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�A <br />K Pure Waterworks <br />8910 Rochester Ave. <br />Rancho Cucamonga, CA 91730 <br />Phone# 909-476-9492 <br />Fax# 909-481-5099 <br />Non -Hazardous <br />Waste Facility <br />GENERATOR'S WASTE <br />MATERIAL PROFILE SHEET <br />PROFILE NUMER <br />NEW <br />AMENDMENT ❑ <br />GENERATOR <br />BILL TO <br />Name <br />Address <br />city/zip <br />Unifed Grocers <br />Name <br />Address <br />citylzip <br />HAZ MAT TRANS, INC. <br />1990 Piccoli Road <br />P.O. BOX 5129 <br />Stockton, CA <br />SAN BERNARDINO, CA 92412 <br />Technical contact I Pat Gerametti 209-931-1990 <br />Contact MIKE HAMMER <br />Shipping Contact JMikeHammer Phone 909-889-5 <br />Ph# 909-889-56 Fax 909-884-8966 <br />TRANSPORTER <br />TRANSPORTER <br />Name <br />AddressP.O. <br />citylZip <br />HAZ MAT TRANS, INC. <br />Contact <br />Ph# <br />Fax# <br />MIKE HAMMER <br />BOX 5129 <br />909-889-5607 <br />1909-884-8966 <br />SAN BERNARDINO, CA 92412 <br />WASTE DESCRIPTION - (Clarifier water, rain water, food process water, <br />Clarifer Waste from Truck Wash Rack <br />CHEMICAL & PHYSICAL STATE <br />Liquid L -J, Multilayered <br />Odor Mild <br />Semi -Liquid Bi -layered Li <br />TSS ? <br />Solid Li Single Phase Li <br />Color Grey <br />PH <br />Flash Point NA <br />*20 8-10 <br />O 2 - 4 O 10-12 <br />O 4-6 O *12 <br />OO 6 - 8 O N/A <br />% Bottoms Sediment 3-15% <br />% Debris 0% <br />%Ash 0% <br />Specific Gravity 1=1 <br />Profile History <br />Has this waste ever been shipped as a Haz waste? Yes No <br />If YES, explain: <br />MANUFACTURING/PROCESS DESCRIPTION <br />Describe type of manufacwnrigicompany and process generating waste stream. Inciude a list of virgin matenais and their Material Safety Data Sheets <br />Grocery Dist Center <br />CHEMICAL CONSTITUENTS <br />METALS (ppm) <br />Water 90-97 % <br />Dirt/Sludge 2-10% % <br />% <br />Arsenic Mg <br />Cadmium Mercury <br />Chromium Nickel <br />Copper Tin <br />Lead Zinc <br />% <br />SHIPPING INFORMATION <br />Shipping Method: Vactor LJ Vac Truck -_ DryVan Tote DrumLJ Roll Off Li <br />Volume (gallons/tons) 4200 Gallons about every 6 to 8 weeks <br />Generator's Certification: I certify the materials described above on this profile are No Rls I Pof subject to federal regulations y for reporting proper disposal of hazardous Was 4 - <br />therefore n ) <br />❑ Signed on Behalf of Generator <br />Authorized Signature <br />Print Name <br />JUL 28 2014 <br />DEPARTMENT <br />