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ARCHIVED REPORTS XR0006108
EnvironmentalHealth
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1876
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2900 - Site Mitigation Program
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PR0542421
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ARCHIVED REPORTS XR0006108
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Last modified
6/21/2019 12:49:02 PM
Creation date
6/21/2019 10:35:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006108
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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ALLIED WASTE Page 2 of 2 <br /> GENERATOR WASTE PROF-ILE SHEET continued <br /> Waste Profile# <br /> V. Physical Characteristics of Waste <br /> Charactenstic Components %by Weight(range) <br /> 1 Soil 99 <br /> 2 plastic liner 01 <br /> 3 debne 09 <br /> Color Odor(describe) Free Liquids %Solids pH Flash Point Phenol <br /> brown mod gasoline ❑YES or®NO 100 6 5-8 0 NIA°F <br /> Content % I NL/Appm <br /> Attach Laboratory Analytical Report(and/or Material Safety Data Sheet) <br /> Includwg R utred Parameters Provided or this Pro ile <br /> Does this waste or generating process contain regulated concentrations of the follo%�mg Pesticides and/or Herbicides <br /> Chlordane,Endrin,Heptachlor(and it epoxides),Lindane,Methoxychlor,Toxaphene,2,4-D, or 2,4,5-TP Sdvex as ❑ YES or® NO <br /> defined in 40 CFR 261 33? <br /> Does this waste or generating process cause it to exceed OSHA exposure limits from high levels of Hydrogen Sulfide or <br /> HX4MSen Cyanide as defined in 40 CFR 261 23'� ❑ YES or®NO <br /> Does this waste contain regulated concentrations of Polychlormated Bi hent'Is(PCBs)as defined m 40 CFR Part 7617 YES or NO <br /> Does this waste contain regulated concentrations of listed hazardous Aastes defined m 40 CFR 26131,26132,26133, <br /> including RCRA F-Listed Solvents? ❑ YES or®NO <br /> Does this waste contain regulated concentrations of 2,3,7,8-Tetrachlorodibenzodioxin(2,3,7,8-TCCD),or any other dioxin <br /> as defined m 40 CFR 2613 1? ❑ YES or® NO <br /> Is this a regulated Toxic Material as defined by Federal and/or State regulations? YES or NO <br /> Is this a regulated Radioactive Waste as defined by Federal and/or State regulations YES or 0 NO <br /> Is this a regulated Medical or Infectious Waste as defined by Federal and/or State regulations YES or NO <br /> Is flus waste generated at a Federal Superfund Clean Up Site) YES or M NO <br /> Vl. Generator Certification <br /> I hereby certify that to the best of my knowledge and belief,the information contained herein is a true and accurate description of the w aste material <br /> being offered for disposal I further certify that by utihzing this profile, neither myself nor any other employee of the company %ill deli,.er for <br /> disposal or attempt to deliver for disposal any waste which is classified as tonic waste, hazardous maste or infectious waste, or any other waste <br /> material this facility is prohibited from acceptmg by law Our company hereby agrees to fully indemnify this disposal facility against any damages <br /> resulting from this certification being inaccurate or untrue I further certify that the company has not altered the form or content of this profile sheet <br /> as #vidaeda Alhed lndustn Inc <br /> AED REP E I N TI E(Printed) COMPANY NAME <br /> A14 SEDAVE <br /> 7 <br /> VII. Alfie Waste Decision <br /> ❑Approved ❑Refected Expiration <br /> Conditions <br /> Name,Title Signature Date <br /> 0 Allied Waste Industries,August 2000 <br />
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