Aggregate Recycling Corporation

A. Generator Information

Generator Name:

Site Address:

Site City:

Site State:

Technical Contact:

Phone:

B. Site Description

Current Site Usage:

Process Generating
Waste:

C. Material Description

1. Contaminants

Virgin Product

Gasoline	#6 Fuel Oil	Lube/Cutting Oil
Kerosene	Motor Oil	JP4/Jet-A/Jet Fuel
Diesel	Hydraulic Fluid	#2 Fuel Oil
#4 Fuel Oil	Mineral Oil	Transmission Oil
Other (please Explain)

Waste Oil

Waste Oil

2. Approximate the amount of debris in this material: %
(ARC retains the option of charging for debris in excess of 15% unless previous arrangements are made.

3. Has the site remediation been supervised by the State of Maine Department of Environmental Protection?

Yes

(If yes, please email soil shipment letter to: )

4. CERTIFICATION - Please check all appropriate boxes

	I certify that, to the best of my knowledge, the waste material submitted to ARC does not contain regulated quantities of polychlorinated biphenyls, as defined by 40 CFR Part 761

	I certify that, to the best of my knowledge of this site, the materials submitted to ARC are generated from remedial activities associated with a Petroleum Underground Storage tank System regulated under 40 CFR Part 280. As such, this material is deferred from regulation under TCLP for Volatile and Semi-Volatile constituents.

	I certify that, based on knowledge of the site, the materials submitted to ARC are generated from remedial activities involving a Petroleum Storage Tank used for the storage of heating oil for consumptive use on the premises where stored. As such, this material can be defined as "Household Waste" as defined in 40 CFR Part 261.4 (b)(1).

GENERATOR CERTIFICATION

By checking the "agree" box below, the Generator certifies:

This waste is not a "Hazardous Waste" as defined by USEPA or State of Maine Regulations
The portions of this sheet and attachments contain true and accurate descriptions of the waste material. All relevant information regarding known or suspected hazards in the possession of the Generator has been disclosed.
The analytical data presented herein or attached hereto were derived from testing a representative sample taken in accordance with 40 CFR 261.20(c) or equivalent rules
If any changes occur in the character of the waste, the Generator shall notify ARC prior to providing the waste to ARC.

I agree to the terms above