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w1m. EZ Profile TM WASTE MANAGEMENT Requested Facility: Chemical Waste Management(Hazardous Waste Facility) ❑ Unsure Profile Number: OR349579 ❑ Multiple Generator Locations(Attach Locations) ❑ Request Certificate of Disposal ❑ Renewal?Original Profile Number: A.GENERATOR INFORMATION(MATERIAL ORIGIN) B.BILLING INFORMATION ❑SAME AS GENERATOR 1. Generator Name:Tesoro Stockton Terminal 1. Billing Name:American Integrated Services 2. Generator Site Address: 3003 Navy Drive 2. Billing Address:1502 E. Opp St (City,State,ZIP) Stockton CA 95206 (City,State,ZIP)Wilmington CA 90744 3. County: San Joaquin 3. Contact Name:JR Lamyuen 4. Contact Name: Lucina Lopez 4. Email: ilamyuenor(5�americaninteg rated.com 5. Email: 5. Phone:(310) 522-1168 6. Fax: 6. Phone: (562) 728-2265 7. Fax: 7. WM Hauled? ❑Yes 0 No 8. Generator EPA ID: CAT000618637 ❑ N/A 8. P.O.Number:82001-001 9. State ID: Rf N/A 9. Payment Method: 0 Credit Account ❑Cash ❑Credit Card C.MATERIAL INFORMATION D.REGULATORY INFORMATION 1. Common Name:Nor,-Haz Fire System Test Water 1. EPA Hazardous Waste? ❑Yes* 61 No Describe Process(es)Generating Material: ❑See Attached Code: Fire Foam Line Testing and or Flushing/Small trace amount of PFAS 2. State Hazardous Waste? 66 Yes ❑ No from line flushing. Code: x004 3. Is this material non-hazardous due to Treatment, ❑Yes* Gil No Delisting,or an Exclusion? 4. Contains Underlying Hazardous Constituents? ❑Yes* 6d No 2. Material Composition and Contaminants: El See Attached 5. From an industry regulated under Benzene NESHAP? ❑Yes* 6d No 1.Water a5-s 6. Facility remediation subject to 40 CFR 63 GGGGG? ❑Yes* 6d No 2.Potassium Chloride 5 5% 7. CERCLA or State-mandated clean-up? ❑Yes* ® No 3.Sodium Benzoate 5 8. NRC or State-regulated radioactive or NORM waste? ❑Yes* 6d No 4.Xanthan Gum 5%Total comp.must be equal to or greater than 100% >_100% *If Yes,see Addendum(page 2)for additional questions and space. 3. State Waste Codes:X004 ❑ N/A 9. Contains PCBs? 4 If Yes,answer a,b and c. ❑Yes 66 No 4. Color:Water White a. Regulated by 40 CFR 761? ❑Yes ❑ No b. Remediation under 40 CFR 761.61 (a)? El Yes ❑ No 5. Physical State at 70°F: ❑Solid m Liquid ❑Other: c. Were PCB imported into the US? El Yes ❑ No 6. Free Liquid Range Percentage:100 to 100 ❑ N/A 10. Regulated and/or Untreated ❑Yes 6J No 7. pH:7 to 8 ❑ N/A Medical/Infectious Waste? 8. Strong Odor: ❑Yes 6d No Describe: 11.Contains Asbestos? ❑Yes m No 9. Flash Point: ❑ <1407 ❑ 140°-199°F lid >_200° ❑ N/A 4 If Yes: ❑ Non-Friable ❑Non-Friable- Regulated ❑ Friable E.ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION F.SHIPPING AND DOT INFORMATION 1.Analytical attached ❑Yes 1. ❑One-Time Event IZI Repeat Event/Ongoing Business Please identify applicable samples and/or lab reports: 2. Estimated Quantity/Unit of Measure: 5000 ❑Tons ❑Yards ❑ Drums 6d Gallons ❑Other: 3. Container Type and Size:TT-5000 gals/275 gal Tote (TP) 4. USDOT Proper Shipping Name: ❑ N/A 2.Other information attached(such as MSDS)? 61 Yes Non-Hazardous Waste,Liquid(Rinse Water) G.GENERATOR CERTIFICATION(PLEASE READ AND CERTIFY BY SIGNATURE) 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 all relevant information necessary for proper material characterization and to identify known and suspected hazards has been provided. Any analytical data attached was derived 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 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. 66 1 am an Authorized Agent signing on behalf of the Generator,and I have confirmed with the Generator that information contained in this profile,as well Certification Signature as supporting documents provided,are accurate and complete. f Name(Print): JR Lamyuen Date: 02/08/2022 ■ �. Title: Waste Coordinator aog119g31�4_,_ Company: American Integrated Services, Inc. THINK GREEN QUESTIONS?CALL 800 963 4776 FOR ASSISTANCE Revised November 06,2020©2020 WM Intellectual Property Holdings,L.L.C.