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ww1vie EZ Profiler" <br /> WASTE MANASSMENT <br /> Requested Facility: Kettleman Hills (Hazardous Waste Facility) U Unsure Profile Number: CA614273 <br /> U Multiple Generator Locations (Attach Locations) U Request Certificate of Disposal U Renewal? Original Profile Number: <br /> A. GENERATOR INFORMATION (MATERIAL ORIGIN) B. BILLING INFORMATION ❑ SAME AS GENERATOR <br /> 1 , Generator Name: CITY OF TRACY 1 , Billing Name: Bradley Tanks Inc <br /> 2. Site Address: 741 N. CENTRAL AVE 2. Billing Address ane Hartz Avenue a ilding C <br /> (City, State, ZIP) Trary GA 95+376 (City, State, ZIP) nanvolls CA 94526 <br /> 3 , County: Can Joaquin 3, Contact Name:Kelly Gras=r <br /> 4, Contact Name: . lank Cook 4. Email: kgrasergDbt'e mental corn <br /> 5 . Email: jackc@cvecorp.com 5. Phone: ,(926) 229-2400 6. Fax: ,(925) 553-2616 <br /> 6. Phone: ( 59) 222-1149 7, Fax: 7. WM Hauled? U Yes W No <br /> 8, Generator EPA ID: lid N/A 8. RO: Number: <br /> 9, State ID: CA000295 016 U N/A 9. Payment Method: O Credit Account U Cash U Credit Card <br /> C. MATERIAL INFORMATION D. REGULATORY INFORMATION <br /> 1 , Common Name: non-RCM solid 1 . EPA Hazardous Waste? U Yes* fd No <br /> Describe Process Generating Material: U See Attached Code: <br /> Old 100 gallon Fuel UST storage tank - Old and rusty with lots 2. State Hazardous Waste? 0 Yes U No <br /> of holes, empty inside. Code: 181 <br /> 3. Is this material non-hazardous due to Treatment, U Yes* Gd No <br /> Delisting, or an Exclusion? <br /> 4. Contains Underlying Hazardous Constituents? U Yes* ® No <br /> 2 . Material Composition and Contaminants: U See Attached 5. From an industry regulated under Benzene NESHAP? U Yes* W No <br /> 1 , 01d Metal UST 100 v 6. Facility remediation subject to 40 CFR 63 GGGGG? U Yes* R No <br /> 2. Pl astic Sheeting and wooden Pallet 100A 7. CERCLA or State-mandated clean-up? LJ Yes* WNo <br /> 3. 8. NRC or State-regulated radioactive or NORM waste? U Yes* Gd No <br /> 4• *If Yes, see Addendum (page 2) for additional questions and space. <br /> Total comp, must be equal to or greater than 100% _>100% <br /> 3 . State Waste Codes: 181 U N/A 9. Contains PCBs? If Yes, answer a, b and c. U Yes 6d No <br /> 4. Color: Brown/Rust a. Regulated by 40 CFR 761 ? ❑ Yes Lot No <br /> In, Remediation under 40 CFR 761 .61 (a)? U Yes U No <br /> 5. Physical State at 707: id Solid ❑ Liquid U Other: c. Were PCB imported into the US? U Yes U No <br /> 6. Free Liquid Range Percentage: to m N/A 10. Regulated and/or Untreated <br /> ❑ Yes 6d No <br /> 7. pH: to N/A Medical/Infectious Waste? <br /> 8. Strong Odor: U Yes 0 No Describe: 11 , Contains Asbestos? U Yes m No <br /> 9. Flash Point: U < 140° F U 1406 - 199° F ❑ z2006 N/A 4 If Yes: U Non-Friable ❑ Non-Friable - Regulated U Friable <br /> E. ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION F. SHIPPING AND DOT INFORMATION <br /> 1 . Analytical attached U Yes 1 . 0 One-Time Event U Repeat Event/Ongoing Business <br /> Please identify applicable samples and/or lab reports: 2. Estimated Quantity/Unit of Measure: 5 <br /> U Tons W Yards U Drums U Gallons U Other: <br /> 3 . Container Type and Size: 20 CY Bin <br /> 4. USDOT Proper Shipping Name: U N/A <br /> 2. Other information attached (such as MSDS)? U Yes NON-RCRA Hu DOUS wnsTE, SCUD, <br /> G. GENERATOR CERTIFICATION (PLEASE READ AND CERTIFY BY SIGNATURE) <br /> By signing this EZ Profile"" form, I hereby certify that all information submitted in this and all attached documents contain true and accurate descriptions of this material, and that <br /> all relevant information necessary for proper material characterization and to identify known and suspected hazards has been provided. Any analytical data attached was derived <br /> from a sample that Is representative as defined in 40 CFR 261 - Appendix 1 or by using an equivalent method. All changes occurring in the character of the material (i.e., changes <br /> in the process or new analytical) will be identified by the Generator and be disclosed to Waste Management prior to providing the material to Waste Management. <br /> If I am an agent signing on behalf of the Generator, I have confirmed with the Certification Signature <br /> Generator that information contained in this Profile Is accurate and complete. <br /> Name (Print): Jack Cook Date: 04-25-18 <br /> Title: Proj . Mngr. -Agent for Owner - <br /> Company: Central Valley Environmental <br /> Revised lune 30, 2015 <br /> THINK GREEN® QUESTIONS? CALL 800 963 4776 FOR ASSISTANCE 02015 Waste Management <br />