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AR <br /> REPUBLICSPECIAL WASTE PROFILE Page 1 of 2 <br /> Waste Profile# <br /> Requested Disposal Facility:4204 Forward Inc. CA <br /> Sc', ,I . I iorM Ni'.til Ci iW G'-' ,U 13r:.-,r!;`N l I'd;4','''. .x.r,0,15 are cvI i[1l-U,,,d <br /> 1. Generator Information Sales Rep#: <br /> Generator Name: Spreckels Sugar <br /> Generator Site Address: 20500 South Holly Drive <br /> City: Tracy County: San Joaquin State:California Zip: 95304 <br /> State IDIReg No: State Approval/Waste Code: (if applicable) NAICS#: <br /> Generator Mailing Address (if different): 20500 South Holly Drive <br /> City: Tracy County: San Joaquin State: California Zip: 95304 <br /> Generator Contact Name: Anne Ogrey anne_ogrey@spreckelssugar.com <br /> Phone Number: (209)834-7679 �E�xt: ��Fax�Numb�er: <br /> Ila. Transporter information <br /> Transporter Name: Jim Thorpe Oil, Inc. Contact Name: Marty Thorpe <br /> Transporter Address: PO Box 357 <br /> City: Lodi County: San Joaquin State: California Zip: 95241 <br /> Phone: (209)368-6175 Fax: (209)368-1851 State Transportation Number: <br /> Ilb. Billing Information <br /> Bill To: Jim Thorpe Oil, Inc. Contact Name: Marty Thorpe <br /> Billing Address: PO Box 357 Email: <br /> City: Lodi State: California Zip:95241 Phone: (209)368-6175 <br /> Ill. Waste Stream Information <br /> Name of Waste: Soil contaminated from gasoline and hydraulic oil USTs. <br /> Process Generating Waste: <br /> Soil generated during remedial excavation activities. <br /> Type of Waste: ❑INDUSTRIAL PROCESS WASTE ©POLLUTION CONTROL WASTE <br /> Physical State: [Z]SOLID ❑SEMI-SOLID [—]POWDER ❑LIQUID <br /> Method of Shipment: [Z]BULK ❑DRUM ❑BAGGED [:]OTHER: <br /> Estimated Annual Volume: 1,400 Tons <br /> Frequency: ©ONE TIME ❑ANNUAL <br /> Disposal Consideration: ©LANDFILL ❑SOLIDIFICATION [—]BIOREMEDIATION <br /> IV. Representative Sample Certification ❑NO SAMPLE TAKEN <br /> Is the representative sample collected to prepare this profile and laboratory analysis, ©YES or[ NO <br /> collected in accordance with U.S. EPA 40 CFR 261.20(c)guidelines orequivalent rules? <br /> Sample Date: 12/29/10 1 Type of Sample:©COMPOSITE SAMPLE ❑GRAB SAMPLE <br /> Sample 1D Numbers: A-(3,6,9), B-(3,6,9), C-(3,6,9), D-(3,6,9), E-(3,6,9), F-(3,6,9), G-(3,6,9) <br /> p Republic Services,Dec 2009 <br />