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t"4 REPUB IC SPECIAL WASTE PROFILE Page 1 of 2 <br /> Waste Profile# <br /> Requested Disposal Facility:4204 Forward Inc. CA <br /> Sa.e:a6Ie fill-in fo-n RCSIriC 0d pnntill g until all regtiIre d(YL llo'aJ)iir_Idc-are winpIded. <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 ID/Regi No: State ApprovallWaste Code: (inapplicable) NAICS#: <br /> Generator Mailing Address (if different): 20500 South:Holly Drive <br /> 1 <br /> City: Tracy County: San Joaquin State: California Zip: 95304 <br /> Generator Contact Name: Anne Ogrey Email: anne_ogrey@spreckefssugar.com <br /> Phone Number: (209)834-7679 Ext: Fax Number: <br /> 3 <br /> Ila. Transporter Information <br /> I <br /> Transporter Name: Jim Thorpe Oil, Inc. Contact Name: Marty Thorpe. x <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: j <br /> City: Lodi State: California Zip:95241 Phone: (209)368-6175 <br /> t <br /> I <br /> .I <br /> 111. Waste Stream Information <br /> Name of Waste: Soil contaminated from a bunker fuel UST. j <br /> Process Generating Waste: <br /> Soil generated during remedial excavation activities. <br /> i <br /> Type of Waste: ❑INDUSTRIAL PROCESS WASTE ©POLLUTION CONTROL WASTE <br /> Physical State: mSOLID ❑SEMI-SOLID ❑POWDER E]LIQUID <br /> Method of Shipment: ❑BULK [:]DRUM []BAGGED ❑OTHER: <br /> Estimated Annual Volume: 400 Tons <br /> Frequency: Q 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: 1124111 1 Type of Sample:©COMPOSITE SAMPLE ❑GRAB SAMPLE <br /> Sample ID Numbers: H-(2,5,9), I-(2,5,8) <br /> ©Republic Services,Dec 2009 <br />