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D US Ecology Nevada (Beatty) ❑ US Ecology Texas (Robst w) Froftle #: - - Fax (775) 333.2123 Fax 1361) 387-0794 itknhP.WW ❑ US Ecology Idaho (Grand View) Fax J34-2119 A. CUSTOMER INFORMATION tit p IndustrWLJNON - Industial *(TV= camoneers o Generator. I ft U40, Paper Check If Wing Is Same Facility Address : 3550 Bcaano Road filling Company: ENV Emftnmentd tntemenon.l hw. (No PO Box) etocirton, CA 05215 Billing Address: also B Egret C1 - - - Mailing Address ity/State2ip: DOW. G to City/StRwzip. 1111112 Contact: Technical Contact: Ann Phona No.• Fax No.: Phone: 208.931 MM Fax: 1; NAICS# 822211 ❑� ❑gw ❑1,QG EPA ID CAL000204766 State IID# 1. US DOT Shipping Name Non RCRA Naordam waw saw (aaaa tsbd tt.orgq r. hazard Cfau Non ROM s. UNMA # Non RORA . Packaging Group Non RCRA s.RQ Non RCRA aCucahta7ypa ❑Built ❑Tom❑Pillet Sim tlSCiall M 7,Fnqueray: ❑Yar QM ❑Month ❑emies ❑gw IDDnxns ❑ww Quandly 1-8 ❑i Time 00lher An needed C. GENERAL M RiAL ULA O Y FORMA IO i. Comma name for this waste anal Red BnrhVo 2. Process generadus the material Ma" nmof d s4cr_ nsemrl ole cuaer (beludf OWN" shaft a nfasar--) 3 Desorft Physical Appowsm of Wage BW" oonhnftted WM ansa 4. Describe odor ofwasto: Done ❑Slight Onwg Describe: Fhyimerbone s, Knowledge b i vm: ❑lab Analysis ❑ MDS ©ftomX,,anera knowledge ❑Other (sPeth) OYU []No To the material <500 PPMW VOC as generated [3Yes g]No Is the waste restricted under EPA Land Disposal Restrictions ❑Yes ONo Waste subject to Benzene NESHAP relatioaa (40 CFR 268), if yea please complete LDR form OYes❑No SIM wastecodoa 362 ❑WasWmW ❑Non-waftwaiar ©Debris ❑Yes mNo CERCLA Regulawl( waste 0yes m No Exempt waste: If yes, fiat ref. 40 CFR No Contains UHCa/Constituents of Concarn: List in section D [:]YesNo PA He& Waft (ibt coda) YealNo YesNo Has the waste been treated after the initial point of generation? ❑Yes Subpart XX []Yes ONo Ntemetive standards for Soil ? Code G Form Cade w Mat. Madwd B D. MA A OMP iTiON (PhyalcaUcherokal) Does the waste exhibit or contaln the following: (Range ToW > or ■ 100%) Valuee ars ❑ TcLP❑ TOTALS ❑Yes oNo oxmimr ❑Yes mNo Raa, BulBdes (haa+sffdmeonlanswanfsfaary)M&Ldvdne unit me ❑YaSNo ppm Explosive ❑Yes (10 itmat.Cyanides _ppm No � Patwdde ❑Yes No Water/Air (Pyraphoric) Re&& YesNo Shoop Sw lve BYes No Thermally Unable YesNo Tim Yes No TSCA Regulated PCB Was YesNo "boric ❑Yes oNo RWbted Medial Wnflow Warta Yes mead"" ❑Yes ©No Comproaod Basses Yea No Baampt RAD** -Aeadmr a tnba po.ldrd r Ueaa WAC Aaeraao Yes ND Halo cb7 40 CFR 266 Aft afdw tma Nseaa masmareasrr ?8-10 x atoox ❑YeaIND ads 20-2e % 0.100 - F. PHYSICAL CHARACTERISTICS I.Ftub Polot: am YYa1s "F (!f <140°F, ITypical pH: som— PH Range: ❑ <2 Yes No Ponibitily of incidental IIgWde Som traoaporoatioc? >2, 41230 ® Yes UND Does waste pan the BPA spscifled palm filar aaP! > 12 3 C. OENERATORIS CERTIFiCATIONr VJYes UND I earthy the matsrlal nay be disposed o(Mlhoas fkrther t leob L tlso 8ttameot: l aettlty Dada goodly of law that i fm titmiliar with fhb wane shesmthrough aaalyab and/or prooea rmowledQe, coil ffid dl iafbamadon provided b repreaeotitive and compile, and the aU known m suspected (onorrdf have urea FmftmwM I em" the in accordance with the bxmwdam provided. Pri11t D signatnro: Title: �/ Date: tee t use on First review Second review Final review: Date roved: Date Denied;