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Waste lIh �^^ Systems WCD No. 55 39330 r BROWNING-FERRIS INDUSTRIES r r r BFI WASTE CODE WASTE EVALUATION REQUEST BFI to complete this area. BFI Initiator Disposal Method Requested ❑ Working Face ❑ Daily Cover Location ❑Other Company Number Date Disposal Site Requested Telephone Number( } Company Number P.O.Number Action Requested: ❑ RCI -24 Hour Response Analyses Requested: ❑ TCLP ❑ RCI ❑ Oil Sheen ❑ RCI, TCLP-5 Day Response ❑TPH ❑ BTEX ❑ PCBs Other ❑Other Analyses To Follow:❑TCLP ❑Other WASTE CHARACTERIZATION DATA UST Contaminated Sails IMPORTANT:THIS FORM 15 TO BE COMPLETED BY A REPRESENTATIVE OF THE PARTY RESPONSIBLE FOR THE STORAGE TANK OR BY A REPRESENTATIVE OF THE PARTY TO BE INVOICED FOR DISPOSAL, IF DIFFERENT. PLEASE READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM. SINCE THIS FORM HAS BEEN ASSIGNED A UNIQUE WCD NUMBER, IT IS TO BE USED ONLY ONE TIME. INSTRUCTIONS. This form is to be used only to describe contaminated soils that are not designated as hazardous waste by the USEPA of. •I to BFI for disposal resulting from the removal of underground storage tanks(UST)once containing gasoline, diesel fuel, heating oil oricle drain oil from non-industrialized areas such as service stations, automobile dealerships, residences and transport terminals. This form is not intended to be utilized to describe storage tanks and associated piping. If the waste is not described in Section 2a, then the BF] Special Waste Characterization Data(WCD)form must be used to identify the waste.This form must be typewritten or legibly printed in ink, and signed. Do not alter the content of this form. 1. GENERATOR INFORMATION a) Generator's Name: Doane Products Company e)Customer's Name: Brunsing Assoc. Inc. b) Generating Facility Address: 4 5 0 East Crantl ine Rd. f) Customer's Address: P-0- Box 588 x City: l aL ---State: t=i-L zip; 3 i b City: Windsor State: CA zip: 95492 c) Company Representative: Bob 1~a undo S g)Telephone No.( 415 ) 364-9030 Title: Plant Manager. Company: Doane After HoursNo.(707 ) 838-3027 d) Emergency Contact: Emergency No.(7 0 7 ) 838-3027 Tide 2.GENERAL WASTE STREAM INFORMATION f i a) Description of The Waste: 1) ❑ Soil contaminated with leaded gasoline 4) ❑ Soil contaminated with heating oil 2) ❑ Soil contaminated with unleaded gasoline 5) ❑ Soil contaminated with vehicle drain oil 31 5a Soil contaminated with diesel fuel b) Type of facility generatin the waste soil: Pet food manufacturing i p 120 c) Anticipated Volume: ❑Tons Cubic Yards ❑Other d) Is this a "Hazardous Waste" as defined by State or local Regulations? ❑ Yes P No I If yes,enter the Waste Identification Number, if one has been assigned: e) Is this a "Special Waste", an "Industrial Process Waste", or a "Pollution Control Waste" as defined by State or local Regulations? �LYes 0 No If yes,enter the Waste Identification Number, if one has been assigned:: i f 'this waste subject to the UST corrective action regulations under 40 CFR 280? �J Yes ❑ No. i g) Recommended personal protective equipment and special handling procedures: Use gloves When handleing, i h) Hasa representative sample of the contaminated soil been provided to BFI for testing and evaluation? ❑ Yes Lf No, If yes,complete the Representative Sample Certificate below. i