Attachment_3a.doc

FACILITY PROFILE SHEET

SP4520-16-R-0001

Attachment 3a

1.

Facility Name:

2.

Location:

3.

Facility Representative(s):

4.

Facility Telephone Number:

Telefax:

5.

Principal Owner(s):

file_0.wmf

List all permits, authorizations and licenses pertaining to collection, transportation, storage, and disposal of waste (attach copies of all that pertain).

Authority Granting Permit Specify if for Collection, Transportation, Storage, or Disposal

Permit Number

Expiration Date

Indicate if waste(s) will be stored, treated, disposed, or recycled at this facility under this contract.

file_1.png file_2.wmf

Temporary Storage file_3.png file_4.wmf

Recycling file_5.png file_6.wmf

Chemical, Physical and/or Biological Treatment file_7.png file_8.wmf

Hazardous Waste Landfill file_9.png file_10.wmf

Incinerator

Describe the treatment processes employed at this location (Attach additional pages if needed) file_11.wmf

For facilities that treat, dispose, or recycle, list in the space provided below, by Substance, CLIN and EC number of the treatment or disposal processes permitted by competent authorities to be employed at this facility. (Attach additional pages as necessary.)

SUBSTANCE

CLIN NUMBER

EWC NUMBER

Chemical, physical/biological treatment, landfill or recycling PROCESSES used for each CLIN NUMBER