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Ah Ah _- TQ " 21US Ecology Nevada(Beatty) ❑US Ecology Texas(Robstown) Profile#: %-AJiJVolof3 Far(775)553-2125 Fax(3611387-0794 ❑US Ecology Idaho(Grand View) Fox(2081834-2919 `i"'I'fA 'C�3 '.L'',1��4G1 #'•T tl1214LA .... [€'•i' *Waste assbipped H,111 be: industrial NON-IndusMal *(Texas crtstanters only) Generator. PickNPull Check If Billing Is Same Facility Address: 3927 ClarkDNve Billing Company: Worldwide Recovery Systems,Inc. (No PO Box) Stockton,CA 95205 Billing Address; 1621 Greenriver Rd. Unit 105,126 Mailing Address Same City/Statelzip: Carona, CA 92882 City/Stale/Zip: Billing Contact: Dong Keeney Technical Contact: Doug Grose Phone No.: 909.597-2999- Fax No.: 909-597-2995 Phone: 916-140-3965 Fax: Email: doug@86690wmte.com NAICS# ❑CESQG Q SQG LQG EPA IDE CAL000269375 State ID# I.US DOT Shipping Name Non RCRA Hazardous if'rum Solid t.Hazard Class_ NA 3.UN/NA# NA 4.Packaging Group NA 5.RQ NA s.Coalainer Type: ❑Bulk ❑Totes ❑Pal let size 4s4 7.Frequency: ❑Year ❑QTR Q Month ❑Boxes ❑Bags ❑Drums s❑Other Quantity 8 ❑I Time ❑Other 1.Common name for this waste ftAbsorbent and Debris 2.Process generating the material Spills and clean u rom auto dismantling operation 3.Describe physical appearance of waste Solid Material 4.Describe odor of waste:Q None ❑Slight ❑Strong Describe 5.Knowledge is from:❑Lab Analysis ❑MSDS Q Process/Generator knowledge ❑Yes Q No Is the waste restricted under EPA Land Disposal Q Yes ❑No Is the material<500 PPMW VOC as generated? Restrictions(40 CFR 268)If=,please complete LDR,Ibrnr ❑Yes Q No Is the waste,or generating facility,subject to regulation under 40 CFR Pan 61 Subpart FF(Benzene Rule)of NESFIAPS? If=,complete farm"attachment 4".(Note:Waste generated fiom chemical manufacturing,coke-by-product recovery plants, petroleum refineries or treaters of such waste are subject to these r_uireme ns.) ❑Wastewater ❑Nan-wastewater Q Debris .r❑Yes ❑No State waste codes 1 52 1 ❑Yes ❑No Alternative=dards for Soil? ❑yes Q No CERCLA Regulated(Superfimd)Waste Q Yes ❑No Contains UHCs/Consdtuents of Concern: List in section D ❑Yes [Z No I RPA Haz.Waste(list coda) ❑Yes Q No Has the waste been located after the initial point of generation? ❑Yes Q No Subpart XX(40 CFR 63.1080)Controls Required? ❑Yes Q No Exempt Waste: If yes,list ref.40 CFR Source Code G Foran Code W Mbit•Method H aa,,�{pp//�� p�s,( .... .. "r':::i isiiiiE: `! :ilii:iii:'siiiii:iii's: 3ii4i:i:ij`i% 4r+M•Y k1 V ,1� ::::131S1V7ATLp,RErYE .'• L• i).:'.P.fi"Iea1/Chemlcal)..E nos., a tvastEaZ7tp:of tt,Eo7ofu]ri.f)tg;.:1!1}0}q!?tbse>:s�:r,:r.. :::r� .... ..::...:.: :.::........,..,,..,............,::..: :: . r-t �--� (Range Total>or-100%) Valuesare❑ TCIPQ TOTALS Yes rl No Oxidizer ❑Yes ❑Q No P.rncr.Sulfide ppm (Includeaddluonalsheetsisnecessary( typiCnlvalue unit range ❑Yes QNo Explosive ❑Yes QNo React.Cyanides ppm Oil 1-5.1 % ❑Yes Q No Organic Peroxide ❑Yes Q No Water/Air(Pyrophoric)React. Absorbent 30-40 % ❑Yes Q No Shock Sensitive ❑Yes Q No Thermally Unstabic Soil 6040 % ❑Yes Q No Tires ❑Yes Q No TSCA Regulated PCB Waste Debris,Rock,paper,ppe 5-l0.. % ❑Yes Q No Pymphoric ❑Yes Q No Regulated MedicoVinfecttous Waste C4Y f11a d i 1-S e/a El Q NO Rndiowdve'" ❑Yes Q No Compressed Gasses ❑Yes QNo Exempt RAD" •`Adddand Rvdd.oiad We is provided is Mrs WAC Addmdw ❑Yes Q No Halogenated Organic Compounds?(per 40 CFR 268,Appendix 10) Z!IENYSIEIli G}7AR TERluf L IC5;;;;;; ;!;;;p[; ji pHRange 5 to 9 LFimh Pot NAi -F(ir<140°F) 2.Typicnl pH: NA pHRonge:❑ 52 ❑Yes Q No Possibility of incidental liquids tram transportation? ❑ >2,<12.50 Q Yes ❑No Dem waste pass the EPA specified point filter test? ❑ >12.5 (Pass is a solid) R;z$.,4�",E[Zow?IQ t [Eyes ❑No 1 certify this material maybe disposed of without further treatment. Certification Statement:I certify under penalty of law that I am rsu liar with this waste stream through analysis andlor process knowledge,and that all information pmvfded is no,accurate,representative and complete,and that all known or suspected hazards have been disclosed. Furthermore,I certify that this rom was completed in accordance with the instructions pmvidcd. Print Nome: Signature: Title: Date: • ..lit:...•: .i'ii2iyyii5?'.'-` i`ir i:`Fi'i'i' '•i6,.;fp4>�:y'�>M E:::::�i:i:�}f:ii:� ...:...........