DSHW-1998-002146 - 0901a0688013c6c6

leanHarboi
BRAINTREE FACILITY
385 Quincy Avenue
Braintree, MA 02184
617-849-1807 »* '
DATE: i ~ IX- f ^
Utah, DEQ
Bureau of Solid & Haz. Waste
P. 0. Box \W'tf6o
288 North 1460 West
Salt Lake City, UT 841lt-'fi^fe?
RECEIVED
MAY 1 9 TO
Division of Solid SHazartewTste
Utah Department Of EnvironmentarQity
Manager, MANIFEST SECTION:
Attached, please find your state's copies of the Uniform Hazardous Waste
Manifest for material
[•^l Received by
[ ] Shipped by
Clean Harbors of Braintree, Inc.
385 Quincy Avenue
Braintree, MA 02184
617-849-1807
Our US EPA ID Number is: MAD053452637
Siiicerely.,. . _ - ^ -- _
Clean Harbors of Braintree, Inc.
M^ i -^
RCRA Clerk, Compliance Department
fc.r-
COMMONWEALTH OF MASSACHL/SETTS
oa IJ^RTMENT OF ENVIRONMENTAL PROTECTI^
J^IVISICJN OF HAZAf^DpUSMATERIALS
One Winter Street Boston, Massachusetts 02108
Please print or type. (Form designed for use onelite <12-pitch) typewriter.)
/UNIFORM HAZARDOUS
WASTE MANIFEST "
^1
1,, Generator's us EPA IDtMp.
U T D 0 0 9 0 8 l':..h 5 7 ^v^
3fHM!55ipFe5ig©^ :
/P.O. BOX 689 '(M/s 30iB)
BRIGHAM CITYr OT 84302
663-8545
Manifest Document No.
0,1 IS 7
Generator's Phone ( '43S:^
'CL^^'iS^SS'^IS^!™SERVIGES, INC. 6, USEPA ID Number
M A D 0 3 9 3 2 2 2 5 0
Page 1
of- 1
A. St^te Manifest Document Number
Information in the sh^aded areas
is not required by Faieral law.
MA J B. State Gen ID-
C, State Trans. ID
D. Transporter's Phone ( aOO) 462-46V8 7, Transporter 2 Company Name US EPA ID Number
): Designated Pacility Name and Sile Addifess IO , US EPA" ID-Number" tss St&te Trans. ID..
lignated Pacility I
CLEAN HARBORS OP:'BRAINTREE, INC.
365 QUINCY:-AVENUE
BRAINTREE, MA 02184
.?^^1
F. Transporter's Phone (^gx^&J'^^ji^P 7"
ill
G. State Fadlitys ID :N0T REQUIRED
ADO 53 4 52637 H. Facility's Phone t 800 ) 462-4678
ll.l US DOT Description (Including Proper Shipping_Name^ Hazai;d Class and ID Number) 12. Containers 13. Totai : NOTTT-- - Typff|""""~QiJantitv"
14.
'Unit
WlWoi
I. ,
Waste t^o.
a WASTE TOXIC, LIQUIDS, ORGANIC, N.O.S,
(1,1,1--TRICHL0R0ETHANE), 6.1, UN2810, PGIII
032 EM
b WASTE 1,1,1-TRICHLOROETHANE, 6.1, UN2831, ,PGIII
/^(Pao
D04,0 FOOl
F002
002 DM U226
J aoo
:^ .^
J. 4i^itiSPHrjJe3H[i^gns(f^y^«jigl&gst^)jJ^g ^ijplc^tjyslcal state andp^ard code.)
p) PROFILE* <?HP^'9628"
K. Handlh]g Cod^ foi^Vgstes Listod Above
yr
Handiipg Codejs f orv^gsies
C^
ERGifieo ; / / 7 ^ ^,..-^'.' — (8pP)-424-9300 a),ERGfl53 b)
16, SN'F
.1 ^/r<^ssr^or;is. \ }
_ _NGBAT0R'S CERTIFICATIQN: I hereby declare ttiat the contents of ttiis consignment are fullyand accur,ately described atwve by • • . j , • •' .'- ^ •.
propershipping narneandareclassified. packed!Smarked/and labeled, and are inal) respects in pVoperconditi^^ ,- ^ i
according to applicable International and national government regulations. r'i' . v ' / •' '• ' ••' '/ -•"'. •
: " . -• ••• • ( y y. ' . ,_-,._- / • j'.- :- .- - -„ -. • - • •'• • •'•• If I ama large quantity gGnerator.-l certify that I have a program in place to redtJce the volume and toxicity of vraste generated to the degree t have determined tp be economically practicable '
and that I have selected the practicable method otlraatFnent, storage, or disposal currently avaiiable.to me whic]ynlnimlzes the present and tuture threat to human health and the environ-
ment; OR, if I am a small quantity generetor, I havemadeagoodfaithefforttominimizemy waste generatio^ and select the best waste management method that is available to me and that I can afford. ' ' .'!.*/ : . ' •'
^^^'^Prmted/Typed Name ' ~II ~ u^T>i
17.' Transporter 1 Acl(nowiedgement of Receipt of Materials
Date.
Year Months Day
•Eliated/Typed Name' ' \ '• 7"
Date
18,. TranspQitef-3-AcKpowledgement-of Receipt of Materials
Montl\ Day Year
Y^x^Jj^ \
Date
19.' Discrepancy Indication Space
Month Day Year
lOiVi/iQlM
20.,-Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19.
Date
Printed/Typed Name tied/Typed Name
ll
Signature Monlh^ Day year
• Form Approved OMB No. 2050-0039. Expires 9-30-96 EPA Form 8700-22 (Rey. 9-88) Previous editions are obsolete.
.1 COPY>E : FAGILITY 'n,AIL-S TO GENERATOR , STAT.E
INSTRUCTIONS FOR COl^PLETING THE UNIFORM HAZARDOUS WASTE MANIFEST , .-, . Z "TO ,'
IMPORTANT: READ/^LU INSTRUCTIONS BEFORE COMPLETING THIS FpF^M .:r/..._. .. - •/
State and Federal regulalions require Generators, transfiorters.' and Treatment, Storage, and Di^osal Facilities (TSDF's) to use Ihis form
and, il necessary, the Continuation Sheet for interstate and intrastate shipments 01 hazardous wastes.
The MA manifest contains 8 copies, ALL COPIES WUST BE LEGIBLBf (Ufegible manifests submitted to the State will be returned to the
generator for proper complstitjn.)T|iis form is designed.for us.eon a 1? pitch (e)i(e) typewriter.-A firm balli point pen may also be,used if you
.press down HARDwEaohof.the 8 copies must be filett wilh th^'appropfiaJB party "as it Is completed. Copy distribution is as follows:,
COPV 1: DESTINATIONISTATE — tvlailed by TSDF: the original slays wilh ihe shipment^rSm generation }o complsttoaby the TSDF,
When the maniiest is coiinpletod, the TSDF must mail this copy to'the sipte where the fadiity is Icfcated, . - •
COPY 2: GENERATORSTATE -^ Mailed by TSISRi VVhen'the TSDF hascompleted his sectioB of the manifest, he mails this^copy to the
State where the waste was generated. ••'••• ' . .
COPY 3: GENERATOR COMPLETED COPY — Mailed by TSDF: When the TSDF has complelBd his section of the manifest, he mai's this
copy back to the Generator of the waste, v/ho must retain it on-gite tor h)s records. ^ , ,- ,.
COPY 4: TSDF COPY: When the "^SDF has completed his section ol'lhe manifest, he keeps Ihiscopy for his records, ' ^
COPY 5: TRANSPORTER 1: When Ihe transporter has completed his section bf the manifest'and transferred the waste to Ihp TSDF, tie
J.I keeps this copy for his records. •'•''.'-.. . ". ' .
C; NOTE: If.a continuing-transporter is used, the gene'(6to{ Is responsible for supplying him with a legible photocopy of the manifest,
J ^ which must contain signatures where roquirtid. ^V ' * , i. ' .-',':-•
COf=V 6:. DESTINATION STATE -t- Mailed by Generator; When Ine Generator has completed his section ol Ihe manifest and tra'nsfen-ed his
.,,. waste to the transporter, he mails this copy to ths Slate wrhare the designated hcility (TSDF) is located. ',
COf^ 7: GENERATOR STATE'—• Mailed by Generator: When lhe genprator has completed his section of the manifest and trafisferred his
waste to the transporter, he mails this copy lo the State where Iho.wast? was genorated. i •
COPY 8: GENERATOR: When the Generator has completed his section "of the manifest and transferred his vvaste lo Ihe transporter, he
t .• keeps this copy for his records. ' . , i
'-' • i ;. : .'GEIMERATORSECTIOJN .7 . ^ '' •^. . '• |
Itemj: GENERATOR'S US EPA ID NO. — MANIFEST DCiCUMENT NO.'— Enter the" U? EPA generator's 12 digit idontriication number.
TheiTtnter a unique 5 digit numtjer you assign lo lhis manife'st. Use oi serially increasing numbers (eg. 00C01, 00002, etc..) is recommended
Item 2: PAGE t of '_. — Enter the total numhar pf pages used to corhplete this manifesl,-i.e.,'lho first form plus the number .Of
Continuation Sheets, if any. Any ^PA approved continualion sheet may be u'sed, bul distribution and completion-musj meel Massachusetts
mafMiest requirements.- • ' ' ' • ' • . ' •. " > , '
• ' ' '•'.-''
'llei^^A: STATE MANIFEST DOCUMENT NUMBEH — Number preprinted by tvIA except on The Continualion Sheets. Enter this number in
ItemTL-on each Qintinuation Sh^et altached lo or part of a manifest. ' , •
Item-S: GENERATOR'S NAME AND MAILING ADDRESS — Enter tho name (as notified^ld-'EPA) and mailing address ol the Generaior This
addTCTs should be Ihe locatian that will manage the relumed manifest forms. ' ' • , , •
ltera.4: GENERATOR'S PHONE JviUMBER — Erjter a telephone number with araa cod&where an a"uthorized agent of the Generator can be
reaihed in an,emergency, _ • , .: ' - P ' •-
i I , • • '•':•. .J ' '
'Item B; STATE GEN ID — The State Generaior ID Is the slreel address of the Generator's pick-up locajion.ilf tha mjilmg address and the
streel address are the same, enter^'same" in this block. - .,'-'": . '
Item-6: TRANSPORTER 1 COMPANY NAME — Enter tha company'name'(as notified to EPA) of the, first transporter ,v»ho will transport the
waslG; j,^. •..•'••- '. ' t
.1. * • ' ; , - 1 '' .. t .
Ilenvg: US EPA ID Number — Enter the US EPA;12 digit klentificalion number of lhe firsltrans'portsr identified in Item 5.
'Ilem JC: STATE TRAN IID — Enter the Stale of registration :ahd the licqnse.plate number'Of the waste-carrying porfion ol the vehicle being
useijjo make Iha pick-upj \ '',-•,'••')-' ] : "„ . ' ', ' ; i
•Item D: TRANSPORTER'S PHpNE — Enter a telephone.tjumber wilh area <)ode wtTprie an autdortzed agent of-the transporter can.be reached ' .. 1 .. p-- -* • -'-^ ' - . '
, - • " , ••,;:-.-. ,1.- ;• . . . .'- •
Item 7: TRAN'SPOR"rER 2 COMPANY NAME —Jlt-ipplicaHe enter Iho-qpmpany hame (as^riotified-td-.EPA) of the sedond tr?nspoffer vvhowill
transport the vyasle. Jl more than two transportets"«ill be used, use a'Continuation Sheet ahd list tf)e;.trpnsporter9 In the order they wilt be
transporting the was'e. y ^1 '"• r-' ' . --.."- '^ . • •','. • ' '• '
Item 8: US EPA ID NUMBER — if applicable, ent^r theUS EPA 12 digit i^entifloaLon number Of the transporter in itemj;. • • "' • .
"Item E: STATE TRAN fa — If applicable, entar the secofttt Ifunspofter's Slate of registralioh^ndjic^nse plate number for lhe waste carryirtg
portion of the vehicle being used td make Ihe pfci<-up. '. ,'• "/• ' -i- '.'ff..' •'\ . ,. '.
' t , • . • . • , r 1 ... „•. - -J .* n -* A • : I '*' '.• :
•Item F: TRA^^SPOHTeR•S PH6NE — If applicable, anliir the second transporter's teiejihoile nuitiber witti area coda where a.ri authoiized
an*»nt nf tho frnn«nnrtor ,.Qn Kn .„—u..j ^- ' . I _•.-'•. _'.---•
. I jqjjuira's the wordi'jasia'belbfedr 13 We Slipping name for'allhajantousy^afle:'' i: . ':
Ilem 12: CONTAINERS (rjO. A TYPE) —^nler the number ot containers for each wasl^.and th^ appropnate abbrevialions (rom Table
agent of the transporter can be reached . I
liem 9: DESIGNATED PACILIT'T-WAME ANDSIE ADDRESS — l-tater the coiiipany-fiams (as"noUtieil io EPAJof thj TSDF designated to
receive tha waste listed op this manilesl. The adc^Bss must be the siti address, wjhich may differ tri^m mailing address". ;
Item 10: US EPA ID NUMBER -^ Enter ttie US ^PA ^y.rl^0\ i(ienlillcat:in''number of tha deslgnaladtSDF listed inttert jJ. , ;
Ilem G: STATE FACILITY'S ID i^ Mo enlry is required by r-dLsachusalts, ' . ' " ._ ;
•Item H: FACILITY PHONE — Errtsr a telephone numbor with area cqde.for the TSDF designatcd'to receive the waste listed or the maniles*.
Horn 11; US DOT DES'lJRIPTTdfvi — All of the fol'owin'g mu'"st be, entared: The cannot US"DOT ("Oepartmcnt ol f ransportaJion) name for the "
-.vaste as idcjnlified in 49 CFR Parts 171-177 (usually found in column's of section 172:101), the ^SSigned.DOT.Haiard-ClaSs (usually in
column 3) and the 4 digit UN/NA ID number (column 3A). (e.g.: Waste Sulphuric Acid, spent, corrosive materia), UN1832RQ). US DQT
(below) for the lype of conlainer u?ed.
DM = Metal drums, barrels, kegs
TP = Tanks, portable
DT = Dump truck
CW ~ Wooden boxes, cartons, cases
TABLE I —;COrJTAINER TYPE
DW s'Wooden drums, barrels, kegs DF = Fibertjoard or plastic dmms, barrels,
TT = Cargo tanks (tanK.lrucks) kegs
CY, = Cylinders TC = Tank oars ' • :
CP = Fiber or plastic boxes, cartons, cases CM == Melai{igites, cartotis.itasfes (incl.
rolli-olfs) '... . ., ' :
"". • • I • . BA = Burlap, cloth, paper/plastio Bags
Item 13: TOTAL QUAN"rrrY — Erlter the total quantily of wasle described on each Una. - ,
Item 14: UNIT (WlJVol.) — Enter the appropriate'abbreviation from Table II (belpw) for tfie unit of measure used in determining the tola
qaantlty of v;aste described on eachJine. Do not useiractions. 1
TABLE II — UNITS OF MEASURE
G = Gallons (liquids bnly)
T = Tohs (2000 lbs.)
M = Metric Tons (IOOO kg)
L -4 Liters (liquids only)
Y =; Cubic Yards - •
N - Cubic [\teters".
1. P-= Pounds'
K = Kilograrijs
'Item I: WASTE NO. — Enter the 4 digit EPA hazardous waste numlier as it "appears in 40 CFR Part 25l, Swbparis O and D. If a non-RCR/
-State-regulated'wasftestrcam is baing manifesfteb, erter the Stale-waste cAde here. It Both the Destinalioo and Generaior Slates havt
assigned codes use'the Deslinatiqn Stato C(5dB. inhere is no EPA/Stald code, enter "none".
'Item .f: ADDITIONAL DESCRIPTIONS FOR MATERIALS USTED.ABOV^ —.fciter desEription.Qf analysis for any waslb which 1^
have a U.S. DOT ^pping name br has an N.O.S. ^BBignation. Enter opnstiluent percentages, chemical'names, physical states (3^Wfd
. L=Llquid, G=Gas, SC=Sludge) anij EPA Hazard Codes (Igoitable (I), Corrosive (C),'Reactive (R), EP Toxicity (El, Acute Hazardous (H), Toxk
(T). Ertter tho specilic gravity if other than 1,0, Any additionai desired waste dascription may also be entered here. ', '
Item IB: SPECIAL HANDLING INSTRUCTIONS AND ADDITIONAL INPORtJlATION — Use Ihis space lo indicale special transportation
IrealmerOi storage .or disposal or-Sill ol Lading, inforraation. If an alternate facility <TSDF) Is designated, notf it hero. For ihtemalio'ria
shipments. Generators must entef the point of departure (City and State) from the US through which the wiasle must travel belore onteHnqt -
foreign, country. Thi5 space may also be used for emergency response telephone numbers, and other information the Generaior wishes tc '
include abjiut lhe shipment, including placarding, . - ' ' . ^
•ltemk:HANDLING'CODES —TSDF Completes this section —See "Designated Facility Section" (bolow). ,- . :
Item 16: GENERATOR'S CERTIFICATIQN — The Generator must read, sign (b^ hand) and dale the certification (with date o(-!ransfortc .
transporter). It a mode other than highway is used, the word 'highway" Btwuld be lin&d oul and tho appropriate modfe (rail, water or air) -'
inserted in the space below. II another modo in addliion'lo the highway mode is used, enter the appropriate mode (eg. "and rail") In the space
. below. In signing the v/aste minimization certification statement, those gefierators who fiSJ-e not b::jn exempted by statute or regulation froir
the duty (0 make a waste minimization certification .under section 3002(b) of RCRA are also certifying that they have complied with the waste
minimization requirements. - *% ' -^
. :-•-' TfWNSPORTEIH SECTION > : ' . '
Item 17: TRANSPORTER 1 ACkNOWLEDGEMENT. — Print or type the name or the, person accepUng Ihe wast? qn behalf:of the firs) ^.
Transporter. Thai person must acknowledge acceptance of the waste described on Jhe manifest by signing and entering llie date of jeceipl^. V
i • ' '• ' ' ' ' * .... .1- • I
Ilem 1$; TRANSPORTER 2 ACKNOWLEDGEMENT —il applicable, follow the Instructions for Item 17 lor T(ansporter 2. . - ". .-•
DESIGNATED FACIUTY (tSDF) SECTlilN ' '• •, "-';.-•?,<.•
•1 ' • • •' , . ''• ' '. -• --•'•.•,
Item K; HANDLING-CODES: TSDF SHOULD COMPLETE — Enter the ulttrtate Handling method utilized at the designated taciiity f|
wasle listed in Iterti 11. Only the following'proce'sscpdei may be used: . ,- '• • , . - :;
TABLE 111 — PROCESS CODES
STOBAQE r SOI (Cemtwr -j|
. •mEATMENT Refer 10 40 Cnj Dirt 265 Appendnt' 1, Toble 1
OlSPOSAJ, D79(lnr3Cl.D^»;p'i)
, • 084 (Orncf Spoctfyl
DBl (bun) Applsaiionl
toA (Su* -o 1fnpoundn-;rtf
: '•" . ' -Hi
pa2lOccjn{].jposal) ^
SOJlOtl>ci.6pi.c.l<)
083 'Suttvelmp J
Item lg: DISCREPANCY INDICATION SPACE —jrhaInuthoriied representative ol [He i;leslgnaled lacilitY'^s.owner or operator must note in
this space any signlfic.ini discrepancy between Ih^ w$ste <iescribed ori lhe PTanifesl a^nd, the vraste Spiially recoivefi at the taciiity. Any
rejected .matenals should be listed here, along wilK'an .indicafioh of theidisposittori ol t^ rejected maten^^^ftnv applicable Discrepancy or
Exception reporting requirements must also be fompliefi wilh. Federal and stale regulatioris rnay yaryl >_ •"( •
Item 20: FACILI"rY OWNER OR OPERATOR CSRT|F1CAT|0M — Print or jype ihi) name ot the person accepting the ivaste oirtahalf of the
O'.-yner br opeislor ofthe desiynaled TSDF. Th^t parson-must ackriciv.'Iettae acceptance ol'tlie waste descn'ljed on the maniiest by 5tgning (by
hand) ^nd entering Ihe date of.recjeipt. The signature of iho fiuthorizGd TSDF ago":: indicates acceptance ot (except for-items r^pjdicti in Item,:
19) and agrcsmenl with statements on this manifesf,- , <,'•.. ':.•{•• ' I ' --f''- ' • '* ' X' . ' Afi ' - '
MOTE: FOR INTERSTATE SHIPMENT YOU MAY EE.REQUIRED TO COMPLy| WlTH'T'HE'iJlANIrESTING REQUIREiViEi-.TS 0"F fiuTM
THE DESTINAl"10l)l AND GENERATOR STATERS REGARDING T^l* COMPLETIOV OF SPFCIHC'IMFORIv^TiOf-M INCLUDED IN
LETTERED ITEH'S A-K -^ •• • . ., ' - :' '- ' . •;.-'. • -.
.-• . ••'••"•' '•"•,!• '.• •".-.,. '.*'.. ..:• Public repiarling burclsn for lhis collectiun of information, is estimated to dverage: 37 minutes for generators, 15 minutfes for !ronspprta^b,',Dnd .
10 miriutes for treath^snt, str::.:y9 and d.^posai facfiltn:'^. This (gc^udes lime tor reviewng instructions, gathering daia. and fcSiiiTpieting and
'EviBv/Ing tha form. Send co:nmanis isgardin^ the bui'cton estifnCLtt.. induding SL-ggsst:cps for rsdudngthis buiden, to: Cluel; Irfo-mation
_°r>lir-y.Branrh. p:-fa23, U S rnvlror:'nrnt--il Prbtccl'im Ag^ni^y, 'jOI.M Slreet, .SW, 'Afeishrrigton, OC S-'MBIj and to the OfficL-'fe' (nic'ffiafion
and Regulatgry Affairs, Offjcoci IVIanagament and Budget, Washington. DC 20503.
Please print or type. (Form designed for use on elite (I lh) typewriter.) -i'-li
UNIFORM HAZARDOUS
WASTE MANIFEST
(Continuation Sheet)
21, Generator's US EPA ID No. Manifest Docurnent No,
UTOooJoS/2.^ 7 I o/is'r
Form Approved. OMB No: 2050-0039.
227Page Information in the shaded
areas is not required by Federal
law. • • . ...-•'.
23. Generator's Name
P-O. OoX C^^'^^.C >^\S lol B)
<;.
^^-
L. State Manifest Document Number
M. State Generator's ID
24", Transporter ^ Company Name • ;•'•• ~~ ' -: . N, State Transporter's-ip ; ^.jJL f.'T^ 25,-US EPA ID Number-
O. Transporter's Phone ^^rti 3 '^'/SrSC C
26: Trarisportei: CompanyName /. .27. US EPA ID-Number p. State Transporter's ID :-,.
Q. Transporter's Phone
28. US DOT Description (Including Proper Shipping Name. Hazard Class, and ID Number)', 29, Containers
No. Ty2e
30." Total Quantity
31.. Unit WtA/ol
^-•;-R::^ '.••
Waste No.
./
S. "Additional Descriptjoris fbTMateriajsTisted Above.: .^L„.. : ' . 'V^i^'**-^-' T, Handling Codes fpr'Wastes Listed Above
32. Special Handling Instructions and Additional Information
33. Transporter Acknowledgement of Receipt of Materials Date
Printed/Typed Name Signatijre Month .Day Year
34. Transportei-. Acknowledgernent bf Receipt of Materials - Date •
'I Printed/Typed Name Signature Month- Day Year
.35. Discrepancy Indication Space
Style F16 LABELMASJER, An AMERICAN LABELMARK CO.. CHICAGO. IL 60646 800-621-5808
PRINTED ON RECYCLED PAPER [MklpmBuowuHl
USING SOYBEAN IMC l^jSOfyiMKl
EPA Form 8700-22A (Rev 9-88) Previous edilions are obsolele.
TRANSPORTER #2