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y.�� 00 - 3_33 - 6 f 1yyy12y Norcal Waste Systems; Inc. (Landfill Division) fy �OOD �iyy_y _ C50 Waste Disposal Application /�V�7- T1?fr/:1'RS`7_ C7�4s�5 Date Submitted: February 25,2010 Authorization#: ✓ Hay Road LF ❑ Ostrom Road LF A. Party to be Intrinsic Transportation, Inc. Email Address: Ilevang c( intrinsictrans.com Billed: Address: 2225 Challenger Way,Suite 100/Santa Rosa, CA 95407 Contact: Lisa M. Levang Phone: 707.578.0960 Fax: 707.578.5408 B. Generator California Army National Guard Information: Address: 10620 Mather Boulevard Mather,CA 95655 Site Address(if 333 North Washington Street Lodi,CA 95240 different): County of Origin: San Joaquin Site within city limits?Yes X No ❑ Contact: Chris Markowski, P.G. Phone: (916) 369-4327 Fax: C. submitting Oneida Total Integrated Enterprises Consultant: Address: 1777 N. California Street,Suite 310,Walnut Creek, CA 94596 Contact: Mike Quillin, P.G. Phone: 925-906-9698 Fax. D.Transporter: Intrinsic Transportation, Inc. Address: 2225 Challenger Way,Suite 100/Santa Rosa,CA 95407 Contact: Stuart L. Levang Phone: 707.578.0960 Fax: 707.578.5408 E. Waste Soil contaminated with diesel from a diesel spill Description/Source: Contaminant: Gas: Diesel: XXXXXXXX Waste Oil: Metals: XXXXXXXX Other: XXXXXXXXXXXX Project/Job Name: Parking-Lodi ProjectlJob Number: IT122501 Process Generating Physical State: Solid: XXXXXXXX Semi-Solid: Powder: Other: Waste/Source: Free Liquids: Yes. No: XXXXX Water Content: 0% Quantity: Tons. 30 Yards: Vehicle Type: End Dump Vehicle Capacity: 23-25 tons Shipping Frequency: All per one time F. Supplemental Certified Analytical XXXXXXX Chain of XXXXXXXX QA/QC: XXXXXXXX Facility Map: Information: Reports: Custody: G. Generator Certification: 1. Does this waste profile sheet and attachments contain true and accurate descriptions of the waste/material? Yes ✓ No❑ 2. Has all relevant information within the possession of the generator regarding known or suspected hazards Yes V' No ❑ pertaining to the waste been disclosed to the facility managing the waste? 3. Is the analytical attached derived from testing a representative sample in accordance with 40 CFR 261? Yes ✓ No❑ 4. Will all changes that occur in the character or classification of the waste be identified by the Generator and disclosed to the facility managing the waste prior to providing the material/waste to the management facility? Yes ✓ No❑ I hereby certify that to the best of my knowledge and belief,the information contained herein is a true,complete and accurate description of the waste material being offered for disposal and all known or suspected hazards have been disclosed. All analytical Results/Material Safety Data Sheets submitted are truthful and complete and are representative of the waste. I further certify that by utilizing this profile,neither myself nor other employees of the company will deliver for disposal or attempt to deliver for disposal any waste which is classified as toxic waste,hazardous waste or infectious waste,decommissioned radioactive waste or any other waste material this facility is prohibited from accepting by law. I shall immediately give written notice of any change or condition pertaining to the waste not provided herein. Our company hereby agrees to fully indemnify this disposal facility against any damages resulting from this certification being inaccurate or untrue. / (Signature) (Date) Norcal Waste Systems,Inc,reserves the right to request additional information prior to acceptance. 7o be considered for disposal,please complete this application in futt, Please fax analyses to(707)678.5148 for review. Administrative Offices • 235 North First Street • Dixon,CA 95620 - Phone,(707)678-5692 • Fax:(707)678-5148 NWS Hay Road Landfill - 6426 Hay Road -Vacaville,CA 95687 • Phone:(707)678-4718 • Fax: (707)678-5695 NWS Ostrom Road Landfill • 5900 Ostrom Road - Wheatland,CA 95692 - Phone:(530)743-6321 - Fax: (530)743-8649 Revised 619/2008