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CleanHar�W5WASTE MATERIAL PROFILE SHEET <br />PH <br />Clean Harbors Profile No. CH1013797KA1138 <br />BTU/LB (MJ/kg) <br />A. GENERAL INFORMATION GENERATOR NAME: Kaiser Permanente - Stockton <br />GENERATOR EPA ID #/REGISTRATION # CAD983600594 <br /><= 2 <br />GENERATOR CODE (Assigned by Clean Harbors) KA11389 CITY Stockton STATE/PROVINCE CA ZIP/POSTAL CODE 95210 <br />ADDRESS 7373 West Lane 0109446 PHONE: (209) 476-3478 <br />% <br />CUSTOMER CODE (Assigned by Clean Harbors) KA11389 CUSTOMER NAME: Kaiser Permanente - Stockton <br />< 0.1 > 20 <br />ADDRESS 7373 West Lane 0109446 CITY Stockton STATE/PROVINCE CA ZIP/POSTAL CODE 95210 <br />B. WASTE DESCRIPTION <br />2,1 - 6,9 <br />WASTE DESCRIPTION: RCRA Healthcare Hazardous Waste "Most in One" <br />1002,000-5,000 (4.6-11.6) <br />PROCESS GENERATING WASTE: PARTIALLY USED & OUT-DATED/OFF-SPEC MEDICATIONS and Toxic / Flammable chemical <br />products. <br />0.1 - 1.0 d Unknown <br />IS THIS WASTE CONTAINED IN SMALL PACKAGING CONTAINED WITHIN A LARGER SHIPPING CONTAINER? Yes <br />V 101 -140 (38-60) <br />C. PHYSICAL PROPERTIES (at 25C or 77F) <br />yo 1.0 (e.g. Water) <br />PHYSICAL STATE <br />NUMBER OF PHASES/LAYERS <br />VISCOSITY (If liquid present) <br />1.1 - 5.0 <br />COLOR <br />SOLID WITHOUT FREE LIQUID <br />V 1 2 3 TOP 0.00 <br />1 - 100 (e.g. Water) <br />> 10,000 (>23.2) <br />% <br />POWDER <br />5.1 - 20.0 <br />5.0000000 <br />> 200 (>93) <br />VARIES <br />MONOLITHIC SOLID <br />% BY VOLUME (Approx.) MIDDLE 0.00 <br />101 - 500 (e.g. Motor Oil) <br />------------------------------------------------------------------------------------------------------------------- <br />GLYCERYL <br />------------------------------------------------------------------------------------------------------------------- <br />1.0000000 -- <br />LIQUID WITH NO SOLIDS <br />BOTTOM 0.00 <br />501 - 10,000 (e.g. Molasses) <br />METAL PLATE OR PIPING >1/4" THICK OR <br />YES d <br />LIQUID/SOLID MIXTURE <br />>12" LONG, METAL REINFORCED HOSE >12" LONG, METAL WIRE >12" LONG, METAL VALVES, PIPE FITTINGS, <br />CONCRETE REINFORCING BAR OR <br />ODOR <br />• FREE LIQUID 50.00 - 50.00 <br />> 10,000 <br />If yes, describe, including dimensions: <br />• SETTLED SOLID 50.00 - 50.00 <br />NONE BOILING POINT °F (°C) <br />MELTING POINT °F (°C) <br />TOTAL ORGANIC <br />• TOTAL SUSPENDED SOLID <br />YES V <br />NO <br />CARBON <br />SLUDGE <br /><= 95 (-35) <br />40 MILD <br />95 - 100 (35-38) <br />< 140 (<60) <br /><= 1% <br />GAS/AEROSOL <br />STRONG <br />140-200 (60-93) <br />101 -129 (38-54) <br />1_9% <br />Describe: <br />d >= 130 (>54) <br />* > 200 (>93) <br />y/ >= 10% <br />FLASH POINT °F (°C) <br />PH <br />SPECIFIC GRAVITY ASH <br />BTU/LB (MJ/kg) <br />< 73 (<23) <br /><= 2 <br />< 0.8 (e.g. Gasoline) <br />< 2,000 (<4.6) <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />BARIUM <br />< 0.1 > 20 <br />5.0000000 <br />73 - 100 (23-38) <br />2,1 - 6,9 <br />0.8-1.0 (e.g. Ethanol) <br />1002,000-5,000 (4.6-11.6) <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />CHLOROFORM <br />0.1 - 1.0 d Unknown <br />5.0000000 <br />V 101 -140 (38-60) <br />V 7 (Neutral) <br />yo 1.0 (e.g. Water) <br />5,000-10,000 (11.6-23.2) <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />CYCLOPHOSPHAMIDE <br />1.1 - 5.0 <br />5.0000000 <br />141 -200 (60-93) <br />7.1 - 12.4 <br />1.0-1.2 (e.g. Antifreeze) <br />> 10,000 (>23.2) <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />ETHANOL <br />5.1 - 20.0 <br />5.0000000 <br />> 200 (>93) <br />>= 12.5 <br />> 1.2 (e.q. Methylene Chloride) <br />Actual: - 0 BTU/LB <br />D. COMPOSITION (List the complete composition of the waste, include any inert components and/or debris. Ranges for individual components are acceptable. If a trade name is used, <br />nio..o Pte, �n nncnc oio��o n nnr „moo ohhrcviotinnc ) <br />CHEMICAL <br />MIN -- <br />MAX <br />UOM <br />ACETONE <br />1.0000000 <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />BARIUM <br />1.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />CHLORAMBUCIL <br />1.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />CHLOROFORM <br />1.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />CHROMIUM <br />1.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />CYCLOPHOSPHAMIDE <br />1.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />DIETHYLSTILBESTROL <br />1.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />ETHANOL <br />0.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />FORMALDEHYDE <br />1.0000000 -- <br />5.0000000 <br />% <br />------------------------------------------------------------------------------------------------------------------- <br />GLYCERYL <br />------------------------------------------------------------------------------------------------------------------- <br />1.0000000 -- <br />5.0000000 <br />% <br />DOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS (EX., <br />METAL PLATE OR PIPING >1/4" THICK OR <br />YES d <br />NO <br />>12" LONG, METAL REINFORCED HOSE >12" LONG, METAL WIRE >12" LONG, METAL VALVES, PIPE FITTINGS, <br />CONCRETE REINFORCING BAR OR <br />PIECES OF CONCRETE >3")? <br />If yes, describe, including dimensions: <br />DOES THIS WASTE CONTAIN ANY METALS IN POWDERED OR OTHER FINELY DIVIDED FORM? <br />YES V <br />NO <br />DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING; ANIMAL WASTES, HUMAN BLOOD, BLOOD PRODUCTS, BODY YES %0 NO <br />FLUIDS, MICROBIOLOGICAL WASTE, PATHOLOGICAL WASTE, HUMAN OR ANIMAL DERIVED SERUMS OR PROTEINS OR ANY OTHER <br />POTENTIALLY INFECTIOUS MATERIAL? <br />I acknowledge that this waste material is neither infectious nor does it contain any organism known to be a threat to human health. This certification is <br />based on my knowledge of the material. Select the answer below that applies: <br />The waste was never exposed to potentially infectious material. YES NO <br />Chemical disinfection or some other form of sterilization has been applied to the waste. YES NO <br />I ACKNOWLEDGE THAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS. YES NO <br />I ACKNOWLEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETTED. YES NO <br />SPECIFY THE SOURCE CODE ASSOCIATED WITH THE G11 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE. W005 <br />WASTE. <br />Report Printed On : Thursday. July 22. 2021 /WINWEB/Profile\Waste Profile.rdl Paae 1 of 6 <br />