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vim. EZ Profile TI'� Requested Facility:Kettleman Hills(Hazardous Waste Facility) ❑Unsure Profile Number: 657300CA ❑Multiple Generator Locations(Attach Locations) ❑ Request Certificate of Disposal If Renewal?Original Profile Number: 657300CA A.GENERATOR INFORMATION (MATERIAL ORIGIN) B.BILLING INFORMATION ❑ SAME AS GENERATOR 1. Generator Name:Tesoro Logistics Operations LLC 1. Billing Name-Patriot Environmental Services 2. GeneratorSite Address:3003 Navy Drive 2. Billing Address-PO Box 1460 (City,State,ZIP) Stockton CA 95206 (City,State,ZIP)North Highlands CA 95660 3. County: 3. Contact Name:Ambrose Kong 4. Contact Name:Sal Rodriguez 4. Email:ambrose.kong@patriotenvironmental.com 5. Email: 5. Phone:(562)676-2330 6. Fax: 6. Phone:(925)349-8269 7. Fax: 7. P.O. Number: 11-23-00198 8. Generator EPA ID: N/A 8. Payment Method: ❑Credit Account ❑Cash ❑Credit Card at Gate 9. State ID: N/A D.REGULATORY INFORMATION 1. EPA Hazardous Waste? ❑Yes* id No C.MATERIAL INFORMATION Code: 1. Common Name:PLANIT SAFE TM 3 X 3 (XG) SURROGATE TEST LIQUID 2.State Hazardous Waste? ❑Yes V1 No Describe Process(es) Generating Material: ❑See Attached Code: Product is off-spec and not contaminated.Facility used this product for 3. Is this material non-hazardous due to Treatment, ❑Yes* Vr No fire foam testing and discharged directly from system into vac truck and Delisting,or an Exclusion? several 275G totes.MSDS attached for reference;physically signed 4. Contains Underlying Hazardous Constituents? ❑Yes* 40 No profile copy by generator 5. Does the material contain benzene? ❑Yes 4No 6. Facility remediation subject to 40 CFR 63 GGGGG? ❑Yes* O No 2. Material Composition and Contaminants: ❑See Attached 7_ CERCLA or State-mandated clean-up? ❑Yes* O No 1.water 85-90% 8. NRC,State-regulated,NORM or TENORM waste? ❑Yes* m No 2. potassium chloride 1-5% *If Yes,see Addendum (page 2)for additional questions and space. 3.sodium benzoate 1-5 9• Contains PCBs? 4 If Yes,answer a, b and c. ❑Yes d No 4.xanthan gum 1-5% a. Regulated by 40 CFR 761? ❑Yes ❑ No Total comp.must be equal to or greater than 100% >_100% b. Remediation under 40 CFR 761.61? ❑Yes ❑ No 3.State Waste Codes: UdN/A 4. Color:yellow/brown c. Were PCBs imported into the US? ❑Yes ❑ No 10. Regulated and/or Untreated ❑Yes No 5. Physical State at 70°F: ❑Solid 0 Liquid ❑ Other: Medical/Infectious Waste? 6. Free Liquid Range Percentage: 99 to 100 ❑N/A 11. Contains Asbestos? ❑Yes GI'No 7.pH:6.8 to 8.0 ❑N/A 4 If Yes: ❑Non-Friable ❑Non-Friable-Regulated❑Friable 8. Strong Odor: ❑Yes Ud No Describe: 12. Contains Dioxins?(If Yes,please attach analysis) ❑Yes rdNo 9. Flash Point: ❑<140°F ❑140°-199°F W1>t200° ❑N/A F.SHIPPING AND DOT INFORMATION 1. ❑One-Time Event 0 Repeat Event/Ongoing Business E.ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION 2. Estimated Annual Quantity/Unit of Measure: 4500 1.Analytical attached ❑Yes ❑Tons ❑Yards ❑Drums WGallonS ❑Other Please identify Lab Report(s)and list specific representative Sample ID#s: 3. Container Type and Size: 120BBL Vac Truck+275G Totes 4. USDOT Proper Shipping Name ❑N/A Non-Hazardous Waste,Liquid,Water Based FFF Test Liquid 5. Estimated Start Date 2.Other information attached (such as SDS)? ❑Yes 6. Transportation Needed? ❑Yes* No G.GENERATOR CERTIFICATION(PLEASE READ AND CERTIFY BY SIGNATURE) By signing this Waste Management("WM")Profile,I hereby certify that all information submitted in Name(Print): Ambrose Kong 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 Title: Branch Operations Manager-Sacramento suspected hazards has been provided.Any analytical data attached was derived from a sample that is Patriot Environmental Services representative as defined in 40 CFR 261-Appendix 1 or by using an equivalent method.All changes Company: occurring in the character of the material (i.e.,changes in the process or new analytical)will be U4/3Q/2024 identified by the Generator and be disclosed to WM prior to providing the material to WM.I am aware Date: that there are significant penalties for knowingly submitting false information. Certification Signature Vf I am authorized to sign on behalf of the Generator and I have confirmed with the Generator that information contained in this profile,as well as supporting documents provided,are accurate and complete. ❑ I am a duly authorized employee of Generator holding a position of technical responsibility 4 with direct knowledge of the waste stream and the information contained in this profile,and I confirm that information contained in this profile,as well as supporting documents are accurate and complete. QUESTIONS?CALL 800 963 4776 FOR ASSISTANCE Revised February 20,2023©2023 WM Intellectual Property Holdings,L.L.C.