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F. PCB Information Does this waste material contain any Polychlorinated Biphenyls (PCBs): ❑ Yes (] No If yes, please spec iFy concentration: If any PCBs are present in this waste material at < 50 ppm, did they result from any dilution of materials containing > 49 ppm PCBs. ❑ Yes ❑ No El N/A G. Regulatory Status U.S Department of Transportation (DO7) Is this waste material defined as a Hazardous Material under 49 CFR Section 171.3: ❑ Yes 0 No Proper Shipping Name (PSN): Non -Hazardous Waste, Liquid _ Hazard Class: ID #: Packing Group fl: Subsidiary Hazard Class: Emergency Response Guide M: Additional Descriptions: (Water, Trace Hydrocarbons) U.S. Environmental Protection Agency (EPA) Is this waste material defined as an EPA Hazardous Waste under 40 CFR Section 261.3: ❑ Yes No If yes, please identify EPA Hazardous Waste number(s): Is this waste material excluded from regulation as an EPA Hazardous Waste as specified in 40 CFR Section 261.4 (b): If yes, please identify exclusion: ❑ Yes 0 No Does this waste material qualify for EPA Universal Waste management as specified in 40 CFR Section 261.9: El Yes ED No Is this waste material subject to regulation under the Benzene Rule of Waste Operation in NESHAP as specified in 40 CFR Part 61 Subpart FF: ❑ Yes U) No If yes, please identify SIC code listed under NESHAP: California Department of Toxic Substances Control (2)TSC) Is this waste material defined as a California Hazardous Waste under 22 CCR Div 4.5, Section 662613: ❑ Yes [A No If yes, please identify California Hazardous Waste number(s): Is this waste material excluded from regulation as a California Hazardous Waste as specified in 22 CCR Div 4.5, Section 66261.4 (b): ❑ Yes No If yes, please identify exclusion: Does this waste material qualify for California Universal Waste management as specified in 22 CCR Div 4.5, Section 66261.9: ❑ Yes El No H. Shipping & Packaging Information Shipping Rate: 5 per: ❑ one-time only ❑ month 0 quarter ❑ year Packaging Method(s): El Drums ❑ Triwall Boxes ❑ Bulk Liquids ❑ Bulk Solids ❑ Other ch -ch nlI Choi mm• opptr CSpecific Requests or Instructions —"–_– ---� Please specify any specific requests or instructions for disposal: Wastewater Treatment J. Generator's Certification i I certify that all information submitted in this and attached documents is correct to the best of my knowledge. I also certify that any samples submitted are representative of the actual waste. If Evergreen Oil discovers a discrepancy during the approval process, Generator grants Evergreen Oil the authority to amend the profile, as Evergreen Oil deems necessary, to reflect the discrepancy. I further certify that any changes regarding any information concerning this profile will be communicated to Evergreen Oil accordingly. AiAhqdzedSi,qnature Print Nmne Title Date —VdL; r 2�y-� 1 b &-grrrn Uu Only Expiration Date: / S/ 11 Last Anal ysrs Date: Evergreen Oil representative cwnpletrng profile. prop Z of Z