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F. PCB Information <br />Does this waste material contain any Polychlorinated Biphenyls (PCBs): <br />❑ Yes <br />❑� No <br />If yes, please specify concentration: <br />as specified in 40 CFR Part 61 Subpart FF: <br />If any PCBs are present in this waste material at < 50 ppm, did they result from any dilution of materials <br />El No <br />If yes, please identify SIC code listed under NESHAP: _ <br />containing> 49 ppm PCBs. ❑ Yes <br />❑ No <br />2 N/A <br />G. Regulatory Status <br />Is this waste material defined as a California Hazardous Waste under 22 CCR Div 4.5, Section 66261.3: <br />U.S. Department of Transportation (DO7) <br />❑ No <br />If yes, please identify California Hazardous Waste number(s): 221,223 <br />Is this waste material defined as a Hazardous Material under 49 CFR Section 171.8: <br />❑ Yes <br />) No <br />Proper Shipping Name (PSN): Non-RCRA Hazardous Waste, Liquid <br />22 CCR Div 4.5, Section 66261.4 (b): <br />Hazard Class: ID #: Packing Group #: <br />❑� No <br />If yes, please identify exclusion: <br />Subsidiary Hazard Class: Emergency Response Guide #: <br />Additional Descriptions: (Oil, Water) <br />U.S. Environmental Protection Agency (EPA) <br />Is this waste material defined as an EPA Hazardous Waste under 40 CFR Section 261.3: <br />❑ Yes <br />ED No <br />If yes, please identify EPA Hazardous Waste number(s): <br />— <br />Is this waste material excluded from regulation as an EPA Hazardous Waste as specified in 40 CFR Section 261.4 <br />(b): <br />❑ Yes <br />0 No <br />If yes, please identify exclusion: <br />Does this waste material qualify for EPA Universal Waste management as specified in 40 CFR Section 261.9: <br />❑ Yes <br />e❑ No <br />Is this waste material subject to regulation under the Benzene Rule of Waste Operation in NESHAP <br />as specified in 40 CFR Part 61 Subpart FF: <br />❑ Yes <br />El No <br />If yes, please identify SIC code listed under NESHAP: _ <br />California Department of Toxic Substances Control (DTSC) <br />Is this waste material defined as a California Hazardous Waste under 22 CCR Div 4.5, Section 66261.3: <br />0 Yes <br />❑ No <br />If yes, please identify California Hazardous Waste number(s): 221,223 <br />Is this waste material excluded from regulation as a California Hazardous Waste as specified in <br />22 CCR Div 4.5, Section 66261.4 (b): <br />❑ Yes <br />❑� No <br />If yes, please identify exclusion: <br />Does this waste material qualify for California Universal Waste management as <br />specified in 22 CCR Div 4.5, Section 66261.9: <br />❑ Yes 0 No <br />I3. Shipping & Packaging Information <br />Shipping Rate: __200 - 1,000 gallons per: ❑ one-time only ❑ month ❑ quarter ❑ year <br />Packaging Method(s): ❑ Drums ❑ Triwall Boxes ❑� Bulk Liquids ❑ Bulk Solids ❑ Other <br />CLu.A ull tlm� nmru/rplp <br />L Specific Requests or Instructions <br />Please specify any specific requests or instructions for disposal: <br />J. Generator's Certification <br />Wastewater Treatment <br />I certify that all information submitted in this and attached documents is correct to the best of my knowledge. <br />I also certify that any samples submitted are representative of the actual waste. lf Evergreen Oil discovers a <br />discrepancy during the approval process, -Generator grants Evergreen Oil the authority to amend the profile, <br />as Evergreen Oil deems necessary, to reflect the discrepancy. I further certify that any changes regarding any <br />information concerning this profile will be communicated to Evergreen Oil accordingly. <br />Print Name Title Date <br />a..r;.�•.•,a,,. o,�n <br />Date: 6114 J„ e Last Analysis Date: b /l. � -7 <br />Page 3 of 3 <br />