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R .'ELi <br />JUN 29 2015 EZ Profile"' <br />WAST£ MANAGEM ENi <br />ENVIRONMENTAL <br />Requested Facility: Altamont Landfill $ Resource Recovery F.IFA'Tu ":TtRWUR' 'rofile Number: 1 10907C <br />❑ Multiple Generator Locations (Attach Locations) ❑ Request Certificate of Disposal 0 Renewal? Original Profile Number: 110907CA <br />A. GENERATOR INFORMATION (MATERIAL ORIGIN) <br />1. Generator Name: HOLT of Califomia <br />2. Site Address: 1521 West Charter Wav <br />(City, State, ZIP) Stockton CA 95206 <br />3. County: San Joaquin <br />4. Contact Name: Nathan Ladd <br />S. Email: Nathan Ladd/administratorCci)holtca cam <br />6. Phone: (91,) 991-8200 7. Fax: (916) 991-8290 <br />8. Generator EPA ID: Lf N/A <br />9. State I D: 9 N/A <br />C. MATERIAL INFORMATION <br />1. Common Name: 11,S "JZarauus soil c Debrls <br />Describe Process Generating Material: ❑ See Attached <br />Soil from Wash Rack Renewal of 11 0907C <br />2. Material Composition and Contaminants: ❑ See Attached <br />1,Soi1 50-95 <br />E. ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION <br />1. Analytical attached El Yes <br />Please identify applicable samples and/or lab reports: <br />WC -14-2 <br />2. Other information attached (such as MSDS)? ❑ Yes <br />B. BILLING INFORMATION ❑ SAME AS GENERATOR <br />1. Billing Name: Intrinsic Transportation, Inc_ <br />2. Billing Address:3250A Dutton Avenue <br />(City, State, ZIP) Santa Rosa CA 95407 <br />3. Contact Name:Lisa M Levang <br />4. Email: LLevangQinlrinsictrans.com <br />5_ Phone: (707) 578-0960 6. Fax: (707) 578-5408 <br />7. WM Hauled? ❑ Yes 0 No <br />B. P.O. Number: <br />9. Payment Method: 0 Credit Account ❑ Cash ❑ Credit Card <br />D. REGULATORY INFORMATION <br />Z. raper, Plastic, PPE <br />0-5% <br />1. EPA Hazardous Waste? <br />3 Spill pad:, pigs, etc. <br />0-50% <br />Code: <br />4. <br />a. Regulated by 40 CFR 761 ? 0 Yes <br />Total composition must be equal to or greater than 100% <br />2100% <br />3_ State Waste Codes: <br />Ef N/A <br />4. Color: varies <br />10. Regulated and/or Untreated <br />5. Physical State at 707: El Solid ❑ liquid ❑ Other: <br />❑ Yes <br />Medical/Infectious Waste? <br />6. Free Liquid Range Percentage: to <br />A N/A <br />7. pH: 5 to 9 <br />0 N/A <br />8. Strong Odor: ❑ Yes If No Describe: <br />❑ Yes* <br />9. Flash Point: 01<1407 ❑ 140'-199'F ❑ X200' <br />Lot N/A <br />E. ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION <br />1. Analytical attached El Yes <br />Please identify applicable samples and/or lab reports: <br />WC -14-2 <br />2. Other information attached (such as MSDS)? ❑ Yes <br />B. BILLING INFORMATION ❑ SAME AS GENERATOR <br />1. Billing Name: Intrinsic Transportation, Inc_ <br />2. Billing Address:3250A Dutton Avenue <br />(City, State, ZIP) Santa Rosa CA 95407 <br />3. Contact Name:Lisa M Levang <br />4. Email: LLevangQinlrinsictrans.com <br />5_ Phone: (707) 578-0960 6. Fax: (707) 578-5408 <br />7. WM Hauled? ❑ Yes 0 No <br />B. P.O. Number: <br />9. Payment Method: 0 Credit Account ❑ Cash ❑ Credit Card <br />D. REGULATORY INFORMATION <br />0 No <br />-8 NRC or State -regulated radioactive or NORM waste? ❑ Yes* <br />1. EPA Hazardous Waste? <br />❑ Yes* <br />lid No <br />Code: <br />Q No <br />a. Regulated by 40 CFR 761 ? 0 Yes <br />2. State Hazardous Waste? <br />❑ Yes <br />19 No <br />Code: <br />❑ No <br />10. Regulated and/or Untreated <br />3. Is this material non -hazardous due to Treatment, <br />❑ Yes <br />Medical/Infectious Waste? <br />11 No <br />Delisting, or an Exclusion? <br />El Yes* <br />L9 No <br />4. Contains Underlying Hazardous Constituents? <br />❑ Yes* <br />13 No <br />S. From an industry regulated under Benzene NESHAP? <br />❑ Yes* <br />S3 No <br />7. CERCLA or State -mandated dean -up? ❑ Yes* <br />0 No <br />-8 NRC or State -regulated radioactive or NORM waste? ❑ Yes* <br />® No <br />*If Yes, see Addendum (page 2) for additional questions and <br />space. <br />9_ Contains PCBs? --> If Yes, answer a, b and c. ❑ Yes <br />Q No <br />a. Regulated by 40 CFR 761 ? 0 Yes <br />❑ No <br />b. Remediation under 40 CFR 761.61 (a)? ❑ Yes <br />❑ No <br />c. Were PCB imported into the US? ❑ Yes <br />❑ No <br />10. Regulated and/or Untreated <br />❑ Yes <br />Medical/Infectious Waste? <br />11 No <br />11. Contains Asbestos? ❑ Yes <br />0 No <br />4 If Yes: ❑ Non -Friable ❑ Non -Friable -Regulated ❑ Friable <br />F. SHIPPING AND DOT INFORMATION <br />I. ❑ One -Time Event lid Repeat Event/Ongoing Business <br />2. Estimated Quantity/ Unit of Measure: 100 <br />11 Tons F1 Yards ❑ Drums ❑ Gallons 13 Other: <br />3. Container Type and Size: <br />4. USDOT Proper Shipping Name: 0 N/A <br />G. GENERATOR CERTIFICATION (PLEASE READ AND CERTIFY BY SIGNATURE) <br />By signing this EZ Profile" form, I hereby certify that all information submitted in this and all attached documents contain true and accurate descriptions of this material. and that <br />all relevant information necessary for proper material chane teozation and to identify known and suspected hazards has been provided. Any analytical data attached was derived <br />from a sample that is representative as defined in 40 CFR 261 - Appendix 1 or by using an equivalent nethod. All changes occurring in the character of the material (i.e., changes <br />in the process or new analytical) w)1 be identified by the Gexrator and be disclosed to Waste Management prior to providing the material to Waste Management. <br />If 1 am an agent signing on behalf of the Generator, l have confirmed with the <br />Generator that in�for%at/ion contained in this Profile is accurate and complete. <br />Name (Print): .C._a� Date: <br />Title: <br />Company: a rc <br />Certification Signature <br />THINK GREEN'.- Revised September 12.2014. <br />QUESTIONS? CALL 800 963 4776 F SISTANCE 02014 waste Management <br />