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':T REPUB S W SPECIAL WASTE PROFILE Page 1 of 2 <br /> SERVICE <br /> Waste Profile# <br /> Requested Disposal Facili :4204 Forward Inc. CA <br /> Saveable fill-in form. Restricted printing unt all required(yellow)fields are completed. <br /> I. Generator Infor ation Sales Rep#: <br /> Generator Name: Union acific Railroad (UPRR) <br /> Generator Site Address: 833 E 8th Street <br /> City: Stockton County: San Joaquin State:California Zip: 95206 <br /> State ID/Reg No: N/A State Approval/Waste Code: N/A (if applicable) NAICS# : 482111 <br /> Generator Mailing Addres (if different):❑✓ 301 NE 2nd Avenue <br /> City: Portland County: Multnomah State: Oregon Zip: 97232 <br /> Generator Contact Name: IPaul Holt I Email: pholt@up.com <br /> Phone Number: (916)540 0496 Ext: Fax Number: <br /> II. Billing Information <br /> Bill To: United Pumping S rvices Contact Name: Valerie Cosby <br /> Billing Address: 14000E alley Blvd. I Email: valerie@unitedpumping.com <br /> City: City of Industry State: CA Zip: 91746 Phone: (626)419-3736 <br /> 111. Waste Stream Information <br /> Name of Waste: Lime <br /> Process Generating Waste: <br /> lime was released onto the round from railcar, cleanup of lime with minimal debris/soil (WR12473). <br /> Type of Waste: ❑INDUSTRIAL PROCESS WASTE ©POLLUTION CONTROL WASTE <br /> Physical State: ❑SOLID ❑SEMI-SOLID POWDER ❑LIQUID <br /> Method of Shipment: ©BULK ❑DRUM ❑BAGGED ❑OTHER: <br /> Estimated Annual Volume: 20 Cubic Yards <br /> Frequency: [Z]ONETIME ❑ONGOING <br /> Disposal Consideration: [Z]LANDFILL ❑SOLIDIFICATION [_]BIOREMEDIATION <br /> IV. Representative Sa ple Certification ❑NO SAMPLE TAKEN <br /> Is the representative sampl 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 /> Type of Sample:©COMP SITE SAMPLE ❑GRAB SAMPLE <br /> Sample Date: 10/5/17 i <br /> Sample ID Numbers: WC-1(a�b,c,d)-100517 4� <br /> ENVIRONMIENTAL H►ALT <br /> ,L_ ItNit- <br /> ©Republic Services,April 2013 <br />