and p- Chlotobenzene 108-90.7 0.057 6.0 Hexachlorocyciopentodiene 77.47-4 0.057 2.4 xvlene concentrations) Chlorobenzilate 510.16-6 0.10 NA HxCDD's NA 0,00063 0.001 2-Chloro-1,3-butodiene 126.99.8 0.057 0.28 (AN Hexochlorodbenzo-p•dioft) constituent Chlorodibromomethone 124.48.1 0.057 15 HxCDF's NA 0.00063 0.001 Antimony 7440.36-0 1.9 21 mpn Tcu, Chloroethane 754W 0.27 6.0 (AN Hexachbrodbenzofurans) Arsenic 7440.38-2 1.4 5.0 mpit TCLP bis(2-Chloroethoxy) 111-91-1 0,036 7.2 Hexachloroethone 67.72-1 0,055 30 Barium 7440.39-3 1.2 7.6mWirco methane Hexachloropropylene 1888-71-7 0.035 30 Beryllium 7440.41-7 0.82 0.014mpnTaLP bis(2-Chloroethylene) 111-44-4 0.033 6.0 Indeno(1,2,3-c,d)pyrne 193-39.5 0.0055 3.4 Cadmium 7440-43-9 0.69 0.19mon TCLP Chloroform 67-66.3 0.046 6.0 lodomethane 74-68-4 0.19 65 Chromium(Total) 7440.47-3 2.77 Q86 mall TCLP b&(2-Chbrolsopropyi)ether 108-60.1 0.055 7.2 Isobutyl alcohol .78.83-1 5.6 170 Cyanides(Total)s 57-12-5 1.2 690 p-Chloro-mcresol 59.50-7 0.018 14 Isodrin 465-73-6 0.021 0.066 Cyanides(Amenable)4 57-12-5 0.86 30 2•Chioroethyl vinyl ether 110-75.8 0.062 NA Lsosafrole 120.58-1 0.081 2.6 Fluoride 16964-48.8 35 NA Chloromethone 74.87-3 0.19 30 Kepone 143.50.8 0.0011 0.13 Lead 7439-92-1 0.69 Q37 rnpli Tcu, (Methyl chloride) Mythocrylonitrile 126.98-7 0,24 84 Mercury-Nonwastewater 7439-97.6 NA 1120mp11 Tcu, 2-Chioronaptholene 91.58-7 0,055 5.6 Methanol 67-56-1 5.6 07.5 myr tar from Retort 2-Chlorophenol 95-57.8 0,044 5.7 Methopyrllene 91-80-5 0.081 1.5 Mercury-All others 7439-97-6 0.15 0.025mg11 TCLP 3-Chloropropylene 107-05-1 0.036 30 Methoxychlor 72-43.5 0.25 0.18 Nickel 7440-02.0 3.98 5.0 myt TCLP Chrysene 218-01-9 0.059 3.4 3-Methyicholonthrene 56-49.5 0,00% 15 Selenium 7782-22-4 0.82 0.16mp/t TCLP o•Cresoi 95-48-7 0.11 5.6 4,4-Methyleneb1s 101-14-4 0,50 30 Sliver 8496.25-8 0.43 0.30mwiTCLP m-Cresol(difficult to 108-39-4 0.77 5.6 (2-chloroaniline) Sulfide 7440-28-0 14 NA distinguish from p-cresol) Methylene chloride 75-09-2 0.089 30 Thallium 7440.28-0 1.4 0.078myt TCLP p-Cresol(difficult to 106-44.5 0.77 5.6 Methyl ethyl ketone 78-93.3 0,28 36 Vandadium 7440.62.2 4.3 0.23 mp/i Tap distinguish from m-cresoq Methyl isobutyl ketone 108.10.1 0,14 33 Zinc 7440.66.6 2.61 5.3mpd)TCLP Cyclohexonone 108.94.1 0.36 0.76 man Tar Methyl methacrylate 80-62-6 0.14 160 1,2-Dibromo-3- 96-12-8 0.11 15 Methyl methansuifonate 66.273 0.018 NA chbropropone Methyl parothlon 298.00.0 0,014 4.6 t CAS means Chemical Abstract Services. When the Ethylene dibromide 106.93.4 0.028 15 Naphthalene 91-20-3 0.059 •5.6 waste code and/or regulated consfEtuents are describes as (1.2-Dibromomethane) 2-Nophthyiomine 91.59-8 0.52 NA a combination of a chemical with Its sags and/or esters,the Dibromoethane 74-95-3 0.11 15 o-Nitroanlilne 88-74-4 0.27 14 CAS number Is given for the parent compound only. 2,4- D(2,4• 94-75-7 0.72 10 p-Nitroaniilne 100-01.6 0.028 28 2 Concentration standards for wastewaters are ex- Dichlorophenoxyacetic Nitrobenzene 98-95-3 0.068 14 pressed In mg/i and are based on analysis of composite acid) 5-Nitro-o-toluldine 99-55-8 0.32 28 samples. • o,p'-DDD 53-19-0 0.023 0.081 o-Notrophenoi 88-75-5 0.028 13 J Except for Metals(EP or TCLP)and Cyanides(Total and p,p'•DDD 7254.8 0.023 0.087 p-Nlrophenol 100-02-7 0.12, 29 Amenable)the nonwastewater treatment standards ex• o,p'-DDE 3424.82-6 0,031 0.087 N-Nitrosodlethylarrdne 55.18-5 0.40 28 pressed as a concentrations were established,In part,based p,p'-DDE 72-55-9 0,031 0.087 N-Nitrosodlmethylamine 62.75.9 0.40 2.3 on Incineration In units operated In accordance with the o,p'-DDT 789-02-6 0,0039 0.087 N-NHfoso-di-n-butylamine 924.16.3 0.40 17 technical requirements of 40 CFT part 264,subpar O or 40 p,p'-DDT 50.29.3 0.0039 0.087 N-Nitrosomethylethylamine 10595.95-6 0.40 2.3 CFT part 265,subpart O,or based on combustion in fuel sub• Dlbenz(o,h)onthrocene 53.703 0.055 8.2 N-Nitrosomorpholine 59-89.2 0.40 2.3 yriKution units operating In accordance with applicabletech- Dibenz(a,e)pyrene 192 65 4 0.061 NA N-Nltrosopiperidine 100-75 4 0.013 35 nlcai requirements. A facility may comply with these treat- m-Dichlorobenzene 541.73-1 0,036 6.0 N•Nitrosopyrroiidine 930.55.2 0.013 35 ment standards according to provisions of 40 CFR 268.40(d). o-Dichlorobenzene 9550-1 0.088 6.0 Parathion 56.38-2 0.014 4.6 All concentration standards for nonwastewatefs are based p•Dichlorobenzene 106-46.7 0.090 6.0 Total PCBs(sum of all PCB 1336.36.3 0.10 10 on analysis of grab samples. Dlchiorodifluoromethane 75-71.8 0.23 7.2 Isomers,or all Arochiors) s Both Cyanides(total)and Cyanides(Amenable)for 1,1-Dichloroethane 7534.3 0.059 6.0 Pentochlorobenzene 608-93-5 0.055 10 non wastewaters ore to be analyzed using methfx19010 or 1, Dlohloroethane 107-06.2 0.21 6.0 PeCDDs NA 0.000063 0.001 9012 found 1n`Test Methods for Evaluating Solid Waste,Physl- 1,11 1 Olchloroethylene 75 3.�4 0.054 6.0 (AN PentachbrodNdenzo-p- cal/Chemical Methods,"EPA Publication SW-846,as Incor- traris-1,2-Dbhloropropylene 156-60-5 0.054 30 dloAis) - 24•Dbhlorophenol 120-83-2 0.044 14 PeCDFs NA 0.000035 0.001 paroled by reference in 40 CFT 260.11,with a sample size of 26•Dichlorophenol 87.65.0 0.044 14 (AN PentochWodbenzofurans) 10 grams and a distillation time of one hour and 15 minutes. 1,2-Dbhloropropone 78.87-5 0.85 18 Pentochloroethane 76.01-7 0.055 6.0 3 Zinc is not an"underlying hazardous constituent*in cis-1,3-Dlchloropropylene 10061.O1-5 0.036 18 Pentochloronitrobenzene -82.68-8 0.056 4.8 characteristic wastes,according to the definition at 268.2M. NOTE;NA means not applicable. C cleChem y Recycling Treatment&Disposal of Hazardous Waste 217 South First Street, Elizabeth, NJ 07206 • 908-355-5800, FAX: 968-355-0562 CYCLE CHEM, INC. LAND DISPOSAL RESTRICTIONS 217 S. FIRST ST. NOTIFICATION AND CERTIFICATION FORM ELIZABETH NJ 07206 NJD002200046 Generator -r-- q�A Manifest Number . USEPA ID No. OA P�-09 70, n (D_ Is Waste Analysis available? x No Yes, Copy Attached I. MANIFEST INFORMATION ) LINE WW LIST ALL EPA HAZARDOUS CCI PRODUCT ITEM �� WASTE COIFS �1 RA CODES) CODES� 1�/y ft r U. 268.9 SPECIAL REQUIREMENTS FOR WASTES THAT EXHIBIT A CHARACTERISTIC The wastes identified below contains underlying hazardous constituents as defined in 268.38 LINE ITEM EPA NO. TREATABILITY GROUP ABCD D001 Ignitable Characteristic Wastes, except for the 261.21 (a) (1) High TOC Subcategory, that are managed in non-CWA/ non-CWA equivalent/ non-Class 1 SDWA Systems. ABCD_ D002 Corrosive Characteristic Wastes, that are managed in non-CWA/non-CWA equivalent/ non-Class 1 SDWA Systems. . ABCD D012-DO43 Wastes that are TC based on the TCLP in SW846 Method 1311. UNDERLYING HAZARDOUS CONSTITUENTS D001, D002, D012-DO43 OR F039 WASTES ABCD ABCD_ ABCD ABCD ABCD_ ABCD_ ABCD_ ABCD_ ABCD ABCD III. LAB PACK CERTIFICATION "For line items, I certify under penalty of law that I personally have examined and am familiar with the waste and that the lab pack contains only wastes which have not been excluded under appendix IV to 40 CFR Part 268, or solid j wastes not subject to regulation under 40 CFR Part 261. I am aware that there are significant penalties for submitting a false certification, including the possibility of fine or imprisonment." I MASSACHUSETTS FIRE INCIDENT REPORT C 10 . FDID DEPARTMENT Revised Form t1922 Hyannis Fire Department Report "' �•, If Ex Date Alarm Arrival In Service Inc' r"` Day 6 01166 Fire w0012/5/97 IFriday � 19 :43 119 :53 121 :48 TI UND ACTION TAKEN IMUTUAL AID PCPpaived w/ No Ign 4 1 Type of Action, Not Class. PROPERTY USE (OCCUPANCY) » IGNITION FACTOR Public Street '9 6 2 NOhE OCORRECT ADDRESS ZIP CODE CENSUS TRACT D ATTUCKS LANE 02601 20 O 1 1 OCCUPANT NAME (LAST, FIRST, MI) NE ROOM or APT.7TELEPHO MATT BALL 508 398-8169 F, OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE 12 MATT BALL 371 LONG POND DR,S YARA 508 398-8169 13 METHOD OF ALARM CO. DIST. © PERSONNEL ENG RESP. _......... JAERIALS RESP. 2 RESP. � 0. 1 SHIFT HAZ MAT PRESENT? Y 1 2 2 TANK. RESP. JOTHER RESP. C .... ": Telephone (Direct) NO. AL SUBSTANCE 0 0 0 SPEC. EQUIP. USED? ABSORBENT PADS O FIRE 2 0 ...... SERVICE O O » OTHER Q Q Q O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LOSS TOTAL INS. 0 CLAIM PD YEAR MAKE MODEL COLOR LICENSE NO. VIN# 30 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION OCOMPLEX AREA OF ::: EQUIP INVOLVED IN IGN. ORIGIN FORM OF HEAT IGNITION "<: MATERIAL FORM ....... TYPE -- IGNITED METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE OEXTINGUISHMENT EXTENT OF DAMAGE Flame ......... Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE »' P 0 Material generating FORM TYPE no most smoke WEATHER AVENUE OF SMOKE TRAVEL R CONDITIONS Officer in Charge: Date GRANT,JOHN IEPUTY CHIE 1 2/5/9 7 Comments for this incident have been printed on an additional comments page. Ccniments'for Incident: 97 001166 Exposure: 00 Date: 12/5/97 RECEIVED A CALL FOR A VEHICLE LEAKING OIL AT THE BARNSTABLE ATHLETIC CLUB ON ATTUCKS WAY. WE'RESPONDED WITH E-826 WITH FF LAMOTHE AND FF BLACK.WHILE ENROUTE THERE WAS A REPORT OF AN MVA IN THE VICINITY OF OUR OIL LEAK.WE STOPPED FOR A QUICK SIZE-UP OF THE MVA AND AWAITED R-828.OUR RESONSE T% ATTUCKS WAS ONLY DELAYED FOR A MINUTE OR TWO. n N UPON OUR ARRIVAL WE FOUND THE VEHICLE WAS PARKED AT THE ATHLETIC CLUB AND THE OWNER STATED THE CAR SLIPPED OUT ON A THE CORNER OF AT-FUCKS AND INDEPENDENCE DR. HE THEN WENT OFF THE ROAD AND STRUCK A CURB.THE CURB DAMAGED THE OIL PAN OF HIS CAR AND WAS LEAKING L ENGINE OIL AN OIL CATCH PAN WAS PLACED UNDER THE CAR TO CATCH THE REST OF THE OIL AND DAVIS TOWING WAS CALLED TO d TOW THE CAR. WE TRACED THEPAT F O H O THE CAR AND NOTICED THAT THERE WAS A TRAIL OF OIL LEADING FROM THE CURB THAT WAS HIT DOWN TO SOFTWARE 2000.WE DAMNED UP THE THREE STORM DRAINS THAT WERE IN THE AREA WITH SPEEDY DRY AND DIRT BUT WERE UNSURE OF THE AMOUNT OIL THAT INFACT MADE IT INTO THE CATCH BASINS.WE ALSO USED \� ABSORBENT PADS TO GET THE BULK OF THE OIL OUT OF THE RAIN WATER. Li WE MADE A CALL FOR THE DUTY OFFICER AND WE MADE A CALL TO THE BOARD OF HEALTH. s THERE WAS A DELAY IN RESPONSE FOR THE BOARD OF HEALTH BUT EVENTULLY JERRY DUNNING WAS CONTACTED AND WAS ENROUTE. ANOTHER PROBLEM WAS THE OIL IN THE WET ROADS WAS A SAFETY CONCERN SO THE TOWN OF BARNSTABLE SANDER WAS CONTACTED AND THE ROADS WERE SANDED. DEPUTY GRANT ARRIVED AND HELPED WITH GETTING THE PROPER AUTHORITIES NOTIFIED. JERRY DUNNING OF THE BOARD OF HEALTH ARRIVED AND ALSO WAS CONCERNED AND STATED WHERE THIS WAS TOWN j PROPERTY AND WAS A WATER SHELTER AREA HE ADVISED THAT A CALL TO CLEAN VENTURES SHOULD BE MADE. MR DUNNING ADVISED CLEAN VENTURES OF THE SITUATION AND WANTED THEM TO RESPOND TO SIZE UP THE h SITUATION. ati DEPUTY GRANT ALSO TALKED TO CLEAN VENTURES AND THEY WERE ADVISED THAT WHEN THEY GOT IN THE AREA TO J` GIVE THE FIRE DEPT A CALL AND HE WOULD RESPOND TO THE SCEENE AND POINT OUT THE PROBLEM. S THE RAIN HAD STOPPED AND THE ROADS WERE SANDED.THE STORM DRAINS HAD GOOD DAMNS AROUND THEM AND ABSORBENT PADS WERE GETTING MOST OF THE OIL WE FELT THE THE SCEENE WAS SECURED UNTIL v THE CLEAN UP COMPANY ARRIVED. 802 AND E-826 RET TO HEADQUARTERS. �A A CALL WAS MADE TO THE D.E.P.AND A MR BRENNA WAS ADVISED OF THE SITUATION. HE WOULD CALL THE �N_ CLEAN-UP COMPANY TO LET THEM KNOWN WHAT WHE WAS LOOKING FOR. IMPORTANT INFORMATION-- VEHICLE DRIVER-MATT BALL 371 LONG POND DR-S.YARMOUTH 508-398-8169 �(`O��LC� p VEHICLE- 1986 MER. BENZ-190 D MA-1740AT �d �"/ v � ~S a S Yn `� INSURANCE-LIBERTY MUTUAL BOARD OF HEALTH AGENT-JERRY DUNNING 2a r y I '� i Town of Barnstable Department of Health,Safety,and Environmental Services ' Public Health Division * > w��B> P.O.Box 534, Hyannis MA 02601 iiu►K p,�i639. 'FD NIl1�'t� Phone: 1-508-790-6265 FAX: 1-508-790-6304 Fcqx To q,` � Y �[h g From: (Z;, "(A, Fax I Z�) 0 13 6 9 Pages(including cover): Phone: 0 -It y 6 - 4 U Z 6 Date: 12,- ! Z C (p..�w. Re: o '4 5"4 2(8 3® 1 CC: t_ KFor O Urgent Review [I Please Comment O Please Reply C]Please Recyde •Comments: x: i 7Op a ME AW LABOR§jiEET• L # 1 2987 . CUSTOMER DAY DATE 4ls i JOB LOCATION CUSTOMER REP. he I ® (Cleat en CVI REP. `CL LABOR SHEET ® NAMES CODE START FINISHHOURS HOURS HOURS HOURLY HOURLY NOURLY AMOUNT AMOUNT AMOUNT St OT OT RATE RATE RATE ST OT OT TOTAL ST OT pT N ' W Ad en �A m to to i p 1 H I I 1 o ~ I � � 1 TOTAL o PROTECTIVE CLOTHING ANALYSIS V t LEVEL OF PROlECT10N PERSONNEL RATEOMANOAY TOTAL NUMBER OF RATEIANALYBIS TYPE OF ANALYSIS ANALYTICALLAS TOTAL «. I SAMPLES U I PPE LEVEL d PPE LEVEL C i PPE LEVEL B LL ! PPELEVELa ---- — --- ------ -- - f y I REOAKS TOTS �-I 1 TOTAL 1 2 t I10, Yerl �00 7z�Yp/m�e LfE6 ms ✓ — - A I ENO: S.SUPS SOR F•FOA AN CT. H9W NICIAN SO.SAFETY OFFICER W.MARINE BORER Q ' I 0-DAIV.S C6 CHEMIST EC+EOUIPMENT OPERATOR FC.F{ELOCLERK BO.BOAT OPERATOR ff I CUSTOMER SfGNATUpE po,Co, i✓ C rennnn nr.�„7Q /Dr�po✓ed %:k�nn v� nc:�l••/� 77 arpIvx I'A.", os# 9 7 3 EC]UIPMENTSHEET Il/ E # 42987 USTOMER r .l+}d L,/p. ,e /� DAY DATE ITT�7 dB LOCATION_ G ,/` Za n eCUSTOMER REP.�,�r�//i�nnin n A & i r, �rleanV .� u CVI REP. m '1 �s75�7C`ram EQUIPMENT SHEET AM"011IITORINOEQUIPMENT OTT THFE TIME TOTAL RATPl TOTAL MARINEEOIEPMWFT QTY TWE 71ME TOTAL RATIV TOTAL an Off HOURS HOUR AMOUNT ON OFF noun HOUR AMOUNT e jw lCO s 2W WORK BOATS ND/TIP _ <2V WORK BOATS tf)OTHER BOOM RENTAL PER FOOT JON BOATS W/ENGINES KILUNO 6TOCK JON BOATS WOO ENGINES ISRSONNELVEWCLESIVAN e� M SPILN.T"LERS O "TRUCKS n• �+ RADIOS -'r171L-- -�— I- PANETfPJCKS SWMPACS YICUUMTAUCKS(STRAIGNT) HIGH PRESSURE WASHER AODUM TRAILEAS ANCHORS ACTOWPAESS VAC OTHER ! ZO NX1aFFBOXE3 TANKOLEASM iACTOIR EXPLOSIONPROOF UGHTS (O MEq T HONSPMKTOOLS V EXPLOSION PROM FAN Awe atom -- ---- AIRNIOSE i u )UBLE DIAPHHAOM-SITE( ) OTHER IMP PUMP-SIZE( J HEAVY EQUIPMENT LL JC79MA DISCHNARGE HOSE — — BACKFIOE tpE( 1 On ! LENGTH( ) VCTOA PIPING- FEET( SIZE( LOADERS MEA•TYPE( ) SIZE( ) FORKLIFT N GENERATORS lT) �j AIR COMPAESSOA t CDj MISC.HANOTOOLS o n V q OTHER PAGE TOTAL CUSTOMER SIGNATURE JOB N MATERIAL SH ET p M # 12987 CUSTOMER DAY — DATE A fig JOB LOCATION CUSTOMER REP. 110 CleanVeaftre CVI REP. cc a MATERIALS MATERIAL SHEET' o aTy RAlrF r. SUBCONTRACTOR M PADS w O NAME DESCRIPTION TIME TIME OF WORK m zd ON OFF Q1 C- ASSOMENTBOOM m SWEEPS IROLLS -- ---- — - - -- — — ----._T.. -- -- - --_ SNARE POM POM( )ROPE 1 ) — BPEEW DRI VERUWMiTE OTHER DISPOSAL pTY DESCRIPTION MANIFESTNNAIBER IIRWOlANDOONTAWERS 0 GALLON 17 H Z 66GALLONITE ¢ en CO 0 6 GALLON PAILSLo ��� r W U OVERPACKSes( ) IS#( ) }Y o�• U OTHER D U SUPPiJBB SUBSISTENCE o PLAsnC sHEET1No•sim( ) LL NUMBER OF PERSONNEL RATMAY TOTAL POLY ROPE �D PLASTIC BARS SNOW FENCE COMMENTS- N ' SAMPUNG TOOLS m CUSTOMER SIGNATURE: i c j CUSTOMER SIGNED D I w DAILY NOTES COMPLETED O o MANIFESTS,WEIGH TICKETS,PACKING SUPS ATTACHED ❑ PAGE TOTAL THESE FORMS MUST BE SIGNED AND RETURNED DAILY. BARNSTABLE FIRE DEPARTMENT �! 3249 Main Street -P.O. Bog 94 s o i 8 97 0' Barnstable, Massachusetts 02630 ''♦���4C m 508-362-33.12 M� FAX: 508-362.8444 WILLIAM A.JONES III,CHIEF GLENN B.COFFIN,cmu m FIRE PREVENTION UNDERGROUND STORAGE TANK REPORT t� Property Address: Old Route 132) 4YA.,� �t Property Owner: Northside Bus Service, Inc. —David A. Jones Removal Date: April 9, 1998, 0945hrs a COMMENT: Witnessed the removal of a 1000-gallon U.G.S. Tank from this location. The tank appeared to be in good condition, and there were no signs that it had been leaking. The excavation site appeared clean with no signs of discoloration or fuel odors. The contractor was advised to remove the tank from this location and backfill the site. William . Jones, III Fire Chie ' Make application to local Fire Departrt, Fire Departn,, At retains original application and issues I plicate as Pec�lyitr- r-- _ .C777 , - _ �� ( i APPLICATION and M PER 1 1 I !T for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions Of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: • Tank Owner Name(please print)Norths ide Bus Service , Inc. X Address 1582 Old Rt . 132 Vg­line aplyN9 arpe M, Barnstable MA 02630 Street . , State TW • , Company Name Enviro-Safe Corp. Pdnt Co.or Individual Address P•G.Box 304 , Sagamore , MA P"r Print Address Signature a P-1 " pp ing for per Signature(if applying for permit) XIFCl Certified Other ❑ IFCI Certified ❑ LSP# Other Tank Location 1582 Old Rt .. 132 , Barnstable , MA Ste—f Address " Tank Capacity City p y(gallons) 1 0 0 0 Tank Dimensions(diameter x length) 121 X 4 ' Substance Last Stored #2 Fuel Oil Remarks: � e Firm transporting waste Enviro - Safe Corp, t u --. State��i c.,. 3 2 9 Hazardous waste manifest# TBA E.P.A.# Approved tank disposal yard _ Turner Salvage Co Tank yard# 002 Type of inert gas Nitrogen Tank yard address 225 Commercial St . , Lynn , MA CityorTown Barnstable Fire District 01919 FDID# Permit# Dateof issue April 8 ; 1998 April 16 , 1998 Date of expiration Dig safe approval number. 981405251 D' afe.Toll Free Tel. Number-800-322-4844 Signature/Title of Officer granting permit After removal(s)send Form FP-29OR signed by Local Fire Dept.t&OST Regulatory Compliance Unit,One Ashburton Place, Room 1310, Boston, MA 02108-1618. FP-292(revised 9/96) TOXIC AND HAZARDOUS MATERIA S REGISTRATION FORM NAME OF BUSINESS: v e = i ! t off' Mail To: BUSINESS LOCATION: 4,2 ZQZZ s 1.,,4t� Board of Health MAILING ADDRESS: tc Town of Barnstable 1- & TELEPHONE NUMBER: - P.O. Box 534Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: (p 2 3511S Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use,4iiUNFe YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case A/, Antifreeze (for gasoline or coolant systems) �,f, Drain cleaners Automatic transmission fluid Toilet cleaners A6 Engine and radiator flushes Vo Cesspool cleaners fy� Hydraulic fluid (including brake fluid) I _ Disinfectants Ha Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel No Refrigerants . A(c Diesel fuel, kerosene, #2 heating oil �, Pesticides (insecticides, herbicides, )k*T Other petroleum products:,grease, lubricants rodenticides) �ooZ (c D.Z Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages 2000 &9 Printing ink Battery acid (electrolyte) N. Wood preservatives (creosote) tZ, Rustproofers AA, Swimming pool chlorine Car wash detergents ., Lye or caustic soda D Car waxes and polishes Mo Jewelry cleaners JVO Asphalt & roofing tar Wo Leather dyes Alc, Paints, varnishes, stains, dyes KA, Fertilizers (if stored outdoors) XJn Paint & lacquer thinners �L, PCB's AZO_ Paint & varnish removers, deglossers Other chlorinated hydrocarbons, ffo Paint brush cleaners 1 (inc. carbon tetrachloride) Floor & furniture strippers � Any other products with "Poison" labels I Metal polishes (including chloroform, formaldehyde, A Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may A4.9 Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents N/c Bug and tar removers /did _ Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business I .'A satisfactory 2.Printers SuppliersMe DFOR IN 0 ow 3.Auto Body Shops unsatisfactory- 4.Manufacturers 5.Retail Stores see"Orders") 6.Fuel 7.Miscellaneous C A ' As .•• • . •.. Case lots Drums Above Tanks Underground Tanks MENOMINEE 0 0011011M 0 loss A � i d • III � 1 �� �_ � .� .. pm 10 gas N 10 r&si I.;,, R, 14A 1w 10119KAiml loss PAN I Name of Hauler Destination Waste Product Licensed? • ��ss-r���r�wnr�swi..� �� �uvr'�.�_u•or--�iia��r:.�a_�t_ n l TOWN OF BARNSTABLE k OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops 6 unsatisfactory- 4.Manufacturers COMPANY '` P� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous UANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MA R Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAUR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Al- 1)6skal 1 b O Town Sewer OPublic O On-site OPrivate L 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO w �" / O Holding tank:MDC f�S/J 0AV S/ 4 O Catch basin/Dry well i O On-site system 5. Waste Transporter. Name of Hauler Destination Waste Product YES I NO 1: 2. erson (s) Interviewed Inspe r Dat h REMIT TO: INVOICE®ICE OFFICE PAGE: 1 leat"In"arbo Clean Harbors Env ger ices Inc New England Service Center �civ ONMENTAI SERVICES COMPANIES 1200 Crown Colony Drive 4th Fl Quincy MA 02169 I617>849-800 617-380-4390 - It you have any questions regarding this invoice,please contact your customer service representative at the location listed above. T&D 3 DRUMS ° o ON CAPE LITHOGRAPHERS INC oT D BE ON CAPE LITHOGRAPHERS INC 1 ATTUCKS WAY INDEPENDENCK PRK HYANNIS, MA 02601 1 ATTUCKS WAY INDEPENDENCK PRK HYANNIS, MA 02601 CUSTOMER JOB:NO:' PURCHASE;ORDER>NO.' " 'SALESMAN. 'TERMS`::' INVOICE`DATE m +:INVOICE NO. ONC100 C 3163 1076 NET 15 DAYS 11/30/9 CC31108466 QUANTITY ITEM J.D: DESCRIPTION PRICE U/M,;' ;AMOUNT 11/29/93 1 .00 T40647 WASTE OIL 195 .0000 55D 195 .00 MAH280493 1 .00 P036335 WASTE WASHWATER/PHOTO CHEMICAI 165 .0000 55D 165 .00 MAH280493 2 .00 T40648 PRINTING INK 335 .0000 55D 670.00 MAH280493 1 . 00 TR TRANSPORTATION 145 .0000 EA 145 .00 55 . 00 TR MASS TRANSPORTER FEE / GALLON 0. 2000 GAL 11 .00 V0111r,'HER# V[_EFL °7 # q DISI DA'E ACCT.4�S3 /D, AI;T. ACCT. # DATE PC. .. is 11 JOB TOT A L: S11111 1186 .00 SALES TAX i MA Sales Tax 0.00 * TERMS: 1186 .00 NET 5 DAYS From Invoice Date .e I 'Triumvirate Environmental,Inc. Hazardous Waste Specialists P.O.Box 136 63 Inner Belt Rd. Somerville, MA 02143-0003 617-628-8098 Fax 617-628-8099 INVOICE 0004338 Attn: Accounts Payable On Cape I...i.thoaraphers, Inc. 22 Attucks Lane Hyannis, MA 02601 JOB# T 417 7 P.O.# DATE OF INVOICE%4/19/95 RE: . Disposal. CONTACT .Mr. Norm Barnes TERMS: .Net 30 DESCRIPTION UNIT PRICE Disposal: 6 X 55 Ink - Heavy Oil. and Soy Based $150.00 $ 900.00 Supplies: 6 X 55 17H Drum 4 `( ,'r' r 30.00 1£30.00 Transportation: 1/200.00 200.00 o UCI / � Mass Transporter Fe 0182/lb 43.6£3 DZST DATE ACCT.9, 3 MIT. ACCT.# KNIT. DATE PD. C ;. TOTAL $ 1,323-68 PLEASE REMIT PAYMENT TO: Triumvirate Environmental, Inc. P.O. Box 136 Boston, MA 02143-0003 PLEASE NOTE: THERE IS A 1.5%FINANCE CHARGE ON ALL OVERDUE INVOICES.. .;.,, r • SPECIAL MARKETS SPECIAL MARKETS MANUAL ORDER FORM I . % DUNS NO.05106-0408 FED.ID NO.39-6090019 �' sate +Hleen® 1000 NORTH RANDALL ROAD Elgin,Illinois 60123 7857 Y n nl I� MANIFEST NUMBER C — — — — — — U CUSTOMER NUMBER CUSTOMER NUMBER S f ") ,, I ff O NAME f/ /I NAME R • ADDRESS I ADDRESS j �.... It t • CITY/STATE I ZIP CITY/STATE ZIP SERVICE DATE SALESMAN'S NO. CUSTOMER P.O.NUMBER SALES TAX EXEMPTION NO. SVC.TAX% PROD.TAX% CART.-PIS BOT.-PIS PROD.-PIS SERVICE INTERVAL USEPA BRANCH GENERATOR USEPA ID NO. GENERATOR STATE ID NO. •` • TRANSPORTER CORPORATE • IDR ILD984908202 "USDESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12.CONTAINERS 13. TOTAL 14.UNIT SK DOT NUMBER I certify that my total waste streams are v PRODUCT NO. TYPE QUANTITY WTNOL within one of the following categories: RO Waste 7 PGIII(EP ih lone 1202,1210 6.1 UN 1897 PGIII EPA F002,D007 D039 ERG p74 NO'S 506 RO Waste Combustible liquid,N.O.S.(Petroleum Naphtha) PRODUCT 1204 1211 0 TO NA 1993 PGIII EPA D001 D019 ERG 1127 NO. 569 220 LBS./MONTH Hazardous Waste,Liquid,N.O.S.(Trich'1motriII"oroeIhane) PRODUCT 521 Initials ' 9 NA 3082 PGIII EPA F002 ERG q37 NO. 1 209 PRODUCT 83358 513 2,200B LBS.MONTH Waste 1,1 1-Trichloroeihane 6.1 UN 2831 PGIII EPA F002 ERGk74 NO. RO Hazardous Waste,Liquid,N.O.S. PHOTO FIXER SOLUTION Initials 9 NA 3082 PGIII EPA D011 ERGN31 629 GREATER THAN 2,200 LBS./MONTH DESIGNATED FACILITY NAME AND ADDRESS: . Initials _ USA EP � /t (� i^ '� ^r,I'- * 9 SPENT MATERIAL MEETS ID NO. a+ f' r?J T j 1 ACCEPTANCE CRITERIA DTNO. YES[I NO❑ SERVICE NUMBER DESCRIPTION SERVICE UNITOF C QUANTITfY CHARGE MEASURE RETURNED ,� LINE TOTAL tt .6 s �. !zlk SERUICE,CHARGES I� l..r _ ?r xTAX _ a a ,-(r t- r:1� _ TOTAL SERUICE,CFiARGE,s MSIDS UNIT•• o `' PART NUMBER DESCRIPTION GIVEN PRICE EASU F QUANTITY INv LINE TOTAL j GIVEN MEASURE CODE I ,f,"?E''i El1� .-- , f �x�a & t vr.trY i ? El El El �a ems°v ..�-+�� s c.�:�ii .�,o, .;.,,, ,.a, .'. ,a,a �; ,...,A9:a .N..:,A„ ao »�:,'.:'X�A. :�-❑ � `Mk" ��� �b DRUMS NAME TITLE SIGN NAME (CHANGE) TITLE SIGN ON HAND a a 1 1 .���,TOETAI�PROD(JG'In 2 2:" TOA�SERVICE CASH ❑ TOTAL RECEIVED, APPLY PAYMENT TO �� CHARGE CHARGE MY ACCOUNT FOR THIS TRANSACTION ,(FHOM,ABOVE) CHECK NUMBER ❑TODAYS SERVICE/SALE UNLESS OTHERWISE INDICATED IN THE PAYMENT , `& RECEIVED SECTION. TOTAL DUE ❑ PREVIOUS BALANCE AS FOLLOWS ADDITIONAL TERMS AND CONDITIONS AND OTHER v`I • - INFORMATION APPEARING ON THE REVERSE SIDE ' INV# AMOUNT$ ARE MADE A PART HEREOF, w i PREVIOUS n CREDIT CARD NO. N 'This s to tort I that the above named malenals ar y c g o CREDIT CARD NO -- s, v proper classified.descrbee,packaged,marked and labeled.and z._:EXP,'DATE"A•b- are m proper condition for hanseenat on acconf n9 to the applicable n,plal ors of the Deparlment of T—sponat on.' 17 AMEX Y1SA �I ImI - Z ' CONSUMERREFERENCE Print 3 1.,. , a /� ; ;;., ; INFORMATION "' Name � ,...- <"", s,,,,. -�• __,., 'w GENERATOR/DESIGNED REPRESENTATIVE SIGNATURE SEE REVERSE SIDE FOR IMPORTANT INFORMATION` TOWN, OF BARNSTABLE LOCATION E#t7'a;r kS Ire Ae SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. I&Aj C, SEPTIC TANK CAPACITY /S®p G 57- LEACHING FACILITY:(type) mi s " — Tcj® (size) /aao al A NO. OF BEDROOMS p0a PRIVATE WELL OR PUBLIC WATER AgLLjc BUILDER OR OWNER a L.if Out DATE PERMIT ISSUED: 2zZ9 / 9/ T DATE COMPLIANCE ISSUED: all al VARIANCE GRANTED: Yes No r/' I� i piqu, CIS xtsr��iy ,• 00,0 tx sri�;l`� � /Soo u�� taoo Gtp No. �: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF.......C� t J.ST9..K1.� ........................................... Appl ration for Bisposal V, Iirks Tontrution ramit Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual Sewage Disposal System at: s-....wAX......i.�,���,�.�:�t�.����k��...........................................:...................................w....._-- Location-Address or Lot No. ...�o-Y.�E...k ...................--........._..... er Add r ss �.......�a.._...1\l .S.A}��.S�5.4�.Jd1. .......................... _ ..I... S7.fntafl...1J�.Q$A.1 .�. l .v, lfl�Q 17. InstaA Address Type of Building AA Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........—W-1-4-------------- Expansion Attic ( ) Garbage Grinder ( ) . Other—T e of Building p Showers ( ) — Cafeteria ( ) W YP g ....G�..,nsut....--.._. No. o persons.......................... Other fixtures ....C�@ra�irtiE:Qei,$l_.�ui� ,ei' ._.ssltt1i_.� + ...................................................... co. W Design Flow............1J.40......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.,frd o.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No-_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date..................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit..--................ Depth to ground water........................ a •---- •---------•-•----•--•-•••----••--------••----••-•......... .................................................................................... 0 Description of Soil..............Egi.Sl4iij----.f-s-'aa---&T _..._I lsr.&Vy...../.Q-A-jp...6LP................................................ V --------- -... ------- ---- ---------- -------------- ------------ .-------- ------- .-------------- ............. ----------------------- ---------------------- --------------------------- ......._......_......... Z --••--•--•-•----------------•----•-•--------•-•--------•-•----------•---------------......-•-----•-------•-•------------•-----------•-••------------••............-----•----•--••--...--•---..........-- U Nature f Repairs or Alterations—Answer when appl'cable...,,[,,.J.$"ar.4(Y*-r1c.,.....ct.F...�9...ktJCuO...tvn p-...C,A1 g� 'v7 .�sJ, ..14zt►�:a.�o t.. ------------------------------------------------------------------------------••-------••------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI:'l.iJ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of healt . qq Signed..... 'tL�.i � ACr �3�..�.1- Application Approved BY--2-•`----a4.ti� --•------•.......................... . ---.........---.��.......�... Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------_ ......--••-----------------------------------------•---------------......---------------•------------...................---------------------------------------------...........•--------•----•--•------ �i Date Permit No......... - ---------•--......_.. Issued.---•-•.�.''. .'-:....i�l........ Date . .. � _ - �-r-• ,�'"�' �.`� �vr-`*^*r'r.".-^." 4 `�.. ..a1_. _.y,� .y:,^ �. .et�r4.;...,.:� Tn.l� �n:I... �.,.-w—•^" 41, THE COMMONWEALTH OF MASSACHUSETTS = BOARD OF HEALTH v ........... .................OF.......,.A.A,.0 r:TA.kL.9.----....----------- APplutttinn for Disposal Works Tonstrur#inn Prrmit14 Application is hereby made for a Permit,to Construct ( ) or Repair (� an Individual Sewage Disposal System at: ... .�'T-rl a{!c:..:. P..t✓..;. _ .M1! .S LA r!!��", Q!�............................................. ..•--........ ................_.._...... Location--Address or Lot No. .s t �_�..� . ::--- i.�•�,►.. .. �. ? _ .F, ,,�'.j._ :►,�sl�. !;!C_ __.!ll�G. e►l ,d eC'f. 1 ................................... ---- _ ner •e Address / s!.�....--•-------------------------••---•-- ..... -9...:rat,�... �cr!_ .t�' ..•...5��1 _`1''. li ::t:!:!:L l�r Instai er Address Type of Building "'' �. Size Lot............................Sq. feet aDwelling—No. of Bedrooms............911-d...................Expansion Attic ( ) Garbage Grinder ( � aOther—Type of Building ....f'�., �,�.......... No, of persons............................ Showers ( ) Cafeteria Other fixtures ..... ........................ WW Design Flow............J10......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.4r'eo_.gallons Length._.............. Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................ Date..................................... ,aa � Test Pit No: 1................minutes per inch kDepth of Test Pit.'................. Depth to ground water................ _..... Test Pit No. 2...............minutes per'inch Depth of Test Pit.................... Depth to ground water........................ x _ O Description of Soil.............Fvg.I'fe -�.�_.............................4ro ��. p.__..._ d...�� .....h�_�,2 -�f�................................................ r --; J W •••--...------. --------- ----------------------------------------------------------------•----•--------------------------. ......................... U '"Nature of Repairs or Alterations—Answer when applicable_...T�.,� '!l f a'1� .....ce> b!...:�.Ei;...•j...l---_-n...15A1 Z -----------------------------------•-•---------•---- --------------•---.....---....---..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..;....1=-A'kAuaA:,: ..� �LtANU A------------- --- /V.11..`�_1. Dante Application Approved By.....__... .. .__ .�: .....�1..... ......... Date -� Application Disapproved for the following reasons:---......------------•------------••-•-•-----•--------------•------------------•------•---.._.......-•-•----- ............................•----...------•-------------------...........--•------•--....--•---------•------------------------•-------.......----•-----------------------•-----•--------------••-------- Date C�i Permit No........!/r - -.. Issued........i;K ..;F..? Date THE COMMONWEALTH OF�MASSACHUSETTS BOARD OF HEALTH I ............ 0..W.uk)............0F......8.d.4...sT4. ..................................... Trrtif iratr of farrmplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� by....................................................B.:.�_A .C:r---1-5��.- :&IJ.:---t ------------------_--_--._----------.---------•----_--------------_.--._---_------ Installer at....................... !4"t .d !1_4._.�• . ...' 1C Q .11_-_ - ....Ail �. ....................................................... has been installed in accordance with the provisions of TIT Tr j of The_State Sanitary Code as described in the application for Disposal Works Construction Permit No....Y2 ...... dated....oO...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ //*^�",, �,�f?✓ +s��Ii�Z�'1� .....fi................................................ Inspector—,:..................._....._.._..... �''' ' ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH aa.�,..........0F........!s)!�l1�..,1.:��'�4. +. .t .................................. .................... .. ---- No.,........:.71A.A. �. FEE........................ Disposal Works Tonstrnrtiun f rrmit Permission is hereby ranted...............O.. MAJ.......cv:. 46.V e. .. ••----.......-•-------........-----................... .... to Construct ( ) or Repair ( � an Individual SewagS Disposal 4 System at No.- 9z'?~_Glr !,r_.....1,�rQ j v! r1� �l.� p ................................................................. r Strcc[ / . as shown on the application for Disposal Works Construction Permit No.F-_!_.�.KDated.._..!"�_�.. .................... `' D ...... __ - ..... DATE....... -----------•-- -------------------•----- ..... Board of Health C�D LOCUTION ' 0t,o #fF SEWQC,E PERMIT 1.10. e /X a-17 1WSTaLLER 5 U&NAE ADDRESS BUILDER 5. Q &MF- ADDRESS D�►TE PERNAIT 155UED '- --/4 D ATE COMPLI & aCE ISSUED ; — Z2 -f--75 d p 1JF71 !1�. r a i d�NrUe�, N �- r t / f REVISIONS L",ER DESCRIPTIC-N OVED _ -'•} ^•".ter - - -- --- - "•7 -_-- t �TO DISPOSAL AREA 1 I _ - (BY OWNER) —� ------- - z z - C, _ IY•� SINK " FAT � � ; I •�� � � - � � I L- 1i 1 _ - --ILz co — �— i ► _ - - _ POLYCHROME - N. _ - , y PLATE PROCESSOR - J SINK .:-- r 1 _ 7F i 46 l� 0 �f 1' 'Q -tea t' U _ I -- ... C N C LOG E LD24AQ , 5� "`� 7- up - f ! 1 FILM PROCESSOR \`,t - I i I I �. T 1 J vry{ - , H t -ter--- I I ' GN AC ` � I SILVER RECOVERY �III v „� ,� E - -- l;,q`=�-.>SILVER UNITS X-RITE 1 ?Z .., ►., Z MODEL *610 & 603 � - TIE- P11 Ul ci SELECT-LINE PERMA-QUICK J RC PAPER PROCESSOR _ i'HALL ��I (SELF-CONTAINED UNIT) s v� 9 1 DE '; V ,EW I � +�'}Y� Y F E SE l : 11•4 _ z � � ► 2 D EP UNDRY SINK co 17, r � - �•10 3'y� '1 0 , -I O 1 � \.3' i ( I Y �! ' a r iG -.._ -, N ��' •r - - - - -- -•►+-1-'► + 1 \_�', .. -- ' - _ � i Nwl CI_ - . .. 111 'iF,A. r;. A` 1 �" K a- ^A D '' G R E # ',`r '� `, T - C #•o` r ,; n{^ tg000 ems. �.+ I[E A r�+�c M.►+•aA.- { - ` u,a6LIL .- Ip(r --- T 7_. '� c:O r.O L.• �'_. /I y • 4 - (/''''�''\+ (\�/\ _•F, I . /• ...: - - �"WA Tar 2 ,vA T`�{- ! - �./ -----'__--_-'; '�.' ".'--� M ( Y �. i AIN • 1 s, a CONDYNE, INC. PROJECT t ' 749-6WO �F 2 DERBY STREET TIGHT TANK SUBMITTAL -';.,,� �INrgHAMA.11 A�2043 - h9h, ENGINEERING CORPORATION CLIENT ` 75 TARKILN HILL ROAD ON LITHOGRAPHERS � ��,�:;- � APPROVED my DRAW04NY NEW BEDFORD, MA. 02745 DATE Li DWN. BY:BDM CHK. BY: RC DWG. TITLE PROJECT N0. — DSGN. BY APPD. BY INDUSTRIAL WASTE PROCESS 320�002 � SCALE� 1 /8` 1�-0� DWG. NO. Mlwl lrve rK,Meep PIPING PLAN 2 0�1 c��� �!T'No . 8Z5 IREVI DATE DESCRIPTION BY APP. DATE $/8/$g Pfr r ,,,,,,,,...r.....•- .,•,,.,,"....w...,- .ram ...• „ r fl! j - - 41, rr 4 'to, .r t • r {i 4-7 SO At J 'six# r J` ' a f r � ol 0.1 OL /� r � ; ',, .1 -. -. � � .. - :✓. 1C � '�I .._.-�..�. . .._.... ,,, ..,(,..+ 'J n. -+►...r~.�...n..^.d+- (yt �G"t..r h.; J4A,J:�'f �^�[„ 4 • G7 t � , t { V / J4 a i i Myyr , .. .. . .. - , .., - � :,,; - ... ! 4 •ram Ra yM j ,