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NAME: ADDRESS: CITY: STATE: CA Pacific Gas and Electric Company - LIOq0 cues} to I-oc tReo S4oGelan ZIP: o,c 4 TELEPHONE: ( Units Quantity, PACIFIC GAS AND ELECTRIC COMPANY HAZARDOUS WASTE SHIPPING PAPER Pacific Gas and , Electric Company SHIP FROM SHIP TO LOCATION/ ADDRESS: V9s.161() es(A 10, CITY: es(„ANA State: CA Zip: i01 ;?) 222 221 223 261 731 731 Required for any amount Required for any amount NAME: Pacific Gas and Electric Company - Number of Containers DATE GENERATED: 03 /la_ SHIPPED: Was this waste held at any interim location? Yes No (circle one) If yes, facility name and address: Container Type v_ Non-RCRA Hazardous Waste, Solid, soil / debris contaminated with PCB NomRCRA Hazardous Waste, Liquid, (PCB•contam(nated oll-filled electrical equipment) Non•RCRA Hazardous Waste, Solid, (Drained PCB-contamlnated electrical equipment) Non•RCRA Hazardous Waste, Liquid 0 oily water with transformer oil <5 ppm PcB 0 used transformer oil <5 ppm PCB Non•RCRA Hazardous Waste, Liquid, (oil filled capacitors <5 ppm PCB) Non.RCRA Hazardous Waste, Liquid, 0 known ppm PCB [5-49 ppm] (OCR-contaminated oil] 0 known ppm PCB [>50 ppm] 0 unknown and assumed 50-499 ppm PCB 0 known ppm PCB 0 unknown and assumed 50-499 •m PCB 0 known ppm PCB [5-49 ppm] 0 known ppm PCB [<50 ppm] 0 unknown and assumed [50499 ppm PCB] known _ppm PCB 0 unknown and assumed 50-499 ppm PCB Non-Hazardous Waste solids ( Soil and debris contaminated with mineral oil) Emergency Contact: PSC Industrial Outsourcing, Inc. 844-334-2468 Name of Driver: Se row,Q, r,A 3( I Internal Job Number REMOTELY GENERATED HAZARDOUS WASTE 2 63 I 1)-I )-- ARRIVED AT CONSOLIDATION SITE 3 CA Waste Code So0 Quantity, Units gallons kgs. kgs, Physical State 'Liquid liquid Sohd all Required for any amount Amounts requiring shipping paper >1 gallon <10 lhs 261 261 0 PCB contaminated oil kgs. MATERIAL (IN-SERVICE ELECTRICAL EQUIPMENT) RQ,UN2315, Polychlorinated Biphenyls, Liquid,9, PG II (Non-leaking, art-Oiled electrical equipment with ?:270 gallons of unknown, assumed 50-499 ppm PCB concentration Liquid Equipment manufacturer and serial #: Page 1 of 2 4. If the PCB concentration is unknown, you must assume the equipment and/or debris to be 50 to 499 ppm PCB. A guide for estimating the RQ and weight of PCB is available on the back. 3 Total waste per shipment per vehicle from an unstaffed facility or spill may not exceed 2,500 pounds or 500 gallons. See Attachment 4 of the Remote Waste Management Procedure. 2. REQUIRED: Departmentof Transportation (DOT) Emergency Response Guidebook (ERG) corresponding pages. Potentially required supporting paperwork: (i)CHP Hazardous Materials 1. Record keeping requirements are three years for non-PCB wastes and five years for PCB-contaminated wastes. RCRA (solid or liquid). lithe volume of pure PCB meets or exceeds one pound in an one container (the Reportable Quantity (RQ) for PCBs), use the shipping name with RQ in description, otherwise use Non- Certificate of Registration. ERG for oil/PCBs is 171 and can be found in the Remote Waste Management Procedure. Transportation License, (ii) DTSC Transportation Regulatory Exemption Application Variance and (iii) DISC Hazardous Waste Transporter Registration, (iv) DOT Hazardous Materials Retain this document for three years. Revised 2 /1 9/2 015 0 drained electrical equipmenla 0 debris contaminated with PCB oiN RQ, UN2315,Polychionnated Biphenyls, 0 oil-filled electrical equipments Liquid, 9,00!! HO, UN3432, Polych/orinated Blphenyls, Solid,9,00 It kgs. kgs. Any container with 21 pound of pure PCB Required for any amount Number of Containers Container Type' 731 Physical State Liquid Any container with 21 pound of pure PCB Amounts requiring shipping paper Any equipment with 21 pound of pure PCB Solid 261 261 731 731 kgs. Liquid Solid COGASZTOK - Photos from Frederick Emest's Phone - 3,12/2022 - 6/15