DSHW-2024-007708

OMB#: 2050-0024 Expires 12-31-88
BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION I.ABEL
OR ENTER:
srrE NAME L-o wN- R e- e-Nnt-- #-oppttau
trq-E- -l-!o-a-N, - -Lpm*-t/r,fr432 I
EPA ID NO.UrrPrqJ $-PE€Jtzr?)
ffi U.S. ENVIRONMENTAL
rh .P_IROTECTION AG ENCY
HL\dffieraste G e n erat i o n
$-roRM'JU
nrffiiff
OI
and Shipment Heport
tgBS
IDENTIFICATION AND
Pj. or rue$[BrlFlcArloN
& llezerdous Waste
WHO MUST COMPLETE THIS FORM? Form lG must be clmpleted by every site that received this package.
INSTRUCTIONS: Please read the detailed instructions beginning on page 8 of the 1987 Hazardous Waste Generation
and Shipment Fleport lnstructions booklet before completing this lorm.
C,omplete Sections I ihrough lV and Sections Vl through lX immediately. Complete Section V,
certification, atter you have linished the full report package.
SEC.
t.
Site name and physical location which may differ from the mailing address. Complete items Athrough G.
Marl lX] for items A, B, C, D, F, and G i, same as label; if different, enter corrections. lf label is absent, enter information.
A. Site/company name
Same as tabel X
or-
B. EPA lD No.
Same as label }{
or-< I r r t-t--L--L--r ---r -l -r l---l
C. Address number and street name of physical locatlon
Same as tabet X
O[.+
if not knourn, enter industrlal park, bullding name or other physlcal location description
D. City, tcnrun, village, etc.
Same as tabet tr
OI -.+
E. County
CNCHE
F. State
Same as labet X
or ......-.+ Ll-J
G. Zip Code
Same as label K
or-.,-.....--..+ I t I t t r-l I l1--l
SEC.
il.
Mailing address of site.
Mark [Xl for A, B, C, and D if same as label; if different, enter corrections.
A. Number and street name of mailing address
Same as label X
or
B. City, town, village, etc.
Same as tabet K
C. State
Same as lauel F
or<l rJ
D. Zip Code
::'"*'":' fl, , , , ,_r , , i l
SEC. III Name, title, and telephone number of the person who should be contacled if quostions arise regarding this report.
A. Please print: Last name First namc M.l.
OsreRMrLL€e , DE n)Mts R.
TilloB.
&-*l-,r
E*b,, €€tr<
C. Telephone
t$toJ r l7-58' ted6"Qt
nsion €tlth rfrl
SEC.
lv.
Enter the Standard lndustrial Classification (SlC) Code that describes the principal products, group of products, produced or distributed, or the
services rendered at the site's physical location. Enter more than one SIC Code only il no one industry description includes the combined activities
of the site. SIC codes are listed beginning on page 1 of the lg87 Hazardous Waste Goneralion, Shipment and Management Report Codebook.
A.
B106,A
B.
L-rU/4')
C.
rN/A)
D.
| )Uht)
E.F.
Ahr
SEC
V.
lcertify under penalty of law that I have personally examined and am familiar with the informaiion submitted in this and all attached documents,
and that based on my inquiry ol those individuals immediately responsible for obiaining the inlormation, I believe thal the submitted information
is true, accurate, and complete. I am aware that there are signilicant penalties lor submitting talse information, including the possibility of line
and imprisonment.
A.Please print: Last name First name
TERtvttL:EP.L DENNT5 R
M.t.
ru.Nr&uaruffiK
B.Signatur"b Date of signaturev @6) 6A 6A)
Page 1 of
EPA Form 8700 - 13A (5-80) (Rev. 11-85) Revised (12-BTl
IO f'
FORM IC.
SECJ!.tl
tr
Does this site's EPA lD authorize hazardous waste generation?
NO
-
SKIP TO SECTION Vll.
YES
-
Did this site gonerato any hazardouswaste during 1987?
'54 ves
-
READ DETATLED TNSTRUCTTON ON PAGE I OF THE 1987 HAZARDOUS WASTE GENERATTON AND SHTPMENT REPORT
- |NSTRUCT|ONS BOOKLET FOR ACUTE AND ACCUMULATTON LrMrTS. MARK D(_l NEXr TO THE HAZARDOUS WASTE
GENERATION QUANTITY CATEGORY THAT APPLIED TO THIS SITE OUBING 1987.
I Gategory 1: More than 1000 kg (2,200 lb) in one or mo.e months
I Category 2: More than lOO kg (220 lb) bur no more than 1OOO kg (2,200 lb) in any single month
! Category 3: No more than 100 kg (220 !b) in any single month
E] Mark mif this site changed from Category 1 to Category 2 or 3 due to waste minimization activity conducted during 1986
or 1987.
E ruo
-
coNTtNUE BELow, MARKlxlNExrroALLTHATApply.
I Generated, excluded or delisted wastes
6 GeneratedhazardouswastopriortolgSTbutdonotexpecttogenerateintheluture-MARKIXIFORREASONINONEBOXBELOW
f] Waste was rrom ons-time event(s) (e.9. spills, remedial actions, etc.)
O Waste minimization activity undenaken during 1986 or 1987
I Out ol business
E Gen€rated hazardous wasie prior to 1987 and oxpect to genorate in the fulure
I Never generated betore but expect to generate in the luture
I Never generated and do not expect to gonerate in the luturo - MARK lX IFOR REASON lN ONE BOX BELOW
Protective notifier only
Misunderstood the requirements
Notified to secure transportation services
CIher EXPLAIN REASON FOR GENERATOR NOTIFICATION lN COMMENTS
D
tr
Du
sfif'
I Ooes this site have RCRA lnterim Status or a RCRA permit to treat, store, or dispose hazardous waste?
[[ NO
-
SKlPTOsECTloNVlll
t] YES
-
Did the site treat, store, or dispose (US/D) hazardous waste in RCm+egulated unirs during 1987?
E YES < SKTPTOSECTIONV|||
E NO
-
CONTINUE BELOry, MARK [X NEXT TO ALL THAT APPLY
D T/S/D excluded waste during 1987
t] T/S/D hazardous waste in exempt units during 1987
tr T/S/D hazardous wasts prior to 1987 but did not T/S/D waste during 1987. MARK lX llN ONE BOX BELOW
I T/S/D will resume in the future
I Have notified of planned closure
I Site is in closure or post closure
I Never T/S/D hazardous waste prior io 1987 but: uanxlXl lN ONE BOx BELOW
E] Expect to T/S/D hazardous waste in the fulure
fl ElonotexpecttoT/S/Dhazardouswasteinthefuture-EXPLAINREASONFORINTERIMSTATUSORPERMITINCOMMENTS
t5fr lO" you wish to withdraw this site's generator notification or EPA Part A permit application?
Withd raw generator notif ication
Wthdraw Part A permit application
nYes ENo
DYes ENo
SEC.
tx.
Does this site have an area not requiring 'r RCRA Part A or Part B permit that is used exclusively for the short term
accumulation of hazardous waste?
KtI
NO
YES .-. DOES THE AREA HAVE:
Containers E NoTanks ;; No
l--l yes ENTER THE NUMBER OF TANKS AND THEIB TOTAL CAPACITY lN GALLONS.
nYes'4 l-f__t-l Number lrllttltllGanoncapacity
Comments:
BEFORE COPYING FORM, ATTACH SITE IDENTIFICATION I.ABEL
OR ENTER:
SITE NAME
tr"fTzt
.,*ttto
*'\
_.-,o'BLvi
'-b<tenoited
U.S. ENVIRONMENTAL
PROTECTION AGENCY
1987 Hazardous Waste Generation
and Shipment Report
WASTE GENERATION AND
SHIPMENT
llyHO MUST COMPLETE THIS FORM? Form GS must be completed by wery site that generated hazardous waste on she or shipped
hazardous wasto ofl site during 1987.
Generation and Shipment Report lnstructions booklet belore completing this form.
Make and completo a photocopy ol this form for each hazardous waste generatsd on site or
shipped off site during 1987.
Complete Sections I through M. Throughout this lorm enter .DK il the information requesled is not
known or is not available; enter "NA'il the information requestod is not applicable.
X Mark E if llou are not ,equired to complete Form GS.
INSTRUCTIONS: Hease read the detailed instructions beginning on page 12 of the 1987 Hazardous Waste
Sec. I n. Waste description
I I lnslruction Page 12
B. EPA hazardous waste code
Page 12
llrrl tltrtttttl
C. State hazardous waste code
Page 13
trrrrrrtttttrrltttrrt
D. SIC code
Pagel3 I I I I I
E. Source code
Pagel3 I I I
F. Waste form code
Page 13 lrlt
G. Waste mlnimlzation results
Page 13 II
Sec. I A. oro.ni",
,,
I
tnslruclion Paoe 14
High I I
Lowll
Test I lNolel I
B. Water
Page 15
High I I
Lorll
Note I I
C. Tolal Solids
Page 15
Hlgh I I
Lqvll
Note I I
D. Suspended Solids
Page 15
High I I
Lorll
Note I I
E. BTU
Page 18
Hishlllllll
Lowlllllll
UOMII Notell
F. Toxic Metals
Page 16 Note I I
Metat High Lor Test
1. l_l_l I I I I I I
2. I I I I r I I I I
3. I r r I I I I I I
4. I I I I I I I I I
5. I I I I I I I I I
6. I I I I I I I I I
G. pH
Page 18
High I I l.l I
Lonv I I l. I I
Note I I
H. Flashpoint
Page 18
Highll ll
Lor
Note I I
o
F
o
F
l. Cyanides
Page 19
High I I
Lowll
Test I I Notel I
J. Halogens
Page 2O
High I I
[orru I I
Note I I
Page 2O
Yes t]
Nof,
Note I I
SeC. I I 1986 quantity hazardous waste generated
Ill I lnstruction Page 20
B. 1987 quantily hazardous waste generated
Page 2O
C. UOM
Page 21
ll
D. Density
Page 21
I I lol I I
f] rusTsat n rg
E. Quantity hazardous waste on site on January 1, 1987
Page 21
lllltlrttt
F. Quantity hazardous waste remainlng on site on December 31, 1987
Page 21
SeC. ! n. EPA lD No. of facillty to wtrlch waste was shlpped
lV I lnstruction Page 22
tlttrtrtrrllt
B. Number of
shipments
Page 22
trrt
C. Transport
mode
Page 22
lll
D. Off-site T lSlDlR code
Page 22
tltl
E. Total quantity shipped
Page 2,
tlrtrtrttr
EPA ID NO.ldrrrD tctT $torfr€t
U.S. ENVIRONMENTAL
PROTECTION AGENCY
1987 Hazardous Waste Generation
and Shipment Report
OFF-SITE IDENTIFICATION
---e*nI,sz.'
'?,ar666ed=
WHO MUST COMPLETE THIS FORM? Form Ol must be completod by ev6ry site ihat shipped hazardous wast6 off site and every site that
X ;::;'Efi;::H I"::,T,1": llli'J,l?lTi;'
INSTRUCTIONS: Please read the detailed instructions beginning on page 23 ot ihe 1987 Hazardous Waste
Generation and Shipment Report lnstructions booklet before compleling this form.
Complete A lhrough E lor each orf-site installation to which you shipped waste or from which you
received waste during 1987.
Complete A through D lor evsry transporter you used during the reporting year.
Throughout this lorm enter "DK' if the information requested is not known or is nol available; enter
'NA' il the inlormation requested is not applicable. Make and complete additional copies ol this
lorm il you need to identify more than ,our otf-site installations or transporters.
Site I n. EPA lD No. of off-site installatlon or transporler
I I lnstruction page 23
-!rr
l_r __r _r_r_r_Lr r_r r I J
B.Name of off-site lnstallation or transporter
Page 23
C. Site type code
Page 24
rl
D. Site relationship code
Page 24
I
E. Address of off-slle installation
Page 24
Street
City srare L._r -l 6lh" l-r r r r r-L-t I I l
Site I A. EPA lD No. of off-site installation or lransporter
2 | lnstruction page 23
-t I L r l---r--i--r]-r r r r I
B.Name of otf-site installation or transporter
Page 23
C. Sile lype code
Page 24
ti
D. Site relationship code
Page 24
IJ
E. Address of off -site lnslallatlon
Page 24
Street
Cily stare t-r I 6'&. L-L---r--I-l-l--t I -l -t I
Site I n. EPA lD No. of off-site installation or transporter
_3_J , lnstruction Page 23"'i'r-'r L-r-- r t- r -t--r- l--l r -r-- i I
B.Name of off-site lnstallation or transporter
Page 23
C. Site type code
Page 24
tt
D. Site relationship code
Page 24
E. Address of off-site installation
Page 24
Street
City Srare L-:-l 6&" I r r r r r-L-r I I I
Site I n. EPA lD No. of off-site installation or transporter
_LJ , lnslruction Page 23--i-r-r-iri-rrrrrll
B.Name of off-site installation or transporter
Page 23
C. Site type code
Page 24
i_t
D. Site relationship code
Page 24
I I
E. Address of otf-site installalion
Page 24
Street
City sratc I r I 6'&' I r r r r r-t I I I I