Laserfiche WebLink
HERITAGE ENVIRONMENTAL SERVICES, LLC Heritage Use Only <br /> WASTESTREAM SURVEY FORM <br /> (877)436-8778 Quote#:420442 WS#:88039-10 <br /> Im. www.heritage-enviro.com Business Type: Repeatable: ® Non-Repeatable: ❑ <br /> Please review instructions before completing this form. <br /> Product <br /> Code: Price: <br /> Preferred TSD Roachdale,IN: <br /> Location Ghariotte,NC❑ Coolidge,AZ❑ Indianapolis,IN❑ 1 Kansas City,MOO Hazardous Landfill❑ WTI <br /> Non-Hazardous Landfill <br /> Service Albany,NY Blaine,MN East Liverpool,OH 0 Hammond,IN Lemont,IL <br /> Location*: Louisville,KY Signal Hill,CA Z St.Louis,MO Ll Toledo,OH U Tulsa,OK <br /> 1.GENERATOR INFORMATION (Heritage# 64495 )* 2. BILLING INFORMATION (Heritage# 125925 )' <br /> Generator Name TIN, INC (#020-TRACY) Customer Name HERITAGE CRYSTAL CLEAN <br /> Address 400 WEST VALPICO ROAD-SITE Address <br /> City, State,Zip TRACY, CA 95376 City, State, Zip <br /> Tech. Contact Name Debbie Turner Contact Name <br /> Phone 209 Fax Phone Fax <br /> 24 Hour Emegency Number E-mail Address <br /> E-mail Address 3.MANIFEST MAIL ADDRESS(if different from generator) <br /> US EPA ID Number CAT000610949 Contact Name <br /> State ID Numbers Company Name <br /> Status LOG Z SQG 0 CESQG C1 Non-hazardous El <br /> AddressCity, State, Zip <br /> 4.Generator SIC If 3312,do you perform Coke Oven Byproduct If 28__,2911, 3312,or 4953,what is the Total Annual <br /> Code 2653 Recovery rations?Yes No Z Benzene TAB in Mea ram ear'? <br /> 5.Common Name OIL FILTERS <br /> 6. Process Generating Waste CHANGE OUT <br /> 7. DOT Description'(if available) <br /> NON RCRA HAZARDOUS WASTE SOLID(OIL FILTERS) <br /> 8. Identify US EPA waste codes none <br /> 9. If D001-13043,are any Underlying Hazardous Constituents VHCs)present?Yes No NAO If yes, list in Section 13. <br /> 10. If F001-F005,or F039,list the F-listed hazardous consthuq&in Section 13. <br /> 11. US EPA Form Code* W310 EPA Source Code* G16 <br /> 12. Identify state waste codes NONE <br /> 13.Waste Composition: Using specific chemical names an ascriptions of waste composition,list all constituents present in the <br /> wastestream,and identify those that are underlying haza constituents(UHCs), or F001-F005/F039 hazardous constituents. <br /> Attach available analysis or MSDSs. Total com osition at <br /> equal or exceed 100% <br /> Constituents Range Units UHC? F- <br /> Listed? <br /> Drained used oil filters fj 1 100 % Yes❑ Yes❑ <br /> • Yes❑ Yes❑ <br /> Yes❑ Yes❑ <br /> Yes❑ Yes❑ <br /> Yes❑ Yes❑ <br /> Yes❑ Yes❑ <br /> Yes❑ 1 Yes El <br /> 14. Color brown Appearance solid Odor none <br /> 15. 15a. Chemical Properties 15b. Physical Properties at 70OF <br /> Flash a 73 D BTUIIb <2,000 Solid Free Liquids? Yes No <br /> Point(F°) < 100 ❑ 2,000-6,000 ❑ Liquid ❑ Will waste dump out of drums? Yes® No❑ <br /> 100-140 ❑ 6,000-10,000 ❑ Sludge ❑ is the waste pumpable? Yes❑ No <br /> 141-200 ❑ ?10,000 ❑ Semi-solid ❑ Debris?(List type in Section 13) Yes❑ No <br /> >200 ® Powder ❑ Is the waste dusty? Yes❑ No <br /> Gas ❑ <br /> Boiling < 100 ❑ pH 4-9 %Solids 100 %Liquids <br /> Point(F°) > 100 ® Range Note: *These sections will be completed by Heritage if left blank. <br /> SLMHESWTIWSSFORMSEP2" 1 of 2 <br />