attachment b waste management documents · 2010-08-24 · chevron pipeline company june 18, 2010....
TRANSCRIPT
Attachment B Waste Management Documents
SLC Red Butte Incident
Waste Management Plan revised v2b Ifsa
Chevron Pipeline Company
June 18 2010
Objectives
1) Handle recovered oil solids including oily waste and clean debris and animal carcasses so that
wastes do not contaminate clean areas
2) Ensure that all wastes are managed in accordance with Utah DOT DEQ and federal regulations
while ensuring appropriate cost management control
Waste Management Summary bull Segregate waste according to waste type bull Hold and transport waste in appropriate labeled containers bull Return recovered oil and water to recovery at the refinery to the extent possible bull The Environmental Unit -Waste Coordinator or Unit Leader will determine whether waste is classified
as Hazardous or Non-Hazardous
CONTACTS IF YOU HAVE ANY QUESTIONS Jim Robbins (CPL) Office 801 9752325 at Command Center Lynn Sadler (CPL) cell 409-291-9138 Lyman Young (Chevron) Cell 925 899 3914
Waste Segregation
In this incident waste will be segregated into the following categories
1 Liquid recovered oilwater mixtures
2 Solid wastes including oily absorbents vegetation sandgravelsoil spent PPE and other oily or
non-oiled solid wastes
3 Dead animals (oiled or unoiled from the response areas)
Oily and clean solid wastes from cleanup locations will be comingled for this incident due to the low
volume of material expected
Keep similar kinds of waste together Different wastes are handled differently because regulations limit
choices for some wastes and because cleanup response records will require special accounting for some
kinds of wastes
June 17210 1
Waste Category Types expected in this response
Recovered Oil and Water Skimmed Oil and Water Decontamination Wash Water
Oily Absorbents vegetation PPE and other oil waste solids
Absorbent Pads Booms
Brush tree branches
Dirt Sand Gravel
Spent Protective Equipment (PPEJ
Wood Hoses
Dead Animals Dead Birds and fish
Special Instructions for All Wastes
bull Keep similar kinds of waste together
bull Keep waste containers closed except when adding or removing waste
bull Provide and use protective covers in case of rain
bull Monitor all waste holding areas for liner integrity to prevent soil contamination If leaks occur move
contaminated soil to oily soil waste and replace the liner
bull Examine containers for leaks If a container is not in good condition store the container on top of
plastic sheetingberm or mark it to be removed from service The waste may be vansferred to another
container
Liquid recovered oil and water
This waste includes recovered oil and water from response operations as well as decontamination wash
water It does not include sanitary (sewage) wastes Total recovered liquid quantities will be critical for
mass balance calculations
1 Transport recovered fluids in vacuum trucks to
bull Salt Lake City Refinery
o Attn Casey Valdez
2 Use a shipping paper when transporting the recovered fluids on public roads with the following
shipping description
bull Watercrude oil mixture Not DOT regulated
June 17 210 2
3 Collect decontamination wash fluids in drums or in vacuum trucks and return as recovered oil and
water
4 Determine recovered oil and water volume by tank gauging CPL has arranged for their personnel to
perform daily gauging of the portable tanks (frac-tanks Baker tanks etcl on site at the refinery These
data will be reported back to the Environmental Unit or directly to Jim Robbins (CPL)
Solid wastes including oily and non-oiled debris
This waste includes absorbent materials (bulk pads booms and pom-poms) spent PPE oily
sandsoilgravel and non-oily debris Mass balance calculations will account for oily absorbents
differently from all other kinds of waste
1 Place loose and light-weight oily materials (pads spent PPE etc) into plastic bags and then into
plastic-lined roll-off bins Large items (boom etc) do not require bagging
2 If dense solids (sandgravelsoil) are expected then bins should be double-lined to avoid punctures and leakage when materials are added or removed
3 Roll-off bins may be held temporarily at
a Enviro Care (505 N Main St North Salt Lake
i contact John Hart 8019511097
4 Transport to the designated waste management company location Waste transporter will be Clean
Harbors
a Clean Harbors Grassey Moutain UT Facility (3 miles east 7 miles North of exit 411-80
i contact
1 Chuck Lawrence 8015970283
2 Cory Cook 4358434854
3 Pam Melancon 435 843 4855
5 Dump material from roll-off bins onto plastic-lined designated disposal areas only
6 Weigh all loads arriving at (facility) on the truck scale Indicate type of waste on the scale ticket
Remember to record tare weight after offloading the waste
7 Decontaminate equipment used to excavate soil Collect decontamination rinsate and manage
according to liquid waste instructions above
8 The incident specific waste material profile for oily debris is shown as Attachment 1 The waste is
classified as Non-hazardous
Temporary Waste Storage for solid wastes
Temporarily store oil-contaminated debris and soil at clean-up sites Roll-off bins will be located at
waste collection areas and at decontamination areas to collect waste
Contact Environmental Specialist to coordinate moving full and empty waste containers
June 17 210 3
EnviroCare is being usedfor temporary holding of rail-offbins prior to disposal
The roll-offbins must be secured with cover and locks or pull down ties every night before the
crews leave the work site
Dead Wildlife
Follow the following procedure for the following types of dead wildlife
bull All fish species under 6 inches in length All fish species greater than 6 inches will be handled as
oily debris and will be disposed of at the Cleanharbor Grassey Maintain landfill
bull All bird species except for Starlings and English sparrows will be handled as oily debris and
disposed at the Cleanharbors Grassey Mountain landfill
bull All Oiled Bird species oiled But still alive notify Salt Lake County animal services (801-243-3813)
bull All Mammal species
1 Advise Environmental Unit Wildlife Coordinator or Environmental Unit leader at as soon as possible 2 Collect in a plastic bag
3 Label the bag with DATE and TIME the animal was found LOCATION and the NAME and PHONE of
person discovering the animal
4 Put the bagged animal on ice (chill) but DO NOT FREEZE
5 Take Pictures of the impacted animals
6 If wildlife officials do not take the species of interest the carcasss should be disposed of as oily
debris
General recommendations
Waste storage areas should
bull Be accessible to recovery site operations
bull Be accessible to nearby roads or highways
bull Be away from steep slope areas
bull Be away from topographical low areas
bull Be impermeable to the waste being stored
bull Prevent access to unauthorized personnel
Approved waste containers Include
bull Roll-off bins with covers Line with plastic sheeting Place absorbent material in bottom if
needed for free liquids
bull DOT-approved drums
bull Plastic bags for debris
Label all storage containers with
June 17 210 4
bull Date accumulation began (ie when you started putting waste in the container)
bull Composition and physical state of the waste (eg contaminated soil solid)
bull Generator information
SLC Red Butte Incident Chevron Pipe Line Co
2875 S Decker Lake Drive 150
Salt Lake City UT 84119
Contact Jim Robbins phone 801 975 2325
bull Use an appropriate container label for all waste bins or drums
Waste Container Labels Waste Classification and Name
Not Classified Wastes Laboratory Analysis in Progress
Use a Non-Classified Waste label for waste that has not
been determined Hazardous or Non-Hazardous
Hazardous Wastes Oily Debris Absorbents Oily Soil or Oily Protective Equipment (PPE) Contaminated Flood Debris Clean orOiled Vegetation
Non-Hazardous Wastes Oily Debris Absorbents Oily SOil or Oily Protective Equipment (PPE)
Contaminated Flood Debris Clean or Oiled Vegetation
Waste Transportation to Disposal Site
bull Hazardous waste will be sent to an approved hazardous waste disposal facility within 90 days of
accumulation
bull A Uniform Hazardous Waste Manifest must accompany all hazardous waste transported offsite
bull Only registered hazardous waste transporters will be used
bull Non-hazardous waste will be sent to an approved Non-Hazardous waste disposal facility
bull A Non-Hazardous Waste Shipping Form must accompany all non-hazardous waste transported off-site
Waste Management Documentation
bull Return a copy of all waste shipping papers to the Environmental Unit at the Incident Command Center
bull Record total quantity and classification of waste moved for each collection location to the compaction
area and shipped for the compaction site to disposal facilities
June 17 210 5
ENVIRONMENTAL SERVCfS INc
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Wednesday June 232010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ill must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule 8 shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 Salt Lake City Utah 84122 Office - (801) 323-8946 bull Fax - (801)323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
SLC Red Butte Incident
Waste Management Plan revised v2b Ifsa
Chevron Pipeline Company
June 18 2010
Objectives
1) Handle recovered oil solids including oily waste and clean debris and animal carcasses so that
wastes do not contaminate clean areas
2) Ensure that all wastes are managed in accordance with Utah DOT DEQ and federal regulations
while ensuring appropriate cost management control
Waste Management Summary bull Segregate waste according to waste type bull Hold and transport waste in appropriate labeled containers bull Return recovered oil and water to recovery at the refinery to the extent possible bull The Environmental Unit -Waste Coordinator or Unit Leader will determine whether waste is classified
as Hazardous or Non-Hazardous
CONTACTS IF YOU HAVE ANY QUESTIONS Jim Robbins (CPL) Office 801 9752325 at Command Center Lynn Sadler (CPL) cell 409-291-9138 Lyman Young (Chevron) Cell 925 899 3914
Waste Segregation
In this incident waste will be segregated into the following categories
1 Liquid recovered oilwater mixtures
2 Solid wastes including oily absorbents vegetation sandgravelsoil spent PPE and other oily or
non-oiled solid wastes
3 Dead animals (oiled or unoiled from the response areas)
Oily and clean solid wastes from cleanup locations will be comingled for this incident due to the low
volume of material expected
Keep similar kinds of waste together Different wastes are handled differently because regulations limit
choices for some wastes and because cleanup response records will require special accounting for some
kinds of wastes
June 17210 1
Waste Category Types expected in this response
Recovered Oil and Water Skimmed Oil and Water Decontamination Wash Water
Oily Absorbents vegetation PPE and other oil waste solids
Absorbent Pads Booms
Brush tree branches
Dirt Sand Gravel
Spent Protective Equipment (PPEJ
Wood Hoses
Dead Animals Dead Birds and fish
Special Instructions for All Wastes
bull Keep similar kinds of waste together
bull Keep waste containers closed except when adding or removing waste
bull Provide and use protective covers in case of rain
bull Monitor all waste holding areas for liner integrity to prevent soil contamination If leaks occur move
contaminated soil to oily soil waste and replace the liner
bull Examine containers for leaks If a container is not in good condition store the container on top of
plastic sheetingberm or mark it to be removed from service The waste may be vansferred to another
container
Liquid recovered oil and water
This waste includes recovered oil and water from response operations as well as decontamination wash
water It does not include sanitary (sewage) wastes Total recovered liquid quantities will be critical for
mass balance calculations
1 Transport recovered fluids in vacuum trucks to
bull Salt Lake City Refinery
o Attn Casey Valdez
2 Use a shipping paper when transporting the recovered fluids on public roads with the following
shipping description
bull Watercrude oil mixture Not DOT regulated
June 17 210 2
3 Collect decontamination wash fluids in drums or in vacuum trucks and return as recovered oil and
water
4 Determine recovered oil and water volume by tank gauging CPL has arranged for their personnel to
perform daily gauging of the portable tanks (frac-tanks Baker tanks etcl on site at the refinery These
data will be reported back to the Environmental Unit or directly to Jim Robbins (CPL)
Solid wastes including oily and non-oiled debris
This waste includes absorbent materials (bulk pads booms and pom-poms) spent PPE oily
sandsoilgravel and non-oily debris Mass balance calculations will account for oily absorbents
differently from all other kinds of waste
1 Place loose and light-weight oily materials (pads spent PPE etc) into plastic bags and then into
plastic-lined roll-off bins Large items (boom etc) do not require bagging
2 If dense solids (sandgravelsoil) are expected then bins should be double-lined to avoid punctures and leakage when materials are added or removed
3 Roll-off bins may be held temporarily at
a Enviro Care (505 N Main St North Salt Lake
i contact John Hart 8019511097
4 Transport to the designated waste management company location Waste transporter will be Clean
Harbors
a Clean Harbors Grassey Moutain UT Facility (3 miles east 7 miles North of exit 411-80
i contact
1 Chuck Lawrence 8015970283
2 Cory Cook 4358434854
3 Pam Melancon 435 843 4855
5 Dump material from roll-off bins onto plastic-lined designated disposal areas only
6 Weigh all loads arriving at (facility) on the truck scale Indicate type of waste on the scale ticket
Remember to record tare weight after offloading the waste
7 Decontaminate equipment used to excavate soil Collect decontamination rinsate and manage
according to liquid waste instructions above
8 The incident specific waste material profile for oily debris is shown as Attachment 1 The waste is
classified as Non-hazardous
Temporary Waste Storage for solid wastes
Temporarily store oil-contaminated debris and soil at clean-up sites Roll-off bins will be located at
waste collection areas and at decontamination areas to collect waste
Contact Environmental Specialist to coordinate moving full and empty waste containers
June 17 210 3
EnviroCare is being usedfor temporary holding of rail-offbins prior to disposal
The roll-offbins must be secured with cover and locks or pull down ties every night before the
crews leave the work site
Dead Wildlife
Follow the following procedure for the following types of dead wildlife
bull All fish species under 6 inches in length All fish species greater than 6 inches will be handled as
oily debris and will be disposed of at the Cleanharbor Grassey Maintain landfill
bull All bird species except for Starlings and English sparrows will be handled as oily debris and
disposed at the Cleanharbors Grassey Mountain landfill
bull All Oiled Bird species oiled But still alive notify Salt Lake County animal services (801-243-3813)
bull All Mammal species
1 Advise Environmental Unit Wildlife Coordinator or Environmental Unit leader at as soon as possible 2 Collect in a plastic bag
3 Label the bag with DATE and TIME the animal was found LOCATION and the NAME and PHONE of
person discovering the animal
4 Put the bagged animal on ice (chill) but DO NOT FREEZE
5 Take Pictures of the impacted animals
6 If wildlife officials do not take the species of interest the carcasss should be disposed of as oily
debris
General recommendations
Waste storage areas should
bull Be accessible to recovery site operations
bull Be accessible to nearby roads or highways
bull Be away from steep slope areas
bull Be away from topographical low areas
bull Be impermeable to the waste being stored
bull Prevent access to unauthorized personnel
Approved waste containers Include
bull Roll-off bins with covers Line with plastic sheeting Place absorbent material in bottom if
needed for free liquids
bull DOT-approved drums
bull Plastic bags for debris
Label all storage containers with
June 17 210 4
bull Date accumulation began (ie when you started putting waste in the container)
bull Composition and physical state of the waste (eg contaminated soil solid)
bull Generator information
SLC Red Butte Incident Chevron Pipe Line Co
2875 S Decker Lake Drive 150
Salt Lake City UT 84119
Contact Jim Robbins phone 801 975 2325
bull Use an appropriate container label for all waste bins or drums
Waste Container Labels Waste Classification and Name
Not Classified Wastes Laboratory Analysis in Progress
Use a Non-Classified Waste label for waste that has not
been determined Hazardous or Non-Hazardous
Hazardous Wastes Oily Debris Absorbents Oily Soil or Oily Protective Equipment (PPE) Contaminated Flood Debris Clean orOiled Vegetation
Non-Hazardous Wastes Oily Debris Absorbents Oily SOil or Oily Protective Equipment (PPE)
Contaminated Flood Debris Clean or Oiled Vegetation
Waste Transportation to Disposal Site
bull Hazardous waste will be sent to an approved hazardous waste disposal facility within 90 days of
accumulation
bull A Uniform Hazardous Waste Manifest must accompany all hazardous waste transported offsite
bull Only registered hazardous waste transporters will be used
bull Non-hazardous waste will be sent to an approved Non-Hazardous waste disposal facility
bull A Non-Hazardous Waste Shipping Form must accompany all non-hazardous waste transported off-site
Waste Management Documentation
bull Return a copy of all waste shipping papers to the Environmental Unit at the Incident Command Center
bull Record total quantity and classification of waste moved for each collection location to the compaction
area and shipped for the compaction site to disposal facilities
June 17 210 5
ENVIRONMENTAL SERVCfS INc
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Wednesday June 232010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ill must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule 8 shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 Salt Lake City Utah 84122 Office - (801) 323-8946 bull Fax - (801)323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
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9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
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0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
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14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
Waste Category Types expected in this response
Recovered Oil and Water Skimmed Oil and Water Decontamination Wash Water
Oily Absorbents vegetation PPE and other oil waste solids
Absorbent Pads Booms
Brush tree branches
Dirt Sand Gravel
Spent Protective Equipment (PPEJ
Wood Hoses
Dead Animals Dead Birds and fish
Special Instructions for All Wastes
bull Keep similar kinds of waste together
bull Keep waste containers closed except when adding or removing waste
bull Provide and use protective covers in case of rain
bull Monitor all waste holding areas for liner integrity to prevent soil contamination If leaks occur move
contaminated soil to oily soil waste and replace the liner
bull Examine containers for leaks If a container is not in good condition store the container on top of
plastic sheetingberm or mark it to be removed from service The waste may be vansferred to another
container
Liquid recovered oil and water
This waste includes recovered oil and water from response operations as well as decontamination wash
water It does not include sanitary (sewage) wastes Total recovered liquid quantities will be critical for
mass balance calculations
1 Transport recovered fluids in vacuum trucks to
bull Salt Lake City Refinery
o Attn Casey Valdez
2 Use a shipping paper when transporting the recovered fluids on public roads with the following
shipping description
bull Watercrude oil mixture Not DOT regulated
June 17 210 2
3 Collect decontamination wash fluids in drums or in vacuum trucks and return as recovered oil and
water
4 Determine recovered oil and water volume by tank gauging CPL has arranged for their personnel to
perform daily gauging of the portable tanks (frac-tanks Baker tanks etcl on site at the refinery These
data will be reported back to the Environmental Unit or directly to Jim Robbins (CPL)
Solid wastes including oily and non-oiled debris
This waste includes absorbent materials (bulk pads booms and pom-poms) spent PPE oily
sandsoilgravel and non-oily debris Mass balance calculations will account for oily absorbents
differently from all other kinds of waste
1 Place loose and light-weight oily materials (pads spent PPE etc) into plastic bags and then into
plastic-lined roll-off bins Large items (boom etc) do not require bagging
2 If dense solids (sandgravelsoil) are expected then bins should be double-lined to avoid punctures and leakage when materials are added or removed
3 Roll-off bins may be held temporarily at
a Enviro Care (505 N Main St North Salt Lake
i contact John Hart 8019511097
4 Transport to the designated waste management company location Waste transporter will be Clean
Harbors
a Clean Harbors Grassey Moutain UT Facility (3 miles east 7 miles North of exit 411-80
i contact
1 Chuck Lawrence 8015970283
2 Cory Cook 4358434854
3 Pam Melancon 435 843 4855
5 Dump material from roll-off bins onto plastic-lined designated disposal areas only
6 Weigh all loads arriving at (facility) on the truck scale Indicate type of waste on the scale ticket
Remember to record tare weight after offloading the waste
7 Decontaminate equipment used to excavate soil Collect decontamination rinsate and manage
according to liquid waste instructions above
8 The incident specific waste material profile for oily debris is shown as Attachment 1 The waste is
classified as Non-hazardous
Temporary Waste Storage for solid wastes
Temporarily store oil-contaminated debris and soil at clean-up sites Roll-off bins will be located at
waste collection areas and at decontamination areas to collect waste
Contact Environmental Specialist to coordinate moving full and empty waste containers
June 17 210 3
EnviroCare is being usedfor temporary holding of rail-offbins prior to disposal
The roll-offbins must be secured with cover and locks or pull down ties every night before the
crews leave the work site
Dead Wildlife
Follow the following procedure for the following types of dead wildlife
bull All fish species under 6 inches in length All fish species greater than 6 inches will be handled as
oily debris and will be disposed of at the Cleanharbor Grassey Maintain landfill
bull All bird species except for Starlings and English sparrows will be handled as oily debris and
disposed at the Cleanharbors Grassey Mountain landfill
bull All Oiled Bird species oiled But still alive notify Salt Lake County animal services (801-243-3813)
bull All Mammal species
1 Advise Environmental Unit Wildlife Coordinator or Environmental Unit leader at as soon as possible 2 Collect in a plastic bag
3 Label the bag with DATE and TIME the animal was found LOCATION and the NAME and PHONE of
person discovering the animal
4 Put the bagged animal on ice (chill) but DO NOT FREEZE
5 Take Pictures of the impacted animals
6 If wildlife officials do not take the species of interest the carcasss should be disposed of as oily
debris
General recommendations
Waste storage areas should
bull Be accessible to recovery site operations
bull Be accessible to nearby roads or highways
bull Be away from steep slope areas
bull Be away from topographical low areas
bull Be impermeable to the waste being stored
bull Prevent access to unauthorized personnel
Approved waste containers Include
bull Roll-off bins with covers Line with plastic sheeting Place absorbent material in bottom if
needed for free liquids
bull DOT-approved drums
bull Plastic bags for debris
Label all storage containers with
June 17 210 4
bull Date accumulation began (ie when you started putting waste in the container)
bull Composition and physical state of the waste (eg contaminated soil solid)
bull Generator information
SLC Red Butte Incident Chevron Pipe Line Co
2875 S Decker Lake Drive 150
Salt Lake City UT 84119
Contact Jim Robbins phone 801 975 2325
bull Use an appropriate container label for all waste bins or drums
Waste Container Labels Waste Classification and Name
Not Classified Wastes Laboratory Analysis in Progress
Use a Non-Classified Waste label for waste that has not
been determined Hazardous or Non-Hazardous
Hazardous Wastes Oily Debris Absorbents Oily Soil or Oily Protective Equipment (PPE) Contaminated Flood Debris Clean orOiled Vegetation
Non-Hazardous Wastes Oily Debris Absorbents Oily SOil or Oily Protective Equipment (PPE)
Contaminated Flood Debris Clean or Oiled Vegetation
Waste Transportation to Disposal Site
bull Hazardous waste will be sent to an approved hazardous waste disposal facility within 90 days of
accumulation
bull A Uniform Hazardous Waste Manifest must accompany all hazardous waste transported offsite
bull Only registered hazardous waste transporters will be used
bull Non-hazardous waste will be sent to an approved Non-Hazardous waste disposal facility
bull A Non-Hazardous Waste Shipping Form must accompany all non-hazardous waste transported off-site
Waste Management Documentation
bull Return a copy of all waste shipping papers to the Environmental Unit at the Incident Command Center
bull Record total quantity and classification of waste moved for each collection location to the compaction
area and shipped for the compaction site to disposal facilities
June 17 210 5
ENVIRONMENTAL SERVCfS INc
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Wednesday June 232010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ill must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule 8 shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 Salt Lake City Utah 84122 Office - (801) 323-8946 bull Fax - (801)323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
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7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
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9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
3 Collect decontamination wash fluids in drums or in vacuum trucks and return as recovered oil and
water
4 Determine recovered oil and water volume by tank gauging CPL has arranged for their personnel to
perform daily gauging of the portable tanks (frac-tanks Baker tanks etcl on site at the refinery These
data will be reported back to the Environmental Unit or directly to Jim Robbins (CPL)
Solid wastes including oily and non-oiled debris
This waste includes absorbent materials (bulk pads booms and pom-poms) spent PPE oily
sandsoilgravel and non-oily debris Mass balance calculations will account for oily absorbents
differently from all other kinds of waste
1 Place loose and light-weight oily materials (pads spent PPE etc) into plastic bags and then into
plastic-lined roll-off bins Large items (boom etc) do not require bagging
2 If dense solids (sandgravelsoil) are expected then bins should be double-lined to avoid punctures and leakage when materials are added or removed
3 Roll-off bins may be held temporarily at
a Enviro Care (505 N Main St North Salt Lake
i contact John Hart 8019511097
4 Transport to the designated waste management company location Waste transporter will be Clean
Harbors
a Clean Harbors Grassey Moutain UT Facility (3 miles east 7 miles North of exit 411-80
i contact
1 Chuck Lawrence 8015970283
2 Cory Cook 4358434854
3 Pam Melancon 435 843 4855
5 Dump material from roll-off bins onto plastic-lined designated disposal areas only
6 Weigh all loads arriving at (facility) on the truck scale Indicate type of waste on the scale ticket
Remember to record tare weight after offloading the waste
7 Decontaminate equipment used to excavate soil Collect decontamination rinsate and manage
according to liquid waste instructions above
8 The incident specific waste material profile for oily debris is shown as Attachment 1 The waste is
classified as Non-hazardous
Temporary Waste Storage for solid wastes
Temporarily store oil-contaminated debris and soil at clean-up sites Roll-off bins will be located at
waste collection areas and at decontamination areas to collect waste
Contact Environmental Specialist to coordinate moving full and empty waste containers
June 17 210 3
EnviroCare is being usedfor temporary holding of rail-offbins prior to disposal
The roll-offbins must be secured with cover and locks or pull down ties every night before the
crews leave the work site
Dead Wildlife
Follow the following procedure for the following types of dead wildlife
bull All fish species under 6 inches in length All fish species greater than 6 inches will be handled as
oily debris and will be disposed of at the Cleanharbor Grassey Maintain landfill
bull All bird species except for Starlings and English sparrows will be handled as oily debris and
disposed at the Cleanharbors Grassey Mountain landfill
bull All Oiled Bird species oiled But still alive notify Salt Lake County animal services (801-243-3813)
bull All Mammal species
1 Advise Environmental Unit Wildlife Coordinator or Environmental Unit leader at as soon as possible 2 Collect in a plastic bag
3 Label the bag with DATE and TIME the animal was found LOCATION and the NAME and PHONE of
person discovering the animal
4 Put the bagged animal on ice (chill) but DO NOT FREEZE
5 Take Pictures of the impacted animals
6 If wildlife officials do not take the species of interest the carcasss should be disposed of as oily
debris
General recommendations
Waste storage areas should
bull Be accessible to recovery site operations
bull Be accessible to nearby roads or highways
bull Be away from steep slope areas
bull Be away from topographical low areas
bull Be impermeable to the waste being stored
bull Prevent access to unauthorized personnel
Approved waste containers Include
bull Roll-off bins with covers Line with plastic sheeting Place absorbent material in bottom if
needed for free liquids
bull DOT-approved drums
bull Plastic bags for debris
Label all storage containers with
June 17 210 4
bull Date accumulation began (ie when you started putting waste in the container)
bull Composition and physical state of the waste (eg contaminated soil solid)
bull Generator information
SLC Red Butte Incident Chevron Pipe Line Co
2875 S Decker Lake Drive 150
Salt Lake City UT 84119
Contact Jim Robbins phone 801 975 2325
bull Use an appropriate container label for all waste bins or drums
Waste Container Labels Waste Classification and Name
Not Classified Wastes Laboratory Analysis in Progress
Use a Non-Classified Waste label for waste that has not
been determined Hazardous or Non-Hazardous
Hazardous Wastes Oily Debris Absorbents Oily Soil or Oily Protective Equipment (PPE) Contaminated Flood Debris Clean orOiled Vegetation
Non-Hazardous Wastes Oily Debris Absorbents Oily SOil or Oily Protective Equipment (PPE)
Contaminated Flood Debris Clean or Oiled Vegetation
Waste Transportation to Disposal Site
bull Hazardous waste will be sent to an approved hazardous waste disposal facility within 90 days of
accumulation
bull A Uniform Hazardous Waste Manifest must accompany all hazardous waste transported offsite
bull Only registered hazardous waste transporters will be used
bull Non-hazardous waste will be sent to an approved Non-Hazardous waste disposal facility
bull A Non-Hazardous Waste Shipping Form must accompany all non-hazardous waste transported off-site
Waste Management Documentation
bull Return a copy of all waste shipping papers to the Environmental Unit at the Incident Command Center
bull Record total quantity and classification of waste moved for each collection location to the compaction
area and shipped for the compaction site to disposal facilities
June 17 210 5
ENVIRONMENTAL SERVCfS INc
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Wednesday June 232010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ill must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule 8 shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 Salt Lake City Utah 84122 Office - (801) 323-8946 bull Fax - (801)323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
EnviroCare is being usedfor temporary holding of rail-offbins prior to disposal
The roll-offbins must be secured with cover and locks or pull down ties every night before the
crews leave the work site
Dead Wildlife
Follow the following procedure for the following types of dead wildlife
bull All fish species under 6 inches in length All fish species greater than 6 inches will be handled as
oily debris and will be disposed of at the Cleanharbor Grassey Maintain landfill
bull All bird species except for Starlings and English sparrows will be handled as oily debris and
disposed at the Cleanharbors Grassey Mountain landfill
bull All Oiled Bird species oiled But still alive notify Salt Lake County animal services (801-243-3813)
bull All Mammal species
1 Advise Environmental Unit Wildlife Coordinator or Environmental Unit leader at as soon as possible 2 Collect in a plastic bag
3 Label the bag with DATE and TIME the animal was found LOCATION and the NAME and PHONE of
person discovering the animal
4 Put the bagged animal on ice (chill) but DO NOT FREEZE
5 Take Pictures of the impacted animals
6 If wildlife officials do not take the species of interest the carcasss should be disposed of as oily
debris
General recommendations
Waste storage areas should
bull Be accessible to recovery site operations
bull Be accessible to nearby roads or highways
bull Be away from steep slope areas
bull Be away from topographical low areas
bull Be impermeable to the waste being stored
bull Prevent access to unauthorized personnel
Approved waste containers Include
bull Roll-off bins with covers Line with plastic sheeting Place absorbent material in bottom if
needed for free liquids
bull DOT-approved drums
bull Plastic bags for debris
Label all storage containers with
June 17 210 4
bull Date accumulation began (ie when you started putting waste in the container)
bull Composition and physical state of the waste (eg contaminated soil solid)
bull Generator information
SLC Red Butte Incident Chevron Pipe Line Co
2875 S Decker Lake Drive 150
Salt Lake City UT 84119
Contact Jim Robbins phone 801 975 2325
bull Use an appropriate container label for all waste bins or drums
Waste Container Labels Waste Classification and Name
Not Classified Wastes Laboratory Analysis in Progress
Use a Non-Classified Waste label for waste that has not
been determined Hazardous or Non-Hazardous
Hazardous Wastes Oily Debris Absorbents Oily Soil or Oily Protective Equipment (PPE) Contaminated Flood Debris Clean orOiled Vegetation
Non-Hazardous Wastes Oily Debris Absorbents Oily SOil or Oily Protective Equipment (PPE)
Contaminated Flood Debris Clean or Oiled Vegetation
Waste Transportation to Disposal Site
bull Hazardous waste will be sent to an approved hazardous waste disposal facility within 90 days of
accumulation
bull A Uniform Hazardous Waste Manifest must accompany all hazardous waste transported offsite
bull Only registered hazardous waste transporters will be used
bull Non-hazardous waste will be sent to an approved Non-Hazardous waste disposal facility
bull A Non-Hazardous Waste Shipping Form must accompany all non-hazardous waste transported off-site
Waste Management Documentation
bull Return a copy of all waste shipping papers to the Environmental Unit at the Incident Command Center
bull Record total quantity and classification of waste moved for each collection location to the compaction
area and shipped for the compaction site to disposal facilities
June 17 210 5
ENVIRONMENTAL SERVCfS INc
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Wednesday June 232010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ill must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule 8 shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 Salt Lake City Utah 84122 Office - (801) 323-8946 bull Fax - (801)323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
bull Date accumulation began (ie when you started putting waste in the container)
bull Composition and physical state of the waste (eg contaminated soil solid)
bull Generator information
SLC Red Butte Incident Chevron Pipe Line Co
2875 S Decker Lake Drive 150
Salt Lake City UT 84119
Contact Jim Robbins phone 801 975 2325
bull Use an appropriate container label for all waste bins or drums
Waste Container Labels Waste Classification and Name
Not Classified Wastes Laboratory Analysis in Progress
Use a Non-Classified Waste label for waste that has not
been determined Hazardous or Non-Hazardous
Hazardous Wastes Oily Debris Absorbents Oily Soil or Oily Protective Equipment (PPE) Contaminated Flood Debris Clean orOiled Vegetation
Non-Hazardous Wastes Oily Debris Absorbents Oily SOil or Oily Protective Equipment (PPE)
Contaminated Flood Debris Clean or Oiled Vegetation
Waste Transportation to Disposal Site
bull Hazardous waste will be sent to an approved hazardous waste disposal facility within 90 days of
accumulation
bull A Uniform Hazardous Waste Manifest must accompany all hazardous waste transported offsite
bull Only registered hazardous waste transporters will be used
bull Non-hazardous waste will be sent to an approved Non-Hazardous waste disposal facility
bull A Non-Hazardous Waste Shipping Form must accompany all non-hazardous waste transported off-site
Waste Management Documentation
bull Return a copy of all waste shipping papers to the Environmental Unit at the Incident Command Center
bull Record total quantity and classification of waste moved for each collection location to the compaction
area and shipped for the compaction site to disposal facilities
June 17 210 5
ENVIRONMENTAL SERVCfS INc
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Wednesday June 232010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ill must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule 8 shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 Salt Lake City Utah 84122 Office - (801) 323-8946 bull Fax - (801)323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
ENVIRONMENTAL SERVCfS INc
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Wednesday June 232010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ill must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule 8 shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 Salt Lake City Utah 84122 Office - (801) 323-8946 bull Fax - (801)323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Tuesday June 22 2010
Waste Name OILY DEBRIS amp Water
Profile ill CH444436B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be listed on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy Mountain Customer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 22 2010
The waste will expire on Wednesday June 22 2011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ID must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO 130x 22750 bull Salt Lake City Utah bull 84122 Office - (801) 323-8946 Fax - (801) 323-8739
Page 1 of 1
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
ENVIRONMENTAL SERVICES INC
Notice of Waste Acceptability Clean Harbors Grassy Mountain LLC
Prepaired Monday June 21 2010
Waste Name OILY DEBRlS
Profile ill CH443265B
Generator Chevron Pipe Line Company
Thank you for selecting Clean Harbors Grassy Mountain for your waste management requirments Your waste stream has been reviewed and is acceptable for management at our facility based on the information provided on the profile sheet identified above and the conditions listed below Our facility has the appropiate permits for and will accept this waste The Profile ID must be Ilsted on all shipping documents and correspondence Please retain these documents for your records ad future reference
To schedule a shipment or should you have any questions please contact Grassy MountainCustomer Service at 1-801-323-8900
This waste is acceptable for delivery on Tuesday June 15 2010
The waste will expire on Wednesday June 152011
An annual certification and review of this waste stream will be required for continued acceptability
Shipping Requirments If the waste is shipped in drums the Profile ill must be clearly marked on the top of every container
Clean Harbors Grassy Mountain LLC PO Box 22750 bull Sail Lake City bull Utah bull 84122 Office - (801) 323-8946middot Fax - (801) 323-8739
Page 1 of 1
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
WASTE MATERIAL PROFILE SHEET [lttanHarttbprs Clean Harbors Profile No CH443265B
A GENERAL INFORMATION GENERATOR NAME Chevron PIpe Line CompenyGENeRATOR EPA 10 IlREGISTRATION UTDOO7939101
GENERATOR cooe (Asalgnod by Cloen HlIfbors) CHE3130 CITY Norlh S Ike STATEIPROVINCE UT ZIPPOSTALCOOE 054 AOORESS fl51 South Redwood R~d
PHONE (801) 975-2325 CUSTOMER COOC (AssIgned by Clean Harbors) CHE3130 CUSTOMER NAME Chevron Pipe Line Compeny ADORESS 651 South RIII1wood Rod CITY North S1t Like STATElPROVlNCE UT ZIPIPOSTAL CODE
B WASTE DESCRIPTION WASTE DeSCRIPTION OIL YDEBRIS
PROCESS GENERATING WASTE (Plelao pmvldll deleijed description 01 process generoting wate)
CInup Atttvtue from Crude Oil RelHse
C PHYSICAL PROPERTIES (el 25C Of 77)
PHYBlCAL STATE SOLIO WITHOUT FREE L10UID
NUMBER OF PHASESILAYERS 1 2 3 TOP
BY VOLUME (Approx) MIDDLE
BOTTOM
ODOR NONE
MILO
I STRONG
Deacribe
Uwlmeorltpn
SPECIFIC GRAVITY ASH lt 08 (eg Gasoline)
08middot10 (eg Elhanol)
10 (eg Weter
10middot12 (eg Antireele)
v bull 12 (e9 ell1y1ene Chloride)
000 POWDER MONOliTHIC SOliD 000 lI0UIO WITH NO SOLIDS 000 lIQUIOISOLID MIXTURE FREE lIQUIO SETTLEO SOliO
BOILING POINT Of lCI TOTAL SUSPENOED SOLID
lt- 2 lt 01
21 middot89 01 0 I
7 (Neutal) 80
71middot124 51 middot200
gt= 125
SLUDGE
I GASlAEIlOSOLI
FLASH POINT Of re) lt 73 laquo23)
73middot 100 (23middot38)
01 middot40 (38middot80)
141 middot200 (80middotIl3)
gt 200 (gt93)
095laquo-35)
95middot 100 (35middot38)
0 29 (38middot54)
bullbull 30(54)
pH
VISCOSITY (H liquid JIfenl) 1 - 100 (og Woler)
101 eoo (eg MoIolt 011)
501 10000 (eg 11010_)
gt 10000
COLOR
~ l2tillD
TOTAL ORGANIC CARBON
MELTING POINT Of lCI
lt 140 laquo60) lt-
140-200 (80middot93) 1middot9
gt 200 (gt93) I raquo 10
BTUIlB (MJIIlg)
gt20
Unknown
I bull 2000 laquo48)
2000-5000 (46- Ie)
5000-10000 (118-232)
bull 10000 (gt23 2)
AcIuel
D COMPOSITION (lISlIhe compIele composilion 01 lhe wasle Include any Inerl componentl andlor~ Rlngeelor Indivtdull componenll Ifeaccepllble atlde namell
CRUDESOliDs bullbullbullbullbull bullbullbull 00000000 bullbull o~ooooooo bull
used p1eatelUPlllY M MSOS PllIOso do nOI USO IIlbreviollonl)
CHEMICAL MIN MAX UOM
ABSORBENTABSORBENT PADS OR BOOM bullbullbullbullbullbullbullbull CLAYBASED middotABSORBmiddotEmiddotmiddotmiddotmiddotmiddot
0 bullbullbull 0 bullbullbull 0 0 bullbull
00000000bullbullbull middotmiddotooociocioc bullbullbullbullbullbull bullbullbullbull bull middotmiddotooocioooomiddot
75000000o s~ciOooooo bullbull bullbull 0000000
0
middotoRAveimiddotampSOli 0 middotooocioooomiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbull bullbullbull bullbull bullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbullbullbullbullbullbull 05O~00000OO
PPE bullbullbull 00000000 bull0 is~oooooOci
RAGS bullbull 0 0 bull 0 bullbull 0 bull o bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull 0 bullbull 0 bullbullbullbullbullbullbullbullbullbull bullbull 00000000 0 bullbullbullbullbull 6~oOOOOOO WiPEs bull 0 bullbullbullbullbull middotmiddotocioOOoOomiddotmiddotmiddot 0 bullbull bullbullbullbullbullbullbullbullbullbullbullbull 5~00OOOOo
OOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EXbull METAL PlATE OR PIPING THICK ORgtr YES V NO LONG METAL REINFORCED HOSE 2 LONG METAL WIRE 12 LONG METAL VALVES PIPE FITIINOS CONCRETE REINFORCING BAR OR PIECES OF CONCRETE gt3)1
yebull describe Including dimonsions
OOES THIS WASTE CONTIIN ANY METAlS IN POWDERED OR OTHER FINELY OMDED FORM YES
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING ANIMAL WASTES HUMAN 8000 8000 PRODUCTS BODY YES FLUlOS MICROBIOLOGICAL WASTE PATHOLOGICAL WASTE HUMAN OR ANIMAL DERIVEO SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL
lackn_ledga Ihallhi$ wale nal is nelhe inlocllOUl nor docs il conlaln any oltoonilm known 10 be a Ihreello human healh This certlfocation Is b8sGd on my knowlodgo ollho maleria Soloct lhe anlwe below hal applies
The wasto W8S nover exPOSed 10 potenUaKy Iflleclious malerlal NOYES
Chemical disinlection 0lt some other form 01 slilizallen hal bean applied 10 lhe wasle Y(S NO
I ACKNOWlEDGE TIiAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS YES NO
I ACKNOWlEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETIED YES NO
SPECIFY THE SOURCE CODE ASSOCIATEO WITH THE WASTE 032 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE wJ19
Report Prlnled On Tuesday June 15 2010 IWINWEBIProfi1eWosle Profilerdl Page 1 of 3
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
--------
_ _
Clean Harbors Profile No CH443265B
E CONSTITUENTS
Are these aluO$ bbullbullcltI on lesling or knowledge 01 Knowledge T85I109
besed on knowledge please deSClibe lIIe raUonaie p1lod 10 idon~1y and chatactonze Ihe waste maleria (exbull Include rellllonco to Malena Salety DaI8 Sheela process conlkloralions erali ocedutebull
Gonerator Knowledge of crude I III _
Pleale Indlcale which conallluenls bolow apply Conconlrallonl must be onlored whon applicable to a5amplat In accurate review and expedited approval of your waete profe Please noto Ihallhe total regulaled mcItall and other conslltuenll Icllonamp require anlwerbull
RCRA REGULATED METALS REGULATORY TClP TOTAl UOM NOT APPLICABLE lEVEL (mgl) mgll
0004 ARSENIC 50 01 middot0005 _ -eARlljmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot1000middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~
0006 -CADMiuMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bullbull ~~
0010 -slLeNiuMmiddot bullbull middot10middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull
middot00middot07 bullbull -CHROMIuM bullbullbullbullbullbullbullbullbull - bullbull 0 bullbullbull shy
- 0008 LEAD _ 60
_ 01
0009 MERCURY 02 01 middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 001 -sLliERmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ 50middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot ~ _
VOLATilE COMPOUNDS
~01~ bullbullbull _~~Zl~ bullbull _bull ~5 g~36Jgbullbullbull 0019 CARBON TETRACHLORIDE 05 0021 CHLOR08ENZENE 1000 _ 0022 CIILOAOfOAM llOmiddot shy0028 12middotD1CHLOROETHIINE 05middot shy0029 11middotD1CHLOROETHYLENE 07middot shy~ METHYL ETHYL KETONE 2000middot shy0039 TETRACHLOROETHYLENE 07 _ 0040 TRICHLOROETHYLENE 05middot shy0043 VINYL CHLORIDE 02
SEMImiddotVOLATllE COMPOUNDS
0023 ocRESOL 2000 oo
0024 m-CRESOI 2000
o0~ bullbullbull ~~~~ _ 2bullbullbullbull bullbullbullbullbullbull
o02 bullbull~~~~~L (~l _ 21 bullbullbullbullbullbullbullbull 0027 14middotDICHLOROBENZENE 75
middot0030middot middot2~4-oiririRoTOCuemiddotNiimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotolimiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot middot0032 -HixACmiddotKLOROBeNiEN~middotmiddotmiddotmiddotmiddotmiddotmiddotbullbullbullbullolimiddotmiddotmiddotmiddot middot0033 -HExACHmiddotLOROiiuTAOiEmiddotNmiddotEmiddotmiddotmiddotmiddotmiddot - bullbullbull O~5 bullbullbullbullbullbullbull bullbullbull 0034 HEXACHlOROETHilNE 30 middot0036 -NITROBENZENEmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot - bull 2~0 0037 PENTACHLOROPHENOL 1000
middot0038middot middotPYRIDINE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbull - bullbullbull 5~middotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot 0041 245TRlCHLOROPHENOL 4000 - 0042 248middotTRICHLOROPHENOL 20middot
PESTICIDES AND HERBICIDES
0012 ENDRIN 002 0013 LINDANE 04
0014 bullbull -METHOXYCHLOR bullbullbull - bull 00 bull - - 0015 TOXAPHENE 05middot 0016 24middotD 100 0017 2A5middotTP (SILVEX) 10 - 0020 CHLORDANE 003
003 bullbull -HePTACHlOR(AND iTS EPOXIDEj - bullbullbull O~C08 bullbullbullbull middot ACOITIONAL HAZARDS
_ OTHER CONSTITUENTS MAX UOM
BROMINEmiddotCHLORItemiddotmiddot middotbull bull middotbull _ FLUORINEmiddotlooiNEmiddotmiddot -- - - - - _bullbull -shy
middotSULFUR- bullbull bullbull bullmiddot bullmiddot bull bullbull bullbullbull bull bullmiddot _
NOT APPLICABLE
loll ~
01 ~~ -
- ~ pOTAssiuM bullbullbullbullbullbullbullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull i~ middotsoDluMmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddotmiddot _ middotI~middotmiddotmiddotmiddotmiddotmiddotmiddot
AMMONiA bullbullbullbullbullbullbullbull _bullbullbullbullbullbull t~ CYANIDE AMENABLE bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull ~ bullbullbullbullbullbull CYANIDE REACTIvE bullbullbull - bullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbullbull~bullbullbull bullbullbull CYANIDE TOTAl bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbull bullbull bullbull suLFiDE REACTIvE bullbullbullbull - bullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbullbullbull bullbullbullbullbullbullbull
-- - - - - - HOC
NONEv lt 1000 PPM
gt 1000 PPM
v NONE
lt~PPM
-50 PPM
IF PCBS ARE PRESENT IS THE WASTE REGULATED BY TSCA 40 CFR 761
YES NO
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED
YES v NO (I yes aXplain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCE EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL 01 NONE OF THE ABOVE
Page 2 or3Report PnnledOn Tuesday June 152010 IWINWEBIProrloIWasle Prorlerdl
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
Clean Harbors Profile No CH4432658
F REGULATORY STATUS
YES v NO USEPA HAZARDOUS~WASTE~[ - ~==============_========J--shyYES v NO DO ANY STATE WASTE CODES APPLY
Texal Walle Codo
YES v NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY
YES NO IS THIS WASTE PnOHIOlTED FROM LAND DlSPOSAL WITHOUT r-URTHER TREATMENT PER 40 CFR PART 268
LOR CATEGORY ~NoIsubJCO LOR VARIANCE INFO -=------------------ ----------1 -------------------------
YES NO IS THIS A UNIVERSill WASTE
YES v NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESOG)
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS II RCRA EXEMPT COMMERCIAL PRODUCT WHICH IS FUEL (40 CFR 2612 (C)(2J(II))
YES NO DOES TREATMENT OF THIS WASTE GENERATE A F008 OR F019 SLUDGE
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIOlTiON FOUND AT 40 CFR 2tI8 3C)
YES NO OOfS THIS WASTE CONTAIN VOCS IN CONCENTRATIONS middot500 PPM
YES v NO DOES THE WASTE CONTAIN GREATER THAN 204 or- ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE gt 3KPA (044 PSIA)
YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSUREgt 17 KPA(II2 PSIA)
YES NO IS THtS CERCLA REGULATED (SUPERFUND ) WASTE
YES NO IS TH WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES v Hazardous Organic NESHAP (HON) lUla (subpart G) Pharmsc80ticals production (subp8l1 GGG)
YES NO IF THIS IS A US EPA HAZARDOUS WASTE DOES THIS WASTE STREAM CONTAIN BENZENE
YES NO eoeslhe waSIe stream come rom a lacllijy with one 01 he SIC codesUsled undar benzona NESIiA Of s Ihll weste regulated unde (he bonzena NESHAP rules because the original source 01 Ihe waste Is from a chemical menu1acluring coke by-producl recavery or peIIOIoum refmory process
yrS NO lithe generating IOOrce 01 his sto stream a lacnitywilh Total Annual Benzane (TAB) gt10 Mglyear
Whaia the TAB quenlily lor your lac~lty MegagramyGar (1 Mg 2200 100)
The baSIS lor Ihis delOrmlnallon Is Knowledga 01 the Wasta Or TOIl Ollie Knowledge TelIng
Doscribo lho knowlodga
G OOTITDG INFORMATION
DOTITOG PROPER SHIPPING NAME
NONE NON HAZARDOUS NON DOT REGULATED (OILY DEBRIS RAGS) NIA
NONE NON RCRA HAZARDOUS WASTE SOLIDS (CRUDE OIL CONTAMINATED DEBRIS amp ABSORBENTS) NlA
II TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY v OTHER liclfI
CONTAINERIZED
0-0 CONTAINERSJSHIPMENT
STORAGE CAPACITY CONTAINER TYPE
CUBIC YARD BOX PALLET
TOTE TANK DRUM OTHER
DRUM SIZE
BULK LIQUID
GALLONSSHIPMENT 0 MIn -0 Mex GAL
BULK SOLID
SHIPMENT UOO YARD TON
TONSlYARDSlSHIPMENT 1800 MInmiddot 2000 Max
I SPECIAL REQUEST
COMMENTS OR REOUESTS GrlSsy Mounllln CDP Direct LilndnU bull RUSH RUSHI
GENERATORS CERTIFICATION I heteby c8flily a aUlnlormaUon lubmilted In this and anached documenls Is corract to tha best 01 my knowledge I al$o cert~y Ihat any $amples submllted ere representative 01 lIle aclual waste If Clean Harbors dlscoverl a discrepancy during the approval ptouu Generalot granls Clean Harbolllho authority 10 omend the ptofile 88 Clean Harbors deoms ne~esaary to renacllhe discrepancy
AUTHORIZED SIGNATURE
firnrobbinschovroncom
NIIME (PRINT) TITLE DATE
611512010
Thi~ wasle prome has been submi1led using Claan Harbors electronic signalure system
Report Printed On Tueday June 15 2010 IWINWEBIProfflalW88te Promardl Page 3 013
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
SLC Red Butte Incident
Recovered oil Tin NumtNr U uld G It WattrGn Tot1 uld Water 011 Cui lockt-dl tltf1 (ol1lmellh
SLC Reflnery loeatJon
lC ~ofmeY 5V2631Sl 97150 29625 18645 5206 11439 219 Vn Vel 61810
SLC Rerlllery 5V19717l 109000 H375 20844 17890 ass Yes 61810
SLCRef1nery 165168 81000 79l15 16380 lSn6 GlI4 963 Yn Yes 61710
StCR~lIIery 259489 85625 8SsU 17141 17141 lDOO Yrs Yes 61710 Trite lTountl 01 011
SLC Rdinery 2S~496 78375 66250 is619 13073 ~S46 83~ Yn Yes 61710
su Rerlflery 158138 79J75 77250 L5829 153113 446 97_~ No Yes ti1810 Unible to loct
ILCRertnePl 259638 6750 59500 l35~8 1l655 l943 857)( rei res 61710
iLCReftnery 165471 82250 38J75 1603 7m ~IS6 40113 Yes Ve 61710
SLC Remlrv 258304 86615 8bull 625 11351 173S1 1000 No 6WI0 T~e- 1T0unts of oil Un~ble to lode
SlCRefinuy 2111891 nooo 77_ 15)]0 15310 100~ Yel Yes 61810 Trne ~rrounts 01 oil
SLCRefinery 251657 45500 45375 17115 17089 26 998 rei Vel 6l9l0
SlCRefin~ry 2S91aS 78150 75000 15593 14910 83 95 Yes Yes 6l010
SlC Refine1) 159226 51115 50000 16748 16249 499 970JI No Yes 62010
SlCRrimcry 15128S 19819 19609 210 989 Yes
SLC Refinery 258878 17430 16853 ~78 967 Yes
SlC Refinery 151611 16853 15934 919 94~ Yes
SlCRefV1l1ry 259153 16117 16091 26 998 Yes
SLCPetlnery 259624 18848 17lJ3 1575 9L6 Vn
18034 420 977 Yes
17850 263 983 Yes Reulecl1middot12middot10durtUllrom JU 1 18848 420 989 Yes Repued 1-12-10 Incr from 5J 1amp1
16853 looOJI Yes RIUlecl7-U-10 no che
SLC RofY 265816 17850 17850 1001llI orr RelUlod 7middot12-10 no nl
SlC Rnnry 258691 17430 17430 100- VOJ Repuled 1middotU-10 no dtln1
StC Refinery 159413 17876 17876 100alI Yes Reluampecl1middotU-l0 no nl
SlC ReRnerv 255326 16255 16255 100~ Vbullbull Raulcd 1-U-10 no champl1lt
Slnmnery 155_ 18711 18711 100~ 1lIUteI 1middot12-10 no ~hlnl
ILCRofirnery 255487 17472 17412 1000 Vbullbull Relumiddot12-10i no hanct SlC~finery 254053 1749] 1749] 1000 Vbullbull RIIUltd 7middot12-10 no ctJallt
SlCReflnery 2rs86O 15495 15498 1000 Yes
~lC Refinery 256807 19241 19241 1000 V
SLCRefinery 239635 20961 20963 1000 Yes ReloUlud from Ubtrty Puk
~lCReflnuy 2655 15~9 15~9 1000 Yes
SlCRlPf1nt1V 5FVPlaquo03l 16933 16933 1000 RekxJilcd from Stalin Are
SLC R~inery 255967 19504 19504 lOOalI
SLC Refinery 2rs045 82000 16380 16380 1000lI 72910
SlC Refinery 16584$ 91150 16amp41 16Ml 1000 72910
SLC Refinery SVl0919l 14-000 2303 2303 1000 72910
SLC Rery SV27260l 81000 1amp842 1amp842 1000 7MIO
SICRefinery 265848 48750 8443 8443 1000 71910
SlC Refinery 259218 89500 18060 18060 1000 72910
SlCRefinery SFVP4421l 98s00 1898amp 18986 1000 72910
SlC Refinery 265BS7 92000 18480 18480 10oltm 72910
SlC Rerll1ery
lCReflnlty
SlC Rerel
lC Refln_ry 259198 16853
SUalniNUI~ U 0 m)
Other locations
239216 Not It rtfineryor stiltlnal ent b~d fo supplier
Subtot~1 SLC hetine-ry 7lS4S0 688903 36705 g~1 552 bbl o(a corre-cttd 101 dralnae nd luk repaIr
Subloul UbertYPark a Iil o bbb
Subll OthUloatKxu
To~1 A1IIOQlion1i n54S0 688903 36705 gJ1
Pip~lle dr~lMampe UCrefltery 13524 ampoJ1 322 bbls Total recoyerCld 16402 SS2 bbls 52 bbJlt
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
Wan~ QuantitY 5C31~ WI
80xNumbN Conuiner Type Wast Dncription (Cub I Ygtrd) P~rtentOI1 locnron of W~~te ShIpment Dati rmrirsl Number Barrels OIlIIoel Gen Tran Fae In (Ib) NotasComments
R20047 R30095RT
5109 4739
20 Pad 20 Pad 70 Dirt
20 ads 800m
70
70 10 20
05 075
05 025
amp287010 003050198 fII
6782010 003050198 FU 727010003050199 flE
67S2010 003050200 fII
9amp 96 48
9amp
048 024 024 024
middot bullbull I
bull bullbull I
bull bull middot bullbullbull
5700
-shy7S1140 8160
Prbullbull perc all (~5)
4742 20 Pads 800m 20 025 6787010 003050200 fLE 96 024 4747 70eu RollmiddotlOp dirt
RI8003S8 20 Dirt
6517 70 Dirt
899 20 Dirt RIS71 70 Dirt
216~ 20 Cl VaClum 80x dirt
0575 20 cu RoIIIOI Dirt
1402 20 cu dirt
258167 20 Cu Pads Boom
10
10 10 10 10 10 15
10 20
05 05 05 05 05 05
1 05 05
62517010 003050701 fII 6747010003050376 flE
6747010 003050377 fII 6242010 003050378 fII 6747010 003050379 fLE 6232010 003050380 fII
6232010 003050381 fLE
6732010 003050382 flE 6242010 003050383 fII
48 48 48
48 48 48
n 48
96
074 024 074
024 024
024
077 074
04l
middot I middot bull 27470
bull bull bull 290400
bull bull middot 3amp020
middot middot middot middot 29140
middot bull bull bull 301160
bull bull bull 36WO
bull bull middot middot 29180
bull bull middot middot 24740
bull bull middot bull 12160
Pre perc all (1-2)
R 1834 25 pads booms 20 05 6247010 003050383 fII 96 OAS 47i3
R26540 4755
20 boom 20 boom 20 boom
20 20
20
025 025
05
612912010 003050384 fII 6797010 003050384 flE 6292010 003050385 HE
96 96 96
024 024 OAS
middot middot bull bull 2320
bull bull middot bull -bull middot middot middot 450W
AlS71 20 boom 20 05 6292010 003050385 fLE 96 04l Sl23 20 cu Had top
4676 4927 20cu os71 20 cu RolltiHp
4755 70 fid Top 651920 eu RolH~rp
dirt 20 pad beam
Pad 800m rllrt
Dirt Boom Pds
15 20
20 20
15 20
1 05 05
Rllff Pun
05 Red Butte
5 1500 E 1050 5
6782010 003050386 fLE
6787010 003050387 HE 6282010 003050387 m fit101 0 003050430 HE 6212010 003050430 flE 6712010 003050431 HE
77 96 96 96 77 96
077 048 OAS 197 036
G48
x bull 25900
bull middot bull 6580 PreY percotl laquoCJ5l bull bull middot - Prev perc oil laquo05)
bull bull bull 13900
bull bull middot -middot middot middot 75860 0516 25 cu Vd tl rdmiddotlop
4736 25 cu 6S18 25 cu rotJmiddottarp
booms pads
p~d booms liJrbaee
8 25 5
79thwe12505 1
05
6712010 003050447 FLE 6212010 003050448 FLE 6212010 003050448 FLE
38 120
24
076 12
012
bullbull x
middot bullbull x x middot
16900 6020
-Prbullbull Qua5-8) perc on 17-5)
Prow Quan 1lt5) ~rc olilcO5) 4748 20 cu Roll-Top ot7S1 25 cu RollmiddotTop
0572 25 tU Rolllar~
6300 20 cu vacwm 80x
Pads Boom dirt dtrtdlllb-is
dirt
12 I
10 10
05 Ub~tv
05 RClid Blrl1a
05
05
6717010 003050449 HE 111000 002050449 rLE 6212010 003050450 FLE 6232010 003050451 FLE
58 48 48 48
029 024 024 024
bull middot bull middot bull middot 6140 w middot -bull bull 21320
middot middot 36S70 Prev percolilcO51
030584 20 cu yd iIltlnmiddotop RUOO3ml 2S cu RollmiddotT~rp
71l4 25 u Roll-Torp R200S4 20 cu
1405 20 tU
looms ralslarbage moslly boom pld $011 Pad Boom
boom Pids dirt
7 10 20 20
05 900 5 1000 W 05
05 05 OS
6727010 003050452 FLE 6222010 003050452 rLE 6272010 003050453 HE 6722010 003050453 FLE 6222010 00305015-1 FLE
34 48
96 96
bullbull
017 024 048
OA8 014
x
middot bull middot middot bull bull 35060
bull middot -x bull 5960
middot bull -middot middot 24220
Prey quan (10-12) perc o~ laquoOSl Prev pcrc oU laquo()_5)
4712 20 cu booms ~ilds 20 1 6722010 003050454 FLE 96 096 2167 20 cu vaWUnI 60x dirt
218993 20 cu VlaJUnI Bax dirt Rl8036Ml 25 cu lell-Ta rp
R26541 25 cu Roll-Tarp DirtRock
5182 20 sell
10 10 10 10 10
05 05 05
1 05
6232010 003050455 FLE 6232010 003050456 HE 6782010 003050457 HE 6282010 003050458 FLE 6307010 003050459 HE
4S 48 4S 48
4S
024
024 024
048 024
middot bull bull 14220
bull bull 71440 x bull middot middot 20200
bull bull X bull 37000
middot middot middot 25260 Pre Qua (10middot12~ perc 011 (1middot7) PreY perc 011lt05)
200
4751
20 ~(jll
20 boom pad I
20 05
025 G012010 0004 rLC 6302010 003050461 FLE
48 96
024
024 middot bull middot middot 27amp40
middot bull 3260 RlII0BB8 20 boom pds 20 025 6307010 003050461 FLE 96 024
1997 20 boom 20 025 61302010 003050462 rLE 9amp 0_24 middot middot middot middot 16000 30584 20 boom 20 025 6302010 003050462 FLE 96 024
R22219B 4934
fl18309
20 dirt 20 20Jrr
10 17 10
05 025 02
6302010 003050463 FLE 6302010 003050464 fU
7(12010 OOlOS04Ci5 FlE
48 82 48
024 0205
012
bull middot bull middot bullbull middot
bull 26060 34240 25700
4745 20 boom 10 025 712010 003050466 FLE 96 024 bull bull 7880 CHRT 25846 25 boom 20 025 712010 003050466 FLE 96 024
8509 20 boom 20 025 712010 003050467 HE 96 024 bull bull 6900 R20051 20 boom 20 025 7112010 003050467 FLE 96 024
4741 20 boom 70 025 762010 003050468 FLE 96 024 bull bull IS 270 1amp203 20 boom 20 025 762010 003050468 rLE 96 024 R1lU4 20 sort 18 0 d~2010 00050409 Flf 87 04) middot middot middot middot 20
OS7S R1864Ml 2S Cu RolImiddottop
0572
20 SQI1
oM 20 dIrt
10 10 10
05
05 bull25
6292010 003050470 FLE 61252010 003050471 fLE
762010 003050473 FLE
48 48 48
024 024 012
bull x
bull bull middot bull x
middot bull x
29680 31560 14680
057S 1405
ClHA250319 fl18036
70 boom 20 boom 25 25
20 20 20 2
025 025 025 oa
762010 003050474 FLE 767010 003050474 FLE 767010 003050475 FLE 71201Q 00300015 IE
96 96 96
bullbull
024 024 024 024
bull middot bullmiddot x
bull x
middot 5260
-4200
-U8375 20 dirt 10 025 762010 003050476 FLE 4S 012 middot x 25620
4976 0571
2amp542
20 dirt
20 boom
20 boom
10 20 20
025 025 025
722010 003050477 rLE 712010 003050479 FLE 712010 003050479 FLE
48 96 96
012 024 024
bull bull middot bull bull x x
2S540 5920
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
bull bull
bull bull bullbull
bull bull
bullbull bull bull bull bull bull bull bull
bull bull
10007 20 boom 20 025 762010 oogt0504811 FLE 96 024 S900bull 2S70 20 boom 20 025 762010 003050480 HE 96 024 middot 1~02 20 lJoom 70 025 162010 oo30S0481 FlE 96 024 8360
214730 20 boom 20 025 762010 00gt050481 HE 96 024 middot middot shy278940 20 boom 20 025 162010 00gt050482 HE 96 024 bull
bull middotx 2860
279611 20 boom 20 02S 762010 003050482 HE 96 024 shylt753 20 be-om 20 025 16l010 003050483 FlE 96 024 middotx
bull x 4440
ltiSS 20 baem 70 025 762010 003050483 HE 96 024 Rl8100 ml 20 ~Irt 10 025 162010 003050484 FlE 48 012
bull middotx 20500
278993 VacuulTI 60x 20cu dirt 10 025 7202010 003050485 HE 48 012 middot 25019 JO dilt 10 025 6292010 003050486FlE 48 012 middotbull middot 27800middot bull
1391 20 boom 20 025 7f72010 003050488 FlE 96 024 x 1138middot0
6516 20 boom 20 025 1f71010 003050488 FlE 96 024 bull middotx shy4748 20 boom 20 025 762010 003050489 FlE 96 024 x x 5360
258167 25 cu RolImiddottop Pd BoOm 20 50 liberty Park 162010 003050489 FlE 96 048 shy6517 25 cu floll-T~p Ooom pJd~ 20 OS Va Hospital 6302010 003050490 FiE 96 048 x middot middot 7960 PreY perroll (ltcS)bull 1194 20 Doom 20 025 6302010 003050490 FlE 9 024 x x x x shy
26540 20 boom 20 015 762010 003050491 FLE ~b U14 x bull 3800
6S41 20 hoom 20 015 7(62010 003Oi0491 FLE 9 024 x x _ 250317 20 1J0arn 20 05 6302010 003050492 FLE 96 048 x bull 11640
_2S81l9 20 boOIl 20 05 6301010 003050492 FIE 96 048 middot x bull
1~02 20 d[rt 10 025 6302010 003050493 HE 48 011 middotx x x bull 28300
25S165 20 boom polds 20 015 6282010 003050494 FIE 9ti 024 x x x x ~56O
274702 10 boom pOlds 10 025 6282010 003050494 FLE 96 024 x x x x shyR2G539 20 dirt lU uJJ OS01010 OOO5D45u 012 middot middot 10100bullbull middot SOOl 200irt 10 025 6292010 003050496 FU 48 012 x x x 24960
6034 20 laquoIirt 10 015 6192010 003050491 FLE 48 012 x x x x 25560
1405 20 pad Boom 20 025 6212010 003050498 FU 96 024 bull x 9680middot bull 6518 20 Polcl Doom 20 025 6271010 003050498 FU 96 024 x x shymiddot x 1405 20 20 025 62S2010 003050538 FlE 96 024 Minifesotcoples mlssln
GS18 2Seu rollmiddoturp 20 05 6282010 003050538 FLE 96 048 Mlnifestcoples miuina 27GIOl 20 drt lU OS 71010 oo310n36 Flf 4 024 11200
1402 20 boorn 10 025 792010 003101187 FLE 96 020 middot middotx 5260
CHLA25S028 2S dIn 10 025 7~l010 003101188 FlE 48 012 middot 2700
11105 20 boon 20 025 2S1010 003107189 FLE 96 024 middotbull bull middotx 9300 4HG 20 boom 10 025 182010 003l07lS9 FLE 96 020 x x shybulln7 Vacuum Box 20ro dirt 10 05 1S2010 003107190 FLE 08 024 28420 No bOIi no on milnUc)l
4747 20 booml rae ebullbulluee 70 025 7S1010 001l07l91 FLE 96 020 x x 4940 llo825ISCH 20 lgtu01n~ lit) 6adJLl~e 20 D_2~ 782010 OOU07191 FL~ 02
4676 20 boom 10 025 7S2010 003101l92FlE 96 02~ middotx middot x 19400
5063 20 boom 20 025 7S2010 003107192 FlE 96 024
7640 20 dirt 10 05 182010 00310713 HE 48 024 x x 29200bull 47S1 20 boom p~ds 20 025 782010 0031071M FlE 96 024 I1ll0
2581G5 20 boom pads 20 025 782010 001l0719~ FlE 96 024
276689 20 dill 10 05 7S2010 003101195 FlE 48 024 x 32200 O~71 20 boom p ds 20 01 7192010 003107106 FlE 009 middot bull
528-0 2654 20 boom pads 20 01 7192010 003101196 FLE 96 0096 middot middot 1402 20 dirt 10 025 7162010003107l91FLI 48 012 32460 7194 20 dirt 10 025 1132010003107198 FlE 48 012 x x 28080bull 1402 20 boom ~3ds 10 025 7122010 003107199 FLE 96 014 4980
RIS003 20 boom pads 20 025 1122010003107199 FlE 96 014 x x -shybull 65ll 20 boom pi3ds 20 025 7122010 003107200 FlE 96 024 x 04380bull
q6 _258020 20 bo-om puh 20 01$ 712J2010 nnn7700FlF n 14 x bull 1391 20 boom pod 20 01 7102010 003107201 HE 96 009 x x 3600 l95 20 bOOr Po1 dS 20 01 7192010 003101201 FLI 96 0096 X shybull OS7G 20 boom pld 20 01 7202010 003101201 FLE 96 0096 x x 4180 t7t7 20 boom pbulluh 20 01 7202010 003101202 FlE 96 0096 1]93 20 bIom pads 20 01 7202010003107203 FiE 96 0096 x x x 5040 7i94 20 boom pi3ds 20 01 7202010 003101203 FLE 96 0096 4979 25 cu Roll top dJll 17 1 Red Duttc 712010003101204 FLE 82 082 x x 33360 5191 20 dirt 10 025 7f72010 003107205 HE 48 012 31220 S510 20 dirt 10 05 7152010 003107206 FLE 48 014 middot x
bull x 16600bull
6519 20 dirt 10 025 7132010oo310n01FIE 48 012 x x 21900bull 1397 20 dirt 10 05 71S2010 003101208 FLE 4S 02~ x 31620 4141 20 boom pad 20 025 7162010 003101209 FU 96 024 X
4]0398 20 boom p~dl 20 025 116(2010 003101209 FLE 96 024 0513 ]0 dirt 10 05 71S2010 003101210 HE 4S 024 x 32820middot x 0571 20 boom padl 20 025 7152010 003107211 FLE 9 014 4080middot x bull 1194 20 boom Ilds 20 025 71S2010 003107211 HE 9 024 8510 20 dirt 10 025 192010 003101211 FlE 48 012 x x 840bull 0511 20 boom pads 0 025 7122010 003107210 HE 96 024 x 1660middot x
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
4745 a510
20 boom pld
20 boom pgtd 20 20
025
01
7122010 003107214 HE
7192010 003107215 HE 96 96
024 0096 bull x 6480
CWA250082CII 20 boam pads 20 01 7192010 003107215 FIE 96 0096
4755 6517
20 boom pads 20 boom pads
20 20
025 025
7122010003107216Flf 7L2I2010 003107216 HE
96 96
024 024
x x
x x
x x
2940 shy
276081RR Vacuum Box 20CU din 10 05 7142010 003107217 HE 8 0-2 x x x 6960 27G128RR Vacuum Box 20cu dirt 10 05 712010 003107218 FIE 8 024 x x x 6300
105 20 boom pd 20 025 7IJ2010 003107219 HE 96 024 x x x 66110 4747 20 boom pad 20 025 7132010 003107219 FIE 9S 024
745 20 boom pads 20 01 7202010 OO3107U7 HE 96 0096 x x x 4700 274705 20 boomoad 20 01 72012010003107227 HE 9amp Oogamp
1395 20 beam pads 20 01 7232010 003107228 FIE 96 0096 741 20 beom po1ds 20 01 7202010 003107229 FIE 9S 0096 x x 3520
274702AR 20 boompdJ 20 01 7202010 003107229 HE 96 0096 279297RR 20 dirt 10 05 7152010003107241 FIE 48 024
75 20 dirt 10 05 7142010 003107242 HE 48 024 x x x 30260 6519 20 dirt 10 05 7142010003107243 HE 48 02 x x x 33940 JIG 10 dit 10 OS 1COj71In oo110n44 FIF 4 024
276622 20 dirt 10 05 7152010 003107245 HE 48 024 692 20 wood amp deb 20 01 72120 10 003107246 FIE 96 0096 x 3800 4753 20 wood amp dCbds 20 01 7212010 00310724amp FIE 9amp 0096 0572 20 wood amp deb 20 01 7212010 003107247 FIE 96 0096 x x 4980 7194 20 wood amp lJeblfs 20 01 7112010003107247 FLE 96 0096 0571 lAC
4747
20 wood amp deb 20 wl)ad a dcb~
20 boompgtd
20 20 20
01 01 01
72120 10 003107248 FIE 72120100031072011 Fl[
7222010 003107249 FIE
96
bullbull 96
0096 oagG
0096
middot x
9300
-36060
6519 20 boom pads 20 01 7222010003107249 HE 96 009S 279338RR 20 boom pld 20 01 7202010003107252 FIE 96 0096 27~9RR 20 soil debris wafer 20 01 7272010003394460 FIE 96 0096
0576 20 boon pads 20 01 7272010003394461 FLE 96 0096 1405 20 boompads 20 01 7272010003394461 HE 96 0096 GS19 20 dirt 10 01 7202010 00)39462 rLpound 48 OQ48
6517 20 boom p~s 20 01 7282010003394463 FIE 96 0096 4755 20 dirt 20 01 7282010 003394463 FIE 96 0096 1402 20 dirt 20 01 7282010 0033944 64 FU 96 0096 1391 20 boom pads 20 01 7292010 003394465 FIE 96 0096
550 20 boom pads 20 01 7292010003394465 HE 96 0096 5063 5001 20 ull-l-I JI
20 dirt dit
10 15
05 1 RtLJ61JUe
6242010 007092555 JJI(
623(20 10 007092J~GJJI( 48 72
024 072
x
middot x middot 23440 middot 21020
0576 25 roll top boom 20 1 6252010007092557 JJI( 96 096 x x x 38lt0 PreY peorc oil(2~S)
4741 20 cu boom 20 05 62520 10 007092557 UK 96 048 x x x -030589 20 boom 20 025 6252010 007092558 UK 96 024 x x x 35580
F3009SRT 25 Roll Tep boom 20 025 6252010 007092558 11K ~6 024 4692 20 boomfl~dJ 20 025 6252010 007092559 UK 96 024 x x x 6280 4758 5123 20 cu
20 boomJ3~]
din 20 10
025 1
6252010 007092559 JJIC 0232010 0070n550 II
96
bullbull 024 048 X X middot 2S20
1396 20 boom 20 025 792010 007092564 JJK 96 024 6518 20 boom 20 025 7920 10 00709256411( 96 024 0576 20 boom 20 025 782010007092565 UK 96 024 51S9 20 boon 20 025 7IB20 10 007092565 JIK 96 024
4768
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
1t2n9904 641 010 Please prinl or Iype (Forin designed1fermiddotuseon elile (12middotpilch) typewriter) Form Approved OMB No 2050middot0039
DESIGNA1ED-nxCILITY TO GENERATOR
UNIFORM HAZARDOUS IGenerator 10 Number 2 Page 10113 Emergency Response Phone 14010t30~rj4 50 WASTE MANIFEST Ul 0 4) 0 7 II S i 0 1 1 (amp00) bull =18 FLE
5 Generators Name and Mailing Address Generato~s Site Address (if different than mailing address)
Ptit aM tom 661SaUItJ ENolttt-hft I~ tIT 84054
Generalors Phone (801~972325 I 6 Transporter 1Company Name US EPA 10 Number
6tun HiiIiott I
1M -~ I MADOa83222GO lt 7 Transporter 2 Company Name I ( ~lcbull) US EPA 10 Number
I B Designated Facilily Name and Site Address US EPA 10 Number
et a -M b TDe 1301748M ~7iFiJ~-of GnmtI lIT 840H - shy
IFacmlys Phone 4qin bull shygao 9b us DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group (if any)) No Type Quantily WINol j
0 1 utMC IUlN HAZAROO D~OT Q TEOOllY I C iY - -0 a-is RAGS) NlA
( ) ~ Iw
2 Iz w Cgt I
I ~ 3 I
I
--r-I-shyI 4
I- -14 Special Handling Inslructions and Additional Inlormation
iCli4 4~t6S-f$
A1 ti 0572 So~ 15 GENERATORSIOFFERORS CERTIFICATION I hereby declare thatlhe conlentsof lhis consignmenl are fUlly and accurately described above by theproper shipping name ~nd are classified packaged
marked and labeledplacarded and are in all respects in prope~ condilion fOf lransport according 10 applicable international and national govemmenlal regulallons If export shipment and I am 100 Primary Exporter I certify lhatlhe contents of lhis consignment conform 10 the terms of Ihe allached EPAAcknowtedgmenl of Consenl I certify lhatlhe waste mlnlmlzatlon statement identified in 40 CFR 26227(a) (if I am alarge quanlity generator) Of (b) nf I am a small quantily generator) is lrue
Generato~sOerors IrinledfTyped Name gtIgnalure MonlO uay Year
I 17 F q-shy I I ( v -1 ~-_~ I 6 I~i I Je)t~ ~ J -J 16 International Shipments o Imp~rt to US o Export from US
v ~ Port of enlryexil ~ Transporter signature (for exports only) Dale leaving US 0 17 Transporter Acknowledgment of Receipt of Materialsw I- Transporter 1 Printe~fTyped Name b sl~ure
Month oay Year0
fir0 JJe Y 1 t 1- -1 I )~hd __ bull 1( J 1(612J I Jcll en
~ Transporter 2 PnnteilfTyped Name Signature - - ~ Monlh Day Year
0 I I I Il-
I
18~ Discrepancy
18a Discrepancy Indication Space o Quantily o Type oResidue o Partial Rejection o Full Rejection
Manifest Reference Number
~ 18b Alternale Facility (or Generator) US EPA 10 Number i U t Facilitys Phone I c lBc Signature of Alternate Facility (or Generator) Monlh Day Yearw ( I I Iz Cl 19 Hazardous Waste Report Management Melhod Codes (ie codes [Of hazardous waste treatment disposal and recycling systems)en w
1 1413 1 2 1
3 1
4
C
11~~Tri iTr7A~T mpoo 100 m~~-c~ j
21 ) oon --V - Month Day YearA j n I t A I i Ii IJ 10 i i f
EPA ForJnarOO22 (Rev 3-05) Previous eeurolitions are dbsdlete v -- - - ~
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
~ vI GM LOAD SUMMARY RECORD ENVIRONMENTAL SERVICES ---------------------=--=-----=shy
LOAD DISPOSALDESTINATION
R ~D D DSPOT STABILIZATION RCRACELI TSCA CEll STABILIZATION
LOAD TRACKING INFORMATION-
PLANT DRQPPED FINAL CODE p WEIGHTS GRIDS MANIFEST RECEIVED
~~ MAILED
0iW DATE LOAD NO ~
lJJ~O (~O I(j () ~ Tq I GENERATpR ( - HAULER
r)1eUVU~ CH ORDER NO DRUM NO
C 1 e -~q g ~tj 1~SObSS-S TRUCK NO CONTAINER NO (s) RAILCAR NO
q~4D7 -T L) 057J
CONTAINER TYPE LOAD COUNT (~AIL ONLY)
ED ~)TT FB V OTHER 1 2 3 4
OPERAteRSIGNATURE COUNT DATE
LOAD WASHOUF INFORMATION WASHOUT STAMP WASHOUT TYPE
~NO ~
INTERIOR E~iOR I WASHOUT SIGNATURE DATE
4 1- 0bmiddott DRIVER SIGNATURE DATE -_shy
ITEM COMMENTS - ~
~
j v
722 06 2~ to 63430 1tt
I) Ib TAFE 53480 Ib NET
YiJ~bull iO 8~17 64BO Ib rl60 lb TR 21320 Ib NET
NAME DATE
~V)) ~Y
I Jy t) 1-1
H r ors Grass Mountain Facili 1l 0 e tClean a b y ty 0 el County U a h
WHITE - Facility CANARY - Generator PINK - Transporter GREEN - Receiving GOLD - Operations
CHI 208
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
Please print or type (Form designed for use on elite (12middotpitch) typewriter) Form Approved OMB No 2050-0039
UNIFORM HAZARDOUS 1 Generator 0 Number 12 pr 1of 3 ERleJoncy Res~ Phone 1
4OOI70Y2S 59 JJ K
WASTE MANIFEST J1OOO7I3III101
5 Generalo(s Name and M8Iling Address _ ~ I _ I Generators Sile Address (if differsothan maiing address) ~ ~ _1 F __VI - UT
Gcnerato(s Phone801-63U-730S I 6 Transporter 1 Company Name US EPA 10 Number
I 7 Transporter 2 Company Name US EPA 10 Number
01JV I 8 Designated Facility Name and Site Address CIeIn ~ Vl US EPA 10 Number
3M amp1
- ---- a UT
Fadli s Phone I 9b US DOT Description (including Proper Shipping Name Hazard Class 10 Number 10 Containers 12 Unit11 Tola9a 13 Waste Codesand Paclting Group (if any)) No Type Quanlity WtNoHM
y~ 1 1~11IC lOllY) eM ~ -~ 0 NA l ~~~ ~O ffil--+2-------------------------l-~--1--I+-fUmiddot t---f---I---t--+---t C)
3 -- -~-t-4
--+----If----J
14 51 ecial Handling Instructions and Addltionalnformation WI) CH4laquole6B Coli boom - - shy
15 GENERATORSiOFFlRORS CERTlFICATION Iheleby declare hal the contents of lhis consignment are fully and accurately described above by the proper shipping name atd are classified packaged marked and labeledplacarded and are in all respects in proper condition for transport according to applicable international and naliJ)fl81 governmental regulalions If export shipment and I am lIle Primary Exporter I cel1ify that the contents ollhls conslgnment conform to the terms of he attached EPA AcAnowledgnlenl of Consent Icel1ify that the waste minimization statement idenlified in 40 CFR 26227(a) (if Iam a large quanlity generator) or (b) (ill am a small quantity generator) is true
Month Day Year
Ib 25110 -I 16lnternationalShipments 0 0z Import to us Export from US Port or enlryexil _
- Transporter slgnalure (for exports only) Dale leaving US
18 Discrepancy
18a Discrepancy Indication Space 0 Quantity DTypc o Resldue o Partial Rejeclion o Full Rejection
) Manifest Reforcnce Number
ffi 17 Tranaporter AcJltnowledgmenl of Recelpl of Materials
~ Transportlf 1PrintedTyped ~ SIgnature bullbull-
~ - y ~~ I ~ 7 I~l Transporter 2 PrintedlTyped Name Signalure
I
~ 18b A1ternale Facility (or Generator) j
U ~ Facilitys Phone
I ~ 1amp Signature ofAlternate Facility (or Generator)
~
~ 19 Hazardous Waste Report Management Method Codes 08bullbull codes for hazardous waste trealment disposal and recycling systems)
2 13~ 1 VltVJ(L 1 I
US EPA 10 Number
I IMonth I Day I Year
4
I I-A1- I A A -
Month Dey Year
16 12S 110
Month Day Year
I I I
1rjr0-0~rJcr~---~~~~IM1amp i JIJ1~ JI rro(f nJ EPAFOtm~6700middot22(Rev ~5) previKsediUonsareobsolele - - -- -DESldNMe6~TYTOGENERATOR
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions
GMll11~ LOAD SUMMARY RECORD ENVIRONMENTAL SERVICESmiddot
Clean Harbors Grassy Mountain FacIlity Tooele County Utah
LOAD DISPOSAL DESTINATION I
RCRACEll ~ D DSPOT 925 06 25 10
STABILIZATION TSCACELL_ STABILIZATION 48480 Ib o lb TA E
LOAD TRACKING INFORMATION 48480 Ib NET PLANT DROPPED ANALCOOE REVIEWED WEIGHTS GRIDS MANIFEST RECEIVED
stY ~~9 MAILED
bvJ DATE
~OTDL~DOlp 11S-ICJ GENEAAT0A HAULER
0M-VYDn YVlP 2middotmiddotl 10 1 -5 3480 Ib
ORDER NO DRUM NO middot42200 1 TR
J 01-C-15-1blsshy 1-~(1-LD-()LLq
b IpoundT
TRUCK NO CONTAINER NO (8) RAILCAR NO
lib rnO-LllLf12 WJf-LJ 1~ CONTAINER TYPE I LOAD COUNT (RAIL ONLY)
ED TT FB V OTHER 1 2 3 4
OPERATOR SIGNATURE COUNT DATE
LOAD WASHOUT INFORMATION WASHOUT STAMP WASHOUT TYPE
Q NO INTERIOGXTE~ WASFIOUT SIGNATURE DATE
~-JI-~ Js-O
ORNER SIGNATURE DATE
~ ~~ ~ cent-~L-o
1E1A lt--
COMMENTS NAME DATE
~ J
1 (hmiddotshy
f
WHITE - Facility CANARY bull Generator PINKmiddot Transporter GREEN -ReceiVing GOLDmiddot Operalions