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Waste Profile #: Disposal Facility: 4204 Forward Landfill CA <br />City: State: Zip: County: 95203 California San Joaquin Stockton <br />Zip: --Select State-- <br />Email Michael.Anderson@yara.com <br />I. Generator Information <br />Generator Name: <br />Generator Site Address: [2835 West Washington Street <br />State ID/Reg No: <br />Generator Mailing Address <br />City: <br />Generator Contact Name: <br />Phone Number: <br />State Approval/Waste Code: <br />E (if different) <br />County: <br />Ext: <br />NAICS #: <br />Same <br />State: <br />916-375-6111 Fax Number: <br />Michael Anderson <br />Yara North America <br />II. Billing Information <br />Bill To: Environmental Logistics, Inc <br />oecia I Waste Profile r 90 'REPUBLIC <br />4,4 SERVICES <br />Sales Rep #: <br />Billing Address: P.O. Box 806 <br />City: [Colton <br />Contact Name: <br />Email: <br />Marcial Barragan <br />Zip: 92324 Phone: 909-873-4141 State: [California <br />Waste Stream Information <br /> <br />L on-Hazardous Waste Solid (Soil) Name of Waste: <br /> <br />Process Generating Waste: Clean up pond that collects rain water. <br />Type of Waste: Pollution Control Waste Physical State: Solid Method of Shipment: Bulk <br /> <br />Estimated Volume: 30 Volume Type: Tons <br /> <br />Landfill Frequency: lOne-time Event (single project) Disposal Consideration: <br />Representative Sample Certification <br />Ei No Sample Taken <br />Iii Sample Taken Type of Sample Grab Sample <br />Is the representative sample collected to prepare this profile and laboratory analysis, collected in accordance with U.S. EPA 40 CFR <br />261.20(c) guidelines or equivalent? ID Yes El No <br />Sample <br />Date: R-14-2021 Sample ID <br />Numbers <br />or SDS: <br />Pond Center, Pond Edge, Bin Door Side & Bin Truck Side <br />Remember to attach Laboratory Analytical Report (and/or Material Safety Data Sheet) <br />including Chain of Custody and required parameters provided for this profile. <br />Poge 1 <br /> Yara North America Non-Hazardous Waste Solid (Soil) <br />April 2019