APPENDIX EWaste ManagementDocumentation
*FOR OFFICE USE ONLYTERRADYNE Site TERRADYNE Job No. DateDate Accepted Date Re jetted Date- ReceivedDate Start Treatment Date End Treatment Date ReturnEXHIBIT AAPPLICATION FOR TREATMENT OFPETROLEUM CONTAMINATED SOILGeneral Directions: In order to determine whether TERRADYNE ENVIRONMENTAL SERVICES, INC.can properly and safely handle and treat your PCS, we must obtain information about thechemical and physical properties of the waste. Please be complete in your answers; ifyOUK response is "none" OK "not available," so indicate: Answers must be printed in inkor typewritten and the completed form signed.1)2)3)4)Generator/Owner Name/Address Naval Facilities Engineering Cormnand/AS/S kvironmentalmacement Buildinq 001, Carno IRieune MCB. NC 28542-5001FZS Site Complete Address/Description (No P-0. Bo~')_.B~~SZ.~~.,,S~~~~~~~-~,..MCB, Camp Lejeune, NCEngineer/Environmental Firm-m Gxwmnwnt SPYV~PPG. TnrProject Manager Taylor Sword, C.P.G.Company/'AdZress- 1244B Executive Boulevard, Suite 106, Cbesatie. VA 23320Telephone Number (804) 436-7881PCS Site Description (Gas station, full service or convenience store, cardealership; number o.f tanks, age of.tanks, type of'fuel sold, tank or plumbing leak,accident, etc.). Attach Engineering Report or Assessment.UST was used to 'store fuel oil at the <strong>site</strong>.5)6)719)10)11)Type of Contamination (Gasoline, Jet Fuel, Diesel,'other) ~11~1 0i.lAnticipated Volume Four 55-sallon drums (TONS)Soil Type (Sand, Clay, Unified Soil Classification) Silty Sand81 Average Contamination 1 IOO.0 ppm Measured by Lab TestsIs this soil a "Hazardous Waste" as defined by Regulations of the U.S. E.P.A.pursuant.to Section 3001 of the Resource.Conservation and Recovery Act (See 40 CFR,Part 261 for definition). 'Yes ,No= .Soil Properties (TCLP, Total Petroleum Hydrocarbon, % Moisture, etc.) AttachEngineeKing~Environmental Report with Laboratory'results.THE PROCEDURES ON'THE REVERSE SIDE SHALL BE FOLLOWED WITH SPECIFICITY AND-ARE MADE APART OF THIS APPLICATION.I hereby certify that the above-attached description is complete.and accurate to the bestof my knowledge and ability to .determine, that no deliberate or willful omissions ofcomposition of properties exists and all known or suspected hazards have been disclosed.In the event that any of the dat.a is determined to be incomplete, inaccurate ormisrepresentation, the undersigned agrees to indemnify TERRADYNE from and against any andall loss, cost OK damages, including attorney fees which it may suffer.Jpon acceptance of this application by TERRADYNE, it shall bec.ome a material part of theAgreement between the parties hereto and attached thereto as Exhibit A.qwners Authorized1. Name @A&~,\D.&~~ Title& is tm Authorized SignatoryDate 4-Z&7-9-3 ,qTitle &&~I.?Registration (P.E.,P.G. 1 State,CCEPTED:TERRADYNE ENVIRONMENTAL SERVICES, INC.By:Date: