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Profile No. 2.0d_—d_- 6-3 4 Expiration Date I <br /> LIQUID WASTE APPLICATION,YOLO COUNTY CENTRAL LANDFILL <br /> �taatfiiictlons: Eomiitc�e <br /> :ATT <br /> Totm>,ttdtstlacG anaiytic:aJ ttttd lrA7C to ii34}5G6•t><53 or email ioUnWft or; <br /> MASPE INBORMATION ..« - --___---_ �y <br /> Waste Type(Cuele am)1)LIQUID 2)SLUDGE 3)OTHER(speciry): Non Hax Liquid Wash out? YES® NO❑ <br /> Approx.amount: 3,200 Gallons (gallons or ions(circle)) Apprax.SolidsX10(";) P11 6-8 <br /> What pmjectlactivity gereraled this unste7 Pumping out site clarifiers <br /> Silt Ad&=- 16888 McKinley Ave City. Lathrop zip.95330 <br /> Anticipated First Day orHwA-01.17.2020 Anticipated last day of heal:As needed <br /> VES❑ NO® Known or suspected hydror.rban contambunts° (rya,provide analytical <br /> YES❑ NO O Known or suspected metals contaminants? irye%provide analytical <br /> YES❑ NO O Known or Auspeeled other contaminants° lfycs,provide analytical <br /> YES® NO❑ Analytical data and/or 111SD5 provided'Analytical dale must be from California State Certified Laboratory <br /> VES❑ NO® For Directional boring fluids,Any addlthes otbcr than f3rolonite3 L61: <br /> VES❑ NO® Odor Polendal? Describe: <br /> TRANSf OR7'ER INFORMATI N' - <br /> Company Namc dr Address: Framww Envhnnmantal Sefs4m.Mr. -6940 Tremont Rd.Dixon,CA 95820 <br /> Driva's/Dispatcher Mame: Carlos AlaWff&Y M Evans Phone o(orrice,mobile,p mer). 7074484700 <br /> Vehicle capacity ❑1)5000 gal,❑ 2)2400 gal,[13)1000 gal,❑Other. <br /> WASTE GENERATOR INFOAIFIATION'_ —- __ _. ... ­ —_. . - - - s <br /> Company Name and Addrita. Superstore Industries 116888 McKinley Ave., Lathrop CA 95330 <br /> Project Marmger Name Jamie Lima !Phone 0(office,mobile.Pager). 209-814-4432 <br /> Adder: 15888 McKinley Ave Cuy Lathrop zip: 95330 <br /> Type of basis=(note if it is a residence) Grocery diylslon <br /> Payment Method: Cash ❑ Cbeck ❑ Credit Cord ❑ Landfill Account No: FREMOUW-11a <br /> CERTIFICATION <br /> The Waste Generator certifus that this application and any atiached information ace true and accurate and representative orthe subject waste. Waste <br /> Generator canifics that he/she has disclosed oil relevant infatmaiion an known or suspected contaminants and unduslands that time may be <br /> odditlanal lees should contaminants be discovered that%vvm not disclosed by Generator. Generator centiles that this waste docs not constitute a <br /> Hazardous Waste is as defined by State of Calirarnia under Section 66261.3 orTide 22,Division 4.5.Chapter I A.Article 1 of the California Code or <br /> Regulatiotts(22 C.C.R.662613) 1f this application is eaacpleted on beheirorGenetator,Applicant ccairirs that hdshe has the full authority to bind <br /> Generator to these terns and conditions. Applicant agrees to be jointly aril scserally liable wi Generator for all inrorrnalion and representations <br /> provided herein. <br /> print: SJfd l+.Lif, Signature <br /> s7RZ& <br /> (Generator or Authorized Represe_niative <br /> Thk: so <br /> 4J;.1 f Date <br /> •••TO BE COMPLETED BV AUTHORIZED COUN-n'PERSONNEL••• <br /> WASTE APPROVED?YES M-KO❑ Approved0y. Date <br /> Account N.�Material: Grid <br /> FEES: Disposal5 Special Handling 5 Wash out YES 0400] <br /> Special Instructions(handlMs fees,hauler.ate.,) -_ <br /> S V W)61%0perarians%Wasre Accepc6dnylapplaarians and eraerialFamniold famsst mR Liquid Waste Acceptability Application 2014-2015 v3 doc <br />