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REPUBLIC <br /> SERVICES SPECIAL WASTE PROFILE Page 1 of 2 <br /> Waste Profile# <br /> Requested Disposal Facility:4204 Forward Inc. CA <br /> Saveablo fill-in to nt. Hoslriclod printing until all required(yellow)holds nro coniploled. <br /> 1. Generator Information Sales Rep#: <br /> Generator Name: California Central Traction Company <br /> Generator Site Address: Intersection of Lodi &Guild Ave <br /> City: Stockton County: San Joaquin State:California Zip: 95206 <br /> State ID/Reg No: State ApprovalfWaste Code: (if applicable) NAICS#: <br /> Generator Mailing Address(if different):❑✓ 2201 West Washington St.# 12 <br /> City: Stockton County: San Joaquin State: California Zip: 95203 <br /> Generator Contact Name: Keith Woodburn I Email: <br /> Phone Number: (925)688-2488 Ext: Fax Number: (925) 688-0385 <br /> Ila. Transporter Information <br /> Transporter Name: Environmental Logistics, Inc. Contact Name. Mark A. "Marko" Freeman <br /> Transporter Address: 140 W. Monte Ave <br /> City: Bloomington County: San Bernardino State: California Zip: 92316 <br /> Phone: (909)546-1354 Fax: (909)873-4141 State Transportation Number: CA0340844 <br /> Ilb. Billing Information <br /> Bill To: Environmental Logistics, Inc. Contact Name: Mark A. "Marko" Freeman <br /> Billing Address: P.O. Box 806Email: markofrs@yahoo.com <br /> City: Colton State: California Zip: 92324 Phone: (909)873-4141 <br /> 111. Waste Stream Information <br /> Name of Waste: Non-Hazardous Waste Solid Soil impacted with diesel/petroleum hydrocarbons <br /> Process Generating Waste,- <br /> Accident <br /> aste:Accident involving a semi-truck which punctured it's diesel fuel tank. <br /> Type of Waste: ©INDUSTRIAL PROCESS WASTE [:]POLLUTION CONTROL WASTE <br /> Physical State: [ZI SOLID ❑SEMI-SOLID ❑POWDER ❑LIQUID <br /> Method of Shipment: ©BULK ❑DRUM E]BAGGED ❑OTHER: <br /> Estimated Annual Volume: 50 Tons <br /> Frequency: ©ONE TIME ❑ANNUAL <br /> Disposal Consideration: [Z]LANDFILL ❑SOLIDIFICATION ❑BIOREMEDIATION <br /> f <br /> IV. Representative Sample Certification ❑NO SAMPLE TAKEN <br /> I <br /> Is the representative sample collected to prepare this profile and laboratory analysis, j <br /> collected in accordance with U.S. EPA 40 CFR 261.20(c)guidelines orequivalent rules? ©YES or❑NO <br /> Sample Date: 04/11/11 Type of Sample:©COMPOSITE SAMPLE ❑GRAB SAMPLE <br /> Sample ID Numbers: SS-1,2,3,4, Composite This sample represents the stockpile. j <br /> I <br /> i <br /> I <br /> ©Republic Services,Dec 2009 <br /> I <br />