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Generator's Non -hazardous Waste Pru file Sheet <br />r+wsra rw-noo�errt <br />Requested Disposal Facility: Altamont Landfill & Resource Recovery Profile Number: <br />u Renewal for Profile Number: 110907CA Waste Approval Expiration Date: <br />❑ Check here if there are multiple generating locations for this waste. Attach additional locations. <br />A. Waste Generator Facility information (mast <br />reflect location of waste generation/origin) <br />1. Generator Name: BOLT of Califomia <br />Unit of Measure <br />1521 West Charter Way <br />7. Email Address: Nathan_Ladd/administrator@-991- <br />2. Site Address: <br />3. City/ZIP: Stockton, 95206 <br />290 <br />8. Phone: 916-991-8200 9. FAR: 916-991-8290 <br />4. State: California <br />10. NAICS Code: <br />95 <br />0 <br />11. Generator USEPA ID #: <br />S. County: <br />% <br />6. Contact Name/Title: Nathan Ladd <br />12. State ID# (if applicable): <br />VIL Customer Information ❑ same as above <br />P. O. Number: <br />Intrinsic Transportation, Inc. <br />p <br />6. Phone: 707-578-0960 FAX: 707-578-5408 <br />1. Customer Name: <br />3250A Dutton Avenue <br />7. Transporter Name. Intrinsic Transportation, Inc. <br />2. Billing Address: <br />Santa Rosa, Califomia, 95407 <br />8. Transporter ID # (if appl.): 4797 <br />3. City, State and ZIP: <br />M. <br />Lisa MLevan <br />Name: 9 <br />9. Transporter Address: 3250A Dutton Avenue <br />4. Contact <br />9@ <br />S. Contact Email: ilevang@intrinsictrans.com <br />10. City, State and ZIP: Santa Rosa, Califomia, 95407 <br />C. Waste Stream Information <br />4. See Attached Analytical <br />1. DESCRIPTION <br />a. Common Waste Name: Non -Hazardous Soil <br />State Waste Code(s): N/A <br />Soil from Wash <br />of 110907CA <br />c. Typical Color(s): vanes <br />d. Strong Odor? ❑ Yes (A No Describe: <br />a Physical State at 70°F: (A Solid ❑ Liquid ❑ Powder <br />f. Layers? 56 Single layer ❑ Multi- layer ❑VA <br />g. Water Reactive? ❑ Yes [A No If Yes, Describe: <br />It. Free Liquid Range (%): to A NA(solid) <br />i. pH Range: to (21 NA(solid) <br />j. Liquid Flash point: ❑ < 140°F ❑ 1400- 199°F ❑ >_ 200°F <br />k Flammable Solid: ❑ Yes t6 No <br />❑ Semi -Solid or Sludge ❑ Other: <br />(A NA(solid) <br />—:, n onoc uv—,4 n -9.n%), <br />66 (See Attached) <br />1. physical Constituents: List aU consumenrs ui waaio --•-- <br />Unit of Measure <br />Upper Range <br />Unit of Measure <br />Constituents (Total Composition Must be >- 100%) <br />Lower Range <br />% <br />100 <br />% <br />1. Soil <br />95 <br />0 <br />5 <br />% <br />Z, Paper Plastic PPE <br />3. <br />4. See Attached Analytical <br />5. <br />6. <br />g ESTIIVf = QUANTITY OF WASTE AND SHIPPING INFORMATION <br />a. ❑ One Time Event ❑ Base U4 Repeat Event <br />b. Estimated Annual Quantity: 100 ❑ Tons (d Cubic Yards ❑ Drums ❑ Gallons ❑ Other (specify): <br />C. gipping Frequency: 20 yards Units per ❑ Month �d Quarter ❑ Year ❑ One Time ❑ Other <br />d. Is this a U.S. Department of Transportation (USD Hazardous Material? (If yes, answer e.) ❑ Yes (A No <br />O'I') <br />e. USDOT Shipping Description (if applicable): <br />3 SAFETY REQUIREMENTS (Handling, PPE, etc.): Level D <br />cW10 Waste Management, Inc. <br />Page 1 of 2 May solo <br />