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A Resource Recovery Program RESOURCE RECOVERY PERMIT(NON HAZARDOUS) <br /> 463 <br /> /J� P.O.Box 24055,MS 702 <br /> Oakimd,CA 94623-1055 Addendum A <br /> EBMUD (510)287-1336 <br /> RRwwte®ebmud.com <br /> Material Acceptance Agreement <br /> A Material Acceptance Agreement must be completed for each material. Include a complete description of the process <br /> generating the material. If applicable, include analytical data and MSDS, along with percentage concentretio i of constituents of <br /> concern wtlhin the material. If your Material Accaplanoe Agreement is approved, a Gate Pass will be sent to au.You may only <br /> deliver materials for which you have received a Gate Pass;each delivery must be accompanied by an EEMU Gate Pass. <br /> I certify that the description of the waste below is a true and accurate representation of the wastewi ter and any <br /> changes to the wastewater described below will be disclosed to the EBMUD Resource Recovery Pro learn for further <br /> review of material acceptability. <br /> To be completed by CUSTOMER To be completed by Fill WUD <br /> Community Fuels e0m 8000-001 <br /> 1)Permit Holder(Company Name) Permit Number <br /> fiNA(_ l h/Anv <br /> 2)Generator/Site Name Material Description <br /> 809 C Snedeker Ave Stockton,CA 95203 Lwow OKl <br /> 3 Site Address Material Type <br /> I inLC l <br /> 4) Material Composition (Ex:liquid,sludge,etc) 5) Estimated Volume (gallons or pounds) <br /> Ongoing Dail <br /> 6 Estimated Delivery Dates (Ex:Apil8-16,2013,oran- oin Delivery Frequent (Ex:M,N',F 3 18dd <br /> 8) Describe wastewater generation and its known and potential pollutants. <br /> Biomass-based diesel fuel production:washwater containing dissolved glycerine,sodium sulfate salt, soap I from fatty acids, <br /> trace methanol <br /> 9) Is the wastewater generation subject to Federal Categorical Pretreatment Standards? Yes❑ No rA <br /> • Ifyes,indicate Federal Categorical regulation 40 CFR <br /> • Ifyes,is the wastewater fully compliant with the applicable federal categorical regulations? Yes❑No❑ <br /> 10) P.O,or job number(if desired for your tracking purposes): <br /> 11) Permit Holder Signature(or duly authorized representative): <br /> Michael Parisi El Manager 8/8/17 <br /> Print Name <br /> � r <br /> and Title/ Dal <br /> } <br /> 41 "le'' V Mich co m ni <br /> Signature of Permit Holder Email Add resa <br /> Recommendation by R2 Program Manager. �a,.� (For EBMUD Use Only) <br /> COMMENTS(such as volume capacity), / f <br /> EBMUD Resource Recovery Program Permit Decision: Approved y Rejected Expiration Dat UI <br /> Division Manager Si nature: Date: <br /> Re%aM 9110013 <br />