COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

RECEIVE ;* wun a+wxwa.nseam DEC 19 2016 EZ ProfileTm Requested Facility:ftaiont Landfill&R o r Go e ❑Multiple Generator Locations(Attach Locations) Q Reques I;e TA T�Unsure Profile Number: _ Nil Renewal?Original Profile Number: A.GENERATOR INFORMATION(MATERIAL ORIGIN) - 1-Generator Name: JMELOT COMPANY a,BILLING INFORMATION ❑SAME AS GENERATOR 2.Site Address• 77 -_ -- 1.Billing Name:SAP ENVIRONMENTA sEg"CES,INC • 07 S JACK TONE RD --- 2.Billing Address:3g00 (City,State,ON STOC•KTON CA a5= mAN.OA SL___ 3.County: ---��- �- (City,State,ZIP) ------ - - __ ty. San M+a_r+rrin I.Contact Namep, pA �L�A-93301 ._ 4.Contact Name:$T z La ODc LITTLE_. 5.Email:_...-__ 4.Email:ALE"F MPFNrtRO C. 6.Phone: ( p41•dCSR 7.Fax: 5.Phone:(8811 921157 6.Fax:j66U 39 a-38U 8.Generator EPA ID:C.AL0002z'=^" 7•WM Hauled? ❑N/A 8_P.O.Number:` D 13 No 9.State ID; if � 9. _- - Payment Method: P6 Credit Account Q Cash D Credit Card C.MATERIAL INFORMATION I.Common Name aIRTAinnia WATER D,REGULATORY INFORMATION 1.EPA Hazardous Waste? Describe Process Generating Material: -.. D See Attached Code: LI Yes* 61 No RINSING OUT OF CONTAINMENTS 2.State Hazardous Waste? - Code: fl Yes 6d No 3.Is this material non-hazardous due to Treatment, Relisting,or an Exclusion? fl Yes* rd No 2.Material Composition and Contaminants: Q See Attached 4.Contains Underlying Hazardous Constituents? fl Yes* ONO 1.NATER - WN/A 5.From an industry regulated under Benzene NESHAP? Q Yes• WNo 2. 6.Facility remediation subject to 40 CFR 63 GGGGG? fl Yes* A No 3• 7.CERCLA or State-mandated clean-up? ❑Yes' pJ No 4. 8.NRC or State-regulated radioactive or NORM waste? fl Yes* 14 No Tota comp,must be equal to or greater than eNYes,see Addendum(page 2)for additional questions and space. 3.State Waste Codes: 19.Contains PCBs? -3 If Yes,answer a,b and c. 4.Color:DIRTY WATER a. Regulated by 40 CFR 761? Q Yes Q No 5.Physical State at 70'F. D Solid Uliquid Q Other: O Yes ❑No b. Remediation under 40 CFR 761.61 (a)7 ❑yes ❑No 6.Free Liquid Range Percentage 98 _ _to D N/A c. Were PCB imported into the US? fl Yes ❑No 7.pR 7 to 8 D N/A 10.Regulated and/or Untreated 8.StmrQ Odor. O Yes O No Describe: Medical/infecticus Waste? fl Yes id No 9.Flash Point: 11Contains Asbestos?D<140'F D 740'-199'F m 2200' , fl Yes 0 No O N/A I> if Yes Q Non-Friable U Non-Friable-Regulated Q Friable E.ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION - A INFORMATION -- 1 Analytical attached RSHIPPING AND DOTINFORMATION Please identifyapplkablesamples and/or lab reports: id Yes I.id One-Time Event fl Repeat Event/Ongoing Business 2.Estimated uam ZALCO LABORATORIES,SAMPLE RN)1809090-01 Q itY/Unit of Measure:bdGa 41 s ❑Tons Ll Yards fl Drums fid Gallons ❑Other. 3.Container Type and Size:120 BEN_ 4.USDOT Proper Shipping Name: id MIA 2.Other information attached(suchasMSDS)7 Dye G.GENERATOR CERTIFICATION(PLEASE READ AND CERTIFY BY SIGNATURE) '• Ry rink;this EZ Profile'form,I herebycertify the all Information submitted in this and allattwhed documents conten true acid accurate dexriptions of this material,andthat allrekvam ln(ormatim necessary for proper material characterization and to identify I="and suspected hazards has been provided.Anyanalytical data attachedwas derived fmma sample that is MPr nosbe asdefined in 40CFR 251-APPen6z7 orbyusing an equivalent method.An cloNeso rrirgin the characterofthe material O.e_changes In the process anew analy6cap will be identified by the Generates and be disclosed to Waste Management priorto pmvldiny the material to Waste Management. if I am an agent signing on behalf of the Generator,1 have oonfirmed with the Certification Signature emratorthat lnformationc taiyfd(n tNSProfiktz accurate atld mpleb, Name(Print):_J tv^ q Date: Title irk 5 sAAgna Q.^ `7 Comparry: J •r• .-"tp (uT THINK GREEN" QUESTIONS?CALL 800 963 4770 FOR ASSISTANCE ReWsedduRa 30.3015 02015 Waste Management