OWS Profile.pdf

HAZARDOUS WASTE PROFILE SHEET

NOTE: Explosives, Shock Sensitive, Pyrophoric, Radioactive, and Etiological Waste are not normally accepted by the DLA Disposition

Contact your DLA Disposition Services Site for further guidance if your waste meets any of these categories.

PART I

WASTE PROFILE NO.

BARNES ANG BASE OS-0001 v1A. GENERAL INFORMATION

01085

MA6570025902

United States

104TH FIGHTER WING

WESTFIELD

BARNES ANG BASE

MA

John Richardson Environmental Contact 413-568-91511

B. WASTE INFORMATION

OWS CLEANOUTS

2C. STATE/LOCAL/HOST-NATION WASTE CODES:

MA01

3. PROCESS GENERATING WASTE: GENERAL FACILITY MAINTENANCE (BA021 - CE STATE)

4. PROJECTED ANNUAL VOL.: 5. MODE OF COLLECTION: TT

6. IS THIS WASTE A DIOXIN LISTED WASTE AS DEFINED IN 40 CFR 261.31? YES

YES

NOX

(40 CFR 268)

HAS AN EXEMPTION BEEN GRANTED?

X

YES7. IS THIS WASTE RESTRICTED FROM LAND DISPOSAL?

YES

(If yes, Enter Reference Standards in Part II, Block 6)

NO

DOES THE WASTE MEET APPLICABLE TREATMENT STANDARDS ALREADY? NO

NOX

X

1. GENERATOR'S NAME:

2. FACILITY ADDRESS:

3. ZIP CODE

4. GENERATOR

USEPA ID:

5. GENERATOR

STATE ID:

6. TECHNICAL CONTACT: 7. TITLE: 8. PHONE:

1. NAME OF WASTE:

2A: USEAPA WASTE CODE: 2B. DEMIL CODE: A B C D E

F G P Q

X

104 CIVIL ENGINEER SQ CE STATE STATE| |

(Optional - Unless otherwise indicated)1. MATERIAL CHARACTERIZATION

COLOR: DENSITY: BTU/LB:

ASH CONTENT:TOTAL SOLIDS: BILAYEREDMULTILAYERED SINGLE PHASE

GAS OTHERSEMI-SOLIDSOLIDPHYSICAL STATE LIQUID

2. RCRA CHARACTERISTICS (Check all that apply) IGNITABLE (D001) REACTIVE(D003)CORROSIVE (D002)

CYANIDE REACTIVE SULFIDE REACTIVEWATER REACTIVE FLASH POINT: PH:

LOW TOC (<10%)HIGH TOC ( 10%) TREATMENT GROUP: WASTEWATER NON-WASTEWATER

PART II

X

X

TOXICITY CHARACTERISTIC (D004-D043) CORRODES STEEL

= 5.0 LAYERING X

(Mandatory)

DLA FORM 2511, NOV (Formerly DRMS Form 1930) Page 1 of 3 PDF (DLA)

WASTE PROFILE NO.

OS-0001 v1

3. MATERIAL COMPOSITION/UNDERLYING HAZARDOUS CONSTITUENTS

CAS#

COMPONENT

Be as descriptive as possible. Chemical names or generic descriptions, e.g. 'sludge', paint solids, 'water', etc, are acceptable

CONCENTRATION

RANGE

RANGE TOTAL MUST EQUAL AT LEAST 100%

3. CHEMICAL/MATERIAL COMPOSITION (List all components and contaminants, including PCB's and any applicable F- Listed and Underlying Hazardous Constituents)

CAS#

COMPONENT

Be as descriptive as possible. Chemical names or generic descriptions, e.g. 'sludge', paint solids, 'water', etc, are acceptable

CONCENTRATION

RANGE

8002059 PETROLEUM = 1 % .0 % to 1.0 %

7732185 WATER = 80 % 10.0 % to 80.0 %

SAND, SOIL, LEAVES 10.0 % to 20.0 %

RANGE TOTAL MUST EQUAL AT LEAST 100%

DLA FORM 2511, NOV (Formerly DRMS Form 1930) Page 2 of 3 PDF (DLA)

WASTE PROFILE NO.

OS-0001 v1

4. SHIPPING INFORMATION

DOT HAZARDOUS MATERIAL? NOYES X

PROPER SHIPPING NAME:

PACKING GROUP:

ADDITIONAL DESCRIPTION

IU.N. or N.A. NO.:HAZARD CLASS:

NOT REGULATED

METHOD OF SHIPMENT OTHERDRUMBULKX

DOT REPORTABLE QTY (RQ) LBS (REF: 49 CFR 72.101, Appendix A)

EMERGENCY RESPONSE GUIDE EDITION: EMERGENCY RESPONSE NO:

5. SPECIAL HANDLING INFORMATION

6. GENERATOR CERTIFICATION: CHEMICAL ANALYSIS

(Attach Test Results)

USER KNOWLEDGE (Attach Supporting Documents) (Explain how and why these documents comply with RCRA requirements)

X

If "NO" skip to block 5

I, __________________________ HEREBY CERTIFY THAT ALL INFORMATION SUBMITTED IN THIS AND ALL ATTACHED DOCUMENTS IS TO THE BEST OF MY KNOWLEDGE AN ACCURATE REPRESENTATION OF THE

WASTE TURNED IN TO THE DLA. ALL KNOWN OR SUSPECTED HAZARDS HAVE BEEN DISCLOSED.

Signature of Generator's Representative

CERTIFICATION:

Date

DLA FORM 2511, NOV (Formerly DRMS Form 1930) Page 3 of 3 PDF (DLA)