SUPPLEMENTAL RADIOACTIVE WASTE PROFILE FORM

Generator Address City State Zip	Phone Fax E-mail USEPA ID No.

DRUM NO.	WASTE TYPE	CONT SIZE (gal)	WASTE STREAM NAME	NUCLIDE	TOTAL ACTIVITY (mCi)	CONCENTRATION (As applicable) uCi/milliliter uCi/gram






THE ABOVE LISTED RADIOACTIVE WASTE MATERIAL(S) HAVE BEEN PROPERLY CLASSIFIED AND PACKAGED IN ACCORDANCE WITH 10 CFR PART 71 SUBPARTS A THROUGH G.

WASTE TYPES:

02. SCINTILLATION VIALS

02P. SCINTILLATION PLATES

02D. SCINTILLATION DRY WASTE

04. BULK SCINTILLATION WASTE

06. URANIUM/THORIUM COMPOUNDS

07. DRY NON-COMPACTED

07C. DRY COMPACTED

07N. DRY NON-COMPACTABLE

17. COMPRESSED GAS CYLINDERS

35. NORM SOLIDS/LIQUIDS

36. NORM WITH RCRA CODES

37. MIXED WASTE LAB PACKS

38. MIXED WASTE BULK LIQUIDS

This to certify that the listed radioactive wastes have been properly described, classified, marked, and labelled in accordance with 10 CFR part 71 subparts A through G.

AUTHORIZED SIGNATURE

TITLE

DATE

5711 Etheridge St
Houston, Texas 77087

(713) 641-0391

Fax:(713) 641-0392

Chemical Waste

RSO/Sealed Sources: Gamaliel Torres

President: Gamaliel Torres

CSBD Technologies

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NSSI/RECOVERY SERVICES, INC. WASTE PROFILE FORM