DSHW-2024-006822

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soRENCoc@RF*RATtoF
2323 SOUTTI WESTTEMPLE
$,{LTITI# CITY, UT 84 I 15
PHONE (80r) d8r_7325
FAX (801) 4b7-9CI24
DArE: ,/.*h,
PAGES INCLUDING COVER SHEEI;
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siORENCO PAGE
l4 = 33 FEOM 'EiOEENCO TO= 5sgEitrtEio PAGE
Chem ical tlilests lt/ilana
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FEOM ' EORENGO T0= SSE1E;AtEi PAGE 4
E. trlAlL CIIEIIIGAL WASTE f,IAHAGEHEI{E lIlG.lNYOlcE$ TO t. tl Generating Facilfty 1A, abonu}, or
2.Companyruamer: .Yar=r'r{iterq=t=Rogiirs ..- - --a.phonet80ltj?8*LIfZ-
ujre.mla,*,,
P.0. Box 23694. AddrEsE:
5. Zip Code: 84rrl 0
c. 1.
2.
3.
HATiE OTWAETE
PNOCESS GEHERATIHG WASTE
lB this wqfiilfl a Eiorin lisled ryaste as de{ined in 40 CFR 261.31 (e.9., F020, Fml, f0e2, F0?3, FO26. ffi7, or Hr28}?
fl Vea Hl n" ffyegDOtl0Tc0nPlEtEthEform.Conleclyour0tnml;alWffitetlianiEemeol,lrr $El€srcfittenLth,slorassistanc6-
_8h
GHAfiACTEB
e. Liqurd Freth Fdhr E< ze.F ry+ff"F Etoclse.F E 14G1ES.F El E .20trF' qTqfte. Fffi;d cup E opencup
D. PHYS ISTIC$ OF ITASTE
I - Color;
h'rti**
e. Doeg the waste haYe a
strgng incident8l odor?
EUo tr Yes lf turo*'n,
de*fibe:
4. Layers:
E uuttitayered
fl gi-tayerod
,HSingh Phased
IffiGreviitlt
Feno*. l, Io;L- t#
S. Frce L'quids:
Eves El tto
Volulne:'-- - A1 # *
T.pH; tr{e #2 r Ez tl L IE.S tr Hange - '. -.- E f.fnE r-ro E ro- <1?.s
E. Cl{ EtuI IGAL C:0}|P{OEITIOH
1.
NAilGE
illH. f uAx..- O..---:-Qi
F<
E<
w<B<
El<
Eil<
EI{lil<
fu<
E<E<
E<
tr<
E<
jr
'qlqt
96
%
qT
%
9t
qb
Ilt
tb
ArEEnic
tserium
Gadmlurn
Chromiurn
Lead
lrtercury
$eleniufi
Silver
Chromlum
Copper
Nickei
Thallium
Zinc .
tr< too
E< iootr< eo
E< too
tr{ soo
EI{ rsr
E.( r8o
rdI--
a-!.r.5
rr--F
Side t ol 2 TUBH PAGE AND COMPLETE SIDE E
!-.-d
-
trl-22-Et 14.34 FEOM= EiORENCO TO = SSEIEElEi PAGE
GENEBATOH'S WASTE MATEHIAL PROFILE
G.
I.
2.
3.
of the above
H, SoHpLETEpT#t?I FOH rVAgteS HTE}{DE6 -
rOf, FUELS or IT$GII{EBATIOH PAFAHETEBS Provide If lnfornratlon lt eveilebfe.
1, Hest Value (BTU/lb):
3. Vlscoai$ tcpsl:
4. Agh;
6. Vrpor Frutture @ $TP (mrn/Hg!:
7- l$ Ihie waste E pumpabla liquid?
rl'
LT Yeg
E Yee
--
E. UYatEr:
-
116
@ tr : cF tr too"F EI rsoor
+S 5. E€ttleable mllda:
il
H
No
Ho
tserylliurn
Potassium
Sodiurn
Total Bromlne
Tolal Chlorine
Total Fluorine
Total Sutfur
9b
96
th
q6
LESSTHAH
F < sooo ppnt
m< Eoooppm
ffi < EompprriEI< aeb&{ ss'rg[{ rer
* ^"tut:*
.PPTN
,Pprtr
tr YsB fl No
Type of purnp?
8. Can thls wssle be h€f,led to impruue flsrl? E Vee tr Ho
9. Is thlr waste toluble in urate r? fl Vea tr No
10, Particle $ze: Will the sotid portiolt of thla IrrEE psss through
a l/E lnch ecreen? tr Yee tr Ho
AnticipatBd u!pG/U
4, Ha?ard Glass:
6.AdditlooalDsscription;( pQQtI- - -,,, ---. . ,-- - 17'fi,€thodofShipment=EButtLriquid.Eeut*sotiufi[orum(Type/$ire|:'l7e,464orher:-
& CEHCLA Heponabh Quantlty {flo}: I aL-_ l-' s. 8o unite (lgg}: . LB
10. UsEPA Hsran oua Wasts? flilVo E mo 11. t sEPA Harsrdous wssre t'tumter(r]: , 'Oaat ; -12. StiteHaeardouewast6? EI V* E tto 13. StateHarerdoueWasteNumber(+): .. DAAI
SPEOIAL HAIIPLIN€ IilFOEilA'
E eOOitionel Pagetal Attnchrd
t. GEllERAtOiGEHTlFlCATlOtllhsrbvcertifvthatellinformiliflrsubmlitedlnilrlarndaHattrcheddocumemrcontdlmtrueand
Eccuretede6criptions of lhis rvsrts meteridl. and ill relevant Informetkln rglarUing kngwn orarsprrlotl frraardr in tlr posse*ion of
lhc gEltBrator hasbeen dirclo*tt. :
fr*fi4rd{ 1,btl*
Nema Fype or Print)
s.
Sids I ol ?
Form Gtln -6000 {} fgBT Chemicrl WrrE ttlutrgament, lnc,
TO = SSEEiArEi I]AGE@1.:2F-Ell
/a\f.5,'llD
\./
ADDENDUTU TO GENERATOR'S WASTE IVIATERIAL
Chemical Waste Managemetrt, lnc.
CWM Location of Original (shaded aree for CWM use only)
A. GSNERATON IXFORUATIOI{_INSTRUSTIONS FOR COMPLETING THIS FOFM ARE FOUND ON THE OPPOSITE SIDE
oF THIS PAGE ta \-
1. Genarator r*amet Yig,aEtrt? -JrNd.-- , ,,, -
USEPA ID Numbg:
PROFILE SHEET FOR LAND DISPOSAL RESTRI TIONS
14=35 FEOM'
(
EiORENCO
2-
'e ,1': ',3'
B.
1.
2,
a.
b,
IYASTE THEAI$ IH FORMATION
ls thi$ a USEPA hazardous waste? F Yes U No
lf yes, is this waste: tr Characteristlc E Usted )tEoth
ls this waste a nonwastewater or a westewaier? Ctreck ONE f, mnwastewater E Wa$ewater
ldentify ALL OBracteristic and Lasted USEpA hazardous wasle numbers that apply (as defined by 40 CFR 261), For
each waste number, identily the subcat€gory (as applicablq check none, or write in the descriptibn from 40 CFH
268.41, 268.4e and 268.43). The following wasle numbers have subcategories: [XDI, D002, O0Oii, D006, D008, 0009,
F001, F0o2, F003, F004, F005, F025, K006, K046, K061, K069, K071, K106-, and U151.
USEPA
HAZANDOUS
wAsrE HO,
SUBCATEGOHY
I{OHE 9ESCBtPilOH
L
fie*rl Itr;r.tasr.E Lr..^tr=r-u -l
To list additional USEPA waste nurnbe(sl, and sutrcategories,
tional pege (CWM€{)()GB] is u$ed, pleEso check here: D
USEPA
HAZAHDOUS
wAsTE f{O,
SUBCATEGOBY
NOf{E DESCBIPTION
use the supplernentat sheet provlded (C1rYM-e00+Bl. lf an addi-
3.lfthewastelsldentlfiedasU$EPAIr*asteNo.D0ffl,identilythetota|conGefitralio6q11g36',L
4. ts this vJaste a soil and/or debris? D Yes, Soil; il Yes, Debris;D Yes, Both; X No, Neither
c. GEHEHATCTH CEhT|FICATION-I hereby cdrtify rhat all information submitted in this and all altached docurnents cen-
taifis lrue and accurate descriptions of this wacte rnaterial and all relevant intorrnation reglarding knewn or suspected
hazard$ in thp-gosession of the generator has been disc{osed.
Sionature-'n -fr4ord bii+-,
It
Thrlt
I
0DateNarne (Type or Print)
El I -22-B I
.llrat{
I
TO=Eitr I Ei53Elo PAGE
{Sfl5 Sr*"r\}$db+ifrf,-r
9o**\ot*C**;,\rtt ttl
Date:Signed,t /.
f gti. r"rt r.rts r,