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Generator's Waste Profile Worksheet <br />Evergreen Oil, Inc. <br />6880 Smith Ave. <br />Ererp—if (lir Only <br />Approval #: j <br />Approval Date: <br />❑/ Liquid <br />❑ 73-140 degrees F ❑ 2.1-6.0 <br />Newark, CA 94560-4224 <br />Phone Fax <br />Process:P <br />W % � <br />.,� - (510)795-4400 - (510)796-2559 <br />w7� <br />EPA ID# CAD980887418 <br />A. Generator & Customer Information <br />> 200 degrees F ❑ 8.1-12.4 <br />Generator Name: _ oh+::p Cv-cL� /� ..5 Generator EPA 1D#: <br />Generator Code: jessigncdbyEvwpiccn) <br />Phone #: <br />Address:'r2y �✓ �/'ctwf—T�`�t, �t7 <br />Fax #: <br />City: _ fC�e State: <br />C_ Zip Code: %rJ6— <br />Technical Contact Name: <br />Customer Name: <br />Customer Code: OssignedbyE,•erpt—) <br />Phone #: <br />Address: _ <br />Fax #: <br />Cit: State: <br />Zip Code: <br />B. Waste Description <br />Waste Name: Monitoring Well Purge Water <br />Process Generating Waste: Groundwater Monitoring <br />Waste Source: ❑ Unused Product or Chemical ❑ Spill Cleanup Q Planned Site Remediation <br />Check an rh tapptr ❑ Waste By -Product from Process ❑ Lab Pack <br />❑ Other <br />C. Physical Characteristics <br />Color: Clear/Light Brown Odor: Mild/None <br />Physical State c@ 70 F: Flash Point: ❑ < 73 degrees F pH: ❑ <2.0 <br />Specific Gravity: <br />❑/ Liquid <br />❑ 73-140 degrees F ❑ 2.1-6.0 <br />❑ < 1.0 <br />❑ Solid Ifliquid,: 21 Single -Layer <br />❑ 141-200 degrees F 06.1-8.0 <br />E 1.0 <br />❑ Sludge ❑ Bi -Layer <br />> 200 degrees F ❑ 8.1-12.4 <br />❑ > 1.0 <br />❑ Gas ❑ Multi -Layer <br />❑ N/A ❑ >12.5 <br />❑ N/A <br />Viscosity: El Low (e.g. water) BTU/Ib: 0 < 5,000 <br />IJ hyuW, ❑ Medium (e.g. motor oil) ❑ 5,000-10,000 <br />❑ High (e.g. molasses) <br />❑ > 10,000 <br />Do any of the following characteristics apply: <br />Explosive- ❑ Yes 0 No <br />Loose -Packed Material- <br />❑ Yes [±—] <br />No <br />Shock Sensitive- ❑ Yes 0 No <br />Bio -Hazardous- <br />❑ Yes 0 <br />No <br />Pyrophoric- ❑ Yes 0 No <br />Radioactive- <br />❑ Yes 0 <br />No <br />Polymerizable- ❑ Yes 0 No <br />Asbestos containing- <br />❑ Yes n] <br />No <br />Reactive Sulfide- ❑ Yes [11 No <br />Volatile Organic Compounds > 500 ppm- <br />❑ Yes 0 <br />No <br />Reactive Cyanide- ❑ Yes Ej No <br />Halogenated Organic Compounds > 1,000 ppm- <br />❑ Yes 0 <br />No <br />D. Chemical Composition <br />Mus( add up to at least 100%. <br />Include inert materials and/or qpe of debris if applicable <br />Chemical Constituent Range <br />Unit Chemical Constituent <br />Range Unit <br />Water 95- 100 <br />% <br />Petroleum Hydrocarbons (Trace) 0 - 1 <br />% <br />Solids (Dirt, Rust, Sludge) 0 - 5 <br />% <br />Page 1 of '3 <br />