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HECEIVED <br />K Pure Waterworks <br />,7 0 Rochester Ave. <br />M Ra o c monga, CA 91730 <br />EN!l6 Phone# 909-476-9492 <br />,1iJ�lt s`d At L # 9 481-5099 <br />Non -Hazardous <br />Waste Facility <br />GENERATOR'S WASTE <br />MATERIAL PROFILE SHEET <br />P O L tvPi2 <br />N_VVI 1_/7 <br />AMENDMENT ❑ <br />S V 4/ <br />GENERATOR <br />BiL'L TO <br />Name <br />Unifed Grocers <br />Name <br />HA -7 MAT TRANS, INC. <br />Address 1990 Piccoli Road <br />City;zip Stockton, CA <br />Technical Contact I Pat Geramett205-931-1990 <br />Shipping Contact Mike Hammer Phone 909-889-5 <br />Address <br />P.O. BOY. 5129 <br />City;zip SAN BERNARDINO. CA 92412 <br />Contact M+KE HA ✓MEP <br />Phi 909-889-56 Fax 909-884-8956 <br />TRANSPORTER <br />TRANSPORTER <br />Name <br />Address <br />HAZ MAT TRANS, INC. <br />Contact <br />Fax# <br />P.O. BOX 5129Phi <br />tMIKEHAMMER <br />89-56QCity/Zip <br />S.AN BERNARDINO, CA. 92412 <br />84-8965 <br />WASTE DESCRIPTION - (Clarifier water, rain water, food process water, etc.) <br />Clarifier Waste from Truck Wash Rack <br />CHEMICAL & PHYSICAL STATE <br />Liquid Muitilayered Li <br />Semi -Liquid Bi-iayered Li <br />Odor Mild <br />TSS <br />Solid Single Phase <br />ofFlash <br />Color Grey <br />pH <br />2_08-10 <br />0 2 - 4 G 10-12 <br />O 4 - 6 O *12 <br />0* 6 - 8 O NIA <br />Point NA <br />% Bottoms Sediment 3-15% <br />% Debris 011/0 <br />% Ash 0% <br />Specific Gravity 1=1 <br />Profile History <br />Has this waste ever been shipped as a Haz waste? Yes Na <br />If YES, explain: <br />MANUFACTURING/PROCESS DESCRIPTION <br />Describe type of manufactunncycompany and process generating waste stream. Include a I:st of virgin matenats and their Maiena! Safety Data Sheets <br />Grocery Gist. Center <br />CHEMICAL CONSTITUENTS <br />Water 90-0, °Jo <br />METALS (ppm) <br />Arsenic M9 <br />Cadmium Mercury <br />Chromium Nickel <br />Copper Tin <br />Lead Zinc <br />Dirt/Sludge 2-10% % <br />% <br />% <br />SHIPPING INFORMATION <br />Shipping Method: Vactor VacTruckL41 Dry Van LJ Tote Drum Roll Oil <br />4200 G IIonabout eve 6 to 8 weeks _ <br />Volume Igallons/tons) a s ry <br />Generator's Certification: 1 certify the materials described above on this profile are Non -Hazardous <br />therefore not subject to federal regulations for reporting proper disposal of hazardous waste. <br />❑ Signed on Behalf of Generator <br />Authorized Signature <br />Print Name <br />Date <br />