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Rancho Cordova LLC <br /> 11855 White Rock Road <br /> Rancho Cordova,CA 95742 <br /> Approvals Fax:(909)385-0382 <br /> GENERATORS WASTE PROFILE SHEET [PROFlLE:NUMEIER, <br /> PLEASE PRINT IN INK OR TYPE <br /> A.GENERATOR INFORMATION: BILLING INFORMATION: <br /> Generator Name: AM/PM WOODBRIDGE Billing Name Shop Hazards Solutions_ <br /> Facility Address 18806 N LOWER SACRAMENTO RD Billing Address P.O.Box 798 <br /> City WOODBRIDGE State CA Zip 95258 City_Turlock State CA_"Zip_95381 <br /> Customer Name JASSI Billing Contact Name:_Steve <br /> /Customer Phone 209-339-8238 Billing Phone:_800-746-7449 <br /> Customer Fax Billing Fax:_209-668-0972 <br /> Generator USEPA/Federal ID#: CAL000312652 GEM Sales Rep.:_Brandon <br /> Generator's S.I.C.Code(4 Digit): <br /> B.WASTE STREAM INFORMATION: <br /> Name of the Waste: GASOLINE&DIESEL PUMP FILTERS&HOSES <br /> Original Process Generating Waste: PUMP MAINTENANCE <br /> Is it a Lab-Pack?_Yes X No If"Yes",attached inventory sheet(s)and skip to Section H. <br /> Is a representative sample provided? Yes X No Is a MSDS attached?_Yes X No <br /> Is there any Analytical attached? TCLP Yes X No Other Yes No <br /> C.GENERAL CHARACTERISTICS: <br /> Color: VARIES Physical state @70 F Phases BtuAb <br /> Odor:GAS _%Liquid <br /> None %Sludge _Single layer -&—<3000 <br /> X Mild 100 %Solid _%Gas(Other) _Multi layer 3000-5000 <br /> _Strong %Powder %Other _How Many? _5000-10,000 <br /> >10,000 <br /> PH: Q.0 2.0 to 4.0 X 4.0 to 10.0 _10.0 to 12.5 _>12.5 <br /> Liquid Flash point: <73 OF_73 to 99 OF 100 to 139 OF _140 to 200 OF X >200 OF —None <br /> Specific Gravity__ 1.1 _ %Total Halogens 0 <br /> D.CHEMICAL COMPOSITION: <br /> Constituents Min% Max% Constituents Min% Max% <br /> GASOLINE/DIESEL PUMP FILTERS 20 50 <br /> GASOLINEIDIESEL PUMP HOSES 50 80 <br /> ABSORBENTS 0 20 <br /> E.OTHER WASTE STREAM INFORMATION: <br /> Is this waste "Used Oil"? Yes X No <br /> If"Yes",does the oil contain Polychlorinated Biphenyls? Yes X No <br /> If PCB's are present,is the waste regulated by TSCA per 40 CFR 761? <br /> Does the total halogen content exceed 1,000 ppm? Yes X No <br /> If"Yes",can you identify the"chlorinated constituent"present in the oil? <br /> Does the Waste have any of the following characteristics?(Please check all that apply) <br /> Oxidizer Organic Peroxide _Water Reactive _Air Reactive _Pyrophoric _Dioxin <br /> —Radioactive _Infectious _Pathogen _Carcinogen _Etiological Cyanides <br /> _Explosive _Shock Sensitive _Undergo Hazardous Polymerization Cylinder Aerosols <br /> 1 <br />