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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4 (STATE ROUTE 4)
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21334
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3500 - Local Oversight Program
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PR0545187
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Last modified
11/20/2024 9:09:21 AM
Creation date
1/23/2020 10:43:56 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545187
PE
3528
FACILITY_ID
FA0007159
FACILITY_NAME
KINGS ISLAND
STREET_NUMBER
21334
Direction
W
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95206
APN
12919002
CURRENT_STATUS
02
SITE_LOCATION
21334 W HWY 4
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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APR-19-96 FRI__03:40 PM PRIORITY LABS 40`P+946-9663 P.02 <br /> GENERATOR'S WASTE PROFIL I-t'GMEET <br /> pt.4'ASE PPINT rN INK Olt TYPE <br /> PHYSICAL CHARACTERISTICS OF WASTE (Seo Instrudrons) <br /> Color 2. Does the waste have 3 PhysicalState 0 7C F/2100 4. UyeM ; b 8pat't Gravity B. Free Liquids <br /> �,Obr 13 a strong Incidental odor? �(Solid ❑Semt•Solid ❑MuIM-layorsE ❑Yes 0 No <br /> NO ❑ Yes; so, Q Uquid ❑ powder <br /> ► ; Ral1Ee `fA Vol�rme. "� <br /> _ descren: �f ❑timer: ^/ <br /> PH:❑S2 ❑ 2.4 K4.7 ❑ ❑7-10 0110-412.5 DZtM ❑Range ❑NA <br /> 1. Flash Point: Shone <140°F/Wo 140-1WF/W-936C ❑ Closed Cu C <br /> UP <br /> :.CHEMICAL COMPOSITION t+Aiiot pA1wMiUri '� • <br /> a 4 f;oIL .o_�.0�96 2. Does thQ, ts cin any of the following? <br /> o <br /> boil �L _1b (Provide 00106110ft"if b wnt <br /> L_s a D _ — .Qj- •O 1 % ND• or LIM THAN or ACTrJAL <br /> PCBs ❑<50 ppm ppm <br /> Cyanides B.. D c 3o ppm ppm <br /> Sulfides ; G<500 ppm PPM <br /> Total: ►_..b d_% <br /> ,"_.note: unless analytical results are attached,the chemical composition identitkabon shCW ftillde,at a minimum,Arsenic.Barium, <br /> Cadmium.Chromium,Lead,Mercury,SeleNum,Silver,Pesticides,Herblotdes,tutq.ay otherTCt.P constituents that maybe <br /> present in the waste. The total composition must be greater than or aqua)1010t}y.: (•0001%:1 ppm or 1 nW) <br /> Indicate method used to determine Composition(if provided): ❑ TCLP .Q NO! Q Other fl <br /> 1.SAMPLING SOURCE:(e.g.,Drum,L&90on,Pit,Pond,Tank Yat) <br /> REPRESENTATIVE SAMPLE CERTILICATION <br /> Print Sampler's Name:._ 9A V*I b �P u o N G 2. Sample flare: <br /> SareqtlarsTide I.ab �ire.e r <br /> Sampler's Employer(if other than Generator): fli 0 10 T9 ENV11.09)0ASA3TAL. LASS <br /> rhe sampteds signature certifies that any sample submitted is representative of the wane sBiOgrlbed am pursuant to 40 CFR 261.20(c)or <br /> equivalent rules. <br /> Ssmpws Sgrletu(o <br /> . <br /> 00 RA OR CERTIFICATION -. <br /> y signing this profile sheet,the Generator certifies: <br /> This waste is not a"Hazardous Waste" as defined by USEPA or Canadian Federal regu4on ww*r the otate/province. <br /> This waste does not contain regulated radioactive materials or regulated conow*adaM o[.PC$'a(PWYohbrkletted Biphenyls). <br /> The unshaded portions of this sheet and the attachments contain true and aocurats deeerlj e Of%W waste material. All relevant informa- <br /> lion regarding}mown or suspected hazards in the possession of the Generator has been OWo'sod. <br /> The Generator has read and understands the Contractor's Definition of Special Waste irtctudid In Psitrt B.S.of the attached instructions loan. <br /> All types and amounts of special wastes provided in incidental amounts have been Identif.W. imSetAlon B.G.of this form. <br /> The analytical data presented herein or attached hereto were derived from testing a repre,SOtttative Sample taken in accordance with <br /> 40 CFA 261.20(c)or equivalent rules. <br /> If any changes occur in the character of the waste,the Generator shalt notify the ContmcW prior to providing the waste to the Contractor. <br /> Signature 8. Title <br /> . Name jUpe or Prat 10.date <br /> u.s,x z <br /> MXA-41N AW).:j <br /> E0 3Wd -iViN3*C8INd3 JLHE)I�M Z91SZE860ZT ZT:ST 966T/6T/bA <br />
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