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i I W �R� REPUBLIC <br /> S p e c a a ste P r f i l o e 4*A SERVICES <br /> Disposal Facility: 4204 Forward Landfill CA Waste Profile#: <br /> Sales Rep#: <br /> I. Generator Information <br /> Generator Name: Associated Tractor Service Inc. <br /> Generator Site Address: 1323 Charter Way <br /> City: Stockton County: San Joaquin State: California Zip: 95206 <br /> State ID/Reg No: State Approval/Waste Code: NAICS#: <br /> Generator Mailing Address ❑ (if different) <br /> City: County: State: --Select State-- Zip: <br /> Generator Contact Name: =Larry Email: lborelli0l@gmaii.com <br /> Phone Number: (209) 466-3003 Ext: Fax Number: <br /> II. Billing Information <br /> Bill To: Associated Tractor Service Inc. Contact Name: Ruth Silva <br /> Billing Address: 1323 Charter Way Email: rsilva@associatedtractor.net <br /> City: Stockton State: California Zip: 95206 Phone: (209) 466-3003 <br /> III.Waste Stream Information <br /> Name of Waste: Contaminated Soil <br /> Process Generating waste: tractor recycling oil leaked out of tractors and had to be excavated for pollution <br /> contro <br /> Type of Waste: I Pollution Control Waste Physical State: Solid Method of Shipment: Bulk <br /> Estimated Volume: 30 Volume Type: Cubic Yards <br /> Frequency: One-time Event(single project) Disposal Consideration: Landfill <br /> IV. Representative Sample Certification <br /> ❑ No Sample Taken <br /> p Sample Taken Type of Sample Composite Sample <br /> Is the representative sample collected to prepare this profile and laboratory analysis,collected in accordance with U.S. EPA 40 CFR <br /> 261.20(c)guidelines or equivalent? [Z]Yes ❑No <br /> Sample 02/28/2020 Sample ID 0022809-01 Back Of Yard <br /> Date: Numbers <br /> or SDS: 2000136-01 Back Of Yard <br /> Remember to attach Laboratory Analytical Report(and/or Material Safety Data Sheet) <br /> including Chain of Custody and required parameters provided for this profile. <br /> Page 1 Associated Tractor Service Inc. Contaminated Soil April 2019 <br />