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U Yes* 0 No <br />LI Yes* <br />LI Yes* <br />D Yes* <br />0 Yes* <br />LI Yes* <br />id No <br />10 No <br />0 No <br />GA No <br />LA No <br />e <br /> EZ ProfieTM# <br />WASTE MANAGEMENT <br />Requested Facility: Kirby Canyon Landfill <br /> <br />0 Unsure Profile Number: 651048CA <br /> <br />0 Multiple Generator Locations (Attach Locations) 0 Request Certificate of Disposal 0 Renewal? Original Profile Number: <br />A. GENERATOR INFORMATION (MATERIAL ORIGIN) <br />I. Generator Name: RYDER TRANSPORTATION SERVICES <br />Generator Site Address: 20920 S. 99 FRONTAGE ROAD <br />(City, State, ZIP) RIPON CA 95366 <br />County: San Joaquin <br />Contact Name: Rachel Locez <br />Email: rlopezgpatriotenvironmental.com <br />Phone: (562) 756-0114 7. Fax: <br />Generator EPA ID: 10 N/A <br />State ID: N/A <br />B. BILLING INFORMATION 0 SAME AS GENERATOR <br />Billing Name: Patriot Environmental Services <br />Billing Address:P.O. Box 62920 <br />(City, State, ZIP) Irvine CA 92606 <br />Contact Name:Accounts Payable <br />Email: AP©patriotenvironmental.com <br />Phone: (562) 436-2614 6. Fax: <br />WM Hauled? 0 Yes 0 No <br />P.O. Number:11-21-00483 <br />Payment Method: 0 Credit Account LI Cash 0 Credit Card <br />C. MATERIAL INFORMATION <br />1. Common Name: Soil Contaminated w/Trace Diesel <br /> <br />D. REGULATORY INFORMATION <br />1. EPA Hazardous Waste? <br />Code: <br />1:1 Yes* 10 No <br />Describe Process(es) Generating Material: 0 See Attached <br /> <br />Emergency Response Diesel Spill Clean Up <br />2. Material Composition and Contaminants: U See Attached <br />Soil 95-100% <br />Debris - Paper, Plastic, PPE, Rags 0-5% <br /> <br /> <br />Total comp. must be equal to or greater than 100% 2100% <br />State Waste Codes: 0 N/A <br />Color: Brown/Dark Brown <br />Physical State at 70°F: 10 Solid 0 Liquid 0 Other: <br />Free Liquid Range Percentage: to 0 N/A <br />pH: to 0 N/A <br />Strong Odor: 0 Yes 0 No Describe: <br />Flash Point: 0 <140°F 0 140°-199°F U 2200° 0 N/A <br />2. State Hazardous Waste? 0 Yes GA No <br />Code: <br />3. Is this material non-hazardous due to Treatment, <br />Delisting, or an Exclusion? <br />4. Contains Underlying Hazardous Constituents? <br />5. From an industry regulated under Benzene NESHAP? <br />6. Facility remediation subject to 40 CFR 63 GGGGG? <br />7. CERCLA or State-mandated clean-up? <br />8. NRC or State-regulated radioactive or NORM waste? <br />*If Yes, see Addendum (page 2) for additional questions and space. <br />9. Contains PCBs? 4 If Yes, answer a, band c. 0 Yes 0 No <br />Regulated by 40 CFR 761? 0 Yes 0 No <br />Remediation under 40 CFR 761.61 (a)? 0 Yes U No <br />Were PCB imported into the US? U Yes 0 No <br />10. Regulated and/or Untreated <br />Medical/Infectious Waste? <br /> U Yes 0 No <br />11. Contains Asbestos? 0 Yes 0 No <br />--> If Yes: 0 Non-Friable 0 Non-Friable - Regulated 0 Friable <br />E. ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION <br />1. Analytical attached <br />Please identify applicable samples and/or lab reports: <br />F. SHIPPING AND DOT INFORMATION <br />Yes 1. 0 One-Time Event 0 Repeat Event/Ongoing Business <br />Estimated Quantity/Unit of Measure: 50 <br />id Tons 0 Yards 0 Drums 0 Gallons 0 Other: <br />Container Type and Size: 20 YARD BIN <br />USDOT Proper Shipping Name: 0 N/A <br />PACE ANALYTICAL - ALL <br />2. Other information attached (such as MSDS)? 0 Yes <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 />Gh I am an Authorized Agent signing on behalf of the Generator, and I have <br />confirmed with the Generator that information contained in this profile, as well <br />as supporting documents provided, are accurate and complete. <br />Name (Print): Rachel Lopez Da te: 12/17/2021 <br />Title: Office Manager <br />Certification Signature <br />iLe2-a--41 <br />Company: Patriot Environmental <br />THINK GREEN! QUESTIONS? CALL 800 963 4776 FOR ASSISTANCE Revised November 06, 2020 © 2020 WM Intellectual Property Holdings, L.L.C.