STATE OF WEST VIRGINIA
STATE OF WEST VIRGINIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF MINING AND RECLAMATION
HAZ-MAT Evaluation and Inventory
|Company Name: | |Permit No.: | |
| |
|1. |Does the permit area have materials stored on it that you believe could be considered hazardous to humans, animals, or aquatic life? |
| |YES NO |
| |
|2. |If yes, list the different types of materials and estimated quantities (Number of barrels, tank sizes in gallons, etc.) For example: |
| |1 – |1000 Gal. Diesel fuel tank, estimate 500 gal. (1/2 full) |
| |10 – |55 Gal. Drums hydraulic fluid – full |
| |20 – |Lead Acid Batteries |
| |2 – |500 Gal. Tanks NaOH – Appear Empty |
| |1 – |Tank for Anyhydrous Ammonia – size and contents unknown |
| |2 – |Powder magazines – contents and quantity unknown |
| |1 – |Anfo Bin – contents and quantity unknown |
| |5 – |55 Gal. Drums – full – contents unknown |
| |(Material and Estimated Quantities List) |
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|3. |Is site access controlled? (locked gate, fenced) YES NO |
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|ADDITIONAL COMMENTS: | |
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|Supervisor/Specialist Signature | |Date |
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